Friday, February 28, 2014

Listen.



Listen. . . . 
I am alone at a crossroads 
I'm not at home in my own home
And I've tried and tried
To say what's on my mind
You should have known


~ from the soundtrack of "Dreamgirls"



_______________________________________

The patient

"No need to remove your coat," the nurse said to me. Her eyes were half mast and she looked a little bored. By the time she'd said it, though, I already had one arm out of it. Besides--there was no way I was going to let anyone weigh me with an extra layer on.

I'm pretty sure I heard the tiniest of groans when I ignored her request and piled my coat and pocketbook on the chair beside the scale. Especially considering the fact that I also kicked off my shoes just before stepping on to the little square platform.

"Did you see Scandal yesterday?" Another nurse popped her head into the room where we were to greet her counterpart. In response, my nurse started laughing and covering her ears.

"Girl! Don't tell me! I mean it, Jackson--don't say anything!"

"Aaaah! You're killing me. How could you not have watched it?" The drive-by nurse swung her head over toward me and smiled. "How you doin' this morning, ma'am?" she asked.

It took me a moment to realize she was talking to me. "Uhh, who me? I'm okay."

"Did you see Scandal?"

"Oh. . .uh. . .me? Umm, no." I'm not fully sure why I said that since I actually had seen that show the night before and had plenty that I could chime in. But admittedly, my mind was far far away. I was too busy staring at digital display on that scale:

231.4 pounds.


The doctor

"I love Ms. Parker to death but I swear seeing her feels like that movie Ground Hog Day." I pushed back from the desk and leaned back in the rolling chair. I had seen enough of her chart. Weight up four pounds since the last visit from 227 pounds to 231. 231.4 to be exact. Pain on a scale of one to ten was "eight" in her knees which makes sense considering they bear all of that weight on her 5'1" frame.

"I don't think I remember that patient," the nurse working with me said. "But I'm sure I will when I see her."

"She was just getting triaged. Didn't you do her vitals?"

"No. That was Jones, not me. But now I think I know who you're talking about because I popped in while she was getting triaged. Nice lady."

"Yes, very. But seriously--every single problem she has from a health standpoint would be better if she wasn't so heavy. Her blood pressure, her diabetes, her joint pain, and maybe her ability to do some exercise. She's young, too." I shook the mouse on the computer screen to refresh the electronic medical record bearing her information. "Thirty seven to be exact. Which really kind of sucks." I pointed at the screen and spoke to those numbers. "Ms. Parker? You need to lose some weight. A whole lot of it."

Nurse Jackson raised an eyebrow as she smoothed out the paper roll covering the examining table. Her backside was shaking when she reached over to pull on it, as were her pendulous upper arms. Right then, I inwardly coiled-- realizing that she, too, struggled with extra weight. I immediately felt like a jerk but didn't know how to fix it. So I just stopped talking which left a rather awkward silence.

Nurse Jackson did a couple of industrious things around the room without speaking. That only made me feel like more of a heel.

Finally, she paused and looked at me carefully. "I can assure you of one thing, doctor. I doubt that Ms. Parker wants to weight 231 pounds. I'm sure she's just as frustrated, if not more. Matter of fact--I know she is." Nurse Jackson reached for the door handle and put her other hand on her ample hip.

"I just. . . I'm sorry. I didn't mean to--"

"Doctor? Just understand that being fat is about a whole lot more than food, okay? A whole lot more."

Nurse Jackson stepped through the door and left it slightly ajar. I could hear her calling for my patient--the one I'd just insulted right along with her, my nurse.


The patient

If it wasn't for me needing my medication refills, I'm not sure I'd ever come to the doctor. Everything about it is shaped to seem so objective when I know that so much of it isn't. Sure, there are guidelines about things like my blood pressure and my cholesterol. But I also know that some of it just comes down to a line in the sand drawn by the doctor.

And that? That's subjective.

Like just how fat do you have to be before your doctor completely gives up on any chance that you'll lose? What BMI must you get up to before your doctor throws up his or her hands and decides that it's just no use? And when does your obesity reach that place where those suggestions about your diet and exercise are more a formality than anything else?

I just wish there was a way to just get my prescriptions and leave.

The doctor

I really like Ms. Parker. I do. But honestly? I don't get it. I don't get how someone can keep every appointment and express over and over again that she wants to lose weight but still drink full sugar Coca Cola and eat fries from McDonalds. That part perplexes me.

Then there's these requests for things to give her a "jump start." Like a pill or some kind of injection or something. Which is senseless to me if you refuse to stop eating. Well. Not stop eating but rather start eating the right things.

231.4 today. Up four full pounds since last time and that was only six months ago.

But I do like her, though. I do.

The patient

My doctor is a slim little fellow. Narrow about the waist and hips with slender wrists and delicate features. I find myself wondering if a person like that could ever be overweight. My guess is no.

"Hey Ms. Parker. It's good to see you." My doctor slid into the chair next to where I was sitting.

"Hey there. Good to see you, too." I did my best to smile and look cheerful. Even though I didn't exactly feel like all of that.

"So, Ms. Parker. How have things been going since the last time I saw you? What's new?"

What's new? I could tell him that my mother's mind is even further away than it was before. That she looks at me like she isn't sure who I am and that my brothers are absolutely no help. But that's not really new, is it? Maybe I could tell him about my oldest son and how he got another girl pregnant even though he's not even twenty. And how the first one is four but doesn't really talk or make eye contact or even let me hug him and how I'm worried that something is really wrong with that baby but how I'm not really sure. But really, none of that is new since the last time he saw me. Unless you count the new pregnant girl.

"Me? Oh. Not much. Things are okay."

"Ms. Parker, your blood pressure is a little up today. And your sugar was 220 in triage. Did you get a chance to take your medications today?"

"I took everything except the water pill. And my insulin I didn't take because I hadn't eaten."

"Ms. Parker." He groaned and then typed something into the computer. "Okay, I'd like you to make sure you take all of the meds before you see us, okay?"

I nodded. I wonder if he's ever known the feeling of riding the MARTA train and needing to pee? Especially if you had three kids and your bladder just don't hold water like it used to. But this? All this was fine as long as he didn't start talking about my weight.

"I want to talk about your weight."

Here we go.

"You've picked up some pounds. I was hoping some of the changes that we made might have helped you lose a few instead."

"Yeah. I know," I answered. "It's just a lot harder than it looks, doctor."

I saw him scrolling through screens on that computer. He was twisting his mouth and studying some list. "Did you make it to the nutritionist?"

You mean the one with the twenty dollar co-pay? "No. I didn't make it."

And that's when I saw it. The point where his body language shifted away from feeling disappointed or frustrated that I didn't do what he'd asked and more towards me being a lost cause. Too far from helping and not even worth trying to create some plan to try.

The doctor

So. . . no nutrition, no compliance with the medications, no nothing. Just great. If she doesn't care I just can't let myself either. I'm so super tired. Of all of this. Hypertension, diabetes, and high cholesterol. That's what I'm sticking to from here on out.

"Okay. Let's retake your blood pressure and look at the rest of your exam and labs."

"Okay."

And that's what we did.

The patient

I couldn't sleep yesterday. Or the day before. I sort of want to talk to my doctor about it but he seems "all business" and besides all that, I think he's a little exasperated since I didn't take my water pill this morning. Or my insulin.

I ate some spaghetti when I was up last night. Technically, I hadn't really had much for dinner but I know that nothing good could come from eating at that hour. There was garlic bread, too. Just being honest. But it seems like with all the worrying I do, I sleep less. And a lot of times I look up and I've eaten something that I didn't even mean to have.

So I'm thinking about all of this while he inflates that cuff on my arm. I look down at it and notice the stretch marks on my skin which means I know that he does, too. And he keeps letting the air out and then pumping it up a few more times just to make sure he's getting the right number.

"Still high?" I ask.

"Still high."

The doctor

It's kind of weird. The last few times that I've seen Ms. Parker, she's gained more weight and had worse control of her medical issues. I look at her and it seems like regardless of what I say, she doesn't seem to care. Here's why I think that: She always has this nondescript expression on her face. Kind of bored. Kind of blah. But not like someone with health problems so out of whack that her life might me abbreviated.

And that? That worries me. Because I like Ms. Parker. I do. And even though I'm feeling super frustrated with her not doing what I ask her to do,  I want her to be well. And thrive. I do. So you know what? I tell her. I decide to tell her just that.

Besides. I'm otherwise all out of suggestions.

The patient

It surprised me when my doctor said it. For once, he stopped typing and talking at me and just sat there looking at me. His chin was in his hand and his eyes were soft. Like he really wanted to know how I felt.

"Ms. Parker? What. . . what's going on with you? I just. . .I don't know. . .feel worried about you sometimes. And I care about you so I want to know what's going on?"

That's what he said. And even though I've been seeing this doctor for almost three years, he had never asked me this before.

Him or any other doctor for that matter.

The doctor

I couldn't believe my ears. Just one little question and this whole world of stress and hurt and pain was opened up to me. In all this time, I never knew all of that. I didn't. I am pretty sure I'd screened her for depression and anxiety but it never occurred to me to ask any details about more since she always looked so put together. Hair done up and nails with designs. I just took that all to mean she was fine.

But she wasn't.

How was I to know that she was caring for her mother with advancing Alzheimer's dementia? And where on my checklist is the part for "are you worried that your four year-old grandson might be on the spectrum of autism?" How could I have known any of that was happening in her life?

The same way I found out today. I asked.

The patient

I'm so glad he had some tissues. I could have gone through that whole box. Nobody ever seemed to ask how I felt about anything. So once I started telling my piece, those tears just started to flowing. I told him all about my mama and her far off mind. He asked me questions and I let him know how sad I felt when she didn't even hardly know me. And having your own mama not know who you are is something to cry about.

It is.

The doctor

She said all of this had been going on for quite a while. We talked and she even started crying. That part surprised me since she's usually so stoic about everything. And after she shared all of the things happening in her life with me something happened.

It did.

For the first time ever, we had a bidirectional conversation about her health. And her weight. And together, we came up with a plan.

The patient

This was the first time I left the doctor's office and didn't feel like a criminal. Matter of fact, I felt good. Like I wanted to make a few changes like limit my portion to the size of my palm. Or not drink sodas or juices. He even gave me this paper that I could take to the YMCA to help with a membership. They have a pool there, so I can even try the water aerobics he was telling me about.

Yep.

I didn't even know about all the stuff that social worker told me when she came in. Like stuff for my mama and even some people that can help with finding out more for my grandson. Something called "early intervention" for him. And these programs that are called "respite" for mama.

I also told him about me not being able to sleep. And he did something for that, too.

I saw the two nurses when I was walking out. "I did see Scandal," I told them. That nurse named Jackson widened her eyes and then covered her mouth. She pointed at the other nurse who checked me in, alerting me not to give away the details. I shook my head and laughed. "All I'll say is this--I think that Mellie is just evil!"

"Yeah, but if you've watched it all, Mellie's been through a lot," Nurse Jackson said. "And people do all sorts of crazy things when they're going through it."

Ain't that the truth.

The doctor

Nurse Jackson caught me in the hallway and asked how it went with Ms. Parker. She said she was asking because Ms. Parker looked lighter to her. Like some weight had been lifted off of her shoulders.

"Good," I told her. "It was really good."

"Good," she replied. I noticed then how wise her eyes are. "Good."

I walked away hearing her sage advice in my head. And vowing never to forget her words:

"Doctor? Just understand that being fat is about a whole lot more than food, okay? A whole lot more."

Yes. That.

***
Happy Friday. And happy belated huddle.

Now playing on my mental iPod. . . .Listen.

27 comments:

  1. New. Favorite. Post!!!
    Wow, this was excellent!

    Xoxo,
    Biz

    ReplyDelete
  2. From the deck of the Poop
    I agree with my little Scoop, this is excellent. As I read this I seceded to do a better job with my health!
    Poopdeck

    ReplyDelete
    Replies
    1. I love how many nicknames we have. JoLai is Scoop and Biz. You are Poopdeck and T-Tone and Poppo. Funny!

      Yes! Your health and wellness--yes!

      Delete
  3. This may be my favorite of all the posts you've ever written. Beautiful. True. Realer than real.

    ReplyDelete
    Replies
    1. You have no idea what that means to me. Thank you.

      Delete
  4. Replies
    1. It felt good to write that. Thanks, Lisa.

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  5. I haven't been on this blog in months, and came back to this fantastic post. We can do amazing things when we feel like someone cares.

    Love this. -Renee

    ReplyDelete
  6. So great. I can absolutely see both sides, as someone who struggles with weight and food-as-more-than-food, but also as a frustrated provider who wishes her patients would take better care of themselves. Lovely writing, as always.

    ReplyDelete
  7. Ave' Barker-TottenMarch 1, 2014 at 9:26 PM

    Great to the core!

    ReplyDelete
    Replies
    1. Good to hear from you, soror. Thanks for the kind words.

      Delete
  8. Real, true, brilliant. The best ever. Things are never what they seem. Lesson well learned and transmitted to all of us. Sweet Jo

    ReplyDelete
  9. Having been on both sides of this story, this post completely speaks to my heart. As usual, Dr. Manning, you rock! Thanks for sharing the gift of your experiences and insight with us. We are richer for it!

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  10. This made me cry....there is just so much going on with everyone.....so many sides to the stories...how we all judge and think we don't....and how it really takes so little to help.

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  11. I want all doctors to read this. I want all doctors to be like this. This is just profound.

    ReplyDelete

"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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