Heavy load

Christine was somewhere in her fifties. She was one of my first giant patients, weighing close to five hundred pounds. Everyone complained about her; she used her call light to ask for help with things a normal sized human would be able to do alone. But she was polite, gracious, and attempted to maintain some independence within her physical limitations. She was in for a congestive heart failure exacerbation. Naturally, she had diabetes and joint problems as well.

During her two week stay, I found myself caring for her a lot. Man, did I learn some things from Christine.

One day, she wanted to talk about her weight. Specifically, how she got this way.

"My mom died when I was pretty young. My father would use food as a way to have power and control over us. When we didn't behave how he wanted us to, he would send us to bed with no dinner. This happened a lot. I remember creeping downstairs in the middle of the night to get a piece of bread for me and my sister to share. I would ball it up in my hand, take it up to our room, and we would pick off tiny pieces, making it last as long as we could. Afterward, we would still be hungry, but I would feel a little better because I was taking care of us. Our father would tell us that these restrictions would help us to stay thin and beautiful.

"When I got older and began to have control over what and when I ate, I chose to assert my independence and freedom through food. I cooked big, elaborate meals for my sister, and later for my two children and now ex-husband."

Listening to Christine made me remember a study I ran across one time that found that a startlingly large percentage of obese women have a history of abuse in their past. There is a significant amount of evidence that points to a link between childhood abuse and obesity in adulthood.

Christine was one of many patients who taught me early in my nursing career that there is always a story, and there's a lot more to it than we usually think. Every human is at the center of a giant web that only he or she knows. When I can remember this, it helps me to talk less and listen more.