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Navigating American Healthcare in a Fat Body

As a fat American woman, every single encounter I have with a healthcare “professional” is fraught. Not only my own personal experience but also copious research bears out the notion that fat people in general and fat women in particular get less accurate diagnoses, get lectured and condescended to more often, are mis and under-diagnosed at alarming rates, and are generally treated like trash by the healthcare system as a whole and the individual cogs in that machine.

Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors.

-National Institutes of Health

As you go through life in a fat body you tend to learn what types of situations to avoid – things that will make you physically or emotionally uncomfortable. Occasions  and events that might engender humiliation or abuse. For far too many fat people, standard trips to doctors offices, labs and hospitals unfortunately become those types of events – ones best avoided if at all possible.

There’s a lot of whining about how fat people are destroying healthcare and costing thin (“healthy” one is to assume?) people money. Ragan Chastain has done a better job than me at breaking down how much BS that is, so I will just link to her work (Ragen Chastain: Fat People and Tax Dollars) and get on with my story.

Yesterday I was scheduled to go in for a cardiac stress test. (Spoiler alert: I am fine) I have been having some arrhythmias and had an abnormal EKG, and once the cause of that was diagnosed last month (it’s nothing serious) my doctor and I thought it best that I also get a treadmill stress test just to make sure that I have no undiagnosed blockages or any other problems.  I have excellent insurance this year (literally thanks, Obama) and I have exhausted my deductible, so if there’s testing to be done I am in the sweet spot to do it. (How nuts is the American healthcare system that we have to schedule our testing in this way? But I digress.)

I’d had a treadmill stress test before and, due to lack of clear communication from the testing center, the entire event was a humiliating nightmare fiasco, after which I had to phone a friend and go out day-drinking in an attempt to mentally recover. That experience (which was bad enough that I still can’t even write about it) has naturally stayed with me, so I was not exactly looking forward to this one. I was at least armed with prior experience and knowledge about how to prepare, and had a chance to mentally gird myself and set firm internal limits for what I would and would not tolerate from the staff at the testing center. I have had enough experiences with bad healthcare practiced on myself and my loved ones that I am now an extremely uncooperative and often outright belligerent patient. I question everything, I do not go along with anything until it is explained to my satisfaction. The fact that I want to understand what is being done to me is shocking and offensive to most healthcare staff, which in itself should tell you something about the mentality of those who work in our healthcare system.

I arrived at the Barnes Jewish Cardiac Diagnostic Lab 20 minutes early dressed appropriately in my workout leggings, sports bra and tennis shoes. I had not eaten for five hours prior, as instructed, and I was taken back to the lab 40 minutes after my scheduled test time because they were running late. As I sat in the over-heated waiting room, listening to other patients make sexist remarks to the nurses, I was anxiety-texting a friend in order to stay in the defensive mindset I need to inhabit in order to deal with health workers. My natural state is pretty go-along, get along, and I have to actively subvert that in order to be an effective medical advocate for myself. Again, I knew what I would and wouldn’t tolerate and was renewing my commitment to just walking out if the techs involved were disrespectful of me or my body.

When we finally got started the nurse began by asking me what I assume are standard check-in questions for the procedure, and explaining what we would be doing.

Nurse: Do you know why you’re here today?
Me: Yes. (was this an early onset dementia question? Do people wander in a lot who don’t know why they’re there?)

Nurse: Can you tell me why you’re here? (I’d assume that you’d have that written down on your paperwork someplace, but OK.)
Me: I am here for a cardiac stress test.
Nurse: OK. So do you exercise regularly?
Me: Yes.
Nurse: Oh, you make time for exercise? (brow lifted in disbelief) That’s good. How many days per week?
Me: (tells her number of days per week)
Nurse: (eyebrow even higher) Really? What kind of exercise do you do?

OK so at this point she Took a Tone. Like most fat people who tell others they exercise, I was being disbelieved. Since I wasn’t there for a fucking weekly exercise-log review I was not in the mood to justify myself to her.

Me: Does it make a difference?
Nurse (visibly startled that I wouldn’t answer her) Well…no.
Me: Then I don’t want to talk about it with you.

At this point, she was taken aback, and then started apologizing for my wait time. I think she thought I was pissed off about the procedure running late and was therefore being uncooperative, which was not the case at all. I was pissed off about the arched-eyebrow, smug look she got when she demanded details on my fucking workout routine. (When scheduling the appointment I was asked if I was able to walk on a treadmill for the test and I answered that I was definitely able to. She wasn’t trying to make sure I was physically able to do the test, that had already been determined at a much earlier stage – had I not been able to walk they would have scheduled an entirely different type of test for me.)

At this point she turned back to her computer and started typing, but she REALLY wanted that information and was trying to figure out how to get it. So she suddenly turned back to me and said:

Nurse: Well, actually I guess it DOES matter, because a lot of times people THINK that what they do is exercise, but really it’s not exercise.

What the penguin fuck, lady. Again, the clear implication here is that my fat ass might THINK that lifting a Cheeto from bag to mouth is good cardio, but CLEARLY I had no idea what “exercise” was or I wouldn’t look like this.

Me: Really? Well (x) days per week I do (activity) at (intensity level) for (x) minutes. (X) other days per week I do (activity) at (x) mph for (x) minutes.

(I am leaving out details here because they are none of anyone’s business and potentially triggering for anyone with body/exercise issues. How I exercise is personal for my own mental and physical health goals and you do not need to exercise at all, or a certain level to deserve access to quality, compassionate healthcare.)

Nurse: Oh. (shuts the fuck up)

We start the test. For those who have not done this before it works like this: you get a bunch of sticky pads stuck on your chest and abdomen, they take your blood pressure and do an EKG while you’re lying down, and then with all that stuff still attached and the BP cuff still on you walk on a treadmill at gradually increasing speeds/inclines until you reach a target heart rate. Each level of the treadmill portion takes three minutes, after which time the speed/incline increases. Your BP and heart rate are continuously monitored during this process. This means you’re walking for 12-15 minutes, which is a lot of time to make small talk with a random nurse.

We were chatting about innocuous subjects, when the nurse brought up that a good friend had been diagnosed with cancer and she was soon traveling to see her. I expressed empathy, and explained that I had lost my brother to cancer, and wished her and her friend good luck. Here’s where it all started to go even further downhill.

Nurse:  A book I am loving now is (XYZ) it’s all about a man who was diagnosed with Stage 4 cancer and he cured it without chemo.
Me: Uh huh. (Obviously this is a topic I am really sensitive about and not prone to tolerate a bunch of nonsense, since I just fucking explained that someone I loved died of cancer.)
Nurse: Yes, he had colon cancer and he had an operation to remove it but then he refused chemo and he used a PLANT BASED DIET to cure his cancer.

She waxes on about pumpkin seeds and anti-cancer vegetables and other complete bullshit. I nod and smile, wondering how long I have to keep talking to her.

Nurse: …but it’s all about a PLANT BASED DIET. I believe this very strongly, we should all eat a PLANT BASED DIET. And he is completely cancer free, he cured himself with this PLANT BASED DIET.
Me: …and the operation to remove the cancer.
Nurse: Yes, he had the operation, but mostly it was this PLANT BASED DIET.
Me: While I agree that highly processed foods are probably not good for anyone, I like meat, and I eat meat.
Nurse: But it is not good for you. What is good for you is a PLANT BASED DIET.

Oooooooh boy. OK, whatever. I don’t have to agree with this lady in order to smile and nod and place my thoughts firmly elsewhere.

Wishing I had told my brother that eating fucking pumpkin seeds would have solved all his fucking problems, but whatever OK.

As we are talking the treadmill has inclined/sped up twice. I am still carrying on a perfectly normal conversation with her while doing this, and not at all out of breath. She tells me it’s going to speed up once again, and that I am getting close to the target heart rate we need. Great. Close to done with this inane conversation. Now, one thing I have to explain is that I am 5’4″ and almost none of that is leg. I have very short legs and consequently I don’t cover a lot of ground when I walk. I genuinely can’t keep up with anyone when walking if they’re taller than me, because I have to take three steps to their one step. This is unrelated to the amount of time that I can walk, or the intensity of the pace I can keep, but I just can’t cover the same amount of ground – I am sure there’s some kind of math that could explain it if you don’t get it. Da Vinci probably made a diagram. So when she warned me that the treadmill was going to speed up again I told her that if it sped up much more I was going to be in danger of falling off, or I would have to start to run, because my legs are short.

Nurse: I can see you are getting tired.
Me 0% tired, I have only been walking like 9 minutes at a modest pace at this point: No I am not tired. I cannot walk THIS FAST without potentially falling off.
Nurse: If you are tired we can stop,
Me: But I am not tired. I am in danger of falling. If I need to keep going for you to have the data you need then I can easily do so.
Nurse: Well, we have met your target heart rate, so it is your choice to keep going or not.

Me: ?????????

Then the treadmill speeds up and I start running.

Nurse: You can just walk faster, not run!
Me: Not without falling I can’t.
Nurse: No, you just need to walk fast.
Me: OK, then let’s stop. I am not prepared to fall off.

I still don’t even get this part. Were we done or not done? Why was that up to me if she had what she needed? Did she think I wanted to hang out walking all day for extra pumpkin seed proselytizing?

Nurse, triumphantly: Well you’ve done some exercise here today at least!
Me: ??????? (This in nowhere near the level of exercise I actually do in a day. At all.)

At this point I lie down and just hang out while the computer automatically assesses how long it takes for my heart rate and BP to get back to normal. Nurse Chats-a-Lot thinks it’s a great time to tell me more about her favorite books.

Nurse: I am also reading BOOK WITH THE WORD OBESITY IN THE TITLE, and that is a good book too.
Me: uh huh.
Nurse: I really thank god for this book about OBESITY.
Me: Uh huh.
Nurse: It is such a good book about OBESITY and it recommends a PLANT BASED DIET.
Me: Uh huh.
Nurse: Exercise in not as important in fighting OBESITY as is a PLANT BASED DIET.
Me: do tell.
Nurse: It’s OK to exercise, good to exercise, but this book explains that it’s about a PLANT BASED DIET.

OH MY FUCKING STARS I AM GOING TO GO MENTAL ON THIS LADY. I mean it’s clear that she really wants to recommend that I be less OBESITY and more PLANT BASED DIET and that I should really read this book about OBESITY because of my own OBESITY and how I don’t adhere to the PLANT BASED DIET and OMG I am all out of fucks to give. I am light-headed from lack of food and also slightly dehydrated because it’s hot in there and I have forgotten to drink water because I was fasting and OMG lady STFU. It’s also no accident how she suddenly discounts exercise as being important now that she knows I do it – I didn’t miss that subtle layer of mayo on this nonsense sandwich she’s peddling.

Finally, finally it’s all over and I can get dressed and leave and she can talk about the PLANT BASED DIET and OBESITY with her next unwilling victim and overall even though this was intensely weird and offensive it still falls into the realm (for me) of “funny” rather than overtly upsetting or harmful. And perhaps to you it doesn’t seem like that big a deal, that this nurse was haranguing a strapped-down fat lady about OBESITY OBESITY OBESITY when said lady just needed a fucking heart test. But had I NOT been prepared and had I NOT steeled myself for even worse I might have let that lady shame me. And shame is not a part of responsible fucking healthcare. Being disbelieved about how you take care of yourself is not a part of healthcare. Being told that pumpkin seeds cure colon caner is FOR SURE not a part of health care.

So it’s things like this that make fat people dislike doctors, nurses, medical tests, medical labs, taking off our clothes and being vulnerable. Whether or not this seems like a big deal to you (and again, on the spectrum of what’s happened to me, it’s not – for example I will never, ever go back in for another mammogram on actual pain of death) this is wrong. It’s shaming and judgmental and wrong, and it shouldn’t happen, but it happens every day, all day long. I am sure that nurse thought she was being nice, and helpful and doing a fatty a favor. But she knows nothing about me, my health goals, my history, my body and my dietary needs. And none of this should have happened.

When the test was over and I had escaped I drove directly to Byrd and Barrel and got some fried chicken and it was fucking delicious, I can assure you.

By the way, on my test results was this note: Above average exercise tolerance for age.

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Cover photo courtesy Envato

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