“How are you?” is not, then, the best thing to say to a cancer patient. Lisa Bonchek Adams, who lives with metastatic breast cancer and chronicles her experience in a moving and informative blog, suggests, “Is this a good day or a bad day?” The question is apt, because even though bikur holim (visiting the sick) is a mitsvah according to the Jews, a visit on a bad day may not be an act of kindness.”

Since being diagnosed nearly seven years ago with a lethal cancer, I have backed my old friends and new acquaintances into a quandary. What do you say to a dying man?

Strangers don’t seem to have any difficulty. Now that chemo­therapy has reduced me to a tattered coat upon a stick, I am routinely praised, when out in public with my four young children, “Oh, isn’t that sweet, you’re spending the day with your grandkids.” Under the guise of being nice, Americans can be breathtakingly rude. After about the hundredth time I was called their grand­father, I tried out a new reply: “These are my children. I am dying of cancer. The disease has prematurely aged me.”

Am I being cruel? Or merely repaying a pretense of frankness with the reality of frankness? The late Christopher Hitchens warned those who were blunt with their questions about his esophageal cancer to expect blunt­ness in return. I’d prefer unembarrassed bluntness to the faux-niceness and cliché-hobbled awkwardness with which many people address me. Only children seem to lack the social phooey which passes for good manners and are unafraid to ask me outright, “What’s wrong with you?” (It doesn’t hurt that they are satisfied by the answer, “I am very sick.” I am always quick to add, “Don’t worry: you can’t catch it from me.”)

I do not want to talk about my symptoms. I do not want to complain about the low-grade nausea which is nearly constant. I do not want to describe the fatigue that leaves me feeling as if I have run ten miles at top speed when I have merely climbed the stairs. I do not want to mention night sweats and the waking from terrifying dreams. I do not want to explain that my days are but pauses between trips to the oncologist and the hospital.

“How are you?” is not, then, the best thing to say to a cancer patient. Lisa Bonchek Adams, who lives with metastatic breast cancer and chronicles her experience in a moving and informative blog, suggests, “Is this a good day or a bad day?” The question is apt, because even though bikur holim (visiting the sick) is a mitsvah according to the Jews, a visit on a bad day may not be an act of kindness.

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