"How's it Going?"

An innocuous enough question. In our culture used in same way you'd say hello, or the Italians would say "va bene" or the French "Ca va?". I remember the old joke about how the French could have a conversation with two words that went like this:
Person One: Ca va? (how's it going)
Person Two: Ca va. (it's going alright)
Person Two: Ca va? (how's it going for you?)
Person One: Ca va. (it's going alright)

Only the tone and inflection vary.

But I digress...even though I know it's just a way of saying hello, I do have to say it's kind hard to say, "fine thanks, and you?". Because it's not going fine. It's not going well at all. I have a wife with metastatic melanoma who also just suffered a massive stroke and brain injury. I need to invent a new phrase to respond that's more appropriate to the situation. Maybe I should just slip into a little of my language skills and answer, "Come si, comme ca". It's closer to reality, most people get the ambiguity, and I don't have to give them the whole sob story.