Thursday, May 4, 2017

What Happens When One Fat Patient Sees A Doctor

On seeking health care for the first time in years.

I am very fat, and on Monday, I will face my first doctor’s appointment in years. I am calm when I make the call to request an appointment with a new doctor. The anxiety sets in with the silence that follows. In the days leading up to the appointment, I hardly sleep. The weekend is tense and anxious. I withdraw from friends, canceling plans, knowing how distant I can be in moments like these. I keep myself busy with long walks, housework, distracting movies, but no matter what I do, I can feel my heart beat in every inch of my body. My skin pulsates with tension, ready to react. Ready to run.

On Sunday night, I lay awake in a sleep mask, my eyes open in forced darkness. A tidal wave of memories crash over me, and I am submerged. The nurse who took my blood pressure four times, frowning, because she couldn’t believe it was healthy. The doctor who prescribed weight loss as after care for an ear infection. The friend whose OBGYN set a weight limit on the patients they would accept — more than 250 pounds, and you would not be granted the privilege of reproductive health. The doctor who wouldn’t touch me.
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The flush of my face when I say yes, I eat vegetables, and I cook my meals at home. The familiar look of skepticism that follows, often paired with a long sigh. Look, I can’t help you if you’re not going to tell me the truth. The providers who seemed so quickly certain that I didn’t want to be healthy, or was too stupid to know how.
The chilling likelihood that I’d be treated even worse if I’d been sick, or had made so much as one misstep in caring for my own health. If my practices are healthy, they are invalidated by my body. Who could be healthy and look like that? If my practices aren’t healthy, they’re proof of the deservedness of my size. Either way, I need health care. Either way, I don’t get it.

If my practices are healthy, they are invalidated by my body. If my practices aren’t healthy, they’re proof of the deservedness of my size.

The crushing disappointment that so often, the person I’ve trusted with my health believes I can’t be trusted with my own body. The dawning realization that even to professionals, my body reads as a foregone conclusion. The heavy sadness of realizing that if you can’t be heard, can’t be believed, seeking medical attention might be a useless exercise. The feeling of being so big, and still so erased, even in my own health care.
The doctor after doctor who denied even simple tests or exams for nearly every health condition until I lost weight. The prescription for anxiety or depression: Lose weight. Treatment for a hormonal imbalance: Lose weight. Intervention for endless bleeding: Lose weight. The frustration at being told I wasn’t worth caring for until I was thin. Basic health care was a carrot, and these visits were the stick.
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The years of fear from not knowing my health. The momentum and pressure of that growing panic and dread. I wanted to know more about my health, wanted to do right by it, but so often, couldn’t get basic answers because of the barrier of my body. The rushing waters that built and swirled, held back by the dam of my skin.
The memory of my grandfather’s diagnosis, and my mother’s anger. Stage four, she cried over the telephone. They could have caught it. Why didn’t he just go to the goddamn doctor?

On Monday afternoon, I am ragged from lack of sleep. I walk into the doctor’s office, voice shaking and legs weak with anticipation. The medical assistant calls me behind the glass, into the depths of the office. She’s kind and outgoing, interested in engaging, and I’m grateful for the distraction. She measures my height: 5'10". She measures my weight. I look away.
In the exam room, she removes two vials of my blood, thick and blackish red, and takes my blood pressure only once. My vitals are, thankfully, taken without comment, just an extension of our upbeat conversation. She asks if I am sexually active, and about the gender of my partners. I say multiple genders, and her face breaks into a smile. “Hey girl!” she beams, holding up an ID tag marked with a rainbow strip.
When she leaves the room, I can feel my heart’s contractions in my chest, but the tight pulsing anxiety that gripped my head has faded. The water still rushes behind this dam of my body.
When the doctor enters, he meets my eyes, smiles warmly, and gets down to business. Smoke? No. Never? One cigarette in high school. Drink? One or two. A day? A week. I’ve never been much of a drinker. Recreational drugs? No, never. He smiles and nods as he notes it on my chart.
“I know,” I say. “I’m boring.”
“There’s another word for that. Healthy.”
He finishes taking my medical history. I answer his questions honestly, ask for the tests I think I need. He never objects, never contradicts, never rolls his eyes or heaves a sigh. He listens, and he might even believe me.

“There’s one more thing we should talk about,” I say, feeling my voice shake. “It’s just about my history with doctors.”
The doctor looks up from the chart, nodding. “I feel like I know what you’re going to say,” he offers. “Go on.”
The dam cracks as I begin to speak, little streams of memory rushing out. I tell him that I’ve only been to emergency care for years now, and I know that’s not helpful. I tell him that I stopped seeing doctors because doctors stopped seeing me. So many wouldn’t touch me, wouldn’t examine me, wouldn’t ask questions, wouldn’t refer to specialists or write prescriptions. Everything, I tell him, led back to the weight loss that years of dieting and disordered eating never delivered.

So many doctors wouldn’t touch me, wouldn’t examine me, wouldn’t ask questions, wouldn’t refer to specialists or write prescriptions.

I tell him I am happy to talk about behaviors, and I mean it. I will talk about practices and food, and I’m not seeking medication or kid gloves. But the answer to nearly every health problem has come without investigation, without curiosity, without anything but seeing the size of me. I tell him that my body casts a long and wide shadow, and that every doctor seems focused on its silhouette, not the body from which that shadow stretches. And if every prescription is to suddenly stop having the body I have always had, I say, that hasn’t happened in the last 20 years.

I tell him about everything I’ve done to manage the health that was so readily ignored by providers. I tracked my food and vitamins in a daily diary; used a nutrition tracker to calculate essential nutrients and amino acids; kept a calendar of exercise, to ensure I was regularly moving; maintained mental health care and kept going to the dentist; prepped meals at home from local produce. I tell him about hiring a personal trainer, and trying every diet I could for nearly a decade. The rushing waters build beneath my skin, turbulent with the force of experiences that have gone unheard for so long.

My body casts a long and wide shadow, and every doctor seems focused on its silhouette, not the body from which that shadow stretches.

I hear my voice crack, strangled, when I tell him that I have tried everything I can since my teen years. In that time, my body did not change. Neither did my health care.
He watches me warmly, attentive and sad while I speak.
“It sounds like your health matters a lot to you,” he offers, his eyes meeting mine.
And suddenly, I burst into tears. All the years of effort, all the machinations to avoid humiliation and erasure, and someone has finally noticed. Later that day, I realize that despite years of trying, no one has ever told me that I care about my health. And I do.
“I’m sorry,” I tell him. “I don’t know why I’m crying.” But we both know why. The dam burst.

In the coming days, I wait for test results, nervous as anyone would be. But my heart beat steadies. The blood calms in my veins. The waters have found their cadence, flowing easy and fast over the wreckage of the dam.
I don’t know what comes next, but at least I know I’ll be heard.

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