A Failure to Care

I like big girls.

More importantly, and to the point, I love my wife. She is a big girl. Not plump, not thick, but big. Fat, if you prefer, or obese.

Even more importantly, she is human. She is worthy of respect and dignity regardless of her size.

She has a host of medical issues. Some of these treatable, but they won’t ever change. Some are barely treatable. Others not at all. All these things are part of who she is – a woman in her fifties who knows her body, diagnoses, and her life.

Healthcare is difficult. I know this. I have some training as a combat medic. I know that some aspects of it are harder, physically harder, with larger patients. I know this very well having been my wife’s full-time carer, especially during this recent four-month episode where she could not bear weight on her left leg much of the time. Even though I was there to help her, and fully committed to that, my first priority was to protect my back. In the end though, when one is being paid to provide care, I don’t care how hard it is – DO THE DAMN JOB! If you need help, get it.

Get over yourself and your attitudes.

Look around at the world. It’s well-documented that Americans are much larger on average than fifty years ago. But that is also only a change in distribution. There have always been larger people.

If you’re going to be a healthcare professional, or run a business that provides healthcare, you have to treat the patients you have, not the ones you wish you had. Or those that you *think* you have.

I have some advice on how to do this.

  1. Start by seeing your patient as human.
  2. Assume from the beginning that they should be treated with dignity.
  3. Treat. Them. With. Dignity.
  4. Start with ensuring they have agency in their own care, save in circumstances where this is not possible.
  5. Know that provision of proper care is not an inconvenience, it is your damnjob.
  6. If a patient suddenly screams in pain, STOP WHAT YOU ARE DOING.
  7. Ask what is wrong.
  8. LISTEN TO THE ANSWER.
  9. Trust that the patient knows their body.
  10. Change what you are doing accordingly.

Above all, apply your common sense and critical thinking skills. If a patient presents as having a broken femur that is being allowed to heal, assume they cannot stand or walk on their own. Assume that they will need assistance. Include this in your planning, that includes having enough staff to assist large patients. This all fits within the Hippocratic oath under “first, do no harm.” You should not make things worse.

When you fail to see people as people, fail to give them their humanity, you will almost always make things worse. We see this is in the stories and research that demonstrate the generally poor medical care Black woman receive. We’ve seen this in the LGBTQ community in the height of the AIDS crisis and every time some legislature gets the ideal to allow gay conversion therapy.

The goal of medical care, of healthcare, is to make people better.

That only happens when you treat them as people, regardless of size, skin color, gender, or who they love.

My wife has now been in surgery for two hours after a night and a day of searing pain. She faces weeks of rehab and a painful recovery away from home. All because the staff of a nursing home chose to ignore her humanity, agency, and knowledge of her own body.

They broke her femur through mishandling her.

And then they tried to say it was her fault.

All of this is after a week in the hospital where the first day was marked by staff ignoring her when she kept telling them to let go of the left leg, it it is the one that is broken. Her right hip turns out an odd angle, they look at that and assumed that is the location of the break. They don’t read the chart. They don’t listen. When I got there I made sure it was on the whiteboard, and she made sure the hospital administrator and the head nurse knew about it. Things got better quickly at the hospital.

But it still the same old thing. A failure to see the person, a failure to listen, a failure to know the patient.

A failure to provide care.

A failure to care.

Be nice. It won't hurt either of us.

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