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An ambulance technician in Scotland, in his post Fat Chance, has finally (and beautifully) put into words some of the frustration I’ve felt so many times when working with obese patients:

Morbid obesity is dangerous, hence the moniker, but in the emergency situation it’s not the ischaemic heart disease that causes the problems, nor the diabetes, cellulitis or dyspnoea. It’s just the weight. If we can’t lift you when you can’t walk, you’re not going anywhere.

Bravo. It’s not that we don’t like you because you’re fat. It’s just so incredibly frustrating not to be able to help you just because you didn’t try a little harder to help yourself when you still had the chance!

When I was a student nurse I once helped care for a 600-pound patient (he might have weighed a good bit more, actually, but that was as high as the scale would go). Amazingly, he had still been able to walk until a few days before, when one of his knees had finally snapped under his weight. It took the paramedics six hours to get him out of his apartment.

In the hospital, he kept wetting himself because he was so embarrassed at having to ask for help with the urinal that he nearly always waited too long to hit the call light. Of course, then he had to be changed and cleaned up, which was almost as humiliating and even more of an ordeal. Each of his thighs was, on its own, bigger than I was, and his bladder capacity was nothing short of amazing, which made those cleanup jobs pretty extensive.

A major part of the difficulty was that the part of him that needed to go *into* the urinal had been out of his reach for years, and had long since been buried in flesh, turning itself inside-out in a desperate attempt at self-preservation, and making the logistics of the situation just that much more problematic.

Picture a red-faced male patient, naked from the waist down, lying helplessly in a state of utter humiliation while two scrub-clad, purple-gloved, urinal-wielding nurses dig through the mounds of flesh over and between his legs, hunting for the pertinent piece of his anatomy…

There are two of us because, once we find it, one has to try to keep the rolls of fat at bay while the other attempts to compress the flesh surrounding the area enough to coax the part in question out far enough for the urinal to be of any use.

Meanwhile, the patient is clenching his teeth and moaning “hurry, hurry!” because in his state of mortification he has, of course, waited until the last possible moment to call for help, and his bladder is on the verge of bursting.

I can’t help thinking we could have ended childhood obesity forever — in boys, at least — if only we could have videotaped the ordeal and made it required viewing in all middle schools. Kids don’t identify with illness, disease, and death. Those are things that happen to other people. But the fear of lying helpless and exposed and being utterly humiliated — that’s something every prepubescent adolescent can intimately identify with.

I bet it would work.

There are cameras in the patient rooms on our psych units. The images they produce are tiny, black and white, and grainy. (That’s not really by design; they’re just very old, and they aren’t broken, so there’s no reason to replace them.) They don’t show much detail — just enough to allow us to keep an eye on people who might be liable to hang themselves with a bed sheet or try to dance naked on one foot on the back of a plastic chair. No, I didn’t just randomly make that up. I’m not nearly as imaginative as some of our patients.

There aren’t, since I know you’re wondering, any cameras in the bathrooms. This ensures the patients some modicum of privacy, but also means that when some of them take showers fully clothed, or stuff their toilets full of socks and underwear to keep the FBI from monitoring their output, or paint pictures on the walls with excrement, we might not find out about it in time to keep from having to clean up some pretty huge sloppy (and possibly smelly) messes.

The cameras are no secret, and are taken for granted by most of the patients, but once in a while we get someone who’s never been on a psych unit before, and they can be a bit startled by the idea.

Recently, one of the latter sort of patients shared this story with me. We’ll call her “Cantalope,” in keeping with my previous post, despite the fact that (oh, no!) I’ve already revealed her gender. (You never know, though. I might have already changed it to protect his her identity, just in case the fictitious fruit name wasn’t enough to fool you!)

Cantalope wasn’t psychotic, just depressed, and had no previous experience with psych units. Her roommate, “Artichoke,” however, had a long history of psychosis and paranoid delusions, a veritable psych unit veteran.

The morning after Cantalope arrived on the unit, she and Artichoke were in their room lying on their respective beds chatting, when Cantalope noticed the camera for the first time.

“Is that a CAMERA?” she asked Artichoke, pointing to the ceiling.

“Oh, don’t ask me,” replied Artichoke, smiling ruefully and shaking her head. “I think everything’s a camera.”

Cantalope laughed, probably for the first time in months. And began to realize that there was a lot she could learn from “these crazy people,” as she had referred to them angrily the night before when informing me that she did NOT belong there with them. After telling me the camera story, she said, referring to Artichoke, “You know, underneath all the craziness, she’s really intelligent, and interesting. And funny. I really like her.”

Artichoke has learned the secret of contentment. Know your weaknesses, and love yourself anyway. Then you’ll be happy, no matter how many standard deviations away from “normal” you happen to live. And Cantalope has learned that “crazy people” really aren’t so different from the rest of us after all.

We were getting a new patient on the psych unit. This person had been picked up by the police with no ID, psychotic and mute. We were informed we couldn’t admit them as J___ Doe, which was the name the police had given them, because that would reveal their gender, thereby violating their privacy. The admitting office, therefore, assigned them the name “Tangerine Doe.”

What I still can’t figure out is exactly who we were trying not to reveal this person’s gender to, and why? Even if I yelled from the rooftops, “We have a new psych patient named John/Jane Doe!!!” it wouldn’t matter, because the name is arbitrary and isn’t any more identifiable because there is a gender attached to it. The person in question could have been any one of millions of people in the Greater Portland Area and surrounding countryside. Sure, knowing their gender cuts that number by roughly 50%, but that just is not enough to make any measurable difference in the odds against anyone being able to figure out who they might be. After all, we’re still talking millions to one!

Aside from all that, this poor person was psychotic. They were seeing and hearing things that weren’t there, and struggling to know which things were real and which were hallucinations. It’s no wonder they weren’t talking; they couldn’t tell who was real and who wasn’t; what was really happening and what was just part of some waking nightmare. How in the world were they supposed to be able to get oriented to reality, when reality consisted of a place they’d never seen before containing a bunch of people they didn’t know who kept calling them by some goofy 70s flower child fruit name?

There’s another problem, too. As I see it, this issue opens a whole new can of worms. If being known in the hospital by a gender-revealing name violates a patient’s privacy, then we’ve got to get busy and figure out what to do about the rest of the patients. Many of them, in fact the great majority of them, have gender-specific names, and are actually admitted under them. These are their REAL names, which makes them much more identifiable, even without the handicap of an easily-determined gender. How can we give “Tangerine” preferential treatment by obfuscating his/her gender for the sake of privacy, without granting the rest of the patients equal protection?

The only solution I can think of is to begin reassigning names to patients upon admission.

Sorry, Mrs. Johnson, but we can’t admit you with the name ‘Mary.’ People would know you’re female, which would violate your privacy. Therefore, during your stay here you will be known as ‘Artichoke Johnson.’

I bet you thought the crazy people were the ones *inside* the psych unit, didn’t you???

Oh, incidentally, Tangerine arrived on the unit during evening snack time, and was escorted past the dining room where the other patients were all gathered to eat and watch TV. As fate would have it, Tangerine’s oversized scrub pants chose that moment to suddenly come undone and fall to the floor.

Staff acted quickly to correct the wardrobe malfunction, but the damage was done. Tangerine’s gender, despite the precautions taken by the admitting office, was no longer a secret.