Many people are unaware of how difficult it is to answer social greetings when one is in crisis. They ask “how are you” mechanically, without thinking. I’ve done that in the past. Before my experience of cancer painfully opened my eyes to the stress of social greetings. I suddenly became one of many struggling everyday to respond to “how are you”. I wrote this post to share my experience, and bring light to this unsettling gap.

Before cancer I didn’t think twice about answering “how are you”. I replied “fine” most of the time, often adding a smile. But now as a cancer patient, hearing “how are you” generates panic inside me. I can feel my belly tighten. My chest contract. My autonomous nervous system getting ready for danger. How am I going to answer this question?!

Here is an episode to illustrate. I was at the cancer center checking in for a follow up appointment, and the receptionist asked, “how are you” and paused. All of a sudden, I felt my body freeze. The first thought that popped into my head was: Shouldn’t he know that he works in an Oncology Department, and that this isn’t an easy question for cancer patients?! Instead I answered “fine”, to keep things simple. No point on lashing out on the poor man. My body, however, wasn’t satisfied with my response. And it made a point of letting me know. I felt a twinge inside my belly. And a protesting voice that said, “I’m not fine!”

While “fine” worked well for a while, after many months of living with cancer, my body is getting tired of lies. (Or is it me becoming more mindful?) Either way, it’s time to find an answer that does not make me feel disconnected from my body.

I tried different responses with various levels of success. Here is another exchange, which also occurred at the hospital. That was week three of a monthlong-daily-radiation-marathon. I ran into one of the administrators I had met the week prior. He recognized me and said, “how are you?” with a grim. That day I was definitely not fine. I was feeling cranky and depleted from the cumulative effects of treatment. The conversation went something like this:

  • Him: “How are you?”
  • Me: (Panicked). “Hmm, I am not sure how to answer this question as a cancer patient.”
  • Him: “How are you besides cancer?”
  • Me: (Feeling an irritated thought arise). How I am besides cancer??! You moron. I’m undergoing daily radiation in your department. You should know better!!! Instead I replied calmly, “well, cancer is taking over my life right now, so I am not sure how to answer your question.”
  • Him: “Oh I know exactly how you feel! I broke my elbow once and was miserable for an entire year!”
  • Me: (Stunned). Ouch, that made it worse. “Well, I’d better get to my appointment”, I said, and walked away.

The exchange made me feel like I had been stabbed. I shared it with a psychologist, and she pointed out that people often use “how are you” as a greeting rather than a question. Therefore I do not have to reply literally. “Answer with a greeting”, she advised. “I use ‘good morning’ when I am in this situation”. Well that may work for her. But it didn’t work for me. The next day I was on the phone with my health insurance. The agent greeted me with “how are you”, and I replied “good morning” hoping she would move on. Instead she paused and asked, “but how are you?” Well this time it was clearly a question. I replied that I was a cancer patient currently undergoing treatment, and that I was not having a good day. To which she launched into a tirade of unsolicited cancer advice. (God spare me!) It’s hard enough to be ill without having to hear such lectures everyday from people who neither have medical credentials nor cancer experience.

Mindful Coping Strategies

Below are strategies that helped me navigate the pain of social interactions during my cancer journey. Rather than closing up when I hear “how are you”, they’ve helped me stay open, and engage in conversations I used to shy away from.

1. Use an unexpected word. A response that works well for me these days is “frazzled”. This word came to me in the middle of the night. I tried it subsequently, and found it worked with both friends and strangers. For people who don’t want to know, or don’t have time to listen, it passes the acceptability test. On the other hand for friends who want to know, and have time to listen, it gives them an easy opening to ask “what do you mean by frazzled?” (It’s a singular response). Then I can explain that it’s a strategy that enables me to answer “how are you” with honesty, while paving the way to a genuine conversation. I like the the peculiarity of world frazzled. It’s different, vague, and descriptive at the same time. And it pretty much describes how I feel when I hear “how are you”!

2. Reframe the question. Take control of the situation and lead it to where it suits you. “It would be easier for me to answer ‘how are you today?'”, I venture to say, “I find it less overwhelming”. Reframing the question gives me an opportunity to reply: “Today I am feeling ____ “.  Adding “today” or “in this moment” normalizes the situation for me. It’s not as big of a question to answer. It also prompts me to connect to the present moment. And in some moments, I actually feel fine. Savoring the good goes a long way towards healing one’s body. (But don’t go assuming that I’m happily sailing through cancer, because it aint definitely easy!)

3 . Radical honesty. Share with others that “how are you” is a hard question to answer as a cancer patient. My personal experience has shown me that this strategy is only beneficial in a small number of cases. With trusted people who have the time to listen, and the skills to hold pain. Otherwise it can be painful, as the above examples illustrated.

I hope that sharing my below-the-surface-experience will be useful to some of you. Perhaps it prompted you to reflect on your own experience or to the deeper meaning of social greetings. Thank you for reading. I look forward to reading and responding to your comments.

Thank you for sharing this post with others.

24 thoughts on “Why Responding to ‘How Are You’ is Hard as a Cancer Patient

  1. Navigating the world of interactions and relationships can be enormously challenging. Sylvie, you shared this so vividly and bravely. I found the post not only a deep inner inquiry about how one is living with cancer but also an insightful investigation into what would be truly meaningful. I hope this can be an invitation for many patients, healthcare professionals, caregivers, friends, and families, or even strangers to reflect on how to be with people in crisis. Thank you for sharing, Sylvie!

  2. Thank you Ying for your comment, and for noting my bravery in sharing with openness. (It wasn’t easy). I do hope this post will be useful to others, and reach people across roles and boundaries.

  3. You captured this challenge so adeptly. It’s hard when people are tying to be courteous or caring, but the “normal” categories of how to answer this ubiquitous question don’t fit. I think “frazzled” is a great word and response. I also love your very honest response of, “I’m not sure how to answer that question right now,” or something to the effect of, “It’s hard for me to say.” I’m reminded of a dear friend whose child died at a young age. She has two living daughters. Whenever people asked her, “How many kids do you have?” (a seemingly innocuous question), it triggered a reaction of panic and un-ease in her. She experimented with telling people that she had three children and one died (then had to deal with whatever reactions they had to that), or that she had two daughters and leaving it at that…ultimately she landed on the approach of deciding in each moment how much she wanted to divulge with the person who asks, given the specific context. We all have to find our “answer” to this type of question–when we are going through something incredibly difficult and we encounter people who don’t know or don’t realize the magnitude of what we’re dealing with…I respect your commitment to being honest and authentic in your experience. It is a form of self-love to check in and ask ourselves, first and foremost, “How am I, really? How am I today?” The extent to which we answer that for others is up to us…and often dependent on our energy levels, sleep, physical and cognitive bandwidth, and spiritual condition in any given moment.

    1. Thank you Ali for your comment, and for sharing your friend’s experience. I was hoping that my post would reach beyond illness, and across other life situations. I imagine that at some times in our lives, when the going gets tough, social greetings have caused (or will cause) tension for all of us. I appreciate your sharing your friends’ (heartbreaking) example of loss.

  4. Hello Sylvie (and Ying!), I haven’t been able to make it to the meetings yet (trying to stabilize chronic pain) but DO hope to meet you one of these months! Thank you for your deeply-felt writing. I have lost family and my dearly beloved soul-sister to that hideous disease and am in total awe of all living with it. It takes phenomenal courage. !!! BTW, sometimes now I answer that question with “I haven’t the faintest (bleeping bleep, which I keep to myself) idea, how are you?” Working on equanimity! With light and lovingkindness (and awe!), Vickie Thompson

    1. Thank you Vickie for your comment and kind words. “I have no clue” is something I haven’t tried. I like the humor in it. Although it goes against my aspiration to be mindful ;-)

  5. I sort of like ”At this moment,…” Fill in the blank depending on who you are talking to, how much you wish to share a complicated response, and what role they play in your life. “Fine” might not be an appropriate response to an oncology professional, for example, but perhaps “better than yesterday (or last week, month, etc.) could possibly work.
    BTW, I don’t have cancer but credit some of the people from our group who have shared this kind of thing over the years. I am very sorry to hear of your struggle, although I don’t think we have ever met.

  6. Hi Sylvie,
    I read your article with interest. I am very sure that you speak for a lot, a lot of people.
    What sense is that for cancer patients the whole spirit can feel under assault by the threat of the illness. So, no the body does not feel fine, and neither the mind. People are so accustomed to having their bodies and minds feeling mostly suffering-free, so they are conditioned to expect a “fine” or “great” from a cancer patient as an answer to the question of “How are you?”
    I am social worker at Kaiser hospital so when I ask “How are you?” I expect patients to tell me about their problems and struggles. I don’t expect a “fine”, but who knows how my patients hear my question.
    I think you are bringing up a bigger point to everyone which is how much do we really care about each other’s real feelings and how much do we think we can handle. The truth is that no one is truly “fine” or “great”, but may be we all want to appear to be so and we live under the assumption that no one can really handle the truth about the misery of life.
    So your article is like a waking bell for everybody to wake up and stop pretending that everybody is fine. Then, cancer patients will never have to feel they are obligated to say “fine” but just the opposite be encouraged to share their real state of being.
    I think the world would be better that way.
    Thanks for writing your blog.
    Brandon Nguyen

  7. Thank you Brandon for your thoughtful comment. It’s nice to meet you. I am humbled by what you wrote: “your article is like a waking bell to wake up and stop pretending that everybody is fine”. I never fully realized how much I was pretending that I was fine, until I got cancer. If my experience of cancer and the sincerity of my writing can be of benefit to others… it would be a dream.

  8. Thank you for your very thoughtful insights. Asking “How are you?” is so automatic for me when greeting someone that I’m aware that I feel like I’m leaving something out when I don’t ask it. Time for me to come up with something different perhaps. Recently when I asked of a fellow member of our support group how he was, he responded that answering that question would involve either stating a brief lie or a very long honest answer.
    I remember when someone asked me how many sibling I grew up with, I always would say that I was the second of 6 kids, but when people pried further, to find out how many boys vs. girls there are now, they would ask why the math didn’t add up and I would have to share that my older sister died in a car accident when I was 18. Frequently I wouldn’t have wanted to share that, but the situation required it. I guess these challenges are a way for us to grow if we are ready for them.
    And I think “frazzled” is a perfect way to answer the question “How are you?”

  9. Thank you, Sylvie, for sharing your lived experience. I find you openly and honestly sharing how it feels to hear this question and what you would prefer to hear instead. This understanding empowers me to be more considerate. I also agree with what Brandon said above, as a psychologist I expect people to answer honestly when I ask “how are you” and yet I still have people playing into the social script of saying “fine” or “good” only to then open up about their pain. It is brave to challenge this social conditioning. It was also jarring for me as an immigrant from the Ukraine to adjust to the American culture of small talk, smiling, and overall pretending to be okay when we are all human beings with real human feelings. It creates a social pressure to pretend to be what you are not and disconnects us from each other, and also sucks all the sincerity out of “how are you”.

    1. Thank you Regina for your comment. I am not afraid to answer “how are you” to people have the skills, desire, and time to hold the pain of others. I welcome those rare moments. They only occurs 1% of the time though. This article is about the other 99%.

  10. Dear Sylvie,
    By tackling this topic openly, you embrace one of your coping suggestions! Radical honesty. Over the years, building relationships and navigating the social norm or script mentioned above, I have become aware that radical honesty is needed and welcomed. It is hard but critical to being human and bonding.
    Pausing and allowing space for silence might also help decide which of the coping strategies to use.
    Thanks for focusing my awareness on the challenges of social greeting.

  11. Sylvie you are by far one of the bravest persons I know, this is such an incredible perspective to share. Many people praise themselves thinking they are “empathetic” but they are not. It requires a certain type of courage to let ourselves feel the pain of others. Thank you so much for sharing this article!

  12. Hi Sylvie,
    This is a great conversation! Thank you, once again, so much for writing about your personal experience with such honesty. Have you seen the Cleveland Clinic video on empathy? It’s really nicely done. I teach communication to medical students and talk to them about “how are you” being a social nicety. Context and relevance are so important in learning. Your beautiful sharing on why this isn’t a helpful question gives voice to the relevance and provides deeply meaningful context (I’ll speak to the students in general terms and won’t share anything personal so no worries about your privacy). I’ve gotta say that the administrator you talk about was really a bone head and should have known better. Their interaction with you speaks to the importance of empathy training for people involved in healthcare. Your suggestion about asking “how are you today” really resonated with me. In my opinion there’s a moral and ethical component to this question, especially in healthcare, that makes it important to actually care what the answer is. People tend to think they know what it’s like to be in someone else’s shoes however we never really know until we find out what the other person is actually experiencing and that takes caring and curiosity. You are one brave and eloquent person and your writing is a gift.

  13. Hi Sylvie, Porfirio spoke highly of you and shared your blog with me. Your post touches many interesting points about social interaction. While reading, I couldn’t stop thinking about all the times I would rather use ‘fine’ as a barrier not to let others in. Perhaps there are certain topics I would rather not share with others and avoid getting into genuine conversations. Nevertheless, if the “how are you” question is asked by someone dear to me, I may use the same ‘fine’ but show body language to give a cue I’m willing to open up if asked for details. Philosopher Ludwig Wittgenstein wrote about language games, stating that words themselves don’t precisely have a meaning, it’s their use in these language games what defines them. So, perhaps people not close to us are using a greetings language game with no other interest than saying hello, while you’re trying to engage in a meaningful genuine conversation game. In summary, I agree with the psychologist that people are using a different meaning of ‘how are you’, but I thank you for underlining that a greetings language game can be hurtful if we don’t consider what others are going through. Thanks a lot for sharing.

    1. Nice to meet you, Ezequiel. Thank you for adding a new perspective. I think that as human beings we are not rational. It is all the more true when we are in crisis. Neuroscientist Antonio Damasio refers to human beings as “feeling machines that think”, as opposed to “thinking machines”. I like that. As a cancer patient, it rings particularly true.

  14. Thank you for these observations Sylvie. “Casual Greetings” says it all. In lives sometimes filled with casualties more than greetings, the casual (in words or “likes”) becomes for many a sort of reminder that somehow most of us do care about others even if we do not know them or do not know how to care for them. “Thanks for asking, and you?” may often complete the greetings formalities.
    We say “hello” as we may say more, but Sylvie, this also echoes the feelings felt when engaging our friends who go through difficult times. As we grow older more of us encounter challenging situations while missing the appropriate words. Cancer is one those afflictions that directly or indirectly affects all of us. When one can only imagine what the other feels there is a sense of powerlessness that leaves friends floating between caring, compassion and prayers, and especially the wish that all can return to a more casual way of life.

    1. Erik: your suggestion “thanks for asking; and you?” is a great response I hadn’t thought about. Thank you; I will definitely use it! I like the fact that it acknowledges the positive intention of the “greeter”, while offering a way out for the person in crisis, or a way to postpone answering the question to a more opportune time. As for “casual”, nothing wrong with that. I changed the title to “social greetings”. Thanks for the remark.

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