[Content Note: Fat Hatred, Diet Talk, Doctor Indifference, Thoughts of Self-Harm]
[Much credit to Melissa McEwan for her excellent Seven Scenes, for a Reason and the format which inspired this post.]
Ana's Note: This spans a couple of years of events in my life, just to be clear.
Scene 1: Sitting my doctor's office, the doctor my parents had been bringing me to since childhood. I'm telling him that I don't feel well, that I'm frequently tired to the point where I can't do my job at work. I'm also nearly constantly cold, even in the warm Texas summer. I've been this way for months, and I think maybe there's something wrong with me. I've started having heart palpitations at night, and am wondering if I need an EKG.
He tells me that I need to lose weight and all this stuff will clear up. I tell him I'm already on a very restrictive diet. I show him my phone app, where I record all my food intake. Once I hit a set caloric intake per day, I don't eat any more for the day. But I don't fast, I assure him. I've gotten very good at stringing out my intake the way I'm supposed to. He doesn't notice that I started the diet a not-very-long time before my symptoms started. I don't notice it either. Diets don't make you sick, I think. Diets make you healthy. He doesn't notice that despite the fact that I'm doing everything right, everything I'm supposed to, I haven't lost more than two pounds in over six months. He doesn't tell me that those two pounds could (and probably are) normal weight fluctuations, even possibly dehydration in a particularly hot summer.
He tells me that I must not be recording everything, since I'm clearly not losing weight and have all these tired-and-cold symptoms. He hands me a brochure, yellowed with age, from his cupboard and I can tell that our visit is over. I look down at the paper in my hands. It feels old and dirty. The printing date on the brochure indicates that the material on the paper is older than I am. They must have made at least a few updates over the years, though, because the old USDA food pyramid is on one page. I wonder if he knows, as I do, how controversial the food pyramid is. I wonder if he knows, as I do, the concerns that agriculture and livestock lobbying groups are frequently credited with undue influence on the pyramid. I wonder if he knows, as I do, that the food pyramid has recently been updated by the USDA, only a few months prior to my visit.
I wonder why he assumes that I don't know this basic, so basic, dieting information after six months into my restrictive diet and after years and years and years of having all this feed to me by my mother's magazines and then, after college, in all my reading on foodie subcultures and vegetarian and vegan material. The brochure sits on the passenger seat as I drive home, and looks blankly at me. I feel alone, and I cry--something I do a lot these days.
A few months later, after the Christmas holidays, I find Health At Every Size and give up my diet. My weight goes up a few pounds more than when I started and then stops and holds steady. I stop being tired. I stop being cold. I stop crying all the time. I don't bother telling my doctor, because I know he won't listen. I just stop visiting him.
Scene 2: I have to visit a new dermatologist, because my old doctor--the one I won't visit anymore--was the one who burned off moles for me. I don't like my moles. They make me think of skin cancer. They catch on my clothes and they hurt when they tear. I know it's a vanity to burn them off when they appear, but it's one of the few I allow myself.
I'd called ahead and asked the nurse if the doctor was accepting of fat people. She'd sounded puzzled, but assured me that fat patients were welcome. I was cautiously optimistic. The doctor walks in, and she's the thinnest person I've ever seen. She circles me a few times and says that she can tell by the tint of my skin--which she insists is orange-tinted--that I'm genetically predisposed to diabetes and I need to change my diet habits now. This very day.
No one in my family has diabetes. No one has ever called my skin orange-tinted. She doesn't know the first thing about what I eat. I've literally not even spoken to her yet. After she finishes burning off the mole, I sit in my car and cry for twenty minutes before driving to work.
Scene 3: A follow-up visit with my surgeon after my latest spinal fusion. I am feeling helpless and frustrated. We'd planned my surgery for almost two years, with deliberate care and without haste. I'd thought he was the first fat-accepting doctor I'd ever had, because he never, never, mentioned my weight. He believed me when I said I was in pain, and didn't (like the doctors before him) try to prescribe anti-depressants for my "psycho-somatic" pain. He promised me, earnestly, that another spinal fusion would fix that, would take away my pain, would make me a new woman.
I have the surgery. My pain doesn't go away. He barely visits me in the hospital, checking on me only twice in seven days, always from the doorway, never coming into the room. He doesn't stay more than a minute each time. I knew he wasn't my friend, I knew he was my doctor, a professional. Still, I feel shocked and hurt by how thoroughly he has avoided me. Prior to the surgery, I'd impressed on him that I wanted no new rods grafted onto my spine--"no new hardware", I'd said. Instead he'd put in two new rods. He doesn't explain to me why he felt this was necessary. He doesn't try to reassure me. I feel abandoned.
A few months later, in the follow-up appointment, I confess to him, choking back tears, that I'm in more pain than before the surgery. That I'm worried. He tells me, flippantly, to lose weight and then I'll be fine. It's like a stab to a chest--it's the same thing doctors told me before I met him, the thing that he never said to me before the surgery, the diagnosis which--because he didn't give it--made me think he understood HAES. I try to explain to him all the reasons why I need pain management now, not in some distant thin-future. He ignores me, picks up a Playstation Portable that I brought to play in the waiting room, and starts playing on it while asking me questions about the game. Stunned, I answer him the best I can. After a few minutes, he stands up and leaves the room.
In the car, I cry.
Scene 4: I have the flu. It's very clearly the flu, or something very similar. I decide to go to the nurse at work, because I've heard that they can fit people in more easily than the outside doctors can. I am hoping that the work-nurse won't fat-shame me. Maybe the nurses here will understand how futile that is, will understand that I just need a throat culture or whatever and maybe a prescription for decongestants or antibiotics or whatever else might relieve my symptoms.
I'm sneezing and coughing and my throat is so raw I can barely speak. The nurses insists on asking me numerous questions about my weight, tries to insist that I take a metabolism test which will help me plan my weight loss regimen. I ask, and ask again, and finally beg him to just take the throat culture. I tell him that I'm not interested in losing weight, that I like my weight. He looks shocked at the very idea, but finally agrees to get the throat culture.
In the corner of the tiny waiting room is a huge machine to weigh yourself on. The TV is running non-stop promotional ads for weight loss products. There is a wall of brochures for people to take. I pick up the one which promises that exercise is a "silver bullet" for fatness. Silver bullets are more expensive versions of regular bullets. They are used not because they are cheaper (they're not) or more effective against regular targets (they're not), but because the magical silver is the only thing that can harm werewolves and other fantastical hard-to-kill monsters.
My fat body is a fantastical hard-to-kill monster which requires a magical solution to kill. My employer wants to kill my fat body with a silver bullet. I don't even cry in the car. I just feel numb.
Scene 5: I'm in the Emergency Room at the hospital, in a visit which will cost me over a thousand dollars. I genuinely, truly, believe that I am dying. I have the most intense stomach and back pain I've ever felt in my life. My stomach feels like a swelled balloon, like if I could just puncture it and let all the bad gas out, I might live.
It takes almost 30 minutes to get a nurse with painkillers to visit us. This is puzzling, because the E.R. hadn't been busy when we arrived. A doctor sends me for a quick CT scan and says whatever it is isn't fatal and I should go home and rest. I'm screaming in pain, howls that are echoing down the hallway. After an entire lifetime of being in constant pain, this is the pain that I can't clamp down. My mother explains, fighting back tears, that I would have to be in Very Serious Pain to react like this. The doctor shrugs.
My mother has a history of diverticulitis, and she points out that she went to the E.R. two years before with the exact same symptoms, and that a round of antibiotics fixed her right up. She tells the doctor that her brother, and his children, have all had diverticulitis episodes, too. We ask the doctor if he might not prescribe antibiotics in this case, just to be sure. He refuses, and says that I'm too young to get diverticulitis and that the problem is probably related to my weight being too high. He sends us home with enough pain medicine to last the day and tells me to see a specialist as soon as possible.
It's Friday. The specialist can't see me for another month. The pain doesn't go away. I suffer through until Monday, and get in to see the nurse practitioner at my doctor's office. She listens to my symptoms and tells me that it's textbook diverticulitis and gives me an antibiotic. The symptoms, which have lasted for three days straight, evaporate within hours of taking the first pill.
Two months later, my mother's sister calls to tell her that she's been diagnosed with diverticulitis. My mother, and her brother, and her sister are all thin and were all diagnosed with diverticulitis without difficulty. I am not, and was not.
Scene 6: With my mother at the specialist's, who costs several hundred dollars to visit, we tell him about my hospital visit, about the antibiotics, about my family history. He is adamant that I am too young to get diverticulitis and that the antibiotics and my alleviated symptoms must be nothing more than a coincidence.
He tells me that my acid reflux problem is nothing more than me being too fat, and that I should try to lose weight and come back in two months for a follow-up. I stare at him in disbelief, that he thinks I can lose weight, any weight, in two months. I flash back to a few years before, when it took me over six months to lose two pounds. I feel more lonely than I have ever felt before. On the way back to the car, I despondently tell my mother that I don't think I'll ever visit a doctor again, and that I feel robbed when I pay hundreds of dollars to hear that I'm fat.
Scene 7: On the way home, my mother loses her temper in a rare moment, probably as a result of worry for me and a lifetime of having it drilled into her that doctors are always right. She berates me for my eating habits, and explains in detail that home cooking is more fattening than eating out four times a week, which is how she and my father eat. A steady diet of Taco Bell, Pizza Hut, and Hamburger Helper has kept them thin and fit, and it's just sheer stubbornness which is keeping me fat, and if I would use margarine in my home cooking instead of real butter then I would see the difference immediately.
I wonder what it would be like if I opened the passenger door and fell out onto the highway. I don't open the door. I press my forehead against the window and try not to cry.
Later at home, my mother apologizes and I tell her I forgive her. I tell her I know she's just worried about me. I tell myself that it's not her fault that she's never had experience being anything but thin. I tell myself that those magazines she reads lie to her, that she doesn't have Shakesville or Fat Nutritionist or anywhere else to counteract those lies.
I call the specialist's office and cancel the appointment they'd made for me automatically. I call my nurse practitioner and ask her to double my GERD medication. After that, my stomach pains go away even though I'm just as fat as always. I wonder if the specialist would call that a coincidence. I wonder if the specialist has the same USDA food pyramid brochures that my old doctor had. I wonder if he thinks a lot about silver bullets.
I keep my facial expression neutral when my mother next visits and presses a brochure to a new chicken fast food place into my hands and gushingly tells me that I have to try their chicken. I wonder if she thinks they use margarine in their cooking. I wonder if she'll ever believe me when I tell her that if I ate like her and dad, my doctors would blame my weight on the fast food instead of the food I eat now--that there's always a reason why I'm fat and she's thin and it's always, always, something I'm doing wrong and should be doing differently. I think a lot about confirmation bias.
I try not to feel alone.