Saturday, December 18, 2010

Some Heavy Reflections

As I posted earlier, I am now what we now call site leader which among other things means I get to referee disputes between the surgeons and us.

Around midnight I was roused from my mid-winter's nap by a phone call from the anaesthesiologist on call closely followed by the surgeon on call. It seemed my surgical friend wanted to do emergency surgery on a 600 pounder. There were a number of problems with this most important was that there was no ICU bed available. (My buddies in ICU are of course in no hurry to take on a patient who may be on a ventilator for weeks.) The other issue was that he did all his other emergencies before taking on this patient instead of doing it early in the evening when people are fresh and there is more help. In the surgeon's defense this was the classic internal medicine Friday afternoon dump whereby they sit on a patient with a clearly surgical problem until the weekend looms. The second call anaesthesiologist was pleading off citing having worked since 0700 and medical issues, leaving the night call person to deal with this horrendoplasty by herself. I figured that now that my sleep was totally disrupted and that the beers I had drank earlier in the evening had worn off, that the simplest solution was to come in myself and help. Plus there was the thrill of the chase; I have never done a patient that big.

I am not going into the details of the case but as we walked from the room where we had gone to see just what we were in for, I remarked to her, "I hope I never let myself go like that."

I thought about what I had discussed with one of the nurses earlier in the day. I was looking at the pile of Christmas candy that grateful patients had brought into the Pain Clinic (and the clinic before it) and I had remarked that with so much hunger in the world, why do we allow so much of our caloric production to be devoted to food that is so unhealthy and so largely unwanted. I realize world hunger is much more complicated than me simply giving up my Ferraro-Rochers but what a concept.

While trying to salvage my Saturday plans that had been turned on their heads by my late night/early morning adventure, I was thinking about the whole issue of obesity. I realize that obesity is again a relative thing; that by arbitrarily assigning a BMI to it we may over-estimate it; that moderately obese patients may actually live longer... etc, etc. The thing is that most of us agree that someone with say a BMI over 50 is probably obese and we are seeing more and more of these. It clearly is becoming a public health issue with its comorbidities of diabetes, sleep apnea and the like all of which we on the front lines have to deal with.

When well meaning politicians or public health people actually talk about doing something about obesity like for example limiting people's choices in the types and amounts of food available, there are howls of protest from the right wing press and their libertarian sometime fellow travelers. Nanny state is one term usually bandied about.

On the other hand, if we look at medicine prior to the first half of the 20th century, infectious diseases were the prime cause of death. Even before Pasteur and Koch public leaders recognized that certain measures could prevent the transmission of illness including things like clean water, clean food and on occasion quarantining people. We also developed things like mass vaccination before we even knew about bacteria virus, and immumoglobulins. All of these were in some way an infringement on individual freedoms such as they existed then. They were however for the most part effective.

So why for example do we tolerate a situation where a pack of Twinkies costs less than the equivalent amount of calories in fresh vegetables. I occasionally talk to patients in the Pain Clinic about eating healthy and the usual response is that they can't afford to. Why do we allow our fast food to become supersized? Remember when you could buy an 8 oz Coke or a 12 oz Coke? Remember when buying a soft drink was something you did once a week as treat?. Our hospital has given over half its cafeteria space to a Tim Horton's outlet. Tim Hortons sells mostly donuts but they do actually sell some healthy food. Our hospital's Tim Horton's however only sells donuts (and coffee). On any morning if I am standing in line about 1/3 of the people in line in front of me are wearing hospital gowns.

By way of disclosure, I have been fat all my life. I currently weigh over 50 lbs more than I did in University. I love food. I love a lot of food that is probably not that good for me. I love beer. Periodically my weight balloons and as my clothes get tight my appetite goes down. I have often wondered at what point does one actually lose his self respect and just start to enjoy the pleasure of food.
Perhaps my distaste for the super obese is similar to that of the alcoholic by the reformed alcoholic. I was looking around the room as we got the case underway and about one third of those in the room were less than svelte but I expect they all shared my distaste.

I hope I never end up like that.

1 comment:

ZMD said...

Like you, I've been overweight most of my life. But my problem is I tend to yo-yo quite a bit. I'll get up to a certain weight then decide it's time to slim down. Once I get thin enough, I'll decide life is too short to deprive myself of good food and start eating again. Where is the happy medium?
I always wondered where the BMI scales were developed. I've noticed that most people who have "normal" BMI's are chronically ill and cancer patients. Regular people typically have BMI's in the "overweight" range (at least in the U.S.) I once dieted myself down to a BMI of 23, and everybody around me commented how emaciated I looked.