Obesity

I admitted a young man in his 40s that weighed 1019 pounds (463 kg); I couldn't believe it, the first thing I thought when I saw him, was did he have a mirror.  I noticed from reviewing his old charts that less than a year prior he weighed about 700 pounds.  Wow! I thought.  It was about 0200 and I was the designated PGY2 on call and I matched downstairs to the emergency room to inquire about his reasons for coming to the hospital and also to examine him.  I learned from the nurses that it had taken 5 hours for the EMS to get him onto an ER bed and, they had to join 2 large beds together.  I thought at that time that he was still 700 pounds until I heard the ER nurse say he is not 1019 pounds chei!
He must have eaten enough to feed the whole of Dunokofia.  I was told that I had to write an order for a shipment of a bed from Oklahoma because he cannot fit our largest bed.  I looked at the bed and wondered why in the world Oklahoma had a bed even bigger than what we had; and I realized how accommodating the U.S. is with obesity.  The young lad had been on disability because of his weight, and got a pay check for food monthly; he had a private apt., and a tv in front of him, he also had a personal nurse aid who claimed to be a girl friend; we, as tax payers encouraged him and told him indirectly that he does not have to be a productive member of society because he was super  morbidly obese.
The Girlfriend..  Hmm I thought at first but tried not to flinch.  I got most of the history from her, and at first she failed to mention that she was also his aid; I got to the part of my exam and I had to go all the way around to auscultate the other side of his chest.  His belly was the size of a love seat, it was disgusting.  During the exam he requested that he wanted to urinate, and I thought how does he do that, she tells me that she gets him up in the morning and he sits in the toilet.  And I thought ta! gbafuo! Liar!  and she kept going, he has been so weak recently, and he is no longer eating as much as he used to.  I said what is he eating now, she answered only 4 large hamburger meats, well I asked how many does he normally eat and she said at least 10.  She fed him to death, and that is why she left out that she was his aide; she was getting paid to feed him and she went over board all so that she could keep her nursing aide job, I could see the guilt in her eyes when I told her that there is a likely hood that he will not make it out of the hospital.
She became his aide shortly after the admission last year and she fed him 300 pounds more.  She immediately became very anxious, and yelled at my icu nurses several times, claimed to be his wife and she wants the best treatment for her husband.  Oh boy! I thought this would be a long day.  I was writing my orders when my nurse came in and said 'doc. are you going to write for a foley cath? ' and I said why don't we watch how she usually gets him to pee at home, we gave her a container and it seriously took her about 10 seconds to dig out his penis and still he couldn't pee.  And I gently asked again you are his girlfriend correct? and she said yes.  I was under the impression that people that called themselves girlfriend and boyfriend that it meant you were doing intimate things.  hmm again so how in the world does it work, I wondered what kind of preparation they had to do just to be intimate.   I almost told her you are a Liar!  I asked what kind of bed he slept with at home and she said 'well just a regular King size bed' O boy! she lied again.
He was intubated later that morning due to severe respiratory distress and a few days later passed away.  I learned a lot from this admission.  Obesity is no good! too many problems were encountered and I cannot mention them all; even intubating him was difficult and finally the family came and asked to pull the tubes.  When he passed, he had to be cremated and I am not sure it was the families believe but no one had a large enough size coffin and the space on the ground he would accumulate to bury him will be too much and too expensive for the family.  So they did not give the family any choice but to cremate him.  I was sad for him that he had such a short life due to his weight and he had no say in anything that happened to him.
I really do believe that there is an overlap were one just gets depressed and stop caring about their weight because I still wonder how people are satisfied with being on a wheelchair because of obesity, or being on disability because of obesity ....  I was once obese and my knee pain was my only drive to drop those pounds.  I did it with just exercise and healthy diet choices.  I have no regrets till today.
I am starting to diagnose a lot of kids under the age of 5 with diabetes type II and it makes me sad sometimes.  We really need to conquer this fight of obesity.