The Assumptions of the Nanny State

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Jennifer is home from the hospital, after nearly two weeks and surgery to remove a small portion of her right foot. All of her toes are still there, the surgeons simply cut out a nice big divot of dead flesh from the top of her foot near her toes, and some more from just below her ankle. But the long gash on her foot, caused when the Metro bus ran her over more than three weeks ago, is healing very, very nicely.

She’s a hungry, sleepy girl, downing the Percocet regularly to deal with the frequent pain from the wound vac. Ahh, yes, the wound vac, a nifty little piece of equipment that sits on our floor, purring and growling while it sucks at the crater of flesh on her foot and supposedly (according to both the company’s brochure and the surgeon who prescribed the thing) will encourage the growth of new, well, flesh in the wound to prepare it for skin grafts in the future.

Two weeks from now. Or four, depending on how well she is healing.

We are spending some quality time together (and there’s nothing better than being with someone you love!), listening to the radio (how odd, Congresscrittur Cynthia McKinney was interviewed by Amy Goodman on Democracy, Now! in the morning and Alex Jones this afternoon — now thereu2018s a combination!), talking, sleeping and watching the occasional movie. She hobbles around, and I may take her on a wheelchair ride this afternoon. I also have to go out to the supermarket and pick up some Marie Calendar microwave meals for her. It turns out the toughest thing about this recovery, as long as she’s hobbling with a walker, is going to be making and moving her own meals.

We’ll figure it out. She figured out how to bathe this morning, and we’ll make the meal thing work too.

Two weeks in a hospital, with a ward full of nurses, aides, technicians, specialists and surgeons is not the best way to spend time. It is impossible to sleep well in a hospital. Jen was admitted more than a week after her accident, during a follow-up at the Fairfax Hospital Trauma Clinic. The doctor who saw her became concerned that the wound and the giant fracture blisters on her foot were not recovering properly. And they weren’t. But the doctor, looking at our ample frames, also angrily lectured us on the evils of diabetes, noting caustically that the disease is endemic in "this country," caused by poor diets, obesity and a lack of exercise.

She never asked us about our diets, our physical activity or our lifestyles. She could have said "this is often a sign of diabetes, and I’m concerned she might have it, and we’d like to run some tests." But she didn’t. She just said: "This is what happens to wounds when you have diabetes." Somehow, getting run over by a great big city bus — while riding a bicycle! — never entered her mind.

Even when all the blood tests they did came back negative, the trauma doctors held hard to their diagnosis. Jen and I were both relieved when trauma surrendered control of the case to the orthopods, who had realized from the beginning that the getting run over by a bus, and not blood sugar and the damage it does to capillaries in extremities, was the cause of the infection and the dying flesh on her foot.

This is not to disparage diabetes or diabetics. In fact, if Jennifer did indeed have diabetes, we needed to know, because that would have complicated her recovery from the accident. So Jen and I are not angry about the question. Rather, we were very offended by the assumption — the very angry and self-righteous assumption at that — on the doctor’s part that that was the problem. Maybe it made sense, a couple of overweight folks and a nasty, infected wound and giant blisters of dying flesh on an extremity, that diabetes was the answer to the problem, because in that doctor’s experience, in nine cases out of 10, or 99 out of 100, it probably was.

I had a similar experience last summer. I have said before I am a big man. Among cyclists, based on the blogging I’ve read, I would be called an über-Clydesdale (Clydesdale being cyclist lingo for big people who ride bikes). It’s why I had to build my own bicycle from scratch and why I’m contemplating — as an adjunct business — building Clydesdale bikes for Clydesdale riders. Don’t know how much of a market there is for such things (I am, with one exception, the fattest man I’ve ever seen out on two wheels), but maybe no one has tried it before. My frame has gone nearly 3,000 miles and the wheel I built has just passed 2,000, so clearly I’m capable of building a bike that will hold up under me. Maybe that is a market just waiting to be tapped.

Anyway, I get a good 80-minute cardio workout every day, riding to and from work, getting left in the dust by the scrawny guys on their carbon-fiber racing steeds. Pushing me around is very hard work, a solid workout, and it gets a little bit easier every day. At 14 miles per hour, I’m not going to win any races any time soon, but thatu2018s okay. Cycling feels good, I feel better and I sleep much better. Some folks also say I’ve lost weight, and maybe I have, though more likely it has shifted some from my soft, fat middle to my steel-hard legs. Muscle weighs more, so I’m still an über-Clydesdale.

Over the years, I have developed a number of allergies — cats, pollen, mildew — and an odd but very unpleasant sensitivity to soy or anything made out of soy. It has taken a lot of trial and error on my part to figure it out, largely because an experience in Dubai with the locally cultured buttermilk left me in serious pain for a weekend and the sole resident of the bathroom in a flat I temporarily shared with nearly 20 engineers and computer programmers from India and Pakistan (I imagine happy, peaceful North American intestinal bacteria suddenly confronted by bearded Arabian Peninsula acidophilus bacilli waving sharp swords and tossing bombs…), leaving consumption of high-fat dairy products an iffy proposition. Some make me sick, and some don’t, and I can never tell which ones will.

But the soy thing snuck up on me. It started with non-dairy creamer, causing serious intestinal pain and getting just a little worse each time. One day, last June, Jennifer and I tried the Trader Joe’s non-dairy creamer in our coffee anyway, knowing that it would likely make my day a little unpleasant. But I wanted to know precisely if it was a problem.

I had no idea just how unpleasant things were about to get.

I rode in to work quite easily, though I had a little difficulty breathing — a difficulty Jen and I had been chalking up to allergy-related asthma. An hour after I got to work, diarrhea set in, I couldn’t keep any liquids in me. And then stuff just started going bad. I got a fiery pain in the left side of my chest — a pain that felt like it was moving. I got cold and could not stay warm. When breathing got very difficult, I got some help from some co-workers and made my way to the George Washington University emergency room.

Okay, you can probably see this coming. The docs in the ER saw the fat man with the chest pains and the trouble breathing and said to themselves — "he’s having a heart attack."

Stuff was hooked up to me. They asked me questions. I told them all about my food allergies, the fact that I had severe intestinal pain and needed something to drink. They wrote it all down but ignored it, hooked machines up to me, checked my blood gases, watched the little strip of paper record my heart beat. They scratched their heads. Something’s not right. "Blood oxygen looks good," they murmured, "lungs sounds fine and his heart, well, I’ve not seen a heart that strong on a person like that." Doctors disappeared and more doctors came. Soy cream, I told them, trying to breathe, I pretty sure I’m having some kind of reaction to soybeans. They looked at the EKG, listened to my heart, made funny faces at each other, and brought more doctors.

When it became clear even to the least of them that my valves were not failing and my coronary arteries were not clogging, they began to poke at my legs. "Does this hurt? Have you been on an airplane in the last 18 months?"

No, it doesn’t hurt, I replied, and yes, I came back from Saudi Arabia January before last. It was a very long flight.

Eyes lit up like neon signs in a Third World shopping district. "We think you are having a deep vein thrombosis," they said, sure of themselves. But what about the intestinal pain, the diarrhea, the trouble breathing? They shrugged. "We don’t know." Doctors left, more doctors came. They poked my legs some more. "Shouldn’t it hurt somewhere if he’s got a blood clot?" one asked.

By this time I had been in the ER for three hours. I had begun to calm down, but I had nothing to drink, breathing was still difficult, and I was still cold. Eventually, when all the finest minds in medicine concluded that they had no idea what was wrong with me, they all left. Later, someone brought me a tiny cup of orange juice and a blanket. An hour after that, with my intestines calm, the chest pain nearly gone, breathing restored and my body warm, I walked out of the GWU hospital and swore never to return unless I was shot by some maniac trying to impress Jody Foster.

"I don’t know if you were having a soy reaction or not," one internist told me before I left. "You didn’t have a lot of the symptoms typical of food allergies. You may only be sensitive, and not allergic, to soy."

Whatever. It’s a difference without a distinction for me. Since then, not only have I given up all soy-substitute products, but after noticing similar problems increasing in intensity every time I eat stuff made with any amount of soy, Jen and I have given up pre-processed foods altogether. It’s been six weeks now, and I feel a lot better for it. I think the chest pain and the "allergy-related" asthma was related to soy stuff. (It may also be the winter, too.) Don’t know how, but since I stopped eating anything with soy in it, I no longer have those problems.

What angered me most about this whole encounter is that as far as I recall, the doctors in the ER never really listened to me. Sure, I understand that 99 out of every 100 fat guys with chest pain are probably having some kind of heart-related problem. But I was the one who wasn’t. Experience, then, should help someone (especially a professional) ask good questions but not dictate conclusions, because eventually you will come across something that looks like one thing — a thing you know and maybe know well — but is really something else entirely. Assumptions can be good intellectual shorthand to help us deal with things — they are often right — but they can also be dangerous — because they are often wrong.

And that’s why the trauma doctor angered Jennifer and I so much. She assumed diabetes was a culprit when she had no solid evidence that was the case and when the original trauma was so significant. She did it so angrily, too, as if she were lecturing two small children on the errors of playing ball in the house while cleaning up the shards of porcelain. She did it without addressing us as individual human beings, or even (gasp!) as patients. We were constructs in her mind: helpless, out-of-control fat people who eat too much bad stuff, lie around on the couch all day and watch too much teevee. And were now suffering the all-too-inevitable consequences of our lazy and gluttonous lifestyle, asking some doctor who’d seen it all before to clean up the mess we in our moral decay had made for ourselves.

Out of those kinds of assumptions spring the nanny state. And the national security state too.

Charles H. Featherstone [send him mail] is a Washington, D.C.-based journalist specializing in energy, the Middle East, and Islam. He lives with his wife Jennifer in Alexandria, Virginia.

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