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over time, indicating changed community values. In the Santa Cruz, California, phone book, for example, Alcoholics Anonymous and Narcotics Anonymous are listed in emergency services; years ago they would have been listed under ''rehabilitation," if at all. The changed status reflects the widespread recognition of the organizations' reliability in crisis situations, as well as acceptance of their theory of addiction as a medical condition. Under the community events section in the beginning, next to the Garlic Festival and the celebration of the anniversary of the city's founding, the Gay and Lesbian Pride Parade is listed as an annual event. Behind this simple telephone book listing lie decades of activism and conflictfor gays and lesbians, becoming part of the civic infrastructure in this way betokens a kind of public acceptance almost unthinkable thiry years ago. |
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ICD-10 is an equally rich text. In the example of common "heart failure," given above, several primary divisions of heart failure are spelled out: congestive, left ventricular, and so forth. Yet those failures caused by mechanical failure of a prosthesispacemaker breakdownare explicitly excluded at this point. We read this and wonder: if the breakdown is due to a manufacturing defect, would that constitute criminal negligence, and so is this the reason the category is kept separate? If the person passed through an area posted as proscribed to pacemakers, could it be suicide as well as heart failure? Or an accident? Or if it were due to a contributing cause like illiteracy, and if so, is there room in the ICD to make this kind of connection? The narrative questions begin to appear. When we look in the cross-referenced section under pacemaker (cardiac prosthesis), there are two factors influencing the category of heart failurepresence of a pacemaker (Z95.0) and the activity of its maintenance and management (Z45.0). A failed pacemaker as proximal cause of death must be pieced together as a narrative by the physician, but then reencoded and reembedded in the statistical list. In final form the death certificate would read as sudden death, with pacemaker in place. |
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We did sit down and read the ICD, and another detailed classification system, the International Classification and Nomenclature of Viruses (INV). This chapter analyses their embedded narrative structures, formal and informal, and the narrative structures in which they are embedded. Our work here is an exercise both in restoring the stories of practical classifying, conflict, and consensus therein and in understanding the design of the list itself. |
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