A Plea

“Oh boy, how much do you weigh?”

His name was Dr. Pfeffer. My discharge papers from the emergency room told me to make an appointment with him. I had a large obstructive kidney stone that wasn’t going anywhere on its own. I get them sometimes, usually they pass with little fanfare. This one (1.1cm) had been causing problems for me for awhile before I knew it was even there, and then it made itself known by getting wedged in an impossible position in my pelvis. I’d had one other big stone that needed the full-boogie surgical treatment years ago; it was terrible and painful and I didn’t want to go through another ureteroscopy. And there I was, in Dr. Pfeffer’s office, with him walking into the room and saying that to me before he’d even said hello. I tensed up. I knew it wasn’t going to go well.

“I’m Dr. Pfeffer, obviously. Come sit in this chair.”

All of the chairs in Dr. Pfeffer’s office were too small and had hard wooden arms. I tried to sit in one in the waiting room and ended up stabbing my ass on the pointed wooden ends of the arms. So, I chose to sit on the table instead.

“If you can sit in the chair. You probably can’t, can you.”

I did my best to stay calm during the appointment. I asked him if lithotripsy was possible, where they use sound waves to crush the stone into smaller, passable bits, and he said it wasn’t, because I was “too large for his table.” He told me I’d need to get surgery tomorrow, because he was going out of town on Friday. (It was a Wednesday.) And then he complained to me about how difficult the ureteroscopy would be, because my legs were so large. I sat there and listened to him with my head cocked to the side. What was I supposed to say in response? Sorry about my fat legs? Sorry I’m making you do this procedure that I don’t even want done? I’m so sorry, Dr. Pfeffer! This kidney stone of mine must be super fucking hard for you!

He asked what I was taking for the pain (because, you know, kidney stones hurt a lot) and said I was getting by with ibuprofen and hydrocodone for any intense pain. He said, “That’s not going to do anything for you, look at you, you’re a large woman. I’m prescribing dilaudid.” The ibuprofen had been working well for me, but who am I to argue with being too large for hydrocodone?

He had yellow, unkempt fingernails, with just chunks of thick yellow and blue nail on his thumb where it looked like a nail fell off. I shuddered at the thought of him touching me.

I asked for my CD with the X-ray of my kidney stone & MRI from the ER on it and left. I got into the car with my husband, who had waited for me there because of coronavirus precautions. I teared up and said, “I’m not letting that man anywhere near me again.” We pulled away from his office and I cried.

Thankfully, my husband and my mother-in-law stepped the hell up and they both spent the next few days researching urologists and making phone calls. My husband called several doctors and spoke to them directly about what had happened with Dr. Pfeffer; he told them he wanted to make sure I wouldn’t be treated like that at their office, and let them know he’d be with me during the appointment. He found a urology office where the mere mention of Dr. Pfeffer’s name elicited groans of recognition. They got lots of patients from him, they said. My husband made an appointment, drove me there, and went with me into the room because he knew I was less likely to be mistreated with him sitting right there. I met a very capable, kind urologist who was comforting and happy to walk me through everything. He pulled up my MRI and showed me how swollen my kidney was compared to the other. He explained that I needed to go into surgery in a few hours, and that I needed to check into the hospital right after our appointment. It was terrifying, even more so because being in hospital during a global pandemic is a new layer of awful, but I felt like I was in good hands.

He ended up removing the troublesome stone, and then going up into my kidney to remove three other stones that were there, just waiting to drop. Recovery was unexpectedly hard. They kept me overnight in the hospital, and it was one of the hardest nights of my life. When I went home, I was covered in bruises, had burst blood vessels in both of my eyes from vomiting, and couldn’t hold down a meal for two weeks. I sucked on Jolly Ranchers and Lifesavers for sustenance. I was so sick I forgot what it felt like to be well. But I eventually got better, and was less four kidney stones.

Shortly after, I got a bill from Dr. Pfeffer’s office. I had to pay him $49.52 for my visit to his office that day, for the privilege of him saying “oh boy, how much do you weigh,” instead of “hello” and telling me to sit in chairs he knew I couldn’t fit into.

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I wasn’t going to tell this story. And there are elements of this story missing, particularly from the night after surgery, but there’s only so much trauma I’m willing to share to make a point.

I started this blog to share my story, and raise awareness of how weight stigma affects people like me. Weight stigma in medicine isn’t a vague, creeping terror. It’s not a philosophical concept or an amorphous idea or fodder for intellectual debate. It’s experiences like this one, and others I’ve written about. It’s chairs you can’t fit into, it’s doctors complaining about your body to you like you should apologize for making their day hard, it’s medical equipment that’s not built for you so it’s harder (if not impossible) to get diagnosed and treated, it’s having to trust people to take care of you when you’re unconscious and vulnerable when they have been openly hostile to you, it’s being told you can’t have surgery you need because anesthesia is too risky but then the anesthesia suddenly not being a problem if you let them amputate part of your stomach. It’s fear of making appointments, going to see a doctor. It’s the fear so many fat people have felt during this pandemic, unsure about whether they would be given ventilators if they needed them or just left to die. It’s the fear that’s made so many fat people barricade themselves in their homes and obsessively isolate because they know that if they catch the coronavirus, they will be blamed. And it’s doctors and the media telling the world about how “obesity” increases people’s risk for catching coronavirus, but then not letting us get in line for vaccines any earlier because the point was not to help us but to shame us.

At this point, I don’t know how to make anyone care. I don’t know if sharing my story helps. I don’t know if people get it.

Despite how vulnerably people tell their stories of weight stigma in healthcare, regardless of how many simple and actionable things we present as solutions that will make healthcare access easier, no matter how many times we film ourselves in tears after facing yet another doctor who said awful things to us, people who do not personally experience weight stigma try to steer the conversation elsewhere. They are the leaders, the ones who have influence and credentials and an audience that could allow them to make a difference in the lives of so many. And they want to talk about how Health at Every Size isn’t good enough, because it is not antiracist enough, even though weight stigma is racialized and we know it leads to poorer care and health outcomes for BIPOC. We need a paradigm shift, they say. Health at Every Size is “exclusionary and colonial,” they say in a paper full of exclusionary, impenetrable academic gobbledygook about praxis. They want to dissect the origins of fatphobia, and explain to us that until we (fat people, I guess?) undo hundreds of years of history, until we successfully decolonize medicine, we cannot have adequate healthcare. They want to pick apart Western medicine and debate its utility and whether or not it’s white supremacist when fat people of all races struggle to even access even the most basic services and trauma-informed decolonized naturopathy not covered by insurance is even less of a practical solution. When we achieve a headcanon futureworld where we have righted every wrong with our righteous Instagram memes made from Canva templates, then maybe fat people can have blood pressure cuffs that fit us. (Or not, because maybe blood pressure won’t be a thing then, who even knows. We can measure our blood pressure by ✨ listening to our hearts ✨ metaphorically instead of literally, probably.) The leaders of the movement are more committed to fighting with each other, arguing over cancel culture and the necessity of callouts, than they are to making actual, measurable change that will make healthcare more accessible. They want to rail against capitalism and then tell us to sign up for their webinar, buy their book, subscribe to their Substacks, like share and save for the algorithm! They have taken what felt like a lifeline of hope for people like me, who often have no one on our side to advocate for us, and turned it into a circle jerk of ego, gossip, sixth grade mean girl machinations, and ways to make money.

I’m tired. 2020 took the wind out of my sails long before I ended up in the hospital having emergency surgery in the middle of a global pandemic. I am beaten down and weary. Was that the point of this all along?

What I want is so simple: I want a movement to reduce and work toward eradicating weight stigma in healthcare so that people can access competent, compassionate care at any size. And I want people who also want these things to have a community where they can turn to each other for support and strength. That’s literally it. I feel like we’ve lost sight of the basics, the fundamentals, in a big way. It’s like we forgot that the point here is that there are a bunch of us out here trying really hard not to fucking die. Health at Every Size is not an amorphous concept that acts as a catch-all for all forms of oppression; it’s a real-world solution to real-world problems that people in larger bodies face when trying to access medical care. It’s a lifeline to people like me who hit wall after wall trying to get care. Health at Every Size is, at its heart, about care, compassion, and inclusion. The fact that people have used their platforms not to advocate for those things but to inject fear, hostility, ego, and exclusion into the movement is heartbreaking.

For most of 2020, I didn’t know what to do with my heartbreak. And I’ve watched half-devastated and half-amused at the level of grotesquerie the fights and feuds rose to, how we elevated them as if getting one lady in a different state to apologize for something she said or did to someone else we don’t know would fix it all and make the world a more just, more equitable place. As if we could repair the world with one great takedown of someone we don’t like on the internet. How low can we go? How nasty can we get in the name of compassion?

How does any of this help anyone access better medical care? How does this improve anyone’s lives? It doesn’t.

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I don’t have all the answers. But I have to believe that there’s a way forward. Because lots of people need this movement, need to access healthcare, need people with the power and influence to reach medical professionals and publish articles in The Washington Post and have their books published to advocate for them. It would be great if we could do this ourselves, and get hired to do these things and build powerful enough platforms and have the influence, but we can’t poke our heads out of our front doors without someone screaming “DIABETES!” at us. So we have to work with what we have.

The work doesn’t need to be perfect. It doesn’t need to fix everything in one fell swoop. It can be baby steps like getting more accessible seating in doctor’s offices, along with the long-term work of educating medical professionals about weight stigma, advocating for fat bodies to be studied more (because at the moment we are rarely studied beyond measuring our deviance from “normal”), building a healthcare system with doctors who are not befuddled by the sight of us and have equipment and resources to correctly diagnose and properly treat us, and making healthcare truly affordable and accessible to people of all stations. It’s a mixture of small pragmatic changes and large endeavors that will require legislation, long-term sustained effort, and buy-in from people in power. It’s going to require coalition-building and multi-pronged efforts from groups and movements with compatible, complimentary goals. This is how social change works. It’s mundane and slow and beautiful and revolutionary all at once. And if you stack the small and medium-size and mundane accomplishments one on top of the other, you can use them to build something new.

I know that’s not as sexy as marching the king to the gallows, but I think we saw how that looks in January 6, 2021. Maybe that’s not so sexy after all, right?

We’re not all going to agree on everything. And that’s good! A movement where people are forced to conform to the same belief system and ideology is closer to Heaven’s Gate than a force for social good. People can be different, and not all get along, and work together to achieve a common goal. We just need keep reminding ourselves, and each other, of that goal. We need to do the work. Are we clear on what that is at this point? Do we understand the goal?

Are you with me?