Agraphia Medical Tragicomedy


Fat Guy In A Little Coat…

I'm on my neurology rotation (and what a difference from surgery it is! No need to scarf down food like a lion on the Serengeti! Residents that look happy! Attendings that leave the hospital at 2!)

Today in clinic we saw a very, very fat man. To my best estimate, he weighed upwards of 350 pounds. He had the distinct, unwashed smell of someone who weighs so much he can't even bathe himself any more. He couldn't say the word "no" without stopping to pause in the middle to catch his breath. He struggled to reach the joystick on his electric wheelchair.

This was one fat guy. It was like Fat Bastard from Austin Powers without the funny.

We were treating him for some arm pain that, for all intents and purposes, is untreatable. We couldn't find a single medication that didn't interact with the other 28 he was taking - or that hadn't already failed to work. We finally prescribed an arm prosthesis for "nerve cushioning" that will probably cost the American Taxpayers thousands of dollars (he's a vet). We know it probably won't help.

I could barely stop myself from saying that losing 100 pounds might give him a shot at some semblance of a normal life. As it is, I give him a few years, tops. Right now he's in constant pain and needs home health to help him shit - not because he's 97 and dying a natural death, but because he's 55 and so fat his body is shutting down.

What I'm wrestling with now is the realization that I was so thoroughly disgusted by him, I'm not even sure we did the right thing by "treating" him. I'm pretty good at keeping my professional game face on, but I wanted to pull him aside and tell him that frankly, I would write him off as a lost cause.

Edit: I've been thinking about the last sentence I wrote- it's not exactly what I wanted to say last night, but at the time I couldn't think of a better way to put it.

I think it might be more accurate to say that the way we're currently treating him, I've written him off as a lost cause. But if he were my patient, and I his doctor, we would have had a very different office visit yesterday. As far as I'm concerned the only solution to his problems is weight loss.

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  1. Awesome post. Maybe (hopefully) one day you’ll be comfortable enough to talk to your patients honestly about their best course of action.

    Several years ago, I was struggling with my weight. Not like the guy you’re talking about, but badly enough for it to affect my life: I had chronic pain, I found it more difficult to do my favorite activities, etc. This was all from 50 extra pounds, not 150.

    I bounced from doc to doc trying to get the pain taken care of. People variously offered to put me on painkillers, muscle relaxers, and antidepressants. Finally, my family doc (an internist) gave it to me straight: I was too fat. My blood levels were all out of whack, and I was tired from carrying around the extra weight.

    She said I’d feel better if I lost 50 pounds.

    It was hard to hear, but I suppose I was in a bit of denial about how much I’d put on. She gave me a diet (that was pretty easy to stick to). I dropped 50 pounds in eight months, and I feel fantastic. All the pain is gone.

    Don’t loose your idealism. Don’t be afraid to tell your patients stuff they don’t want to hear. You can make a difference in peoples’ lives. Maybe not everyone, but definitely some.

    Hang in there, doc.

  2. Being fat is not just a cosmetic problem. It’s a health hazard. And a deadly one.

    Someone who is 40% overweight is twice as likely to die prematurely as is an average-weight person. This is because obesity has been linked to several serious medical conditions like cardiovascular disease, stroke, diabetes, high blood pressure, cancers, osteoarthritis, gout, respiratory diseases (such as asthma and sleep apnea), and gall bladder disease.

    Handing out meds to treat these symptoms is not the answer. Treat the problem. Treat the obesity. I feel that you have your finger on the pulse of the issue at hand that plagues Americans today.

    I’m a 49 year old Caucasion mother of 5, who is considered obese at 200 pounds. I don’t know how this happened. I work hard, I don’t eat unhealthy, or alot for that matter. I run around like a mad woman until I drop late at night. Yet the pounds crept up on me over time and so has my blood pressure, my pulse rate, my cholestrol, etc. Typical.

    A choice to be made…HBP meds??? No freakin’ way!

    I took control a few months back by doing the only thing that was lacking, physical exertion. I began walking, slowly built up to a daily pace of 5 miles with one day off a week. (now added some running and swimming a weights) I’ve lost 18 pounds so far. And, although the weight loss was my incentive, now it is my well-being that I care for. I feel great! My blood pressure is lower, my pulse is lower and I am more energized. I feel healthy again.

    This is just the beginning. I have another half a century to live!

    I’ve enjoyed reading your blogs…and had to comment on this one. Although, you locking yourself out of your house had me lmfao!

    Good health to you and your patients!


  3. whatup doc. i don’t like fat. vasuclar surgery = fat, smoking, and fam hx sometimes. fat and smoking = preventable. tell the truth, the truth hurts, but its the only comfortable incentive to change. tell it with love my dear friend.

  4. I don’t think he was only 350 lbs, hon. I’m a 350 lb woman, and though I am very fat, I can bathe myself (in a normal-size bathtub) and care for myself with no problems.
    I dated a guy who was closer to 450 once, and he was probably closer to what you described. Though he was able to care for himself and wash, if he were ill, I could see that he’d have problems.

    For comparison,
    A fit 350 lbs:
    A decidedly NOT fit (and naked, though in sitting profile, so nothing is showing) guy who is 550+:

  5. Great tips, I’ll need to subscribe to keep up with your new posts

  6. I think that your ignorant for even thinking that this poor guy is a “lost cause” as you say it. How do you know what he has gone through in his life to be in that type of physical shape? You don’t know therefore you should SHUT UP and not judge him.

    It just makes me so angry that ignorant people like you are even working in the field of medicine. IMHO you should not be working with patients. It takes someone with a heart and someone with compassion to truly work in the field your in and YOUR NOT IT.

    Think before you start judging because ONE day you may be in the same exact boat as that poor guy and it may be way beyond your control.

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