Thursday, June 5, 2014

Team S.J.G.R. Thursday Huddle: Brave.

You can be amazing
You can turn a phrase into a weapon or a drug
You can be the outcast
Or be the backlash of somebody’s lack of love
Or you can start speaking up. . . .

Honestly. . . I want to see you be brave.

~ Sara Bareilles

I saw a patient recently that deeply disturbed me.  She was upset about the weight she'd picked up over the last five years and was frustrated with the slowing of her metabolism. But that wasn't the part that bothered me. What dug under my skin was the absolutely horrific way she spoke about herself and the way that no amount of positivity or encouragement could get her to stop.

"I'm a fat ass cow," she said. "I'm never going to meet anybody because I'm undatable. And who would want to date anybody who looked like this?" She grabbed her waistline and shook the excess skin.

What's worse is that there wasn't really too much excess to grab. But even if there was, this was still awfully harsh. Damn, it was. I mean, sure, she could stand to lose a few pounds but no person deserved to be talked about like that. I don't give a damn what size they are.

"I am just wondering," I said carefully. "Why do you speak this way about yourself? Like, if someone spoke this way about your sister or your best friend, what would you say?"

She laughed. "I'd kick their ass. But neither of them is a fat ass slob. I look horrible. I hate how I look. And no matter what I do, nothing works to lose weight."

That's when I gently pointed out that she'd told me that she skips breakfast and eats like a bird at lunch. I tried to encourage her by letting her know that modifying this could improve her metabolism. I showed her some cool smartphone apps like My Fitness Pal and Fooducate. And pulled out all the stops to get her believing that trying a little of this just might help.

But none of that was working. NONE of it. She was caught in a do-loop of self-hate.


My resident had already screened her for depression. And that screen was strongly positive. But when we tried to broach the subject of managing her mood disorder, she shut that down.

"It might make me gain weight," she said.

"But feeling this way can make your energy low. This could actually help."

"I'm scared of that stuff."

"I understand," I replied. "Would you be willing to let us have you see our mental health specialists?"

"You mean a psychiatrist? Oh hells no."

Then she called herself "double wide" and described herself as "nasty-looking." I'd never heard anything more awful said about another person straight to their face. Unless you count those horrid reality shows.

I wondered what would happen if she used all of that same energy to say positive things about herself. To list those "what I love about me" things instead of decimating herself like this. But I realized quickly that this wasn't even in her control. The self-hatred was squashing her and suffocating her from any flicker of daylight.

As I looked back through her chart, I saw that others had explored the diagnosis of a mood disorder with her before. She had shut down depression management over and over again, calling it "voodoo" and "make believe." In her chart you could see that with every year that she went untreated for depression, she gained more weight.


So I could go on and on about that unfortunate encounter. Fortunately she wasn't suicidal or homicidal. And we did at least convince her to see a provider in mental health but beyond that she wasn't trying to hear much else.

She also went off on me for not wanting to give her a diet pill by prescription. And even accused me of plotting to keep her looking like a "fat ass cow."


Look--I'm not even sure what my point is of telling you about this. I think it's mostly me wanting to implore everyone who is a member of this team to NOT speak negatively about themselves. But also, I hope anyone who feels depressed will be brave enough to get some help.

Depression impairs so much. And I know for sure that mental health issues are very, very complicated sometimes. But I left that visit thinking about how, how, HOW can I do better as a provider next time? How can I be more helpful, more encouraging, more empowering? Was this totally beyond my level of expertise? I still don't know the answer to any of that.

But let me just say this:

If you are reading this and you are feeling depressed? Or anxious? Or like your only outlet is to mistreat yourself? Please. Do whatever it takes to get some help. Because you deserve to be happy. To be well. To thrive. And to see yourself as worthy of the fat of the land.

The last thing I said to that patient was this:

"You are NOT a cow. Or a double wide. Or nasty looking."

And you know what? I feel certain that, as of the end of that visit, she didn't believe me. Especially because she said she deserved to be on the side of a Chick fil A highway billboard.

So no. She didn't believe me. But you know? I am praying that someday she will.


No matter how grey the clouds, there is still some beauty underneath just waiting to get out.

Happy Huddle Day.

Now playing on my mental iPod. . . . I love this video because of the self love and bravery it took for these participants to dance like no one was watching. Even though everyone was. Honestly Team S.J.G.R.? I want to see us be brave.


  1. To be honest....I think she wanted to bully her way to the diet pill. Unless I am so off base that anyone could feel that way about themselves.

  2. It's all so tied together, isn't it?

  3. Yes, Ain'tForCityGals, people CAN feel that way about themselves. I know -- I do. And no, I wasn't the patient in question. What puzzles me is how do y'all learn to NOT think like that? Like Dr. M, my doctor also saw the signs of depression in me. Unlike this lady, I am taking the Prozac she prescribed and seeking help through my work's EAP. Still, I've not had a romantic relationship in 20+ years, and frankly, that takes a toll. The message I've gotten (believe me, I've gotten it!) is that yes, I'm fat (no debate there; I wear a size 24), I'm ugly and I'm not dateable. Oh, and I've never been married (did I really need to say that?). I am independent (thankfully), intelligent, educated and well-informed -- and I live in a state when none of those qualities are considered positives, especially in women and especially when they lead to thinking that's "out of the norm" and NOT conservative! Sigh...

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