Wednesday, August 4, 2010

Weighty Matters

I've been called in with four other people to help hold up the panniculus of a fifty-year old woman in our emergency department so that one of the nurses can catheterize her. The big flap of abdominal tissue that nearly extends to her knees is firm and pocked, and almost scaly in areas with patches of dry skin flaking off under my gloved fingers. With the help of my coworkers, we grab the the heavy lump of tissue and pull it up so that Matt can prepare to insert the Foley.

"I can't find her vagina," he mutters in exasperation.

We all shift around a little bit, trying to pull the panniculus up a little higher and shift the position of her legs. After a few more minutes, Matt manages to find her vagina.

"Are you guys doing okay?" He asks. "How are your backs?"
"We're fine, don't worry," says one of the ED techs, her forehead damp with sweat.

Mike unwraps the catheter package, puts on his sterile gloves and prepares a sterile field, lubes up the tip of the tube, drapes her, swabs her, and gives it a go. The catheter is in. None of us thought it would be that easy.

"You're done?" Our patient asks. She smiles. "I've never had anyone put in a catheter that fast before!"

These kind of situations were initially really shocking to me, but more and more, I'm realizing that they are becoming commonplace. It is not all together unusual that I will come to work and we'll have a patient in the ICU who is so obese that she is unable to move her legs or even turn onto her side. I will later read histories and physicals, and see that some of these patients were not in nursing homes before they were admitted to the hospital. How do they live independently? How do they go to the bathroom, take a shower, clean their house and get groceries? Who takes care of them? It is terrifying to me that some peoples' obesity has become so out of control that they are nearly trapped within their own homes.

It is physically strenuous to care for these kinds of patients, even in the hospital setting. It sometimes takes four or more people to turn and clean up the patient in bed if she has a bowel movement. They seem predisposed to skin breakdown between the folds of their skin. We need to find special bariatric commodes, wheelchairs, and beds (in our hospital, there are a limited few) with special bariatric sheets, and use bariatric gowns because normal hospital gowns do not provide adequate coverage.

Many of these patients are in the hospital due to complications of their obesity (heart disease, hypertension, diabetes, sleep apnea), and some healthcare personnel are not terribly sympathetic, having an attitude something along the lines of it's your own fault that you let things get this out of hand.

I don't know exactly how I feel. As an aide, it's rare that I have the chance to get a very complete picture of any of our patients. I don't really know what the contributing factors are to their obesity, how they got there, what they tried to do to help themselves. What did their doctor try to do to help? Did they even have a doctor? There's a part of me that's always a little baffled. I always imagine if I were becoming seriously overweight, I would be alarmed at my weight gain and I would do something. If my attempts didn't help, I would seek help until I found a weight-loss strategy that worked.

At the same time, I feel like these patients who are so obese they can barely move are practically past the point of no return. How can they exercise if they can't stand up? Even just as a pregnant woman it was uncomfortable for me to exercise, so I can't even imagine what that would be like if I were 300+ pounds. By the time these patients are in the hospital, their prognosis is likely even more dismal, so in my book, these patients are deserving of any kindness and help they can get. After all, it's our job.

So I guess my big question is, how does a healthcare provider keep patients from getting apathetic about their weight? Do you think it's an issue of motivation, education, or something entirely different?

1 comment:

  1. I think it is easy to judge and far more difficult to find compassion. I applaud you for taking the time to empathize - medicine could use more of that kindness.