Kate Otto Chebly is an American internal medicine physician working in Caracas, Venezuela.
What does “normal” mean in the realm of human health? In my short story “Panic Value” (Intima, Spring 2022), we meet Asha, a laboratory technician who is responsible for reporting her hospital’s abnormal lab values. We observe her in a moment of transition, questioning what “normal” really means. She grapples with painful memories—as a mother, wife, and immigrant—in which she sensed things were not right, but was told to not worry. She interrogates: have I ever accepted as “normal” something that was actually cause for panic?
As a physician, I’ve seen Asha’s tension play out in the lives of many patients. I remember a young woman with crippling sickle cell pain crises, who recounted how often her pain went under- or untreated, told by various clinicians that such suffering was to be expected in her condition. I recall an older man with uncontrolled diabetes, his family far away in his home country, who had been made to feel that his debilitating loneliness and subsequent health complications were an unavoidable given his circumstances. These patients, and so many others, experience realities that may indeed be “normal”, in the sense that they are commonly occurring, but are not remotely acceptable.
In Asha’s case, it is the memory of her deceased son Kunal that prompts her to question normality and trust her instincts. I immediately thought of their dyad when I saw Dr. Mohamed Osman’s “Visual Hallucination” (Intima, Spring 2015), which portrays the image of a woman staring at her shadow against a wall. The woman sees and embraces something else in her shadow—someone else—and we might wonder if the person is real, or a hallucination (after all, the person in the shadow seems to have their own shadow, too). The image reminded me how Kunal remains a very real part of Asha’s reflection, and how she still lives in his shadow as well, as she tries to reconcile his death.
Dr. Osman’s work reminds me that it is essential to honor patients’ individual experiences, as normality can become oppressive, especially when defined through biased lenses. Consider for how long doctors have left untreated the pain of intrauterine device insertion or the discomforts of menopause, as if they are unavoidable rites of passage. Consider the disproportionately high rate of death among post-partum Black people, whose calls for help are often ignored with fatal consequence. Simultaneously, medicine also struggles with defining ‘normality’ too rigidly. Not so long ago, being gay was medically classified as a mental health disorder, and even today the validity of transgender lives is often questioned and threatened.
Reference ranges are, of course, helpful guideposts. Appropriate reassurance that not every abnormality is dangerous can be healing. But physicians must learn to craft clinical insights that are informed by each patient’s instincts and needs, and free from the physician’s biases and expectations of “normality.”
Kate Otto Chebly is an American internal medicine physician working in Caracas, Venezuela. She is the author of the book Everyday Ambassador: Make a Difference by Connecting in a Disconnected World.