Doctor, Do You Really Want To Hurt Me?

It happened again –apathetic care from yet another physician who offered  substandard healthcare to me – a fat person. This latest incident really cut me to the core.

Let me explain. When I saw the nurse practitioner at the heart failure center April, 2021, she suggested that, perhaps, the swelling in my legs was a result of lymphedema. My primary physician at that time referred me to a vein specialist who ordered a compression pump to help rid me of edema in the legs. Because diuretics trigger several health issues for me (agonizing muscle spasms, A-fib, gout), I was hopeful the compression pump would be exactly what I needed.

Unfortunately, after using the system only three times, I was hospitalized unable to breathe. The pump had pushed all the fluid from my legs into my lungs, and by time I arrived at the Emergency Department via ambulance, I had no air movement in my lungs.

I was admitted to the hospital for four days while strong diuretics were administered to remove the fluid from my lungs. An echocardiogram revealed a deterioration of my heart failure.

I was eager to see the cardiologist at the heart failure center to discuss what had happened with the compression pump.

Additionally, I wanted to stop taking a medication due to kidney damage and worrisome short-term memory problems. But mostly, I wanted to discuss the Barostim Neo, a relatively new heart failure device that has been energizing patients when other forms of therapy have failed.

I had been promised a co-appointment with both the nurse practitioner and the director of the center. The NP exhausted most of my appointment time with pointless, nit-picking questions which reduced the amount of time the director had for me. I have no doubt it was designed that way. When he finally entered the room, I was totally caught off guard for what happened next. He blamed me for everything.

“I’m not treating you for your heart failure because you’re intolerant to medications or unwilling to do what’s necessary,” he spat contemptuously. (I guess his reference to my unwillingness was my inability to tolerate high doses of diuretics so I self-regulated the higher dose as necessary for edema).

When I defended myself, stating I lived alone, got gout from diuretics and had to be able to walk and take care of myself, he snapped, “See, right there. You can’t do what I need you to do.”

It’s not an excuse. In fact, I got gout during my stay in the hospital while on 40 mgs per day of Torsemide. Then a regiment of Prednisone had to be prescribed because I could not put any pressure on my right, gout-infected knee. That’s exactly why I hoped the compression pump would help.

Excuse me but isn’t it the cardiologist’s job to assist my body, not blame my body? To try different medications to see what might work best for me? However, from the minute he walked in the room, he was blaming me instead of seeking a solution.

He did little to hide his disgust and anger. “Your heart will get weaker and weaker, and you will die,” he stated coldly. He insisted the new heart failure medication Verquvo and the Barostim device would be of no value to me. After stripping me of all hope, he walked out.

I learned later via participation in an online Barostim Webinar with an Atlantic physician that my cardiologist – the director of a heart failure clinic – was wrong when he told me I could not have both a defibulator and a Barostim.

The doctor running the Webinar suggested that I return to my carteologist and have another discussion because yes, I could have both devices, especially if the synchronized defibrillator was not handling my congestive heart failure.

It would seem that my cartiologist didn’t know what he was talking about, but he was adamant about putting me in my place and letting me know I wasn’t the important one in the room.

I figured it was useless to have another one-sided conversation with the doctor. My primary physician is making a referral to another heart failure carteologist as I write this.

More importantly, what kind of a person says that to a heart failure patient? Would he talk to a cancer patient in that manner?  I’m not dead yet.

Ten days after the carteologist told me I was going to die anyway, a new defibrillator was implanted in my chest because it needed a generator.

Since this device procedure, my heart rate went from pacing in the 70s to erratic fluctuations with a daily heart rate in the 90s & into thé 100s. Moreover, the in-home remote monitor to regulate the device is on back order for three weeks. Curently, the heart failure clinic has no way to monitor what’s going on with my heart.

I have a suspicion the new defibrillator was not paced.

According to a 2015 review of studies, doctors spend 25% less time with patients in larger bodies and fail to refer patients for diagnostic testing or to consider alternatives for treatment.

As Cat Pause at Massey University in New Zeeland states in his article, “Die Another Day: The Obstacles Facing Fat People in Accessing Quality Healthcare,” “Doctors may deny life-saving, preventative care or diagnostic procedures (MRIs, for example) because they are blinded by their own weight bias.”

It’s well documented that faultfinding, especially responses of disgust, anger or blame from health professionals jeopardizes care and discourages many patients from seeking help or returning for appointments.

The media and society reinforce stereotypes that fat people are lazy, unmotivated, undisciplined, and incompetent (Puhl & Heurer, 2009; Tiggemann & Anesbury 2000).

Moreover, other studies have shown that physicians associate fatness with poor hygiene, noncompliance, hostility, and dishonesty. This, in turn, affects how they are treated by medical professionals, usually blaming them for poor health.

The attitudes of nurses are no better. In a one study by D. Maroney & S Golub (1992) nurses insisted that obese persons are unsuccessful (24%), overindulgent (43%), lazy (22%), and experience unresolved anger (33%).

With these attitudes, is it any wonder people with larger bodies receive poor health care?

Hopeless comments from the arrogant cardiologist mentioned above is only the latest in a long list of poor healthcare I’ve received over the years. Take these prior examples (sadly not a complete list):

• A surgeon broke off the drainage tub after performing gall bladder surgery when I was only 13 years old. This blunder required a second surgery to search for the wandering tube. He charged my mother for two surgeries while I missed 6 weeks of school.

• A primary physician told me my heart was “good, very good” (2008) as I suffered three heart attacks which resulted in severe heart damage, 6 cardioversions, 9 stents, eventual congestive heart failure and a greatly reduced life caused by inactivity and depression.

• A surgeon who missed a spinal fracture at L-3 on the MRI and subsequently performed a lumbar fusion from L1-L5. ( 2014). When I was unable to complete the rehab, another MRI revealed the screws and rods lying loose in my back. The initial hardware was removed and replaced with bigger screws and rods which required two major spine surgeries within 18 days all of which left me with crippling nerve-pain, dependent on a walker since the surgeries, and taking a huge toll on my heart.

• A cardiologist nicked my artery when implanting two stents, (2017) needing to implant yet a third stent to shore up the damage he had done. In the meantime I was lying on the surgical table feeling as if I were having a heart attack as he and his colleagues frantically searched through drawers for the right size stent because they weren’t prepared for this error.

• Ureter repair by a surgeon, inexperienced in using the new De Vinchi robot (2012). He dumped me on my head which left me with a hematoma the size of an acorn squash in my abdomen. I was labeled “adult failure to thrive” and kicked out of the hospital after 9 days. I was re-hospitalized three more times because I could not eat or drink.

• A general surgeon who insisted my CT Scan showed no bowel problem (2009) as I pleaded with him about my pain. He then pushed on my abdomen so hard, I screamed. His actions put a hole in my bowel which required bowel resection surgery, removing 16” of bowel.

• A general surgeon, who had a hissy fit over my insistence that I could not take the antibiotic he prescribed (2013). He stopped all antibiotics and I subsequently, developed infection which required that my stomach be re-opened to remove a liter of blood and infection. The wound was packed from the inside out for the next five months.

How can so many medical errors happen to one person? What I find is that medical people pay very little attention to fat people. They are MIA because they blame and judge the larger body and don’t give the larger person their best. In some cases they treat fat people out of resentment.

The Hippocratic Oath says: “to treat the ill to the best of one’s ability”. Where is that promise for the person with a larger body? I rarely encounter it. Look at the research.

They also treat the fat body as if you’re an elephant with tough skin that has to be pushed and prodded and poked with harshness. My skin and organs are as sensitive as those of the smaller person.

What do you do?

First, leave all healthcare professionals who offer inferior care. It is your life. It’s the only one you have.

Moreover, do not let any physician or healthcare professional define you. I felt blamed, that it was my fault that I couldn’t take certain medications. But it was his job to find a protocol that would work for me. Instead, I was silenced and left defenseless in the patient-physician encounter.

Deal With Your Emotions

Deal with your emotions using ISTDP (Intensive Short-term Dynamic Psychotherapy)

Being treated disrespectfully by the medical profession is extremely stressful, especially when you are dealing with a life and death disease. Studies show that humans increase their food intake, particularly high fat and high sugar “comfort foods,” when exposed to stress.

If, like me, you obsess about situations where you are stigmatized and treated inferior, you can re-enact the scenario in the confines of your home or other safe place to release your feelings and offer a new ending to the storyline. It might save you from eating your feelings.

Dr. Howard Schubiner, Director of the MindBody Program in Southfield, MI, stated in a recent Swedish mindbody conference on YouTube that many people are doing emotional expression work because they are angry with their doctors. Schubiner facilitates an ISTDP (Intensive Short-Term Dynamic Psychotherapy) program to help patients release anger. I sought his services after I was ambushed and upset by the cardiologist. Anyone can learn to use it.

Recall the situation.

Get in touch with your feelings about it.

Express the emotions you did not allow yourself to express at the time it happened.

Pretend the person who upset you is in the room. Speak to him without restrictions. Say whatever you want. This person is not there to silence you like when you were in the throes of a one-sided power dynamic at the office. What would your anger or your impulse want to say or do? For example, I wanted to choke the cardiologist so I didn’t have to hear his hopeless words.

I allowed myself to imagine doing just that.

Next, I told him in no uncertain terms, “You fool. Congrestive heart failure is difficult enough without you stripping me of all hope. Who do you think you are? I came here for help. You don’t deserve this position?”

Finally, I fantasized reporting him and having him stripped of his position as director of the heart failure center.

When I had no more words, I pictured myself walking away with my head held high. “Good riddance,” I yelled, slapping my hands together to express a job well done.

I continued: “My anger is justified. I have no guilt about it. Now I choose to let the anger go. You are not worth holding a grudge against. You don’t get to take up space in my brain anymore. You no longer have the right to stop me from having hope for a better possibility. Good riddance!”

With each deep breath, I let the anger go.

When Sadness Arises

It’s common to feel sad over a situation where you must leave or have been deeply invested or disappointed, but remember that the sadness expresses the care and concern you hold for yourself.

When you’re fat, there are many times when you must be your own best friend, your own caretaker, your own parent or protector.

For example, a study published in the Advances in Nursing Science 2004, points out that large people are reminded daily by family, friends, peers, healthcare providers, educators, employers and even strangers that they are inferior to those who are smaller. This denigration, condemnation, stigmatization and discrimination is so pervasive, it has been referred to as “civilized oppression.” It is like racism. (Harvey J. Civilized Oppression. Lanham, Md: Bow man & Littlefield; 1999).

Think for a moment how much internal rage that would trigger within a person who has had to live a life of inferior treatment when they knew it was untrue. Is it any wonder fat people feel “braced” for life all day every day?

After doing the emotional therapy work, spend time breathing in compassion and love for yourself

Maybe not today but at some point you might want to give your perpetrator a break, to let them off the hook for their ignorance and insensitivity.

Dr. Fred Luskin, Director of the Stanford Forgiveness Project and author of several books on forgiveness explains that the definition for forgiveness is: (1) giving up all hope for a better past; or (2) making peace with the word no. In other words, one must grieve that they didn’t get what they wanted and then find a way to accept that and move forward. When you become ready to do that, you will feel better.