“How are you?”

This innocent, well-intentioned question often trips me up.

I have lived in a small Colorado town for the last 40 years. Until recently, I was a nursing professor in the same valley for 15 of those 40 years. In addition, I have been a very active participant in this mountain valley community. I was a vol­un­teer with the local fire department for years, I belong to the same small church, and I volunteer in schools and the local art organization. For fun, I par­tic­i­pate in a local tri­athlon team.

You get the idea; I know a lot of people.

Many of these same people know that I had a stem cell transplant five years ago for a strange cancer. During that year, I was hospitalized seven times, usually in Denver – miles away. I was very sick and looked sick – pale, bald, and underweight. All throughout that difficult year, angels from the community gave our family immeasurable assistance. It included meals, baby sitting pets, drives to appointments, and an apartment in the city for follow-up visits. My close friends took turns spending the night with me in the hospital when my husband couldn’t be there. The personal notes of encouragement I received were a comfort during those dark times; I would read them over and over. The outpouring of support from this large circle of friends was powerful, sometimes overwhelming.

At the end of this demanding year, we changed our plans for retirement. We had bought land in another Colorado town, where the living expenses were quite a bit cheaper. The plan was to move there when we retired. However, we decided that we are not moving anywhere. This mountain town is our home town.

Move forward five years. I no longer look sick. I certainly am not underweight and have all my hair back. I wear bright colors, a bright smile, and often look younger than my 71 years.

Whenever I meet someone, the beginning statement is usually “You look great,” followed by “But how are you really?” The questioner is serious and focused. This is where I can get in trouble because my medical history is complicated.

After my stem cell transplant, I enjoyed two years of remission with just the Revlimid (lenalidomide) and dexamethasone. Answers were easy then. For three years now, I have been on one treatment or another fighting the chronicity of this disease. I call this fight my part-time job.

I learned quickly most people don’t know that multiple myeloma is a chronic, incurable disease. The same people who brought meals five years ago want to believe that the stem cell transplant cured me. So in the beginning, I felt a responsibility to explain my disease process to everyone. My children identify this as TMI (too much information).

A classic case of TMI happened several weeks ago at the grocery store, when a long-time friend asked the question. I pulled my shirt open to show her my new port. Her eyes widened, she backed up, gasped, and almost fell into the dairy case. I really thought she might pass out on top of the eggs and butter. “I don’t do medical things,“ she replied.

Note to self: Too much information, wrong setting, wrong person. That encounter was a low point for both of us.

After several similar embarrassing or ineffective answers, I realized that I needed new skills to manage the question.

Gradually, I have developed the following strategies that I consider and apply when people ask me how I am:

I consider the location. Grocery stores, art openings, and movie lines are not good places to give in-depth answers. This is not the setting to share “Today I received two units of blood, and I’m afraid my multiple myeloma is becoming more aggressive.” Instead, I practice “Reader's Digest” answers that are honest but not too honest. For example, I just reply “Today is a good day, I’m glad to be here. How are you?”

I identify who I’m talking with. If this is someone who has a meaningful relationship with me, they may want to know more. Usually I can tell if they ask for a phone call, or coffee, or a walk. I now also use email with several friends to provide updates.

I use the avoidance strategy when necessary. I believe avoidance in small measures can be helpful. For example, I now tend to go grocery shopping during the off times. If I am invited to a large community gathering, I assess whether I am strong enough to see a lot of people. If the event is something I’m not that excited about, I may skip it. I seek out smaller groups, such as exercising with a couple of friends, a spin class, or dinner together. At the same time, I make sure I am not isolating myself.

I find a safe place. When I realize that I am using the TMI response in all the wrong places, I know it is time to find a safe place – a place where I can be brutally honest about my feelings. I am blessed that I have several choices, including a weekly cancer support group, a monthly woman’s support group (which has been meeting for the past 15 years), and many good friends who are willing to walk, listen, and comfort.

When I am back on treatment, I usually participate regularly in the cancer support group. Attending the cancer support group and the woman’s support group is always a positive experience, with both laughter and tears. In both groups, I listen as much as I talk. In short, my life is rich in safe places to share my joys and fears.

How are you?

Do you have strategies to deal with this innocent question?