The first line of the chart read, “ID: 42y F. Markedly obese”.
Not simply “42y F” as I would have written, but “markedly obese”.
As if her obesity was the most important part of her. Her defining feature. The reason she came to the Emergency Department.
Written by a young male colleague, this way of identifying the patient I was about to meet unsettled me. Mrs. D. had presented to the ED the night before, due to pain in the back of her left knee and lower leg. She was asked to return this morning to have a venous duplex exam, which is an ultrasound of the veins of the leg, to ensure she didn’t have a blood clot.
Walking into the room, I met Mrs. D. as she stepped off the digital scale. It read 412.7 lbs. She looked at me, and I could see the shame in her eyes. Before she could speak, I said,
“Why were you weighing yourself?”
“It’s been years since I did. No scale will hold me.”
“It doesn’t really matter, you know. Your weight doesn’t define you.”
Giving me a sad but sweet smile, Mrs. D. sat down on the lazyboy in the corner. I knew we could relate, because I myself weigh at least 100 lbs more than I should, and it shows. I smiled back at her, taking in the fatigue on her face but also the light and the beauty.
In that same moment, I glanced at her legs, showing from the knees down as she pulled up the flowy spring dress she wore. On quick inspection, I couldn’t tell if one was more swollen than the other. After asking permission, I leaned down and palpated each leg, pressing deep to see if I could elicit pitting edema (when the tissues stay pressed in, forming a divot, for a few seconds). The legs looked equal-sized and non-pitting (which argued against a blood clot), without any redness or heat to suggest infection. Her left knee, however, was quite tender in the medial (inner) aspect, and upon further discussion I came to the conclusion that her pain was most likely related to a knee sprain as opposed to any other pathology.
It wasn’t a stretch to see that the colleague who was so quick to brush off Mrs. D. as obese, likely hadn’t taken the time to adequately examine her very large legs. He probably felt revulsed by them, and would not have worked very hard at identifying landmarks or particular points of tenderness. I, on the other hand, having no fear or concern about her size, quickly ascertained a more appropriate differential diagnosis.
When Mrs. D. returned from her ultrasound with a report showing no clot, I was not surprised. Sitting her down again, I explained what I thought, which was that her pain was joint related. While true that her weight could be a contributing factor, I was careful to explain that I thought she had actually injured the knee with a particular movement. She told me that her work involves heavy lifting, and that she is always on her feet both at work and at home where she functions as a caregiver to her elderly parents. Her kids are teenagers already, so don’t need as much help as toddlers would, but she still finds herself running after them at times.
As we neared the end of our conversation, I could see the tears brimming to the surface, though Mrs. D. tried to seem stoic and nonchalant. It was easy for me to understand her fatigue, her sheer exhaustion, and in that moment I grasped why she was really in the ED. Yes, her leg was hurting. But more than that – she was hurting. Sitting down across from her, I asked if she was ok. Tears began to spill down her cheeks as she realized that yes, this doctor actually cared. This doctor was going to delve deeper than flesh, look beyond the obesity that my junior colleague had marked as her defining characteristic.
She chose to trust me, and with the tears spilled her story. She needed a break. Her body ached. Her emotions were fraught. She was stressed at work, stressed at home, pushed to her breaking point. She couldn’t take it anymore. But she didn’t feel right taking time off work, because the team needed her. They were short-staffed. She thought they would be upset with her. She didn’t want to leave them in the lurch.
I left the room momentarily and returned with an Off Work note. I told her that my prescription for her was two weeks off, to rest and recuperate. I explained that her knee needed a break, and so did she. Looking at me with relief, I could see that this was what she needed – someone else to say, “You need to stop”. She thanked me for actually listening to her, and left the room with a small smile.
Mrs. D. made me reflect on what it means to be an obese person in this world. Being obese myself, I feel shame at the size of my body, the rolls of my stomach, my flabby upper arms, my enormous thighs. I feel disgusted with what I’ve let my body become. But then, I look at a woman like Mrs. D., twice my size, and I recognize how truly beautiful a large body can be. My girth holds me up; it bolsters me. It can be a strength, rather than a weakness. A large body is just that – a large body. It doesn’t define who a person is, how they see themselves, what they can do in the world. As a physician, I try to remember this every day and with every patient. Every body is different, as is every soul.
Defining a person by their obesity, their anorexia, their body hair, their scars – this is not how I want to practice medicine. It is not how I want to live my life. I understand what it’s like to inhabit a body that others judge, and knowing how that makes me feel, I would do an utter disservice to my patients were I to judge them based on their looks.
Thank you, beautiful Mrs. D., for stepping on that scale with courage, letting me see your fortitude, and by doing so, reminding me of my own.
One thought on “How we define you”
Dre A, this brings tears to my eyes! A doctor really « seeing » the patient! Priceless! And the way that I tried (and tried, and tried…because it’s a process) to practice. Namaste 🙏🏻