"Ain't that a shame
You're the one to blame."
~ Fats Domino
The patient knitted her brow and had this complex expression of anger mixed with hurt when she said that. I had just come into the room with the resident and was admittedly taken aback by this being the first thing she hit us with.
"Pardon me?" I said that rather reflexively. Normally, I would have introduced myself before saying anything else. But walking in and immediately hearing something like this threw everything out of order. "Uhh, I'm sorry. My name is Dr. Manning. I'm the senior doctor working with your primary physician."
She had her phone in her hand and was still studying it. I'm not even sure if she heard my obligatory introduction. "Why do y'all have to call somebody 'morbid' obesity?"
Here's the thing. This patient was no less than three hundred fifty pounds. Her knees were being crushed under the weight and this, more than anything, was the medical problem that plagued her the most. She needed knee replacements but wasn't a good candidate for the surgery. Why? Because of her weight.
Just outside the door, the resident asked me if all patients with morbid obesity had to "just live with the pain" until they lost some substantial weight. That's when I responded by discussing the likelihood for effective healing/outcome of a newly imported weight bearing joint under so much weight.
"Y'all said I was morbid obesity." She said it matter-of-factly. "I ain't know what that meant so I looked it up."
My resident and I exchanged glances. Neither of us knew what to say.
"You know? I been fat my whole life. But nobody never called me morbid. Damn."
"That's just a medical word we use to describe. . . um. . .when somebody has . .like. . . .a lot of extra weight on them."
"I understand," she replied. "But I want y'all to know something. It ain't right to call somebody morbid. I don't give a damn how big they is."
I stared at her for a beat and then let her words sink in. My resident and I had both tossed that word around outside of her room. Loud enough for her to hear -- and then subsequently enter into a Google search.
We had just put a remix on, with our medical jargon, something hurtful that she'd been hearing for her entire life: "You're too fat."
And yes. She'd heard us correctly. Our words could not have been clearer. You aren't just obese. You're the morbid kind of obese.
I googled that word--morbid--just like she did. And here is the first thing that pops up:
- Characterized by or appealing to an abnormal and unhealthy interest in disturbing and unpleasant subjects, esp. death and disease.
- Of the nature of or indicative of disease.
unhealthy - diseased - unsound - ill - sickly
So this is the medical jargon-y word that we tack on to that word obesity when describing the disabling kind to other health care providers. Not just obese. Morbidly so.
I thought about the word "morbid" and how I usually use it when not speaking to other physicians. Mostly I'm referring to something deathly, sickly or awful sounding. I imagined hearing this word being spoken about me by others and then looking it up only to find that definition. I could see why this was hurtful.
So what happened? Well, all that could happen, really. I told her that I was sorry for saying something that was clearly hurtful to her. I acknowledged that we often use medical terms without thinking much of how they might sound or feel to someone else. We agreed that saying the word "morbid" to describe any person's body habitus was probably not very kind. Even if it was an accepted medical term.
And the patient? She just stared ahead and mumbled that it was okay. But I could tell that her feelings were hurt.
Obesity is so, so complicated. It stands as one of our biggest barriers to health and hardest to overcome. The mind and the identity component, the emotional parts, and the social aspects. People learn to live with that part of who they are and it gets very tricky when we hit them with these overly simplistic suggestions for overhauling all of that.
The other struggle is just the whole socially acceptable practice of open discrimination to those who are very overweight. I admit that I've been there, too. Fighting against rolling my eyes when an overweight acquaintance who regularly complains of being overweight or who pays good money for a personal trainer cracks open a can of full sugar Coca Cola. Or even cringing last night while watching the "pleasantly plump" actress on HBO's GIRLS playing a game of nude ping pong during a love scene.
That actually made me write about this today. Thoughts about obesity and the flip words often tossed about in reference to it. Even the medical ones.
So, yeah. I don't have the answers. But I do know that I don't want to be a doctor who hurts patients' feelings with words that aren't absolutely necessary. I also want to be understanding, even when something deep inside fights against that.
That's all I got today.
Welcome to Saturday, y'all.
Now playing on the mental iPod. . . . Mr. Fats Domino.
And some old school hip hop--The Fat Boys with "Don't You Dog Me." You just gotta love the Human Beatbox!