Saturday, July 12, 2008

Count me out - totally, dude

After a good discussion with the staff nurse, who by the end of the conversation was sounding like she would throw herself in front of the gates to keep me out of there, I decided that this weekend retreat in the mountains was way too risky for me to participate in and I would not go. I wrote this email detailing the reasons for not attending:

Dear Really Nice Upper Manager Person,

Thank you so much for sitting down with me on Wed. to discuss my allergy issues and accommodations that could be made to make the trip to Waaay Out in the Mountains safe for me. I appreciate the time and thought you put into dealing with this issue and the helpfulness of Nice Place to Work in allowing me to make the final decision about my personal safety. As we discussed, ultimately it is an issue of balancing risks and taking into account all the factors. After weighting the risks, I have regretfully decided not to attend.

The thoughtful accommodations for my allergy you offered, of a single room with a private bath, asking people not to spray bug spray or perfume in the buildings, and staying out of the dining hall, sounded like this trip could be a safe one for me. I did take your advice and speak with the conference coordinator and one of the staff nurses yesterday. After speaking with them I don't feel that I can control my exposure to corn products enough in the Waaay Out in the Mountains environment, in a best case scenario, to be able to participate in the activities, or, in a worst case scenario, to be safe. The conference planner and nurse both spoke about the amount of bug spray people need to deal with the biting flies and mosquitoes and about the store that makes and sells popcorn on the premises, among other issues. It sounds like an environment very rich in aerosolized corn products. I think the best case scenario for the Waaay Out in the Mountains trip would, unfortunately, have me in my room within hours of arrival, full of Benadryl, and taking another staff member away from the group as a watcher. (The nurse's office is attached to the dining hall, making that an unsafe area to recover from a reaction and I should not be alone for several hours after even a minor reaction, incase of a rebound reaction.)

Just like a ballpark, where peanut shells and fragments may blow around, is too risky for someone with a life-threatening peanut allergy, this situation is simply too risky for me. I don't know if your allergist discussed the bucket theory of the allergic cascade with you, if you have already heard this please forgive the repeat. Think of your histamine load like filling a bucket, every encounter with an allergen raises the water level in the bucket. If the level is low you have a better chance of stopping a reaction, if your level is already at the top and you add one more small drop, you get an overflow, allergic cascade.

My feeling is, as much as I hate to miss the retreat at Waaay Out in the Mountains, with the small repeated exposures that are inevitable in the 36 hours we are there, there is a large potential to start an allergic cascade that becomes a life-threatening issue. If it progresses to an unstoppable anaphylactic reaction the nursing staff there follows the level III anaphylaxis response protocol, this may not be enough to provide the support necessary for the time it takes to reach an ambulance or a hospital from this remote area. This response basically uses the same emergency meds I carry. The nursing staff there cannot provide ACLS, cannot intubate, and cannot provide other emergency life support necessary in this type of a medical situation given the amount of time until a hospital is reached. If I have a severe reaction, they will inject epi, call the ambulance and start driving me toward Home Town in a Waaay Out in the Mountains vehicle to meet the ambulance coming from Home Town. The worst case scenario is that I add to the horrible warnings about how not to manage food allergies, no one wants this. (US statistics range from 100-300 deaths per year, and 30,000+ hospitalizations from food allergies)

Best case scenario is not zero reactions, with the amount of bug spray necessary to be outside it sounds like corn will be in the air, period. Best case scenario would only have me being a very limited participant and a drag on the rest of the group.

I started to discuss our meeting and my phone call to Waaay Out in the Mountains with Helpful Immediate Managers 1 and 2 before our staff meeting last night. They were trying to brainstorm ways to be able to include me, and while I appreciate their enthusiasm and willingness to accommodate my health issue, I don't think I have fully communicated the scope of the safety issue to them. I didn't have a chance to finish the discussion with, since during the meeting a treat (which I thought it looked perfectly safe, and I didn't eat) was passed out to celebrate the birth of coworker's beautiful new baby and I had a minor reaction to something in the air; I took a little benadryl to stop the reaction and felt too awful by the end of the meeting to further discuss it with them. I am certain that they will respect my decision to choose the safe option, but if they come up with has a corn free "bubble ball" that I can wear, count me in!

Thank you for your willingness to accommodate my health issue. The changes I have made in my life to stay safe and healthy seem so normal to me that I don't think of this as a disability till I try to do something as fun as this weekend retreat in the mountains. Now I see why life-threatening food allergies are included the ADA. I hate to miss both the team-building and the fun of this weekend, but ultimately staying safe is the intelligent choice.

Please let me know if there is any further information you need from me to support my decision not to attend.

Your a bit alarmed by "we can't protect your airway" staff member who doesn't want to die over a 36 hour team-building program and who really does understand the risks

[I sent this to several friends to review and one friend who is a lawyer commented that perhaps I should not list out any of the areas where corn is an issue since that is a place to start picking at my argument, but I simply mentioned a few things "among other issues." If we want to start picking this apart, corn exposure starts with transportation --can't drive up with a bunch of normal (corn fragrance exuding) people, can't drive myself back if I've had benadryl.I'm waiting to hear back, but I assume from the discussion with Really Nice Upper Manager Person the final decision is mine.]

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