Roots of bias about obesity.
My basic nursing education was in collegiate program from 1968 to 1972. I will always remember several patients assigned to me.
One was Mrs. L, who was admitted in 1970 to the medical ICU for what was then called Pickwickian Syndrome. Today it is called: obesity-hypoventilation syndrome, and consists of the triad of obesity, sleep disordered breathing, and chronic hypercapnia (high levels of carbon dioxide in the blood). The chest wall muscles lack the strength to expand the chest enough for the lungs to work well, so carbon dioxide is retained, instead of expelled.
I, a third year nursing student and a LPN, was one of a gaggle of 8 young nurses working that shift. We were all skinny little white girls in our late teens.
The story we were told about Mrs. L, was that she had to be lifted out a second-story window by the fire department because she was too large to be able to walk. She weighed 545 pounds, and was weighed on a meat scale in the kitchen as no regular patient scale was large enough.. None of the beds in the ICU were large enough to hold her, so two were secured together. Census in the ICU that shift was 10; the number of beds was 11. All 8 of us had to coordinate our work to join together once a shift to bathe Mrs. L, turn her and change the sheets. She was the focus of conjecture and gossip; one story was that she had been trached (a breathing tube surgically inserted into her throat’s airway) to shut her up because she was so nasty. Another story was that one night a group of resident physicians were curious and gave her as much to eat as she wanted; this was a entire industrial-sized loaf of bread and a institutional-sized jar of peanut butter.
Once, during the group work to give her care, I was assigned to measure her temperature rectally. I had no idea where her rectum was because all the usual landmarks weren’t visible. So, I counted down the folds of her flesh and inserted the thermometer. .. .between her knees. Oh, how I was both embarrassed and shamed.
There was never any recognition of Mrs L’s humanity, nor of how she had been lovingly cared for by her family. Mrs. L. had been cared for so well that her skin was clean and fresh, without any sign of breakdown.
She was talked about as a freak, a source of fascination, jokes and judgement. Her nastiness was never seen as a reaction to being treated poorly. If there had been but one voice to say, “Hey, this is a fellow human here, who needs the same compassion as do you”….but there wasn’t. I lacked the confidence and self-esteem to speak up. I wanted to fit in with the group. This information was downloaded into my unconscious, where it joined the other energies and information given by my parents, family and society.
That bias led to feelings of annoyance and resentment, reinforced by the reactions of other nurses, when future obese clients represented nothing but more hard work. Hoyer lifts in those days, pneumatic devices to move immobile or large bodies, were cumbersome and difficult to use; they had to be manually cranked to lift, once tthe patient had been rolled onto the sling. At that time, there was nothing available to make taking physical care of obese patients easy.
Nearly 40 years later, the technology has vastly improved, as I saw when my own paralyzed husband was easily and quickly moved by a modern version of the Hoyer lift, where a button is pushed to raise the patient.
My nursing education never mentioned the word compassion. I was taught that I was the one who knew what people needed, and that the patient who didn’t follow a well-developed care plan was non-compliant. The question was always, “What is wrong with them?” Never once during that era were we nursing students taught to be curious and collaborate with our patients in their care. My job was to do what the doctor ordered, and transmit his orders to the patient through teaching. In those days, teaching meant telling the patient what to do. The patient’s job was to follow the orders.
We learn from the past to figure out what is wrong today, so that we can make the future better.. This process is awkward and painful; and, essential.
