Firstly, to the anonymous alleged doctor who wrote offering unasked for criticism and advice - that is SO UNETHICAL!!!! I hope in fact that you are not actually a doctor because your idea of boundaries and helping are seriously screwed up. To list just a few of the objections I have to your letter: the internet is no place to be offering up unasked for medical advice based on the most scant information; it's no place to be poo-pooing the advice of doctors who have actually met with and examined the person in question. What if she is stupid enough, or vulnerable enough, to take your advice on board? Can you be accountable for the repercussions your letter may have, both on her health and emotional well being? You flat out contradict and refute her account of her own health management. As someone who has worked extensively with the top global experts in diabetes I need to tell you this: you have to respect people. You have to win their trust if you want to actually help them. It's very easy to tell people to do things that in real life are actually very challenging to do. And until you understand this you can never really help them. Finally, you are in no position to be telling someone you have never met and know almost nothing about that they are in fact NOT managing their health or their emotions well. I hope you are a better doctor than this letter reveals. But I doubt it.

Now, to the letter writer. I want to offer my sympathy. I think I understand why your friends react the way they do - as someone who has put their foot in their mouth too many times to count. Personally I've often said the wrong thing because I've been freaked out, blindsided by my own emotions. Then I've thought: no! That's selfish! Try to be helpful! And said something totally inappropriate and sometimes offensive. It's because tragedy and sadness bring up fear and all that stuff we spend most of our time repressing. Which puts YOU in an incredibly bad position where you're meant to be a kind of therapist to everyone at the time when you in fact need the most help.

If possible can you quickly put out the fire by quietly (so as not to expend precious energy) saying: yeah, na. Done that. Don't want to do that any more. Here's what I need. I need you to love me by providing fun and support and help on my terms. I'd really appreciate that. If you can be low key and positive about what you DO want that might help. Seems to me you need the permission of the people you love to let go. Elisabeth Kubler Ross talks a lot about this in Death and Dying. How hard it can be for people who love you to give you that permission but how important it is.

Finally, please know that people offer advice about EVERYTHING. Not just to sick people, to ANY people. I've had unasked for advice about losing weight, giving birth, raising babies, EVERYTHING. It's incredible how much people love to do this. I don't know why. But it's just awful when you're actually feeling vulnerable. I send you my sympathy and I really hope it all works out for you. As someone with a tonne of theoretical experience in this area your account of things makes sense to me. And it makes sense that the removal of the tumour may well make a big difference. I hope it does.