When "How Are You?" is a Trick Question

When people ask each other how they are there are only a few categories of answers that fit sufficiently into the socially accepted norm well enough to leave the questioner feeling as though the social contract has been satisfactorily fulfilled. The categories, from what I can tell, are these:

1. Fine, thank you. You?
2. Fantastic! (usually this person works in sales)
3. Pretty good, but (insert modifier common to mankind, such as fatigue, which can lead to further conversation of the commiserating and weakly bonding sort).
4. (Sharing current, actual, dramatic news, such as an auto accident).

Anybody stepping outside the bounds of these categories risks being shown an odd facial expression. Horrors! And yet in our busy lives when so much of our human interaction consists of little more than the polite question and the categorically correct answer it can easily come to pass that most of the people we interact with have no idea what is actually going on with us.

These days when people ask me how I am I have a disconcerting tendency to answer in a way that does not fit with one of the accepted categories. I have different categories, which depend on when the last time was that I was at the doctor and what the latest test result was. My categories are:

a. Fine! I think.

b. (gazing off into space with an odd expression) How are you?

c. (vague, undifferentiated arm waving) I should know more next week.

d. (dramatic shrug and strangled laugh) (description of some new symptom)

As you can imagine, I get a lot of odd looks in response, if not outright fleeing. But the problem is, I have cancer and a damaged heart, and “fine” is not really an honest answer. Oh sure, we all lie to each other all the time. But if I just go around lying then I create two problems. First, the caring people don’t really like to be lied to. They want to know what’s up. And second, life is a very lonely experience when nobody has the slightest idea what your life is like.

These are the facts of my health, which I am going to say succinctly to get it all over with. I promise not to turn into the whining old auntie who nobody wants to visit, and go into a long list of complaints, but there are a lot of people who don’t know what happened and who would like to know and perhaps even feel bad that I didn’t tell them, as though I didn’t care enough about them to tell them.

Several years ago during a routine physical my doctor found a lump on my thyroid gland which was tested and found to be cancerous (http://www.endocrineweb.com/capap.html). There were no symptoms. It is unknown what caused it. The gland was removed and I was given radiation treatment. A year later I was scanned and more cancer was discovered in my neck. I was given a huge amount of radiation. During the second treatment a whole bunch of damage was done to various other parts of me, much of which is under control, but the worst part was that my heart was severely damaged (https://health.google.com/health/ref/Dilated+cardiomyopathy). When this was diagnosed it was functioning at 7% (ejection fraction).

Fast forward through all sorts of weird stuff like losing all sense of taste for a while, damaged salivary and tear glands, new allergies, etc. (kicking each other under the table – sorry Auntie but we have to go, and um, walk the cat) My current status is that I am continually being monitored for thyroid cancer, and I have a heart that is a “mass of scar tissue” in the words of my cardiologist. I generally feel pretty good except my stamina is poor. I go for 3-4 mile walks to try to stay as fit as possible. I am unable to go to high altitudes because I can’t breathe well enough if the air is thin. Goodbye, mountains!

This is what it’s like living with cancer: last spring I had just gotten adjusted to the fact that I can’t go into the mountains anymore because of my heart, and had put the cancer out of my mind, when I went to a routine appointment with the cancer doctor. He found a lump on my neck at the site of the previous cancer. I then spent the entire summer having test after test trying to figure out what that lump is. Some of the tests seemed to indicate it was just a normal lymph node, and some tests were inconclusive. I never felt like I could make any plans because I didn’t know if some test was going to come back positive for cancer and I was going to have to have surgery, radiation, and all that again. The lump is still there but the latest test indicates it is almost certainly just a lymph node. So all summer it was present in my mind: did my cancer come back? Am I okay? I ran this train of thought past my internist because I don’t want to be paranoid. I said, is every swollen lymph node, every cough, every mysterious pain going to make doctors test me every which way for cancer again? Can’t I ever just relax about this? And he said, that’s just how it is when you have cancer.

This is what it’s like living with heart disease: you go to a doctor for anything, anything at all, and all they want to talk about is your heart. They spend a lot of time with the stethoscope. You’re like, hey, I sprained my ankle, or I cut my finger, and they’re listening to your heart.

The two biggest killers of women in the US are cancer and heart disease and I have them both, and neither of them was because I didn’t eat right or exercise enough or any of those things everyone is trying to do to increase longevity. But just watch, I will probably die from something completely different. That will make the best story!