Friday, February 27, 2009

What I wish patients would do:

Lose 100 lbs. (The many that can afford to lose those pounds).

So Happy Hospitalist is a rabid anti-smoker and he lectures his patients on their smoking habits. That's good. I applaud that. Smoking gets under his skin, and it pisses him off that Medicare covers the serial intubations of smokers who continue to smoke. That pisses me off too.

What pisses me off is morbid obesity. Like smoking, morbid obesity is a choice. No, nobody did hold a funnel to your orifice. The argument that you don't have the emotional control means only that you need to be responsible and OBTAIN self-control. If you have an eating disorder, seek therapy, not my sympathy.

A full 37% of the American population is obese. Not 'overweight', not 'wish that damn 7 lbs would go away' of fat obese. Can't get oxygen into their bodies while sleeping because of obesity-induced sleep apnea.

I was at a hospital yesterday dialyzing a patient who is so obese, her bed needs to be constructed inside the room. She is unable to leave this room. There are TWO patients currently at that hospital that we dialyze this way. It's actually not uncommon anymore.

The patient barely spoke to me yesterday because she hates the whole dialysis process. She begrudgingly answered my questions and consented to do things like moving her arms so that I could get to her vascatheter. The one time she did speak to me was to complain about the bland food. "Your diet is killing you, Mrs. RollsOfAdipose." "You think I should eat that food?" "I think you are in the hospital because of your weight. You are unable to leave this room because you're eating yourself to death. You need to change your lifestyle or you will die here. A few vegetables might be what you have to do to get out of where you put yourself." She was mortified. And was infuriated at the suggestion that soon, she would need to actually leave the room to go down the hall to dialyze. "I can't sit in a chair for 4 hours."

The old....I'm so fat I can't sit up excuse.

In the meantime, I haul a half ton worth of machinery to her so that we can get all the damn potassium and protein wastes out of her blood so she doesn't die.

One nurse I respect told me a story that she was bathing an obese woman one time, and found a Twinkie in the woman's rolls. The woman giggled and told this nurse it was part of a game she and her husband play: find the food.

I don't actually make this stuff up.

If you're over 30 BMI (and you are neither very pregnant nor a bodybuilder), you need to stop the madness. Unless you're Mother Teresa or Albert Schweitzer, you don't deserve dessert every day. You need to eat some vegetables instead of Big Macs. You need to cut your portion sizes down by two-thirds. That's not debatable, much as you'd like that to be told to you in a more sugary sweet way. You're fat. You did it to yourself. You choose to stop, or you choose to die slowly, painfully in a medically protracted and undignified way. Period.

I have no sympathy for the 'helplessly' obese people that big. The vast majority don't have an eating disorder. They have Entitlementus Americanus Lazii. A lousy economy might be a partial cure for that.

I'm tired of my taxes going to paying for specialty beds to be built in your hospital room. My taxes pay for your insulin. They pay for your CPAP machines. Your weeks and weeks of inpatient hospitalizations. Your dialysis treatments, your heart surgeries. Worst investment my taxes ever made.


Strong One said...

If I knew where ya lived I'd give you a boisterous HIGH FIVE.
It angers me greatly when people/patients view obesity like it's some sort of disease.
...Like they 'caught' the obesity virus or something?
Great post.

RehabNurse said...


Oh.My.God. How very appropriate this topic is!

So many people out there are a mess because they have a whacked out addiction to food.

I had one bariatric patient last year who had horrible coping skills. My guess is her best friend was the food. She was personable, sweet, and very social, but damn, her coping skills sucked.

It won her a trach and a trip to ICU for a long time. She did eventually lose weight (not enough while with us, but a good start). I think about her often. I wonder if she's ever seen a psych because she needs it if she ever wants to lose that weight for good.