my employee is being rude to others — but I think it’s from the stress of cancer

A reader writes:

I am a manager for a department of 11 people inside a large organization. One of my long time employees, Zed, has stage 4 pancreatic cancer. When Zed was first diagnosed about three months ago, I asked if he might consider taking FMLA leave (our organization and state have very generous medical leave policies). Zed refused. I think it’s because being his job is a big part of his identity, so he wants to work as much as possible while he is going through chemotherapy.

Zed is an exempt employee. He comes in days when he is up to it (two or three hours is a “good” day) and takes sick days when he is in treatment or can’t come in. He has been pretty good about giving me his anticipated schedule a week ahead of time so we know when we can expect him.

All of us like Zed a lot personally and are rooting for him.

Zed has recently begun exhibiting behavior that I do not find appropriate in a professional setting. One of his responsibilities is interfacing with, let’s say, the basket weaving department. Zed sends angry emails IN ALL CAPS to and about the basket weavers, complaining about their work, bringing up things the basket weavers did wrong five years ago, and generally making statements like “I don’t know what is wrong with these people.” My staff and I are frustrated that we only have two or three hours a day with Zed, and when he is in the office he spends his time complaining about other departments and what everyone else is doing.

Zed’s tone and behavior are starting to have consequences for his coworkers and our department, and I know it’s time for me to talk with him. Do you have any recommendations for how I tell Zed he needs to improve the tone and manner of his communications? It doesn’t seem like much of a stretch to think that that his cancer diagnosis is having consequences for his mental health, which is spilling out at work. Should I suggest counseling or bereavement groups, or just stick to the facts of “your work is not up to standards, and you must improve”? Should I push harder for him to take FMLA leave so he can focus on getting better? (I would expect resistance to this.)

I’d appreciate your help knowing how best to respond to this difficult scenario and be a good boss and a good human being. Thank you!

The best thing you can do is to kindly talk to him about what you need him to do differently, so that he’s able to decide for himself if he’s able to meet the expectations of his job right now or not. While the bottom line of the message is the same as it would be if he wasn’t sick (“you need to stop X”), the overall tone and framing will be different so that it’s sensitive to the situation he’s in.

So it might sound like this: “I know you’re dealing with a lot right now. I want to be honest with you that I think the situation is affecting how you’re showing up at work. That’s understandable! But I can’t have you sending the basket weavers angry emails like you’ve been doing, or spending so much time complaining about them to the rest of us. This would be true in normal circumstances as well, but it’s especially true when we’ve only got you for a few hours a day. I want to make sure that your time here is being spent where we most need it, not getting bogged down in frustrations with another department.”

If he seems to get it, that may be all you need to say. But if he doesn’t — or if the behavior continues — then you’ll need to move to something like this: “I want to be clear — I understand that you’re frustrated, but you cannot send emails like this. Your emails to other departments need to be polite and constructive, not hostile. That means no all caps, no complaining about things they did years ago, and generally being civil and ideally pleasant. If you can’t do that, I want to revisit what you’re responsible for right now, so I want to know what you think is realistic.”

Another option: “I know you’re dealing with a lot right now, and it’s completely understandable that you’re under a lot of stress. But it’s spilling out into how you’re treating other people. I’m glad to have you here, but this can’t continue. I want you to take a few days and think about whether you can get this under control at work, or whether it would be better to take more time off while you’re in treatment. I support you in whatever you decide — but if you come in, I need you to change the way you’re interacting with people.”

I wouldn’t suggest counseling unless you’re unusually close. That’s not really your role as his boss … although if he has access to an EAP through work, you can definitely remind him of that.

You also need to be careful about pushing for him to take leave, because you’re potentially getting into sticky legal territory there. (For example, if you push him to take leave but not your employee with another illness, you risk that being seen as trying to pushy Zed out of work because of his cancer diagnosis, even though that’s not your intent.) Plus, he may be saving his FMLA in case his condition worsens and he has greater need for it later. But if your employer offers short-term or long-term disability insurance, make sure he knows about that. (If you have an HR department, they should go over the available options with him, if they haven’t already.)

Ultimately, you do need to be clear with him that he needs to change what he’s doing, but you can do that with kindness and compassion.

{ 161 comments… read them below }

  1. Forrest

    It’s also possible that it’s not just the impact on his mental health, but has a physical cause: steroids are pretty common for stage 4 cancer treatment and can definitely make you more aggressive, shorter -tempered and so on. So I’d be careful not to make any inferences about why his behaviour has changed. You should be absolutely clear about what’s required and necessary, though.

    1. B

      I was going to say the exact same thing. “Roid rage” is real and it’s horrible for the person to go through – you have little control over your feelings in the moment and feel terrible afterwards. But I agree you should be clear with him.

      1. Eeyore's missing tail

        Roid rage is real. My husband says I channel demons when I’m on them, I know my dose is probably no when near Zed’s.

        OP, definitely focus on what you need from Zed at work. Don’t try to read all the reasons why he could be acting the way he is.

    2. Gerald

      Agreed that it could be a physical response to medication, or also pain (from what I understand it is painful).

      I had a colleague who died of pancreatic cancer. They were diagnosed in March, and dead by December. The likelihood of surviving to a year is so slim (and is apparently focused on a particular part of the pancreas) that the remaining time is best spent doing what you love most. I saw my colleague after a few months, and they were barely recognisable because they looked aged by decades (instead of someone healthy in their 40s, they had yellow/grey skin and were very frail). They had barely enough energy to walk around, and working was not physically possible.

      Having written that, the anger may also be an emotional reaction to the reality that they are not going to be able to work much longer. They may want to have a positive influence – a legacy. I don’t know how easy it is to have that conversation with them, but if this applies to the OP’s workplace then maybe consider a project where they can have a positive influence on something with a lasting impact?

      It is an awful situation to deal with, as we all know that we won’t live forever but it’s hard to address in the moment with such absoluteness. This doesn’t excuse bad behaviour, of course, but I do like the approach of “We want our time with you to be positive” as it is compassionate.

      1. Gerald

        To add, he has likely been given a timeline by the medical community – “There is a high probably that you will survive X months”. In which case he may be trying to work as long as possible to get as much benefit as possible (I don’t know how FMLA works, but if they have been given 10 months to live and they get 6 months of short-term disability, then they might be aiming to work 4-5 months). This would be much more of an issue if the employee has a family (and I worry that access to health-care services might also be a problem for someone in the US).

        1. Common Welsh Green

          So very well said. I had a friend who was diagnosed with stage 4 lung cancer. He worked far past the time when he could actually handle the job (he died less than 2 weeks after he stopped working) because he wanted to accumulate as much salary, savings, and benefits as possible for his wife and two daughters.

          1. Katie the Fed

            that’s horribly depressing. He might also be worrying about maintaining his medical and life insurance and need to stay employed

            1. Green genes

              My husband was on chemo for 4 years. It changed his response time (both physical and mental), changed his demeanor (more self involved), changed his focus (work and one hobby were his life), and he never did recognize that he had changed. It’s understandable, that’s a long time to be “almost but not quite” poisoned. He refused to quit working until the week before he died. I never heard that he treated his coworkers or customers poorly though, I’m guessing because he loved being helpful to others regardless of his health status.
              My point being, cancer patients go through hell, and they are not always aware of how they have changed, not admit it when its pointed out.
              I agree with addressing the problems with the work itself, and expectations. Perhaps bring up benefits only as a reminder of what is available through work as a separate conversation…

        2. BananaPants

          That’s what I was thinking. A man at my workplace did this when he was diagnosed with Stage 4 pancreatic cancer. His kids were grown and gone, but his only life insurance was through work and his wife didn’t work, so they had no other access to medical insurance (this was pre-ACA). He used intermittent FMLA for treatment and then went on short term disability shortly before going into hospice. He was technically still employed at the time of his death so medical insurance covered his end-of-life care and his wife got the life insurance payout.

      2. JSPA

        Let’s throw a few facts out there.
        Median survival is 2 (or 3) to 6 months after diagnosis.
        Five year survival is between 1 and 3%.
        The disease is hellish; the treatment is miserable too.

        Could be steroids. Could be it’s spread to his brain. Could be the pain and the nausea. Could be the chemo-brain. Could be flight from the knowledge of his mortality into the minutiae of his daily work. Doesn’t really matter; point is, it’s really unlikely to be something he’s going to be able to get a handle on and change.

        In that context,

        a) this is unlikely to have a chance to become a long term problem (and you are all really, really lucky if it is).

        b) “going home to focus on healing” is, for most people in this situation, a euphemism. Expect push-back. Perhaps ask him to work from home for a week “to get used to his new normal.” He may or may not be back.

        c) I’d put him on a creative and rewarding subset of his duties (if such exist) to “concentrate his efforts.” Also tell him you are limiting whom he can contact outside of those duties (and do so via your computer system; that is, set up blocks so that his messages to basketweaving go to you instead).

        Frankly, putting it on him to manage himself is almost certainly going to fail, and it’s going to be a failure of management, on your part. You can do this with love, but you have to stop him from spreading anger and confusion in your workplace.

        1. greenthumb

          This is a really thoughtful summary and note of next steps. We just lost a family member to another cancer, and really this is a disease quite adept at being dehumanizing.

        2. the other one

          As a stage 4 cancer patient, I think this is wise. My prognosis is longer – maybe 2 more years. I struggle every day with managing treatment, depression, side effects, grief, terror….and still trying to work as full time as possible. Work is my escape from cancer. Where I’m competent and somewhat in control and have control over some things…I feel closer to the old me. The new me is poked and prodded, and tested and scanned and given medications to stop the cancer that end up creating 10 new problems…I sit and wait and wait and wait and wait on treatment days, I have no control over when I get in and when I get out. Being constantly powerless is draining. They don’t seat you at a restaurant after 30 minutes? You go to another one. Your treatment is running three hours late? You sit and wait some more, again

          And giving up work before I absolutely have to feels like being one step closer to death. You know why? Because it IS one stop closer to death. This is the last job I will ever have. When I leave it, it will be because my disease has made it impossible for me to work.

      3. media monkey

        my dad died 4.5 years ago of pancreatic cancer, diagnosed at stage 4 (as most people are – there are few symptoms at earlier stages and so people go from feeling healthy to seriously ill in what seems like overnight). my dad was always a very fit and healthy person – he ran marathons when younger and shortly before his diagnosis he had been finishing the house he was building with my step mum.

        he was diagnosed in October and died the following november – this is a virtually unheard of amount of time to survive with that diagnosis, but it was not at all easy. chemo is a bitch – he was barely eating (and had little weight to lose before), he had a mouthful of ulcers constantly and felt sick all the time. he was living in the US and we were all in the UK and we flew over twice at short notice as he wasn’t expecting to live but pulled through both times (one of the times he had part of his bowel removed and a stoma bag inserted/ attached).

        so if all of this is going on in the background, he will very much appreciate the kind thoughts and sympathy you all have for him. Of course you do need to speak to him and Alison has suggested some really kind ways to approach this. i honestly think that the effects of steroids notwithstanding, this illness is extremely aggressive and comes with a big dose of shock as a side effect. all the best of luck to him – he is lucky to have kind colleagues like you!

        1. media monkey

          and i’m not in the US but from what i understand of the healthcare and hospital system as well as the workplace leave issues, anything you can do internally to advocate for the company to be kind to him and continue his employment/ benefits would i am sure be very much appreciated by him and his family. if you are in a position to do so of course.

    3. Liz600

      I was also going to say the exact same thing. In addition to the stress and the steroids, there’s a good chance that he could be experiencing side effects from other medications that a lot of chemo patients are on, including some of the medications for nausea, pain, and other generally hellish chemo reactions.

    4. SDSmith82

      As someone who’s mom never fully readjusted after the steroids from her cancer treatment, any one who saw what they did to my mom’s moods will tell you that the roid rages were the worst part of the treatment. Totally unmanageable, and unpredictable. I am the oldest of 4 kids, and was 14 when she had cancer. My Dad and I begged her doctor to put her on something else because it was unsafe for all of us.

    5. Is It Performance Art

      Pancreatic cancer can also cause something called “cytokine storm”. Cytokine storm can cause mood changes. Yet another reason pancreatic cancer is so terrible.

    6. Close Bracket

      So it might be useful to point out that his behavior is a change from his previous behavior without speculating about cause. Just something like, “these angry emails are out of character for you.” Bc the employee may not realize!

    7. Maria Lopez

      Catabolic steroid, which is what he would be given for this, do not cause “‘roid rage”. It is the anabolic steroids that athletes take that do that.
      Zed doesn’t have long to live, so I would just talk to the recipients of his abuse to see if they think it is as bad as you say. If his diagnosis is generally known, it would actually be easier for everyone else to just cut him some slack.

      1. Forrest

        really? About ten years ago, me, my mum and my friend’s mum were all on prednisolone (for an auto-immune problem in my case, but for cancer in but both my mum and my friend’s mum did), and it definitely had an effect on our moods. Me and my mum weren’t angry, but were both slightly manic and less aware of the world around us, and my friend’s mum was really noticeably more irritable and shorter-tempered, and said some deliberately horrible things to people. I just remember it because of being so grateful that it didn’t have that effect on my mum, because it was so hard for my friend. But it could have been some other side-effect of the cancer which we mistakenly attributed to the steroids.

      2. Not So NewReader

        One coin two sides.

        I know my husband was slacking (meaning more than one noticeable problem) on the job. I know his boss looked the other way. I am not sure about his coworkers but I never heard anything negative. There is no way the boss could not have known there was something massively wrong. I am so grateful they kept him working as long as they did. So. very. grateful.

        The other side of this coin is I have been on the receiving end of the raging. It’s not good, to the point of being down right scary, as in call the police, scary. In slightly tamer forms it can end relationships, forever.

        One thing I have tried with both family and subordinates, OP, is to say, “We will do this for a while and then we won’t have to do it anymore.” This seems to offer some relief in SOME settings. (No magic wand, sorry.)

        I have tears in my heart for you, your cohorts and him, OP. Absolute tears. You have to provide a safe workplace for everyone. It’s not unreasonable to tell him what Alison says. All you can do is hope for the best as you go along. Just do one day at a time. Try not to think about next week, next month. Just handle what is going on today. Breaking things down into smaller sizes does help some what also.

      3. shartheheretic

        I am another person who has mood changes with corticosteroids (prednisone, etc). If I have to take the 7 to 10 day pack, I turn into a rage monster. I thought it was just a side effect of being sick and exhausted from not being able to breathe (normally bronchitis is why I was taking it), until I realized that I only got ragey when taking that prescription. I mentioned it to my doctor, who stated it is a pretty common reaction. He agreed it’s best that nobody has to deal with me while I’m in a steroid rage, so now he gives me a steroid shot instead (which seems to work and only makes me surly for a short time).

      4. Owler

        Dexamethasone is a steroid given as a pre-med along with various chemos to prevent nausea. It most definitely causes mood swings.

      5. Nesprin

        Yes, but high dose glucocorticoids can be hellish for related reasons. The list of known side effects include sleep disturbances and manic episodes.

    8. Seeking Second Childhood

      This. Whether it was the tumor or the treatment, my father’s personality changed in the last six months of his life. He became irritable & paranoid, seeing Nazi spies everywhere. (He was a WWII vet.) And the man who taught me to admire professionals & business owners & craftsmen of all colors also developed an out-of-character racist streak. I was 10, so Mom protected me as best she could… but I heard plenty and learned more later.
      Cancer & its treatments are two sides of an evil coin.

    9. CastIrony

      I didn’t know pancreatic cancer was this terrible! I had a high school P.E. teacher who was nice to me that died from it. I hope Zed and his family get through this. Well wishes from me!

      1. WS

        There are several kinds. The most common kind is the really awful one, unfortunately, but there are less bad ones that are more likely to be survivable.

    10. TooTiredToThink

      That’s what I came here to say. I had a co-worker that there were days when he was aggressive etc… because of his meds. Thankfully we all knew *why* he was like this and we decided to accept it since it wasn’t a daily issue.

    11. TardyTardis

      Yes, my husband had RCHOP for his lymphoma and the P is prednisone. Affected him emotionally, and let’s not talk about chemo brain and say we did.

  2. Jennifer

    Such a tough situation. I hope Alison’s script helps and it doesn’t have to go any further than that.

  3. Psyche

    Another option to consider is whether you can reassign this particular task. If he is doing well with everything else and just can’t handle interfacing with the other department and it isn’t a core part of his job, it might be easier. If that is a viable option, it could even be presented as one of the choices when you talk to him.

    1. Walter White Walker

      This is honestly one of the few situations where reassigning a task, rather than directly confronting the problem head-on, may be the right thing to do as a manager.

      If your employee would never manifest this behavior outside of the stress of stage four pancreatic cancer (!), the kindest thing may be to re-assign this task and remove the stress of this interaction from all parties.

      If it helps, think of it as “an exception to best practices under extraordinary circumstances.”

    2. KR

      Love this idea and love the idea of picking out particular tasks he could take off his plate and putting it out as an option. Often I feel like managers say that they can reassign tasks or take things off your plate but it’s hard as the employee to know what they can take off their plate, what’s too much, not enough, ect

    3. AK

      This is also probably the best option in case Zed is no longer able to do the job, for whichever of the worst case scenarios that could occur here. If this is an important task that can be reassigned, it’s probably also important that someone else is familiar with the responsibilities should they be reassigned permanently.

      1. Pomona Sprout

        This was my first thought as well. With him out of the office so much, it makes sense to look at reallocating some of his responsibilities anyway. Assigning this task to someone else would relieve him of an area of responsibility that seems to be stressing him out AND give him more time to focus on ther things. Sounds like a win-win to me!

    4. Not So NewReader

      I have seen this done successfully also.
      One thing, though. Get the buy-in some how of the people picking up his work. This could be as simple as, “We want to keep Bob working as long as he can. Are you willing to help?”
      Resentment starts when the people picking up the slack have no say in what is going on OR they don’t even understand what is going on.
      If no one knows his diagnosis, you can simply point to what is common knowledge. “As you can see Bob is having some difficulties right now. I was hoping to shift some of his work over for a bit. This would be temporary. Would you be willing to help out here?”

    5. nnn

      That’s what I was thinking. Especially since, not to be morbid, but given his diagnosis you’re likely going to be reassigning all of his tasks at some point anyway.

      And if for some reason it’s not possible to take this task away from him, that’s something to bring up when you talk to him.

  4. Duncan

    Zed is essentially already taking intermittent FMLA leave – OP’s employer just hasn’t designated it as such, so he is able to “save” it; however, most employers wouldn’t be so generous to allow it to be saved like that.

    Regardless, his behavior does need to be addressed. Any employee’s sudden behavior change is likely due to some stressful personal circumstances and in this case, it’s obvious what that is. That may make it easier to maintain a sympathetic tone, but he does need to know he still has to meet standards. Really can’t blame him for being angry at the world right now, though.

  5. Wonder

    It’s also possible it may be metastasis to the frontal lobe. This can cause serious personality and impulse control changes!

    1. Drew

      I don’t think it’s appropriate for us to try and diagnose the employee’s problem, just as it wouldn’t be for a mental ailment. The issue at hand is Zed’s behavior, not whatever underlies it.

      1. Dagny

        There is a difference between diagnosing someone and suggesting alternate reasons for the behaviour. The latter is important because of the nexus with proposed solutions. If Zed is struggling because of mental health, that’s a different situation than struggling with the side effects of steroids or an advanced stage of cancer; the latter aren’t fixable by a talk with the EAP.

        That aside, I like Alison’s scripts but would put some emphasis on the idea that the company is open to a variety of options in this situation, but the current situation is not workable.

      2. The Original Stellaaaaa

        He has already been diagnosed. People are making suggestions based on the diagnosis that has been delivered by actual health professionals. It’s fair game.

    2. Ask a Manager Post author

      I do ask that we not armchair diagnose here, especially without context attached on how it would change the advice. “In case it’s Y, you could try X” is okay. But just “maybe it’s Y” isn’t that helpful.

      1. JM60

        I don’t think anyone is “diagnosing” here. The underlying diagnosis of stage 4 pancreatic cancer has already been made. There’s a difference between diagnosing, and explaining how an already made diagnosis may explain an unusual change.

        1. Ask a Manager Post author

          I’m responding to “It’s also possible it may be metastasis to the frontal lobe” with no explanation of how it would change the advice.

          From the commenting rules:

          If you’re speculating on facts or context not in the letter, explain how it’s actionable for the letter-writer. “She might be stealing your lunch because she can’t afford her own” is not actionable (and quickly becomes derailing). “She might be stealing your lunch because she can’t afford her own, and so you could try XYZ” is actionable.

          1. Dagny

            Non-sarcastic reply: if the issue is from stress, then an EAP may help. If the issue stems from either a progression of the illness or a side effect of the treatment, the proper solution may be to remove him from this duty and assign other work to him, or have him focus on other areas of his job.

            At the very least, when the OP has this discussion with Zed, the OP can be prepared to hear “I am on heavy doses of steroids” or “the cancer is now in my brain.”

      2. McWhadden

        I think it’s important people understand that this is much more likely to be a literal side effect to his treatment than some “stress is making him act out” thing.

        1. fposte

          But we don’t know that–we don’t even know if he’s on steroids–and it doesn’t change what people will do about it.

          1. Jennifer

            +1
            Whatever kind of treatment he’s getting is none of our business. The only thing that matters in this context is being fair to him and the other employees affected when it comes to his behavior in the workplace and what he has shared about his diagnosis.

            1. fposte

              And it’s not likely that anybody who knew he had stage 4 pancreatic cancer was prepared to be hard on him about his temper until they found out he was also taking steroids. I mean, the cancer is sufficient explanation right there; while it doesn’t mean that other people can always shrug off his temper, I suspect those who can are already doing just that.

              (I have a dear friend in the rarefied group of five-year pancreatic cancer survivors. They like to include her in studies.)

              1. JM60

                I think you’re right about someone being hard on an employee with stage 4 cancer probably isn’t going to stop being hard on them after finding out they use steroids. However, it’s probably best to keep in mind that the temper isn’t likely to subside, and someone attributing the temper to stress might be a little slower to make changes with that in mind, such as gradually transitioning their job duties away from tasks where their temper may affect others.

        2. Duncan

          My comment about a change in behavior being due to stressful personal circumstances was meant to be a broad statement, not minimize what Zed is going through. Zed’s is likely due to his medical condition, for others, it may be due to health, relationship or family, finances, etc. Yet no matter the cause or what is going on in our lives, we need to be professional at work. It’s understandable that Zed is not, but it also can’t continue.

  6. Memyselfandi

    Pancreatic cancer is a very serious cancer to begin with. Stage 4 means it has spread to other organs. Both the suggestions by Forrest and Wonder are possible. Doesn’t really answer the question of how to deal with the behavior, but context can help.

    1. Aud

      Very serious, and rarely diagnosed before stage 4. Whether his behavior change is a side effect of medication, result of stress, or a winning combination of the two I am so appreciative that this letter writer is equally concerned with being a good manager and a compassionate human in addressing this.

  7. Ashley

    He may not want to take leave because he needs the money and health insurance. Disability doesn’t pay as much as a regular paycheck. He may want time off but not be able to afford it.

    1. betty (the other betty)

      I was going to write about this. It’s entirely possible that he would like to quit, but would then lose his health insurance (or have to pay the full cost through COBRA). He might also have life insurance through work which will also stop if he quits.

      Financial stress plus serious illness is enough to make anyone angry. Doesn’t mean it’s ok, but makes it understandable.

  8. Lucille2

    Also, FMLA is unpaid time off and there are limits on how much can be used within a year. As Allison states, he may be saving that for when other options have been exhausted. But please also be mindful that unpaid time off can be a hardship employees can’t easily absorb. Especially for a lengthy illness like cancer. I used FMLA for maternity leave, which is planned, but the added health costs from my surprise early labor were not expected. The 12 weeks of unpaid time off + health costs took a hit to the budget. I can only imagine trying to work through stage 4 cancer AND trying to balance the sick leave/health costs/incoming pay. My heart goes out to this person.

    1. Yikes

      This was also my first thought. FMLA is unpaid. Even if he is 100% sure he is dying, he will still leave medical debt, plus the average funeral is like $10k. A lot of people in that situation, even if they have some savings, will be very motivated to get a paycheck until they literally can’t. I know I would.

    2. Bend & Snap

      This is what I came here to say. I doubt he’s dragging himself to work with stage 4 cancer because he wants to; it could very well be a money issue.

      I feel bad that this guy can’t just stay home and rest instead of dealing with work BS that probably seems meaningless in the face of cancer.

      1. fposte

        I’ve worked with people who had the financial ability to take the time off but who wanted to keep working, so I wouldn’t dismiss that possibility out of hand.

        1. Corky's Wife Bonnie

          Right, same here. A gal I used to work with just wanted a sense of “normalcy” while she was going through it. Staying home and having her family hovering over her just kept reminding her of her illness.

        2. JSPA

          Indeed. In fact, with pancreatic cancer.

          Especially if it’s a “life’s work” situation, plus you don’t have someone at home with you during the day.

          So you stare at the walls and listen to the clock tick down your remaining minutes. Or watch bad daytime TV, in the knowledge that you’re spending precious last few days and hours doing so. But you’re too sick to do anything really enjoyable (because feeling queasy and exhausted and having belly and back pain is what finally brought you to the doctor for the late diagnosis). You pick up that fat book you saved for a long illness or injury, then wonder if you’ll be alive to read the end. Going in to work really does make sense.

          1. Owler

            Or you don’t even have the attention span or the energy to read. I couldn’t keep my mind focused on a book when I was going through chemo—which was a huge disappointment for a reader like me. Everyone jokes about getting a stage IV diagnosis and just chucking it all to by a motorcycle and see the world, but the reality is that being that sick is justifiably hard to do stuff like that.

    3. Anna

      FMLA is unpaid once you’ve gone through vacation and sick time. I believe the way the law is written, you have to use your banked paid time off before you can go unpaid. So he can’t be unpaid unless he’s already burned through his paid time.

        1. fposte

          Right. The law permits that but it doesn’t require it.

          And while at some employers it’s quite possible that treatments for cancer would have meant he has used him his PTO already, it doesn’t sound like that’s the case here. The OP seems to be on top of the sick leave, says it’s generous, and didn’t mention burning through it.

    4. Katie the Fed

      also if your health and life insurance are through your employer, you have to, you know, WORK to get it.

      1. Not So NewReader

        Yep. In the end, my husband became separated from his company. He had to file for disability which is an epic process. Because the stars were in alignment, his app was approved very quickly. The lady said it was because we had filled in so much information that people usually leave blank plus other things were in his favor. That was one big, scary jump to make. (I must say, everyone was incredibly kind.)
        I remember wondering where the nearest food banks were, because I knew pretty soon food was going to be a luxury item.

      2. Tired of Winter

        Fed insurance continues through sick and annual leave, and six months leave without pay. Thirty-two year fed here. Terminally ill employees could be on disability from their employer and still covered under the insurance plan. I have a friend in that situation now.

  9. Sylvan

    That is an extremely serious diagnosis. Please remind him of any resources available like an EAP, if your company has them.

  10. bdg

    My dad and I work for the same company, although in different areas. When he was first diagnosed with Glioblastoma last summer, he tried to keep working as much as he could. His behavior on phone calls was markedly different – he was angry and frustrated and easily confused, which just made him angrier. My dad has worked here longer than I’ve been alive, so everyone knew that wasn’t “him” but was steroids or brain cancer.

    Eventually he had to go on long term disability, which was a huge, terrifying step for him. He was definitely one of those “my work is my passion” people, so I get why he wanted to hold on for so long.

    Anyways, all of this is to say that what you have to say to him may be difficult. A lot of things dealing with cancer are difficult. But how you act towards your employee will matter even more. If you need him to quit working, that’s fine. But try to call and just check up on him every few weeks. My dad felt so isolated when he had his access blocked. He had the terrible timing of going on disability when his very kind boss moved out of state for a new position. The new boss had worked with my dad for a long time but didn’t even send an email when my dad’s mom died.

    So my point is – say what you need to. But afterwards, please remember that this work is and always has been important to your employee. He’s made sacrifices for it. Keep in touch and let him know that he matters and the work he’s done for so long matters.

    1. Not So NewReader

      Ah, a happy tear. I remember one day after my husband had been out of work for a bit, the boss put him on a conference call for their department. Hubs could talk to everyone over the phone. The boss probably should not have done that. But what I saw on my end, was nothing short of a miracle. Being connected to work, brought my husband back to life. He sat up straight, he cracked jokes, he did all those normal things we take for granted.
      That call was such a blessing.
      And I could hear the warmth in his coworkers’ voices (speaker phone). They got almost as much out of connecting like that as my husband did. And the boss indicated he knew it was one of those rare moments in life that endures in people’s memories.

  11. somebody blonde

    Just to keep things in perspective, you may want to go to the basket weavers and see how mad they actually are about the rude emails. He may be in treatment, but people generally do not survive stage 4 pancreatic cancer for more than a few months (several people in my family died from it). If they’re willing to cut him the slack, sure, ban him from caps, but try to humor a dying man as best you can.

    1. Bagpuss

      I think this is a good point, especially if his diagnosis is generally known . I do think it is reasonable to speak to him, but possibly also look at damage limitation – speaking to those on the receiving end, and perhaps putting in place arrangements for them to refer any particularly unreasonable decisions to someone else.

    2. Yvette

      That is an excellent point, I would like to think that if I were one of the basket weavers and I knew what was going on I would be inclined to cut massive amounts of slack. They may feel the same.

      1. SierraSkiing

        Yep. And as a basket weaver, I would also appreciate OP checking in to say, “hey, I’m sorry he’s been directing this at you, you don’t deserve it and we know you do good work. Can you put up with this while he is still in the office?”

    3. gmg22

      I was thinking something along those lines. Someone with this type of cancer, knowing the fatality rates, is likely experiencing anger/fear that is rooted in more than just “I am going through chemo and it’s hard.”

    4. Undine

      Zed might feel his privacy has been violated. We’ve had plenty of people here who want to keep their health status private.

      1. JSPA

        This was suggested provisional on, “if his diagnosis is generally known.” Nobody’s suggesting sharing his condition without his approval.

        Once the diagnosis has been shared by the employee, it’s not a violation of privacy to literally google survival information from NIH or the Mayo clinic.

        The idea that we have to pretend ignorance of common knowledge to somehow “create privacy” deserves a world of push-back. Survival rates are not arcane witchcraft. They’re tabulated facts, just like the other facts we use in our jobs. Ditto “common symptoms,” ditto “common complications of treatment.”

        A person’s individual prognosis, symptoms and complications are not the SAME as these things, but they exist in the context of these things. Surely it’s possible to draw a distinction between “the norm” and “the coworker,” while at the same time reasonably hoping for a bit of extra forbearance on the basis of “the norm.”

    5. OP

      I think the basket weavers have been basically understanding, so far. I’m concerned about Zed’s coworkers being put in a position where they have to explain/justify/rationalize Zed’s behavior. So far the basket weavers aren’t confronting Zed directly (because, cancer) but it does feel like some of the snark/nastiness is affecting the work, even on days when Zed isn’t around.
      FYI, Zed has lost his hair and a considerable amount of weight, so there are no secrets about his health and diagnosis.

      1. Not So NewReader

        Just thinking about this, I hope you see my comment.

        You may want to consider a couple things:
        a) You could talk to the boss of the basket weavers and give her a general idea of what is happening and why you are allowing it to continue on. You could ask her to ask her people to lead with compassion as often as possible. Or you could say that you are leading with compassion first and let her figure out the implied thought is you are hoping she will do the same. Tell her you would like to keep the door open here for further conversation if necessary.

        b) You can tell your own people that if they get complaints from basket weavers, they or the basket weaver can come talk to you. This sounds like it could work into something super labor intensive. But for some reason, I have never seen too much problem. For some folks, just knowing the boss is available to talk is enough. People do rally and pull in the same direction when they know a person is facing giant struggles.

  12. OP

    Thank you, Alison, and thank you, everyone for the helpful comments and suggestions. Zed definitely has good days and bad days. I understand the side effects from his treatment are significant. I like the idea of focusing the conversation specifically on “best use of time” given the circumstances.

    1. RandomusernamebecauseIwasboredwiththelastone

      I’ve done this with an employee who was diagnosed with ALS. There’s an open secret in my company that anyone who is end stage dying from something gets to work* as long as they want and the decision to go on STD/LTD is left to them.

      Usually the manager will work with them on modifying job duties slowly transitioning things away from the employee and eventually they will be working on documentation and transition totally behind the scenes. Usually the first to go is customer facing and time sensitive duties.

      By the time the employee chooses to go on disability they’ve been transitioned out of all major job duties.

      *Work is subjective and often entails… why don’t you stay home and if you can do some things great, but nobody will be looking at what you get done.

      1. VictorianCowgirl

        This such an unexpectedly kind policy in today’s climate, and I want to commend you and your company for this and thank you for some renewed faith in humanity.

      2. Seeking Second Childhood

        May I also add appreciation for that policy. If I learned that detail about a company, I’d look hard to see if I could be a match to work there.

    2. Cassandra

      Thanks for wanting to handle this in a matter that is fair and compassionate for all involved. I wish it were an easier balance.

      Having had more than one family member (including one immediate family member) pass from cancer… you are the boss I wish they’d had.

  13. The Man, Becky Lynch

    My dad was a raging…butthead [nicest word I can come up with right now] when he was going through treatments. Not just because he feels cruddy but they’re pumping him full of medication to destroy the cancer, it destroys so much more than the cancer as well naturally. My dad once snapped at my brother for his sleep apnea, woke him up while he was sleeping [and snoring/snorting as usual] to scream at him about getting it “fixed”…it was horrifying to listen to my brother tell me about, needless to say. We did talk to dad about it but he was so drugged up that he couldn’t compute the real issue at the time. Fast forward to him being healthy and happy now, we tell him what he said on chemo and he’s outraged at himself.

    Is there anyway to run interference between him and other humans? They cannot necessarily use their usual common sense because again, their body is being bombarded with so much medicine.

    If you cannot work with him to at least shield others from his outbursts, then you may need to approach the situation as “I know you’re having medical issues and therefore I must request you use medical leave, you cannot be in the office with your erratic behavior.”. In the end, you can deem it a hardship to let him work through treatments because it is a hardship if he’s acting inappropriately towards his coworkers, despite the knowledge of why it’s happening.

    1. RandomusernamebecauseIwasboredwiththelastone

      Sorry, I get that this is well meaning but the advice here is totally wrong and could get the OP into trouble.

      1. The Man, Becky Lynch

        Only it’s not because you can require someone to go on leave and designate it as FMLA. Yes, it’s dicey and you should proceed with caution but no it’s not “wrong”.

        The other option is to be brutal, give them the standard talking to and advice, then move forward with a termination in the end. It’s all going to get ugly if you cannot just remove him from the interactions with other employees, tbh. Damned if you do, damned if you don’t comes to mind in these situations.

        1. Ask a Manager Post author

          No, in this case when there’s an ADA-covered condition in play, you have to make sure that you’re handling it consistent with how other disabilities have been handled, or you may be violating the law.

          1. JSPA

            They’re not sending him home for being sick, though. They’re sending him home for being erratic and disruptive.

            Surely you can tell someone who is being erratic and disruptive that their choices are to discuss with HR what sorts of leave are available to them (and then go on some sort of leave), or be banned from the workplace. That need not be via termination; it might be “work from home and we ensure that you can only email your managers and direct reports.”

        2. VictorianCowgirl

          How unmerciful and unhelpful, not to mention likely illegal. He likely stood by his employer when things weren’t great. They can do the same for him and give him a chance to self-correct.

          1. JSPA

            The presumption that someone can self-correct, no matter what is going on with them biologically, is frankly a bit 19th century. It’s right up there with “chin up, you don’t have to be depressed” or “how dare you have eating problems when people are really starving in Africa” or “why on earth would someone with diabetes choose to eat sweets.”

            I get we don’t “internet diagnose,” but the reason for mentioning all the auxiliary things that can and often do happen with pancreatic cancer is that quite a few of them remove the ability to perform this sort of self-correction–and concurrently remove that ability to recognize that fact.

            I know it’s painful to face the fact that the vast majority of us will someday be “not ourselves” in the sway of a major illness that affects mood, memory, sensory processing, judgement, impulse control, and all of those things that we use as a stand-in for “the self.” We generally cling to the idea that managing people in crisis is ideally about drawing clear lines, while also giving them a clear path to get back to their “best self.” But that presumes that such a path exists. Heck, it assumes that such a “self” exists.

            1. Jennifer

              The next time my boss asks me to change how I do something, I’m going to tell them, “That’s like, so two centuries ago.”

              1. JSPA

                I didn’t say “people generally can’t.” I said, “people can’t necessarily.” It’s not really something to make light of, though admittedly jokes are more comforting than the reality.

                1. JSPA

                  Yes, most of us indeed can (and sometimes do so).

                  That is a common ability. Like other abilities, it can be biologically obliterated.

                  Victorian romances have characters who implore each other to throw off their blindness and somehow see again (as if an act of will could repair a retina). Or “throw off” their lameness.

                  Do you find that a mixture of strange, quaint and offputting? I do.

                  But we’re still doing much the same thing, when the injured part twists internal (not external) perceptions. Decision making, not physical steps. Loss of emotional self control, not physical stumbling.

                  If we wouldn’t tell someone suffering from MS to step up briskly when their gait is shaky–and I trust most of us wouldn’t–then we should not be expecting someone whose medical symptoms or side effects include a loss of self control, to exert self control, if only we remind them to do so.

              2. Tinker

                I mean, you’re presenting this in a way to make it sound ridiculous, but I actually have had to have the real non-flippant version of this sort of talk with managers because without appropriate supports my disability can manifest in ways that look like “bad employee who is not trying hard enough and needs to try harder”.

                In my case, there are a number of things that I can do that work around my inability to decide not to have executive dysfunction and sensory processing issues — it’s not so hard to imagine that Zed probably has fewer options. As other folks have pointed out, the typical course of pancreatic cancer is not long and not nice while it lasts.

            2. Sylvan

              Thank you for making this comment.

              Sometimes people who are sick or in a crisis aren’t able to see that their behavior is out of the norm, or if they are, they aren’t able to course-correct. “Setting boundaries,” which is a good thing to do in so many other situations, won’t make them able.

        3. Sylvan

          I can definitely empathize with your situation with your dad, but I disagree. This employee has a type of cancer that often leaves people with months to live. You don’t need to teach him any lessons. You just need to provide the accommodations that you can, which might include less interfacing with other departments.

        4. Katie the Fed

          “then move forward with a termination in the end”

          Um….you realize this situation is already terminal right?

  14. epi

    The OP sounds like a very thoughtful, perceptive boss. This is a really great question.

    I am a cancer researcher and pancreatic is one of “my” cancers. I think the OP is probably correct that Zed has chosen to continue working in part because his job is part of his identity. The reality is, pancreatic cancer survival is typically measured in months. Since Zed was not just diagnosed, he is likely in his final months or even weeks of being able to work. There may not be anything to save FMLA for. Probably a combination of things are causing Zed’s attitude, including physical discomfort, side effects from drugs, digestive and appetite changes, and grief.

    It would be a kindness for the OP to facilitate Zed’s continuing to work, without patronizing him. Regardless of what is causing his behavior changes, most people– especially people who derive enough meaning from their job to keep working at the end of their life– want to continue to be treated as professional adults who can take responsibility for their actions. So I totally agree with Alison’s advice to talk to Zed about this.

    The only other thing I would add is, it may be time to consider which of Zed’s roles he should start to relinquish. He can’t fulfill them all if he is only working a few hours a week, and it is time for the OP to make sure others are cross trained to take over Zed’s work anyway. It’s possible that Zed’s role as a liaison to this other department was never an enjoyable part of his job, and he would be happier focusing on some other part of his role during the time he is at work. I can imagine it would feel maddening to commit to continuing to work, deriving pleasure and meaning from one’s job at the end of life, and feel that those few hours are taken up by something obnoxious. At this point, his 2-3 hours a day might be better spent on a pet project or an area where his personal contribution is truly essential– for everyone’s sake.

      1. epi

        No problem, I hope it helps! It sounds like you are doing a great job as Zed’s boss and trying to be sensitive to his needs. All people with chronic illnesses should be so lucky.

    1. Perpal

      Would be careful – in general pancreatic cancer survival is under a year, but there are a few people who survive years. That’s one of the frustrating things, lots of unknowns. Though if the employee is obviously deterioriating, that’s a bad sign.

      1. epi

        I’m not sure why you would think I need to be careful, since my comment is based on more than general knowledge of pancreatic cancer. I’m not really interested in arguing with you about it, but it’s not true that there are “a lot of unknowns” in stage four pancreatic cancer.

        In any case, the OP’s problem is that they want to be kind to a seriously ill employee, but they still need their department to run and people to behave appropriately. Speculating that Zed may experience a miracle really has nothing to add to the advice here. He’s only working a few hours a week, he can’t possibly do everything he used to do in that time, so he should probably do work that he finds fulfilling and that makes it easy for him to be professional. If he makes a miraculous recovery and has to take back the frustrating jobs someday, I’m sure he’ll consider that trade more than fair.

        My point in mentioning survival is that the OP’s situation is likely a short-term one. There is probably a short window in which Zed’s coworkers can be kind to him by helping him continue to work on his own terms; there is very little risk that by doing so, they are setting up a long term situation that might not be workable. What’s the counterpoint here– that is isn’t urgent to help a seriously ill person?

        1. JSPA

          I think the point is that OP has to keep in mind that a tiny percentage of patients do respond to chemo fairly dramatically and/or survive for 5 years or more.

          So OP should not guide Zed in a way that leads to “no job and no remaining resources” if Zed in fact is one of those rare few.

          But that seems like something that would be covered by, “we’ll create a position for you, if we have to, with your input, once we all know what sorts of tasks will work well for you, going forward.”

          1. Jasnah

            Surely if Zed made a miraculous recovery, OP and the company could reallocate resources and job duties again so he has something to do. I don’t think anyone would begrudge that, and I don’t think epi ruled that possibility out in their clearly-well-researched comment.

        2. Perpal

          FWIW I am an oncologist; the only thing I was getting at, as others pointed out below, was not to assume he only has weeks left, and perhaps come up with a plan that is unsustainable if he has months +. But yes you are completely accurate that the great majority have under a year, often under 6 months; most likely that is the case for him; and the rest of your comment was great! I didn’t emphasize that as much as I probably should have since many others had, but yes, sensitivity and compassion are important, and a gradual transition where he can feel as valued and in control as possible is ideal.

    2. NoLongerYoungButLotsWiser

      Thank you for the thoughtful, helpful comment. My husband just died of stage 4 colon – metastasized to liver (and brain) cancer a few months ago. There was no one to guide me well in understanding that some of the behaviors and issues were about the buildup of toxins in his brain / body from the cancer (many good providers and care team members, don’t get me wrong – we were very fortunate! – but I just didn’t bring up the right things and was tired and overwhelmed).
      He worked long past when he “probably” should have. But he lit up and pulled himself together for me to drive him to the business. He didn’t quit going in until he no longer had strength to leave his bed.
      That interaction with people was his motivation to keep going on, a key part of his quality of life. Thank you epi, and thank you to OP for the thoughtful kindness.

      1. Not So NewReader

        Well said. I am grateful for those people and I don’t even know them.

        Now I have to get these damn onions off my keyboard.

  15. Marlene

    OP – you’re doing your best, but you may in over your head here. As Allison said, you could inadvertently veer into legal discrimination. You’re also making assumptions about his behavior that you really can’t know for sure.

    If you have an HR and Benefits rep to sit with you during this meeting, include her.

  16. Amelia Pond

    I agree it’s very likely it’s the stress, especially since it’s pancreatic cancer. Pancreatic cancer already has a very low survival rate and add in it being stage 4… there’s a fair chance he’s already received a terminal diagnosis. On top of it, he’s probably on a number of medications, some of which may be impacting his personality. This is a heartbreaking situation, and while I don’t have any specific advice, I want to thank the LW for handling this with compassion.

  17. MinnieK

    I’ve been in this situation, but as a co-worker, not as a manager. Unfortunately it culminated in such a dramatic and offensive outburst from my “Zed” that she ended up being put on two-week suspension without pay. The outburst was not directed at me, but I was just feet away when it started and even though that was almost 9 years ago, I still get stressed out when I think about it. (The person who was on the receiving end of the outburst ended up having heart palpitations and collapsing afterwards, and was taken to the hospital via ambulance.) When she returned, they moved her to a new location in the office, closer to managers. She was also someone who was defined by her work, had worked for the organization for over 35 years, and worked until the day she went into hospice care. No one wants to have the conversation you are going to have with Zed, OP. But your compassion will go a long way, and it may help prevent a really unfortunate escalation. Best of luck to you, your team, and Zed.

    1. OP

      That sounds like it must have been a very scary situation. I certainly would rather have a slightly unpleasant conversation now in the hopes of avoiding an even more unpleasant conversation in the future. Thanks for the kind words, MinnieK.

    2. JSPA

      This. This. This.

      Zed as OP has known him would not want it to get to this.
      No manager wants it to get to this.

      Sending angry all-caps broadcast emails IS enough of a cause to create a mutually-helpful buffer zone (physical or electronic) around Zed.

  18. Anon attorney

    Thank you for your humanity.

    My late husband continued to work after he was diagnosed with stage IV (not pancreatic) cancer. For the last few months he was unable to work meaningfully or go to the office although he did what he could remotely. The owners of the company treated him with kindness and respect – they valued the work he was able to do, but didn’t put him under any pressure to come to work or to stop working, at least to my knowledge. The way they treated him allowed him to maintain a sense of being useful, part of a team, and valued as a person. He needed that. They also supported me after he died. I will always be grateful to them.

    It might well be that Z knows he is reaching the end of his working life and his actual life, which given his diagnosis is the sad reality. In that light, I do wonder how important it is to deal with this kind of behavior at all, if people are prepared to be tolerant of a dying man – is a bit of email ranting really that important? If that’s not possible, I’d urge you to deal with this in a way that doesn’t force him to confront the reality of his impending loss of working identity if he is unable to do so. I’d be inclined to take the approach that this behavior wouldn’t be acceptable from anyone regardless of their health status and ask him to knock it off, but not to invoke the disciplinary consequences that would normally follow. It may be important to him to be treated as a professional and not a patient (and cancer strips away these identities, one by one) but I would prioritize kindness over everything else here, because the problem is, sadly, self limiting anyway.

  19. Sunshine

    Normally I’m all about workplace cohesion and employees being nice to one another. But Zed’s dealing with an incurable diagnosis with painful palliative treatments. I’ve dealt with worse behaviour from colleagues that have oversized egos or nepotism or mental health issues going on.

    People need to suck it up. Most things are not excuses for bad behaviour. This is.

    1. WellRed

      I think the manager could find ways to mitigate the bad behavior without expecting coworkers to suck it up. Sure, they can probably suck it up quite a bit, but then comes the day it’s too much for someone that’s having their own struggles.

      1. Sunshine

        I know you’re right; after all what if Y also has cancer? Or a myriad of other issues just as serious. I’ve just seen people molly coddled and excused for such petty reasons compared with what this poor man is going through.

        1. Not So NewReader

          Fortunately we are only talking about Zed and not considering the Ys of the world.
          Just as every person is different, so every situation is different. This means there are no real rules of thumb and most certainly there are no rules etched in stone.
          Part of management is to factor in the differences in people and the differences in circumstances. If a person has difficulty doing this then that manager can read books to try to learn, write into AAM for situation specific advice, or decide they are not cut out for management.

          My husband’s boss faced this situation. My husband and another employee were both faced with terminal cancer. Boss treated each employee individually. He found out what each needed and figured out ways to help each one. This does not have to be an adversarial situation between cohorts.

  20. LaDeeDa

    Allison’s answer, as always, was wonderful, I just wanted to offer up my own experience. I had an employee who had breast cancer, a double mastectomy, and reconstruction surgery that went horribly wrong and caused her to be is so much pain.
    She would react to things in a way that was out of character, she couldn’t remember things, she was putting herself in physical danger- driving, lifting, long hours- all against doctor’s orders. When I sat her down to talk to her, from a place of compassion, I also didn’t want her to ruin her amazing reputation. She was so immersed in her turmoil and pain, and her fear of losing her job, losing her insurance, going on FLMA gives employees a fraction of their pay, and she financially couldn’t take that reduction in pay.. she desperately needed not only her identity as an expert in her field, but the pay and health care (US health care sucks!), I was met with ANGER.
    It was in her best interest to take off work, but once you go on short term disability after so many days it turns into long term disability, and after so many days you can be terminated (Did I mention US health care sucks!) I told her my concerns, I told her I wanted her to work, and together we worked out an option/recommendation from her doctor to allow her to work half time, and extend the disability coverage. She wanted to be in the office, but she couldn’t handle being in the office. I changed her role, goals, responsibilities, to allow her to do work that she could do from home whenever she felt like it.
    This isn’t an option for everyone, we were lucky we could do this. It was difficult, she never fully recovered, our professional relationship never recovered, she was in so much pain, on so much medication and in so much turmoil that her thinking was skewed. BUT, we got her through this- at least career and financially.

    1. Mobuy

      I’m sorry you feel US health care sucks. I do want to push back on that a little, though. After experiencing Canadian health care and later going through serious illness in the US, our health care in the US was amazing for me. According to my husband, Japanese health care also had a lot to be desired. I think that what sucks is having cancer.

      1. Japananon

        I’m sorry you had a bad experience with Japanese health care. Bedside manner is not always so great here. But because healthcare is not tied to employment here, people can get cheap(er than the US) healthcare for most issues regardless of their employment status. Also many companies also offer short term/long term leave, if it’s unpaid you can get 2/3 of your pay while you are taking time off work due to illness if your company does not have some other system in place.

        Cancer sucks, but not having a social safety net also sucks.

      2. Name Required

        People in the US die due to lack of access to healthcare — a Harvard School of Medicine found that 45,000 deaths annually are associated with lack of health insurance, and around 17% of American adults are uninsured, mostly commonly because it is too expensive. The US has some of the worst healthcare outcomes while healthcare costs make up a substantially larger percentage of our GDP as compared to other first-world nations. We spend the most and aren’t even in the top 10 of best healthcare systems. Healthcare in the US, compared to similar nations, “sucks.”

        https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
        https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/?fbclid=IwAR1zzg-SoQzLNvbReFEJUoruFioLxJB16tLXz00mzDfafOnWwFDfmCPZqfM
        https://www.reuters.com/article/us-health-spending/u-s-health-spending-twice-other-countries-with-worse-results-idUSKCN1GP2YN

        Even if there wasn’t data supporting an understandable frustration with the US healthcare system, in LaDeeDa’s specific experience with her employee, the employee was stressed and worried in addition to her cancer because of the structure of the US healthcare system. LaDeeDa’s opinion of the US healthcare system isn’t cancelled out by your ancedotal experience, so pushing back in this scenario seems condescending and unnecessary. OP’s employee could be reasonably going through the same fears and frustrations, and it does suck that our healthcare system is set up in a way that people would worry about dying because they can’t afford the treatment they need.

      3. JSPA

        Depending on your insurance and situation, it can be great! It can be good. It can be fair. It can be poor. It can be effectively nonexistent. And you can go from category “great” to category “nonexistent” startlingly easily (and people often make that transition while very, very ill). Not discounting your great experience, but individual great experiences says rather little about how the system works for people overall.

      4. Sunshine

        I think she’s saying the financial implications suck. That it sucks that an excellent employee who wasn’t capable of working was being forced to work because otherwise she couldn’t afford her cancer treatments.

      5. LaDeeDa

        I am a Canadian citizen as well as an American citizen. I have also lived in Europe, I am familar with many health care systems. And I think you misunderstood, I meant INSURANCE and health coverage sucks, not care. My bad.

  21. Jane

    I’d also add that I would ask for his input as to what may be causing his new behaviors. It is easy to pin it on his cancer diagnosis, and it may be that for sure, but it doesn’t mean it is DEFINITELY that–it could be something else. And just assuming that it is could make him feel…more like a cancer patient and less like a complex human with a lot going on, and he may not like that much.

    I assume that a) this is new behavior for him and b) the things he is getting angry about are not new. I’d point out both of those things to him and ask him what he thinks is going on. Hopefully his answer can steer the both of you to making a plan for changes that need to be made, whether it is his taking more time off, having adjusted responsibilities, or implementing some solution to a problem you may not know about yet.

  22. nnn

    Another reason not to suggest counseling is that he quite likely has a terminal diagnosis and only a few months left to live, and it’s a bit much to ask someone to take on another time commitment under those circumstances.

    I do agree that the rest of your staff shouldn’t have to be the targets of his anger, but that’s better handled by figuring out a way to adjust his duties or otherwise put a firewall between him and the targets of his anger, and/or finding a way to let him take time off without losing pay or benefits. (Can he work from home?)

  23. Mobuy

    When I was in the middle of my student teaching, my a-hole husband told me he wanted a divorce. My cooperating teacher was awesome; however, at one point he asked me if I wanted to go home because I “wasn’t doing myself any favors today.” Maybe ask Zed if he wants to go home when he’s being extra grouchy. Be compassionate (it sounds like you are) but let him know that his attitude needs some adjustment of he wants to be there today.

    Oh, and when I was diagnosed with cancer, I was so happy to be able to keep working. You don’t want to sit home all day and think about having cancer. It’s probably great for Zed to have something else to think about. Thank you for helping him keep his mind on life instead of death.

    1. Not So NewReader

      This is a good idea.
      OP, you could do this by saying, “Zed, you sound a little tired today, how are you doing?” You might be able to get him to say he has had enough for one day and he’d like to go home and try again tomorrow. Or he might say that specific thing X is too much today and he would prefer to work on easier thing Y.

  24. Not A Manager

    Reading the comments above, my summary is, either Zed can control himself, or he can’t control himself. If he can control himself, then having the conversation Alison suggests is the best option. Even if his colleagues are willing to tolerate his abuse, if he’s able to self-regulate, that’s best for them and also best for him.

    You won’t know if he can control himself until you have that conversation, so have it. See what happens. If his behavior doesn’t improve, then assume that he can’t control himself. It doesn’t matter why. Maybe he’s depressed or angry, maybe there’s an organic change, maybe it’s a side effect of his treatment. Doesn’t matter.

    If he can’t control himself, can his colleagues tolerate his behavior? If they can, and if it’s a kindness to him, then let him be. A few months of ALL CAPS might not be intolerable under the circumstances. But if he’s harming his colleagues, then you need to re-direct him to other pursuits, or even eliminate his access to certain people and media as discussed above. Surely there’s some way to protect his colleagues, if necessary, without shaming Zed or harming him.

    I think the most important thing is not to continue to ask Zed to control his behavior if he can’t actually do that. That’s not useful and it’s not kind.

  25. Comment

    I feel bad for the guy. That type is one of the most painful (so they may not be able to get much sleep), Unless there have been significant advances in tx of this cancer, stage 4 implies that there isn’t a wealth of time remaining.

    I get that he may be frustrated. Maybe considering all of the circumstances: Hey _____, Is there anything we can do to help (or offer support) while trying not to get invasive? Can they work from home if desired?

    He may be concerned about his future (in many ways: ability to work and keep a job, keep insurance, afford treatment, not able to eat much). The leave thing is another issue legally, There’s FMLA/Intermittent FMLA, ADA, etc. There are some huge hardships here which I would argue that a lot of us may not have experienced. I am not excusing it or trying to downplay it. Just trying to give some background so hopefully something can be worked out.

    The leave thing is another issue legally, There’s FMLA/Intermittent FMLA, ADA, etc.

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