Sunday, February 05, 2006

A fat girl goes wooing

Some of my earliest memories of doctors involve the pediatrician we saw when I was seven or so. He put me on a diet in which I couldn't eat corn (my mom only cooked three kinds of vegetables: green beans, carrots, and corn so that eliminated a third of my vegetable choices) and had to drink these Sego shakes that tasted like chocolate and vitamins mixed together. I also wasn't allowed to eat the candy hearts my Girl Scout leader gave me for Valentines Day while my skinny sister could.

At ten years old I was pushing 120 pounds and the new pediatrician I had was particularly peevish about obesity, as the nurse in a quiet, frightened voice warned me after weighing me before he came in. Dr. P scolded me in a voice that was about as scary as my browbeating stepfather. He demanded to know how much I was eating (not any more than my scrawny siblings) and how much exercise I was getting (two-mile-round trip walks to school as well as kickball at recess). "You're lying," he insisted. Turning to my mother he said, "she has to be secretly eating." I didn't know what to do with that. I knew I wasn't lying, but he was an adult -- and a doctor at that.

Unfortunately, after I started getting sick a lot when I was eleven or so with what may have been the early stage of Chronic Fatigue Immune Dysfunction Syndrome, I had to see doctors a lot. Most of the time weight wasn't really an issue. I mean, you can't blame pneumonia or dysmenorrhea on being overweight. But then again, I've had an ear, nose, and throat specialist advise me about my weight even though he was seeing me for benign positional vertigo. And it was that constant possibility that I might be harassed for being fat that has had me terrified every time I go to see a new doctor. Last spring as the appointment with a neurologist approached, I thought I was going to start having panic attacks.

I find myself preparing for a new appointment like I might for a date. What outfit should I wear? I want to look like I take care of myself, so something somewhat nice. But not too dressy that it would be hard to get in and out of. Or look like I'm not really sick (yeah, having an illness that is not taken seriously hasn't helped). Maybe something sporty...

Of course, if they make me undress into one of those paper tops, it doesn't really matter anyway.

Studies (yes, nameless ones that I can't be bothered to look up) show that people who are overweight have a harder time getting jobs and are often paid less. Yet I've never found that to be the case with me. Jobs usually love me. The academy has adored me (well, most of the time). I have this way of wooing people with a combination of intelligence and charm.

But get me in a doctor's office, it's a whole different story. I don't even think to woo. I'm bad, and I know it. I timidly review what the problem is and submit to whatever the doctor decides.

It occurred to me a few weeks back to ask myself why. What have I to be ashamed of? Why can't I woo the doctors the same way I woo professors and employers? I'm hardworking when it comes to taking care of myself. Indeed, last month when we checked my blood sugar for diabetes because, well, you know, my obesity puts me at risk, it was 96. Not even close to diabetic.

And I know my shit. Sure, I have only a rudimentary knowledge of human physiology (I mean, damnit, I'm an historian who studies Arabic and religion, not the autonomic system and leukocytes). But that rudimentary knowledge is a hell of a lot more than most of the patients who walk through their door. Plus, I live in my body. I know every little thing it does. I know it way better then they ever will.

And yes, I'm fat. I haven't been below 200 pounds since I was 15, and it's very unlikely (barring a major medical breakthrough) that will ever change. That diet the first pediatrician put me on, along with all the dieting I've done since, has made my metabolism run so efficiently I could live through a biblical famine (though probably not through the accompanying diseases). The damage is done, and I have to live with the body I have -- as do they.

I've been practicing my wooing at the free acupuncture clinic I go to. A year or so ago I admitted sheepishly to the acupuncturist that I'd been eating some Ben and Jerry's frozen yogurt. "Oh god, if that's the worse you do, I wouldn't worry about it. Seriously, you take care of yourself better than most of the patients I see." Since then I've amazed the other acupuncturists (mostly students) I've seen there with my tales of making congee and doing qi gong. Just last week as I left my appointment, I could see that look in the new acupuncturist's eyes that I'm used to seeing in new professors.

So as I approached my appointment with the new urogynecologist, I decided to be that Michelle who got accepted to grad school at Harvard, Chicago and Georgetown. I prepared the night before by putting together a list of meds, supplements, and hospitalizations, as well as a review of symptoms, treatments, and other pertinent information. And yeah, I did put some thought into what to wear, which in the end didn't matter because I met the new doctor with my feet in stirrups. After the catheterized clean catch (the antiseptic way to get urine) and pelvic exam, I returned to a slightly more dignified position to discuss my problems with her. Like two equals.

Sure, it helped that this was a clinic devoted exclusively to women. That the doctor supervising the resident treating me was named one of the 400 best doctors for women in America (and held my labia open with a kind hand during the pelvic exam). But for the first time I left a first appointment feeling like I had effectively advocated for myself. Left feeling empowered. Left knowing this fat girl can woo doctors just as well as I wooed cynical, judgmental, well-published academics.


Rob said...

I'm sorry for what you've gone through.

I have some idea; I wasn't heavy growing up. In college, I weighed 120 lbs. at 5'9". As an adult I got heavy and, in very short order became a diabetic from that weight and family history.

Diabetes sucks big time to me, and I'm incredibly well controlled, which most people can't manage. It's the fear of that and the other illnesses that obesity causes that drive doctors to push for weight loss.

Losing weight is incredibly difficult for most people, and if you don't know what it's like to lose it, you have no idea. One of the problems might well be that we try to lose weight too fast. The usual recommendation is 1-2 lbs per week, but even at that level, it may provoke the body to go into "starvation" mode. Weight loss may take an incredibly long time to be done successfully in most humans.

There's strong indications that obesity may be at least partially the result of a viral infection. The virus affects the hormonal system, which in turn dramatically affects the brain.

I hope you hang on to this doctor and I hope that you continue to build up your self-confidence. I hope for both of us that one of the treatments for weight that are being studied actually works.

Rob of UnSpace

Serenity Everton said...

I won't even go into the whole overweight phenomenon, except to say that I've had numerous similar experiences when meeting new doctors.

Ask my husband - I'm terrified of going to a doctor. I've had several - beginning in college when I saw one who wasn't my pediatrician and I wasn't with my very aggressive mother - who have either not taken my very apparent symptons seriously, or who have ignored my physical ailments to ask impertinent and unrelated questions about my sex life.

Obviously, my health is not nearly as difficult to manage as yours, but I'm commenting because I've come to the opinion that the majority of doctors, specifically, are much less knowledgable and professional than we expect them to be.

I once had a doctor order (and bill me for) a battery of sex-related blood tests when I very clearly told him I was *not* pregnant (because I was a virgin, which I also said quite clearly) and on the Pill. My symptons were yet another episode in a long history of serious sinus infections... headache, pressure on the front of my face, swollen jaws, sore throat. Still, he insisted on a complete blood panel, including STD and pregnancy screening imaginable, before he would prescribe me some penicillin.

Apparently, he didn't believe me when I explained that the movement in my eyes was congenital nystagmus (CN), diagnosed at 18 months, and not related to the use of LSD, because he also ordered a whole battery of tests related to illicit drug use. (I'd never even smoked a cigarette, something else I'd told him.)

[Nystagmus can be a sympton of recent drug use...]

He also commented about my weight. I've gained at least another 25 pounds since then.

No, the bill didn't get paid. I wrote a letter of complaint copied to the Dean of the University, walked into his office and ranted about it for about twenty minutes, and went back to work at his front desk.

Two days laer, the poor doctor walked past my desk, recognized me and got an awful look on his face.

I graduated in May, but I understand his contract wasn't renewed. I still am not sure whether to feel justified or bad for the arrogant bastard.

Unfortunately, I have had a few additional experiences in the years since that have supported and otherwise reinforced this first experience.

There is a doctor with whom I don't mind discussing my sex life, by the way. He and his staff are actually the only doctors I'll see without C to hold my hand (tightly). That's my ob/gyn. He delivered our little girl, and my feet have been in his stirrups more times than I choose to recount... sometimes *while* we're discussing my sex life.

His comment last time? "You're still tense. Haven't you gotten used to this yet?"

My reply? "Would you?" followed by a comment that he could always expect the same when sticking something metal inside me. Thirty seconds later, he took it out and I was fine.

And no, he didn't mind that I talked back to him. He even laughed a little.


Michelle said...

Yeah, obesity is an incredibly complex disorder. I remember one doctor I saw tried to say it was just a matter of how much you put in and how much you burn. But, it's so, so much more complicated than that. Obesity is the one disease in which the body actively works against trying to "heal" itself. They are discovering that fat is actually an organ with an extremely complex relationship with the other organs in the body, most especially the brain.

One of the movements within the fat acceptance campaign is to be fat AND fit. I can't change that I'm fat, but I can do what I can to stay strong and eat healthy. And that's what I've been working at. As well as coming to a point emotionally where I no longer feel that I have to woo doctors but rather just be myself.

I think your point, sparkle, that doctors are not nearly as professional and knowledgable as we think they are is a very, very important one. I think that's what I finally had to come to realize. I always think of doctors as these great authority figures but ultimately I'm the greatest authority on my body. And, well, there are a lot of doctors who I've realized I'm a hell of a lot smarter than. So, why am I being so damn obsequious?

As my grandma always says, "doctors are still in practice." ;)

ann regel said...

Wow, I just stumbled here and can I relate. Thank you for being an intelligent woman who just happens to carry extra weight. I like to think of myself that way but too often I just be submissive and hope the doctors get me out of there fast. Thanks for sharing.


TP said...

Great post.

Anonymous said...

I share your wariness of new doctors. Even now, some think fibromyalgia is all in my head, or would go away if I just lost enough weight. (Then why was it first diagnosed when I weighed only 120?) Never mind that fibromyalgia has a wonderful symptom called exercise intolerance.

Most infuriating is when I have to explain to medical personnel (as opposed to your garden-variety ignoramus) "No, I don't need the cane because I'm fat -- I'm fat because I NEED THE CANE!"

Michelle said...

Heya SmartNnaughty -- glad you found something that resonated for you and that your trips to the doctor will be a bit less distressing. :)

TP -- thanks! I loved the post you had in the carnival. I have that same sort of ambiguous feeling when someone says something like, "wow you look like you've lost weight," especially if the opposite is actually true. Usually I know they mean it as a compliment so I smile and say thanks. But it does leave me with an odd feeling.

Malachite -- oh, so been there! I walk with a cane also because my "abnormal for unknown reasons" vestibular system makes me dizzy and just generally off balance. So far I've only had one medical professional -- the urologist from earlier entries -- ask me why and when I told him his reply was, "well, that sucks." Yep, it does indeed.

Thankfully more and more doctors (at least here in the U.S.) are familiar with Fibromyalgia (though I do happen to live next to one of the world's premier Fibromyalgia clinics) and I don't have to explain much or hope I'm taken seriously. Even the neurologist who I saw in May, while four years earlier dismissed Fibromyalgia and CFIDS as not "real" diseases," took them very seriously when we discussed my bizarre neurological issues.

Little bits at a time. :)

Reena said...

I can't tell you how many times I have experienced this when I was overweight and GOD is it ever frustrating!!
These fat-phobic docs thing the solution to all health problems is losing weight!!
Even for stuff weight has absolutely NOTHING to do with. I'd go in for my asthma (which kicked in when I was 11 and I was absolutely SCRAWNY when I was a kid) and would be told that if I my "lifestyle" changed (read: lost weight) that my asthma would magically disappear!!
What a load of SH!t!!
Sure, obesity can cause a host of health concerns and should be addressed, but if the condition presented by the patient has nothing to do with weight, then leave 'em alone and treat their immediate concern.
At my heaviest, I weighed in at 270lbs. I am just above 200 now and still losing, but, as I gradually move out of the "plus size" bracket, I take with me a vital understanding of the battle the obese in this country fight. How they fight to be treated equally in a country which has waged war on their kind.
The war on obesity is bullsh!t!!
Keep your heads up and walk proud!
but most importantly, find strength in one another!
great post, by the way!

Michelle said...

Thanks, Amoreena.

It's sad that doctors are so often the most fat-phobic, despite the fact that they should know more than anybody about how the body -- genetics, neurochemistry, etc. -- works.

I'm still working on holding my head high. Or sometimes just brushing off whatever comments doctors might make. I know my body and generally, I know it best.