O Dear

This is an open letter to my doctor and her practice, where I was this morning.

Dear Lady Bits Medical Practice,

I really, really hate my annual (and now my bi-annual) visits to you.

It starts with the fact that to you, the "first thing in the morning" is nearly 9AM.  Must be nice.  And sure, I know your docs are out delivering babies at all hours, but they're getting paid for that.  Anyway.

It is perfectly clear that I am, as a not-pregnant, never-pregnant patient, not your primary concern.  I was told once that you do have a doctor who does gynecology only.  I was also told by the girl at the desk that I can't just "switch doctors" without going through the office manager for "permission".  Whatever.  As the customer, I think it's my right to see the doctor who best meets my needs, but you do you, front desk girl.

And here's the deal- even if I'm as you say, "like, the first appointment of the day" (again, 9AM) I will always, always ask if the doctor is running on time.  Because she may be on rounds, or in surgery, or with her hands full of placenta.  It's a fair question, and I am going to always ask it.  Be honest with me.  I'm not going to get mad if you manage my expectations right away.  I will absolutely lose my shit if you lie to me and I end up sitting for a long time with no information as to why.

Now, to the nurse.  You and I have been working together for years.  And every time I come in, you take my blood pressure - and you CAN'T HEAR IT.  So you re-pump the arm you just used.  Nothing.  Then you try the other arm.  Nothing.  By the time you get out the electronic cuff, my BP is SKY HIGH.  If that happened once, it would be funny.  It's no longer funny.  Put a note in my chart.  Get another nurse to squeeze my arms please!!

Under Pressure

And then the scale.  Never fun.  But I do it.  And that, my friends, is where the impetus for today's letter originates.

After weighing me, the nurse takes me in to the end of the hall - a smallish room.  She asks a bunch of questions, and I tell her, like I wrote on my intake form, I was taken to the ER with vertigo.  No reaction.  She goes to the cabinet to pull a gown and drape.  She pulls the fat girl gown off the top shelf.  There's one of those.  One.  The rest of them are on the lower shelf.  The fabric pattern is different.  It's also huge.  I mean, massive,  I wrap it around me one and a half times.  There is no skin showing.  In a pinch, I could wear this in public and be fully covered.  It occurs to me that I could probably squeeze into one of the smaller ones.  But whatever.

The doctor comes in after a few minutes and pulls a jokey frowny face while she utters dismay that I have gained some of my weight back.  I explain to her that when you stop eating only 1600 calories a day, it happens.  I explain that I am back on track, and that this is going to be the rest of my life.  She mentions that if I exercise, and eat grilled chicken and salads, I can lose weight.  All I really have to do is expend more calories than I consume.

And for the first time in my life, I finally understand why I am fat.  Because I haven't been burning enough calories.  And if I had only known that eating grilled chicken and salads and exercise would do it, I could have been thin years ago!  THANK YOU for laying that information out for me.  What a fool I've been!

J/K, doc - I actually knew all that.  Here's the thing - I'm fat.  Not stupid.  I've done a bunch of different diets (and even blogged about them, here).  I have had moderate success at some of them, not much with others.  So, although it may look as though I have no idea how one might be thin, I do understand the general physics of it.

My body is un-toned and flabby - but my brain, doc - well, it's ripped.  Swole.  Cut.  My brain has a six pack, and is the Sports Illustrated Swimsuit model of brains.  OK, I didn't go to medical school.  But I'm bright enough to understand that steamed vegetables with no butter are better than bacon cheese fries.  I get it.

And I appreciate that you went on to tell me that you don't think diets work.  That it has to be a change in lifestyle.  That you can still eat the bad foods from time to time.  You called them cheats.   Which, if we're being honest, is counter to all my mindful eating classes from last year.  Food is neither good nor bad.  It just exists.  And it's counterproductive to exercise more to burn off "cheat" food.

Then, to further your point, you tell me the only time you really lose weight is when you're training for marathons.  Wow, that's amazing.  You're telling me that running 26 miles on a consistent basis burns lots of calories?  I am so glad to know that.  My goodness, who'd have thought?  Believe or not, I know a lot of runners, so I'm familiar with the rigors training for distance runs.

But here's the thing.  I am not a runner.  I don't want to be a runner.  It's terrible for your knees and ankles, and it makes your skin leathery, and you end up (with a few exceptions) being a crashing bore who talks about your runs in a holier than thou kind of way.

Also, I don't have a whole bunch of spare time.  My workday starts an hour earlier than yours.  I'm also willing to bet that you have a nanny and a housekeeper.  Maybe one of them even cooks for you.  Or, you make enough money that Mr. Doctor is a stay at home Daddy.  I don't know your arrangement, but I bet your home has more than one closet, so putting away clothes isn't an intricate game of Tetris.

Also, I'm going to go out on a limb here and make a guess.  I bet you've never been truly *fat*.  I mean 30 pounds or more over what's acceptable.   I bet you have some DNA that makes grilled chicken salads taste good.

My father was a big man.  He fought that his entire life, until the very end.  I should pull up my picture of Bessie to show you.  I should pull pictures of my heavy aunt and cousins.  My bulk was not formed in a bubble.   If you look at my build, compared to that of Mom or my sister - well, you can see I don't have the same luck.   Now, OK - my sister runs and watches every bite of food that enters her mouth.  And she doesn't seem to care about sugar like I do.  She doesn't like doughnuts.  How do you not like doughnuts?

So, I appreciate that you have probably dropped five pounds, maybe ten after the kids were done being born.  But you have the build of a skinny person, and the attitude of a skinny person - believing that fat people could just not be fat if we put our minds to it.

I told you that I am so much more than my weight.  That of course it's top of mind to me, and ironically, I spend more time obsessing about food when I'm watching what I eat.  I don't think you heard me, though.  So I'll say it again.


I am a daughter, a wife, a sister, a dog-owner.  I am a Predators fan, and I love stand-up comedy.  I sing in the shower and car.  I whistle a lot.  And well.  I'm a Scorpio.  High I on the DiSC analysis.  ENFP on the Myers-Briggs inventory.  I have a high IQ - I tested at 136 when I was 10.  That's pretty solid.  I went to college, I joined a sorority.  I kick ass at puzzles, Scrabble, and making salad dressing.  I remember birthdays.  I send great greeting cards.  I always send Christmas cards.  I speed sometimes, but haven't had a ticket in about five years.

I'm Hilton Gold this year. I have a library card, and a badge that allows me to take the elevator to the 4th floor of our office.  I have a terrific job, where I am loved, appreciated and encouraged.  I create the monthly bulletin board.  My managers appreciate me.  My colleagues are enthusiastic about my contributions.  Customers like me.  Several people have said they want me to come back to my old company. 

I love bright colors.  I have cute clothes, nice jewelry and almost never wear makeup.  I give blood.  A lot of blood.  I buy cookies from Girl Scouts, and donate to Heifer International,  Alzheimer's Association, American Cancer Society.   I buy copies of the Contributor and always put something in the Salvation Army Kettle.  I put food in our local little pantry a lot.  I love to cook, I love to feed people.  My pepper jelly has won State Fair ribbons.

Notice that in three paragraphs, nothing came up about my size.  Of course, it's the first thing I think of.  It may be the first thing you notice.  I don't know.

But don't think I've just overlooked it, or I didn't know how to deal with it.  And frankly, you don't know a damn thing about what I've done, or tried, or how I feel about it.  So, don't just solve my problem with a couple of obvious suggestions - they won't fall on deaf ears, but you can bank on it that I'll try to blot out the bitter taste you leave in my mouth with snack cakes, and candy and Pepperidge Farm Goldfish.

Again, I'm sorry that I disappointed you, a woman I see for about an hour a year, tops.  I'm sure you know I spend my year getting ready to wow you.  If you were bummed at having to see my giant carcass for a few short minutes today, you can only imagine how I feel on a daily basis.

Now, moving on.  I appreciate, doc, that you are using the power of positive speech to will my Pap Smear to be normal.  But I have had, what, four or five abnormal reads in the past 2 years?  So, as much as I'd like to think my cells are all perfect and normal, there's a chance they won't be.  And even if they are, you still get to see me in August.  Maybe by then, my body will be such that you don't have to feel sad about my chart.

Next. In focusing on my body image you missed two things - they may or may not be important.  They may or may not be related...but:

I mentioned that I went to the ER with vertigo.  That's pretty serious.  At least, I think it is. Maybe you think that feeling dizzy and vomiting yourself dehydrated is OK.  But I'd have asked a few questions - you're a D.O., meaning that you tend to have a more holistic approach.  But fine, the vertigo is a non-issue.  Great.

The second one is something both you and the nurse missed.  My right arm is mangled.  I have a lot of abrasions and bruising.  So, obviously, the blood pressure cuffs, that's right, plural, because the nurse can't hear my blood moving through my veins, they hurt.  It does not feel good to have an already painful arm compressed down.  Multiple times.    And OK - I had sleeves on -  though, they didn't conceal the scars.  So maybe the nurse just didn't catch it.  But while I was naked and splayed out on your table?  You should have noticed that.  And you should have used your keen mind to ask, "Hey, Allison - do you think your vertigo affects your balance and makes you prone to falling?"  And I would have said, "Actually?  Yes.  I feel like that's a problem.  Anything I can do?"

You probably would have given me a scrip for grilled chicken and some spring mix.  But honestly - if you're looking me over, you would see the injury and at least say, "That's upsetting, are you OK?  Is there anything you need?" 

No.  I get the pep rally in re: my test results, with a reminder that I still need to come back in six months, and I'm going to need a new Mirena this year, and that I need to sign a card to release my info to insurance to see if they cover it.  So, it's going to be a pricey year.  I get to pay for the pleasure of not having my blood pressure heard.  And the scrutiny of a naturally thin marathon doc who wonders why her excellent advice didn't automatically slim me down.

If I were not in the middle of having my weird cells monitored, I would tell you where you can stick that Mirena.  And I'd find a different doctor who is GYN only, in a practice that doesn't feel like a patient factory, and with a nurse who can get my blood pressure on the first try.  And maybe less preaching from the Book of Obvious.

But here we are.  I will await the news of today's test, and either way -  I'll see you in August.  Unless my cervix falls out before then. Quick question... how much does a cervix weigh?  Would that help my adiposity?

Hope you enjoy your Spring, and that you don't get shin splints, or chafing and that you don't have to go frowny on too many people.   Thanks for the superlarge gown, the invaluable words of wisdom, and an order for my mammogram.  See you soon!

Best regards,