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Tuesday, March 31, 2009

Barren Advice: Thirty-Seven

This is the 37th installment of Barren Advice. You can ask questions that are fertility or non-fertility related.

Barren Advice is posted each Tuesday-ish. If you have your own question for Barren Advice, click here to learn how to submit. Please weigh in with your own thoughts in the comment section and indicate which question you're addressing if there are multiple questions in the post.

Dear Mel:

I'm on my 4th injectibles IUI and I'm not moving to IVF. So I have one or two more months and maybe a 10% chance of getting pregnant and then that's it. Life forever without getting pregnant. In the mean time, I have appointments at the fertility clinic about 3x/month. During each appointment, I have to interact with 3-4 people who each always ask me how I am. Truthfully, I am not handling the crushing disappointment very well. I realize their questions are their way of being polite and my normal answer, outside of the doctor's office, is a simple 'fine'. However, inside the doctor's office, I just refuse to say that I am fine. I am nowhere near fine.

I've tried ignoring the question, I've tried a nonsensical answer ("Right"), I've tried truthful ("Not well"), I've tried truthful/mean ("You don't want my answer"), and I've tried crying (that was fun). But in certain situations, like shelling out $1200 while sitting across from the billing person who I have nothing to say to, I feel like I need an answer that doesn't make me feel like a total bitch and also doesn't make light of my situation. Frankly, considering why people go to fertility clinics, I'd think I'm not the only person who's at a loss how to answer this throwaway question. Any advice would be very welcome.


Frankly, it's a throwaway question pretty much every time it's asked. Think about how we say it--this week, I said it to Steve who brings in the carts at the food store. "How are you doing?" I called over my shoulder AND KEPT WALKING. What is he supposed to do--shout the answer at my back?

Every culture has some variation on this question and uses it as a greeting. Isn't that bizarre? Why wouldn't we just use a statement as a greeting instead of utilizing a question--a conversation starter--when we don't really want to talk?

Because we want to appear friendlier than we really are.

It's not that I don't care about Steve's answer. When I step back and think about it, I actually care about Steve a great deal and when he was absent for a few days, asked at the customer service desk about him. Steve is a constant: he's always at the food store. If he started to answer my question, I would want to hear it because if there was anything I could do to help, I'd want to do it. And yet I realized by the way I called it over my shoulder that what I was doing was really just acknowledging him, making myself feel like a friendly person rather than actually making a connection with him and listening to what is happening in his life.

Your question reminded me that I need to do better next time. I need to either choose a statement rather than a question or I need to slow down in the parking lot and show him with my body language that I'm actually as interested in the answer as I am in asking the question.

But what do you do with the people who aren't considering how their question is hanging in the air like a sick joke? I mean, how would you be doing if you were in a fertility clinic? Unless they just gave you the golden ticket out of treatments, you're probably doing crappy. And while you can't change the fact that they asked the question to you, you can change (at least for the perceptive ones) how they ask it in the future.

I'd answer every "how are you" with an "honestly, not that well." And then wait for the follow up. Those who say "sorry to hear that" are giving you a clear sign of how they wanted their question taken. They didn't truly want to start a conversation with you, even if you're someone they see constantly. It's not that they don't care about you, but in fairness to the limitations of life, they only know you so well and therefore are only so invested in your answer.

Those who return with a "why" are inviting the conversation. They want to hear why you're not doing well, and these are the people I would focus on rather than foisting the answer on those who aren't receptive in the first place. They may not be closer to the situation--you may find that you receive more care from the woman doing billing than the nurse in charge of your case--but for whatever reason, they are more invested in helping you emotionally.

"How are you" can be such a loaded question that I'm not sure why anyone would use it as a greeting. And while you can't control whether or not it is asked, the way you answer will at least save you the annoyance of sharing your life with someone who isn't there to actually receive that part of you.

I get the feeling from your question that you're not really struggling with the answer insomuch as you're struggling with the reality of the situation: someone has asked you how you are, you've answered, and they have essentially let your words fall directly to the ground rather than catching them in their hands. No one wants to see a beacon of care (that shining light of a question: how are you doing?) and then find that the light shines off of them as soon as they start speaking. Ask anyone who has experienced a situation that would fall under the category of "uncomfortable topic" (loss, illness, failure, divorce, unemployment, etc) how they felt when they began sharing their news and watched the conversation grind to a halt how incredibly hurtful it was to have someone figuratively holding out their hand and then drop it before human contact could be made.

I've written about the Twilight Zone episode before that explores that need for human contact and I think we need that contact, that connection to others, even more so when we're undergoing something as emotionally draining as infertility. You need to be recognized, you need to know that people are still seeing you as a member of society because YOU are redefining where you stand in society. Fertility clinics need to be doing a better job at recognizing that they're treating the whole person and not just their reproductive organs. The "how are you" is a nice start. Listening to the answer, whatever it may be, is the next step. And your office is falling short on that back end, asking the question to appear friendlier than they actually are.

It would be great if office staff read this post and thought about how the questions they ask affect the receiver when they are clearly asked without the answer desired. But they most likely won't and to be fair, the best clinics don't need it because they already are thoughtful (by best I mean best experience, not the highest success rates). Hopefully, you'll change some of the perceptive people.

And, if nothing else, you won't hear the awful thud of your words hitting the floor as the other person drops them carelessly if you only give them to people who truly want to hear them. For the ones who don't follow up your response with the next question ("why?"), answer every time they ask in the future: "thanks for asking; how are you?" Oh, and then change the topic before they can respond if you want to drive the point home that asking their question in a fertility clinic is inane if it's not going to be followed up with some comfort. Or listen to the answer and show them how a pro does it.

No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely.

Leave a comment in the reaction box below--only keep in mind that conflicting advice is embraced and rudeness is not. Want to ask your own question? Click here to see what you need to send in order to be included in a future Tuesday's installment of Barren Advice


Jendeis said...

Excellent advice as always, Mel. My rabbi once discussed during a sermon that to show we really care, we should ask the person, "How are you doing on scale of 1 to 10?" Such a question requires an answer more than the obligatory "fine" and demonstrates that the asker cares.

perchancetodream said...

I have a personal issue with people who ask "how are you?" without really caring about the answer.

That being said, I usually say "hanging in" or "as good as can be expected" in those situations. Anyone who truly cares will get the gist and the door is opened for further questions but it also stands on it's own for people who are just asking.

Tash said...

I always say, Awful but Functioning.

Elizabeth said...

I agree that the way the question is used ritualistically has nothing at all to do with the literal meaning of the words. We might as well substitute "gadzooks!" or some other nonsense words. Functionally, all we mean when we say "how are you" is "I acknowledge another human being is in my presence."

(Maybe we could just SAY that, eh? :-) Mel, I acknowledge another human being is in my presence.)

My cousin used to always respond with "Never better!" even if sarcastically. My husband always says "oh, gettin' by." Or he says "still bald and bitter," for the funny. (Maybe we could say "still barren and bitter!)

Humor aside, it sounds to me like what Robin is longing for is to REALLY be acknowledged as a human being, and not just a number, a body, a patient, but as a whole person who is living through an intensely difficult time. To be heard and recognized as suffering. Medical bureaucracies really get in the way of this recognition, they produce indifference on the part of the humans working in them.

I think that most of the time it takes some kind of jolt to get medical workers out of their groove, to see the human being sitting across from them. Not always, and not everyone, but a lot of the time. Just because of the bureaucracy. Humor, rudeness, or pretty much anything that "breaks script" has the potential to do this. Even so, though, it won't always work. I think medical workers also have a lot of defenses because they see so many people in crisis or who are hurting, all the time, that they have to build up some kind of shell so that they can continue to function themselves.

Robin, I'm so sorry that it hurts so much. I hope that you can find that human connection as much as possible in future interactions.

Furrow said...

Every time I went in to see the nurse who managed my IUIs, I would break down. It was crazy, because nothing would bring it on, but I was holding it in for everyone else, and she knew the intimate details, so why not? She was not at all comfortable with that. That setting can make us so raw. I wish connection was emphasized more in fertility clinics. I understand how medical professions can become numb to pain, but it does hurt to feel so alone.

areyoukiddingme said...

My standard response to How are you? is "Tired and cranky, as usual." My secondary response is "Just lovely" with varying degrees of sincerity/sarcasm. I do not believe that anyone asks how I am because they care; that's why I have standard responses.

I have a friend who always greets me with "Fine. How are you?" before I can even say a word to him. Try that on some people and enjoy the ensuing confusion! I am a habitual "how are you?" kind of person to strangers, but if they answer in other than a surface way, I am willing to listen to what ever else they have to say. When I'm not willing to listen to it, I don't ask.

Also, if someone asks me how I am in a medical setting, I tell them. In minute detail. Because I've spent a lot of years forgetting what I wanted to ask the doctor, and never having an opening because I didn't mention any concerns. I guess this would also apply to the billing people - if they asked me how I was, I would respond "broke and unhappy about it" if I had just shelled out $1200 for something.

Cassandra said...

Something I've struggled with in life is my own inability to engage in such inane back and forth -- in large part because if I don't care about the answer, I don't ask the question. "What's new with you?" will be followed by my own answer, and only with immense effort do I remember to ask, "How about you?" unless it's someone that I actually really like.

"You look great" is answered with a thanks and then just hangs there unless I actually think they look great.

I honestly still haven't figured out whether I'm better off being disingenuous. Do people value my compliments more because they know that I'll never say anything that isn't true? Do people who receive my full interest feel extra-special? Does everyone else think I'm a bitch? All of the above, perhaps.

Phoebe said...

In the West African language I spoke, their greeting was translated literally as:

Q: "How's it going?"
A: "I'm here only."

I always loved the truth in that. I think it gets lost in translation here though.

For you that want it in Wolof:

Q: "Nanga def?"
A: "Mangi fii rekk."

Cece said...

I always just say "Awesome" when asked that question. If I'm not "awesome" I wish I was... and maybe saying it outloud will make it happen. Just like I try to always smile when I get my picture taken.

Smitty76 said...

Hi, Mel. This was such an excellent, amazingly thoughtful response. And I wholeheartedly agree with your statement that these throwaway questions are more about letting the questioner feel more friendly than they're actually being.

Someone here commented on how raw these treatments/experiments can make us feel. And the secrecy and isolation that comes with IF only makes matters worse.

When I'm asked this question, I try to respond with the truth: "exhausted" (as I'm arriving for a 6:45am monitoring appointment), "broke" (as I'm writing another check for $1,600), "Not great, but hanging in" (for any number of other messed-up scenarios in this process).

Polite enough so that I don't offend, but truthful enough that I don't feel like a fraud for saying "fine" when I'm anything but.

Rachel said...

I usually answer questions like this as, "Surviving" or something like that. Sometimes I just say, "Ok." I try to have a pat answer to a pat question where I'm not actually lying. But I didn't want to prompt more questions either.

BTW, I think Robin was published in some other advice column, too. I'm a bit of an advice column junky, so I'm not sure which one. I'll try to find it.

holly said...

I usually say, "OK." Unless at the Doctor's office especially the Fertility Clinic. I feel they should know better. If one of the staff asked me I would say "I'm here so I can't be doing that great."
Bitchy, but truthful. Those who work in the land IF should know better.

itsazooaroundhere said...

This is wonderful advice, and giving me something to think about. I'm a cheerful "how are you?" kind of person, but I should probably re-think it when I don't listen for the answer.

Last week I had a really rough monitoring appointment, and was on the verge of a panic attack during the ultrasound. My nurse noticed, and asked if I was doing OK. I burst into tears, and they were totally shocked. But, very comforting.

As I was telling my mom this story, she said they were probably relieved to know that I am a real person with emotions, because usually I keep everything inside and am smile-y and cheerful. I think she was right, it kind of made them see me in a different, more real way.

Robin, hopefully you know that there are so many of us feeling just like you do, especially at the clinic and when paying bills. I'm sorry for what you're going through. (((hugs)))

Io said...

I like what you said Mel! Ooo...I also like what all these other people said too! Lots of good options.

Deathstar said...

I vote for, "Not pregnant - and you?"

battynurse said...

That is such a difficult question sometimes and yet I'm so guilty of frequently using it myself. I'm a nurse in a hospital and I catch myself all the time asking patients "how are you?" I try to follow up with acknowledgement of surroundings and circumstances. I also know that for myself being asked that question when I'm at a particularly low spot is enough to push me over the edge and has frequently ended with me sobbing hysterically.

Bea said...

A lot depends on the tone of voice, too. You also need to be careful how you interpret responses in clinical settings. "I'm sorry to hear that," might mean, "I'd love to ask you more but I have sixteen gazillion patients and none of them are doing any better, so I think I'd better leave it at a shoulder pat and get everyone's blood to the lab before it sours." It might not be a matter of emotional investment/niceness of person/etc.

But yes, I would just answer simply but honestly. "Not the best I've ever been." Or whatever you feel comfortable saying.


infertilityrocks said...

I love this column, Mel!

I have had to re-evaluate this exact issue when my friend's son died last year (many of you have read about it on my blog). I caught myself asking the standard, "How are you?" when I would talk to her as the usual greeting. And it seemed like such a crappy thing to say, not that I didn't actually care how she was doing, but because I knew that she wasn't doing well.

I changed my 'greeting' to "It's so good to talk with you (or see you" or "I've been thinking about you."

Honestly, I'm not sure that my RE's office staff has even given me the politeness of those questions....I definitely feel like patient number 2836 there some days.


Jen J said...

I agree! This is a GREAT question!!! I also really like your answer Mel!

When someone (especially at a clinic) asks me how I am I tend to Sigh & say one of two things lately - unless I know that it's a person who isn't just using the phrase as a greeting.

I either say "I'll be OK" or "I'm here." I figure that it's a good non-response that doesn't involve me pouring out all the details that I might not want to discuss and they might not want to hear, but I'm also not faking it and pretending to be OK.

I also hate getting that question at the GP's office when I make an appointment and tell them that I'm coming in for a sinus infection. Nurse Janey comes in and says "So how are you today?" Umm.... I'm SICK! I wouldn't be here if I wasn't sick! I can think of a million other, better ways to pass my time today!


By the way --- I'm fine, thank you! =)

NotTheMama said...

Oh my.... Guilty as charged!! I just realized that when I make med deliveries to our mental health group homes, I ask the residents I see how they're doing... Maybe a simple "hello" and a smile should suffice!

Natalie said...

I went through a [long] phase as a teenager where I refused to ask or answer that question. I hated the insanity of it, the fact that no one really cared what the answer was, it was a greeting phrased as a question. Drove me NUTS! But I've also learned with time that it's a social custom and in order to be polite I do answer now. (But I still refuse to say it, unless I genuinely want to know info.)

My canned answer right now is, "Okay," or, "Fine." I always used to say, "Good!"... you know, back before the shit hit the fan. With the nurses and such... I'm much more apt to give a truer answer. Not a long explanation, but something more... apt. Like, "Frustrated." "Tired." or a simple, "Not good."

I figure, hey, they asked the question... they get my answer, whatever it may be.

T said...

"Probably about as well as you would be in my shoes."

This reminds me of my nurse that told me I "could" take tylenol if my miscarriage was "uncomfortable". "You've obviously never had a miscarriage" was my response - to which I received a lovely vicodin prescription.

So many of our problems are represented by this problem - few people care about how their fellow man is actually doing.

Robin said...

This is Robin - I really appreciate your thoughtful answer to my question. Oh, and I did send it to the Post first without all the details. It occurred to me afterwards that you all here would be able to answer me better than some generic advice column. No one else understands.

It's an interesting question you raise - what am I looking for after my response? Do I want the questioner to really listen to me? I'm not sure. Thanks for giving me the opportunity to think about this in a new way.

I find the sympathy of the negative beta calls to be very annoying. Same with the personal questions at the office (not that "How are you" is supposed to be personal, but in that situation, it is to me) You're a professional I am begrudgingly seeing/paying/naked in front of, not my friend. I don't want to have to deal with your feelings too. I guess that's it. I have all these crazy negative emotions but I just want the facts from you. I don't want to talk about how I am. I don't even want to think about how I am. I want to complete what I've come to the office for and get out of there. Because while I'm there, all I think about is what a massive failure this has all been.

But thanks for the arsenal of funny, negative responses. I'm the queen of saying awful things with a big smile on my face so I'm looking forward to using a few.

barrenisthenewblack said...

Robin, I don't have any amazing advice, but your follow-up completely encapsulates my thoughts, and it highlights some of my (not critical) feelings about another cycle. I'm not quite sure what it says that I happen to be eager to start again. I'm sorry it is so hard

Anonymous said...

Very good question and response. I go to a general ob-gyn clinic for my fertility services (nothing more specialized in my area) and the insensitivity of some of the people that work there is unbelievable.

One time, an appointment of mine was cancelled (after I was alreay at the office) because my OBGYN was delivering a baby. When I was sitting with the scheduler, I definitely had a sad/mad look on my face. She ASKED me what was wrong...I was truthful and said "I'm just upset that I came all the way here and my appointment was cancelled"...and then, the scheduler, in all her sensitive glory, said, "Well, we can't control when babies are born." OH, NO KIDDING?!!! I cried all the way home.

I think my Dr. must have got wind of what happened, because she called me at 7 or 8 PM that night. That's what ticks me off about this office--my OBGYN is just fine, but some of her staff could use some serious sensitivty training!!