WhiteCoat

Transporting Morbidly Obese Patients

Obese Woman Dragged From Home, Hauled Away After Death

A 750 pound woman dies at home. According to police and the coroner’s office, there is no truck big enough to transport her to the morgue, so police call the towing company, they drag her out of her apartment on a mattress and load her onto a pickup truck to bring her to the morgue.

According to witnesses, the tow truck drivers threw a piece of carpet over her instead of a sheet. I’m assuming the reason for this is because not too many tow truck drivers or coroners carry extra large clean sheets in the backs of their vehicles, but that is purely speculation on my part.

Family members and neighbors were appalled. It was “like putting a cow up there,” said the deceased’s boyfriend. They don’t treat [dead dogs] that way,” stated a neighbor.

Supposedly the fire department has equipment that will handle patients up to 1000 pounds, but no one knew that.

Assuming that the fire department didn’t have the equipment available, what would the family have done to get the patient to the morgue?

If people allow themselves to get so obese that traditional transport mechanisms won’t work, then what duties should providers have?

[Thanks to Alexander for the link]

UPDATE JUNE 8, 2009
Amazing how posts take on a life of their own.
When I originally posted this, I did not intend for it to morph into a discussion of “political correctness,” but also agree that being “PC” has gone too far. Many thoughtful comments in this regard.
My original intent was to show how the medical system said “no.” “No we can’t transport your body in the coroner’s vehicle because you’re too large.” Patients need to understand that sometimes there are consequences to their actions. In some cases, providers will have to get the job done with what’s available to us, and you may not be happy with the results. In other cases, patients may not be able to receive appropriate treatment. What happens if a 750 pound person passes out on the second floor apartment and there is no elevator? What if it happens in a rural location and there are not enough volunteer EMTs to lift the patient? Will providers get sanctioned for saying “we can’t help you”?
As Shadowfax notes, there is an entire industry catering to the morbidly obese patients. We have “big boy” beds. Stretchers are now guaranteed to hold more than 500 pounds. But there are also limits to diagnostic equipment. MRI machines might not accommodate a patient’s girth. CT scan gurneys “only” hold 350 pounds.
So what happens if we suspect a morbidly obese patient has a pulmonary embolism, but we can’t do the diagnostic testing to confirm the diagnosis? What if we need to do a CT scan for a morbidly obese patient who has a head injury?
And what’s going to happen in the future medical delivery systems if there is not as much of an incentive to purchase expensive equipment necessary to cater to the morbidly obese population … or an incentive to risk the increased likelihood of bad medical outcomes in providing medical care?

62 Responses to “Transporting Morbidly Obese Patients”

  1. Tex says:

    Perhaps the family should have stopped the tow company, refused their help, and made their own arrangements.

  2. William says:

    What responsibility does society have to take care of an individual who will not take care of themselves (assuming that they are mentally competent)? Unfortunately I believe that we, as a group, have decided that last election cycle….

  3. Russ says:

    IMO, you don’t get to be 750 pounds without substantial help/enabling from others. Only in America is poverty associated with obesity. My hospital has recently enacted “sensitivity training for the overweight” for all nurses & techs – one jewel that I observed: ‘the obese person is no longer to be referred to as ‘obese’, instead, they will be referred to as a ‘person of size’. Now, WTF does that mean?! Hell, a dwarf is a ‘person of size’! Obese and morbidly obese have actual medical definitions (BMI), ‘person of size’ means bupkis! I think we have stooped to a new low, but the hospital is trying to be a Center of Excellence for care of the obese patient, yet we don’t have a CT scanner nor MRI that can take over 350 pounds, but we do have sensitivity training! It’s all just lip service to some industry that ‘certifies’. Fudda fudda fudda, got me all riled up before my shift!

  4. MedicMatthew says:

    Sounds to me like there should have been a consultation with the local EMS, and I have a hard time believing that the coroner didn’t think of doing so. Moving around a 750 pounder really isn’t that difficult. With the proper equipment (i.e. hydraulic ambulance stretcher) it can be done with four people assuming the deceased isn’t on the floor. Even if they are on the floor it can still be done by a crew of four to six

  5. Pink says:

    Would a sheet even stay on if she were transported in the back of a pickup truck? I don’t think it would and hence the need for something heavier so that the driver and everyone else on the road wouldn’t be made to watch the transport. I could be wrong though.

  6. Roy in Nipomo says:

    Russ-

    Suggest “person of girth” or “adipose hyper-sufficiency” as less ambiguous alternatives.

    Note: The exit interview is probably the best time to make the above suggestions. “Sensitive” people in management have somewhat limited sense of humors.

  7. honest says:

    Dogs don’t weigh 750 pounds. If they did, i’m sure that they would be treated in a similar manner.

  8. C. says:

    All due respect to the family, however if the family wanted to worry about something it should have been her eating habits.

  9. Rebecca says:

    Oh this is a very sensitive post.

  10. Nurse K says:

    The fire dept shouldn’t have to transport dead bodies to the morgue. If the coroner can’t handle her because she’s so massive then any means necessary (that doesn’t tie up EMS) should be used. If the fire dept wants to help, great; if they are busy with alive people and fires, then, sorry, tow truck it is.

    “Person of size” = Bullcrap.

  11. Rogue Medic says:

    If the family and neighbors were so shocked by the treatment of this corpse, why didn’t they do something about the abuse of the person, while the person was still alive.

    The person is dead.

    There may be an autopsy. This is hardly as pleasant as a ride in a truck, covered by a rug.

    There may be embalming. Ditto.

    There may be cremation. Again, not exactly a pleasure to watch.

    These neighbors and family are out of line.

    Person of size? Is there nothing out of reach of the Orwellian redefinition of the language? We are removing all meaning from the language, just to protect people from the possibility of being offended. In 5 or 10 years, person of size will be seen as similarly offensive. It isn’t the language that is the problem. The medical condition, and it is a medical condition, is the problem. Changing the name will not do anything to help the obese person. Changing the name will just help the Oh so sensitive bureaucrat to feel Oh so superior.

    There are many things we can do to help obese people. Prohibiting the word obese and hiding the complications of the illness are not sensitive to the obese, but to those who want to hide the obese. Out of sight, out of mind.

    • Matt says:

      I think the reason we prohibit the word obese when marketing our new facility is because that doesn’t cost anything, and we still look sensitive, while higher weight limit MRIs do cost money.

    • Outofvoguemedic says:

      ?Is there a “nucula” crematorium in your state or do you think they will perform 4 or 5 normal cremations?

  12. William the Coroner says:

    The coroner doesn’t move bodies. Bodies are moved by local ambulance companies or the fire-rescue folks of the jurisdiction where they die. The costs of transport are paid for by local tax dollars, that go for the local fire department appropriations.

    Autopsies on the morbidly obese are a pain. They tend to fall off the edges of the tables. If they are large enough, they can break the tables. X-rays are problematic, one needs to use veterinary equipment. Cremation is difficult. The heat renders out the fat, which can cause a grease fire, and can burn down the crematorium.

  13. paul says:

    i’ve always preferred “failure to fail to thrive”

  14. medrecgal says:

    Thank you, WhiteCoat, for talking about this issue without the appalling lack of sensitivity I’ve seen on other medical blogs. I’ve never been a skinny minnie, but neither can I imagine neglecting yourself so badly that you get obese to this extreme. As for that sensitivity training another commenter mentioned above, I think that might swing a little too far in the other direction; you (collectively, as the medical profession) won’t be able to help the morbidly obese in any way at all if you’re overly sensitive to the point where their obvious problem doesn’t get addressed appropriately. But you can’t be an insensitive clod, either. My thought is that people who become this extremely obese have much deeper problems that won’t be solved by putting them on a diet and exercise regimen. (Though of course that should be part of the program overall.)

    And I think the people who were trying to transport this unfortunate soul were doing the best they could with what they had. I don’t think they meant anything to be demeaning or otherwise inappropriate. Had I been this lady’s neighbor, I probably would have called the fire department first and asked if they had the necessary equipment. (I don’t know, but I don’t recall ever seeing a vehicle from a morgue that would have been large enough to handle this situation.) Just some thoughts on a tragic situation.

  15. ER RN says:

    “Cremation is difficult. The heat renders out the fat, which can cause a grease fire, and can burn down the crematorium.”

    I know Im a sick insensitive bastard but, thats funny stuff right there.

  16. Russ says:

    Need another example of how far we’ve gone? My employer just built a brand new, multi-million dollar addition to the hospital – you know, one of those nice sparkly buildings that look like a 5-star hotel? Well, on each floor there are special bariatric rooms with BOOM LIFTS anchored to the steel I-beams in the ceiling! That way, the patient can be placed in a special sling (I guess they get the slings form the local large vet supply company) and moved to the toilet without the threat of falling. A good idea for patient (and staff) safety, but I find it ridiculous nonetheless. Where do we, as a society, draw the line?

  17. Shalom (R.Ph.) says:

    @Rogue Medic: the euphemisms of today are the insensitive epithets of tomorrow. “Handicapped” is now offensive; we have to say “special” (as in “Well isn’t that special.”) or “differently abled” or some such BS. What people forget is that “handicapped” was the euphemism of ten years ago, being a more sensitive replacement for the offensive term “disabled”… which itself was invented as a more sensitive replacement for the offensive term “crippled”. What are they going to call it in ten more years when “otherly abled” people start taking offense at that term? When does the chain of euphemism get so far removed from actuality that someone looking at it from outside won’t know what the hell it’s supposed to mean?

  18. M says:

    I think what some people are forgetting is that English is a constantly changing and evolving language. Notice we don’t call black people Negroes or Chinese people Oriental anymore? So while I think it’s more important that we actually find a way to safely treat people who are overweight to the point of danger to their health than finding the least offensive term I also don’t think there’s any need to have outrage at a new term being used for a group of people. The phrase “person of size” instantly brings to mind BIG people. Just like “person of color” brings to mind someone who is black, brown, or asian, even though white people aren’t exactly colorless.

    • Katy says:

      It’s only offensive if someone gets offended and personally, I think a lot of people need a couple of teaspoons of cement in their cup of Harden Up, because this is ridiculous. I will be calling an obese person obese, because that’s what they are, just like I would call Asian an Asian, and an elederly person elderly, not the PC “older adult”, because THAT’S WHAT THEY ARE. Plain and simple.

  19. SeaSpray says:

    So much for leaving this life with dignity!

    My heart goes out to the deceased woman, the family, neighbors and workers. What a sad,humiliating,difficult,frustrating and unnerving situation that was and they did their best with what they had. The carpet over her is what seemed the most disrespectful… but they probably didn’t think ahead. It must have been traumatic for all involved. And they were at risk for hurting themselves in the process. (I assume the tow truck didn’t drag her from in the house)

    I don’t think things are as black and white as they may seem and we don’t know what goes on behind closed doors..nor do we know her actual medical condition.

    Obviously it was a raging addiction with co-dependents aiding her. But unless you’ve walked in those shoes… you can’t really know what went on or why. People often feel powerless in those situations…both the addict and the co-dependent. I am not making excuses. Life can be complicated.

    Yes..calories in, energy expended..black/white..facts..you will normally lose weight if you make healthy choices.

    But as someone who has wrestled with weight almost her entire life… I can tell you first hand your metabolic system gets screwed up with crash diets… my forte (not now though). The most fun was the beer and lettuce diet when I was 18 … naive I know..all I did was dehydrate myself .. but the scale was less in the morning!and it was short lived. :)

    (I just deleted a whole bunch of stuff WC-but you’ve all inspired a post with maybe a picture in a couple of days ..to make a point)

    Why do they consider obesity to be the poor person’s disease? There are plenty of overweight people of means.

    This is actually such a deep topic..many layers to sift through..no pun intended.

    Oprah…with all her money, personal chefs and trainers at her disposal still wrestles with weight.

    How does someone get that heavy…aside from the obvious? I don’t know. I have questioned that myself. I think anyone in here who has wrestled with weight regardless of amount knows it is a difficult addiction to break. Not impossible… but you handle your substance all the time..not just for yourself, but for family and friends because you need it to live. Imagine doing that with cigarettes alcohol or drugs.

    I think if anyone ever comes up with a safe solution to permanent weight loss…they would be worthy of the Nobel Prize.

    It must be so frustrating for health care workers… although a good many of them have weight issues themselves.

    And why is it that so many respiratory therapists smoke?

    Why… do we humans recognize our self destructive behavior and yet perpetuate it?

    But as far as family… we don’t know the dynamics going on there, education level, etc.

    It is just so sad.

    Russ you should direct the powers that be to these comments. ‘person of size’ is RIDICULOUS! Oh..so is ‘person of girth’! P.O.G.! “the POG is here..what should we do?” Gotta love that one…not!

    C’mon! Obese and morbidly obese is medical terminology for the overweight condition and IMO…connotes the seriousness of the condition. That wordage should NOT be changed!

    For Pete’s sake… I think their ‘person of size’ comment is humiliating and I’d want to wither away on the spot! That’s like telling everyone not to acknowledge the elephant in the room…when everyone including the elephant…KNOWS they are in the room! THAT..makes it worse.

    And besides…what medical staff ever says..”will the obese person please come here?” “The doctor is ready to see the morbidly obese person now.”

    I don’t get their concern with obese and morbidly obese. Life can be complicated enough without having to tiptoe through a landmine of PC verbiage.

    This PC stuff is ludicrous and out of control. I agree with the other bloggers here regarding all this PC stuff.

    Although… I have often stated that when it comes to public respect… some people are cruel about fat people and often people that should know better and that is in the media and everyday life. Heavy people are an easy target and it is seen as laziness… piggishness or should I say POGishness? In that instance…they might do well to be a little PC and show respect. An overweight person’s failings/addictions show physically. But many thin people aren’t necessarily healthy and have addictions or habits that they can hide.. until out of control.

    Oh and I shouldn’t give any recognition to this blog but read about it in another ED blog and was horrified when I saw the FUPA Hunter blog. People can be really cruel and in this day of instant electronic media… that is seriously disturbing.

    There is a saying in the 12 step programs: “But for the grace of God..there go I.” Most of us have a vice with something. Why does it get out of control for so many? And why for some…does it get so dangerously out of control as with this woman?

    I do think having the bariatric scales is a good idea because like it or not… the American population is gaining weight. If it is important to know a patient’s weight…then you need to have some means of obtaining the information.

    I have to say I was disturbed by William the Coroner’s comment “Cremation is difficult. The heat renders out the fat, which can cause a grease fire, and can burn down the crematorium.”

    I thought surely he jests.

    But as fate would have it I happened to speak with a funeral director on the phone a little while ago and so I told him about the comment and wanted to know if that could possibly be true? he actually described the situation and said..maybe with the older ones with a person of that size. ??

    C’mon…is THAT true? That would be so bizarre. What.. would they have to have the fire department on stand by? isn’t that what crematoriums do..handle fires?

    I was overdue for a novella WC and so delete if you wish. Do ya think this post evokes just a few feelings? :)

    • Bipap says:

      Actually, it is not true anymore that so mant RTs smoke. They have a lower incidence then the general population.However I do remember the glory days of being able to find the Inhalation Therapy Department by the clouds of cigarette smoke billowing out into the hallways in the 70’2 and 80’s. Also, apropos of nothing-why are psych people crazy?

      • SeaSpray says:

        Actually Bipap-in the hospital I worked in..everyone in respiratory smoked but 2 people. But I haven’t worked there for a few yrs now so who knows.

        I worked with a surgeon who once said that if smokers could see what the inside of their arteries look like that they would never smoke again. Somehow… I think people being human..they probably would. I think we either think it won’t happen to us..or someday we’ll stop, etc,.. and it’s hard.

        I know someone with early stages COPD..well..that is what they were told 2 years ago…who is STILL smoking and they cough a dry cough all the time.

  20. I can see how this situation strikes a (diss)cord among those of you who are forced to care for morbidly obese people — either helping tend to their overall health or assisting them in actually getting from point A to point B.

    So what you have said in that regard comes to me as information, pure and simple — offered up by people who want to care but who also want every one of us to take responsibility for ourselves. (See? I got it, I got it — and I am a knee-jerk liberal progressive with socialist tendencies!)

    I found I had enough sympathy to go around, and was in general agreement with most everyone… all the while lamely wishing this just hadn’t happened. (Now I sound like the usual wishy-washy knee-jerk liberal progressive with socialist tendencies!)

    I just don’t get why some chose to go after the family (a boyfriend and 13 year old son) and neighbors.

    “They shoulda” done this while she was alive. “They shoulda” done that. Never mind all that they should not have done, Dasterdly Enablers!

    Never mind that we are making the whole situation more tolerable for ourselves by villainizing a boyfriend, a 13 year old boy, and some neighbors who probably walk around muttering something about walls (I just reread Frost’s Mending Wall this afternoon!).

    I guess, once again, it’s your experience speaking to my lack thereof. You’ve seen families and friends play some nefarious role in a patient’s life of obesity.

    SeaSpray is so right — the targets here sure are easy, our rhetoric completely predictable.

    I’m thankful my various vices won’t show on my dead body, though I doubt that my neighbors will even notice me leaving the house one final time!

  21. Carla Cunningham says:

    I wrote a book called “Alone in the Storm” which is an inspirational and heart warming story about an overweight British woman who travels to New Orleans to visit an old friend. There she witnesses the devastation and destruction caused by Hurricane Katrina. The story was based on real life events.

    – http://www.eloquentbooks.com/AloneInTheStorm.html 

    (I’m on Facebook & MySpace)

    Carla Cunningham
    Published Author of Alone in the Storm

  22. C. says:

    To maintain a weight of 700lbs, one must eat approx 14,000 calories a day, a minimum of 12k cal more than she should. She was not a little over weight, this was not an “I dont have a chef like Oprah” situation or a lifetime of yo-yo dieting. She wasnt struggling with weight, she was obese and being “sensitive about it, isnt going to help anyone. She was eating a ginormous amount of food and at that weight she wasnt running to the local convenience store herself to stock up on chips, or apples, or whatever she was eating. That is a lot of food and she couldnt do it alone.

    • SeaSpray says:

      C -14,000 calories? Is that possible with the human stomach?

      Maybe because she must’ve been just laying there expending no energy whatsoever?

      I think if you screw up your metabolism with yo yo dieting, crash diets and or starvation… you can actually create a situation where you eat a lot less than people think to maintain that weight.

      • C. says:

        Yes, it’s possible and she wasnt eating 1200 cal a day. I did a little research in responses to this post and on average a seditary 700lbs person needs to consume approx 14,000 cal per day. Maybe she ate 12,000, or 10,000. Whatever the case, that’s a lot of food.

  23. SeaSpray says:

    Bianca -this mostly conservative minded girl sees you as compassionate. :)

    And I hope I didn’t offend anyone about smoking. I am grateful to say that is one vice I’ve never had… but weight has always been a wrestling match for me.

    I wish I knew the things I know today because it is lifestyle change with something you can LIVE with vs when docs used to give you these 1000 calorie 1 page diets that were about as exciting as cardboard and sure as heck to create the forbidden fruit mentality..hence binging… or they gave you diet pills which didn’t teach you to change your habits and so weight gain was inevitable once you stopped the pills.

    Even though I have head knowledge and motivational reasons..like I want to live… it is still hard. I lost 53 lbs, but then put 12 back on and so I fall back and move ahead … but the difference is I am not giving up.And sometimes it’s discouraging and I think I can’t do this. I can’t even imagine how daunted and discouraged that woman must’ve felt.

    Smokers can usually avoid cigarettes, drinkers-booze and drug addicts drugs.. but not so with food.

    It would really be simpler if we just didn’t have to eat. :)

  24. Erik says:

    No one could find a closed truck large enough to move a couch or a dining room table?

    And the family let them take away their relative on a flat bed truck??!!

    So many oddities here…

  25. lisa says:

    Look—-by the time you weigh 750 lbs, you can’t leave the house. Someone is bringing you food…as youcan’t even probably get up to void. So the someone could stop furnishing so many calories, no? Try feeding the person boiled eggs and lettuce, and tell them if they want better food to get up and go get it….hmmm……

    I have no patience with diminished responsibility. If you weigh 250 or 750 lbs, you choose to weigh that much, because you believe that the benefits of that weight are greater than the drawbacks. There are no excuses.

  26. SeaSpray says:

    Lisa…I don’t think it is that black and white.

    Yes ..I have heard that if a person remains heavy, continues smoking or participating in whatever their self destructive vice may be… that no matter how much they feel or say they want to change… the fact that they don’t… is an indicator that the gain to remain in that state is greater than the gain to change and get out of it. That is so deep seated -subconsciously… because any of us females who wrestle with even 10 lbs… that we can’t keep off… know how miserable we are when we can’t fit into our favorite jeans or look like what we perceive to be perfect on the beach etc.

    So at the subconscious level…something is fighting our conscious desires… both emotional and intellectual. Something is fighting what we consciously know and want to do. WHY? WHY is it so difficult to stop a self destructive behavior… or even if it’s not at the point of being self destructive… but one decides they want to change a behavior so they don’t go down roads they would never want to go down… is it so difficult for intelligent, reasonably thinking individuals? Just do it. Why don’t we?

    It’s either black or white, Yes or no… no big deal. Facts are facts. Follow the rules and you’ll succeed.

    It’s that darn web of gray in between. Why is it so hard for so many to break free from the gray web?

    And really if a person is only 10 lbs overweight or 750… if they aren’t successful in losing it and keeping it off .. they both have a problem.

    And this applies to any vice. As I stated earlier…plenty of thin people have their own vices/issues but they aren’t as readily apparent as a person who has a weight issue. Why don’t they just stop?

    That is a sincere question?

    If anyone out there has some insight into this..I’m listening. (Okay..Ive been watching way to many Frasier reruns, because I just heard Frasier’s voice when I type the “I’m listening”! I LOVE that show! :)

  27. lisa says:

    Well…In the first place, I think it more than a small bit disingenuous for the family to complain about the pts treatment when they are the direct cause of the pt weighing 750 lbs…..They assisted if not caused this problem, as most of my pts are immobile by 400 lbs or so, did nothing to get help for the pt, and then complain? Well, yeah, this is America, but I still don’t buy diminished responsibility.

    And why, you ask, can’t we lose the 10 lbs or so, or stop any other vice? Because we choose not to. Ask anyone who has ever really stopped drugs, alcohol, obesity, or smoking: One day, they DECIDED that they wanted to stop. And, to no-one’s surprise, they stopped.

    It isn’t a web of gray at all. You choose. As soon as we quit medicalizing everything from alcoholism—I’ve yet to see a bottle of JD jump up and pour itself down someone’s throat, they are CHOOSING to drink—to obesity, we will have greater success in treatment. All we do otherwise is offer excuses for people to continue what they are doing.

  28. SeaSpray says:

    Lisa -I don’t think family is the direct cause for the addiction (pick your poison) for a family member. The addicted person makes the poor choices. The family suffers the fallout from the addicted persons behavior/consequences and become.

    (Yes..in THIS case…someone had to buy the food… but we STILL do not know the family dynamics going on.)

    The family becomes co-dependent and can become more sick than the person with the addiction because they are scrambling to pretend and make everything appear that everything is normal. There are all kinds of emotions going on and so many variables depending upon family member’s age, personality, etc.

    You would think…that people would just say…ENOUGH! and give ultimatums etc… and some do… but I believe most do not… because there are so many concerns to consider and when in that situation… they can’t see the forest for the trees and often NEED INTERVENTION from outside sources to help break the cycles. Physicians, therapy,clergy,rehabs,12 step programs.

    I don’t know if this is still true… but I heard years ago… that the 12 step programs have the highest success rate in helping people overcome their addictions. AA, Al-anon, over eaters anonymous, I assume for drugs and other addictions.

    The 12 step program does approach alcoholism as a disease. And many people have been able to turn their lives around because of this wonderful program..and it’s free for anyone seeking help.

    I do hear you with regard to what you are stating about choosing our behaviors and it is true. But..if that were all there was too it… people would keep the weight off.

    I don’t know the stats… but it seems that most people who quit smoking..really do quit. It also seems that most people who lose weight… DO gain it back in some amount. WHY the disparity?

    I personally believe there are physical components to this dilemma. Fat cells, body chemistry,body set points, metabolism,lifestyle (sedentary vs active) heredity and now studies are also pointing to lack of quality sleep. That being said…I know most people do not have a problem with their thyroid but rather it is a matter of calories in and calories burned, etc.

    Then there is environment,cultural and psychological and also spiritual.

    We are all so different and there are so many different variables.

    And there is common ground.

    But… lets say a woman was attacked by a sexual predator in her past. There is a good chance she may use food to insulate herself from that pain and also to ostensibly cause others to reject her by making herself unappealing. Yes..I used an extreme scenario… but those things do happen.

    She would be a classic case of her underlying gain to stay heavy was overriding her gain to lose. Afraid of success, depressed, whatever.

    Instead of telling someone suffering from depression (serious kind)”Just pick yourself up by the bootstraps and get going..stiff upper lip and all that.”… it would be important to get at the cause of it. But there is a time and place for it too. I am not saying coddle all the way… not at all.

    I also think patients need to hear the truth from people in a respectful way that allows them to maintain their dignity but not negate the consequences of their behavior.. i.e., your gonna die.. if you don’t change, etc., whatever the concern may be.

    I certainly don’t pretend to have the expertise of a physician or therapist… and perhaps you all would take issue with this line of thinking… but these things have come to my attention through various media sources and life’s experience… and I was blessed with a best friend who was a counselor… who was like a mentor.

    And if what I have said is misguided.. then certainly..someone correct me… but it is what I believe.

    It is not ALWAYS black and white.

    If our bodies were purely physical…with out the psychological component operating/motivating us… then I suspect weight loss would be easier… assuming there were no physical causes to hinder weight loss other than what the person chooses to do to aid or hinder their success.

    Now if someone can come up with a way to insure the weight will stay off permanently for people… Nobel Prize is theirs… says me. :)

    Also… It doesn’t escape my attention that here in America and other countries… we are getting heavier (England’s recent stats show they have the most obesity) and yet so many are starving in 3rd world nations. It just seems so unfair.

  29. SeaSpray says:

    WhiteCoat, I just noticed your addition to your post and of course all of that is a concern… and thought provoking.

    I agree with your points.

    I take issue with generalizations some people have espoused.

    Things do have to change. People need to do what they can to be healthier and I include myself in the mix.

  30. lisa says:

    “.The addicted person makes the poor choices. The family suffers the fallout from the addicted persons behavior/consequences and become.

    (Yes..in THIS case…someone had to buy the food… but we STILL do not know the family dynamics going on.)

    The family becomes co-dependent’

    Here is where I step out. Addiction is no more nor less than a lack of moral fiber. Calling it a disease—no matter to what one is addicted—simply transfers responsibility from the person who is using whatever substance to the disease.

    It remains a matter of choice. We are all free to make choices—but our right to choose ends when we expect someone else to pay for our choice. I dearly love chocolate, for example. It is entirely conceivable that I could eat it til I became ill…..should I then go to the ER and expect someone else to pay for my folly? Have my chocolate problem declared a disability and go on welfare? Somehow I doubt this.

    We are back to diminished responsibility. If you make a choice, you should be fully responsible for the consequences. Ignorance is no excuse, if one is not a child, an imbecile, or senile.

    • DreamingTree says:

      I am all for personal responsibility, but think you are missing the boat when you state that, “Addiction is no more nor less than a lack of moral fiber.” It’s always hard to tease out how much is due to nature and how much of a role nurture played, but regardless, it’s not a simple “I LOVE Big Macs” case. Psychological & medical help is needed, not scorn and judgment.

      But, back to personal responsibility, I agree that if a person refuses to seek such help, and continues on a destructive path, then he/she shouldn’t get a free ride. A free ride kills a person’s motivation to change.

  31. Nurse K says:

    We had a [now deceased] 700 lbeur whose family brought her bags, yes, bags of Quarter Pounder w/cheese burgers from McDonalds. I think about 12 sandwiches at a time? She’s hungry after all! If you banned the outside food, the personality disorder kicked in and you had screaming, yelling, throwing things at staff.

    There is no way to be that big and not have someone bringing you massive amounts of food IMHO.

  32. WC, it seems folks are weighing in (heh) on their reactions/judgments/projective blame about obesity versus your original query about the medical care and treatment of same. “Blaming the victim”–or their loved ones–detracts from keeping responsibility where it belongs, with the individual.

    The deceased woman was enormous. And? I have worked with folks in this position and they do not kid themselves. They are more than aware of the stress their behavior places on others. Think What’s Eating Gilbert Grape. The emotional challenges associated with the obese mother’s death and her subsequent removal from the family home was perfectly portrayed.

    Sad and true: live by the sword, die by the sword.
    So effin what? I don’t live in a glass house and neither does anyone else I’ve ever met.

    As for special arrangements to provide care for such individuals, I personally subscribe to the notion you do the best you can with the resources you’ve got and do not add additional stress to the larger system as the result of outliers. (My experience with outliers is they are aware of the “deal”, as previously noted, accepting society’s terms as part of the package. It’s the rest of the masses that struggle…largely looming idiots, all. And that’s just my two cents.

    /stepping off the soapbox

    Sincerely,
    Arthur Schopenhauer

    • DreamingTree says:

      Complete agreement! Too many people are unable to view the world from a different perspective. If you don’t have an addiction, or never experienced trauma, then your brain does not reason the same as one who has. And, nature & nurture are so intricately intertwined that you can’t simplify a problem by blaming one or the other.

  33. SeaSpray says:

    Nurse K – Am I coming across that I support people giving up… resting in the knowledge they have a disease so they can collect disability, and have all med expenses paid for by the government or state? Because if so… that is not my intent.

    I abhor that. As we all know…too many people abuse the system (and they’re all not overweight)and shouldn’t be allowed to collect disability, etc. And then there are those that need it… and thank God there is help for them.

    “Addiction is no more nor less than a lack of moral fiber.”

    Sure there are times we can give someone a “pep talk” and set them straight, letting them know they need to get their act together or have to use tough love because you shouldn’t have to be subjected to the fallout of someone’s self destructive behavior.

    But it’s also short sited to frame everyone as being morally weak because they succumb to their vices. There can be physical reasons why one person is more predisposed to a behavior than another is. There can be psychological issues that drive someone toward the behavior… that even the person isn’t aware of.

    I don’t condone what you are describing with that patient. Obviously she had mental health issues… I would guess severe. No one has the right to be abusive toward others and if we let them continue in that behavior then we aren’t helping ourselves or them.

    You can’t make someone do something or it won’t last. They need to choose to get well. But you can say you won’t enable them anymore. You have a right to take care of yourself and remove yourself from the situation.

    I am all for accountability and responsibility. I just know there is more to it and it isn’t fair to judge with such negativity.

    WC… if they make larger beds… can they make larger CT machines? I know..not cost effective and particularly not if we do adapt a socialized medical system.

    • DreamingTree says:

      “WC… if they make larger beds… can they make larger CT machines? I know..not cost effective and particularly not if we do adapt a socialized medical system.”

      Although I empathize with the morbidly obese, I don’t think this is the way to go. There has to be a limit. Believe me, I hesitate as I write that, but there are limits to societal responsibility. In the big scheme of things, we’d be better off forcing the person to accept psychological help BEFORE he/she gets to that point. I’m not saying we should force treatment, just that it’s better than watching the person slowly kill herself and then making a feeble attempt to slow the death process.

      • SeaSpray says:

        I know Dreaming. When I wrote that I figured it wouldn’t fly with most people.

        That’s the problem..you can’t force someone… but the flip side is then why should society be obligated to bail the person out in whatever way necessary if they don’t do what they can to help themselves?

        People see overweight people and they equate them with the stereotypes: excess,laziness,unmotivated, gluttony,being lower IQ,low income and now I will add selfish after reading these posts. It seems they are quite the easy target. And with all this PC BS going around about everything these days..It is still acceptable to knock an overweight person.

        People that have never struggled with the issue think just stop already.

        Maybe they are right.

        Maybe we should all have the ability to break any bad habit in our lives as easily as turning off a light switch.

        Wouldn’t that be nice? I’m done. Turn the switch off now. No more drinking,drugging,smoking,overeating,compulsive spending, compulsive lying,porn,gambling, sex addiction,BLOGGING,electronic games of any sort,anger,workaholic,etc. Basically… no more of any behavior that hinders your life or the life of another.

        And I am not saying… so..because it’s hard people shouldn’t have to change… or they don’t have a responsibility to change. It would be better for them and those around them. Oh..if only life were so perfect… what a wonderful world it would be.

        Perhaps this isn’t a good analogy… because you would need the machines for normal sized people anyway… But not wanting to accommodate morbidly obese people is akin to not wanting a CT machine for an alcoholic or a PET Scan for a smoker.

        These people may have gone around in beautiful/handsome socially acceptable bodies and yet their self destructive habits led them to their diseased lungs, hardened arteries and damaged livers, etc. People with these habits add to the burden of medical facilities, staff, health care costs and society. Heck the drunks kill people on our highways everyday. Innocent nonsmoking people are affected by second hand smoke through no choice of their own… thankfully limited now… and families of alcoholics are often destroyed and the repercussions of that manifest in medicine and society in other ways.

        Please know…I am not excusing her behavior or others, or saying she doesn’t have responsibility for her actions. I am pointing out that it can be complicated and it is not fair to judge without facts. Fat is repulsive to most people and it represents failure on many levels. It is an easy target.

        WC…I think you answered your questions with your questions. To me..it is obvious that in order for you to do what you need to do with *all* of your patients…you need the equipment to follow through so you can help all patients to the best of your ability.

        Like it or not… there is an obesity epidemic going in in this country. These people deserve quality care… just as the alcoholic with cirrhosis of the liver, the cancer riddled smoker or the brain fried, diseased drug addict.

        You wouldn’t question whether or not any of those people should have medical equipment available.

        I know you say.. but the *additional* cost is what’s not right… and adds to an already financially strained medical system. But then the logical conclusion is that the people with all the other vices I mentioned are of more value than the obese person.

        We’re all human… but our weaknesses manifest in different ways and cause different challenges and some are more socially acceptable then others.

        So.. personally… I believe..YES… there needs to be a way to accommodate the morbidly obese because they are what they are and they *will* need your medical expertise at times.

        The difference between them and other patients that are a drain on the system is that their weakness, disease.. whatever you want to label it manifests on the outside which immediately sets them apart from the average person and is usually perceived as repulsive and lazy POGishness, causes more risk(back injury for staff), man power for transport/cost and inconvenience and initially more expense with having to invest in the equipment.

        I say Kudos to Russ’ med facility for adding the bariatric rooms/lifts, etc.! Having the equipment *makes it easier* for the staff and *safer* for the *morbidly obese* patient and staff. It is what it is.

        All that being said… EDUCATION, PUBLIC AWARENESS… keep hammering away to hopefully reach people *before* these things happen.

        This post and everyone’s comments have been most thought provoking and I am going to be mulling over this one for awhile.

  34. Peter E. MD says:

    The tragedy of a 750lb human being has many causes, and is the result of many failures by multiple people over a very long time. Whatever indignities this person suffered in death pale in comparison to those she suffered over decades of life at the hands of those closest to her.

    Compassion for people and families so afflicted does not mean we ought to accept irresponsible behavior or torture the language with PC obfuscations. Compassion requires clear thoughts and clear words. It was obfuscations, denial, excuses that led to the tragedy in the first place.

    PC terminology is destructive and deserves our mockery. My contribution is “Adipo-American,” for the morbidly obese in this country.

    Regards,
    -Peter

  35. SeaSpray says:

    I agree with Peter. I especially like that he said “Compassion requires clear thoughts and clear words. It was obfuscations, denial, excuses that led to the tragedy in the first place.”

    While the syllables have a certain rhythm to
    “Adipo-American” ..its too close to Hippo. However…I can envision the term in a YouTube or SNL parody. :)

    Obese…morbidly obese… calls it like it is medically speaking and should suffice.

    Unless you’re talking about urine… ahem… then everyone knows that’s whizzie winkles (SCRUBS).. I’m just sayin. ;)

  36. AMcA says:

    Really, I doubt that life at 750 lbs is all that dignified. You can’t even move under your own power. The problems associated . . . elimination . . . and bathing, for that matter, must be appalling.

    I imagine a ride on a flatbed after death is nothing by comparison.

  37. SeaSpray says:

    Katy- I didn’t know we were supposed to refer to the elderly population as “older adults”. ??

    That seems to be a broad range of possibilities there…depending on the age the person referring to “Older Adults”.

    I really do hate PC.

    Maybe people should just focus on being respectful and live by the Golden Rule because it seems our society could use some lessons in manners and respect. That would make a huge difference. many of us were taught to have good manors but it is appalling to see what other people don’t do to help others and be courteous now.

    There are 2 words that I do think are an improvement.

    Crippled… to me implies weakness and not capable and so handicapped or physically challenged…good idea.

    The other was retarded.. just associated in a derogatory way and developmentally challenged much better.

    There are probably other positive changes… but some of them are just absurd.

    • Katy says:

      “Older Adults” – that’s first year nursing for you these days. ;) And didn’t you know, children are “little adults”? I only remembered them because I found it so ridiculous, I’ll never be using the terms.

      I agree with you completely SeaSpray, people are so anal about being politically correct, how about just being polite?

  38. SeaSpray says:

    Katy – Exactly! :)

  39. Dop says:

    As a morbidly obese person myself, I think it’s reasonable for EMS to refuse transport or treatment to someone my size or larger. I’ve worn a DNS bracelet since I was 200 lbs (now 300 lbs). I pre-planned funeral arrangements for same day cremation. Maybe I should add permission to dismember me if it’s too difficult to move the body whole. I accept that a lifetime of bad choices made me what I am and I don’t expect anyone should have to put themselves at risk on my account.

  40. These we’re all very thought-provoking comments, as well as the original article. But I wonder, where does this leave those with Marfan’s Syndrome, or Acromegaly? Even if everyone developed a healthier lifestyle, you’re still going to have others who’ll need special ammenities (sp?).

  41. b says:

    Obesity is complex and has many factors. But I believe one thing that many folks fail to realize is that some morbidly obese have brains that make them susceptible to obesity. They may actually qualify as mentally ill. For example, they could have too few dopamine receptors and actually not feel that they are satiated when eating.

    Or, there was a recent news article about brain scans of obese folk. Learning from positive outcomes is normal for some of them. But some had deficits in learning from a negative outcomes. They literally don’t recognize the negative effects like a normal person would so they aren’t motivated to alter their behavior to get a better outcome.

    Just a couple of the many things I’m sure we’ll learn over time about this disease (yes, at least for some it is a real bona fide disease). So, trying to condemn this entire group of people as moral weaklings in need of a stiff kick in the pants isn’t very enlightened. About as effective as telling a schizophrenic he’s being silly cuz those voices aren’t real.

    • WhiteCoat says:

      I’m not aware of any studies bearing out the assertion that obesity is a neuroendocrine problem. Can you link to a couple?
      I agree that some diseases, such as Prader-Willi Syndrome, may cause obesity, but 30% of the population does not have Prader-Willi Syndrome.
      If we classify obesity as a disease, and I’m not sure that we should use such a broad brush stroke at this time, then do we just say “it’s OK to eat a poor diet — you have a medical condition”?
      Using your example, people will become upset with schizophrenic patients who repeatedly stop taking their medications. Should the reaction to obese patients who continue to eat a poor diet be different?

  42. [...] http://www.epmonthly.com/whitecoat/2009/06/transporting-morbidly-obese-patients/ “No we can’t transport your body in the coroner’s vehicle because you’re too large.” Patients need to understand that sometimes there are consequences to their actions. In some cases, providers will have to get the job done with what’s available to us, and you may not be happy with the results. In other cases, patients may not be able to receive appropriate treatment. What happens if a 750 pound person passes out on the second floor apartment and there is no elevator? What if it happens in a rural location and there are not enough volunteer EMTs to lift the patient? 56 Responses Leave a Comment [...]

  43. b says:

    WhiteCoat, my main point is we should *NOT* assume that every obese person has the same condition. My point is that it is *COMPLEX*.

    http://www.medicalnewstoday.com/articles/156373.php
    http://health.yahoo.com/weightloss-overview/are-you-addicted-to-food/prevention–23233.html

    And schizophrenia has a spectrum of severity too. One person might not take his meds because it makes him tired, while another might think he’s being poisoned and fear for his life.

    It seems people too often take a single example of something and interpret it as a universal truth.

    • Painless says:

      To be honest, I’m considered obese. I know that and I don’t put it any other way. I lead a sedentary lifestyle. Again, I realise this and don’t put it any other way. I DON’T weigh 750 pounds. Folks don’t alway’s realise the impact of weighing that much has on other parts of society. I have a permanent back injury thanks to a morbidly obese person weighing over 700 pounds I was helping another nurse care for in an ICU a few years back. It nearly ruined my career and my livelyhood. Thanks to that person and the people that enabled them to become that obese, I almost lost the ability to care for myself and my family. Yes, workers comp kicked in for the 6 month’s I was out of work. Yes, workers comp pays for the medication I take on a daily basis, and it paid for the surgery I had to implant an intrathecal pump. Do you really know what workers comp pays these day’s? Do you know the hastle I have when i go to the pharmacy… for the past 6 years… on a monthly basis? It doesn’t keep up with the fact that over the last 6 years I make more money than I did – when I was out for surgery I got paid HALF of what I make now – that’s what I was paid back when I hurt my back. If I should lose my job I would likely have a hard time finding another – because I have a history of a back injury and I have lifting restrictions. Not to mention the things I’m unable to do around the house because of the restrictions put upon me so I don’t make my back worse. No longer do I play tennis or softball, no longer do I go hiking. I can no longer carry heavy stuff to/from the car, I have to pay to have things delivered that a few years ago I would have carried with friends and not thought anything of it. I hurt when I mow my yard, bad enough where I have to have a bolus on the intrathecal pump when I start, and another when I’m done.
      Yes, I feel sorry for this lady that her dignity in death wasn’t the best of circumstances. I feel sorry for her family for losing their loved one, and the embarrasment at how their loved one was taken away. I only hope and pray that no one lost their livelyhood, no one had to live with chronic pain and disability in order to get her from her home to the coroners, or to the funeral home, as undignified as it might have been.
      I sit here and read everyone debate whether obesity is the right term to use or not, debate whether family has complicity in the patient being obese, but nowhere do I see anyone talking about the others who have little choice in what happens to them while taking care of folks who are this heavy. Yes, the hospital could have had better equipment to deal with people of this size. But is it their fault they didn’t have equipment to handle what is not the norm in our hospital (or wasn’t the norm then)? We didn’t have lifts certified for her weight at that time. There were 5 staff helping and still there was injury. Or is it the fault of the patient and the family for allowing themselves to get into this state? Or was it my fault because I was doing my job properly, trying to care for someone who was this big in a competant, caring manner. In the end I blame society in general. We try and make things nice for everyone, we don’t want to insult anyone, and we enable this situation to happen in doing so.
      I know, I know…. I’m sorry I’m ranting about all of this, I guess I’m still bitter at the life changes I’ve had to go through because of doing my job caring for a very very obese patient on a ventilator. I don’t claim to be a skinny minny myself, but I’m nowhere near even half the weight of the patient in this story or the one I took care of. Too often we worry way too much at hurting someones feelings – we are in the wrong for calling them obese instead of weight challenged – yet they bear no responsibility for their condition or anything that happens because of it. Get real….

  44. Diana says:

    My brother’s girlfriend is taking care of her dying mother. The dying woman weighs 700 lbs. They live in a remote part of the state and there is a volunteer fire department. Looking at the logistics I can see that moving the woman’s body is going to be a nightmare! I’ve suggested to my brother than the family start talking about how to transport the dead woman’s body and if the local funeral homes can accommodate her size, just to avoid any ‘humiliating’ procedures that the funeral home or local fire department might have to do in order to move the body. I’m thinking back to the movie with Leonardo Decaprio & Johnny Depp where they play the sons of a woman weighing 600 lbs. The mom has never left the second floor of the house because she could not walk down the stairs. The woman dies in the end of the movie and the kids are freaked out because they don’t know how they are going to get her down. Johnny Depp plays the older brother. He gets the kids out of the house with all of their belongings. He torches the house with the body of his mother inside. Very powerful and practical.

    • Becca says:

      If remotely possible, suggest moving mama to somewhere with double doors, ground floor, ramp access etc. now. (Hospice maybe? Hope the daughter has help, 700lbs is not a one-woman job).

      Contact relevant agencies for sure, there are lots of options and it will all be easier and less distressing with planning. Uck. Not nice. My thoughts are with the girlfriend – and her mama of course. Never met someone so big who wasn’t hurting badly.

  45. cathy sylvia says:

    hey theres no arguing getting that obese is not what nature intended. and im sure the coroner did try to creatively solve a difficult situation. that being said, my all female removal crew can move 600lbs. plus using just 2 or 3 of us and we are not amazons we are young, trim, professionally dressed yet smokin hot. and we can do it with dignity and respect. just a shout out to my funeral home.. but… our equipt ment does have a limit. around 1000 lbs.

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