MyChart

You are at your kitchen table in the early morning, avoiding checking your email, as you have often vowed and usually failed to (not) do. Perhaps you are on Facebook, Twitter, or on what remains of your newsfeed after refusing to renew your Apple Plus subscription in a vague but admirable attempt to be “more present.” Perhaps you are doing something less guilt-inducing like browsing Thanksgiving recipes, or something more important, like writing a to-do-list, a novel, a blog post. As, for example, you ponder the problem of too many side dishes and too little oven space, an email alert pops up. “You have a test result from MyChart.” How this alert registers, how it sounds, looks, and feels to you, depends in part on how anxious you are about the test(s) you have taken. This email could be anything from the faint echo of a routine check-up to an answer to prayer. Even in the first case, you realize as you do or do not open the email with the test result, that the medical world has reached out into your home to touch you. The surge of adrenaline—small or large, depending—transports your body from your kitchen to the doctor’s office, to the lab, to the mysterious non-place of MyChart.

If you choose to open the email, you will have to go through the process of entering and sometimes resetting your password. You actually have multiple MyChart accounts, even though in your city many of the hospital systems you use have merged, although not always completely, and not always in a good way. All the accounts have different passwords, since you have been warned not to duplicate  them in the interest of what is sometimes expressed as “security” and sometimes “privacy.” Usually but not always, clicking the link in the email takes you to the right place, the place where you can open one test or nine, and scroll down to a series of terms you may well not understand, words you do not associate with your body. After a dermatologist appointment and a biopsy, you might encounter the words “squamous carcinoma, subdural.” You might understand the words separately, but perhaps not as a package. You will likely focus on “carcinoma.” After a routine blood test, you will, if you have the stomach for it, scan a list of words. Some are familiar, like “glucose,” others like “creatinine” sound more familiar than they are. Then there is what critics of literary critics dismiss as “jargon”: words like “alkaline phosphatase,” which at least sounds like something that might be found in nature (or at least in a chemistry set), and AST (SGOT) or ALT (SGPT) that do not. Another column will list the “normal ranges” of each of these analytes, itself a word that you probably would not know (unless you’d happened to consult a chemist friend) and which means “a chemical constituent of interest in an analytical procedure.” You spend considerable time peering at and comparing your numbers to the normal ones until you realize that abnormal values are tagged, in a separate column, with a red letter, H, presumably for “high” and “L” for low. You only figure this out, of course, when you get to an abnormal value. These test results, including the squamous, are what baseball folks now call “low-leverage.” Then there are other test results, that even in their anticipation have the power to stop your heart; where you must contend, for example, with the word “mass.”

What you do not see, at least recently, are any contextualizing notes by your doctor or nurse. You are, the first to receive the alert, the results, the news. Unless you have a medical degree or have a longstanding condition about which you have educated yourself, you will not know what the test results mean.  You may well not know what a squamous carcinoma is, although you might understand and be terrified by the second word. You will not know if the red letters signaling abnormality in your blood tests are important, whether a high level of chlorine, for example, is something that should or can be remedied, whether it is a sign of a fatal condition, or whether it is, as doctor’s sometimes say when you get to see them, “just one of those things” or, sometimes, “just one of those things that are high in women.” You may not know that definitions of “normal”—for example for blood pressure—have shifted over the last few years so that more and more people get abnormal results.

You remember the early days of MyChart, when test results would not be released until your doctor had seen them, when you would find a note at the top of the first page from a nurse that might say “Dr. X is not concerned about this.” These days, MyChart assures you that any questions you have can be addressed to your doctor. The app invites you to call your doctor’s office, or to send a message through the app that will be answered within 2 business days. It is always a weekend. Also, calling your doctor is not easy, if by “calling” you mean, not “dialing a number, waiting on hold, pressing buttons and leaving a message that will be answered in another two business days if you carry your phone everywhere,” but “getting a response to a question.”

You have complained to your doctor that you do not like receiving test results that have not been read and contextualized by her. She is sympathetic, although she cites legal and bureaucratic forces beyond her control. Her solution is to tell you not to read the text results, not to open the email until she has had a chance to go over the results and communicate with you. Sometimes she explains that she will only write to you through the app if the tests are abnormal. Ignoring the messages is harder than in sounds, especially since your app sends you reminder alerts that you have not figured out how to turn off. Mostly it is hard because you, long ago, and perhaps too easily, bought into the slogan that knowledge is power without. You never thought about degrees of knowledge, or what you have come to think of as different, plural, kinds of knowledges. If you are, improbably, an academic, or someone who values knowledge perhaps a little too much; or if you are, I hope less improbably, a feminist, who thinks often about power relations, you will—desperately—want to know, if only because you don’t want someone else to know first. People like you always, for example, want to know the gender of the baby, even if you don’t really care what that gender is and it might be more fun to be surprised, because you don’t want doctors knowing more about your baby than you do.

You will probably be able to ignore your test results for a day as you wait for a sign from your doctor. When there is no such sign for several days, you breather easier. Surely, you tell yourself, if there were a problem she would get in touch with me? That thought, alas, is for daytime only, as are the following somewhat rational mantras: she is waiting for all the tests to come in to get the big picture; she is very busy/on vacation/has herself been overtaken by illness.  At night, even the last imagined narrative loses its power, and at some point, perhaps in that most vulnerable moment just before bed, you succumb, open the email, click on the link, try several passwords before resetting yours, and begin your nighttime reading. Unless you come across the word “unremarkable,” you will likely not sleep.

MyChart and its e-cousins—the endless apps that claim to allow you to “manage” your own health, money, electricity—thrive in the name of knowledge and empowerment. They also, of course, depend on a relatively new idea of home—one that reconstructs the domestic sphere as an information hub, a place of data collection and dispersal. In this view, leaving home to meet a doctor registers as something of a defeat for the middle managers that we have all (had to) become. It is easier, perhaps, to imagine the abstractions of management for some activities than for others. Since the age of credit, and then of the check, money has become increasingly abstracted to the point of its conversion into bytes of information, Zelle-ed or Paypal-ed from one kitchen to another. But the body is messier, more freighted, more connected to physical spaces like the doctor’s office, the free-standing lab, or the endless unmanageable parking lots that surround both. Telemedicine LINK has done much to keep our bodies out of the public eye, although of course there are limits to this success. MyChart, with its strangely individualistic and indeed possessive name, is another step in the abstraction of the body in the name of domestic management.