But the worst part was the loneliness.
Her friends and family didn't know what to say, or said the wrong thing, and many of them simply disappeared. And then there were the sympathy cards.
From the perspective of someone receiving and buying cards, McDowell found herself put off by the categories: religious, weird jokes or impersonally stating "with sympathy" next to a depiction of flowers.
"When you get sick or lose someone, your identity by default becomes 'sick person' or 'someone who lost someone,' " McDowell said. "In many, many ways, you are the same person you were before your diagnosis or before this thing happened.
You still appreciate humor, you are still a whole person. There wasn't really anything in greeting card world that allowed for that."
After McDowell's cancer went into remission, she discovered a passion for creating her business Empathy Cards
, "cards for the relationships we really have."
The open, conversational tone of the cards and their unique illustrations connected with people. McDowell's business grew and she received thousands of responses. It made her realize that there was more to be done.
She wanted to create an approachable book that picked up where the cards left off by continuing the conversation around empathy, but McDowell also wanted it to be research-based.
"We just don't know what to say as a culture. It's not something we are taught," McDowell said. "People are terrified of saying the wrong thing or making it worse or feeling awkward, and awkwardness is scary for people.
I wanted to make a book that was attractive to people who would be scared off by a self-help book."
A mutual friend told her about Kelsey Crowe, a fellow cancer survivor and empathy expert who founded Help Each Other Out
, an organizer of empathy bootcamp workshops that help people learn to be supportive and navigate tough times. And Crowe had been accumulating research for years that she wanted to put in a book, but she also wanted it to be illustrated.
"I wanted the tone of this book to be super friendly and relatable and even light so people aren't turned off by it because it's such a heavy topic," Crowe said. "Encountering Emily's work, it seemed like such a good pairing of mindsets about how to make people feel comfortable with the awkwardness of this situation, which is being there in times of suffering."
"What Emily's illustrations convey in a way that all my verbage could not is beyond my wildest imagination because that's what makes it accessible," Crowe said.
What to do, what not to do
Empathy can be a powerful tool that strengthens relationships and bonds, and it's a critical tool to nurture rather than ignore, McDowell said. The book takes readers through the dos and don'ts, as well as diving into the reasons behind them.
Don't do this: "The absolute worst thing you can do is nothing," McDowell said. "That is so much worse than reaching out and fumbling or saying, 'I don't know what to say, but I care and I want to be here for you.'
"The person going through a hard time doesn't expect everyone in their life to become an emotional ninja and know what to do and say, but when people don't try it's really hurtful."
It's because we don't want to do or say something hurtful, but we also don't want to fail, Crowe said. When someone is experiencing a tough time, the potential for failure feels even greater.
Be kind to yourself: The first step is self-care and taking stock of who you are, Crowe said. Focus on positives rather than putting yourself down if you're afraid to connect and figure out your roadblocks to empathizing with others.
"Trust yourself and trust that you are not perfect at this because no one is perfect at this," Crowe said. "Your friend isn't looking for you to turn into Oprah, they are just looking for you."
Understand grief: After taking a deeper look at yourself, it may be easier to stand in the other person's shoes and determine the source of their grief and how you can show support and offer kindness. Grief looks different for different people and it's important to remember that it doesn't have an expiration date, McDowell said.
"When someone passes away that we don't know very well, we grieve, feel sad and life gets back to normal," McDowell said. "But for the loved one, there is no normal to go back to. Try to remember that with grief, talking about the person who died is welcome, whether it was a month or two years ago. People generally want to talk about them."
It's not about you: Apart from doing nothing, even the best-intentioned attempts at empathy can go horribly wrong and turn a supportive gesture into a conversation all about yourself, Crowe said. Trying to make a tragedy or issue seem miniscule by using the phrase "at least" is one way. Or in an effort to relate, reaching to make a comparison about an experience that isn't comparable at all is also unhelpful.
Crowe herself recounted a time when her friend, Carla, confided that she had multiple sclerosis but was feeling optimistic. In an effort to show Carla that she didn't have to sugarcoat the news, Crowe shared a story about a college friend with MS who ended up starving herself to death.
"Thanks to Carla's gracious understanding and forgiveness, our friendship remains incredibly close, and I went on to learn a bunch of better ways to support a friend," Crowe said.
It's not an equation, either: Another misguided attempt at empathy is when people try to solve someone else's problem. These aren't problems to be solved, and those attempts can make people feel judged, misunderstood, even if that isn't the intention, McDowell said.
Keep it simple
: Sometimes, shutting up and listening is the best option, Crowe said. Simple gestures can have the greatest impact. In her Empathy Bootcamp workshops
, Crowe found that many people listed things like texting, calling and listening as the best and most memorable things people did for them.
"It can be really simple," McDowell said. "Somebody that cares enough to text every day just to check in and doesn't require a response back but is doing it just because they want to, or someone who shows up once a week with food and a standing date to watch TV."