Laughing Through the Flare-Ups: A Comedy of Tummy Troubles

By Yeabsira Taye from Addis Ababa, Ethiopia

In the world of IBD, where troubles arise,  

I found a way to bring laughter, a humorous surprise.  

Though the pain is real, and the challenges persist,  

A funny poem about my IBD, let's coexist!  

Oh, my dear intestines, you mischievous pair,  

Always causing chaos, it just isn't fair.  

One day you're calm, the next you're a riot,  

Leaving me running to the bathroom in quiet.  

Oh, the adventures with food, what a ride,  

A guessing game where my gut decides.  

One day it's a friend, the next a foe,  

Leaving me wondering which way to go.  

From endless doctor appointments to scopes so grand,  

I've seen my insides more than I'd ever planned.  

They explore my colon like an uncharted land,  

While I lie there, wondering how I got so grand. 

Oh, the joy of explaining my condition to friends, 

As I try to make light of the awkward trends. 

They offer well-meaning advice, bless their hearts, 

But I know deep down, they can't grasp the arts.  

So here's to you, with your IBD tale,  

Finding humor even when things derail. 

In laughter, you'll find strength to carry on, 

Turning your trauma into a comedy marathon.  

Remember, my friend, in the midst of the strife, 

Laughter is the best medicine in life.  

So embrace the funny side, let it be your guide, 

And conquer IBD with laughter as your stride.

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Featured photo by Tim Mossholder from Pexels.

When the cared for becomes the carer.

By Selan Lee from the United Kingdom

I’m not the biggest believer in Astrology. I might complete an occasional zodiac quiz or look up my horoscope when life seems complicated - but I’m not one to base my whole personality around my status as an Aries. However, in light of recent events - I’ve become a bit more of a believer. 

At the start of 2024, I made my annual Google search on the predictions for the Lunar New Year. What started as a little harmless fun quickly turned depressing. My fortunes for 2024 looked bleak as a dragon zodiac, and now I can see the start of my 2024 misfortune. Coincidentally, my mum began experiencing balance and coordination issues at the same time as my feeble attempt to predict the future. Following visits to the GP and A&E, a transfer to a ward and surgery - Mum has been relieved of the meningioma that started it all. I realised our roles had been reversed for the first time on Mother’s Day. I, who had been cared for as a daughter and a daughter with Crohn’s disease, had become the carer and guardian of a mother who’d been caring from the moment she found out about me. 

Only now that she is home, with the benefit of retrospect, I realise I had a small glimpse into a carer’s experience. Many of us with chronic illness gripe that often, and quite rightly, our experience is never fully understood or communicable. But the trauma and sacrifice of carers is something even less understood. My mum would never call herself a hero or a loyal supporter, as many news headlines and commenters like to attribute to partners, loved ones and friends of chronically ill people. It is a title that never sits well with her and similarly with me following the last few months. 

I sat next to her at every medical appointment. I anxiously walked the hospital corridors during her surgery. I memorised every detail of the conversations with the nurses. I visited her every day and filled in every piece of paperwork. Just like she did these last 6 years. 

The roles had thoroughly been reversed, and not once did I feel heroic - I felt helpless, even more than I did when I was freshly diagnosed.

With the advantage of improved research and awareness, more and more people are aware of the intersectional and complex identities of people with chronic illness, as exemplified by the IBD Disk (Ghosh et al., 2017). However, this level of understanding and empathy has yet to be mirrored in the perception of carers. They are still a monolith of loyal, self-sacrificing heroes - not deeply traumatised, frequently tired and overwhelmed soldiers.  

I am fortunate to have someone and a support network to rely on to come with me to hospital appointments or to talk to when being sick becomes a little too tough. I am acutely aware they are one of the reasons I’ve been resilient with my IBD (Keefer, 2018). Their endless care, kindness, and generosity are never lost on us, but as Atticus Finch said, “You never really understand a person until you consider things from his point of view...until you climb into his skin and walk around in it.” The experience of chronic illness can never be fully understood, but so is that of the carer. Some will be lucky to encounter this responsibility later in life. Still, one thing is for sure - it is one that no one is ever truly prepared for, and though it shouldn't be lauded to a pedestal which diminishes the status of the chronically ill person - it definitely is one that I believe deserves the same comprehensive appreciation.

Featured photo by Matthias Zomer from Pexels.

References

1. Ghosh, S., Louis, E., Beaugerie, L., Bossuyt, P., Bouguen, G., Bourreille, A., Ferrante, M., Franchimont, D., Frost, K., Hebuterne, X., Marshall, J. K., OʼShea, C., Rosenfeld, G., Williams, C., & Peyrin-Biroulet, L. (2017). Development of the IBD Disk: A Visual Self-administered Tool for Assessing Disability in Inflammatory Bowel Diseases. Inflammatory bowel diseases, 23(3), 333–340. https://doi.org/10.1097/MIB.0000000000001033

2. Keefer, L. (2018). Behavioural medicine and gastrointestinal disorders: the promise of positive psychology. Nature Reviews Gastroenterology & Hepatology, 15(6), 378–386. https://doi.org/10.1038/s41575-018-0001-1

Patient Summary on the AGA Clinical Practice Update on Diet and Nutritional Therapies in Patients With Inflammatory Bowel Disease

By Peter Park, TX, USA

Obligatory Disclaimer: 

This article is strictly for educational purposes. This article is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any patient-physician relationship and should not be used as a substitute for professional diagnosis, treatment, and/or management. Please consult your health care provider before making any health care decisions for guidance about any specific medical condition. References and links to third parties do not constitute an endorsement or warranty of any kind by Crohn’s & Colitis Young Adults Network (CCYAN). 

Who is AGA?

The American Gastroenterological Association (AGA) is a professional organization focused on digestive health. They bring together doctors, researchers, and others interested in stomach and intestine problems, including IBD (Inflammatory Bowel Disease). The AGA publishes scientific journals, holds meetings, and works to improve patient care.

How was this study done?

Experts (doctors, researchers, and others) in IBD performed a review of existing research articles and studies alongside expert opinion to provide practical guidance on diet and nutritional therapies in IBD patients.. This received peer review both internally within AGA and externally outside of AGA.

This was not a formal systematic review, meaning they cannot recommend the strength of any singular suggestion. 

Key Points:

1. There has not been sufficient data to suggest a singular TRUE diet.

1. According to the AGA, if there was one diet for patients to start from, then it would be the Mediterranean Diet which is “rich in a variety of fresh fruits and vegetables, monounsaturated fats, complex carbohydrates, and lean proteins and low in ultraprocessed foods, added sugar, and salt for their overall health and general well-being”.

2. Low amounts of red meat have been associated with decreased flares in patients with ulcerative colitis.

2. Crohn’s, Stricture subtype 

1. Some Crohn’s patients can develop strictures which narrow the tunnel of the colon that can increase the risk of inflammation with certain harder-to-digest foods. 

2. AGA recommends decreasing fibrous foods and raw vegetables that are easier on the colon to channel through all the way to the rectum.

3. Feeding tube feedings should be discussed with the doctor on staff as there are several specific clinical guidelines. 

1. AGA recommends that patients share this document with their doctor on the most updated guidelines.

4. Vitamins 

1. Patients with IBD are at higher risk for low levels of Vitamin D, B12, and iron. 

2. AGA recommends to speak with your doctor on monitoring levels regularly.

5. Involving the professionals

1. Diet can be complicated by malnutrition, short bowel syndrome, enterocutaneous fistula, and/or requiring more complex management.

2. AGA recommends involving a registered dietitian to help patients in individualizing their diets. 

Summary

Managing IBD requires a multifaceted approach that goes beyond medical interventions. Dietary adjustments, stress management, medication adherence, and regular follow-ups with healthcare providers are essential components of effective management. Additionally, having a supportive network of peers who can offer empathy, understanding, and practical advice can significantly enhance the quality of life for young adults living with IBD.

In conclusion, the key takeaway for young adults struggling with IBD is the recognition of its complexity and the importance of assembling a supportive team, including a GI doctor, registered dietitian, and peers from organizations like CCYAN, to navigate the challenges of living with this chronic condition.

Information in forming this article was taken from the 2024 AGA Clinical Practice Update on Diet and Nutritional Therapies in Patients With Inflammatory Bowel Disease: Expert Review

Source: Hashash, J. G., Elkins, J., Lewis, J. D., & Binion, D. G. (2024). AGA Clinical Practice Update on Diet and Nutritional Therapies in Patients With Inflammatory Bowel Disease: Expert Review. Gastroenterology, 166(3), 521–532. https://doi.org/10.1053/j.gastro.2023.11.303

Featured photo by picjumbo.com from Pexels.

When One Diagnosis Leads To Another…

By Maria Mutka from NC, USA

“Don’t you have enough chronic illnesses?”

No one has actually ever asked me that before, but despite my efforts to push the question out of my mind, occasionally, when all my chronic illnesses seem to flare simultaneously, orchestrating a cacophony of discomfort, I ask myself that question and wonder if others in my life are silently asking it too.

At the age of 24, I have been diagnosed with three chronic illnesses. Sometimes I feel like I am collecting them like Pokémon cards. I was first diagnosed at age 10 with inflammatory bowel disease (IBD), specifically ulcerative colitis. 

I remember throughout my adolescence and teenage years periodically filling out a symptoms questionnaire that asked about joint pain, rashes, and fevers. I was aware of the potential extraintestinal manifestations of IBD, but I was so focused on my gastrointestinal symptoms that I relegated any other discomfort to the sidelines.

At the time, I attributed those extraintestinal manifestations only to Crohn’s disease, so I avoided asking the doctor about my sleep attacks or leg pain. On a deeper, subconscious level, I avoided acknowledging the potential correlation between these other symptoms and my IBD because I would have had to accept the fact that my ulcerative colitis was not under control and was affecting more than my gastrointestinal (GI) system. 

I was trying my best to maintain the cognitive dissonance of living with tangible symptoms, fatigue, and depression from my ulcerative colitis without fully acknowledging the ramifications of the disease activity on my whole body and overall health. I succeeded at ignoring the flares of my leg pain and increased sleep attacks that seemed to occur in concert with my colitis flares. 

That’s part of the reason it took me almost 7 years to get diagnosed with sacroiliitis after I first began experiencing lower back and leg pain that left me with intermittent problems with mobility due to leg spasms and shooting pain down both of my legs.

No one could explain why I was experiencing such debilitating pain in my lower back and legs at such a young age: not my gastroenterologist, an orthopedic specialist, a physical therapist, a chiropractor, or, initially, a rheumatologist. It took me first researching chronic lower back and leg pain conditions that are comorbid with ulcerative colitis and then presenting the possibility of sacroiliitis to my rheumatologist for me to finally get diagnosed. 

Once the MRI confirmed it, my rheumatologist noted my prowess in correctly diagnosing my own condition. I couldn’t help but think how silly it was that if I did not have the medical literacy and access to health information that I have due to my education and professional experience, I may have not gotten a diagnosis and treatment for my pain and mobility issues for who knows how many more years.

My next diagnosis of idiopathic hypersomnia at 23 after chronic sleep attacks also resulted from self-advocacy with my providers. When you are continually the one bringing medical attention to your disorders, it can be difficult to not have a type of medical imposter syndrome, essentially believing that you’re just a convincing hypochondriac. Having experienced a long diagnostic journey several times, it has become clear to me that it is not sustainable for chronically ill young adult patients to continually self-advocate for their health without their providers’ support. It is hard enough to live with a chronic illness like IBD as a young adult without having to feel like you are fighting for the care you need all on your own.

Providers who fully collaborate with patients on approaches to their care help to ease the burden of self-advocacy for chronically ill patients. They can partner with patients to think critically and innovatively about management and treatment options that align best with patients’ values, goals, and unique clinical histories. This partnership can lead to the proactive identification of connections between patients’ IBD and other aspects of their health and functioning (i.e., sleep, mental health, pain, fatigue) which can prevent gaps in care due to unaddressed needs or undiagnosed comorbid conditions.

It is no secret to many providers that IBD as an autoimmune disorder can affect more than the GI system and can be connected with other autoimmune or inflammatory disease diagnoses. This knowledge should be widely shared with patients, especially youth and young adults, to empower them to discuss their overall health in a holistic context. The focus should not solely be on the gastrointestinal system; fatigue, sleep issues, joint pain, mental health concerns, and various comorbidities are also relevant to IBD and should be addressed in tandem with GI care.

Provider and patient relationships should serve to empower patients to let providers know when they feel they’ve missed something. Providers should especially take chronically ill patients seriously when they mention newer pain or discomfort. As chronically ill youth and young adults, we spend a lot of our time getting to know our bodies as frequent flier patients. We know our bodies best and deserve to be taken seriously by our care teams. 

It probably goes without saying that I shouldn’t have had to wait 7 years for a diagnosis and treatment of a chronic condition that, when active, makes it difficult for me to walk.  Dismissing the pain of chronically ill patients because they tend to constantly experience pain or discomfort of some sort is an all-too-common occurrence. It is easy for providers to chalk the pain up to an already diagnosed disorder without probing it further. I can’t help but think, though, what the possibilities for improved quality of life and well-being could be if providers and care staff not only heard but listened to my voice. 

Your pain should not be invalidated because you already have a lot of it. If you feel your providers are missing something, speak up. You are the real expert on your body and your health. 

References:

1.  Sacroiliitis: Causes, Symptoms & Treatment Options (clevelandclinic.org)

2.  Idiopathic Hypersomnia (Mayo Clinic)

Featured photo by Medhat Ayad from Pexels.

Navigating the Fatigue Roller Coaster: My Personal Journey with Crohn's Disease

By Yeabsira Taye from Addis Ababa, Ethiopia

Living with Crohn's disease, a type of inflammatory bowel disease (IBD) which is chronic, comes with its unique set of challenges. Among the many symptoms that accompany this condition, fatigue has been a  constant companion on my journey. Fatigue in Crohn's disease is unlike any tiredness I had experienced before. It goes beyond feeling simply tired or sleepy. It is a bone-deep weariness that affects every aspect of my life. The unpredictability of fatigue is one of the most frustrating aspects. Some days, I wake up feeling relatively energetic and ready to take on the world, only to be struck by an overwhelming wave of exhaustion a few hours later. Other days, the fatigue is  ever-present and weighs me down from the moment I open my eyes.  

The constant battle with fatigue takes a toll on my emotional well-being as well. It can lead to  feelings of guilt, frustration, and even isolation. I often find myself feeling guilty for not being able to fulfill commitments or meet the expectations I have for myself. The inability to keep up with social activities or spend quality time with loved ones can lead to a sense of isolation and a fear of missing out.

As a medical student with Crohn's disease, battling chronic fatigue in the midst of hectic schedules is a formidable challenge. The unpredictable nature of the fatigue makes it difficult to plan and commit to my studies. There are days when I wake up feeling relatively energetic, only to have my energy levels plummet suddenly, leaving me unable to fulfill my obligations. This inconsistency can be disheartening and can lead to feelings of guilt and self-doubt.  

The experience of thriving for two years with Crohn's disease taught me that living with fatigue of Crohn's disease is an ongoing journey that requires patience, resilience, and self-compassion. By accepting the realities of fatigue and implementing strategies such as energy management, rest, nutrition, exercise, stress management, and building a support network, I have transformed my experience from one of mere survival to one in which I am thriving, despite the challenges.

Remember, you are not alone in this journey, and with perseverance and a tailored approach, it is possible to  reclaim control over your life and find moments of joy and fulfillment amidst the shadows of fatigue.

Featured photo by lalesh aldarwish from Pexels.

Things I Learned After 1 Year Diagnosed With Crohn’s Disease: Advice for the chronically ill and their loved ones.

By Giana Formica from OH, USA

A year ago today, I was diagnosed with Crohn’s disease and my life was forever changed. My body has gone through a lot in a short period of time. I’ve had four hospital stays, an ostomy bag for three months, two surgeries, and one colonoscopy. I’ve learned so much but this is just the beginning. I’m growing and learning everyday new ways to cope and accept the fact that I’m chronically ill and my life looks a little different than most. I’m proud of all that I’ve accomplished this last year but I am still learning and working on these skills and accepting these changes to my life. 

Progress isn’t necessarily linear.

The unfortunate reality of having a chronic illness means you are going to have bad days. It’s hard to measure your progress when focusing on the negative. 

How to change an ostomy bag.

Really I should say I’ve learned what an ostomy bag is. I have so much respect for my friends with lifelong ostomies. 

If you think you need to use a mobility aid, just get one.

When beginning to search for my own this was the best piece of advice I found. They are made to help people enjoy their lives and not be in pain. Why wouldn’t you want one? 

Art is healing.

Being able to have a creative outlet while growing with the life changes chronic illness brings, makes a world of a difference. 

It’s okay not to be resilient and strong all the time.

As a disabled person, we all hear the phrase “you’re so brave” or “they’re so strong” thrown around by able-bodied folks when referring to our conditions. We deserve to be able to break down and be frustrated about our experiences because sometimes it is just plain exhausting. 

Community building is incredibly important.

Having a support system of disabled friends and able-bodied allies makes such a difference in personally healing. 

Be the representation you needed.

Everyone’s experience being chronically ill is unique. It’s up to you to speak out and use your voice to advocate for what’s important to you.

You are a whole person, beyond your chronic illness. 

Medicine is very scientific. It’s important to remember the holistic aspect of your being beyond your illness or disability. 

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Featured cover photo by Miguel Á. Padriñán from Pexels.

Haemoglobin Heist: Anaemia as a Complication of IBD

By Zahraa Chorghay, Montreal

I transformed into a vampire in a field of daffodils

their lips drooped aghast as I soaked in the blood

of another human

my body was consumed with insatiable hunger

a voracious appetite for haemoglobin and oxygen

for life

the first miracle of life is birth, the second is living 

with all its defiance of the inevitable

of death

Do you know where all my blood went when I showed up to my hospital’s emergency department (ER), my head pounding and tests showing anaemia so acute as if I’d just bled out? They patched me up — a needle inserted into my left antecubital area (inner elbow) to deliver a unit of blood, stat, and some iron too — but remained bewildered as to the cause. On a stretcher parked next to the nurse station, I stared up at the ceiling tile painted with five daffodils, feeling like absolute shit yet relieved at the thought that maybe when all this was done, I would finally be rid of the headaches that had haunted me continuously for over a month.

It’s always the same, believe it or not; “It’s always the Crohn’s, believe it or not,” I told the tired attending doctor. Then, I headed home after an eventful day spent in the ER. 

Anaemia is “the most common metabolic complication” of inflammatory bowel disease (IBD), defined as a haemoglobin level of less than 13 g/dL in men or 12 g/dL in non-pregnant women (Mahadea et al., 2021). Given that haemoglobin is the oxygen carrier within your red blood cells, individuals will have reduced blood oxygen levels in anaemia, underlying the following symptoms:

• fatigue 

• weakness

• low blood pressure

• shortness of breath, even at rest or with mild activities

• rapid heart rate

• numbness or tingling in your extremities

• irritability

• headaches

• pale skin

• slight fever

What makes anaemia particularly complicated in people with IBD is the susceptibility to blood loss, dehydration, malabsorption, and malnutrition from chronic intestinal bleeding, inflammation, and ulcerations. IBD symptoms such as chronic fatigue, along with side effects of medications or surgical procedures, can further mask symptoms that medical practitioners otherwise rely upon to diagnose anaemia. To demonstrate just how complicated it can be, over months, I gradually had all of the symptoms listed above, which I complained about to my family doctor (GP) a couple of times, yet my anaemia remained undiagnosed.

The decrease in haemoglobin levels seen in anaemia can arise from iron deficiency since iron is necessary for haemoglobin formation. To increase iron intake, you can consume iron-rich foods, such as red meat, eggs, legumes, and leafy green vegetables like spinach and kale (Mayo Clinic, accessed 2024). (Palak ghosht, anyone?) Iron supplements, either oral tablets or IV infusions, may also be administered to individuals with anaemia, but those can have adverse effects so dietary changes are preferred. 

Unfortunately, even people who consume sufficient iron can show low haemoglobin levels due to lack of absorption through a diseased or surgically excised gut in IBD, other deficiencies (e.g., of folic acid or vitamin B12), early destruction of red blood cells in hemolytic anaemia, inherited disorders like sickle cell disease or thalassemia, menorrhagia (excessive menstrual bleeding), or adverse effects of certain medications (Penn Medicine, accessed 2024). Depending on the aetiology of the anaemia, different treatment options can be pursued.

In case you’re wondering how anaemic you need to be for your suggested treatment to be a blood transfusion — a last resort option due to its well-documented adverse effects, including potentially immune rejection — I showed up to the ER with a haemoglobin level of just 4.2 g/dL. I can’t get over how I was still able to get through that month of continuous headaches and shortness of breath everytime I stepped out of the house, appearing relatively functional to everyone else, despite calamity looming within me, literally within my veins. The human body is marvelously resilient, subhanallah! Nevertheless, I hope that having read this piece, you will be more easily able to recognize these signs and symptoms of anaemia as well as to advocate for yourself in medical settings, preventing you from having to find out firsthand just how resilient your body can be.

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Featured cover photo by Irina Iriser from Pexels.

I’m sorry to all the people I hurt while I was hurt

By Yeabsira Taye from Addis Ababa, Ethiopia

Being diagnosed with Inflammatory Bowel Disease (IBD) is an experience that is difficult to put into words. It is a moment that carries a mix of emotions, thoughts, and uncertainty. For me, it was a  whirlwind of confusion, fear, relief, and hope all at once. It offered a sense of closure to that chapter of uncertainty.  

During the difficult times of my flare-ups, I found myself longing for the support and understanding of  my beloved ones. Perhaps what hurt the most was the way “some of them” invalidated my experiences.  Whenever I tried to share my pain or express how I truly felt, they dismissed my feelings as mere  exaggerations or attention-seeking behavior. It was devastating to have my emotions disregarded and to  not have my pain acknowledged by those I held so dearly.  

BUT of course I am very grateful for the love and support of the people who take care of me. They  understand the challenges I face and go above and beyond to ensure that I am comfortable and well-cared  for. Now, after I have faced three flare-ups within two years I understood that, it is important to  acknowledge that everyone has their limits; chronic illnesses bring with us a multitude of physical,  mental, and emotional challenges. It is not uncommon for loved ones to experience emotional detachment as they witness their beloved family member, husband/wife, fiancée or friend endure the hardships of a  chronic illness. They may distance themselves emotionally to shield them from the pain of witnessing our  struggle.  

There are moments when the perception of distance from those we hold dear can lead us to inadvertently  detach ourselves from them in an attempt to protect ourselves. It wasn't easy dealing with the physical and emotional pain that accompanied our condition, we may blame them for making our flare-ups even harder  to handle.  

As time went on, I realized that the mistreatment I endured from others was not a reflection of my worth  or value. It was a poignant reminder that everyone faces battles of their own, and sometimes, their harsh  words or actions are merely the projections of their own pain and insecurities. While navigating through  my flare-up, I understood that forgiveness was essential. Forgiveness became a powerful tool in reclaiming my strength and power, transforming the negative energy into something positive.  

Today, I am grateful for the difficult journey I endured during that time of flare-up. It allowed me to tap into my resilience, strength, and inner resources that I might have otherwise overlooked. It taught me the  importance of self-reflection, self-compassion, personal growth, and forgiveness. 

Featured Photo by Vie Studio from Pexels

“I think but dare not speak.” - The hidden misconceptions of chronic illness.

By Selan Lee from the United Kingdom

I interned in the Perspectives Programme at Kaleidoscope Health and Care during my placement year. During this internship, I designed and managed client events and workshops, created weekly progress reports, and learned about healthcare systems and policy (in the UK, at least). But most importantly, I designed, curated and hosted an art exhibition celebrating intersectionality in chronic illness entitled ‘Low on Spoons, Not Identity’. Among the fabulous photography, fantastic comic illustration and fanciful jewellery pieces on display was a set of 3 (very amateur) A4 panels by me. Entitled “I am not…” each panel addressed a misconception often thought of but not spoken about chronic illness (some of which many in the chronic illness community still believe or are associated with by society, our loved ones or even ourselves.)

The first panel focused on the sainthood or idolisation of the chronically ill. Now, it may seem strange to find inspiration or guidance from someone who is often house- or hospital-bound and barely has enough energy to perform miracles - but the sick have been canonised as martyrs or lauded as idols for years. For example, fictional characters such as Tiny Tim in A Christmas Carol and Beth in Little Women are seen to be too good for this world. Katie Hogben remarks in her exhibition ‘Breaking Apart the Sick Girl Trope’ - that Beth is a “happy flower girl… Her amenable nature never falters, even in her long-term suffering and eventual death.”[1] In modern times, the misconception prevails - so much of the media surrounding chronic illness showcases a beautiful, rose-tinted, inspirational view of life with an often draining and limiting condition. The only way you can tell Hazel in The Fault in Our Stars has cancer is because she has a nasal cannula and an oxygen tank with her—no sign of fatigue, weight loss or steroid-induced moon face. Our social media is also filled with inspirational chronic illness stories and comments praising our ‘bravery’. I’ve received comments which praise ‘my dedication’ for studying during my infusions when really there’s no choice otherwise. 

Such aesthetically pleasing and morally affirming portrayals of chronic illness omit the less beautiful aspects of chronic illness. Consequently, this omits many realities and negates the ability of people with long-term conditions to voice the negativity in their situation. The misconception of being akin to a saint may be desired, but it enforces toxic positivity on the chronically ill - the individual must maintain a positive attitude and minimise their struggles; their lives are not validated if they do not meet this ideal. I, too, play my part in perpetuating this image. I have made social media posts highlighting my achievements since my diagnosis, but rarely do I post about the days I shut myself away in my room when I’m too exhausted. I don’t tell friends about the time I cried about my situation in an accessible toilet in a train station, but rather about the perks of having a RADAR key. Many of us fear isolation and lack of empathy by sharing the ugly side of chronic illness. Still, by continuing this misconception, we are abetting it, and its existence will remain ingrained in its stained glass iconography - distorting our authentic lives.

The second panel confronted the depiction of journeys in chronic illness as a ‘battle’ and the chronically ill individual as a ‘warrior’. I’m sure many people with chronic illness have encountered button badges, hoodies and posters emblazoned with the phrase ‘chronic illness warrior’. Or you probably have seen quotes that link your day-to-day existence with chronic illness as a ‘fight’ or ‘daily battle’, and by living, you are ‘winning’ or ‘not backing down’. These phrases can be supportive, but only temporarily. Chronic illness is something you can never win - hence the use of chronic. Being a warrior means you are courageous, like Joan of Arc (a figure I drew inspiration from in the panel), but I don’t think I am. None of my choices in my health journey are necessarily brave. I chose to self-inject my second biologic because the first stopped working, and I wanted to reduce the time spent in the hospital. I had surgery for my fistula because the pain was unbearable. None of these actions fit the definition of brave. The Cambridge Dictionary defines bravery as “showing no fear of dangerous or difficult things”.[2] I dealt with my dangerous or difficult things, the risk of a flare, anaphylaxis and infection, with plenty of fear. To live my life to its fullest possible extent, I have to accept hard-to-swallow realities and understand that when my life is on the line - I have no choice otherwise. Realising you have no choice is terrifying, but it is equally terrifying knowing the word brave is used here as a stand-in for ‘I’m glad it’s not me’. You’re right - you should be glad it’s not you, but like with the inspiration misconception, the use of ‘warrior’ and ‘courageous’ minimises our lives and makes our entire existence seem pitiable. Our existence is the same as yours - human.

Finally, the last panel looked at the misconception of chronically ill people being lazy. I’m sure plenty have felt lazy and wanted to ‘rot’ away in bed for the day, but the fatigue many chronically ill people suffer from is never the same. In early 2022, the term ‘goblin mode’ began trending, and many embraced an aesthetic which encouraged unapologetic laziness and self-indulgence. However, the aesthetic, as highlighted by Hannah Turner, ignores how much of the disabled and chronic illness community “embody goblin mode because there is often no choice not to”.[3] When you have low energy, you don’t want to expend the few spoons you have to change clothes or wash your hair. You use them to feed yourself or conserve that energy.

Moreover, laziness has connotations of purposeful slovenliness. I doubt anyone wants to be restricted to their homes while their friends go out or we miss out on cultural experiences. I missed my first concert, didn’t get to spend the last few months of high school with my friends, and had to cancel at the last minute for so many things because of my fatigue. My ‘laziness’ is a harbinger of regret over every missed opportunity. None of this is purposeful. I do not want to be ‘lazy’, but laziness has been thrust upon me.

There are many misconceptions out there about chronic illness, and there are probably some I don’t know of. But by keeping them unspoken and allowing them to penetrate our thoughts - we are enabling their pervasive influence on how we tackle chronic illness. Letting them be spoken and discussed will allow us to change the perspective and reduce their potency - one misconception at a time.

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References

1. Brave. (2024). https://dictionary.cambridge.org/dictionary/english/brave

2. Turner, H., & Sacca, P. B. B. (2022, March 21). As A Disabled Woman, The Goblin Mode Trend Doesn’t Sit Right With Me. Refinery29. https://www.refinery29.com/en-gb/goblin-mode

3. Welcome to Breaking Apart the Sick Girl Trope online exhibition. (2022, November 1). Breaking Apart the Sick Girl Trope. https://thesickgirltrope.wordpress.com/online-exhibition/

Don't Give Me Morphine!

By Peter Park, TX, USA

Like a knife in my gut, I feel the pain in my belly twist and turn inside of me. It’s midnight and I shout from the pain. I’m in my second year of medical school and I wonder if this is going to be the rest of my life. I start to cry because I know how this night will go. Another to the Emergency Room (ER). Another chance to defend my case. Another plea to doctors and staff to say, “my pain is real”. 

It started when I was 16 when the pain first began. It would follow the same pattern every time. I would be under a lot of stress from an important test, a breakup, or family issues. Then suddenly within a few hours, I would develop severe pain, and then no bowel movements for several days. First time I went to the ER, I was diagnosed with small bowel obstruction. They would stick the dreaded nasogastric (NG) tube from my nose to my throat. Give me some morphine. Then we wait for the first bowel movement. Go home after some intravenous (IV) fluids and call it a day. Doctors said it was a one-time thing at first. Then when I kept coming back with the same pain, they suspected me of opioid use.

From then on, quarterly trips to the ER in high school. I suddenly became an emergency regular. My favorite cocktail: IV saline, an NG tube, and a vial of morphine. I would be out in a few days. This went on for nearly ten years. Some diagnostic workup including abdominal CTs/MRIs, endoscopies, colonoscopies, small capsule endoscopy pill studies, balloon gastroenteroscopy with biopsies. All for “indeterminate”or “inconclusive” findings. For years, I would push for myself suspecting I had inflammatory bowel disease (IBD), Meckel’s diverticulum, complicated irritable bowel syndrome (IBS) or a whole differential of items to pursue. Still, I would be met with, “what’s your drug history, again?”

But this time, I know it’ll be different. I mean, I am a medical student now. I have presented my patients to doctors before. Now as the patient, I feel ready to present my case. 

After waiting in the ER for several hours, I am checked in and situated in a room in the ER. Still in severe pain, the ER nurse and I go over my history, symptoms, medications, social history, etc. Then, I ask for something for the pain. I can’t bear it. The ER nurse looks back and says “Let me ask approval from the doc for morphine”. 

Medical knowledge rushes into my head with a fact stating, opioids (i.e. morphine) cause constipation. Don’t take morphine when your bowel is obstructed! 

I turn to the nurse and tell him, “Please don’t give me morphine. I need a strong Tylenol or Tramadol. Just don’t give me an opioid.” And I will never forget the look he gave me, stared at me in the eyes and said, 

“All we have is morphine. Take it or leave it”

What? 

I’m suddenly so confused. I’ve worked in ERs before and I know what he’s saying is not true. Every neuron in my brain is fighting on what to say between the medical knowledge of other non-opioid alternatives to the supply and demand of medications that could allow for this situation to reasonably happen. Stuck between a stricture in my stomach and ever growing imposter syndrome, I cave and submit.

“Fine just give me whatever you have”

Following stabilization, I stayed in the hospital for a total of five days, where the last three days the whole medical team was just waiting for me to pass a bowel movement before discharge. So what if I had to stay in the hospital a few more days, who cares? 

And you would be right. The outcome didn’t affect my life in the grand scheme of things, but what I cared more about was the lesson I took away which was that:

Knowledge is power until you’re powerless. 

That previous system did not ever officially diagnose me with Crohn’s disease. In fact, I went about my own way to seek out two different Gastroenterologists from two different hospital networks to compare different opinions, run multiple different tests, and was finally diagnosed almost a year after my last emergency room visit.

Now, I am stable on a biologic and have not been in the emergency room for over a year. My final takeaway is this: Don't take no for an answer when it’s about your medical health. If you're confused, speak up. The only one that suffers from your silence is you, so stand up for yourself.

Peter Park is a 4th year medical student at TCU Burnett School of Medicine. He is pursuing Psychiatry and set to match in 2025 with hopes of treating mental health in patients with chronic disease.

Featured photo by Pixabay.