Is this the ultimate test of friendship?

We like to think our closest mates will be there for us through thick and thin. But, as these women tell Anna Moore, even the tightest bonds can be stretched to breaking point by illness. ILLUSTRATIONS: NATHALIE LEES

Emma Haslett met her best friend Sophie at primary school in Bath and, by secondary school, they were inseparable.

‘It was a very traditional girl friendship,’ says business journalist Emma, now 35. ‘We had sleepovers every weekend. We wore the same clothes and the same make-up, we liked the same music and snogged the same boys. I shared every thought with Sophie. We grew up together.’

friendship challenges

Although they went to different universities and eventually settled in different cities – Emma in London, Sophie in Bristol – nothing dented their closeness. At 28, they both married just a few months apart– and were each other’s maids of honour. After that, Sophie quickly became pregnant with her daughter Ava. Emma also began trying for a baby. ‘But months passed and nothing happened,’ she says. ‘And that’s when our paths began to diverge.’

Just as Sophie became immersed in motherhood, Emma was discovering that the appendicitis she’d had aged 11 had caused an infection that had scarred her fallopian tubes so badly they didn’t function. Multiple procedures followed– scans, blood tests, laparoscopies, an egg collection, a failed embryo transfer.

Meanwhile, Sophie wasn’t finding motherhood easy – she was attending a support group that she jokingly called ‘the sad mums’ club’– but as far as Emma could see, her friend had everything.

‘The thing about infertility is that you’re scrutinising your own body all the time,’ says Emma. ‘You’re tracking your cycles, your temperature, your diet, you’re googling information at 3am every morning. You’re so focused on yourself, you can become quite blinkered. I didn’t have the headspace to see what was going on with other people.

‘I also became incredibly emotional and bitter, too,’ she adds, and she continued to do exactly what she’d always done, which is share every unedited thought with Sophie. Once she messaged her to say that she felt like punching pregnant women on the street. Sophie didn’t respond. Then she messaged to say she hadn’t given her seat to a pregnant woman on the tube. More silence from Sophie. Finally, Sophie sent a long reply explaining that she no longer felt able to share anything with Emma as she didn’t want those bitter thoughts directed at her or her daughter.

friendship challenges
Emma (right) says her fertility struggle put a strain on her friendship with Sophie

For both Emma and Sophie, the experience felt devastating – but they’ve since discovered it’s far from uncommon. In the midst of this, Emma had launched a podcast to explore every aspect of infertility with her friend Gabriella Griffith, who was also trying to conceive. Big Fat Negative has had more than a million downloads and they’ve now turned it into a book of the same name.

One recurring theme raised by their listeners is the impact on friendships. They describe the searing pain that comes when friends announce they are pregnant. There’s the dread of every baby shower, christening, first birthday party. The hurt that comes from so many careless remarks, however well meaning. (‘Just relax! The more you stress, the harder it’ll be to get pregnant!’ ‘Why don’t you just adopt?’)

Infertility can turn into make-or-break points for friendship, says Irene S Levine, psychologist and author of Best Friends Forever: Surviving a Breakup with Your Best Friend. She points out that friendships can start off quite easily: ‘In school, we are thrown together with people doing the same things as us, at the same time, in the same place. Friendships are based on reciprocity; two people feeling equal, not across every dimension at every point, but over time.’

However, when a serious diagnosis blows one of you on to another planet, all that reciprocity can seem to vanish. ‘If you’re experiencing the crisis, you may slide into a mode of self-preservation,’ says Levine. ‘You’re more self-absorbed and self-protective. It’s difficult to share widely discrepant experiences and old friends can fall by the wayside. It’s lack of understanding, lack of bond, lack of time, interest or convenience.’

Happily, this wasn’t the outcome for Emma and Sophie. After Sophie’s message, both women spent a week thinking about what had happened. Sophie spoke to some of her new mum friends, one of whom had experienced years of IVF and was able to describe some of what Emma must be feeling. Meanwhile, Emma realised that she could no longer share every vitriolic thought with Sophie.

They had a tearful reunion, did a lot of talking and when Sophie was going to start trying for her second baby, she asked Emma how best to relay the news when she became pregnant. They decided on a brief phone call – and one month later, that call came. ‘We’ve been friends for 20 years,’ said Sophie. ‘If you need to take the next nine months off, I’m OK with that. I’m going to go now.’

‘That might be the kindest thing anyone has ever said to me,’ says Emma. ‘It’s such an impossible situation – your friend is having this big happy moment yet she’s got this guilt. You’re happy for her and sad for yourself.’

In fact, Emma didn’t ‘take the next nine months off’ and Sophie went on to have twins. One month before they were born, Emma discovered she was pregnant after a successful embryo transfer.

‘I have a photo of us together three days after the transfer when Sophie is about to pop,’ says Emma. ‘It’s such a bad photo but I truly treasure it. It’s probably the only one we’ll ever have of us pregnant together.’ Her daughter Noah is now two.

friendship challenges

So what’s the best way to support a friend who is struggling with a major health challenge and what are the common pitfalls?

Emma Campbell, 50,a writer and speaker from London, found that it was her friends’ actions, not their words, that helped most when she was reeling from a breast cancer diagnosis in 2010. At the time, she was a single mum of four, including baby triplets – her relationship had ended just a month earlier. ‘It was such an intensely catastrophic period and I needed full-on chemotherapy, surgery and radiotherapy,’ she says. ‘I was barely keeping my head above water.

‘If someone asked, “What can I do?” or “Let me know if you need anything”, I wasn’t together enough to respond. Instead, the mums from my son’s nursery took over and organised a rota. They’d say, “This week, you’re getting lasagne on Tuesday, chicken casserole on Thursday, X is taking your washing, Y will take the babies out and Z will take you to your chemo.” It was phenomenal – these random acts of kindness from people who did everything right.’

It’s not surprising that studies on cancer patients have shown that close friendships and social integration can have a protective effect on survival rates. However, that support remains crucial long after the treatment has ended. As Emma explains, it was when her life outwardly returned to ‘normal’ that she actually felt most alone. The disappearance of medical care, regular appointments and ‘next steps’ left her feeling exposed. Suddenly there was no ‘team’ behind her.

friendship challenges
Emma Campbell with her children in 2010, shortly after her breast-cancer diagnosis.

‘People step back because life goes on,’ says Emma. ‘But it’s only when you’ve been through this that you can possibly understand that it’s so much more than growing your hair back and recovering from surgery. That’s when I went into a very dark place. Your friends need you to be well because they love you. You hear, “Oh, but you’re fine” but you don’t feel fine. You feel like you’re on an island.’

According to Levine, this is the point when new friendships with people going through the same experience can quickly deepen. Sometimes they replace old friendships because they offer something unique– instant understanding, a picture of the path ahead, and sometimes a beacon of hope for recovery.

Although Emma hadn’t connected with the ‘cancer community’ after her diagnosis – ‘I wanted to run a million miles from that world’ – in 2014 she was diagnosed with secondary cancer in the skin. This time, she did find others like her, first through blogging and Instagram (@limitless_em) and also through her hospital, the Royal Marsden in London. Emma is now a close friend to Deborah James, the You, Me & the Big C podcaster who is living with stage four bowel cancer. For Emma, these friendships have given her something precious. ‘There’s this shared vocabulary, you never need to explain and they just get it,’ she says. ‘You can’t watch someone like Deborah, who is fighting against the odds, with incredible spirit and passion for life without thinking, “Well, she’s doing it – I can, too.”’

When Emma was diagnosed with cancer in her other breast in 2019, Deborah was the first friend she called. ‘You panic, you go into a tailspin. You don’t want to speak to someone who brushes it away and says you’ll be fine. You want someone who has been through these moments, too.

‘Deborah immediately went into practical mode. She wanted to know what I’d been told, what the plan was, did I have options? By the end of that call, I had this sense of calm and relief. I felt safer.’

Emma is now on a maintenance programme of targeted chemo every three weeks– which often dovetails with Deborah’s treatment so they are able to support each other. ‘She has been there at so many pivotal moments and that friendship has deepened very quickly. I love my old friends with all my heart but I rely on them less now. Maybe I don’t open up about the cancer highs and lows as I share that with people in a similar position.’

Many diseases are less visible than cancer and supporting a friend when there’s no sudden diagnosis, no clear treatment path and more questions than answers can be the hardest challenge of Jenny Bohn, 46, a former care worker, says that many friends have ‘dropped off the radar’ since her life was turned upside down by long Covid.

friendship challenges
Long Covid sufferer Jenny Bohn says many friends have ‘dropped off the radar’

Jenny, who lives with her teenage son, first tested positive for Covid in May 2020 and, though she recovered well, she tested positive again five months later, and then again three months after that. By then, she was chronically tired, signed off work and advised to shield. It was after her vaccinations that her symptoms intensified. She now suffers constant pain and fatigue, brain fog, inflammation, skin rashes and hearing loss.

‘Covid has changed me. It’s lonely and scary and so hard to explain and understand,’ says Jenny. She rarely has the energy to go out. She may make plans and cancel – or she may forget she has made them.

‘When people can’t “see” anything wrong with you, they don’t understand,’ Jenny continues. ‘I’ve had many friends unfriend me on Facebook because I’ve used it to give regular updates – maybe they want their feeds to be full of positive posts.’ Certain recurring comments have made her feel even more alone – such as ‘Try to be more positive’ and ‘Why are you letting this win?’

Given how Jenny’s life has shrunk, she fully understands that it’s hard for friends to ‘step up’. Checking in by phone or social media means a lot – but some have gone far beyond this. ‘The most wonderful thing happened just before Christmas,’ she says. ‘One of the mums I knew from my son’s old primary school contacted me to say she was in the area and could she do a doorstop drop-off and catch-up? She turned up with an amazing Christmas pudding made by another mum and a beautiful arrangement of flowers with a card.

‘It wasn’t until she’d left that I opened it and saw that ten mums had got together and put £300 in there for my son and I to spend on Christmas. I burst into tears. In the past we’ve helped one another through so much – deaths of husbands, breakdowns, cancer, you name it. To see them still there for me all these years later…I was lost for words. People care.’

GOT A FRIEND IN NEED?

Emma Haslett, Emma Campbell and Jenny Bohn give their tips on how to offer words of comfort – plus the things you should never say…

INFERTILITY

Don’t say ‘Just relax’, ‘You can just adopt’, ‘You can just do IVF’– or anything else with ‘just’ in it. Another no-no is, ‘Take it from me, motherhood isn’t that great– enjoy your freedom!’

Do say ‘I know this is hard and I’m here for you’; ‘How is your treatment going?’ – followed by listening when they tell you, rather than offering advice.

If you are a person with children, there is nothing more powerful than telling your friend, ‘I know you may need to take some breaks from our friendship, but I will still be here when you are ready to come back.’

CANCER

Don’t say ‘Let me know if you need anything’– your friend will probably be too exhausted to know what she needs– or, ‘You’re fine, you’re going to be OK’.

Do say ‘Whatever happens, I’m here, there’ll be a plan and you’re not on your own.’

Try to pre-empt the help that may be needed. For example, tell your friend: ‘I’m in Sainsbury’s, I’ll pass by afterwards and drop off some bits for you.’

Send messages, share news, but don’t write lots of questions, and try to end with ‘no need to reply’ as it liberates

the person from obligation – and if there’s no reply, don’t take it personally.

LONG COVID

Don’t say ‘You’ve always been so independent. Why are you letting this get the better of you?’ or ‘Try to be more positive. That always helps.’

Do say ‘When you feel ready to meet fora coffee, let me know and

I’ll be there for you’ or ‘Take each hour by hour if you have to, or even minute by minute.’

Check in regularly– someone with long Covid can easily drop off the radar. Keep messaging them, drop by if you can – anything to reduce the loneliness.

Big Fat Negative by Emma Haslett and Gabriella Griffith is published by Piatkus, priced £14.99*. To find out ways you can support The Royal Marsden Cancer Charity, go to royalmarsden.org/support-us

TO ORDER A COPY FOR £12.67 UNTIL 4 MARCH, GO TO MAILSHOP.CO.UK/BOOKS OR CALL 020 3176 2937. FREE UK DELIVERY ON ORDERS OVER £20