Wednesday, February 26, 2014

Sappy Self-Reflection Stories About The Fat Guy At The Hospital

There's an article going around on my Twitter that was published on the Washington Post and tells the story of a 600 pound man who went to the ER for pain and was subsequently shamed by hospital personnel, who repeatedly tried unloading him onto another hospital.  You can find it here, although I warn you it's heart-wrenching and eventually ends with a description of EMS responding to the patient's death.

It's one of those articles that I wish I could call a "good read" based on the fact that it draws so much attention to the abysmal way fat people are treated by the medical establishment.  Unfortunately it's ridiculously problematic and fatphobic.

1. Why is an article talking about compassion for fat people who look for medical care giving statistics about how dangerous obesity is and showing a stereotypical picture of a headless fat person?

It's typical practice nowadays for any article about fat people to be accompanied by a headless picture of a fat person, driving home the point that being fat is so shameful that nobody would reasonably show their face in a picture talking about it.  Years ago The Onion wrote an article about this phenomenon called "Camera Crew Discreetly Trails Overweight Woman For Obesity Segment" that encapsulates this process pretty well.  In the article, the picture is captioned with obesity health statistics... "According to the CDC, more than one-third of U.S. adults are obese. Obesity-related conditions include heart disease, stroke, type-2 diabetes and certain types of cancer."

"But Jack," you may be asking, "are you saying we shouldn't allow people to know facts?"

Here's the thing: Even if we were to accept without any question that being fat undeniably always causes health problems (it doesn't always, and overblowing the role of fat lulls unhealthy thin people into a false sense of security), this article isn't about the dangers of fat, it's about the disrespect fat people run into when they seek medical care.  People already know about the purported links between fat and health issues.  They are a huge contributor to the stereotypes fat people face.

Of course, there's a good chance the author didn't choose the graphic and the caption... but the article itself has its problems, too.

2.  The author is making a damn big deal out of things people stereotypically associate with fatness without much explanation about them.

Take this quote here:
"The patient is in his 40s. He spends his days on the sofa at home, surviving on disability checks related to his back pain." 
This image of the fat person as somebody who sits on their couch all day surviving on government aid (I'm surprised the author didn't bring up riding a scooter at WalMart) is a damaging stereotype.  Well, there are fat people who sit at home on the couch collecting government aid... but there's nothing about knowing that fact about somebody that truly suggests how they got in that position.  This guy is described as having debilitating back pain.  It's possible to get debilitating back pain because you are fat.  It's also possible to get fat because you have debilitating back pain.  You don't know what happened here.

Truthfully?  It shouldn't matter.  It was an irrelevant point that the author presumably threw in just to justify his initial disgust.

He then moves on to invasive descriptions of the man's body, describing him as a "mountain of flesh" and referring to his "panorama of skin."  We already know what a fat guy looks like without these descriptions.  They're added for titillation, and perhaps even justification ("Of COURSE I was having a hard time working with him!").

3.  The entire issue of accessibility is totally brushed off.

There's a section where the patient mentions the Americans with Disabilities Act.  This is how it's described:
"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.”

I don’t quite know how to respond, so I say nothing.
I'm not sure why the author doesn't know how to respond, so whether he views this patient's statement as reasonable or unfair is unclear.  He takes great pains to describe the physical difficulty they have treating this patient, from X-rays not reaching far enough into his body to morphine dosing being unreliable, to paramedics not having the appropriate-sized gurney to transport him properly.

This isn't uncommon.  Abled thin people are the "default" average that is being used to develop medical advancements.

Accessibility of fat people is abysmally underemphasized in all aspects of life.  Yet despite the vivid descriptions of failing to properly give this man an X-ray, there isn't much else.  It focuses on the snide comments of hospital staff, instead.  It doesn't really say you shouldn't make snide remarks to fat people (I'll talk about that in section 4), but it's kind of implied.

This is absolutely an important issue, but focusing only on it gives license to focus all of one's efforts on feelings while ignoring these very real physical challenges.  Is it really enough of an improvement to say medical staff should be more compassionate when they tell fat people they won't fit in their equipment?  If one day I find I can't get a medically necessary X-ray because I just don't fit, will it really help me much if the technicians are nice about it?

4.  It turns the whole thing into a thin person's self-exploration journey... by assuming every fat stereotype under the sun is true.

The original title of this piece was something like "I confess: My patient's obesity made it hard for me to treat him."  There was also a little blurb afterward: "It wasn’t just the physical limitations. He made us feel bad about ourselves."

This has as far as I know been edited, but it's a pretty good indicator of the attitude of the person who wrote this.  It wasn't about the difficulty of a fat person getting medical care.  It was all about the author and some bullshit transformative experience he has had because of it.  He had the potential to shed light on some really important issues, and instead decided to write this:
"I know why my colleagues and I are so glad to have this patient out of the ER and stowed away upstairs: he’s an oversize mirror, reminding us of our own excesses. 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."
I want to think that why this statement is awful is self-evident, but the fact that so many people are sharing this article as an inspirational piece tells me that's not so.

This is basically a fat version of people insisting that homophobes are really afraid of being gay.  It's saying "The whole reason people are tormenting this man who has come to them in a time of need for help isn't because of pervasive stereotypes telling us he's lazy, oversensitive, or undeserving of care... it's because we're all 'mentally fat' and he reminds us of our own excess."  He's basically arguing that all the stereotypes of fat people are undeniably true, and that thin peoples' appalling behavior is veiled self-criticism in the face of a more-intense version of themselves.

Maybe, just maybe, the reason people are assholes to fat people is because they're assholes and not because they're forced to look inside themselves at their own flaws?  Because you know, there are plenty of thin people out there who are assholes to fat people who give me absolutely no indication that they see themselves in fat people.  Just the opposite:  They assume that since thinness came to them easy (whether by biology or whatever else) that anybody who has not attained their body shape is clearly lazy and enjoys "excess."

I wonder if this author has ever had a Facebook friend who was a runner or a bodybuilder or something like that who constantly posts pictures bidding the viewer to give an "excuse" for not running five miles a day or being heavily muscled such as they.  This is not people looking into a mirror and I have no idea how anybody could seriously come to that conclusion.

5.  There is no indication to me that the author actually talked to this man about the assumptions he was making about him.

When I was a personal caregiver writing things like "seems like" was code for "I think that this was the case, but my client is either nonverbal or I'm just flat out too embarrassed to ask."

Take this awful paragraph:
"The patient lies trapped in his own body, like a prisoner in an enormous, fleshy castle. And though he must feel wounded by the ER personnel’s remarks, 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."
"Must feel" and "seems to" come off to me as "I didn't actually talk about either of these things with this guy, but I could see it in his eyes somehow."  If this had been a reasonable conclusion, like if he'd stopped at "he must feel wounded by the ER personnel's remarks," then I could give it a pass.  But the assumption of how many calories this man consumes daily (a more accurate calorie count at this guy's age and weight would be more like 6,000 just by a pure calories-in-calories-out standard, and plenty of factors could lead to him being able to maintain that weight with much less than that), why he eats (do we really know he is eating to soothe his emotions?), and so forth.  Considering the fact that he flat out states in the paragraph about the man's physical ailments that this was an actual conversation with him, I find it highly unlikely that these latter statements are his own imagination and not from any sort of interview.

In other words, this author is writing about these epiphanies he's having about this man's "plight," but he doesn't actually have a full concept of what that "plight" is outside of his own stereotypes of fatness.  He might very well be right on the dot... but we don't know that.


That said, the author is constructing a narrative--not around his patient, but around himself--based on his own assumptions and feelings and turning it into his own transformative experience.  This is a shame, too, because the experiences he is relaying could really have been made into a positive article if he'd dropped his own victim complex and focused on the needs of his patient, instead.  And that's what's so terrifying about this:  Knowing that this guy--who is now a family practitioner--has written something so detached from his patient's needs.