Two years ago, I landed myself in the ER at around 2 AM. I’d been puking my guts up multiple times per day, every day, for months—binges, meals, mere snacks all found themselves subject to the perverse First Law of Bulimia: what goes down must come up. The night of my ER trip, as I paid homage to the porcelain goddess yet again, I found that along with my stomach contents, the toilet was filled with blood.
The doc in the ER was compassionate and thorough, if somewhat clueless about eating disorders. Aside from being somewhat anemic and dehydrated, all my tests were clear, and as I coincidentally already had an appointment with a new internist in the morning the doc apprised my internist’s office of my situation and released me.
Three hours later (approximately one of which was spent sleeping) I made my way into my new doc’s office. I explained that recently I had lost about a bunch of weight starving and puking nonstop and that now I was restricting much less but still bingeing and throwing up constantly; I told her that I’d had an active eating disorder for about four-five years and I filled in the details of the previous night’s ER episode. She asked about my highest and lowest weights—despite several times losing dramatic amounts of weight quickly and unhealthily, I’ve never been “thin,” and when I told her my highest weight, she said it was “great” that I’d lost the weight, even though I told her I’d only lost it restricting and purging.
Then she put me on the scale. I told her I didn’t want to know my weight, and that she at least respected, but then I got off and she said to me, “well, you’re overweight, but I’m sure you knew that. What are you, like five-two?” (I’m five-four, but telling her that didn’t seem to give her pause at all though it would most definitely change the point at which “overweight” came into play. I’d also now been sitting in her office waiting for about three hours, mainlining water—as per the ER doc’s stern instructions—to the point where I thought my bladder would explode and she decides to weigh me fully clothed including my SHOES and then acts like the number she has is real.)
She goes on to tell me that what she wants to do is put me on a modified Weight Watchers plan and have me come back in a month and weigh me again. (I am 5’4” and 145 pounds—which is 30 pounds less than I weighed six months ago, though I lost the bulk of it in six weeks—and I am so sick with an eating disorder I am barfing up blood and she’s talking about a DIET?!)
I tell her that I’m really not interested as I’m already working with a nutritionist. She then asks me, in a hostile tone, what exactly I want from her; I’m at a loss for words since I figure it’s pretty self-evident that, um, she’s a doctor and I want her to…monitor my health?
She takes my stupefaction as a sign that perhaps I’m looking for an amateur psychologist, as she then asks why I have an eating disorder—“were you raped or abused or something, or is this just kind of a going-off-to-college/growing up thing?”
She did not do a physical exam other than weight and blood pressure; she did not discuss the ER incident. She did not bring up the possibility that, given that I was puking blood, more tests might be necessary, nor did she discuss that though I seemed fine I was fairly anemic and had just barely avoided spending the previous night hooked to IVs. I’m not sure what level of insensitivity or stupidity you have to reach to actually think that the most important thing you can tell a 21 year old with an eating disorder is that she should lose weight. Clearly those few extra pounds I was carrying were FAR more threatening to my health than whatever other damage I was inflicting on my body.
The medical community needs a serious wake-up call: not only can there be health at a range of sizes, there can also be illness at a range of sizes. WEIGHT IS JUST A NUMBER!!!