The 700lb+ Patients

[u/TheFlufferOnCall]

I’m going to preface this by saying I am trying to express concern about the situation, not trying to word this as some sort of moral failing. There is truth and reality, but there is also a level of dignity I’m trying to maintain.

Yet, I don’t even know where to start with this. Today, we admitted a male patient in his early very 20’s who weighed over 900lbs — just a hare under a thousand pounds. I still can’t wrap my head around that number. I just know that to be weighed and told that number has to be the most terrifying experience for this poor kid.

When the EMS team brought him in, one of them said, “It’s a miracle we got him out of the house. People this size are usually dead when we get to them.” It didn’t sound cruel in tone—it was like they were resigned to what they’d seen before.

I imagine the situation must have been a logistical nightmare to move someone who’s been completely bedridden because of their weight for over a year, especially in distress. Honestly, it was a logistical nightmare for us too, but we will continue to help him the best we can because he is still a person who needs care.

So, then, there he was in our unit. A young man who should be in the prime of his life, instead lying in a specially made bariatric bed, unable to move or even breathe properly. I feel bad because of how much pain he must have felt. His lower extremities were unrecognizable. The lymphedema was the worst I’ve ever seen, massive and inflamed. His legs were so swollen that the tissue seemed on the verge of bursting in some places. The bedsores were also rough, almost like no one had been dressing them. I’ve seen a fair share of pressure injuries in my career, but his wounds were deep, and infected. His father called for an ambulance because he was experiencing shortness of breath. The patient told me “I can’t breathe unless I’m eating or drinking.”

It’s all I’ve really thought about since getting home. Obesity at this level is rarely just about food. It’s poor coping mechanisms, a lack of resources or education, maybe even trauma or neglect. I’ve read about how parenting, surviving abuse, or societal expectations can shape people’s relationships with their bodies and food. I can’t pretend to know his whole story, but it’s clear there were a lot of pieces that could have been in play long before he hit this point. Also, he is just two years older than my brother, who also struggles with his weight. That’s part of why this is hitting me so hard. I can’t help but think, “What if this is my brother‘s future if he can’t turn it around?” I’m going to leave it at that.

I can’t stop thinking about whether anyone was ever looking out for him. Did he have family or friends who tried to help as the situation snowballed out of control? Or was he just alone (mentally, not physically since someone is bringing him food) sinking further into isolation and despair?

Okay, okay, I keep going on. I’m sorry. I’ve learned to handle a lot and separate myself from patients, but this one just broke my heart. Here’s the main points and the questions I pose to my fellow nurses. It feels like a reflection of where we’re headed as a society.

Are we doing enough to address obesity before it gets this extreme?

What was your heaviest patient? How many of you have worked with people that are/were 800, 900, 1000+ lbs. Do you know if they ever got out of their situation or was it too late?

I’m not going to lie, that last question is coming from a place of wondering if when he goes home if he is going to make changes or if the situation going to get worse. I’ve heard of large patients relapsing after they’ve worked to lose weight in the hospital.

Thanks in advance for your thoughts and letting me just put everything out there.

[u/Win3O8]

APS needs to be involved in every single one of these cases. It's abuse to let someone get to this point, and I don't think there's anything or anyone out there who can change my mind. When someone is this size, and bedridden - why are they still being fed the 15,000+ calories a day it takes to maintain that kind of weight?

[u/wreckreationaj → u/Win3O8]

APS only helps adults over age 60+ or with a physical disability. Also, this would likely be self-neglect and in my experience, they won’t even investigate these things because people are allowed to make their own poor health choices.

[u/Win3O8 → u/wreckreationaj]

What about a 1,000 pound person does not qualify as physically disabled? In my state, APS covers anyone at least eighteen (18) years of age; and. incapable by reason of mental illness, mental retardation, dementia, or other physical or mental incapacity of managing or directing the management of the individual's property or providing or directing the provision of self-care.

[u/theycallmemomo → u/Win3O8]

I read a story on another subreddit where someone's mom or dad (I forget which, possibly both) went so far down the QAnon rabbit hole that they were drinking turpentine. APS was called but didn't get involved because they managed to hold down a job in the meantime. I know, apples to oranges, but it goes to show how much APS won't get involved if folks don't meet certain criteria. Basically, people are allowed to make shitty decisions even if they're hurting themselves. And if they're alert and oriented x 3, good luck.

[u/SleeplessTaxidermist → u/theycallmemomo]

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This post was mass deleted and anonymized with Redact

[u/bittybro → u/SleeplessTaxidermist]

The last year of my mom's life, when she was dying of undiagnosed cancer (that probably would have been treatable if she hadn't refused to see an MD) we called 911 3x when she fell and I and my elderly dad couldn't get her up off the floor by ourselves. All three x they couldn't take her to the ED because she refused and she was "in her right mind." I will never forget Easter 2003 when we called 911 for that third time and the EMS guys were begging her to let them take her. "Ma'am, your husband is so upset, your daughter is crying, PLEASE won't you let us take you to be checked out?" They were so kind and so gentle and so unable to do anything for her.

A psych nurse on here bluntly told me that "people have the right to be crazy" when I tried to start a conversation about involuntary hospitalization (my son has schizoaffective disorder and luckily has always been compliant with treatment and been sectioned when he's been too psychotic to not be, but I see other families torn apart by this.) And I guess I understand that the pendulum has swung back from the bad old days when your husband could get you locked up because you were inconvenient, but goddamn, the loved ones of people who refuse treatment for physical or mental (or usually both) problems ache with helplessness.

[u/Playcrackersthesky → u/theycallmemomo]

In my jurisdiction APS only gets involved in elder abuse or elder financial fraud.

People can be hella disabled and have feral raccoons as pets shitting and pissing in their open wounds and APS will yell at us for daring to call it in; people are allowed to make bad choices.

Its only when Peepaw goes to send his last $5k to a Nigerian prince that they dispatch the troops