By Wendy Harpham‚ MD

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.

Dr. Wendy Harpham was diagnosed with non–Hodgkin’s lymphoma in late 1990. She has since had five recurrences of her cancer. Next month she celebrates 12 years of survivorship and four years of remission.

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