As some of you may know already, Kate and I are in the midst of navigating the Alberta Healthcare system for different reason – Kate for her MS treatment (read her blogs here) and me for a third round of knee surgery. I can’t speak for Kate, but I can say for myself that, up until the pre-admission clinic I attended two weeks ago, I had really faced very, very few challenges relating to my knee injury, or the subsequent years since that fateful February day in 2015 when I slipped in a puddle and ended up under my vehicle in the parking lot at work. I should clarify here that the challenges I have faced have been entirely due to the way my body healed – or didn’t heal, as the case now seems to be – and not to do with either my on-going relationship with the Workers’ Compensation Board or Alberta Health Services.
Last month, I learned that my knee has not healed properly. After an x-ray, a CT scan, and follow-up conversations with a specialist, it was determined that the best course of action for my future is to go under the knife for a third time since sustaining the initial injury. Armed with more in-depth information about the way my knees developed, it seems that the chronic pain I have experienced for the last four years is a combination of my bizarre kneecaps (I was told they’re about 30% HIGHER than the average kneecap) and the way my body healed after I completely shredded my patellar tendon, causing my kneecap to move practically to the back of my leg – barrrrf.
Now, getting in for WCB-related surgery in Alberta can either be very tricky and frustrating, or it can be efficient and relatively quick. I am extremely fortunate in that I have had nothing but INCREDIBLE treatment by way of my case with WCB. From a hospital bed in my living room
after each of the first two surgeries – and the one that is now awaiting my drugged-up body after the third round next week – as well as all the bathroom fittings and aids to get around (I now own three pairs of crutches, a walker, and my very own plush wheelchair), I have felt a level of care and compassion second-to-none from both of the case workers I have had since I fell. Another silver lining in all of this is that my surgeries have been scheduled quite quickly after the decision was made to operate. I have heard nightmares of people waiting YEARS to have something done about an injury, and yet, within a few days of the confirmation for my own procedure, I had a list of dates in my hand for the first post-op follow-up appointment, the pre-admission clinic, and an exact formula for when I have to stop eating and start fasting in preparation for the operation. I even had the date of my surgery handed to me, which was about a week after I found out I required further fiddling with my leg. I am so grateful to the staff of each of the facilities I have been in to deal with this, and I want to hug them ALL.
Except… except the anesthesiologist I saw during the pre-admission clinic I attended two weeks ago. As part of the greater process, I had to participate in a mandatory “workshop” type dealio at which I met with two nurses and a Gas Man (when you grow up as the daughter of an anesthesiologist, you learn the funnier nicknames for those in the profession). I, along with about eight other people who were also having knee surgery, learned how we will care for ourselves post-op, and what to expect in terms of recovery time, ability, and safety. Unfortunately, my own procedure is to be more complicated than the less-so ACL repair surgery I realized the rest of my classmates were having, and thus much of what was discussed in that session doesn’t actually pertain to me – but I digress.
After a rather long waiting room event, I was called in to see the anesthesiologist on duty that day. Now, I’d just spent the last 2.5 hours curled up in an unusually comfortable hospital chair, watching a fantastic Australian show on Netflix (I HIGHLY RECOMMEND “SECRET CITY” if you haven’t seen it already), and I was feeling quite positive about the situation as a whole. I had no reason to believe that anything would go sideways for me that day, and entered the office with a big smile and eagerness to discuss the procedure with the doctor across the desk from me.
We began our conversation with me discussing how I’d reacted to going under during the last two procedures. Again, I’m fortunate in that the worst symptom of post-anesthesia I have is an inability to get comfortable. I don’t suffer from bouts of nausea, and it never takes me that long to fully regain my faculties. But after the second surgery, I got in to some respiratory trouble – I began to experience significant chest pains, which didn’t seem to ease up with my inhalers or a small bottle of nitro spray. I found out shortly after that my lungs had deflated more than normal, resulting in the pain and shortness of breath. I was admitted for an additional three days, and monitored closely for further issues.
I mentioned this to the doctor in the pre-admission clinic, and he immediately flipped through my chart, seemingly looking for further detail of that particular event. After a short silence, he looked up at me; his eyes narrowed, and he quietly said to me, “Your BMI is quite high, you know.” I sat there, not really stunned, but unsure of quite what I should respond with. “Thanks, Doc, yours is… quite high, too?” “Gee, I hadn’t noticed!” “Have you heard that the BMI chart is actually a bunch of bullshit?” Instead, I sat in silence, rolling his words around in my head. He, too, sat there in this awkward silence – he might have been looking at me, or he might have been flipping through my chart again.
Then he said something that really floored me: “You’re not a suitable candidate for surgery at this hospital.” At this point, the words came flying out of my mouth before I knew it: “Are you telling me I’m TOO FAT to have surgery at this hospital?” He immediately looked down at my chart, and began to shuffle through with increasing speed. I sat there staring at him, willing the papers to suddenly catch on fire in his bare hands. But alas, I haven’t mastered that aspect of Witchcraft – YET. Though he never fully confirmed that that was indeed the reason, he did go on to explain that my size combined with the fact that I’d run in to respiratory issues made me a significant risk for further trouble – and that this particular hospital is not equipped to deal with someone like me – and, should I experience the same dangerous issue again, that they would then have to transport me to a hospital within the city of Edmonton (this particular hospital I was sitting in is just outside of city limits) – and that transporting me comes with its own risks. Blah blah blah. I’m pretty sure I stopped listening to him at that point.
Okay. So, here’s the thing. I actually understand what he was saying to me. Ultimately, there are absolutely risks involved where weight and anesthesia are concerned – and that goes for both over and under weight. Putting someone to sleep is an exact science, and calculations must be undertaken with the strictest care to ensure proper amounts are dispensed, and a patient’s life is as out-of-danger as possible during the delicate balance of anesthetizing someone and keeping them alive and breathing. And not all hospital facilities are equipped and prepared to take on these higher-risk cases, and that is entirely their prerogative. And further to that, I’d rather that the person responsible for keeping me alive during my operation is brutally honest with me – including a discussion about the risks of being overweight and having surgery. BUT. And there’s a BIIIIIIG but here. I’d prefer to have these conversations with someone who can show me at least a single ounce of compassion when relaying this sensitive information me. I’m not saying I need to be handled with kid-gloves, but for god’s sake, be at least a LITTLE compassionate about it. That day, I was dismissed for my size. Told that my surgeon’s office would be contacted, and my surgery would thus be postponed until a slot at a city hospital became available for me. I left feeling ashamed, frustrated, angry and totally shit on.
I drove straight to my parents’ home, knowing that my mother would be there, and she would be more than willing to have a candid discussion with me about this conversation I’d just had. If there’s one thing I’ve always been able to say about my mother, it’s that she is simply unafraid to have sensitive conversations – but she approaches them with compassion, kindness, and a gentler angle than I had just experienced. I felt certain that she would likely agree with the doctor’s assessment of my particular case, but that she would ultimately understand my anger at being told I was “too fat” to have an operation at that facility.
And she was, as I knew she would be – kind, compassionate and gentle. She seemed a little taken aback by the message that was conveyed to me, and she absolutely understood my frustration. But where she really surprised me was when she told me that this particular anesthesiologist was known for his insensitive approach. As I understood it, he was considered to be unable to communicate with anyone – peers, other hospital staff or patients – yet he continued to practice anesthesia in Edmonton. I suppose if there were one operating room position that would require the least amount of interaction between doctor and patient, it would be the anesthesiologist. After all, they are charged with constantly monitoring levels – oxygen, CO2, drugs – as you, the patient, are completely in their hands. You’re knocked out – what do you have to talk about? I frequently hear people voice concerns about their surgeon… I’m here to tell you the surgeon is the SECOND person you should be concerned with in the OR. The first is the one tasked with keeping you under AND alive. Once more, I digress…
As I sat there with Mum, discussing the reputation of this particular doctor, it dawned on me that there had been people sitting in the waiting room with me who were at least twice my size; none of the other women, really, but certainly a few of the men. I wondered aloud to Mum if any of those larger patients had also been told they were not suitable candidates for surgery at this hospital because of their size? She echoed my question, though had no answer for me. But I feel fairly certain they likely faced the same (embarrassing) conversation as I had – and where did that then leave them?
My original date for the procedure was March 28th. The hospital bed arrived on the morning of the 25th and, despite being in limbo for a new date, I began to organize myself for life-after-surgery (let me just say, it’s way more complicated than I would have thought – but having now been through this twice, I’m kind of old hat at this point) in a duplex. On the morning of the 26th, the surgeon’s office phoned, and told me I would be heading in on April 11th. I’m not complaining – the difference between waiting a few more weeks and waiting a few more years is HUGE in this particular context – and a few extra days to zoom around independently is actually much-appreciated. But to my total surprise, the operation is still taking place in the hospital at which I was “not a suitable candidate” only two weeks ago. I quizzed the nurse who phoned me with the update, and she sort of laughed and said she actually didn’t understand what had happened, either, but she didn’t seem entirely impressed with what I had been told.
Fast forward a week and a bit, and I was having dinner with my folks. They’re away for seven weeks, and I seized the opportunity to have a face-to-face conversation with my Dad about what had transpired with my surgery. Now, it should be noted, my Dad is a highly respected and much celebrated member of the anesthesia community in Canada. He is so kind, so loved, and has more compassion in his little finger than so many people I know have in their entire body. I pressed him to explain the back-and-forth decision I had been given, and at first, he seemed a bit hesitant to answer my question. He has never been one to totally criticize someone for their size, and has frequently struggled with his own weight, and I believe this gives him an even more compassionate approach when dealing with larger patients. But he (and I) can’t deny that there truly are risks associated with surgery on an overweight or obese patient. That being said, I could see he felt a bit weird about having this conversation with me, and that he was considering how best to articulate without hurting my feelings. But he still respects me enough to actually take the time to explain these complicated matters to me, and that he did.
He explained to me that at certain facilities, there are “rules” laid out for vetting patients during a pre-admission clinic. One of those is previous anesthesia history, and another is size. There’s zero denying that I am overweight, but Dad did go on to explain that he feels I am really only a “little outside the norm” for the safe parameters of BMI and anesthesia (I felt a bit of relief here, but it’s worth noting I was definitely eating a rather large slice of carrot cake as we spoke). He then went on to say that the head of the department at this hospital had reviewed my case and decided that it didn’t make any difference which facility I am to have my operation at – I’m not as high-risk as the first anesthesiologist had told me I was. And low-and-behold, the head of the department is going to be my Gas Man on April 11th. What luck! I trust this man that is now going to be with me as I fall under an ether-spell – he was my Dad’s anesthetist when he had a hernia operation only a few months back. I know he will keep me safe and, even more importantly, he’ll keep my alive.
Now, all this being said, I’m incredibly blessed to have the connections I do in the medical community in Edmonton. This is not to say that I am able – or have the desire to, actually – jump the queue; but it is to say that I definitely understand how fortunate I am to be able to have these conversations with my Dad and even his colleagues. Yet, I can’t help but wonder how many other people have been told they can’t have required surgery because they are “too big” – and not TOO BIG, but just a “little outside the norm”? How many patients, in desperate need of a procedure that could potentially alter their life for the better, have been dismissed for being fat? Why is this type of discrimination still such an issue? And again – I am in this strange position of both understanding why size can be a risk where medical procedures are concerned, and also being discriminated against because of my size. I think where I take issue is in the area of conversation – why is it SO HARD to have a respectful, decent dialogue with someone about their weight? Is it because they think we’re going to get offended and storm off in a huff, and that that makes the idea of even having the conversation pointless? Telling me I can’t have something simply because I’m fat and then closing the book on me isn’t exactly helpful – and believe me, this won’t be the first (OR LAST) time someone tells me I’m fat. It’s a fact of life – I am fat. I am completely aware of the risks that come with being overweight, and I am absolutely not interested in defending my position with woes of “I’ve tried every diet and nothing works” or “Just because I’m overweight doesn’t mean I’m out of shape” – those are conversations for a different day. A day that I’m not staring down the barrel of a complicated surgery made more complicated by my BMI, though.
So, what now? Well, I’m aware of a few things here: a) I’m overweight;
b) My BMI is higher than it should be; c) Surgery on an overweight patient carries greater risk;
d) This subject is sensitive for a lot of reasons;
e) Overweight folks are constantly discriminated against for their size, and may not be receiving the proper care and subsequent treatment they truly need;
f) I am not alone in this.
I am not alone in this.
And strangely enough, I just read a post from a friend on Facebook saying that there is a man standing on a busy street corner in downtown Edmonton with a sign that says “FAT WOMEN ARE GROSS. STOP EATING, YOU FAT PIG” – UGH. Size discrimination is ever-present, no matter what we think we’re doing right. What has happened in this asshole’s life that has made him hate fat women so much so that he has to scream it from a street corner while holding a sign??? He clearly has nothing better to do with his life, and feels he is doing the world a service by projecting his hatred for himself on to a group of people who actually surprisingly hate themselves LESS – fat women. Despite being shamed, made to feel less than human, and told we are unworthy, we still likely hate ourselves less than the people who discriminate against us. Try that on for size, hey?
As I round the final bend of this blog, I just want to say that these days, I’m seeing so much progress in the area of body-positive activism. Despite being repeatedly told to believe the contrary – by family, friends, the media, and medical professionals – it’s obvious to me that fat people are really starting to love their bodies, no matter the size. We are starting to believe that we ARE worthy, we ARE beautiful, we ARE human. Where I’m not seeing as much progress is specifically where dialogue is concerned. It’s actually possible to have an informative, respectful and appropriate conversation with a fat person about their weight. But that is only – and I must stress ONLY – if that person is willing to have that conversation. Unsolicited advice or comments with respect to weight and size are unnecessary, lack respect, and never, ever produce the results that are supposedly intended. WE ARE FULLY AWARE THAT WE ARE FAT. WE ARE FULLY AWARE OF THE RISKS ASSOCIATED WITH BEING FAT. But we are also fully aware that we have autonomy over our bodies – large and small – and what we choose to do with them is up to us.
I’m totally open to having conversations with people about my weight – but if you’re gonna be a shithead about it, I’m gonna shut you down RIGHT FAST. My weight has little to nothing to do with the person I am – and shitty comments will never change that. Not a chance.
I’ll see y’all on the other side of the Ether Sleep…
Xoxo
M.
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