In my field of biomedical imaging, we often talk about having to make trade-offs. The idea behind this concept is that reality is never perfect and you will always have to make choices between rocks and hard places.

When doing a heart scan, for example, there are a lot of requirements to take into account. Preferably, you would like to have as much detail as you can, so the resolution should be as high as possible. At the same time, you would like to have as much time frames as possible to give you enough temporal information. Also, you don’t want to put your patients in a large, noisy and claustrophobic MRI machine for too long. Sounds reasonable, right?

However, the problem is that it takes time to generate a high resolution image. Choosing a better image quality is definitely possible, but this will limit the maximum amount of frames and will force the patient to stay in the MRI machine for a longer period of time. Vice versa, you could choose to make the scanning time very short, but this means you don’t have enough time to scan in a high resolution or produce a lot of frames. In the end, as a biomedical researcher, you will have to choose what you think is the most important.

These kinds of decisions, of course, are not limited to technical problems, but arise everywhere in life. Although we like to think our choices are binary -good or bad, healthy or unhealthy-, almost nothing is! In fact, my favourite comedian wrote a song about this called ‘The Fence‘.

As you can imagine, eczema comes with its entirely unique and frustrating set of trade-offs. In fact, it can sometimes feel like I have to choose between being healthy, comfortable and sensible or uncomfortable, compromising my body… but happy. For example, going out and spending quality time with loved ones is basically a basic need. But other people don’t live in sterile homes, restaurants can be very dusty and pub owners have the horrible habit of supplying drunk people with peanuts. 


Making the decision to prioritise not having a flare up over your temporary happiness sucks, but it gets even worse if you feel like you have to choose between two impossible options.

A clean house is paramount to good skin care, but cleaning a dusty room immediately triggers an allergic reaction.

Stress is the main cause for flare ups, so being unemployed is not the best situation to be in. Nor is writing perfect cover letters and hoping to get hired for jobs.

Sunshine is very good for my skin, it makes my skin much stronger and will help my wounds heal faster. So is tar ointment, except for the fact that it makes my skin extremely sensitive to UV. Like, go outside for 5 minutes and you are red. Oh, and the tiniest amount of sunburn will immediately trigger a flare up and of course increase the chances of skin cancer. The kicker? My skin is way too sensitive to stand sun screen. Seriously, I’ve tried all of the brands. Also, wearing too much layers when it’s hot out will make you sweaty, itchy and can cause an inflammatory response. But well… not covering yourself up when it’s 26 degrees Celcius and sunny… How the hell am I supposed to decide how to dress in summer?!

Of course, the answer lies in balance. Much like a rope-dancer, the challenge for someone with a chronic illness is to figure out what is the right decision for you at this exact time, in this exact situation and for your exact state of body and mind. Of course you can’t reasonably decide to stay home every single time just because this is the safer option for your skin. Neither is it wise to throw caution in the wind and just stop cleaning altogether, have nothing else but pillow fights and adopt sixteen cats. Your decision has to be contextual.

But this can be quite difficult to grasp for people who are close to you. How do you explain to your good friend that you can’t attend their birthday because they have a cat, even though they know you spend the night at your parents house last week and they have two…? Or that you politely decline the allergy-proof food that they prepared specifically for you because you have a bad skin day and you prefer to skip dairy, but you just had ice cream together last week.

Well… you can start by writing a blog post about it 😉


We divide the world to stop us feeling frightened
Into wrong and into right and
Into black and into white and
Into real men and fairies
Into status quo and scary
Yeah we want the world binary
But it’s not that simple.

The Fence – Tim Minchin

2 thoughts on “Trade-offs”

Leave a Reply

Your email address will not be published. Required fields are marked *