A woman standing in the path of an approaching bus

When Someone Talks About Being Hit by a Bus...

I used to use this phrase a lot when urging clients while I was actively practicing law to think about life insurance, estate planning, and advanced directives. The concept I was trying to get across was that we don't know when we might encounter a situation where death occurs quickly and without warning, like being hit by a bus, so it's important to plan and have important documents in place beforehand. The first time I heard this phrase being applied to living with stage IV metastatic breast cancer (MBC), I was mystified as to why it felt so yucky since it was a phrase I was accustomed to using myself.

Words and phrasing matters in the metastatic community

Yes, I have a hard time naming my emotions at times, especially strong emotions. I'm working on this since it often hampers me from responding appropriately at the moment.

As part of my musings, I posted a message on Facebook and received comments from many of my friends and fellow advocates about their thoughts as well. I am not surprised that the majority of us living with MBC think very similarly about the comment often offered about the bus in conjunction with a discussion about MBC. I'll share some of the comments below and I think you will see how the words people use are powerful and cause a reaction/response that is often strongly negative in many.

As many on this forum have shared over and over, words matter, and the more we can educate each other, our circles, and the public on alternate narratives, alternate words, the better. I've found conversations to be much more productive when I offer an alternative rather than just telling someone that they are wrong. I don't know what would be the alternative here, but here's what I've taken to saying to people who offer the bus analogy:

"This analogy highlights the surprise of death when it happens suddenly. For those of us living with a terminal illness, it is much more accurate to say that we've already been hit by the bus and now are granted a reprieve, to live with many limitations and side effects of medication for a bit longer, but with the specter of death in the near future hanging over our heads 24/7. Death is no longer something in the abstract, but something we face every day."

In essence, since those of us in the MBC community have already been hit by the bus, the reality of death is no longer a surprise, but a constant. That's usually when the other person either ends the conversation or changes the subject. Very few enter into conversation further and seek to understand. Those that do, I know they will continue to learn and grow, not just about MBC but about other things. Those that do, I know that they care more than just lip service. Those that do, I usually want to give them a hug.

Describing life with metastatic breast cancer

Here are some comments from others living with MBC that resonated with me as well.

Caitlin explains

"I can’t tell you the number of times someone has said to me “Well, I could get hit by a bus tomorrow”. No. We are not sharing the same experience. And I will not allow someone to minimize (intentionally or not) what it means to have terminal, metastatic breast cancer. I have a lot to carry, and your analogy is not only uncaring - it’s flat out disrespectful to those of us in the thick of it.

Those of us who are living with cancer, in particular metastatic/terminal/incurable cancer, often find that talking about our disease, and how we deal with our feelings about this disease and death, elicits reactions and responses from non-cancer-havers that don’t quite feel supportive. Especially when it’s one of those "things you never say to someone with cancer" phrases...

One such response is the "I could get hit by a bus tomorrow..." line, which is one of my least favorites. A friend posted this fact tile today, along with a response from a friend, in her support group, who died from MBC, when someone invalidated her fears & anxieties (perhaps unintentionally) by using the bus analogy.

Her response was the best I’ve heard yet, so I’m sharing - for all of the non-cancer-havers, as it resonates perfectly with me: "do you know where your bus is? Because I know where my bus is. Mine is on the corner and it’s just waiting for me sometime soon."

We may not know when our "bus" is coming to get us, but it has been identified, labeled, named, and parked on our street in front of our house, and we look at it each and every day of our lives. The only question is when it will go from park or neutral (NED/NEAD, stable), into drive (progression) ~ sometimes OVERDRIVE because things can go south so quickly ~ but, it’s sitting there like an enormous elephant on the street in front of our house. We can’t unsee or completely ignore it. And, unless an unexpected bus comes along and gets us before that one, we know exactly what our bus looks like.”

Thank you, to those brave enough to speak up, and help us bring awareness. Sometimes I can’t find the words myself, and I am incredibly thankful when someone else steps in to articulate exactly what I’m feeling.

I love you, you are heard, and you are not alone. 💕

Caitlin Kozma

What a powerful visual using this metaphor, which admittedly, has it's limitations in representing real life, as with many metaphors.

Martha's experience

"The nurse who works within the office with my oncologist said, "You look like you've been hit by a truck" (lol, not bus) when I got the news that I wouldn't be able to participate in a clinical trial from the get-go because a rule-out scan followed by oophorectomy and lung biopsy showed metastatic spread. I did feel like I'd been hit by a truck. I agree--that impact came on the day I was diagnosed and for a long time I was scraping along under the bumper (I suppose if we must continue the analogy) wondering when I die. Now, approaching 6 years with mets, I'm still on the truck but maybe I'm more like one of the spikes."

Martha Carlson

I love how Martha continues the metaphor and makes it personal to her and how she feels now, showing that we can work with these metaphors, even if they don't do a great job of describing our lives now.

Janice shares

"One thing I didn’t mention in my “bus analogy” post yesterday, but I find it weighs heavily on me ~ it’s watching my friends climbing onto that bus parked in front of me, the one I sit here staring at as it continues loading my friends to take them away. I’m fortunate to be NED and not be in immediate danger of becoming a passenger on that bus, but that could change in a hot second - I’m always one scan away from loading myself on that bus. I have a friend who loves to use the bus analogy anytime I attempt to discuss my disease and it hits such a raw nerve with me. I realize it’s her way of dealing with it, but it feels like complete invalidation and total lack of compassion coming from someone who has been a dear friend for decades. Perhaps it’s my issue to deal with more than other cancer-havers, but that statement feels like a bus hitting me every time it’s delivered."

Janice Cowden

Janice brings us out of the abstract metaphor and into the inner world of the terminal patient who is responding to this concept.  Those of us with MBC are often in the position of having to help others and deal with their issues/concerns.

Amanda's response

"After my diagnosis in 2018, I found people used the phrase with me — anyone could be hit by a bus at any moment — to somehow try to make me feel “better” as in...everyone is in this together. Although I understand that perspective, I think it diminishes the reality that my “bus” is a lot closer than others’ bus. And if I were to counter respond in that way, it’s seen as negative. I believe people have used the phrase with me to try and take away the pain of unknowing or the pain of this diagnosis, but in actuality, it diminishes reality. And I’ve learned lately when people diminish your reality, it has more to do with them—unable to sit in pain and unknowing for themselves and therefore being unable to sit with others in their pain and unknowing."

Amanda Raffanaud

Amanda hits the nail on the head here with the concept of healthy people attempting to diminish her reality, the reality of having been already hit by a bus or that the bus is so much closer than theirs.  Is this way of coping helpful?  It seems that most people living with MBC would say no.

Tori's take

"Personally I always found it minimizing, and more of a way to try to equalize for the person saying it. It feels like someone saying calm down, you’re overthinking death, it’s not as eminent as you think. But here’s the thing about trucks - at least if a truck was heading my way I’d have a chance to jump out of the way or stay out of the street all together lessening my chance of dying from being hit by a truck.

Terminal illness is like having a truck coming at you that you can see, hear, feel and smell for miles away, while being chained down in your spot and knowing you just have to brace yourself for impact - because it’s no longer an if - but a when.

I guess I can see it as a way (like you used it as a lawyer) to get people to start thinking about death and the fact no one truly knows when we will pass, so better take care of arrangements just in case, but the majority of times I’ve heard it - it’s been more as a phase that has been weaponized to minimize people’s fears about their impending death from the disease."

Tori Geib

Tori takes this concept further when she describes this metaphor as having been "weaponized to minimize people's fears."  I love this phrasing since it captures in a significant way how BIG it feels when someone says it.

Hurtful statements

At the end of the day, I think it becomes clear how much these types of statements are about the person saying it, not the person they are saying it to. While it feels very personal to the MBC patient to whom the comment is directed, understanding that the speaker is scared, uncertain, avoidant, struggling, etc., can help us to respond better in the moment rather than clobbering the speaker over the head.

I'm sure you can't guess which one I'd prefer. ;)

Libby's thoughts

I'll leave you with this succinct comment from my new Canadian friend:

"I feel like I have the same chance of being hit by a bus as everyone else.  But I also live with my own murderer."

Libby Joan

Pretty sure that's a #MicDrop moment.

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