People ask "How are you?" all the time. It's the default greeting. Nobody really expects you to say how you actually are. They expect: "Fine, thanks." And you give them that because we're all too busy for the real answer.
But when you have cancer, "How are you?" becomes this minefield. Because the honest answer is complicated, and you're never quite sure what people are asking.
The Question Is Ambiguous
Are they asking:
- How's your cancer situation (in medical terms)?
- How are the treatment side effects today?
- Can you physically get out of bed?
- Are you emotionally holding it together?
- Did you remember to shower?
- All of the above?
These are wildly different answers on any given day. You might be physically exhausted but emotionally fine. You might look great (because your hair grew back) but feel absolutely shit (because the nausea is relentless). You might have good test results and terrible energy levels. You might be bouncing with nervous excitement about a new treatment protocol and completely unable to focus on work.
The question tries to collapse all of that into a single dimension, and it doesn't fit.
The "You Look Well" Paradox
Here's the most frustrating part: people tell me I look well. And I do. I'm not skeletal. I've got hair (mostly). I'm not visibly dying in the street.
But looking well and feeling well are absolutely not the same thing. I can look well and feel like I'm moving through molasses. I can look well and be genuinely terrified about upcoming scans. I can look well and be unable to sleep because the steroids are messing with my brain.
And the "you look well" comment, while well-intentioned, can feel weirdly dismissive. Like because I'm not visibly failing, the cancer can't possibly be that bad. Like my invisibility is somehow a referendum on my experience.
Percentage Days
I've started describing days as percentages. "I'm about 60% today." Meaning: I'm at 60% capacity. Could do some things. Couldn't do others. The percentage accounts for physical exhaustion, mental clarity, emotional resilience, and the sheer will required to pretend everything is normal.
Some days are 30%. I can basically sit on the sofa and exist. Some days are 90%. I can work, I can think, I can parent with something approaching normalcy. Most days are 50-70%.
People seem to get that better than "how are you?" Because it's specific and relative and honest without requiring a conversation.
The Timing Problem
There's also the sheer logistics of it. Sometimes people ask how you are, and you actually need to tell them, but you just don't have the energy for the explanation. Not because you don't trust them, but because explaining your medical situation takes spoons, and on bad days you don't have any.
I've stopped apologising for not replying to messages. Sometimes I see a "how are you?" and I just can't respond. It's not rude. It's honest. My capacity for communication is limited, and sometimes I have to save it for the people I live with.
Flipping the Question
I've started asking myself a different question most mornings: "How shit do I feel today?"
Because framing it negatively is weirdly more honest. It gives permission for the answer to be "very shit" without it feeling like I'm failing at some invisible wellness standard. It's the opposite of toxic positivity. It's just: okay, baseline assessment of how much I'm struggling today.
And on days when the answer is "not very shit at all," that becomes genuinely good news.
What Would Help
If you're asking someone with cancer how they are, here's what actually works:
- Be specific. "How's the nausea?" or "How's work going?" or "Have you slept?" These are answerable.
- Don't expect a cheerful answer. If they say "shit," believe them. Don't try to reframe it.
- Don't comment on how they look. Or if you do, don't use it as evidence they're fine.
- Accept short answers. "I'm 45% today" is a complete answer.
- Don't take it personally if they don't reply. It's not about you. It's about their capacity.
And maybe just: stop asking "how are you?" and ask something that actually has a real answer.