Borderlands

Borderlands are perilous places where you are neither here nor there. You have no tangible grounding and may not even fit on one side or the other. We often think of borderlands in terms of ethnicity; of great barrier walls rising up between nations to define who fits and who does not. These are structurally violent borderlands—by this I mean they are landscapes where governments or groups of people create social structures to deny human rights to another group. And eventually, these hot spots of structural violence lead to actual violence as individuals rage for their justifiable human freedoms. Yet what is this doing in a blog about illness?

Well, there are borderlands in medicine—created structures that allow certain status quos to remain in place that are harmful. For example, two individuals are seen at an ER for chest pain. One has pain in the heart region and radiating down the left arm; the other has pain in the back and just where the stomach is. The first patient is male and the second patient is female. The male patient is identified as having a heart attack and treated quickly. He survives. The female patient is diagnosed with epigastric pain likely due to stomach-related issues; she dies. The problem: men and women present differently when it comes to heart attacks, but research, until recently, only studied men leaving women stuck at the borderland or flung over the wall with an entirely incorrect diagnosis based on nothing more than hunches and stereotypes.

Borderlands pop up all over medicine. Sometimes they are as simple as appearing in labwork, where your bloodwork skirts the edge of normal, indicating something violent is brewing but it is ignored by physicians as being spurious, incidental, mistaken. Borderlands appear when doctors are unsure as to what is going wrong in your body and when pressed for an answer, physical illness is denied in favor of very rare, rare psychiatric conditions. If you do not fall on this side of the wall, you must be on that side—one side are physical illnesses and on the other are psychiatric illnesses, as if the latter has no biological basis for its occurrence. And your bloodwork is the fence that divides the two. The danger is obvious—a wrong medical diagnosis leads to improper treatment, at best. At worse, death.

I’ve sat on those borderland fences many times. Every time I have to talk to a doctor about a new symptom, I am right back at that fence. That is how I feel heading into my neurology appointment next week. I am already worried about it, despite the fact I have known my neurologist for 10 years now. Is there a medical cause for failing muscles or is it simply “all in my head”.