Surviving "How Are You?"

Debbie commented on my last blog post: "This definitely reminds me of the question 'How are you?' and how tricky a question it can be. Thank you for helping me become a more sensitive friend."

It is I who should be thanking Debbie. Almost two decades ago, our discussions prompted me to write the following essay in an attempt to understand my problem with people asking "How are you?" It helped me. I hope you find it useful.

Surviving "How Are You?"

When I was first diagnosed with cancer, everyone asked me, "How are you?" As if troops were gathering to wage battle against my loneliness and fear, “How are you?" became a comforting codeword for "I'm on your side." 

But within a few weeks, the chemotherapy began to take its toll, the shock and novelty of being a patient wore off, and I came to dread being asked, "How are you?" This question undermined the distraction and healthy denial that minimized my distress.

If I answered truthfully, I had to absorb the hints of disappointment, anger, frustration, sadness, fear, and helplessness that splintered others' words of comfort. I found myself consoling those who asked and then fighting the contagion of grief and fear. Even when the news was good, I didn't have the energy to include all the people who wanted updates.

After my treatments ended and I returned to my solo practice of medicine, the prickles of "How are you?" sabotaged my attempts to move on. One day I spilled my frustration to my good friend, Debbie, "People keep probing! They don't say, 'How are you?' but 'How ARE you?'"

Debbie suggested that I was being oversensitive. "It's just an everyday greeting, Maybe they don't mean anything by it," she said gently. Not buying her argument, I explained how I'd answer, "Fine," and they'd double check, "Really?" their eyebrows raised and their chin dropped ever so slightly.

I told Debbie how, after a satisfying morning of seeing patients in my office, I went to a medical conference where one of my colleagues came over and asked the usual. Despite my enthusiastic, unequivocally positive response ("Great!"), he then asked, "Are you still in remission?"

He might as well have splashed ice water in my face. My privacy invaded, I was furious that he wasn't confident enough of my remission to trust my answer that all was well. No, it was not my imagination.  People weren't simply saying "Hi"; they were asking for my latest scan results.

No matter how it was intended, being asked "How are you?" rattled my heightened sense of vulnerability by virtue of its literal meaning and my sense of not knowing how I was. My desire to be polite often battled rising confusion and panic as I thought, "I'll find out when I have my check up." Sometimes I actually said this aloud to friends, and then felt embarrassed or guilty for sounding curt or unappreciative. I told my friend Debbie, "I wish they didn't ask."

Debbie took their side, "Wendy, your friends are asking because they care about you." She then listened patiently and tried to understand as I shared my struggle to find a "new normal" after cancer, one that included persistent fatigue and frequent doctor visits. I suggested she say, "How are things?" or "Good to see ya,” adding, "Don't walk on eggshells, Debbie. When, out of habit, 'How are you?' slips out (and it will), don't worry about it. I won't take your question literally unless I want to."

That offhand last comment led me to the key to surviving "How are you?"

When friends ask, I respond whatever way works for me, trusting that the person wants to "be there," whatever "be there" means that minute. With my answer, I share the truth about survival: Some days are good, some bad; sometimes I need to escape, sometimes I need to talk it all out; sometimes I need to be held, other times I need space, and I'm not always sure what I need (so they can't know, either.)

I'm learning to recognize when "How are you?" is meant as nothing more than "Hello." Occasionally I screw up and start to give a detailed or philosophical answer to someone who really doesn't care or doesn't want to hear. That's okay. And I forgive all the people who say the wrong things. I've said a lot of stupid things in my time. As for the rubberneckers, I tell them "I'm fine."
 
"How are you?" is not an intrusion, but the glue that holds Debbie and me together. Our initial responses, both verbal and nonverbal, telegraph if one or the other has news or problems or worries to share. We know within seconds if one is in need, even if that need can't be met at the time.

I was mistaken when I thought that I didn't know the answer. Although on any given day I may not know what my next scans will show, I do know how I am. Cancer tuned me in to my body and clarified my relationships and what's important in life. If anything, after cancer is when I started to really know how I was.

"How are you?" may never again have that innocent sound because I can't go back to the way I was before cancer. That's good. In letting others care for me, I've learned about caring for others, and I've learned about love.

Whether I'm anxiously awaiting a check up, undergoing another round of treatment or enjoying a blessedly ordinary day, Debbie and I will be friends, together. Her three little words -- How are you? -- stir emotions because they are powered by three other little words: I love you.

Comments

[Jan Baird Hasak]

Very powerful post. I used to resent that question, "How are you?", almost as if the person were asking "How are you, really?". But they are asking out of concern, and that is what we patients must remember. People don't always know what to say. I even find myself sometimes saying the "wrong" thing to a newly diagnosed patient, and then catch myself.

[mesa pediatrics]

Very inspirational! It seems like I come across these stories just when I need to hear them the most. Thanks!