Conversely there were circumstances in which teens situated their congenital heart disease diagnosis into the foreground, making a clear case for themselves as different from their peers. This most commonly came up when the teens discussed physical activities and more specifically gym class. The teen who wanted to avoid gym class would tell substitute teachers: “I'm like ‘I'm tired. I can't breathe. You know I had a heart disease’ and so that's always the subs that I say that to sometimes so I get out of it.” This teen portrayed herself as similar to her peers, yet she brought her congenital heart disease diagnosis to the foreground to avoid an activity she did not enjoy. She was able to use the congenital heart disease card to her advantage in direct contrast to how she used it in the other situations where she spoke of congenital heart disease as being a part of her life to which she did not pay attention. As the teens endeavored to understand the role congenital heart disease played in their everyday lives they situated this diagnosis from the foreground to the background in a reflexive manner that they may not even be aware of playing the congenital heart disease card in some situations and not in others.