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The Loaded Question of “How are you?”

Having cancer means more medical advice than most of us know what to do with, but when it comes to advice about the day-to-day business of living with cancer, there aren’t a ton of practical resources. Ask Emily Alford, a breast cancer survivor who’s been there and back.

Everyone is trying to be kind to me right now, but friends and coworkers keep asking me “how are you” and I have no idea how to answer that because I feel like garbage. What should I say? —Callie L., Savannah, GA

Oof, I feel you. I got this question all the time when I was going through breast cancer treatments, and it consistently threw me for a loop. It’s really strange how so many “normal” things become weighted with meaning after a cancer diagnosis, isn’t it? Ordering takeout used to be such a simple act, but now it’s… complex. And answering a question that you used to answer unthinkingly—”busy!” “great!” “so good!”—stops being mundane and becomes, well, incredibly fraught in light of your new reality. Callie, you don’t say exactly what you’re concerned about in regards to the question, but from my own experience as a breast cancer survivor, I suspect there might be a couple of different issues at play here.

For most people, there’s usually only one correct answer to the question, regardless of how a person is actually feeling, and that answer is, “Fine.” The problem with “Fine” for many battling cancer is that one is obviously, visibly ill. Well-meaning loved ones, co-workers, and even observant strangers can see that illness and want to make sure that they express appropriate levels of concern, which is nice! However, there’s such a thing as “How are you?” overload when one has cancer, with the question rolling in from all sides—via text, in person, on phone calls, work meetings, at the doctor’s office. It can feel overwhelming to keep being asked how one is, feeling like garbage, and then offering the standard “Fine” when it is very obviously a lie.

The good news is that outside medical professionals, you owe no one a play-by-play of your ups and downs (especially the downs). If you’re feeling exhausted by the question, “I’m okay” is a perfectly acceptable answer. One alternative that I found pretty effective: when I was going through the aftermath of my bilateral mastectomy and chemotherapy, I had a sort of adorably macabre image of a newborn chicken saved to my phone’s camera roll and responded to the three or four “How are you feeling?” messages I got each day with the chicken picture and copied and pasted a message that said something like “I am gross tiny chicken. Gross tiny chicken is me.” The response pretty much always shifted the conversation in a direction that was not me having to list my complaints yet again. 

Of course, there might be another reason you are asking for advice on how to answer the question. After a while, it can begin to feel burdensome to have no positive change in your response to “How are you?” The messaging around cancer, especially breast cancer, is aggressively positive. Picture pink banners and grinning people in headscarves with bold text reading “Breast cancer can’t take my smile!” But the reality is that cancer hurts. The treatment, the grief, the fear—it all hurts for much longer than many people realize, and not wanting to continue telling people without cancer that you are in pain, or still tired or still sick for a prolonged period of time for fear that they will write you off as a downer—is completely understandable. 

I hope you are feeling emotionally okay, in spite of your illness. And even (or especially) if you’re not, I hope you have a place to be free and honest about whatever your experience is right now. Because though everything about cancer is unfair, the pressure to stay positive is specifically, though usually not intentionally, cruel. If you’re asking how you should respond to the question “How are you?” because you feel you’ve been too sick for too long to satisfy the well-meaning but clueless people who might seem to be waiting for a new answer, I’d encourage you to find a group of people with a similar experience to yours. Find support groups online and even on social media, since meeting in person isn’t advisable right now—they can really provide a safe space full of people for whom cancer is also a reality and who are more likely to understand an honest answer to the question of how you really are. 

Take care of yourself,

Emily

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