the morbidly obese patient
the very first thing i heard when they were talking about him was: “his parents should be in jail!”
he is 20 years old, i would say approximately a little over 5 feet, and weighs 589 pounds. he has multiple wounds on his buttocks. his skin is scaling off. he is unable to turn to his side by himself, not able to clean himself, and admits being extremely embarassed that we had to do almost everything for him.
one thing that breaks my heart about the whole thing is that he is so young. at his age, he should be living the good life…fun, friends, endless possibilities. but he isn’t, because he can’t. literally.
people in our unit have a lot of sympathy towards him, and they also have a lot of things to say about him. they mostly agree on one thing: his parents should be blamed.
unable to make a strong opinion about it, i wonder what exactly compelled everyone to conclude, without a doubt, that it was his parents’ fault that he gained all that weight.
i don’t know what to think. i am a parent. i also don’t know what to say, because i have parents.
as a parent, the line to cross is very thin. i worry about saying anything that will impress my kids that eating and weight is the end all, be all of life. i worry that they will think if they gain a little weight they should be ashamed to the point of killing themselves slowly by being anorexic. i worry that if i don’t say anything, they will end up in a hospital, lie in that big boy bed, stinking and humiliated because it takes four to five nurses just to clean their butt.
as a parent, everything extreme worries me. the challenge to maintain a balance is difficult, it keeps me awake at night. it bothers me that we are living at such a time when the simple act of eating becomes such a stressful, sensitive issue.
as somebody’s child, where does one stand? when your weight gets out of control for all sort of reasons, is it really that easy to put the blame on your parents for not taking control?
he has wounds that shouldn’t have been there. he can’t breathe just because of his size. i help three other nurses so he doesn’t lie on his own poop. he puts a washcloth on his mouth so we won’t hear him scream in pain. he keeps saying sorry for being such a pain, he said we have no idea how embarassed he is.
i want to blame someone, or something.
but i don’t know how, and i don’t know who, or what.
My favorite scapegoat lately is the intestinal flora.
I read a study not too long ago where they transplanted intestinal flora from a fat mouse and a skinny mouse into mice that were raised in a sterile environment. The mice with the flora from the fat mouse became fat! Pretty wild. Some of the details of the study were withheld, supposedly because they don’t want people screwing with their intestinal flora to lose weight without knowing what they’re doing.
That’s…a pretty wild height and weight for a 20 year old, there must be more involved than diet and activity level, dont you think?
Comment by PM, SN — January 14, 2008 @ 3:59 pm
I get tears in my eyes reading this. It is so sad. I think people are too quick with judgement. Somehow in this case the weight got way out of hand.
It is difficult for a parent to walk that fine line between teaching and nagging.
My oldest used to be chubby in childhood, my second is a skinny tall shrimp, and my youngest is what is pretty close to fat. They all grow up in the same family, but why is one so different? I worry about him, but I also don’t want to make him feel guilty about food.
I hope your patient will get his life back!
Comment by annemiek — January 14, 2008 @ 6:00 pm
This is sad. I can’t imagine how much you have to eat to weigh that much intestinal flora or not.The parents were probably in denial and the kid…well I hope he CAN salvage his life.
Comment by Cinder — January 14, 2008 @ 7:02 pm
My admittedly knee-jerk reaction is that he needs bariatric surgery.
Comment by shrimplate — January 14, 2008 @ 9:46 pm
I agree with shrimplate… this guy needs bariatric surgery if he wants to lose big time pounds.
If he were like 10 years old I’d blame the parents. But he’s 20. He’s been able to make his own food choices for several years now, at least. His parents have no control over him. That being said, they certainly contributed to this, and likely they were allowing this to happen when he was a child. They probably are also the ones who provide his meals and snacks seeing that he is likely homebound.
I don’t think any of us can understand where this guy is at mentally. I am sure he feels to some degree completely defeated. And where do you begin to change things when you weigh almost 600lbs? It’s not as simple as joining weight watchers or taking alli. He needs major medical help now.
Comment by labor nurse — January 15, 2008 @ 6:45 am
My understanding (see Gina Kolata’s “Rethinking Thin”) is that a great deal of this sort of thing is genetic, and only a small part is behavioral. What are this young man’s treatment options? It sounds like he doesn’t want to be this way, and would be open to trying bariatric surgery or an intensive inpatient weight-loss program.
Comment by Jane — January 15, 2008 @ 12:14 pm
he was not my patient, i was just one of the nurses who helped everytime he pooped and had his dressing changed. i asked him who takes care of him at home, and he said before he had the cellulitis in his legs, he was able to walk. but, even when he was able to walk, he needed help in cleaning himself, and his mom helps him with it. i don’t know about surgery and future plan for his weight though. it’s just sad.
Comment by may — January 15, 2008 @ 12:49 pm
May:
I had a 600+ lb patient a couple of months ago. She was 26 and got ARDS when she got pneumonia. This bought her a really funky trach and the docs told her she couldn’t lose it until she lost 200 lbs.
I’m no psychologist, but I know her coping methods were horrendous, which is probably how she got to this weight. We had to really work on redirecting her and getting her to work with us. (Thank goodness for neuropsych staff) Surprisingly she was self-sufficient prior to hospitalization.
Thankfully, she did lose weight while she was with us. No 200 lbs. but a good amount.
The thing that made me mad was that some staff (not from our unit) would make the most callous comments about her. People (even in the hospital) can be so unkind and it really makes me mad.
Comment by RehabRN — January 15, 2008 @ 3:53 pm
I think it’s up to us as parents to set good examples and try our best to provide a good foundation for eating healthy and choosing wisely, but there comes a point when we become adults and begin making choices for ourselves and our parents are no longer in control or to blame.
As far as him having gastric bypass surgery-won’t happen until he is in control of his eating habits and his life.
Obviously, that is not the case.
Comment by kimmyk85 — January 15, 2008 @ 4:29 pm
That is so sad.
Call me ignorant but how is it possible to gain that much weight without an underlying medical condition (thyroid, etc)?
Is it really possible? If I eat a ton of junk food until I’m super-full, is it really possible for me to get that big?
I feel sorry for the patient. I feel sorry for the family.
And I’m with you on how hard it is to parent. I worry that my son’s too thin and not eating enough but then I’m worried that my son would grow up to be either a glutton, obese or an anorexic because of my obsession with his food intake. Which is why I try to keep it to myself.
Comment by rinna — January 15, 2008 @ 5:24 pm
i think the parents should have been the first to notice that something might be wrong… whether medical or psychological
Comment by Rygel — January 16, 2008 @ 8:21 am
I have one child who is fat.He is the only one out of our family. He is also Autistic. I think when you are heavy to start with, food is your only friend and your only form of entertainment.I monitor what he eats, and we make sure he gets exercize.The amount of sneaking is amazing. I think that the care of this patient is a lot of work for the staff at the hospital, how much is it for parents?
Comment by blueraspberry — January 18, 2008 @ 12:51 am
This is sad. I too have seen hospital staff say unkind things and the squads. Sometimes it is out of their frustration when they have a hard time moving the person and sometimes I have wondered if the pt heard the remarks. I am guessing yes because some people are just ignorant.
Comment by SeaSpray — January 19, 2008 @ 10:52 pm
This is so sad…
We are seeing more and more morbidly obese patients in the OR. They are getting hip and knee replacements. I wish they could get counseling before they require such a surgery.
Unfortunately, it becomes this vicious cycle. They are morbidly obese causing a strain on their joints. They come in for surgery and then end up experiencing a lot of pain post-op. Rehab is difficult and many don’t want to go through the required therapy. They end up gaining more weight. Sigh.
What’s the answer?
Comment by unsinkablemb — January 20, 2008 @ 6:17 pm
I have flabby thighs, but fortunately my stomach covers them.
Comment by Rusty L. — February 16, 2008 @ 10:32 pm
[…] patient A was our 589 pounds male who had multiple wounds on his buttocks and was having severe diarrhea. i started the shift cleaning him. since everybody was busy, and i can’t wait to clean him, i tried the routine of pushing his leg to the other side to help him turn. i felt or maybe imagined my lower back made that little crackly sound when it is strained. he pooped four times, making me change his dressing twice, which each time, takes about 20-30 minutes. […]
Pingback by not sick, but TIRED » about a nurse — February 29, 2008 @ 9:08 pm
How does a person who cannot clean himself or roll-over, manage to obtain enough food to maintain that huge weight? Is someone bringing him all this food, knowing it is causing this condition?
Comment by barbara — March 10, 2008 @ 6:52 pm
I have a 34 yr old son who is 6′4 and weighs in excess of 500lbs. and it just kills me everyday to think of him being this big. Yes, the creulty of people is astounding. He has no health insurance and I fear that he will have some crisis. I pray everyday that God will be with him and help him. I talk to him about looseing weight and he just thinks its hopeless. I’m scared for him but am not wealthy and can’t help him get the help he needs. All that I can do is be there for him and encouage him and love him and pray.
Comment by Linda — July 2, 2008 @ 7:36 pm