I'm sure the majority of people with chronic illness, whether invisible or not, have faced the confusion of how to best answer the "how are you" question on a regular basis. Whether you are at home, work, hospital, store, etc this question is all too familiar. I know that most people ask out of habit, as it's natural to say these three words when greeting someone. Most people are accustomed to replying with an "okay", "fine", "good", or some other simple response. I am guilty of answering in that fashion often, especially around strangers that I don't know. However, like many, I am not always speaking the absolute truth, just trying to be polite.

​It's easy when the person that you are speaking to is not familiar with you or your health and it's not imperative for them to know the truth, then quickly saying "fine" and moving on is alright. But what if it's a family member, friend, medical professional, colleague, or someone else that knows you personally? How do you answer the question then, especially on days when you really don't feel fine or when being falsely positive can be a hindrance in your care or best interests? 

Below are a few recent scenarios that have made answering the ordinary "how are you" complicated for me to answer. ​​

• Intense pain - I have become somewhat accustomed to feeling below par, varying degrees of constant nausea, and nagging levels of low-moderate level pain. However, the past few weeks I've been needing my heating pad continuously for higher than normal abdominal pain. There have been numerous nights, recently, when my body required me to sit or recline in my recliner with my heating pad on hi and a vomit bag nearby. The night before last, we were actually questioning if calling for an ambulance or an emergency room visit was necessary. (I've lived through a lot of severe pain experiences, but we've only broken down and called for EMS once.) My hesitation to reach out for emergent care is partly due to my lack of trust for the local ER. I don't know the cause of the pain that I was struggling with. It literally came out of no where and was extremely severe, easily a level 9 at onset. I was sitting on the couch watching Family Feud with my family, when all of the sudden my upper left abdomen had what felt like a Charley Horse spasm. But unlike normal muscle spasms it remained in spasm mode for a couple of hours straight. I was unable to move in any direction, couldn't sit up straight or stand up, and was in tears while trying to take short shallow breaths because breathing and position changes intensified the pain much more. All I could do was focus on my breaths, hold a heating pad as tightly as possible to my abdomen, and try to deal with the pain until it started decreasing. As time continued, my pain did not let up. It continued to be constantly sharp and began radiating to my side and back. None of our attempts for pain control were working. I remained at a level 8-9 for what seemed like hours at end. The pain can best be described as being comparable to labor (without breaks between contractions) or the ileus I had in the hospital after having my colectomy. Even sitting still was very difficult, and trying to talk only intensified my pain even more. My kids were very concerned and worried about me, scared because they didn't know what to do, not wanting me to end up going to the hospital, wanting me to feel better. When they frequently asked "How are you?" I hesitated before answering: "I'll be okay" and "I'll be fine". I think it worked to begin with, as they've witnessed many painful days before. However, after awhile they weren't so sure if they believed me anymore (Heck, I began doubting my own words as I said them) as this piercing pain was much different and more severe from the norm. Our oldest daughter tried to talk me into letting her take me to the ER, however, I had no idea how I could make it up out of my chair (yes the pain was still that severe), and knew the ride and wait would be unbearable in their hard uncomfortable chair. I convinced her that there wouldn't be much that they could do anyway, but if the pain increased any further or continued for another 30 minutes without any relief, that I'd seek medical help promptly. Thankfully, the pain did eventually begin to slowly decrease in intensity, avoiding the ER this time, with lingering but more tolerable pain afterwards. I admit that this situation could have been handled differently. I was not thinking clearly, possibly putting my health at risks, which I firmly suggest that no-one else doing. All I could think of at the time was how to make the heat numb the pain more, how to make sure that I kept calm with my breathing, and surviving 1 minute at a time. In this example, my response to "how are you" was complicated because I was fearful and in some of the most severe and extreme pain that I've ever been in at home. My response was to tell my kids what they wanted to hear, and I wanted to be true, so they would remain calm. I didn't want them to see the reality of my pain or cause them to worry about me. I just wanted the pain to end. Mentally, I was okay, I just had to keep holding on until I could feel decently okay physically.


• Hospital and Medical Appointments always seem to make the "how are you" question tricky to answer, simply because I don't want to give anyone the wrong impression. If I say that I'm alright, then why would I be at the doctor in the first place? If I don't say I'm okay, will they think that I'm having a difficult time coping? I want and need them to understand my symptoms so that they can help me, but don't want to come off as an emotional complainer. More often than not, I try to answer it with an "I don't know" or "I'm hanging in there." I am well aware that these answers are vague, but hope that the remainder of the appointment will lead to more clarity. 


• A family friend or family member will sometimes ask me "how are you". Knowing that my immediate family understands my situation for the most part, I will often tell them the truth, unless it's a really bad day. In that case, I often try to change the subject or downplay it to prevent worrying them. However, when it comes to a family friend or family member that knows I've been sick but may not understand the impact that it's had on my life, it becomes troubling. Do I say "fine" and walk away, leaving them with the wrong message, or do I try to elaborate?  The other day I was with my dad at the store when we ran across a family friend. Of course the initial pleasantries were exchanged and the dreaded "How are you?" was sent my direction. I hesitated at the moment, but decided that I would take the easy way out with an "okay". I mean I might not have felt great, but when compared to my new "normal" it was a pretty good moment. (Can't say day because unfortunately it didn't remain that way for long.) Unfortunately, or not, when she started to say that she was glad to hear it, my dad swooped in and told her that I wasn't doing great, but was having a more tolerable day.

As you can see the common question, "How are you?", can be complex to answer, with the normal "okay, fine, and good" answers carrying a variety of different meanings, sometimes accurate and sometimes just portraying what everyone, including me, wants to hear.