Blow

Sailboat in the Hudson Bay

“How much time are you spending on social media?” 

“Well, I stopped completely until about a week ago. I’m easing back into it.”

“Really? You stopped it all? Completely?” I tried to keep the suspicion out of my voice.

“Yeah. For about six months.”

“Why?”

“I didn’t like how it made me feel.” There was real, actual eye contact, no phone in sight. 

“Now that you are back at it, what do you think? Does it make you feel good?”

“No.”

“So what do you think you are going to do?”

“We’ll see.” She shrugged. “Maybe I’ll pull the plug again.”

That, folks, is a kid who is going to be all right…

Proximity

Pizza shop in New York City

“I need to do a six month physician supervised weight loss program before I can get the gastric sleeve covered by my insurance.” She wasn’t even that heavy to start off with, her BMI was 32. She wasn’t diabetic and did not have high blood pressure. 

“You are going to be married to a fistful of vitamin supplements for the rest of your life.”

“I don’t care. I am tired of being fat, of having people judge me.” I understood. People can be so cruel. “My friends have all had it done and they look great,” she said hopefully. “But I can’t loose too much weight right now or I won’t qualify anymore…”

We both knew she had no intention of really trying. 

Sure enough she demonstrated a nice weight gain at each visit and steadfastly refused to count her calories or exercise or do anything except to say, “I’m cutting back, Doc. Really I am. I don’t know why I keep gaining this weight!” 

I don’t know why that sort of thing qualifies someone for surgery. A barbaric surgery with lifelong consequences. Sometimes I wonder about the ethics of the surgeons doing these things and why there isn’t better after care for people undergoing the knife. Cut them up and then cut them off seems to be the plan across the board. 

She had her surgery. 

Three years later her weight was back where it started from and then some and she wanted a referral for a surgery revision. 

I wanted to say, “I told you so.” And then I wanted to call her surgeon up and give him a piece of my mind.

But I didn’t….

A few weeks ago I was at one of those giant outdoor malls. There were easily 20-30 restaurants clustered around. Right there in the midst of it all there was a weight loss clinic. 

Having just eaten at the Melting Pot myself I was so stuffed it was hard to breathe. Way too much food to be healthy but then why didn’t I just stop eating? I was too focused on not wasting anything. Getting my money’s worth. I blame my upbringing. I blame past poverty. I blame portion sizes. 

I blame myself.

Where does that come from, anyway?

At first I was offended that this clinic placed itself where it did. Then I realized it was a brilliant marketing strategy. This is what we have become, isn’t it?

Binge. Purge. Binge. Purge.

Binge.

“How’s your daughter?”

He smiled and pulled out his smart phone, flipping through pictures of a grinning, curly haired toddler. They’d had so much trouble having a baby. 

“Oh, she’s beautiful!” 

He nodded, beaming.

“How is your wife?”

His face changed in a instant. He looked stricken. “You knew she had the gastric sleeve done?”

“Yes, I had heard.”

“Well, she developed Korsakoff Syndrome.” Oh. Wow. “She got confused, couldn’t remember things. Couldn’t walk straight.”

Thiamine deficiency.

“When she said she wanted to get the surgery, I didn’t say anything. I just wanted her to be happy. She suffered so much emotional turmoil over her weight. We had no idea something like this could happen, though. If I could go back in time I would tell her she didn’t need to do it. That I loved her just the way she was. Now she is not the same person. She has to carry a book with her to write everything down since she has so much trouble remembering things and she uses a cane to get around.” 

“Mommy, I’m thirsty!”

It was swelteringly hot. I stood in line to get our fifth soda refill of the day in the $15 red amusement park drinking bottle I had purchased earlier that morning.

*Free* refills on Coca-Cola products all day!

I don’t need Coke products. My kids don’t need Coke products. Water would do just fine to keep us hydrated. But STILL…. I paid $15 for that stupid cup since I could not bring anything into the amusement park. I want to get my money’s worth, dang it. A small bottle of water costs $4.50 a pop multiplied by at least five times per person per day… but soda pop in the big red drinking bottle? Yeah. What is anyone going to pick?

So here we are.

Making money by making people fat. Making money to make people skinny again. Making money getting them fat again. Making money to get them skinny again.

And so on.

It does not ever stop.

How do we make it stop?

Tall and Skinny, No Whip

The Empire State Building

“Your patient is on social media Tweeting about it.”

“Tweeting about what?”

“The weight thing that prints out on the after visit summary for the patients.”

Come to find out she had also called and spoken to my office manager and my practice administrator. 

Good for her.

When we first moved to this electronic health record last fall one of the most annoying things was that on everyone that the program deemed “overweight” or “obese” got a large bright yellow box on the screen that alerted to me to the fact that I needed to add weight loss to their goals. 

I always hit the ignore button but it annoyed me that now I had to click an extra button because it stood between me and each patient’s active problem list. Not everyone needs to have “obesity” on their problem list and I would argue that NO ONE should have “overweight” as an official diagnosis. People who are “overweight” and  “obese” know good and well where they fall. They certainly do not need a computer “diagnosing” them with it, too.

I growled inside each time I saw that yellow box.

Then sometime in March I noticed that all of my “overweight” and “obese” patients were getting detailed weight loss instructions printed on their end of visit paperwork. It was going so far as to tell them exactly how much weight they needed to lose to reach a BMI of 25.

WHAT? I didn’t tell it to do that!

It was autopropagating. Someone flipped a switch somewhere which meant a good many other someones approved the change.

What were they thinking?

Shouldn’t I have control over that? Shouldn’t I be the one to decide? I am the doctor. I know the patient. 

I complained.

Nothing happened.

I mentioned it again.

Still nothing happened.

Some of my patients have eating disorders. A number of my patients have serious emotional issues wrapped up in their obesity. These people for sure should not end up with that kind of stuff on their handouts.

I messed around with the program for a while and discovered that I could manually remove it from the print outs if I clicked an obscure “X” box on the wrap up page at the end of the visit. I have to scroll down to the bottom of the screen to find it. That meant that on every patient I see every day I would have to scroll down to that area and click a box to remove weight from their goals.

I should not have to do that. There are literally 30 million other clicks I have to remember on each patient at each visit. Give me a busy day and things will slip through the cracks. This is something where the cost of human error is too great in my opinion.

For this patient, I was running 30 minutes behind. On hers I forgot to click the button. The print out told her she needed to loose over 30 pounds and detailed the diet and exercise changes she needed to make to get that accomplished. So she went to social media with it.

Suddenly, everyone downtown started scrambling. There will be a meeting now to discuss this.

And I am so very angry.

But not at her.

What does it say about a system that responds to social media pressure before it listens to its own physicians? And why would you ever pick a BMI of 25 and set it as the automatic weight loss goal for every single patient? What about the studies that show that people who are in “normal” BMI range do not live as long as those in the overweight range? That a decrease in life expectancy does not occur in obesity except for the extreme morbid obesity range?

Obesity isn’t killing people. Diabetes is. Cardiovascular disease is. We have put such a focus on weight that we have sabotaged the patients who are most vulnerable and as far as I am concerned we are killing them.

“I can’t lose weight so what’s the point of exercising and eating healthy?” 

I hear this every day.

Weight is not the point. It should not be the point. Healthy lifestyle is. But rather than use those things as the goals they made weight loss THE goal.

Fine.

Maybe I cannot change their mind. Maybe I cannot change yours. But do NOT force me to participate in a game that I do not want to play.

Next time I see that woman I am going to give her a great big hug and a high five.

The Artist

Room detail, Metropolitan Museum of Art in NYC

Over twelve years ago I met an artist.

What she had was a gift. I never had to tell her what to do. It was like she just knew. Left to create on her own she did the most amazing work.

Today was my last appointment with her. 

My hair stylist is retiring and I am grieving. She was the first and only person to ever take charge of my hair and make it look GOOD. She made me feel better about my hair, about myself. I cannot put into words how important and life changing that was.

When I ask patients what they do, often I’ll get the, “I’m JUST a…. fill in the blank.” Hair dresser, office worker, mail handler, Mom, etc. I hate, hate, hate that phrasing. 

Never doubt that what you do has an impact. No matter what your job happens to be, it matters to someone. 

It matters to me.

Maybe I will find someone just as good. 

Maybe I won’t. 

I loathe this kind of change so it will be a growing experience regardless but for now, I grieve. She was an artist in the true sense of the word and she will be missed.

Uncovered

Mission ruins, San Antonio

“Mommy!” my daughter gasped urgently. “Look, she’s a mermaid…” There was reverence and surprise in her voice. 

Imagine meeting a mermaid here!

“Yes, she is…. now, shhhhhh,” I responded.

I held my breath waiting for my little girl with no filter to say something about the woman’s size. She was probably close to 400 pounds and she was wearing a two piece bright purple and turquoise mermaid swim suit like it was the most natural thing in the world.

Mercifully my daughter said nothing more. Instead she snuggled up against me wrapped in her towels and fell asleep, smiling. I am grateful that she and the towels completely cover up my thighs.

I found myself very jealous of that woman. If I could have even half of that confidence, I could… 

But then, I remembered, what I saw was probably only just the tip of the iceberg so to speak. What kind of ugly things had been uttered by people under their breath as she walked by? Was she really, truly confident or was her swim suit an act of defiance, a f**k you to the world wrapped up in flashy purple and turquoise lame fabric? I would never know the reality of what lies beneath.

In contrast to the mermaid, there was a woman who must have been a size 4 standing in the wave pool with a voluminous hot pink coverup who looked so incredibly self conscious and miserable. I felt and understood her pain. She hid her body but did not succeed in hiding her discomfort. 

“Nothing makes a woman more beautiful than the belief she is beautiful.” —Sophia Loren

I looked around me at the hundreds of other men and women, bodies of all shapes and sizes and the swimsuits of all sorts, each one an act of courage. Bacne, surgical scars, stretch marks, cellulite, fat rolls, belly bulges, love handles, etc. all exposed. 

My body is a blessing.

“You are the best looking woman out here,” he whispers in my ear as I take off my cover up. I’m not. The mermaid is, but I love that he can make me feel like he believes it is the truth. 

So I decide to walk around like I am, like I really do believe I am beautiful in my deep cobalt blue velvet one piece swimsuit. I don’t like my body but that is OK. I am not this body. I am not this swimsuit. 

I am beautiful.

Taking The Lumps

“You should probably wear a girdle with that,” my mother said, poking at my lumpy bits. 

I was maybe twelve or thirteen. I had no idea what a girdle was. 

She explained.

When I had put the dress on, a hand me down from some unknown person, I had felt beautiful. Now? Not so much. I hid in my room and took it off, never to wear it again.

My mother did not mean to be mean, I suspect. She had her own her serious body image issues, but it still stung something fierce and those words stuck with me for many, many years. 

Food in my house was torture. My father was obsessed with feeding us as cheaply as possible. For breakfast we ate slimy gruel every morning that he would concoct and which made me gag. My siblings and I would choke down bites, watching with extreme envy as my mother chowed down on a bowl of Cheerios.  To this day even oatmeal is hard for me to eat. He would bring home cans of salmon and forbade my mother to take the spine bones out. A salmon patty, which might have otherwise been tasty, was punctuated by chalky bits of vertebrae. I could go on, but I won’t. It was driven by a certain degree of poverty at one point but even as that improved, the food torture did not.

When I could get good food, edible food, I over ate. 

After my mother’s comment, I stopped eating much of anything, skipping meals whenever I could get away with it, even the things I liked to eat. As I saw it, I did not deserve to eat tasty things if I could not control my weight.

Thus began my issues with food and weight.

I have been blessed to have love in my life that does not see me for my weight, whatever it happens to be at the time, but that does not stop me from being hard on myself. For decades I have struggled with the fact that I have a curvy butt and fuller thighs. I still struggle but it is a losing battle. My body shape is in my genes. I cannot change that without plastic surgery. Even when I lose weight, even when I exercise like crazy, my butt and thighs are always “disproportionately” larger than the rest of me.

Who determines correct proportions?

You know what has helped the most? Finding jeans and pants that fit ME right. It seems so silly. It would appear obvious that women are not made the same. It was not until these past several years, though, that the clothing industry really began to embrace this fact. Thank God, because I feel less shame when my pants fit right. 

Go figure. 

Now, I am starting to like me better. I don’t feel like I have to punish myself by withholding food or exercising. I don’t have to squeeze myself into clothes that don’t fit. Exercising is fun. So is food. And the weight is fixing itself.

Is this going to be the end of my issues? 

Maybe not. 

But it is a very good start.

Hanging Out

Old Ferris wheel in black and white

I find that I am more and more conscious of my own nose hair. What is interesting about this is that I never, ever notice the nose hair of other people and if I did happen to see some bits poking out of a nostril it would not gross me out. So WHY on Earth do I care about my own nostril hair? 

Is this because my nose hair is getting longer? 

Perhaps I am growing more and more sensitive about the change of appearance that comes with aging and I am finding myself more interested in controlling the things that I can have some influence over? 

And then I wonder if there are people who do care about other people’s nose hair and if so, why do they care? What else do they do in their free time?

These are the thoughts I have on a Sunday morning after yet again having one of those pesky hairs ripped from my poor tender nostril by the stupid nose hair trimmer that is supposed to CUT the stupid things. I swear, next time I may as well just tweeze them out….

Sharpies

Interior dome at the Vatican
What is it about Sharpies, those black permanent marker, that makes them so attractive to kids?!?!!??!

We have dozens and dozens of regular (washable) markers in every shape, size, and color you could imagine…. including black. But what marker do they just *have* to use? 

The dang Sharpies, for crying out loud.

Is it the smell? That pungent chemical smell that you can get high off of? The satisfyingly wide, dark line it draws? The squeak you get when dragging the tip across some surfaces? Maybe it’s the permanence. The danger.

Well, I sure wish I knew.

Soft Scrub with bleach will take it off of countertops. But old hardwood floors? Bathroom tile grout? Matte finish walls? FABRIC? 

It isn’t that they are going around marking up everything simply to mark it up. It’s just that when you are excitedly drawing a race car onto a giant cardboard box from Amazon, things happen…. And apparently, it is far more fun to be drawing such things on boxes camped out in the bathroom while mom is distracted addressing oncall patient concerns.

I probably don’t beat them enough.

Wavelengths 

Tiffany stained glass window at Chicago Navy Pier

My microwave died and went to appliance heaven. 

Well. More like fell apart. 

The door plastic started cracking and then the tempered glass front exploded all over the kitchen one evening as I was about to heat up water for tea. Freaked the kids out. Personally, I thought it was super cool. Did you know tempered glass can still pop and explode even as the pieces are lying on the floor? 

It might seem like a simple thing to fix, right? Just order a new door. Except they no longer make this model of microwave. There is no door replacement. We will need to replace the whole dang unit.

However, this is not a microwave that sits on the countertop. Oh, no. It is mounted under a cabinet over the stove/oven and also serves as the stovetop ventilation unit. Apparently, it is also hard wired in, meaning there is no plug to unplug. Getting someone to take this out and install a new one when it is hardwired in is no small feat as it turns out. 

So, for a number of weeks I have been forced to go without a microwave. 

And you know what? It has not been the end of the world. 

In fact, I have found that I prefer heating things up in my toaster oven. Reheated bacon is crispier. Pizza is heated evenly. Corn dogs are yummier. Left over scones taste like the first day they were made. Tea? There is something nice about a whistling tea kettle as opposed to a microwave ding and I swear the tea actually tastes better steeped in water from my kettle. 

The other thing I have found? The couple of extra minutes it takes to use those other methods? They don’t really make a difference in my life. Schedules have not come crumbling down. We have not run late, we haven’t had to make cuts elsewhere. 

Never would I ever have believed I would ever say this: I can live just fine without a microwave. Not only can I live without a microwave, I now choose not to have one. 

That is incredibly liberating.

Makes me wonder what else I can live without…