Writing

On Writing Medical Conditions in Historicals

A week or two ago, I put out some feelers about what my readers would like me to write about, and someone suggested writing about medical conditions in a historical context. This is something I’ve dealt with my entire writing career since my first book features an amputee main character and my latest series follows an autistic main character, and after eleven books, I have a bit of a process for researching medical conditions in a historical context. Before we get going, I will say that medical history is one of my special interests, so I tend to go down the rabbit hole because I enjoy learning about this kind of thing. Also, this research tactic is predicated on the idea that you already know what the condition you plan to use is and know at least a bit about it. If you don’t have that, start there first. If you know the condition you plan to use, onward to step one!

Step One: To Wikipedia!

Yes, yes, I know Wikipedia is not a source we can immediately trust, BUT it is AI-free, updated regularly, and linked to sources. What I like about Wikipedia for writing about diseases in a historical context is that Wikipedia often has a history section where articles from the Mayo Clinic do not. The point of researching is to find out when this condition was discovered, when it got its name, were there older treatments, etc. Step one is a cursory word and basic fact-finding mission. I would take notes about discovery, any antiquated names for it (ex. stroke being called apoplexy back in the day), antiquated cures (ex. drinking executed criminal blood for epilepsy), any past beliefs about how this condition occurred (anything regarding humors or pre-germ theory ideas). If you’re just using this for a side character or a passing sentence, you could just double check the info against the sources at the bottom of the Wikipedia article and move on.

Here is a link to a website with a bunch of antiquated names for diseases. Keep in mind that the time period the name was used is not listed, so make sure to research that. ALWAYS double check your sources/information. NEVER use AI. AI is wrecking the planet and is far less accurate than just using a basic search engine. Put in the effort to read and synthesize the information yourself.

Step Two: Research the Antiquated Name

Once we have the antiquated name for the condition, you will have an easier time finding how it was treated back in the day. My suggestion would be to try to find antiquated medical textbooks as a primary source. The National Library of Medicine has a database of old medical texts, and the Internet Archive as well as Project Guttenberg have a ton of scanned books you can look through. Once you go past the 1700s, things get a bit dicey in terms of medical knowledge as they tend to stray into alchemy and Ancient Greek beliefs in European texts on the body. Often, when researching a specific illness, you’ll find a handful of scientists or a single doctor who knew a lot about the specific condition, I suggest researching them as well because you will be able to trace back their sources and potentially find more information on how it was treated pre-modern medicine.

Aside: What if the Condition Wasn’t Known Back Then?

If there isn’t an antiquated name or mentions of the condition in a medical textbook, I’m going to assume the disease was unknown at the time your story takes place. In that case, I would suggest focusing on the symptoms and how to portray them in your story in such a way that a modern audience would recognize them. Keep in mind that even if the audience doesn’t know 100% what the condition is, they should recognize it as a medical condition and how that effects your character’s life.

While writing The Reanimator’s Heart, I debated using the word autism, even though it would anachronistic. I ultimately decided not to because Oliver wouldn’t know why he was different from neurotypical people and that would be part of his characterization. Autism wasn’t a recognized condition until the 1930s, and what we would recognize as severe or high support needs autism would have been classified as schizophrenia in the 1800s. Oliver wouldn’t have met that criteria, so it made more sense to just have him exist as someone with traits that a modern audience would recognize as autism.

In our modern world, we are quick to label things to make life easier and to clue the audience in faster, but it isn’t necessary. The vast majority of medical conditions we have now were lumped into “delicate constitutions,” “old age,” “queerness,” etc.

Step Three: Research Treatments

Now, that we know what we’re dealing with, we can now look up treatments. Those old medical books will come in handy again, and you should also look up antiquated folk medicine. If you’re writing in a time period like Ancient Greece or Rome, you have medical texts from those folks, but much like the Middle Ages or Enlightenment, there will be a lot of nonsense and magic wrapped up in the cures presented. Even with more modern eras, there will be a lot of cures that can also kill. Some will be quack medicine, others are just not great in terms of efficacy. Something I would like to stress to modern writers is that disability and death were the norm back before WWII and the invention of antibiotics. It was very common for people to get sick and never return to full health or to suffer with conditions for their whole life without much relief. More than likely, these characters will be coping as best they can, but they won’t be living at a modern “standard” of health. For my disabled readers of this post, many of you know that chronic illnesses mean always feeling off and never being at full health. When you are writing about sickness, injuries, or chronic conditions, you need to keep in mind the limits of medicine at the time you are writing within it.

Example: In Kinship and Kindness, Theo has epilepsy. When discussing his epilepsy in the story, the social/cultural context of epilepsy is brought up (saints, being possessed or divine punishment, being seen as lesser, etc.), and Theo also mentions going to a doctor in New Orleans who prescribed him bromide. Bromide was the standard treatment for epilepsy at the time and is still used today, but the dosage and purity wasn’t as well regulated, which means patients often had more negative side effects than they would today. Theo mentions how the bromide made him feel catatonic and awful to the point that he stopped taking it and tried to manage his stress (seizure trigger) instead.

Aside: Can We Finagle a Treatment?

Often, there isn’t a good treatment for a condition during the period in which the story is set, but we might be able to look at modern treatments and see if there is anything that might help that existed back then. For example, I have eczema, which means in the past I would have been a cracked and inflamed mess, but in the late 1890s, doctors realized coal tar helps treat eczema. The character might have had some interaction with the substance and then tried to mix it with animal fat or lotion to create a cream. Vaseline also came on the scene in the late 1800s, and that would also be used to help calm the itching and soreness. The character might also notice that when they interact with things that make their nose run, their eczema worsens (allergies weren’t a diagnosis until later). I would be cautious with creating treatments because you want to keep in mind that, like modern supplements, they can help lessen symptoms, but they aren’t curative or able to fully treat a condition.

Aside: What About Magic?

Magic and congenital conditions or neurodivergence is where things get dicey. It’s easy to veer into ableist territory when we magically cure things that are innate parts of the person. I think the best way to think about it is, would removing this thing change who the person is fundamentally? With autism and other flavors of neurodivergence, the community generally states they would rather be accepted than cured. This also goes for many parts of the disabled community. Treating symptoms that make life hard and creating a more inclusive world through world-building is better than eliminating disabled characters entirely. Do your due diligence in regards to ableism and disabled or neurodivergent representation (sensitivity readers can help).

Step Four: Time to Write

Now that you have done as much research as you can, it’s time to write this character. My main suggestion with this is to remember that the character is a person first. They are a person with a condition or disability, not a walking pile of symptoms. You should research what it’s like to live with the condition you’re writing about and keep the community’s experience at the forefront. People with disabilities and chronic conditions (or injuries) are still going about their lives, sometimes having jobs, loving their partners and/or families, and they have hopes, dreams, goals, feelings, etc. We certainly have times where our conditions are at the front of our minds more than other times, but we aren’t 24/7 hyperfocused on our symptoms because we live with it all the time. Your ableist leanings will show through if you haven’t worked through them yet, and while it is fine to explore a character’s internalized ableism or how they deal with ableism, we want it to be purposeful rather than something that snuck in because you have some ableist feelings about disabled or neurodivergent people. As always, do your homework and be respectful.

I hope this article helped you figure out how to research diseases and conditions while writing in the past. If there is anything you would like me to write about in the future, feel free to leave it in the comments.

Personal Life

On Autism and Disability

April is Autism Acceptance Month, and right now, I’m reminded of how autism is a part of who I am but also very much a disability. If you want to know what it feels like to be autistic and seemingly low support needs in our society, it’s like being told you’re supposed to juggle constantly, but you aren’t very good at juggling and people keep adding balls. When you’re in front of people (if you’re good at masking your autism or have a job), you can manage to juggle decently for an audience for a while. Sometimes, they even think you’re good at it, but the second you’re alone, you start dropping balls and getting mad at yourself for doing so. No matter how much you practice, you really aren’t good at it, but if the conditions are perfect and you’re feeling good mentally, you can manage more balls than usual. The problem is that other people see that, assume you can do that all the time like they can, and get mad at you when you can’t consistently perform. Is the metaphor a little tortured? Probably, but it serves its purpose.

Right now, I’m juggling a lot of balls, my arms are tired, and I think some of the balls might be on fire. That’s the problem with being a seemingly low support needs autistic person with a master’s degree; people assume you are consistently fine and expect you to perform as such. When I was younger, I used to be able to hold it together to the end of the semester, and once it ended, I would crash and be completely unable to function for like a week. As a 30+ year old adult, I no longer am able to do that without a very large cost physically, emotionally, and mentally, and I refuse to do so. Unfortunately, I can’t call out sick with autism or autistic burnout.

If you’ve been following the dog saga this year, you know all of the trauma and chaos that has unfolded in my life since February. If you haven’t, the Reader’s Digest version is that my oldest dog died, my middle dog scared the shit out of me by bleeding heavily and spitting out a benign tumor (he’s fine now), and my youngest dog had a soft tissue sarcoma on her nose and is currently going through daily radiation treatments. To say 2026 has been a stressful year is an understatement. One of the emotional components of autism is that you don’t process emotions like a neurotypical person, which means I’m great in an emergency and an emotional wreck on a random Tuesday when I’m suddenly whacked over the head with whatever emotion I should have felt in the moment. When a lot of high emotion things have been going on, I don’t always know what I’m feeling or what I’m upset about beyond overwhelmed. As you can imagine, not knowing what you’re feeling or why makes dealing with those emotions difficult.

In order to deal with that stress, my body has decided that the best course of action is to stay in fight or flight mode 24/7. After weeks of hypervigilance, I am emotionally and physically exhausted. Being in that state makes it hard to get anything done beyond what I force myself to do (like grading papers) and even that is slower than I would like. It also causes my chronic health issues to kick up. Most autistic people have several comorbidities that are tied to connective tissue disorders. For me, this is autoimmune problems and hypermobility that is likely some form of Ehlers Danlos. The autistic burnout feeds into the autoimmune issue which in turn worsens the burnout by sucking up your energy reserves and making you feel crappy. It becomes a vicious cycle until your ability to function is well and truly in the shitter.

More than anything, I would like to lay on the floor with my dogs and watch Kitchen Nightmares or Ghost Hunters for a week straight without a single thing brought to my attention that could stress me out. With our current administration, I doubt that would be possible, but I’m trying to cling onto what functionality I have until the last few weeks of the semester are over. I was lamenting on Bluesky about how I wish Biden was president again solely because I know I would be handling all of this better without the background noise of political chaos. I had major autistic burnout during Trump’s first administration in 2018 to the point that I tanked what momentum I had built with my writing career. I really don’t want to do that again, and the only good thing about experiencing it once is that it’s easier to recognize (hopefully) the next time.

The point of this post wasn’t to listen to me gripe about how my life has been sucky for the past few months but to illustrate that autistic adults who have partners, jobs, driver’s licenses, etc. are still disabled. I appreciate having autism for the strong sense of justice/fairness, the different way I think and view the world, etc., yet I’m still disabled. Our society isn’t set up for people to say, “I need a week long time out because my nerves are fried.” Most jobs will tell you to either take vacation you might not have or to find a new job, and ultimately, this is one of the many reasons autistic adults end up under- or unemployed. If I wasn’t in academia where I work only a few days a week and have summers off, I would be fried constantly. The trade off is that I make abysmally low pay and am underemployed. Most of us would love to find a situation where we could do something we’re good at under conditions that don’t make us pray for death or feel unappreciated. When we tell you that we can’t do something or that we truly don’t want to, please believe that we aren’t just being difficult. It takes a toll on us that is far greater than what neurotypical people experience, and what’s an inconvenience for you is something that causes us to be less than functional for several days. We save up our energy or functionality and carefully plan how to allocate it, so when plans change or something unexpected happens, we end up paying the price for it.

Writing

Giving Myself a Pep Talk

I had a rough week. It was one of those weeks where nothing objectively terrible happened, but a bunch of small things conspired to absolutely wring the life out of you. I was exhausted from the semester starting again, I had a butt ton of papers to give feedback on, I had to go to the DMV to get my car inspected and have my partner get a new ID, my body decided to kick my butt in terms of fatigue and pain, and my partner’s mom ended up in the hospital for a moderately scary issue. Ultimately, mom-in-law is okay and on the mend, the papers got graded, and everything went well, but I barely got any writing done this past week.

On Thursday, I got home from work and thought I would finally be able to write now that everything had settled down, only to have the words bounce off my brain. I could feel myself ready to beat myself up over it, but instead, I stepped back and listened to an audiobook for a few hours before bed. Normally, I would try to just push through or punish myself by refusing to let myself read or decompress with anything fun because I didn’t “deserve” to have dessert if I didn’t eat my vegetables (aka writing). I’ve been trying to be better about recognizing when I’m mentally fried and need to do things to help me refill the well. Void staring as punishment does not help, and I’m glad that I trusted my body and allowed myself to decompress because, even though I didn’t write much on Friday, I was able to reread what I wrote the previous week to reacquainted myself with the text and edit a decent chunk of it.

Even if it was tiny, it was progress. Saturday was a bit better. I hit the point where I realized I needed to major edits on a scene and spent most of the day untangling that mess. Once again, it was a semi-low words day, but I still wrote and still worked on my book. Editing is time consuming and uses up a lot of brain power, which is why it’s sometimes hard to write afterwards. I resisted the urge to beat myself up again on Saturday because I did not hit my minimum goal or catch up. This was all made worse by this being the first week of September– first week, start strong, fresh start, blah blah blah. You get the mentality.

By Sunday, I had hit the realization that it’s just another week in the year. It is one week out of fifty-two, and falling short of your goals because you had a week from hell isn’t a going to ruin The Reanimator’s Fate or set me so far back I can never catch up. It’s fine. I’m fine. The book is fine. Ever since I realized I had to push back the release date for The Reanimator’s Fate, I have felt very guilty about it, even if my readers have been lovely about it. Releasing the book in early 2026 isn’t going to ruin anything or let down my readers who are eagerly waiting for the final book. No one is mad at me. No one hates me. The only one who is beating me up over it is me.

That’s really the crux of the matter: the only one punishing me for not being perfect is me. It’s still hard for me to grapple with the fact that giving 100% does not mean being at peak performance 24/7. I always feel like I should be writing 1k or more a day without fail, but that is unrealistic. 100% sometimes means just rereading what I wrote. Other days, it means just editing, and on bad days, 100% is refilling the well and watching Deadliest Catch while I passively think about what I want to write tomorrow.

My writing career is a marathon, not a sprint, so sustainability is key. Listening to my brain and body is a major part of that, and I’m trying to get better about not beating myself up when I need to take a short break to recharge. Sometimes, a month starts out rough, and that’s okay. A new week is a new week, no matter where in the month it falls. All that matters is that you start again and keep going.

Personal Life

Ambition v. Spoons

I hate making banana bread. And it isn’t because I hate bananas or banana bread or even baking. It’s because somehow, no matter what I do or how I plan the bananas and I are never ready at the same time.

This has been a theme throughout my life, especially as an adult as my inflammatory issues have taken a toll on my energy levels. If I have the energy, I don’t have the inspiration. If I have the inspiration, I don’t have the energy to work on my creative projects.

If you’ve heard of spoon theory, should sound familiar to you. In short, spoon theory is the idea that we all have a certain allotment of energy (spoons), and certain activities cost more spoons that others. The problem with being neurodivergent and chronically ill is that there is no such thing as a work-life balance. There isn’t a single activity that doesn’t cost me spoons, whether they’re physical or mental.

Spending time with people outside my partner, costs me even if I greatly enjoy our time together. Washing my hair will ultimately feel better, but it will cost me energy to do, which means I end up putting it off until I have to because I have work or I put it off so long that it starts to bother me from a sensory perspective.

What people don’t seem to grasp with spoon theory and autism is that things cost you spoons that don’t always make sense to others or they cost a disproportionate amount. Going to the grocery store isn’t physically taxing for me, but the lights, the noise, trying not to get clipped in the parking lot, the people, remembering to get everything on my list (I need a list because I have gone totally blank at the store), acting “normal” at the checkout, etc. is a lot that most neurotypical people take for granted. For me, this mental stress converts into physical stress, so once I get home from the grocery store and unpack everything, I wind up in a heap of fatigue for a few hours decompressing. It’s the same thing with my job(s) and why I avoid going to conferences or conventions. Even if covid wasn’t a thing, they still suck the life out of me and require a multi-day recovery period. Part of the reason I diligently mask and try to reduce my chances of catching covid is because if I got long-covid/a post viral illness, I would have even less spoons to go around, and I can’t imagine limiting my life more.

I’ve tried to organize my life in such a way that I’m expending as few extra spoons as I possibly can, so I can still do my writing and creative stuff and not be an overstimulated misery to deal with. It sucks though because I don’t think most people who casually know me would think of me as disabled or even autistic, and people with invisible disabilities or neurodivergence will always be held to impossible standards. They might be attainable for a time, but they aren’t something most of us can manage long-term without burning ourselves out. There is no way for me to have a standard neurotypical work-life balance without losing something, whether it be hobbies, socializing, chores, or my actual job. Something will always be falling to the wayside, and in neurotypical society’s eyes, I will always be failing.

For people where most of these things are near effortless or the effort is only required in short bursts, they will probably never understand how much I struggle and how little of a safety net there is. There are many reasons I support Universal Basic Income (UBI), but one of the main reasons is for when people who are ND or disabled burn out or need time to recover from a flare, they won’t be left destitute or having to keep working at seemingly 100% while actively hurting themselves. We live in a society that is very much all or nothing. If you aren’t disabled enough, you get zero benefits/support. If you are able bodied enough, there is no safety net. The best way to support your neurodivergent or chronically ill friends is to help them out when they need it (after asking, of course) and pressuring your government and politicians to expand things that actually help our society and those who need that extra help or safety net. Being able bodied is a temporary state for most people. Shaping our society to support rather than penalize a state most of us will end up in will benefit everyone.

Personal Life

Maintaining My Sanity

I have recently learned a valuable lesson: you cannot mandate relaxation.

My tendency is to be a bit of a workaholic when it comes to grading, writing, etc. to the point that I burn myself out. I rarely get to the point of actual burnout, but I definitely end up giving myself a time out or not being able to work for a few days due to my brain just being fried.

Of course, because I’m a workaholic, I got annoyed at the fact that I sometimes required a few days off every now and again, so what did I do? I added mandated relaxation to my to-do list. If you’re face-palming at this, you aren’t wrong.

What does mandated relaxation look like? At first, I put on my weekly to-do list that I had to play video games. At the time, certain games were doing it for me and helping me relax. The first few weeks of this, allowing myself to play games did help. Having it on my to-do list eliminated the guilt associated with playing games while fried instead of doing something “productive.” The problem came when I started to feel better, and gaming went from relaxing to another thing on my list that I didn’t feel like doing. Soon, I switched it from gaming to doing crafts.

Once again, it worked at first, and then quickly became a chore. I sat there being like how do I phrase this to allow myself to relax or force myself to break without feeling bad?

It feels like a very obvious answer now, but I need to unpack my own productivity issues and allow myself to enjoy myself, rest, do relaxing things instead of void staring until I’m productive again. Fixating on productivity and what I can do or get done isn’t healthy, and it’s ultimately what’s holding me back from maintaining a more realistic healthy schedule. Sometimes I also like to forget that I have chronic conditions that make it so I’m not 100% on or at the same level all the time. I would never beat someone else up over having to take it easy when they don’t feel good, but with myself? I take no quarter and am very mean to myself.

Listening to my body isn’t easy, but I’m trying. I’m trying to pay attention to when it needs rest or to do something creative because creativity is as nurturing to me as food. When I say creative here, I mean something besides writing. I like to do art, crafts, puzzle games. Anything intellectually stimulating that isn’t my writing or grading. I tend to think I’m at peace with having chronic conditions since I’ve had them in some form for the vast majority of my life, but when the condition becomes more internal (versus being very outwardly obvious as it used to be), it’s harder to face the expectations people put on you when they assume you’re running at normal/full steam all the time. That’s the part I need to work on: advocating for myself with others while listening to my body and brain rather than punishing it for its needs.

Personal Life

When You Don’t Recognize Your Face

Today’s post is probably going to be a little on the odd side as this is, I think, a niche experience. I hope it’s a niche experience because it wasn’t a very pleasant one.

If you’ve followed me for any length of time on social media, you may have seen me post about how my eczema used to be really bad until I started taking Dupixent in 2020, and it finally was brought under control. When most people think of eczema, they think of a crusty, red patch on someone’s arm or the back of their leg, but I had severe eczema. What qualifies as severe eczema? Treatment resistant, over a significant portion of your body, impairs quality of life, and flares last a long time. I had all of that.

As soon as I hit puberty around 11, the eczema patches that were on my arms and legs basically took over my entire body. I had angry, red skin that weeped over most of my body, and at the time, the doctors prescribed cream, which helped but wasn’t enough to bring down the internal inflammation. Steroid pills helped while I took them, but within days of stopping a course of steroids, the eczema came back worse. Nothing I did worked, no amount of avoiding triggers was enough. My body was raging from the inside out, and I was consumed by pain and fatigue.

It feels so dramatic to say that, but until I felt better, I didn’t realize how awful I felt at the time. My skin cracked and burned constantly. The inflammation made me exhausted (like having HORRIBLE allergies or a cold 24/7 for weeks or months on end). And my self-confidence plummeted because I looked and felt ugly. I didn’t bother to try to cover up the open wounds on my face because makeup made it more irritated. Between not having enough spoons to care and fighting a loosing battle with my skin, I gave up on giving a shit about how my face looked and stopped looking in the mirror beyond checking specific body parts (teeth, eyes, nose, etc.).

Even the clothing I wore required me to work around my eczema. I wasn’t hiding it so much as covering it in fabric that could act as a wick for sweat. In summer, I ended up wearing long-sleeve t-shirts or light hoodies and long pants because when the open wounds were exposed to the air or sweat on a hot day, they burned and got more inflamed. I was never someone who enjoyed showing skin, but what I wanted to wear and what I could wear didn’t always align. The open wounds also liked to bleed at random, so I ruined many a t-shirt that way.

When I started taking Dupixent back in 2020, I was hopeful but skeptical. My dermatologist was convinced it would help me, and I wasn’t opposed to trying an expensive medication if my insurance was willing to cover it since nothing else worked. Shockingly, it worked incredibly well. Within weeks of starting, there was marked improvement on several fronts. It turns out what I thought was a deviated septum making it hard to breathe was inflammation in my sinuses. The Dupixent calmed my whole body. My skin cleared up, my sinus passages deflated, and my asthma has all but cleared up. I no longer sound like Darth Vader when I breathe (thanks, family, for pointing that out repeatedly when I couldn’t control it). I had no idea how miserable I was since I had been suffering with such heavy inflammation for over 18 years, but now that it’s better, I can’t imagine going back to feeling that shitty. At this point, I’m paranoid about my insurance no longer covering my meds, but a post on the failings of the American healthcare system is for another day.

Now, here comes the weird dilemma: I didn’t know what my face really looked like.

I can hear some of you now. “Kara, you had a mirror, and no one swapped out your head when no one was looking.” Yes, but I have literally had eczema covering my whole face since I was 11 years old in 2002. I never really understood what my adult face looked like with clear skin and without heavy inflammation, which causes your face to look puffier than it is. My face shape has changed, my nose looks different, my skin (obviously) looks different, and now, when I stare at my face in the mirror, I have to remind myself to zoom out and see my face as a whole rather than parts. When I try to do a Tiktok or take a selfie, my brain still rebels at seeing my face. It’s simultaneously closer to the person I have in my head and incredibly jarring because I’m not used to seeing it like this. I’m not the person who is riddled with eczema and miserable. I still have inflammatory problems that like to pop up (stiff or achy joints, the occasional small eczema patch, IBS), but my quality of life is so much better that it’s painful to think of how many years I wasted feeling horrible. Not that, that could have been helped without access to Dupixent.

So, now, I’m thirty years old, and trying to figure out my face and get used to it. I’m happy that I have so many trans friends because I think they understand this feeling of suddenly not recognizing yourself but also being happy with the results. In their case, it’s hormones. In mine, it’s a lack of inflammation. I think it helps, too, that I’m nonbinary, and I don’t feel the need to cram my face into a feminine box because it certainly doesn’t fit. The other day, I made a goofy face, and my partner looked at me and was like, “You have a nice face. Your face looks very neutral, like not too girly or masculine.” Somehow, that made my day because, ultimately, I fall somewhere in the middle. Having my body cooperate with that feeling for once in its itchy, angry life still feels strange, but I’ll take the weird small victories.