You sit in a chair. The chair is plastic. The chair is in a room with white walls. You hold a piece of paper. The paper has your name on it. The paper also has letters.

The letters are in groups. You see LDL. You see HDL. You see ApoB. You see Lp(a). You do not know what these letters mean. You feel like you are taking a test. You did not study for this test. You are the subject of the test. This feels wrong.

Practicing the Vocabulary

Owen sits in his car. The car is parked in a lot. Owen looks at his phone. He looks at a word on the screen. The word is lipoprotein(a). He says the word. He says it again. He wants to say it right.

He thinks the doctor will listen if the word sounds right. Owen is worried. He is not worried about his heart. He is worried about the word. He is worried about the letters. He is practicing for an entrance exam. He wants to enter the conversation about his own body.

The medical report is a document. A document should give information. This document hides information. It uses a code. The code is made of acronyms. You need the code to understand the blood. The blood is inside you. But the information about the blood is behind a gate. The gate is the vocabulary.

Jasper G. and the Physics of Sound

I know about gates. I tune pipe organs. My name is Jasper G. I work with wood and metal and air. A pipe organ has many parts. It has thousands of pipes. Some pipes are small. Some pipes are large. If a pipe is out of tune, the music is bad.

I once told a man his organ was leaking air. I could hear the hiss. I could feel the drop in pressure. The man had a gauge. The gauge was a digital tool. The gauge said the pressure was fine. The man believed the gauge. He did not believe my ears. I was right. The organ was failing. But I lost the argument. I lost because I did not use the word for the specific valve. The man wanted the technical name. He wanted the entrance exam.

Health literacy is the same. We are told to be informed. We are told to take charge. But the report is not written for us. The report is written for the gatekeepers. If you do not know the letters, you stay outside. You stay in the plastic chair. You stay quiet.

Consider a statistic. This is a fact about people. In a group of five people, one person has a high level of lipoprotein(a). You can see five fingers on your hand. One finger represents that person. This person has a risk. The risk is in the genes.

Most people do not know this. They do not know because no one told them the letters. They do not know because the letters are hard to say. One in five is a large number. It is 20 percent. If you walk down a street, every fifth person is carrying a secret in their blood. They do not have the password to the secret.

The password is the name of the marker. The marker is a thing in the blood. Doctors look at the marker. They see the ApoB. They see the hs-CRP. They see the homocysteine. These are nouns. They are the names of parts. Like the pipes in an organ. If you do not know the name of the pipe, you cannot talk about the sound.

The Clock and the Circle ‘a’

Owen enters the building. He walks to the desk. He says his name. He sits down. He waits. He repeats the word in his head. Lipoprotein. Lipoprotein. He thinks about the ‘a’ at the end. It is a small ‘a’ in a circle. It looks like a mistake. It is not a mistake. It is a specific marker.

When the paper arrives at home, there is no plastic chair. There is no white wall. There is time. Time is what the doctor does not have. The doctor has fifteen minutes. In fifteen minutes, you cannot learn a new language. You cannot learn the history of the lipid panel. You can only listen. If you do not understand, you nod. Nodding is a way of giving up. It is a way of saying you failed the entrance exam.

The Wall of Vocabulary

I once worked on an organ in a small town. The organ was old. The leather was dry. I told the priest the leather was dry. The priest asked me about the “pneumatic action.” He used the term from a book. He did not know what it meant. He just wanted to use the word.

“He looked at the crack. He still wanted to talk about the ‘pneumatic action.’ The word was more important than the crack.”

– Jasper G.

I told him the air was escaping. I showed him the crack. He looked at the crack. He still wanted to talk about the “pneumatic action.” The word was more important than the crack. The vocabulary was a wall between us.

This happens in the clinic. The doctor says your ApoB is high. You do not know what ApoB is. You know it is a letter and a number. You feel the fear. The fear is real. But the word is abstract. You want to ask what the word means. You worry the question is stupid. You worry you are not literate.

Health literacy should not be a test. It should be a bridge. A bridge connects two places. A bridge allows you to walk from the chair to the understanding. But many bridges are toll bridges. The toll is the technical fluency. If you cannot pay the toll, you do not cross.

Owen is in the room now. The doctor is looking at a screen. The doctor does not look at Owen. The doctor looks at the data. The data is a collection of markers. The doctor says the words. The doctor says them fast. Owen hears the words. He hears lipoprotein(a). He hears the word he practiced. He opens his mouth. He wants to say he knows that word. He wants to say he studied.

The doctor moves to the next marker. The doctor talks about triglycerides. Owen loses his chance. The conversation moves. The exam is over. Owen did not get to speak. He had the word, but the doctor had the clock.

A Partnership of One

The problem is the prerequisite. We are told to participate in our care. We are told to be partners. But a partnership requires a shared language. If the language belongs to only one person, it is not a partnership. It is a lecture. It is an instruction manual for a machine you are not allowed to touch.

I look at the pipes. I see the dust. I see the way the wood has bent. I do not need a gauge to tell me the organ is tired. I know the organ. I have spent my life with the organ. You know your body. You know when the air is escaping. You know when the sound is wrong.

But when you go to the clinic, your knowledge is discounted. It is discounted because you do not have the acronyms. You have the feeling, but they have the letters. We need a way to get the letters without the gatekeeper.

We need to see the ApoA and the ApoB on our own time. We need to look at the hs-CRP in our own kitchen. When we see the markers at home, the markers become familiar. They are no longer a password. They are just words on a page. We can look them up. We can read about the small ‘a’. We can learn that it is a protein. We can learn that it carries fat. We can learn that the fat can stick to the walls of the tubes.

When the Exam Disappears

When you know the words, the exam disappears. You are not a student anymore. You are a person. You are a person with a body. The body is a complicated machine. It is more complicated than a pipe organ. It has more parts. It has more ways to fail.

Owen leaves the building. He walks to his car. He did not say the word. He practiced for an hour, but he did not speak. He feels like he failed. He is not sick, but he feels small. He feels small because the language was too big.

The next time, Owen will have the report before the appointment. He will have the results from a lab. He will have the numbers in his hand. He will read the numbers. He will see the markers. He will not practice the pronunciation. He will write down the questions. He will ask about the pipes. He will ask about the air. He will not wait for permission to enter the conversation.

The entrance exam is a trick. It is a trick that makes us think we are not qualified to speak about ourselves. We are qualified. We are the only ones who live inside the machine. The letters are just names. LDL is a name. HDL is a name. They are names for the way the body moves the fuel.

You sit in the chair. You hold the paper. You look at the letters. You do not feel like a student. You feel like a person. You see the ApoB. You see the homocysteine. You see the markers of your life. You have the password. The password is the data. The data is yours.

The paper uses the letters to hide the man.

You move your feet on the floor. The floor is cold. The air in the room is thin. You wait for the doctor. You are ready. You do not need to practice. You have the report. You have the facts. The entrance exam is over. You passed. You passed because you took the information for yourself. You did not wait for the gate to open. You walked through the wall.

I tune the organ. I listen to the pipes. I do not need the priest to tell me the name of the sound. I know the sound. I know the air. I know the wood. You know the blood. You know the heart.