Conversely, there were circumstances in which teens situated their CHD 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 CHD diagnosis to the foreground to avoid an activity she did not enjoy. She was able to use the CHD card to her advantage, in direct contrast to how she used it in the other situations where she spoke of CHD as being a part of her life to which she did not pay attention. As the teens endeavored to understand the role CHD 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 CHD card in some situations, and not in others.