The Human Diagnostic

The Invisible Work of Being Unwell


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Format: Post-call

Runtime: ~8 minutes
Source: Psychology , illness cognition and self-efficacy (Leventhal's self-regulation model, 1980s); reduced executive capacity; adjustment without drawing attention

There are calls where you figure out pretty early that the job in front of you is not the whole job. The HVAC is one thing. What it takes to complete the call well is another.

She called about the heating. Late November. The system was short-cycling and she'd noticed it had been doing it for a few days. Smart observation , she'd written down when it happened and for how long. The kind of observation that tells you someone is paying attention carefully to the things they're responsible for.

When I got there I could see she wasn't well. Not dangerously, acutely ill , she wasn't in crisis. But the kind of unwell that a person manages over a long period. She moved a little slower than you'd expect. She got tired during the walk from the front door to the unit. She had the particular quality of someone who uses their available energy carefully because there isn't as much as there used to be.

She didn't mention it. I didn't ask.

The system had a failing inducer motor. Not unusual for the age of the unit. I quoted the repair, which wasn't cheap. She listened to the whole quote, asked a few questions about timeline , how long she'd be without heat, whether the repair would hold for the season , and then said yes.

Clear. Direct. No hesitation.

I want to say something about what it takes to make that call , to be that clear and direct about a significant repair decision , when you're managing a health situation.

Howard Leventhal spent decades studying how people process illness. His self-regulation model documents something he called illness cognition , the mental and emotional frameworks people build around being sick. One of the things his research found is that illness doesn't just take physical resources. It takes cognitive resources. Attention, executive function, the bandwidth for processing complex information and making decisions under uncertainty. When those resources are already deployed managing symptoms, managing medications, managing the daily logistics of being unwell , there's less available for everything else.

She'd allocated enough of what she had to get through the call. I could see it was costing something.

I adjusted the call in ways I didn't announce.

I kept my explanations shorter than usual. Not incomplete , I told her everything she needed to know. But I chose the essential version of each thing instead of the full version. When the quote had parts that were adjacent-but-not-essential, I didn't walk through all of them. When the payment process had steps, I made them as simple as possible.

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The Human DiagnosticBy Dave Hartzell's Heat & Air - Kingfisher,OK