My child just had a terrifying medical crisis. I’m shocked by my best friend’s response.

Dear Prudence is Slate’s advice column. Submit questions here.

Dear Prudence,

I have a dear friend, “Sage,” who I’ve been close to since our freshman year of college, more than 25 years ago. They are someone I thought of as chosen family—something especially important to me as an only child with no extended family. My daughter also loves Sage and considers them an aunt (and Sage refers to her as their niece). In the last few years, although Sage lives in a different state, I have supported them through three different medical events—two involuntary and one voluntary. I have texted, called, and sent care packages for each one, even when I was going through a lot in my own life. Sage is currently healthy with no caregiving responsibilities.

Two weeks ago, my child had a terrifying medical crisis. She was in the hospital for three days and now has a life-changing diagnosis. To say it has been hard and overwhelming for us all is an understatement. Apart from a brief text response to my message when we were in the hospital, Sage has been completely absent. No texts, no calls, nothing. Not even asking if we were out of the hospital, if my daughter—their niece!—is OK, nothing. I don’t expect them to send care packages, but I am so hurt that they haven’t even made the barest expression of care. We’ve gotten more support from literal strangers and distant acquaintances than we have from one of my oldest and dearest friends.

How do I process this? How do I address it with them? I don’t want to torpedo the relationship, if only for my child’s sake. But I am so, so, hurt, and I can’t think of any explanation that would make this OK—either Sage doesn’t care about us as much as I thought, or they are so self-absorbed they didn’t even think I/we would need support at this moment.

—Hurting Friend

Dear Hurting Friend,

Something I’ve realized about friendship over the years is that the extent to which a person is able to show up for others—sending care packages, flying out to visit, calling frequently to check in, organizing a meal train, providing practical support—has so much more to do with their current life situation than how much they care. I often think about how I was pretty unimpressive as a friend when I was in law school and practicing law, mostly because I was very busy and deeply miserable. I didn’t just skip bridal showers and birthday parties. I failed to return phone calls and did a terrible job of checking in on people who were going through hard times, in ways I still regret. I even skipped a family member’s funeral that would have required taking a few days off because I was so afraid to be away from work. Ugh.

Fast-forward a few years to when I was single, making decent money, not super drained by my work, with plenty of free time, and I was the care package queen. I kept a stockpile of greeting cards for various occasions and remembered birthdays. If someone needed me, I was generally there. I remember feeling so proud that when a friend who had a three-month-old baby needed to attend a conference at a resort two hours away from my home, I showed up to her hotel to provide nanny services so she could work during the event. I was often thanked and praised for being a great friend, although in the back of my head I knew that my time, money, flexibility, and good mental health were doing a lot of the work for me.

Fast-forward another decade to now, when it feels like every moment I’m awake is spent working, taking care of my kids, or conducting basic life functions, and I’m a C+ friend at best, constantly nagged by guilt over declining invitations to events (trips are out of the question) and often thinking of someone multiple times without making time for a call to catch-up. Birthdays seem to sneak up out of nowhere, and I’m no longer likely to be the one creating personalized party decorations for a loved one’s child. At no point in this timeline have my feelings about my friends or care for them changed. I’ve just had more and less to offer at different times.

All of that is to say that I approached this letter with an open mind to the possibility that there was an explanation between “Sage doesn’t care as much about us as I thought” or “Sage is self-absorbed.” I was ready to make an excuse for them not mirroring the support you showed when they were having medical emergencies. I was prepared to remind you that we’re all working with a different set of tools and resources. But!

I can’t get around the fact that they didn’t even send a follow-up text. The thing about modern technology is that no matter how busy a person is, at some point they are sitting on the toilet or setting their phone alarm before closing their eyes at night and can dash off a few lines. At some point they can choose to stop scrolling social media and communicate instead. Especially for a friend in a crisis. And if they’re not doing that, it does say something. Of course, we have to allow for the possibility that Sage suddenly sunk into a deep depression, and that everything in her life began to feel overwhelming. But barring that, there’s something else going on and you have to talk to her to figure out what it might be.

The explanation for her ghosting could be as simple as an incorrect assumption that you wouldn’t want to be bothered during a rough time and that check-ins would be annoying. It could be that the relationship pattern where you’re always the one who is caretaking and Sage is always the one who needs help is so entrenched that they couldn’t break out of it to check in on you. Very unlikely, but it could be that before or during the announcement of your daughter’s medical crisis, there was a misunderstanding or said something that offended them. You should find out before you downgrade the friendship. That starts with a message that says, “Things have been so hard since Lilly’s diagnosis. Do you have time to talk?”