“I know this is a sensitive topic,” you say to me as I sit on your examination table.
Don’t go there, please don’t go there, can we just get through one appointment without this conversation? We had this conversation last time and it was so awful it had me in frustrated tears for hours after my appointment.
But you go there anyway.
“We need to talk about your weight.”
I’m at this appointment because something is happening with my legs. One of my legs has gotten so swollen and painful that it sometimes interferes with my mobility. It has begun to keep me from doing things I want to do, like taking walks with my husband, going to the park with my dog, or even just walking through the grocery store without pain. I am terrified it is a blood clot because I am on hormonal birth control and traveled on a plane very recently. I told you at the beginning of this appointment that I have had fat legs my whole life, but this problem is new and frightening. Sometimes I will lose control of my legs and they will just shake and shake and they won’t move. I trip over my feet and lose my balance, even when I’m not moving. I am in pain. I’m scared. I want help.
Instead, you want to talk about my weight.
Here is what I want you to know, doc. This isn’t a topic I want to avoid because I’m “sensitive” about it, because it hurts my feelings when you acknowledge my body weight. It’s because this topic results in me receiving poorer medical care. It’s because the last time we had this chat, we spent 80% of the appointment going in circles on this topic and only a few minutes on the actual reason for my visit: the swelling and pain in my legs that had just started. You held my swollen, painful leg in your lap and pressed on the swelling with your fingers. “Yep, you’re definitely retaining fluid there!” You said this and you offered absolutely nothing else. No diagnostic tests, no suggestions, no treatments. Because you wanted to talk about my weight instead.
This is a topic that can drive me to tears. It’s not because you’re Getting Real™ with me in a way no one ever has before. And it’s not because I have never once considered that I am on the higher end of the weight spectrum and you are bringing this to my attention for the very first time. It’s because I get so angry and frustrated that all I can do is cry. The anger chokes me, burns in my chest, and wells up in my eyes. Do you know how many times I have had this conversation? If I had a dollar for every time as doctor has sat on their little stool Getting Real™ with me about my weight, I’d be searching for a new McMansion with a pool and media room on HGTV. But, alas, I’m the one ponying up the cash for this discussion.
I’m tired. I came to this appointment with a list of possible diagnoses that I had Googled and crowdsourced. I wrote down a list of things to ask for: an ultrasound on my legs, a referral to a specialist. You tried to offer me diuretics with zero qualifiers, but I said, “I don’t want to take diuretics until we know what kind of fluid this is because if it’s lymph fluid, diuretics could make it worse, and if it’s a blood clot, it’ll do nothing.” You nodded your head and said, “You’re right.”
I am tired of being my own doctor.
This may come as a shock to you, but I am aware that I am fat. I know! I even have a whole entire blog about it! I’m aware that I’m fat because I live in this body and have been fat for 36 years. I was aware of it when my pediatrician advised my mother to put me on a diet before the age of 10. I was aware of it when a school nurse suggested I join Weight Watchers in 4th grade, because I “would be so beautiful if only I’d lost the weight.” I was aware of it when my mother encouraged me to go on Atkins with her at 17, and I ended up with gallstones, that my doctor did not diagnose for a full year because she thought I was making up my symptoms. I was aware of it when that same doctor prescribed Phentermine to me in my senior year of high school, and was annoyed that I stopped taking it because I couldn’t sleep (because it was speed). I was aware of it sitting in endless Weight Watchers meetings, learning how “healthy swaps” and Greek yogurt would save me. I am aware of it each and every time I travel, especially by air. I am aware of it when I cannot fit into a seat. I was aware of it when a gastroenterologist compared my body to “an overstuffed suitcase.” I was aware of it when I worked for an employer that refused to send me to a conference I helped plan because I was not fit to represent the organization. Jesus Christ, my blog post about going to Disney World is one of the first Google results for “fat at Disney.” Believe me, doc, I am aware.
And I want you to hear me when I say I have accepted that my fatness is not a temporary state. This is it! This is my body. I spent the vast majority of my life trying to unleash the skinny bitch within, but much to my dismay, she was never there. I have tried everything short of surgery to will my body into being smaller than it is, but it just hasn’t happened. In fact, these attempts have wrecked my relationship with food and movement. I couldn’t even tell when I was hungry, full or thirsty after years of restrictive dieting. I have tried and tried to mold my body into something different. I have spent thousands of dollars. I have cried thousands of tears. I have invested years and years of effort. And what did I get for that? I get to have this fucking conversation, yet again.
Do you know that it took a tremendous amount of courage to even come here to ask for your help with this problem? Because I knew what you would do, and you did it. I spent days dreading this appointment. I rehearsed my speech about why I do not want to have weight loss surgery in my car on the way to this appointment. I rehearsed my attempts to get you to refocus on my presenting complaint. I’ve fretted and imagined every possible direction this conversation could go in. Last time I was here and I declined weight loss surgery, you said, “Well, if you have cancer in your breast and getting a mastectomy would remove the cancer, you would do it, right?” So you know how to throw some serious curveballs at me. At the time I just gaped, because I had never before heard someone insist that my healthy, functioning stomach was diseased before. That was a new one for me! You keep me on my toes, so I had to be ready this time.
At this point I’m just done with the shame. I am done with the notion that every ache, every illness, every difficulty, is something that I’ve done to myself. I am done with being labeled “noncompliant” because I refuse to submit to an expensive, permanent surgery that I don’t want. I’m done defending my own humanity. I don’t want to have this conversation anymore, because I have a right to receive evidence-based, compassionate medical care, and you are not providing that. Even if you furrow your brow and look at me with your best Pity Face, you’re failing me. You’re falling short. You’re wasting my time. I swear, I am not being fat at you. I am just a fat lady, sitting in her socks in front a medical practitioner, asking for medical care.
I want to know what you expect to get out of this conversation. Do you expect me to look at you in shock and go, “Oh my god, I had no idea I was fat! Please, explain what a vegetable is!” Or, do you expect me to go down to the bariatric surgery center and get operated on immediately, just so you can begin treating my legs, even though you have no idea what is causing the pain & swelling because you have not done anything to diagnose it and there is no evidence that weight loss surgery will cure or treat whatever the fuck is happening? Do you just want me to cry? Do you like those tears? Do they make you feel better about yourself? Or do they make you feel like maybe I had a breakthrough, and one day I will give you credit for saving my life? Am I supposed to apologize? Is there an apology threshold I must meet before you deign to treat me? Let’s say we take it for granted that my weight is the one and only cause for this mystery issue. How much weight must I lose for you to treat me? 20lbs? 50lbs? 100lbs? How thin do I need to be to be worthy of medical treatment? How long will that take? A year, two years, more? What if I never get there? Do I just accept that this is my life now and no one can ever help me? If I never become worthy of treatment, do I deserve to just live with pain? Is that my just desserts?
It’s confusing because, aside from weight loss surgery, you have offered no advice. You have not asked me about my diet or lifestyle. You don’t even know what I do for a living, nor did you care to ask. (You seem to be under the impression that I am unemployed, come to think of it.) So, you just drop this bomb at my feet, this discussion about my weight you insist on having, and then you leave. What am I supposed to do with it?
My biggest fear is that one day my weight will kill me. Not because I am too fat to live, or because of all of the “obesity-related” diseases out there, but because I will be suffering from something life-threatening and you will not notice. You will not be able to see past my fat body (with a pretty face, you note) and you will insist on having this conversation yet again and something will kill me. Who knows what it could be! Cancer, a blood clot, an aneurysm like the ones my mother had that may run in the family, a stroke, a disease. I imagine myself sitting on the table in my socks, like I am now, and you sitting there with your best Sympathy Face on telling me that I did this to myself and I need to lose weight. And then, BOOM, I am dead from something you didn’t even try to diagnose. BOOM, that bomb you dropped at my feet kills me.
My other fear is that one day, you will wear me down, and I will get part of my stomach removed. I will do this so that perhaps you and others like you can maybe see past my weight, or at least appreciate my compliance, enough to offer me medical treatment. And that I will die on the table, or after the surgery I will suffer from painful complications, malnutrition, my hair and teeth will fall out, and then I will die. I have nightmares about this.
All I want is for you to do your job. I think you feel like this is your job, because you would be irresponsible if you let someone as large as I am just walk out of your office without a thorough tongue-lashing about how I should be smaller. And, sure, you want to be able to bill my insurance for “obesity counseling.” I know how it works. But in reality, you’re just refusing to treat me.
I ask you what evidence or facts you have that my weight is the cause of my issues with my legs, and you have none. You admit that it is just a feeling. Who knew that your feelings were science?!
You press on. I feel them coming, the tears. My throat locks up and my eyes start to burn. My eyes well with tears.
You inch in closer. Oh god, you’re going to hug me, aren’t you? You fucking did it. You gave me a goddamn hug. You chastised me about my weight, refused to listen to me, refused to treat the problem I came here for, and wasted my time. And you gave me a motherfucking hug.
I got your notes from this appointment the next day, through the patient portal.
“Tried to discuss patient’s weight but she is sensitive about it and prefers not to discuss it.”
Oh, fuck you.