I’m Good, I’m Alright, I’m Fine, I’m… Lying

“How are you?” It’s such a simple question. I’ve heard it asked thousands of times in my life. I’ve asked it thousands of times too. It’s a social custom to greet everyone from friends and family, to colleagues, to your dental hygienist with some version of this question. It never occurred to me how difficult this question is for some people to answer until the first time that I hesitated to provide one of my usual canned responses: “I’m well”; “I’m good”; “I’m fine”; “I’m alright”; “Good, thanks! How are you?” All of these replies tasted wrong in my mouth. The true answer, “not so good”, felt impolite.

Reflecting on this now, I think that a lot of people struggle with answering this question. Whether you are dealing with a chronic illness, as I am, battling depression, living through a global pandemic, or have run up against one of the many challenges that life has a tendency of serving up, this question can leave you at a loss for words.

I recently had an appointment with my endocrinologist. In addition to having Multiple Sclerosis, I also have Non-Classic Congenital Adrenal Hyperplasia (CAH), a rare genetic disease which causes improper hormone production by my adrenal glands. I see my endocrinologist every 6-12 months or so for ongoing monitoring of my CAH. This appointment was conducted over telephone, as we have been doing since the start of the COVID-19 pandemic. I answered the phone and heard my endocrinologist cheerfully say: “Hi Margaux, how have you been?” I started to say: “I’m doing well” but caught myself as the last word was coming out of my mouth and quickly corrected myself to tell her that “actually, I’m a lying liar who lies and I’m not doing well at all”. I went on to tell her that this has, without contest, been the worst year of my life (and yes, I’m including the year when I had all the miscarriages in that assessment). I filled her in on my MS diagnosis and the course of treatment that I had selected. This didn’t come as a big surprise to her, as my neuro-ophthalmologist had consulted her on prednisone dosing when I presented with optic neuritis. We were then able to move on to the happier news of my weight loss success and a discussion of my latest labs.

I had a similar experience with my dental hygienist. After having just told her that I was “good”, I then found myself spilling the beans that I had a new MS diagnosis when she asked the question “are you on any new medications since your last appointment?” Oh boy, am I ever on new medications. I felt pretty silly for having answered “good, thanks, how are you?” just moments prior.

During my most recent annual performance review, my manager called me over Teams and started the conversation with “How have you been?” I am pretty open with my manager, so responded with “you know, once upon a time that was an easy question to answer, but these days I either lie to be polite or answer honestly and bum everybody out”. We went on to have a really good discussion about life, work, and even MS.

I’m making a cognizant effort to be candid and honest with those closest to me. I still respond with some variety of “good, thanks” when a relative stranger asks this question, but I’ve been trying to be more open with those who I perceive to care about the actual answer.

What if you don’t want to start a conversation by asking what may be a loaded question for the recipient? What are the alternatives? I’ve been thinking about this a lot lately. Here’s what I’ve come up with so far:

·        What have you been up to lately?

·        Any plans for the weekend/summer/holidays/whatever event that is coming next?

·        What’s new?

·        What’s on your mind today?

·        It’s good to speak with you. It’s been a while. I hope that you and your family are doing well.

I’m still grappling with finding a new icebreaker for conversations, and I still have a habit of reaching for that old go to of “how are you?”, notwithstanding my newfound dislike of the question. Old habits die hard, but I am making an effort to change up my language to remove this unnecessary loaded question from my vocabulary.

What about in situations where you are genuinely interested in hearing about the other person’s physical, emotional, and psychological state? I think doctors and other healthcare providers should consider being more direct. “How are you?” encourages the lie “I’m fine, how are you?” They not only want the real answer but need the real answer to effectively do their jobs. I think a direct approach also works for those seeking a genuine answer in other contexts, including friends and family. Here’s what I’ve come up with so far:

·        How have you been feeling lately?

·        You have been on my mind! How are things in your world?

·        How are you holding up?

I have come to believe that one of the kindest gestures that we can extend to other people is to make it clear that they don’t have to pretend that they are fine for our benefit. Emily Post be damned.