Monthly Archives: January 2016

Tag, You’re Ill: My Decision to Wear a Medical Alert Bracelet

by

In this week’s post, Xan reflects on medical sign equipment and the self through the example of decision-making regarding medical alert bracelets.

I started my year in South Tampa with a dead car battery, a small moment of panic, and a series of tough realizations about my health and life. Turning 32 during the winter break made me reflect on how far I have come with my physical and mental health, and my ability to engage in effective illness management in all of those areas. I have never felt happier to grow older or to continue to challenge myself with new goals for well living, both within and outside of my professional life. At this point in my journey, giving myself those challenges means really moving out of my comfort zone and daring to dismantle some of the boundaries I previously erected in order to feel like I belong.

A curious artifact of my illness experience on which I’ve increasingly focused attention via critical autoethnography research is my staunch refusal to use any devices that obviously signal to others that I am ill.   Despite multiple loved ones and colleagues persistently reminding me that I might enjoy much better comfort in meeting spaces and at community events were I to carry a “donut pillow” to pad my sit bones on hard seating surfaces, I still find the prospect incredibly unpleasant. Reflecting on my reactions to this very intelligent suggestion always brings me to the same conclusion: Although I have built my entire career on using my own experiences of chronic illness to conduct impactful research and outreach on same, doing that kind of work also means that I mostly control the narrative of my disease.

By contrast, using a medical device—however simple or subtle—gives others very prominent evidence that I have a chronic condition, and allows them to form a wide variety of conclusions about my diagnosis and what my life is like. I suppose I have not really changed that much in some ways, because even though I accepted long ago that my own agency is merely a component of the complex social fabric in which I spend my days, I still feel the urge to control as many things in my environment as I can. The idea that I might not get a chance to shape how others interpret my illness still does not sit well with me.

Of course, this notion is problematic in and of itself. Being an 85-pound adult does invite people to draw all sorts of conclusions about what I live with, some reasonably accurate and some remarkably off-base. For instance, in community settings I have sometimes been mistaken for a methamphetamine or heroin user. These situations are likewise uncomfortable, and perhaps drive me to control what elements of the narrative I still can. Perhaps for this reason more than anything else, I have never worn a medical alert bracelet despite having a heart condition as a result of my autoimmune disease. When my potassium levels dip lower than usual, a bit of excitement or panic can make the Q and T waves of my heartbeat spread so far apart that my heart actually stops for a split second.

Long QT syndrome is a tough condition to miss if you know what to look for. Just look for the person who randomly passes out with seemingly no rhyme or reason, only to wake up fully alert moments later. It’s common in people with a history of severe hypokalemia, which often owes to chronic diseases of the mucous membranes and/or kidneys. My own disease is very similar to cystic fibrosis and may in fact be a rare form of CF—genetic tests remain inconclusive. So my whole GI tract is affected, as are my kidneys to some degree.

As a result, my body requires large amounts of supplemental potassium to sustain itself and keep my heart functioning. I’m also hypotensive thanks to a family history of low blood pressure, which doesn’t help matters. Neither does the thiamine deficiency I’ve become vulnerable to because of all the scarring on my small intestine, which in turn can exacerbate heart problems. So I pass out sometimes—when I’m excited, when I’m panicked, when I’m dehydrated, when I’m fighting a virus… I collapse and hit the deck, then wake up a few seconds later, usually with several very confused people surrounding me.

So far, I’ve been lucky. I’ve never lost consciousness for that long—maybe 60 seconds during the worst episode I’ve had to date, where I collapsed at the entrance to a busy store. I’ve never passed out in a place where I would have been in danger physically. I’ve fainted in showers and living rooms, in quiet parking lots and in my partner’s arms. I’ve never gotten a concussion, never broken bones from the fall. When the fluttering starts in my chest and I start to feel my body lifting off from the ground, as if I will finally fly away from the pain it has caused me, I know what’s coming and I let it happen. I just crumple like a marionette with slack strings, folding gently to the ground. I relax and keep my body loose to minimize my chances of getting seriously hurt.

I also try to calm myself during moments of panic so things do not progress to that point—a lofty challenge when I am still figuring out how to live well with PTSD, but one I conquer more and more with each passing day. And when I invariably wake again, still in the same body with all its same foibles, I try to make light of things and share a laugh with anyone who has come to help. But it isn’t really funny, and on the few occasions this has happened in recent months, I have increasingly felt that the joke may be on me. I reflected on all of this as I lay on the pavement outside our apartment in Palma Ceia, cold sweat on my brow and heart fluttering beneath my ribs. My partner stood above me, hand on phone in case this would be the one time where I did need an ambulance. I blinked, vision coming back into focus, looking up at my partner with a sheepish expression.

I should probably get a medical alert bracelet, shouldn’t I. My partner looks down at me, arms crossed, eyebrows raised. Uh-huh. I accept help getting up, which represents substantial progress in and of itself. This is gonna be an adjustment, I say. I don’t usually wear anything that would tell people I’m sick. I know it’s kind of obvious but I have this illusion that I control the message all the time. And this makes it obvious in a really big way. I guess I’m just gonna have to be okay with it. I want to be around for a long time and that’s not going to happen if some well-meaning paramedic shoots me up with adrenaline because they think I’m a drug user who has overdosed. My partner relaxes and listens, satisfied that my usual mile-a-minute sharing of my thoughts means I’m doing all right.

I let my partner find me an auto parts store nearby that will replace the battery and send me on my way back north to get started with spring semester teaching. We watch through the store windows as the old battery comes out and the new one goes in, me talking endlessly about the significance of deciding to order a medical alert bracelet. I talk about what I’ll engrave on the back. I already know I’m going to get one with rear engraving—my compromise with myself about discretion and narrative control. I think about my bracelet the whole drive home: what it will say, what it will look like, how I will wear it. I think about getting a wallet card to hold all the other information I cannot possibly fit on a bracelet that might be of use to first responders.

I think about how I’m going to talk to my parents about all of this. They know I have “a little long QT”, as they like to put it. But they don’t really know that it still flares up sometimes, even with my potassium and thiamine levels managed with supplements. I debate just not saying anything, to them or my colleagues or anyone else. And then somewhere between Tampa and Tallahassee I decide that I’m just beyond sick of hiding, of erecting these arbitrary boundaries in a life where my illness is already common knowledge because I think somehow they will protect me, allow me to keep control of a body that has been killing me since the day I joined this world. Perhaps I’ve finally realized that if I behave like a prisoner of my body, I become one. Controlling the narrative doesn’t give me the kind of freedom that I once thought it might. I suppose I’m beginning to feel okay with just how much I cannot control in this body, in this life.

Back at home, I spend hours researching different bracelet options, settling on a professionally engraved tag for which I can make my own bands. I’ve always loved bracelets—a signature part of my aesthetic for years—and figured that would be a good way to make the experience less intimidating. It is a whole new world of scary, even if you’ve been very open about your illness for many years as I have and even if you have made it a huge focus in your career, to put it right there on your arm for anyone and everyone to see. A “scarlet A” of sorts, a piece of sign equipment branding you as different. I thought about this as I deliberately chose a tag design with a black caduceus symbol. Then I spent several hours mulling over the engraving content—making notes, stepping away, coming back to it, revising. If I was going to put the core of my life on my wrist to speak for me at times when I could not speak for myself, I was not going to take the process lightly.

My medical alert tag arrives in the mail a couple weeks later, and I make a simple band for it with supplies purchased from a craft store. I begin wearing it the next morning. The tag is a simple steel oval with a black caduceus symbol on the front side, and on the back several lines of engraving:

 

AUTOIMMUNE DISEASE

LONG QT & HYPOTENSION

MULTIPLE MEDICATIONS

INFO ON WALLET CARD

J (SPOUSE): XXX-XXX-XXXX

 

I’ve accepted that this is something I need to do to live the best life I can. I’ve made every effort to ensure that I will be happy to wear the tag every day, customizing the band exactly to my liking, ensuring that I’ll have no excuses to leave it behind in a drawer. I’ve also accepted that I still have the freedom and agency to tell people who I am, both within the context of my chronic illness and outside of it. I won’t become a walking stereotype just because I wear a medical alert tag. I’m still me, which entails living with a chronic condition but hardly ends there.

I also have peace of mind from knowing that something so small and simple can advocate for me when I cannot speak up for myself. So do my parents, who nod sagely and say I’m making a smart choice when I tell them I’ve decided to start wearing an alert bracelet. So does my partner, who quietly breathes a sigh of relief over the phone when I say I’ve ordered the tag. I’m not usually much for New Year’s resolutions, but I feel good about making and fulfilling this one. Since the tag arrived, I’ve worn it proudly—hanging a lantern on it, using it in my teaching and community outreach, the same way I’ve done with so many other elements of my illness experience. It’s just one more way of writing where it hurts.

Incorporating Underrepresented Populations in Teaching and Research

by

In this post, the Write Where It Hurts editorial team reflects on their experience advocating strategies for teaching to and about marginalized populations often left out of mainstream educational materials, research protocols, and data sets (see our recently published Teaching Sociology article on this topic here) in hopes of facilitating dialogue about the incorporation of marginalized and otherwise underrepresented populations in teaching and research.

As people who belong to, write about, teach, study, and engage in advocacy related to varied populations marginalized or otherwise often left out of mainstream education and scholarship (i.e., donor conceived people, adopted people, transgender and non-binary people, people managing chronic physical and / or mental atypical experiences, etc.), we have become intimately aware of the limitations or missing elements within much existing scientific data and educational resources. At the same time, we know all too well the structural and ideological barriers that slow alteration and revision of existing educational rituals, traditions, and structural patterns in concrete settings. As we did in our recently published Teaching Sociology article focused on strategies for inclusive teaching about gender via the use of survey data that often does not explicitly measure the gender diversity of our shared world, we would like to encourage our colleagues to consider strategies for overcoming existing structural and ideological traditions in hopes of continuing dialogue about methods for creating greater diversity and inclusivity within and beyond scholarly and educational materials.

As we note in our recent article, many data sets called “representative” and used to make far-reaching claims often do not contain and / or do not explicitly measure people like us. If, for example, Xan seeks to learn about social patterns related to donor conceived or agender people, such data sets offer no answers despite the use of such data to “represent” national or other whole populations. Likewise, if J seeks to learn about the experiences of transgender, adopted, or sexually fluid people, all ze will learn from data is that such people are not part of the representation of this society. Similarly, if Lain seeks to ascertain attitudes concerning or held by genderqueer and / or bisexual people, most data sets called “representative” will only offer a “representation” wherein such groups do not exist in any identifiable manner. Despite these “missing” populations, researchers, teachers, and advocates will often utilize these sets to make claims about, for example, families, gender, and sexualities that – we would guess unintentionally – ultimately reproduce existing power structures as well as the marginalization of the groups left out of the official representation contained in the data. In fact, we can see similar problems for other marginalized groups including but not limited to homeless people, neuro-atypical people, and multi and inter racial people despite the use of such data to make claims about housing, mental and physical health, and racial dynamics on a regular basis.

Alongside growing recognition of issues with calling limited collections of people and measurements “representative,” we have heard some advocate doing away with these data sets while establishing more inclusive and diverse forms of data collection, measurement, and sampling. Doing so, however, would require massive changes structurally, ideologically, and institutionally, which will likely take much time, debate, and discussion to accomplish. At the same time, we have heard others advocate for maintaining existing practices or rituals while seeking to explain away the limitations or problems with existing data collection, measurement, and coding practices. Doing so, however, would require accepting the ongoing marginalization and erasure of many sections of the population from official representations. In our article, we propose a middle ground between these two extremes wherein we utilize the existing limitations to illustrate important patterns, power dynamics, and structural issues in contemporary society while continuing to push for revisions in existing data collection, measurement and sampling procedures and encouraging scholars, teachers, and others to talk about such data sets in more inclusive ways within publications and classrooms.

With this information in mind, we invite dialogue, commentary and discussion on strategies for inclusive teaching with existing data limitations and issues. Whether one seeks to join this conversation on this site or in relation to our call in Teaching Sociology or in any other space, we invite and appreciate other educators’ perspectives on these matters. To this end, ask yourself what do we say to unrepresented populations when we call data sources devoid of their presence or measurement representative of our world? What institutional and structural steps might we need to take to make our data sources and educational materials more inclusive of marginalized, underrepresented, and otherwise “missing” populations? Why do we push so hard for generalizations instead of seeking to empirically map the complexities, nuances, and diversity of our shared world, and is this pursuit of “representative” or “generalizable” claims worth the potential negative effects such practices may have on marginalized populations? While we will not pretend to have some “right” or “absolute” answers to these questions, our experiences to date within and beyond classrooms tell us these questions might be incredibly important and useful in many ways. Thus, we encourage members of our intellectual and activist communities to engage openly in these (admittedly challenging) conversations in order to move us closer to truly understanding the complexities of our social world and challenging the inequalities that exist within it.