The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, April 26, 2006

My Newest Patient

So in the town where I work, the hospital is GP-run. That means that all family doctors are the most responsible physician for their patients when they're admitted to hospital. If someone is admitted to hospital and doesn't have a family doc, or if their family doc doesn't have priviliges at our particular hospital, they get assigned to a family doc who will look after them while they're in hospital.

We got an assigned patient over the weekend. Well, we actually got about 5 of them. And she wasn't really ours... she was assigned to another family doctor in our call group. There are 4 physicians in our call group, so on the weekends the doctor on call rounds on everybody's patients. We ended up rounding on about 35 patients. It was a long weekend.

The patient I'm referring to was transferred from another larger hospital to us for rehabilitation. She had been admitted with respiratory failure, which in someone her age (in her early 50's, relatively young) usually means underlying asthma or COPD brought on by a lifetime of heavy smoking. But since I'm telling this story, it's obvious that it wasn't straightforward.

The patient in question was 650lbs. It required the fire department to transfer her from the big city hospital. She was being transfered to us rather than the hospital in the town where she lived because, quite simply, they didn't have the resources to manage her. She required a double-sized bed, which then required a two-person room to become a private room. The nursing staff required for her care was staggering... she is an EIGHT person transfer. Just to roll her over to change her position or put a bedpan under her required a call for assistance to be made to the two adjoining units. Nurses had to be pulled away from the care of their own patients to assist in the care of this one. The nurses told us that it took three of them to move one of her legs when she wanted to shift onto her side. The patient had to be kept on an incline as the pressure of her pannus (apron of abdominal fat that hangs down over the groin) against her diaphragm made her increasingly breathless.

Walking into the room, I struggled to keep my expression neutral. Her facial features were seemingly concentrated in the center of her face, dwarfed by a large roll of fat under her chin. I spoke to her, feeling overwhelming guilt at my own reaction. I'll admit it... I was disgusted. Her hygiene wasn't good... rashes were evident in the areas between skin folds and it was obvious that the extra flesh severely limited the range-of-motion in her arms and legs. All I could wonder was how on earth anyone could let themselves get this big. As someone who has battled their weight all of their life, I understand that is probably not a fair thing to assume-- that she had 'let herself' get that big. But she had no disability before she put on the weight (which was apparently put on gradually though her 20's and 30's, according to her medical record) and here she was, disabled by it now.

I know my reaction was wrong. And I made sure that I treated her the same way I treat everyone else. And I felt very uncomfortable when I overheard some of the nurses making comments about her afterwards-- not that I said anything to them about how inappropriate their harsh judgements of her were. But I knew that deep down, I agreed with them.

And for that, I still feel guilty.

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Blogger smileyj said...

As someone who has battled a weight problem my whole life, I found this post particularly saddening. 9 times out of 10, overeating is emotional. The pain you feel is numbed when you eat. This type of overeating is akin to being alcoholic, or addicted to drugs. You are still doing yourself harm even if it isn't immediately evident. Carrying around excess weight, you are showing the world your pain. It is sitting there on your hips, thighs, stomach etc. I am sure this patient has done more damage to her own ego and self worth by now, than any other person could ever do. I just find it sad that a human being could be that lonely and sad that they have had to find that much comfort in food.

1:58 PM

Blogger ArizonaDB said...

Dr Couz,

I wouldnt feel too quilty about your gut reaction to your "large" patient. It is perfectly natural to marval at something so unnatural. Its impossible not to wonder how it is even physically possible for a human body to get that big and still function.

Its a shame that our society today provides people with ability to get that way. But you have to wonder at how they maintained the weight. She obviously does not work so she cant earn a living to provide the money for all the food she eats. Also, she is not ambulatory so she is not able to go out to buy the food for herself. This means someone is "enabling" her behavior by providing the money and food to allow her to maintain this lifestyle. This person, or people are just as guilty for her condition as she is.

These typse of patients are becoming more common here in the US, as hospitals that provide bariatric surgery are becoming more common as well. Therefore it will be necessary for future nurses and doctors to be trained in how to care for these kinds of patients.

Unfortunately, you may have just encountered the tip of the iceberg.

5:59 PM

Anonymous Anonymous said...

I too am fat. I am 45 now. I've had PCOS since I was 17 years old at which time I weighed 135 and was 5'9". NOT FAT. Now I am 225 pounds. I lost weight twice since being an adult and it took drastic measures which I look back now and know was as unhealthy as being fat was, but the hate you feel when you know the world looks at you as if you are a horrible person just because you're fat hurts so much, that dying doesn't see to be such a bad option sometimes. The last time I lost weight, I ate one can of tuna a day. Period. Nothing else but water. STupid yes, but my point is all I lost was maybe 30 pounds during that time period of approximately 5 months. Someone without PCOS would have been skin and bones. I hurt for the 600 pound lady. Even in an atmosphere where people should be more aware and more empathetic, she still got snide remarks and hateful looks. I'm sure that helped her.

4:54 PM


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