Donna

Scott Whitby, 2023

Donna is just a year older than me. She has high blood pressure, diabetes, depression, high cholesterol and arthritis in her knees. She is on medicines for each of those, as if they all just happened to end up there in her unlucky body. It’s easier to tell her she has all these things wrong and to intellectualize each as a separate problem.

It is awkward to say “You are morbidly obese and it is because you eat more calories than you are using. Your body is storing up energy for a famine you will never experience and that fact is responsible for all your problems, even your depression”. I told her she needs exercise. She says she can’t because of her knees. She’s probably right.

Part of it is willpower, or lack of it. As big, though, is what good calories cost. Fresh food like greens, carrots, berries, melons and nuts cost a small fortune and may be unfit to eat later that week. Bad dense calories like potatoes, rice, and noodles are cheap and last for months. Our mammal bodies interpret all those dense calories as temporary abundance and store it as fat for a bad winter that never comes. The abundance is permanent but it will take a million years for our bodies to adjust.

I refill her medications. It is a lie. Her diabetes can’t be controlled without eating less. Her cholesterol can’t be controlled without her diabetes being controlled. Her blood pressure can’t be controlled without exercise and her knees will hurt until she loses weight. The resulting depression is inevitable. So, I lie. It’s a sophisticated lie she doesn’t understand, but still a lie.

She’s back in a week with abdominal pain. It’s a simple diagnosis for me after just a few questions. It’s diverticulitis. Examining her abdomen is a waste of effort. There’s nearly a foot of fat between my hands and the problem. It would be like feeling a pecan under a mattress. She goes to the hospital.

I see her a month later, sick again. Part of her colon was removed. The surgeon “got it all” but the wound didn’t heal. The scar is hidden deeply under two folds of fat (‘pannus’ to be fancy). A place where a newspaper could hide. Bacteria love it there. Back to the hospital with necrotizing fasciitis. That’s another fancy term for rot.

In a few weeks I see her again. She lost forty pounds from being sick. Still 200 too many. She seems satisfied that where the surgeon could once reach into the wound to his elbow can now only get up to his wrist. I tell her it’s normal that wounds like this need to heal by “secondary intent”. She is still depressed. Now she’s in a wheelchair. I note her thighs look like whales.

I am reminded of a patient I managed when I was learning to be a doctor. She had all these same problems and was morbidly obese. I told her that. I told her she needed to cut out the food. She said “Doctor! All I eat is a little corner of a piece of cracker!”. I told her she had to cut it out…that it was killing her. She’s dead now. Donna will be soon.