(I hope this post doesn't offend too many people...please read my comments when I replied to a reader)
I have to admit. I have a hard time emotionally with severely overweight people. I'm wish I didn't, but I do. I have to really work at not being judgmental of them. I get a sinking feeling in my stomach and frustration bubbles up into my chest when I see a patient's weight is over 250 pounds. I have to really work to put on my smile and be as kind as possible. I know that they are real people, with real problems and they can be wonderful or they can be jerks. Just like every one else. I usually end up liking them after I've had a chance to visit with them.
I try really hard to provide them with the best medical care. That means we talk about their weight. I don't skip over it so that I don't offend them. I don't ignore it. I do try to understand that they would change their life if they could. They don't want to be fat. Some of them get angry with me. They don't want to be told that their health problems are linked to their weight. Some of them appreciate the honest and open communication about something they really want help with.
She weighed over 400 pounds. I met her months ago when she was sent for an emergency room follow up. She needed a pelvic exam. She said that they had broken four speculums, including metal ones, when they tried to do a pelvic on her. I knew this poor woman was absolutely horrified to find herself in a GYN office about to undergo a pelvic exam. She was embarrassed and frightened. It was only because she was fearful for her life that she was even in my office. She hadn't had a pelvic exam in over 10 years when she was 200 pounds lighter.
There are a lot of difficulties in doing exams on women who are morbidly obese (that is the correct medical term even if it isn't a nice one). They have a lot of excess fat tissue that folds in around the speculum and obscures your view. Some have so much extra tissue inside their thighs that it is difficult to even find where to put the speculum in. All the weight of their abdomen sits directly on top of the vaginal vault and the weight alone can snap a speculum. If they are very obese, they may not be able to lay flat on their backs because the weight of their chest is too heavy to allow them to breathe. Then there is the worry that our exam tables aren't built to hold a lot of weight. Probably the biggest difficulty is the women won't come in for the exams in the first place. They are just too scared or embarrassed.
I've done a lot of pelvic exams on heavy women. I've learned a few tricks along the way. I use long metal speculums with wide blades to help hold the tissue out of the way. Some people say they cut the end off a condom and slip it over the blades of the speculum to keep the tissue from folding into your view. I've never had much luck with that trick because the condom or glove just slides up the speculum instead of staying on the end. I've had women make fists with their hands and put them under their bottom to tilt their pelvis so that I could see. And for those ladies with the big bellies, I have them grab under their bellies and pull them as far up towards their chests as possible. That pulls the weight of the belly off of the speculum blades.
I spent time with this lady calming her down and letting her know that I would be as gentle as possible and that I would try not to break any more speculums on her. I told her exactly what I was going to do and what she could do to help me. She pulled on her belly, I used the greatest care and as soon as I could get that speculum open far enough to get the specimens I needed, I did them even though I couldn't see the entire cervix. I didn't break a speculum and it only took a couple minutes. She was happy to have it over with. We talked about her weight and what things she has tried so far. We talked about surgery. We talked a little bit about her life. I told her that she really needed to come back for an annual exam and a pap smear.
I never expected to see her again. She had been in tears during my exam. But she did come back. I told her she was very brave and that I admired her for coming back even though I knew it was really hard for her. We repeated the same procedure as last time and I got the Pap smear done. (Yes, it would have been better to do the pap smear last time but she was bleeding too heavily).
I really am proud of her. I really do admire her for coming back. I am flattered that she trusted me enough to come back. That's a pretty big complement. I guess that's why I love what I do. When I can get past my own prejudices, and see into the hearts of these women I take care of, I find that they are brave, loving, amazing women.