Answering “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 fear and loneliness‚ “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‚ 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 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?” “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.” I told my friend Debbie‚ “I wish they didn’t ask.”

Debbie took their side‚ “Wendy‚ they 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 can respond whatever way works for me‚ trusting that the person wants to “be there‚” whatever “be there” means that minute.

With my answer‚ I can 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 OK. 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. And‚ 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 who and what are 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. Whether I’m anxiously awaiting a check-up‚ or undergoing another round of treatment‚ or enjoying a blessedly ordinary day‚ Debbie’s three little words‚ “How are you?” stir emotions because they are powered by three other little words: I love you.

[I wrote this many years ago. Ever since, I’ve had no trouble with the “How-are-you” question. This supports the idea that sharing and working through something in my head — or with someone who cares — makes a difference, even when the circumstances remain the same.]

Surviving “How are You?”

One unexpected challenge of my early survivorship was the question “How are you?”  In particular, I didn’t want people asking me that all the time when I was with my children, because it focused everyone’s attention on my illness.

On the rough days I could have lied and said “Fine, thanks.” And sometimes I did. But lies and half-truths make me uncomfortable. So I asked my friends to just say “Hi” as they do for everyone else and to please NOT ask “How ARE you?”

I explained why, too, saying, “We talk about cancer enough already. My children need windows of time when cancer is not part of the picture, especially at school and after-school activities.

I acknowledged the difficulty my request may pose for people who want — even need — to express empathy. “Your concern touches my heart. ”

I offered an alternative to asking in front of my children. “You can always email, write or call me when I’m not with the kids for cancer talk.”

And I thanked them. “Thank you for understanding and respecting what helps me deal with this.”

Lastly, I couldn’t worry about what they thought of my approach. I had to do what I felt was right for my children. If their reaction caused me some self-doubt, I’d touch base with a voice of reason (such as the oncology social worker or my oncology nurse) to make sure my approach was justifiable and sound.

Mothering through cancer for me entailed doing what was best for my family, even when it might be uncomfortable or offensive to others.

Hello, again, from mommydoctor

Hi. I call myself “mommydoctor” because when my middle child was three years old or so she said something about her pediatrician being a “DD.” When I looked confused, she pointed to the initials after my name on my white coat and explained, “Well, you are a ‘MD’ — MommyDoctor — and he is a DD — DaddyDoctor.” 

Right.

The twin challenges of cancer survivorship and motherhood are nothing new to me. When I was first diagnosed with non-Hodgkin’s lymphoma in 1990, my children were 1, 3 and 5 years old. I’ve been in and out of treatment ever since.

Right now my cancer is in remission, and my children are happy, healthy young adults. 

None of it has been easy, but a lot of good has come out of an unwanted and unwelcome situation. I’ve learned a lot through my successes and many mistakes.

At the time of my diagnosis, I had a busy solo practice of internal medicine. Ongoing illness forced me to close my medical practice and then leave clinical medicine. So I’ve been writing and speaking about all aspects of survivorship, advocating for patients everywhere I go. 

A topic most dear to my heart is rearing healthy children when a parent has cancer. I’ve written When a Parent has Cancer as well as two children’s books – Becky and the Worry Cup and The Hope Tree (co-authored with Laura Numeroff).

Underlying all of my blog posts, lectures, articles and books about parenting is one theme: The greatest gift we can give our children is not protection from the world, but the confidence and tools to cope and grow with all that life has to offer.

I hope to offer whatever insights or advice I can from the perspective of a mom who has been there and is now a happy empty-nester.

With hope, Wendy