[Content Note: Fat hatred, dehumanization, medical malfeasance, fat bias]
We have had extensive conversations in this space about how fat hatred kills people. We have these conversations over and over and over again, because it continues to be something that kills people, over and over and over again. Today Liss shared with me, via Shaker P, yet another example of just how deep-seated fat hatred is in medical practice and I felt the need to call it out once again.
On Monday, the ever progressive (not actually a true statement) Washington Post published a piece by Edward Thompson—a doctor who I believe is writing under his real name—which is, as Liss described it, one of the most vile, dehumanizing, exploitative pieces of fat hatred I've ever read."
The actual title is 'A Morbidly Obese Patient Tests the Limits of a Doctor's Compassion,' so right away we're made aware that this piece is about Compassionate Doctors and the trying fat people who are so terribly cruel with all their testing the limits of everyone's compassion with their fatness.
The first sentence sets the tone:
The patient is large. Very large. At more than 600 pounds, he is a mountain of flesh.And I almost stopped reading right there because when you start out by reducing a human being to a 'very large…mountain of flesh,' there is very little hope that you are going to say anything that I want to read. The piece just gets worse from here.
"My stomach hurts," he says, his voice surprisingly high and childlike.Fat Stereotype #1: Fat people are 'childlike,' simple fools unable to take care of themselves and their own basic needs. The implication of this stereotype is inevitably, as here: If they'd just grow up and take some responsibility they'd be thin and pleasant to look at just like everyone is morally obligated to be.
Asked if he's ever felt this kind of pain before, he says, "No, never. At least, not like this."Fat Stereotype #2: Fat people are all—and should expect nothing other than to be—in debilitating pain. Never mind that fat people, like not-fat people, generally seek medical treatment when they experience pain that isn't normal for their bodies.
"Well, what'd you expect?" the unit secretary mutters, only half to herself.
But, referring back to Fat Stereotype #1, obviously, the only reason anyone is fat is because they are an irresponsible, uninformed, and stupid person who cannot properly understand the world around them. Including important rules like: You aren't allowed to be simultaneously fat and comfortable.
The patient is in his 40s. He spends his days on the sofa at home, surviving on disability checks related to his back pain.Fat Stereotype #3: All fat people are fat because they lounge around all day, every day, sitting on their asses doing nothing but eating junk food and watching TV. Fat Stereotype #4: All fat people are lazy, and lots of them are scam artists who mooch off hard-working, honest, thin taxpayers by tricking the government into paying them for their back pain.
Never mind that there is no indication whatsoever, if this doctor even bothered to inquire, whether the patient's weight and/or inactivity was, in part, a result of his disability, or whether, as is clearly implied, that his disability is the result of his weight and inactivity.
Facing him, I feel momentarily put off.Fat people are gross. In case you hadn't heard. Off-putting by virtue of their existence. Like ghouls and monsters.
I'm not sure just where to start the examination,I'm no medical doctor or anything, so I could be wrong, but my totally uneducated guess would be: Wherever you start the examination with every other human you see in the ER complaining of abdominal pain. But, like I said, I'm not a doctor.
when I begin, my hands look small and insignificant against the panorama of skin they're kneading.Again, let's remind everyone that this man has a panorama of skin; he's hugeand freakish and makes the doctor's hands look small and insignificant. Not for nothing, but this is definitely analogous to how monsters are frequently described in literature all the damn time.
It's hard to tell, exactly, but I think his pain is coming from somewhere around his stomach.Again, I'm not a doctor, but this does not seem terribly surprising since, in the patient's own words, his stomach hurts; but it's a good thing the doctor verified it (as best he could, there's a whole panorama here to circumnavigate, remember) because we also need to remember that fat people are fat because they are stupid and simple, so they can't be trusted to actually know what's what about anything, including their own bodies.
Awaiting [the surgeon's] arrival, we try to shoot some X-rays. When we roll him onto his side, though, he turns an unnatural shade of blue-gray and can't tolerate the position long enough for us to put the X-ray cassette behind his back.Which is obviously and exclusively because he's a fatty fat person, and not at all, possibly, because he's suffering from acute abdominal pain. Again, I'm not a doctor, so my thoughts on this are clearly suspect.
We try a chest X-ray, turning up the power to the maximum setting. All we see is white… he is a walking lead shield.Again, excellent use of dehumanization and monstrous construction. This isn't a normal human; this is a walking wall of lead. How can he even expect basic medical care or decency in a hospital for humans when he is barely human himself?
Our standard GI cocktail of shot-in-the-dark digestive tonics plinks into his stomach without any effect."Plinks." Because, as a fat man, he obviously has a GINORMOUS stomach that cannot possibly be remotely affected by 'standard' medical quantities.
Morphine at doses high enough to make me dance on tables merely makes him a bit drowsy.This is not an unusual phenomenon among people—of any size—with chronic back pain. Something of which, one imagines, any doctor would be aware.
But this doctor is more concerned with his own unhappiness at giving his fat patient so much morphine—a thought that even seems to supersede concern that the patient is still in acute abdominal pain. After all, fat people are monstrous non-entities completely to blame for their own discomfort and health problems; what matters is how medical providers feel in relation to them.
I talk to the patient between procedures, trying to get a sense of him as a person. He recites a litany of consultants he's seen for his back pain, his headaches, a chronic rash on his ankles, his shortness of breath, his weakness, his insomnia and his fatigue.Fat Stereotype #5: Fat people are whiny hypochondriacs. Fat Stereotype #6: All fat people's health problems would magically go away if they would just stop being fat!
"All of them have failed me," he says, adding that the paramedics didn't have the proper ultra-wide, ultra-sturdy gurney to accommodate his body.(emphasis added)
"The Americans with Disabilities Act says that they should have the proper equipment to handle me, the same as they do for anyone else," he says indignantly. "I'm entitled to that. I'll probably have to sue to get the care I really need."
Fat people! Expecting basic medical care like everyone else! Where do they get off with their entitlements and outrageous demands!! If they want medical care like everyone else, then they should try being thin like everyone else! They're clearly just looking for handouts and clogging up the legal system with frivolous lawsuits because they are whiny and immature and have no sense of personal responsibility. Etc.
Here, I would like to insert that a lot of what we talk about around here has to do with human rights and that ALL people are entitled to food and medical care. That includes fat people. Fat people exist, period; just like people with latex allergies exist and people who can't take penicillin exist (and those are not mutually exclusive from fat people). Casting the provision of basic medical care for fat people as some bizarre and extravagant luxury rather than a basic human right they are entitled by by virtue of being human is a pile of eliminationist and hostile garbage.
We've placed the patient in a room with an oversize hospital bed, so at least he's resting comfortably.We've done the bare minimum of providing him with a bed; we are spectacular human beings!
Finally, we move an ultrasound machine into his room — it barely fits between the bed and the wallBecause this man is SO FAT that he needs a larger bed, he is breaking the hospital procedures; this is all his fault for existing the way he does. This is clearly, according to the doctor, not a case of a gross lack of accessibility, having rooms too small to accommodate both diagnostic equipment AND a fat patient who needs it; this is a case of fat people being too inconvenient for the world to deal with and they really should stop it already.
A half-hour later, the chief of radiology comes out of the room, rings of sweat under his arms. "I think we have something," he says. "A gallstone."(emphasis added)
Remember everyone, this dude is totally fat!! He's so fat the chief of radiology is sweating from the effort of trying to diagnose him! This is a truly trenchant and relevant detail for the story; I almost forgot it was about a fat man who is beyond an inconvenience to everyone with whom he interacts.
There follows a description of the surgeon assigned to the patient spending time and making phone calls trying to get the patient moved to another hospital rather than admitting him where he is, because the surgeon just doesn't want to deal with him. The way it is narrated, this is taken to be understandable; there is certainly no critique or even implied disapproval of the surgeon's actions. I guess this hospital's policy is: Fat people—unload them anywhere you can, because we don't have time to deal with them; we have real humans to see.
But, it turns out no other hospital can take this monstrous man until the next day:
"Don't put him in a room right over the ER," whispers the unit secretary to the admission clerk. "The floor won't support him. He'll come crashing through and kill us all."Ah hah hahha! My aching sides! You know those fat people—those monstrous, lead-walled, panoramic fat folks—they'll break the world!!! Ceilings in hospitals were never designed to hold several hundred pounds at a time!
As awful as this piece is up until now, I was still surprised by how awful the next sentence is:
Glancing across the hall at the patient, I see by his eyes that he's heard her comment, and I'm suddenly sure that he's heard all of the side remarks aimed his way.(emphasis added)
Fat people! They exist in the world and can hear you! They may even be entirely aware of your loathing, your disgust, your discomfort, and your judgment. They may even (probably) take these things into account when deciding if the acute pain in their side is bad enough to face the dehumanization, the hatred, the vitriol, and the humiliation of interacting with medical staff (you know, those compassionate care givers ostensibly tasked with giving a shit about their well-being and health and trying to diagnose and help them) or if they should just wait it out and see if it gets better.
Fat hatred kills people. Not least of all because sometimes living with pain and not knowing what is may just be preferable to being dehumanized, hated, and sneered at by the people you have to trust in order to access medical care.
I wish I could say this is the end, but it's not. Things get worse from here.
Finally, a slew of huffing, puffing, grunting attendants wheel him down the hall, leaving me to reflect on his plight.Let's remind everyone that he's fat, in case anyone has forgotten, and share that it takes a whole crew of people doing strenuous labor just to move him down the hall! I mean, one sentence ago we almost acknowledged that he was a person with feelings completely aware of the abuse and hatred leveled at him by everyone in his vicinity; let's not reflect on that or anything, let's get back to focusing on the thin people (ie, real humans who actually matter).
He lies at the very large center of his own world—a world in which all the surgery mankind has to offer cannot heal the real pain he suffers.So, again, this man isn't just in the center of his own world, it's a very large center. Because he's SO FAT; get it? Did you forget he was fat? I almost did; I'm glad our narrator made sure to remind us again that this entire situation is a result of how completely and utterly fat this particular patient is.
Additionally, (again, as a non-doctor), I feel like 'all the surgery mankind has to offer' could start healing his pain by removing his gallstone and then maybe not treating him like a piece of filthy and inconvenient garbage that is just SO MUCH trouble to deal with.
But, bitter sarcasm side, I know what the narrator means.
Fat Stereotype #7: All fat people are broken and in terrible emotional pain.
He doesn't mean 'the abdominal pain so bad this man sought medical attention even knowing the rank amounts of hatred and disgust he would be subjected to,' he means 'the inner pain that all fat people have which they try to assuage with eating and laziness.' Because no one is fat for any reason other than emotional dysfunction and a lack of loving themselves. Fat people are broken from the ground up and that brokenness is clearly proved by their fatness.
This narrative is utter reductive, dehumanizing, and vile garbage. The only thing you can tell about a fat person by looking at them is that they are fat. You know nothing about their emotional state, their life, or their inner self; to claim that you do is to continue to silence, marginalize, and dehumanize them.
The patient lies trapped in his own body, like a prisoner in an enormous, fleshy castle.Again, this doctor has NO WAY OR KNOWING how this man feels about his own body, he is projecting lazy, dehumanizing narratives onto a man he doesn't even see as fully human.
Also, we were in danger of forgetting this patient is fat, so we needed another reminded that it's not just a castle, but an enormous (not big), fleshy (i.e., Ewwww!! Gross!!!!) castle.
And though he must feel wounded by the ER personnel's remarks…Honestly dude, you don't seem to give much of a shit about how wounded this man may or may not feel by the way EVERYONE in the story (including, you, Dr. Thompson) have treated him during this entire encounter, so just shut the fuck up about it, okay. One sentence pretending you care doesn't make your writing any less of a garbage nightmare of fat hatred and eliminationist rhetoric without an ounce of empathy or self-reflection.
Especially when you finish the sentence with:
…he seems to find succor in knowing that there's no comment so cutting that it can't be soothed by the balm of 8,000 calories per day.Fat Stereotype #8: Fat people are fat because they soothe away the vile way the world treats them with emotional eating! It's a fact, proven by science! This is a doctor, so he clearly knows everything about everything, including why all fat people are fat.
(Note from Liss: The doctor claimed in comments of the piece that he knows how many calories the patient consumes because the patient told him. In which case: I question whether publicly disclosing that information is not a breach of doctor-patient confidentiality. If it's not a technical breach, it is certainly breaches the spirit of the provision, as far as I am concerned. Further, if it is accurate that the patient was consuming 8,000 calories per day, that is evidence of disordered eating, which is something doctors should be keen to treat as a medical issue, not ridicule and sneer at with disgust on the pages of a major international publication.)
Later on in my shift, still feeling traces of the patient's presence, I sit and stare at my 700-calorie dinner, all appetite gone, wondering where empathy ends and compassion begins.That truly is a question for the ages, Dr. Thompson. I'm also not a philosopher, but I have a sneaking suspicion that neither empathy or compassion (neither of which have been displayed by anyone in this narrative, by the way; quite the opposite, in fact) are anywhere near write a naval-gazing and dehumanizing piece about a fat patient, how he was totally gross and disgusting and awful, how he is stupid and childlike and whiny, how he is an emotional and stunted human unable to care for himself and how he is an object lesson in what not to do; with a side-helping of fat hating narratives and projections.
But, that's just me, I guess we disagree on this one.
I know why my colleagues and I are so glad to have this patient out of the ER and stowed away upstairs…Stowed away, like an unused piece of furniture, because he's huge and unwieldy and just an object of inconvenience, not an actual human being.
…he's an oversize mirror…Another reminder that he is fat ("oversized"), in case you'd forgotten, and another example of describing him as an object rather than a human being.
…reminding us of our own excesses.Ultimately, he is not a person in his own right, but a symbol. A breathing metaphor for excess. A lesson for thin people to learn from and guard against.
It's easier to look away and joke at his expense than it is to peer into his eyes and see our own appetites staring back.Appetites. In case, again, you forgot he was fat.
How about you try peering into his eyes and SEEING HIS HUMANITY you unmitigated, unempathetic asshole? You could try that, just for a start; maybe then it wouldn't be so easy to 'look away and joke at his expense.'
And again, this patient is still an object that reflects thin people's (implied: real humans) appetites back at them. Did you forget the patient was fat? He's totally fat; he's a symbol of 'appetites' because he EATS ALL THE THINGS, ALL THE TIME; that's why he's fat.
And this is how the piece concludes:
Though I have no way of knowing it, within a few months a crane will hoist the patient's body through a hole cut in the side of his house, a hole that allowed EMS personnel to lower the body onto their new ultra-wide, ultra-sturdy gurney.There is then a note about the author:
Thompson worked in emergency medicine for 32 years and now practices family medicine in Frederick County, Md. This is an edited version of a story that appeared in Pulse — Voices From the Heart of Medicine, an online magazine of stories and poems from patients and health-care professionals.Let me just tell you: If I lived in Frederick County, MD, I would feel TOTALLY unsafe going to an ER for help after reading this; I would have no reason to expect I would be treated like a human being worthy of empathy or understanding, or as anything other than a freak, an object, and a moral lesson for not conforming to expectations of what a human should be.
And this is part of how fat hatred kills people.
This attitude, blatantly recounted in a doctor's own words, is what fat people can expect to face when they ask for help. The game of 'is the pain bad enough to deal with dehumanization and humiliation just to find out what it is?' of 'I don't know if I have the personal fortitude to deal with those looks and those comments and that hatred today.'
Fat hatred kills people.
It is unacceptable and needs to stop.