Active Engagement as a Cancer Patient I - PowerPoint Presentation

1. Active Engagement as a Cancer Patient IRMCA April 4, 2020

2. Why This Paper?10 plus year BRCA-1 Breast Cancer SurvivorDue to the need to make daily life decisions during treatment and recovery about what I could or could not attempt to do on a given day – learned a lot about the physical and emotional energy as well as the talk work involved in interactions in the medical context between provider and patient

3. Interaction Discourse?During this time I had interactions within the medical context that were particularly strikingBut as a discourse analyst, I was unable to capture these interactions via recording and then transcriptionsI was able to summarize some of these interactions

4. MethodologyPERPLEPractically engaged reflection on the processing of lived experience Combines auto-ethnography and Practical theorizing of communication practicesTo move from a striking personal experience to proposals for how to go about doing things in communication, through writing that resonates with the reader

5. Initiating MomentPERPLE typically begins with an initiating momentA moment in the lived experience of the researcher that strikes her as something that needs processingIn this case this was a follow-up call from my surgical gynecologist to share results from a set of testsThe energy and feeling of wellness from this call, for me, merited my scholarly attention

6. Relevant Communication PracticesIn processing this lived experience, other interactions in the medical context became relevantThree communication practices defined my experience as a cancer patientAn everyday practiceAn emotionally draining practiceA energizing practice

7. Script-Based InteractionStandard Everyday Communication Practice of a Cancer Patient in the Medical ContextProvider TalkDoes the job of generalized, typical medical carePatient TalkMakes personal medical situation relevant in the interactionExample: call from nurse of primary care physician

8. Culturally-Based Transactional GamesProvider TalkMaintains Culturally-Sanctioned Role PerformancePatient TalkWork to make personal condition relevant = not workWork to make interaction go smoothly = can achieve though significant interactional workWork to “get through” the interaction as quickly as possible = move from work of interaction to whatever is next including to the relief of the chemotherapy infusion room for treatment, as little drained as possibleExample: pre-treatment appointment with oncologist

9. Intercontextual InteractionSpecific details in the talk reference aspects of my contextual life as a cancer patient, and our shared contextsSurgeon mentioning, can use deodorantSurgeon sharing pager message source: “Good God it is the ER”Feel well and as a particular cancer patientDon’t have to do any interactional work other than being cancer patientPresentational contexts of both participants fully relevantInteract not in personal waysBut through reference to details in individual and shared contexts

10. Initiating Moment RevisitedIn the talk of this call, doctor referenced multiple parts of the “job” of being a cancer patientDoing research to understand diseaseScheduling and coordinating between specialistsWorking through chemo treatmentsFelt almost like I was the one directing the conversation without having to do that interactional work

11. IntercontexualityIntercontextuality is an interactional version of intertextuality (Kristeva)Where a text can speak to other textsInteractants can reference contextsContexts “hang together” as articulated presentational forms (Langer)

12. Creative AgencyOne explanation for why intercontextuality made me fell well and alive is that it invoked my creative agencyIn that my medical providers and I were not borrowing from scripts or culture, these shared contexts needed to be created.

13. Doing Creative WorkAs a cancer patient, then, in doing something I needed to doGo to my appointments and talk with my providersI was able to both Use positively co-constructive interactional skillsAnd create, bring something new into being

14. Pragmatic ProposalsBuild new scripts where professionalsDo interactional work to open the conversation to the particularities of he patient’s conditionBecome aware of the draining nature of culturally-based interactional gamesBecome aware of the possibility of intercontextuality

15. A Sense of Wellness in a Compromised StateThe communication practices we engage in matterThey take discursive work and they take energyAnd even in a medical contextWith a cancer patient in a deeply compromised stateInteraction between patient and providercan create a sense of wellness