Nightengale

Anyone else doing Blogging Against Disabilism Day?

2008-05-01T23:18:00Z

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(slightly modified from the version printed in my Live Journal)

I've posted twice for Blogging Against Disablism Day, although never enrolling in the offical blogroll, just posting thoughts to my own LJ. In 2006 I talked about working in the newborn nursery where I couldn't examine the babies the way everyone else did because my hands are not strong enough. And about how no one was quite sure how to help me find another way. And in 2007 I talked about some recent conversations with other medical students in which they expressed opinions about how it must suck to be a kid who uses a wheelchair, CP=MR and that kids with CP who can't communicate must be suffering so we shouldn't try to save them.

Today my thought is that I am thankful to be working at a place that is relatively free from ablism.

Oh there's ablism. I mean, it's health care. There's "wheelchair bound" and there's discussions about kids with hypoxic brain injuries at birth because they grow up to be neurologically devastated and there's the surgeon who referred a family to the society for "crippled children." There's the attending who keeps trying to write my prescriptions for me. There's the nurse who didn't get how I could write an "out of bed as tolerated" order for a patient who doesn't walk until I pointed out that getting in her wheelchair was indeed "Out of bed"

But there's a lot less ablism here than in my previous life as a medical student. A tangible amount less. Enough less that I actually feel safe as a PWD (that's Person with a disability) at work.

When the attending in the ER says to me "you'll have to tell me what you can and can't do" and then listens to the answer - that's freedom from ablism. When the attending in student health says "I'm guessing you don't suture?" but then listens when I say, "well I have sutured but I think it would be better if you do this one for reasons A B and C" - that's freedom from ablism. When a residency-mate with a hearing impairment says "I can't take notes for the group on the board because I can't hear" and people respect him anyway - that's freedom too.

When I tell my program director I need to type and he says "I don't care if the notes are typed or handwritten so long as they are on the charts," that's an amazing statement of freedom to someone whose prior institution required an OT and MD eval and letters typed on letter head and months of meetings to reach, grudgingly, the same conclusion. It's a statement that the problems of PWD in that workplace are everyone's problems and that the important thing is to find a solution so that work can go on.

When a local community pediatrician spoke up at Grand Rounds about how Medicaid dollars should never have been spent on the patient just described, but rather one who might grow up to be "productive," and two of our own attendings immediately jumped on him, showing me I wasn't alone in my feelings, that's a kind of freedom also. And when a resident-mate who himself had been a baby similar to the one described stood up and walked out, he was demonstrating his freedom of expression.

When I can test my blood sugar in front of my colleagues without criticism - freedom. When people notice my pretty new springtime cane instead of staring mutely - freedom. When other residents sometimes take the elevator with me or sit at the back of the auditorium with me - on purpose - that's freedom.

Freedom from ablism in the workplace means freedom to be yourself, a person with a disability, not yourself trying to hide your disability or prove yourself despite your disability. And really it means freedom to do what people at work are supposed to do in the first place, which is get the work done.

It's funny that my first BADD post was about working in the nursery because that's where I start today. I still can't lift a baby onto my outstretched hand but I can roll one over and examine every inch as need be. I can teach medical students how to examine a newborn baby and point out what I do differently than they are likely to, not as a deficit but as a difference. The job gets done. Two years ago I posted "And so I'd better just get over it" and I guess I got over it. Not being put on the defensive at school/work for my very existance helps a lot in the getting over of it. About a year ago I was told I should "rethink my career choice" of pediatrics since I couldn't carry babies around the delivery room. Someday I hope that person can rethink her predjudices. I can do the essential job functions of a pediatric resident with and without reasonable accomodation. The rest is commentary.

Is there still ablism here? Well yeah, I work in health care. There is so far to go. But there is so much less of it, I feel thankful every day when I come to work that I ended up in this place. And let me never take for granted what it's like to work somewhere that is free enough from disablism to let me get the job done.

Little Boxes

2008-03-10T02:51:00Z

There was a Disability Blog Carnival about this a few months ago, but the idea had been cooking in my head for a good while before that. It’s about the boxes that people with disabilities get put into, or put ourselves into, or put each other into. These boxes are fallacies, because once you are in a box, you can’t simultaneously be in another box, or three other boxes, or to use the cliché, outside the box entirely. And it pains me to say it, but I know that I am not immune to some of these fallacies. What can I say? One of my autistic delights as a young teen was to sit outside in an upside-down dishwasher box with a book and my thoughts and the illusion the whole world had been reduced to the comfortable boundaries of four cardboard walls, with just a small hole in the roof for ventilation.

Some of the boxes are set up as dichotomies. The one that frustrates me the most on a daily basis are the two assumptions. Either a person with a disability can do Everything or he or she can do Nothing. And in fact, most other boxes seem to be derived on some level from either the Everything Box or the Nothing Box so I’m going to start with those.

The Everything Box

Here’s how the Everything Box works. You say, “well I’m not going into neurology because I can’t do a good neurological exam on adults”. They say “oh you’ll get it.” You say “well I’ve tried a lot of techniques and worked out some of the problems, enough to get by with teens once in awhile, but it does boil down to not having enough strength and that just isn’t solvable.” They say “oh I’m sure you can do it.” You bang your head against the wall.

The Everything Box is the bane of those with invisible disabilities because in the immortal words of Christine the Spoon Lady, we don’t LOOK sick. How to explain that despite being verbal and mobile, we may not have adequate vision, hearing, stamina, blood sugar or dexterity to drive a car, hear overhead announcements at the airport, climb three flights of stairs, leave our food outside the testing room or fill out 10 forms in 5 minutes. And even more fun, how to explain these things while in a crisis situation of one or more of them.

The Everything box has high walls reinforced with duct tape, also, when we try to explain to our schools or employers or the transit authority that we need accommodation. Because all the other students and employees can do it. Because we “manage” so well with our disability otherwise. Because it’s a requirement in some rulebook somewhere. Because if they made an exception for us they’d have to make one for everyone. Because even a person presenting with a cane, walker or wheelchair can’t possibly need an accessible entrance, because of course everyone can do everything.

You’d think it’s great people assume those without disabilities are capable people And it is good to be assumed to be able to do things we are able to do. But once we state our disability or inability, the Everything assumption is not liberated and liberating. Rather it is confining. Because the very fact of having a disability means one cannot do Everything, under Every circumstance, Every time as well as Everyone Else. Sometimes we need an alternative technique, an accessible route, an accommodation. If the expectation is Everything and one cannot live up to everything, well then the only alternative is an expenses not paid trip next door to Nothing.

The Nothing Box

Nothing is the one people know about, which is why I started with Everything. We’re all familiar with the Nothing stereotype. People with disabilities can’t do anything. Can’t, can’t, can’t.

The way this one plays out is, “Oh you can’t do a rotation there, because of your disability.” “You shouldn’t go into pediatrics if you can’t carry babies in the delivery room.” “You can’t major in this because” “go to that location because” “hold a job because.” I’ve coded these as “you” statements but they could as easily be “I” statements.

People with visible disabilities get this one all the time. Wheelchair equals complete and total physical and mental inability. “What would he like to eat?” the companion of a wheelchair user is asked at the restaurant. Sometimes after “he” has just ordered for himself. People see my cane and start to help me with things - like pulling my suitcase out of my hands as I swing it up onto the train luggage rack. Ironically, this help puts me in more danger of losing my balance than just hoisting the bag myself.

People with invisible disabilities get this as soon as they disclose, though, too. I tell people I have difficulty with handwriting and they start offering to write things for me. Like their phone number as I have a pen in my hand and am already writing it down. I tell people I have diabetes and they make all sorts of assumptions of what I can eat, usually Nothing. (Either that or they assume I can eat Everything. Always boxes)

Nothing is the one we have had as a model far too long. It’s the Nothing box we’ve been put into instead of regular education classes when all we needed was access to school and class. And the Nothing box where we’ve been asked to live at home being cared for instead of working and perhaps even caring for others. The Nothing box that keeps airlines from letting some of us fly alone. And the Nothing box that makes it OK for our relatives to euthanize us and have it called charity instead of murder. The Nothing box is a black hole to nowhere.

Tiny Tim and the Supercrip

These are a couple of the common disability stereotypes out there. Although like I said they seem to be variations on the Everything theme and the Nothing theme.

Tiny Tim is a Nothing version. In the Tiny Tim model, people with disabilities are objects of pity and need our charity. Jerry Lewis and the Telethon love this model. They show poor helpless children with disabilities sitting sadly on the sidelines watching others play. This is what generates the cash, after all. Never mind the MDA actually gives the money to things to help kids with MD have fun, like new wheelchairs or van lifts or camperships. That model doesn’t sell as well apparently.

The evening news loves this model also. They show cute kids with disabilities and nice charitable people or celebrities or Easter Bunnies giving the kids a good time. Aww.

The Supercrip is a reverse where a person with a disability is highlighted for doing all sorts of amazing things. Things which would be amazing even if a non-disabled person did them, some of them. Things like climbing Mt Everest or skydiving. Or things like holding a job like doctor or lawyer. Or in some cases being a mother. Right now there’s a supercrip making the news because his prosthetic legs are considered BETTER than regular legs so they won’t let him run in the regular Olympics.

The evening news is a fan of this model as well.

The Supercrip can do Everything. Why we don’t even think of him as disabled. Isn’t that the highest of complements? And then he can inspire us because if he can do it, so can we the non-disabled. Only the news doesn’t use the term “non-disabled”. They say “normal” or “healthy” Phrases like “dreams” or “disabled in body but oh so whole in spirit” are used. You know, maybe the Supercrip Everything fallacy isn’t so far from the Tiny Tim Nothing one after all.

Disability and ‘on disability’

So this one gets into the very way disability is defined. And in fact, the way it is defined by the government. And on some levels, this is the one where I slip up the most, leaning too far towards the Everything Box in my frustration for the way the Nothing Box plays out here.

The definition of disability I tend to use is that of the Americans with Disabilities Act (ADA) which defines disability in terms of accessibility and civil rights needs. Specifically a person with a disability (PWD is an acronym I like a lot) has a substantial impairment in one or more major life activities. Some major life activities they suggest are walking, talking, using hands, seeing, breathing and working. The ADA also covers people who don’t have such an impairment but are treated as though they are.

There’s a couple of sections in the ADA. One is about accessibility and accommodation requirements so that PWD can come out into the world and participate in the same arenas as everyone else. Parking lots need accessible spaces. Hotels need accessible rooms and visual smoke detectors and Braille signage. Concerts and sporting events need accessible seating. It’s not quite an Everything definition, of course, but does imply needing access to More Places so can do More things.

Then there’s the section that keeps me employed. There’s some powerful language in here. It’s not Everything language but it’s a lot closer to that than to Nothing language. Basically it says that a workplace can’t discriminate in hiring against an “otherwise qualified” PWD who can perform the “essential job functions” “with or without reasonable accommodation.” These are some powerful statements, although of course it’s always up for debates who is “otherwise” qualified, which job functions are “essential” and what accommodations are “reasonable.” Overall, though, it’s designed to get and keep a lot more of us working, because a lot of us can work, if we are not experiencing discrimination and receive reasonable accommodations. And working is a good alternative to the Nothing alternative.

The Nothing definition of disability is the one used by a lot of lay people, a lot of people in health care, and the part of the government that doles out disability benefits. Only they don’t call it the Nothing definition of disability of course. Often they just call it “Disability” Or qualifying “for disability.” Or “being on disability.” Now if it were up to me, I’d call what the ADA calls disability “disability” and call what the SSI/SSDI people call disability, “disabled in such a way and to such an extent as to be unable to work.”

Now this is where the confession part comes in. Where I explain how I buy into a disability stereotype. Even though I try not to buy in, this one I have some problems with. And yes I understand that there are people who are disabled in such a way and to such an extent that they are unable to work. I know such people, as friends, as patients, as people I have met in the disability community online. And I believe SSI/SSDI should exist to help people in this circumstance. In fact I believe SSI/SSDI should do MORE for people who are truly disabled in such a way and to such an extent that they are unable to work. Especially those who might actually in fact be “disabled in such a way and to such an extent that they are unable to work sufficient hours to have a job with benefits like health insurance but in fact are able to work part time in certain jobs with sufficient accommodations.”

No my problem is to use the one simple term “disabled” in place of such an explanation. Because it starts to descend so quickly into the Nothing model. Because then people start thinking of “disabled” as a synonym for “unable to work.” And without invalidating those people who are unable to work, disability doesn’t mean that and it’s just going to make things harder for those of us who can and do work.

To wit, the diabetes educator who told me I was “inspirational” because I work with my diabetes and disabilities. Because she has Type 1s who are “on disability” and don’t work. She didn’t mention anything about them having serious complications or other reasons for disability besides Type 1. And while Type 1 does meet the ADA definition of disability (at least as originally written) nothing in just the Type 1 diagnosis should render a person completely unable to hold any sort of full time work. Considering that all the Type 1s in my life are either employed full time or are full time students.

To wit, the people who tried to offer me disability insurance when I started my residency. Now admittedly there is a possibility I could become disabled to in such a way and to such an extent that I could no longer do the work of a pediatric resident. I could develop an inability to stay awake all night. I could develop cognitive impairment and not be able to remember names of medications safely and reliably. I could develop severe hearing AND visual impairment. I could lose the use of my hands completely. I’m not saying these things can’t happen, and perhaps I am playing with fire by not having disability insurance.

But the whole point of the sales pitch was not about becoming disabled in such a way and to such an extent that one can’t complete a residency. It was about “if you develop a disability” and can’t work. And I’m sorry but, well, I already HAVE a disability and I AM working. (I told you this was the one with which I have the most trouble) I wonder if I applied for Disability Insurance based on my current level of ability and my current job I’d qualify. I sure hope not!

Then there’s the people in the disability community I meet who tell me they are considered 100% disabled. I’ve met patients like this too, people who walk into the ED with chronic back pain and when I ask if they work, explain they are disabled. 100%. Yet there are people with quadriplegia who require attendant care at home to get out of bed and dress, and who then are able to work. So I assume would not qualify as 100% disabled. How does the government determine percentage of disability anyway? It can’t be as simple as number of damaged limbs. 12.5% off for each arm? 40% for an eye? Number of possible hours a week someone could work?

Like I said, I think disability insurance, SSI and SSDI should exist. I think people who are disabled in such a way and to such an extent that they are unable to work should be covered. And even more, I think people who are able to work part time but can’t get insurance benefits should be covered for health care while still working to the extent possible.

But I do wish there was some way to convince the insurance people, the government people, the medical profession and the general public that “disabled” does not mean “disabled in such a way and to such an extent as to be unable to work enough to support oneself or get health insurance.” This is a SUBSET of disability that needs 23 more words . And to use “disabled” for both uses is to slam an awful lot of us into the Nothing Box who simply don’t belong there.

Not that there should be a Nothing Box in the first place. Or an Everything Box. Because disabilities and people with them really live somewhere in between any box you could name. We can’t do Everything. We can do more than Nothing. We are People With Disabilities taken all together but more than that, we are individuals. And so rather than get stuffed into a box, I think I’ll dump out the soap and climb atop. And suggest to the world that they treat each of us with individual weaknesses, individual abilities and that the single word “Disability” only goes so far in describing any one of us. So instead of using the label as an ending, stamped onto a box after sealing, how about we start using it as a beginning, tear off the duct tape and talk about what’s actually inside?

DRVSS, NLD, the disability I don't officially have

2007-10-09T22:06:00Z

(This is cross-posted from my Livejournal. I hope that's allowed)

DRVSS

It’s pronounced, roughly, Diverse, and stands for “Difficulty Responding to Visual Stimuli Syndrome.”

And no, it doesn’t exist.

It was around tenth or eleventh grade that I concocted the term, because that was when I began to notice just how much difficulty I was having dealing with visual stimuli, what I would now call “visual processing.” Before then I had had difficulty recognizing people (and as a tormented child at a school where “everyone knows everyone” by definition, I had been unable to explain that I couldn’t recognize my tormentors) and difficulty following certain TV programs, but this was the first time it was beginning to impact my academics.

Mostly it was a problem in French class. We were doing a lot of conversational work preparing for the language AP exam and I was struggling. One task involved telling the story from a series of cartoon pictures. I recall not recognizing a lifesaver and thus not realizing the setting was a boat. Another was a movie-watching assignment where we had no book (unlike movies we’d seen in English class that were based on books we’d already read, or those in History class where we were not expected to have an involved discussion about plot and character.) In both scenarios I was completely lost, and the teacher mostly unswayed by my plaintive whimper that I “couldn’t do this in English either!”

The one that sticks out the most in my mind, though, is a scene from US history class. I had generally been a good history student, and got on well with this particular teacher. I read the textbook, participated in class and LOVED writing essays. So when the teacher put some contemporary political cartoons on the overhead and asked me to explain the first one, he was acting in good faith that I’d have a timely, appropriate response.

Instead, I stared at it. There was silence.

The teacher decided to prompt me, a good pedagogical technique. “What is the cartoonist trying to say about President Clinton?” The year was 1993.

I stared some more, at the three figures sketched. I had watched the debates on TV, lived with Clinton supporters for the past election cycle. I knew his voice. “Which one is he?” I asked. There were snickers. The teacher pointed. I stared some more.

“What does what President Clinton is wearing say about what the cartoonist thinks?” he prompted still further.

“Is he wearing something unusual?”

It was with a good bit of understandable impatience that the teacher said, “Nightengale, he’s wearing a dress!”

Oh. Well if I had stood there with my eyes closed and been told, “there’s a cartoon with the newly-inaugurated president in a dress, what does that mean?” the whole thing would have been over and done with by now. I interpreted the cartoon.

This was the first of many times I suspected I would have done better with my eyes closed, if people didn’t think I had 20/20 corrected vision and had to explain things to me verbally. At that point it was more of an annoyance than anything else. But it was becoming an issue in the classroom and I decided it needed a name, so I gave it one. DRVSS.

I went off to college and took Greek. I’d always been good at languages. Latin. French (cartoons and movies and names of American brands of soda notwithstanding.) Spanish, for the short time I’d taken it. So why not Greek? Well, there was always a point in learning those other languages where the letters formed themselves into words, and then phrases, and then sentences. Greek stayed as letters I had to sound out. Everyone else was reading Plato and I was still sounding out words. Greek and I agreed to walk away slowly before anyone got hurt.

The next year it was organic chemistry. Everyone always says orgo is a lot of memorization. Well I’d always been good at memorizing, but here I couldn’t find anything to memorize! The pictures all looked the same to me. This time I couldn’t walk away slowly because I needed this course if I ever wanted to attend medical school.

So I went to get myself tested. Because, see, by that point I had learned there really is a DRVSS, it just has another name. NLD, or sometimes NLVD. Non-verbal learning disability. NLD has some other aspects, like difficulty interpreting non-verbal social cues, but one of the hallmarks is a relative difficulty interpreting visual, as opposed to verbal input.

They gave me IQ tests and a Rorschach test. Most of the visual questions on the IQ test were things I could reason through verbally. Those blocks to rotate in your head, for instance, I had always been good at those because I could just talk my way through them. I failed the Rorschach. Oh, don’t tell me you can’t fail it. I failed it. There were 20 little cards, and for the first 15 or so, all I could say is that each looked like an inkblot. Sometimes I prevaricated a bit and said they looked like butterflies, which, with their inkblot symmetry, they did, sort of. I was told, not without some condensation, that most people my age could see more than one thing in the inkblots. This infuriated me, since I could barely see one. Then this one inkblot near the end, it actually DID look like something! I was ecstatic. It looked, I said, like an acetabulum. “A what?” the tester asked. “An acetabulum,” I said. “At least I think that’s what it’s called. It’s a bone in the pelvis.” In retrospect I would have said it looked like the entire pelvis, acetabulum, ilium and all, but I hadn’t had anatomy at the time. And I don’t think this explanation would have gone over any better.

In due time I got my results back. There was a 16 point discrepancy between my visual and performance IQ scores, which was statistically significant and “associated with a non-verbal learning disability” according to the report they gave me. However, they told me in person this didn’t count as an LD because both scores were above average. They interpreted my problems with the Rorschach as inflexibility. Swell.

I took orgo again, found a way to type footnotes to my handwritten diagrams explaining what the differences were between each picture, memorized the footnotes and did well. My non-NLD was not really a problem for the rest of college, or indeed my years of teaching. Oh, watching Star Wars or the Princess Bride was a nightmare, until, of course, I was given the book to read, so I either avoided movies, went with a friend to interpret or did my homework during them. I had a little trouble telling if the kids had cleaned up an area according to specs, and I had a few students I found it difficult to tell apart from time to time, until I learned their voices. And then, of course, there was the complete lack of any sense of direction, like the night I drove from Delaware to Delaware by way of Maryland twice. Or the little city of Salisbury Maryland, where I got lost so many times, the wrong turns looked just as familiar to me as the right ones.

But mostly I made it through until medical school. When I was confronted with anatomy. Which is about as visual a course of study as is out there, I would imagine. It was like trying to memorize not just a map but a road atlas, including the names of all the overpasses and bridges. For the written exams, there were lists of muscle attachments and organs supplied by each branch of a given nerve I could memorize, but for the practical exam, there was really no hope.

I went to the prof and was given “study tips.” I went to my dean and was told not to worry (a saga in itself.) I was sent to the Adult Learning Specialist and explained to her how I am an auditory and kinesthetic learner with lifelong poor visual processing skills. She went to her file cabinet and rummaged through it, emerging triumphantly with her “Tip Sheet for Visual Learners.”

“But I’m NOT a visual learner!” I protested.

She suggested I work on my visual skills.

I pointed out sweetly that while I was more than willing to work on them, I really doubted I was going to get significantly much better in the next 6 weeks than I had gotten in the past, oh, 26 years, and might she possibly have any Tip Sheets for auditory or kinesthetic learners?

Eventually I managed to pass a written re-exam. After that, I learned to ask for help early and often for histology and pathology, the other visual fields. The people who helped me with histo and path were really wonderful sorts. They were constantly commenting on how good a grip I seemed to have on the material, how I had clearly read the text. How I was really only asking for help on very few, specific things. Which is true - I was only asking for help on things I couldn’t learn from the text. Like how to tell two different pictures apart that looked pretty much like a sea of cells to me.

You know how a picture is supposed to be worth a thousand words? I’d rather just read the words.

I am fortunate that in most medical settings, I do not have to visually identify people in a vacuum. Patients generally stay in their rooms, which have names written next to the doors. Or they are found in clinic rooms, and the chart is handed to me with the room number written clearly at the top. And they come in a pretty decent array of ages and colors, so if you walk into a room looking for a 2 month old girl, and the room instead contains a 15 year old boy, even I can generally figure out I’m in the wrong place. (Unless, of course, the 15 year old has actually brought the 2 month old to the doctor, which does happen, but that’s another commentary.) Many doctors and NPs wear white coats with their names embroidered above the pocket, and employees of all medical settings I have ever experienced are supposed to wear ID tags at all times.

I’m a doctor now. A real, live doctor, although practicing under a fair bit of appropriate supervision for the next few years. I feel pretty comfortable taking care of children with trachs and G-tubes, children who have rare genetic conditions I have to look up in the 45 seconds before I enter a patient room, children who take 5 different medications before breakfast and 3 of them preparations I have never heard of before. I take a good history, my physical exam skills are improving daily, and I consider myself a decent diagnostician given my level of training and experience. But there are two aspects to general pediatrics which regularly trip me up.

Ear infections and rashes.

Because there is no history in the world that will tell you if a child’s ear drum is white, grey, red, flat, bulging or retracted. Either you have a clinical suspicion of ear infection or you don’t, but it’s the exam, not the history that confirms it. And there is no history in the world that will tell you if the bumps you see before you are hives, no matter how suggestive the history may be of an allergic reaction.

The result of which is there are a few attending down in clinic who are probably becoming convinced I know absolutely nothing of useful whatsoever, because every time I present a child to one of them, it is either all about a rash or all about an ear infection.

What can I say, if I closed my eyes and the mom described the rash to me, I’d probably be in better shape? There’s an old joke about the doctor suggesting the patient “hold the rash up to the phone,” but there’s a bit of truth in there for me as well.

Every now and again, the topic of blind physicians comes up. There are blind physicians out there, I know, although I have yet to meet one in person. Some attended medical school as blind people, others lost vision after completing training. And often sighted medical students or physicians express concern about the appropriate of blind doctors, about all the things they can’t do. About how they have to rely mainly on descriptions of visual phenomena. Of course I leap to the ADA argument, the “essential functions” argument, the “otherwise qualified” argument. And all the while I am somewhat envious, because I would probably do much better if I were given those descriptions myself and bypass the visual pathway all together. But my vision is fine. 20/20, corrected.

A few weeks ago, I got ahold of the map that explains where to park in case of a football game. The stadium, you see, shares a parking lot with the hospital and the first home game was Saturday. On Monday I found the alternative parking area behind the hospital but not the route to it I would need to take when the main road would be blocked off. On Tuesday, I found the alternate road, but couldn’t find the parking area from it. On Wednesday I got groceries. Thursday I found the parking area again and then drove out through the alternate road. Friday, I think I went home.

Early Saturday morning, I made it up through the alternative route to the alternative parking area in the foggy pre-dawn and parked my car. I was on call, so I loaded up my luggage rack and tried to figure out where I was, wondering where the promised security officers might be. Luckily I heard the voice of another intern and followed her in. I worked all day Saturday, and then Saturday night, and was done with my work around 10 AM Sunday, as was the medical student who had been on call with us. The attending sent him out with the instruction, “Your last duty is to help Dr. [Nightengale] find her car!”

The student was sweet and chivalrous and he did. We tried where he thought it might be based on my foggy description, only to discover someone else’s slate blue Ford Taurus there instead. A few minutes later and further away, we did find my car.

But somewhere that week, between the driving and the frantic map-gazing and the wandering, it occurred to me. DRVSS may not exist, I may not officially have NLD. But my poor visual processing skills probably impact me so much on a daily basis, that really I think it’s more disabling than asthma, CP, chronic pain and Type 1 diabetes all combined.

Maybe someday I’ll get DRVSS recognized after all.