Q: How are you?
A: Fine, thanks! And you?
Remember when it was that simple? Not so these days, especially since my encounter with cancer. Since then, a different set of brain synapses trigger when I hear that question. It actually sounds different now, and the days of mindless automatic answers are gone.
This came into focus for me when a friend recently asked me in an email, “How are you, Ron? Really.” The last word was a tipoff. She was not looking for a rote “fine, thank you” answer. It started me thinking about the many ways I could respond to that seemingly simple question.
Cancer or not, as we move through the decades of life, the implications of that perennial question become more complex. In the second half of life our answering options range from a simple “fine, thanks” to a full medical report. Our challenge is to pick the one that matches the intent of the questioner, providing just the information wanted—no more and no less.
An after-cancer guide
It’s a tricky proposition but fear not: you can use this blog post as a guide. Put a link in your smart phone. When you are hit with this challenging question you can hold up your index finger to buy an extra minute, click the link for this guide, and then confidently give precisely the kind of answer the asker was seeking.
First, we’ll outline four main types of answers. Then we’ll look at some common situations in which we must choose the appropriate reply to the big question …
How are you?
Answer Type #1 is the easy one: “Fine, thanks.” It provides no information whatsoever and might not even be true. Fine or not, it doesn’t really matter. The point in using this answer is merely to acknowledge that we heard the question. With a two-word answer, we send the message that we regarded the question as merely a salutation, and not really an information-seeking question at all. For convenience, let’s call this the EZ answer.
Answer Type #2 is a small step beyond EZ, so we’ll call it EZ+. It adds some nuance, but still doesn’t provide much insight. Rather than a bland, meaningless “fine,” we can choose from a list of short answers indicating a degree of wellness. Phrases like “absolutely great,” “pretty good,” “I’ve been better,” “getting along,” “not too bad,” “fair to middling,” and “good enough,” are common examples. EZ+ includes the ever-popular but overly optimistic “couldn’t be better,” and the needlessly glum “getting by,” both of which are generally far from the truth.
If you’re creative, you can use an EZ+ answer as an opportunity to exhibit some cleverness, or maybe to establish an identity. There’s Dave Ramsey‘s signature response, “better than I deserve.” A former employee of mine adopted “sunny side up” as his stock answer. You might already have your own favorite rejoinder. I know several people who regularly use “I’m still vertical,” so avoid that one if uniqueness matters to you.
Answer Type #3 is still brief, but it’s more informative. It provides a headline for the single specific item topping your health-news-of-the-day. CNN and Fox would call it “breaking news.” It’s mostly just a teaser, promising “details at 11.” Let’s call this one the T-ZER answer. T-ZERs open the door for the asker to request more information … or not.
Examples of the T-ZER include “I have a migraine,” “I stubbed my toe,” “my shoulder is killing me,” “better than before,” “my back is out of whack,” “my ear is barely whistling,” “I bruised my knee,” and “my tennis elbow’s acting up.” You can also allude to specific diagnostic tests, but without giving the details, as in “my PSA is steady,” “my scan looked okay,” and “my cholesterol’s up a bit.”
Answer Type #4 is full disclosure—all the health news worth reporting. Hardly anyone wants this, but when it’s warranted it’s important. It does not necessarily include specific lab results, but it must at least provide a clear indication of the significance of the underlying numbers. While still conversational, this type of answer is a reasonably complete Medical Disclosure, so we’ll call it the MD answer. As a happy coincidence, MD also stands for medical doctor— precisely the people most likely to want this level of detail.
A typical MD answer would be “Well, my PSA dropped again, my cholesterol is still fine, thyroid’s fine, but I do seem to run out of energy late in the day.” An even more specific version of this is “My PSA fell to 0.8, my total cholesterol is a solid 180, TSH is still barely normal, but every other day around 5:00 I run out of steam and sometimes get an early evening headache, probably from allergies.”
A compulsively thorough MD answer sounds like “My ears are ringing, my ocular floaters are distracting, I can’t breathe through my right nostril, I’m urinating pretty well and not too often, my PSA is steady at its nadir, my TSH is just under 4, my back aches, my sexual function is about what you’d expect for a man my age, and my bowel movements are stellar. And how are you?”
So with all these options – the EZ, EZ+, T-ZER, and MD answers – how do we choose? Through example, the following scenarios will help you respond appropriately each time you are confronted with another “how are you.”
You’re in line at Starbucks. A friend is right behind you. You don’t realize she’s there until you hear her call your name, immediately followed by the question at hand. “Hey, Ron! How are you?” This and similar chance encounters are clear-cut occasions for the EZ answer. No question about it. She’s not asking for your PSA.
One exception is hanging around the water cooler at the proton center. In that environment, a patient-to-patient greeting has a deeper implication.
One exception is hanging around the water cooler at the proton center. In that environment, a patient-to-patient greeting has a deeper implication. If you have begun to know the person reasonably well, use the EZ+ or T-ZER to show some warmth and to encourage more discussion. After all, wellness is the theme there, and it’s the reason you’re both hanging around.
You sit down at the table to dine with some friends. It could be at your home, theirs, or a restaurant. It might be one-on-one, couples, or a group. Wherever and whoever is included, someone will surely start the ball rolling with the time-tested ice-breaker, “How are you?”
Now, this is a little different than the coffee encounter. It is planned, and you have more time. You have made a commitment to spend one or more hours together, which indicates that your relationship is more intimate. These people are part of your life, and EZ won’t do.
… if you’re dining with fellow proton alumni or cancer patients, the T-ZER would allow a nice segue into some detailed health talk …
Depending on the nature of your history with them, you can respond with either the EZ+ answer or the T-ZER. The former can be sufficiently friendly and conversational, while still providing an easy exit from further health talk. But if you’re dining with fellow proton alumni or cancer patients, the T-ZER would allow a nice segue into some detailed health talk—possibly a full MD discussion. So only offer a T-ZER if you are willing to risk moving into some serious subject matter.
When you finally make it into the examination room one-on-one with your doctor, it’s MD answer time. In fact, you should prepare your answer in advance and possibly have notes. Lay it all out there and let ol’ doc sift through the detail.
If you have an ongoing, friendly relationship with your doctor, it’s fine to precede your MD answer with an upbeat EZ one. But then move along quickly, without pausing in between. You have your doctor’s attention at that moment, so make the most of it.
What about those greetings from folks we’ve never met? In any venue, how do we respond when greeted by a total stranger? Their question might be a variation of the standard one, but whether they ask “how’s it going,” “how’re you doing,” or simply “how are you,” our response to a stranger should be different. In this case, we must proceed with caution.
In general, it’s prudent to take it down a notch. Offering too much information too quickly is inappropriate at best, and at least a little weird. If the usual answer to a known person would be EZ+, a simple EZ will suffice. The stranger behind you in line at Starbucks wants no more than an EZ answer (unless the situation is one of the exceptions described below).
Likewise, dial down a T-ZER to an EZ+. And above all, never give a full-blown MD answer to a stranger, at least not right away. Start with any other response. Then size things up and see where it goes. A new nurse in a doctor’s office might eventually warrant the MD response, but probably not in the first few minutes. If you’re optimistic, toss out a T-ZER. Otherwise, you’re not obligated to serve up more than an EZ+.
There are special situations in which our underlying motivation influences our answer. Normal protocol as described above might not apply when we have an ulterior motive or a hidden agenda. We might then use our answer in a benign, but productively manipulative manner.
… you hear “hey, how’s it going,” you turn around, and the chemistry is instant. What then?
Let’s return to the stranger behind you at the coffee shop, bar, hotel lobby, grocery store, or airport. What if you’re solo and hoping to strike up a new friendship? If you hear “hey, how’s it going,” you turn around, and the chemistry is instant. What then? If you answer creatively, perhaps this unexpected encounter could become more. It’s definitely time to elevate your EZ answer to an impeccably delivered EZ+, followed immediately by a sincere “… and how about you?”
Conversations with support personnel are also special situations, whether online or in person. This includes a chat to solve a computer problem, an interaction with an airline rep about a canceled flight, and a request to a banker to reverse a late fee. In situations like these, your chance of success increases if you humanize the exchange. These people tolerate a lot of undeserved hostility and will quickly become your ally once they see you’re different. Your warm EZ+ answer to their scripted question, and a genuine expression of interest in how their day is going is your ticket to a pleasant and successful outcome.
As one final example of an endless variety of special situations, consider your work environment. When your boss asks “how are you,” it’s important for you to focus quickly. It’s a golden opportunity for posturing. Your answer should subtly convey that your boss’s well-being is far more important than yours. “I’m okay, thanks, but how’s your unimaginably difficult and stressful day going, and how can I help?” BOOM! Ten brownie points in ten seconds. Good move!
As cancer survivors, we all need a little sympathy now and then. For us, any “how are you” is an opportunity to play the wild card. Friend or stranger, coffee shop or doctor’s office, whoever and wherever—if we want some sympathy we can always get it. When we’re asked “how are you” all we need to say is, “Pretty well, other than keeping an eye on that cancer.”
It always works.
So may I ask, how are you? to send me your answer or comments.