w00t w00t booyah

The memory still bothers Ken Keller: A panicked ambulance crew had a critically ill patient, but the man weighed more than 1,000 pounds and could not fit inside the vehicle. And the stretcher wasn't sturdy enough to hold him.

The crew offered an idea to Keller, who was then an investigator with the Kansas Board of Emergency Medical Services. Could they use a forklift to load the man - bed and all - onto a flatbed truck? Keller agreed: There was no other choice.

I'm going to point you back to a post I made some time ago: This is not about the pretty.

Because here it is again. And this time, it's going for the pocketbook, without shame.

*reads article again* Over $1,000 to simply move someone to the hospital. Yikes. And let me remind you that the worst bill to get covered by Medicare is ambulance rides. When they finally do pay? Company has either gone out of business or is on their way out. I swear most of the ambulances in San Bernardino county have at least five coats of paint on them as they change hands over and over again, bankruptcy to bankruptcy.

And before you jump in there with the 'UNFAIR TO THE - ' cries, I might remind you of the biggest 'invisible disability' around.

Burnout. And if you work in the healthcare profession, it's estimated that it occurs 100% of the time. (Kind of like riding a motorcycle. Do it enough, and it'll kill you - statistically speaking.)

Trying to cope with this one specific challenge - over and over again - you see it, you know you can do nothing about it, and you've seen both the short-term and long-term. You know what's coming. And it's not cancer. It is a chronic condition, with pitiful little support or sympathy.

I won't say this one issue causes burnout in health care professionals by itself; but damn, it sure is the one I hear responsible for most of the 'problems facing Americans today' when the educational films are shown.

Burnout ruins a lot of people - and it's so common, nobody even notices. They just keep going to work because that's what they're supposed to do.

So yeah. Not with the surprise here, because we're dealing with two things here - a poorly reimbursed service that's vitally necessary and worn-out care providers thinking where to place the blame, going for the -ahem- largest target. (And honestly, the one that scares them the most.)

So very broken. So very, very broken...this is.

For those of you who voted 'kitty' yesterday, this fluff's for you:



For the rest, color me amazed. NOBODY said no. Not one.

Hooookay, then.

*kid gloves taken off, burned and ashes scattered*

I'm going to start this off then, with some caveats. The only thing that's going to look like a cut is a link to the original stories. And this is going to be a long one - if that upsets you, hit the scroll button now.

If I'm going to talk about this - I'm not going to hide it. If dealing with the concept of weight/body image bothers you to the point of despair? I don't know that you're going to enjoy this.

Just talking about it mind. A post cadhla did some years ago comes to mind - and gives me a bit of pause before plowing ahead. This one. I'd go check it first, you have any qualms about whether or not I've been handed 24K clues on the subject or not.

Now I'm going ask you to put that to the side. Because -

THIS IS NOT ABOUT THE PRETTY.

Thought you'd wonder. At first blush? Sure looks like it.

...Then on November 29 of last year, a few weeks ago, he suffered chest pains. Wanting to live and knowing what to do, he called emergency services. The operator stayed on the phone with him as he waited for the ambulance to arrive. He collapsed and the operater listened to every sound hoping to hear his door open and help arrive. Well, she did hear everything, and what she heard astonished her.

The two ambulance attendants saw this big, fat, disabled guy, living in a messy home. They stood talking about him and decided that he wasn't worth saving. So they stood there and let him die, deciding to tell everyone that he was dead when they arrived. One more cripple out of the way, one more unnecessary life done away with. One more of us gone.

The operator immediately handed in the tape. Charges and investigations ... blah, blah, blah ...

Fact Checked - and damning in the bargain.

Fat, a poor housekeeper...and a gimp. Oh, and unmarried and childless in the bargain. Didn't even have parents to grieve his loss anymore.

*looks at pictures* I could have put that right in a couple of hours, mind. I've mentioned being 'proud' is pretty expensive, right? And he was social - he wasn't a shut-in, or housebound. But nobody deserves the fate he received - let's be clear on that. He had some reasonable expectations of the culture around him - and it failed him. Why?

Let's talk about burnout for a moment. No, really. I'm pretty sure some care providers are gonna go to jail for this - and really, losing their jobs is going to do them a favor. That's clear as a busted nose to me - these guys have seen so many of him they've lost it completely. It's burnout - in a form nobody would accept.

This is where it's gone beyond an occupational hazard and killed someone - and left everyone aghast about how it could happen.

I'm going to try - and I can only try - to give you a perspective on what it is to be the person tasked with saving your life...and can't. Because you weight more than 400 pounds.

And in particular, I'll talk from recent experience - and that's listening to the rad techs. And the rad tech students.

There isn't a story much more heartbreaking than the one about a nineteen year old that could have lost her leg after tripping over a laundry basket, and likely will have years of recovery ahead of her - it was a very near thing. Bad fall? No. She fell, sure, but wedged herself between the wall and the dryer...and it took 45 minutes to extricate her by the fire department, (after someone found her, mind) because she weighed over 380 pounds. She had dislocated her knee so badly the arteries and veins were pinched shut. She was so top heavy she couldn't free herself.

Forty five minutes - you can't free yourself - and according to Jim, she was on as much morphine as it was safe to give, and it wasn't touching the pain she was in.

Please lose the weight.

And she was one of the small ones.

Type II diabetics (and I've heard the term 'metabolic disease' as well) are a complete package - and the social Darwinists like to point out that in some populations (most of them of color), this is an evolutionary change to survive famine, and hence a normal process to weed out those that won't survive our current way of life. Adapt or die. (I'd wish these people sex, but why.)

They gain weight easily - scary easily. And getting it off again? Nearly impossible...and once they're on medication to either max out what insulin production they do have, or insulin replacement entirely? Even more so - losing weight being entirely insulin-dependent is something not for the faint of heart. You'll see the inside of an ER often, either in shock or acidosis. Promise. But the alternative is even worse.

When these people end up inpatient over 500 pounds, they are the sickest people you ever saw. They're losing limbs to amputations, having heart attacks and losing their minds having strokes. They're on dialysis. Their joints are shot, they're in constant pain and maybe even addicted to prescription medications. Physically? Decades older than their healthy peers. They die by small increments, huge leaps and in pieces.

The worst part is that every year, they get bigger - and the technology can't keep up. Most of them are bed-bound. Most of the beds are rated for about 300 pounds. (Check your bathroom scale, you haven't seen this yet. You'd think nothing was more than 300 pounds.) Up to recently, the only scale I ever saw that could measure more than that was one you rolled a wheelchair onto. That probably should have tipped me off.

You've heard the recent upgrade to "It's A Small World" at Disneyland was to deepen the tracks so the boats would stop bottoming out, right? Jim works less than 15 minutes away.

We're not talking about people who carry more than 50 pounds more. Or even 150 pounds more. Those folks get just as sick - for the same reasons - but two people can move them, if they can't move themselves. Diagnostics can be done. The bigger ones?

They break beds. They can't be moved without extreme measures. They suffocate under their own weight. X-ray machines shut down, overheating when they try to do exams on them - and the films aren't usable. Anything more would be dangerous to them - and what can be used? Doesn't work.

And they are often surrounded by family members, desperate to do anything they can for them - dearly loved - and all of them are as large or larger. Everyone of them a client at some point, of the facility. To them, and it's easy to imagine why - big is inevitable. Why fight it?

Please lose the weight.

This stuff doesn't roll off. They stay with you.

When the students graduate, if I get a chance to talk to them...I congratulate them on gaining their majority with an education, their clinical and their dedication to caring for their patients.

And then I ask them to consider what it is going to take to stay in the business of caring for others, not just to enter it. Because they don't tell you the patients are going to break your heart, infuriate you and be absolutely deaf to your fears for them. There are no classes on how to deal with burnout.

Or even how to recognize it.

You'll blow off steam with your colleagues. You'll have to - and somewhere in the mix, you all come to consensus that the really big ones can't be helped. Consciously or unconsciously...and even the patients seem to agree with you. They come in complaining of ailments, want you to help them - and it's plain as plain it's their own fault!

One day, you suggest they lose the weight, they take it wrong and report you. You can't insult patients, after all. You stop caring, after passing that warning point of getting overly involved in your patients problems - burnout is here, and you might not even notice it.

Then you start blaming them for being an inconvenience and taking up valuable time that could be spent on patients that will recover because they aren't so damn FAT.

Patients start getting labelled 'noncompliant' even before treatment begins.

And there are so many, they start to blur. You stop seeing faces.

It's so easy. Just lose the weight. Anyone can do it. It would be so easy.

And then it's all their fault.

I'm not going to go into the character assissination that already goes on towards people of size. You want a really good clue, go to YouTube, search up 'Fat Rant' and let the lady tell you all about it.

I'm not even going to say THAT'S what happened here.

We need to grieve for others besides Barry Baker. And know that the grief exists and not sublimate it.

And then I run into this thing:



Welcome to the world of confirming you're okay in the world. I speak of feeling your affluence.

Right around the waist.

I looked at that - step by step instructions and all, and thought about it. As a party food for more than twenty people? Pretty spiffy - I'm thinking of slicing that bad boy and serving it with slices of sourdough bread. Some beer to go with.

About 1/4" slice per.

Who thought that having the whole thing to yourself would be better? Or even more appropriate?

I mean, every ad I've seen for fast food is BIGGER, CHEAPER and YUMMMMMMMMMIER lately. (There's some $1 value menus going right now that are double burgers - 1/2 lb of beef - come on down!)

There's one that would feed both Jim and I for $4 right now. Seriously. And it's marketed as a meal for one person. Any 'reasonable' person would agree. It only has one soda, after all.

*headdesks*

There's been a lot of talk lately about obesity being a disease of poverty. As in - you're too broke to have anything pleasant to do but eat. You can't travel, you can't go outside, who in their right mind would stop watching television, playing games or reading books if they don't have a job? And food is EASY to come by - compared to housing or transportation, those other things that self-determination and employment demand.

I mean - get a 12 pk of soda, pound that and then recycle the cans? There's another burger, fries, and a soda for you - maybe even a couple of deep-fried tacos. There are a bunch of food banks. Not so much a decent place to work or sleep.

And fast food is cheeeeap. You get so many strokes for showing up, it's incredible.

Things aren't so bad. Have a coke and a smile. You DESERVE that cookie. And you really CAN eat the whole thing!

There's a lovely book on my shelf at home called What to Eat by Marion Nestle. It echoes my college nutrition class so eerily, decades after I took it - it's not funny.

Food isn't just big business here. It is - pun intended - HUGE.

It's nothing less than creepy the way our culture adores the people who eat to excess...and then hates them when the predictable outcome occurs.

And then makes money hand over fist selling them diet aids that don't do dick. Books. Relabeled crap that tastes like shit, probably isn't at all good for you - but it doesn't have any carbs/fat/sugar/name it this week!

Food is also one of those things that doesn't keep like - say - gold or artwork. So if you don't sell it quickly, you'll lose money and in a big way.

So we're told to eat fast - and have some more!

Don't forget how social eating is as well. GOOD TIMES.

Just don't gain weight. Well, gain TOO much. Ya gotta eat, after all.

*raises hand* I have a great-grandmother who died in her bed, over 700 lbs. If I am to believe what her daughter told my mother. And my grandmother was paranoid about her size. And no, she wasn't small, either.

Mom did Weight Watchers when I was a teenager. I did it a couple of years ago now and lost a total of 50 lbs from my high point. (I'm a bit up from the holidays, somewhere between 5 and 10 lbs more. I'm back on plan, and it'll come right back off - trust me.)

It's portion control. It's knowing how much is enough, and leaving the table afterward. Yes, that takes a whole system, meetings and support networks. It does.

Please lose the weight.

EAT EAT EAT YAY!

I have a sister who probably is over 250 lbs. I have a niece who could be her and I, put together. Cousins, ditto.

I lost the weight because my doctor threatened me with drugs for the rest of my life. It was never about the pretty - because let's be blunt. I'm not, and being thin won't make me pretty.

It will make me invisible to public scorn, however.

It's cheaper. And not in the grocery bill department. I don't need a lot of medical care, prescription drugs, adaptive equipment...hell, even my furniture doesn't wear out that fast.

I wish we rewarded people as well when they were of normal size. You just don't register on most of the radar.

And I wish we paid more attention to what being so obese does to the culture and systems that provide care around us - attention, not insults and disgust. Not indifference until someones dies of it.

It's not your fault. It's your responsiblity. It's your choice. You didn't know.

The only way out is through.

Please lose the weight.

And don't get fooled again.

For those of you who voted 'kitty' yesterday, this fluff's for you:



For the rest, color me amazed. NOBODY said no. Not one.

Hooookay, then.

*kid gloves taken off, burned and ashes scattered*

I'm going to start this off then, with some caveats. The only thing that's going to look like a cut is a link to the original stories. And this is going to be a long one - if that upsets you, hit the scroll button now.

If I'm going to talk about this - I'm not going to hide it. If dealing with the concept of weight/body image bothers you to the point of despair? I don't know that you're going to enjoy this.

Just talking about it mind. A post cadhla did some years ago comes to mind - and gives me a bit of pause before plowing ahead. This one. I'd go check it first, you have any qualms about whether or not I've been handed 24K clues on the subject or not.

Now I'm going ask you to put that to the side. Because -

THIS IS NOT ABOUT THE PRETTY.

Thought you'd wonder. At first blush? Sure looks like it.

...Then on November 29 of last year, a few weeks ago, he suffered chest pains. Wanting to live and knowing what to do, he called emergency services. The operator stayed on the phone with him as he waited for the ambulance to arrive. He collapsed and the operater listened to every sound hoping to hear his door open and help arrive. Well, she did hear everything, and what she heard astonished her.

The two ambulance attendants saw this big, fat, disabled guy, living in a messy home. They stood talking about him and decided that he wasn't worth saving. So they stood there and let him die, deciding to tell everyone that he was dead when they arrived. One more cripple out of the way, one more unnecessary life done away with. One more of us gone.

The operator immediately handed in the tape. Charges and investigations ... blah, blah, blah ...

Fact Checked - and damning in the bargain.

Fat, a poor housekeeper...and a gimp. Oh, and unmarried and childless in the bargain. Didn't even have parents to grieve his loss anymore.

*looks at pictures* I could have put that right in a couple of hours, mind. I've mentioned being 'proud' is pretty expensive, right? And he was social - he wasn't a shut-in, or housebound. But nobody deserves the fate he received - let's be clear on that. He had some reasonable expectations of the culture around him - and it failed him. Why?

Let's talk about burnout for a moment. No, really. I'm pretty sure some care providers are gonna go to jail for this - and really, losing their jobs is going to do them a favor. That's clear as a busted nose to me - these guys have seen so many of him they've lost it completely. It's burnout - in a form nobody would accept.

This is where it's gone beyond an occupational hazard and killed someone - and left everyone aghast about how it could happen.

I'm going to try - and I can only try - to give you a perspective on what it is to be the person tasked with saving your life...and can't. Because you weight more than 400 pounds.

And in particular, I'll talk from recent experience - and that's listening to the rad techs. And the rad tech students.

There isn't a story much more heartbreaking than the one about a nineteen year old that could have lost her leg after tripping over a laundry basket, and likely will have years of recovery ahead of her - it was a very near thing. Bad fall? No. She fell, sure, but wedged herself between the wall and the dryer...and it took 45 minutes to extricate her by the fire department, (after someone found her, mind) because she weighed over 380 pounds. She had dislocated her knee so badly the arteries and veins were pinched shut. She was so top heavy she couldn't free herself.

Forty five minutes - you can't free yourself - and according to Jim, she was on as much morphine as it was safe to give, and it wasn't touching the pain she was in.

Please lose the weight.

And she was one of the small ones.

Type II diabetics (and I've heard the term 'metabolic disease' as well) are a complete package - and the social Darwinists like to point out that in some populations (most of them of color), this is an evolutionary change to survive famine, and hence a normal process to weed out those that won't survive our current way of life. Adapt or die. (I'd wish these people sex, but why.)

They gain weight easily - scary easily. And getting it off again? Nearly impossible...and once they're on medication to either max out what insulin production they do have, or insulin replacement entirely? Even more so - losing weight being entirely insulin-dependent is something not for the faint of heart. You'll see the inside of an ER often, either in shock or acidosis. Promise. But the alternative is even worse.

When these people end up inpatient over 500 pounds, they are the sickest people you ever saw. They're losing limbs to amputations, having heart attacks and losing their minds having strokes. They're on dialysis. Their joints are shot, they're in constant pain and maybe even addicted to prescription medications. Physically? Decades older than their healthy peers. They die by small increments, huge leaps and in pieces.

The worst part is that every year, they get bigger - and the technology can't keep up. Most of them are bed-bound. Most of the beds are rated for about 300 pounds. (Check your bathroom scale, you haven't seen this yet. You'd think nothing was more than 300 pounds.) Up to recently, the only scale I ever saw that could measure more than that was one you rolled a wheelchair onto. That probably should have tipped me off.

You've heard the recent upgrade to "It's A Small World" at Disneyland was to deepen the tracks so the boats would stop bottoming out, right? Jim works less than 15 minutes away.

We're not talking about people who carry more than 50 pounds more. Or even 150 pounds more. Those folks get just as sick - for the same reasons - but two people can move them, if they can't move themselves. Diagnostics can be done. The bigger ones?

They break beds. They can't be moved without extreme measures. They suffocate under their own weight. X-ray machines shut down, overheating when they try to do exams on them - and the films aren't usable. Anything more would be dangerous to them - and what can be used? Doesn't work.

And they are often surrounded by family members, desperate to do anything they can for them - dearly loved - and all of them are as large or larger. Everyone of them a client at some point, of the facility. To them, and it's easy to imagine why - big is inevitable. Why fight it?

Please lose the weight.

This stuff doesn't roll off. They stay with you.

When the students graduate, if I get a chance to talk to them...I congratulate them on gaining their majority with an education, their clinical and their dedication to caring for their patients.

And then I ask them to consider what it is going to take to stay in the business of caring for others, not just to enter it. Because they don't tell you the patients are going to break your heart, infuriate you and be absolutely deaf to your fears for them. There are no classes on how to deal with burnout.

Or even how to recognize it.

You'll blow off steam with your colleagues. You'll have to - and somewhere in the mix, you all come to consensus that the really big ones can't be helped. Consciously or unconsciously...and even the patients seem to agree with you. They come in complaining of ailments, want you to help them - and it's plain as plain it's their own fault!

One day, you suggest they lose the weight, they take it wrong and report you. You can't insult patients, after all. You stop caring, after passing that warning point of getting overly involved in your patients problems - burnout is here, and you might not even notice it.

Then you start blaming them for being an inconvenience and taking up valuable time that could be spent on patients that will recover because they aren't so damn FAT.

Patients start getting labelled 'noncompliant' even before treatment begins.

And there are so many, they start to blur. You stop seeing faces.

It's so easy. Just lose the weight. Anyone can do it. It would be so easy.

And then it's all their fault.

I'm not going to go into the character assissination that already goes on towards people of size. You want a really good clue, go to YouTube, search up 'Fat Rant' and let the lady tell you all about it.

I'm not even going to say THAT'S what happened here.

We need to grieve for others besides Barry Baker. And know that the grief exists and not sublimate it.

And then I run into this thing:



Welcome to the world of confirming you're okay in the world. I speak of feeling your affluence.

Right around the waist.

I looked at that - step by step instructions and all, and thought about it. As a party food for more than twenty people? Pretty spiffy - I'm thinking of slicing that bad boy and serving it with slices of sourdough bread. Some beer to go with.

About 1/4" slice per.

Who thought that having the whole thing to yourself would be better? Or even more appropriate?

I mean, every ad I've seen for fast food is BIGGER, CHEAPER and YUMMMMMMMMMIER lately. (There's some $1 value menus going right now that are double burgers - 1/2 lb of beef - come on down!)

There's one that would feed both Jim and I for $4 right now. Seriously. And it's marketed as a meal for one person. Any 'reasonable' person would agree. It only has one soda, after all.

*headdesks*

There's been a lot of talk lately about obesity being a disease of poverty. As in - you're too broke to have anything pleasant to do but eat. You can't travel, you can't go outside, who in their right mind would stop watching television, playing games or reading books if they don't have a job? And food is EASY to come by - compared to housing or transportation, those other things that self-determination and employment demand.

I mean - get a 12 pk of soda, pound that and then recycle the cans? There's another burger, fries, and a soda for you - maybe even a couple of deep-fried tacos. There are a bunch of food banks. Not so much a decent place to work or sleep.

And fast food is cheeeeap. You get so many strokes for showing up, it's incredible.

Things aren't so bad. Have a coke and a smile. You DESERVE that cookie. And you really CAN eat the whole thing!

There's a lovely book on my shelf at home called What to Eat by Marion Nestle. It echoes my college nutrition class so eerily, decades after I took it - it's not funny.

Food isn't just big business here. It is - pun intended - HUGE.

It's nothing less than creepy the way our culture adores the people who eat to excess...and then hates them when the predictable outcome occurs.

And then makes money hand over fist selling them diet aids that don't do dick. Books. Relabeled crap that tastes like shit, probably isn't at all good for you - but it doesn't have any carbs/fat/sugar/name it this week!

Food is also one of those things that doesn't keep like - say - gold or artwork. So if you don't sell it quickly, you'll lose money and in a big way.

So we're told to eat fast - and have some more!

Don't forget how social eating is as well. GOOD TIMES.

Just don't gain weight. Well, gain TOO much. Ya gotta eat, after all.

*raises hand* I have a great-grandmother who died in her bed, over 700 lbs. If I am to believe what her daughter told my mother. And my grandmother was paranoid about her size. And no, she wasn't small, either.

Mom did Weight Watchers when I was a teenager. I did it a couple of years ago now and lost a total of 50 lbs from my high point. (I'm a bit up from the holidays, somewhere between 5 and 10 lbs more. I'm back on plan, and it'll come right back off - trust me.)

It's portion control. It's knowing how much is enough, and leaving the table afterward. Yes, that takes a whole system, meetings and support networks. It does.

Please lose the weight.

EAT EAT EAT YAY!

I have a sister who probably is over 250 lbs. I have a niece who could be her and I, put together. Cousins, ditto.

I lost the weight because my doctor threatened me with drugs for the rest of my life. It was never about the pretty - because let's be blunt. I'm not, and being thin won't make me pretty.

It will make me invisible to public scorn, however.

It's cheaper. And not in the grocery bill department. I don't need a lot of medical care, prescription drugs, adaptive equipment...hell, even my furniture doesn't wear out that fast.

I wish we rewarded people as well when they were of normal size. You just don't register on most of the radar.

And I wish we paid more attention to what being so obese does to the culture and systems that provide care around us - attention, not insults and disgust. Not indifference until someones dies of it.

It's not your fault. It's your responsiblity. It's your choice. You didn't know.

The only way out is through.

Please lose the weight.

And don't get fooled again.

Yay IE tabbing.

I have This little jewel in one tab....

this delicious morsel in the next one.

It is begging me to write a post. Taunting me. Daring me.

If this wasn't so painful to discuss...in (literally) a heartbeat.

The fact the conversation took some VERY tricksy turns at dinner on Saturday? Doesn't help. (Oh discuss weighty matters with folks who take X-rays for a living. You won't get much acceptance...unless you can get into the headspace and realize that it IS acceptance...and grieving...at the same time.)

I'm giving you guys the coin. Flip it.

[Poll #1331119]

I'll be back later.

Results not typical, my foot. All I did was follow the directions - and follow the directions every day since 6/11/06.

This doesn't mean I stop counting points or begin eating whole pizzas by myself, either.

But it does mean I now have enough room on plan for a real live candy bar if I make room for it - eating just like I have before.

Six weeks of staying stable, and I go to lifetime status, where I don't have to pay anymore and only have to go in monthly for weigh-ins. Oh, and I get another charm. (There's only three of them that you can get - ) My existing charm bracelet is silver - these are gold-toned aluminum. Guess I'll just have to get a bracelet to match.

I celebrated by having honey on my toast with breakfast this morning. Finally. That job's done.

EDIT - Yay YouTube for making my point for me. Or Dove. Take your pick.

Results not typical, my foot. All I did was follow the directions - and follow the directions every day since 6/11/06.

This doesn't mean I stop counting points or begin eating whole pizzas by myself, either.

But it does mean I now have enough room on plan for a real live candy bar if I make room for it - eating just like I have before.

Six weeks of staying stable, and I go to lifetime status, where I don't have to pay anymore and only have to go in monthly for weigh-ins. Oh, and I get another charm. (There's only three of them that you can get - ) My existing charm bracelet is silver - these are gold-toned aluminum. Guess I'll just have to get a bracelet to match.

I celebrated by having honey on my toast with breakfast this morning. Finally. That job's done.

EDIT - Yay YouTube for making my point for me. Or Dove. Take your pick.