My Turn
by Dr. Mo Lerner

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The alarm on the cardiac monitor in front of me went off and the rapid irregular heart rhythm on the screen automatically changed color to a deep and ominous sanguine red. I didn't need all the new technological bells and whistles to advise me of what it meant as I rushed next door to the Intensive Care Unit. The 63-year-old woman had been unaware of the seriousness of this moment but I knew the end was near. My years of experience had taught me about the "look" of impending death. It is in the eyes, the facial expression, the aura. As she sat up right clutching the Intensivist's arm she looked at me across the room and begged for redemption. She wanted to live. She wasn't ready for mortality. She expected that we would fix the problem. "Help me!"were her last words.

I am disappointed. My life hasn't turned out like I wanted it to. With each passing day (which seems to be shorter) I am less satisfied with my existence. And just as I want a rest from it all and a chance to reflect, I must face more pain, suffering, depression and death in my work. People continue to pour into the ER with still more heartache. Each person seems desperate about his/her own situation. It may be as minor as a sore finger or a child's earache, but to each their problem seems paramount. Each looks to me for comfort, relief and the ultimate answer. I grow tired of playing wise, calm, and compassionate. There are times I am weary of being the clown for a frightened child, the priest to a confessor, the mediator in a family dispute, and the sounding board for a helpless soul addicted to drugs or alcohol. I am weary of rushing to the aid of my colleagues when a childbirth goes sour, or meticulously piecing together a face or a limb that has nearly been destroyed in a split second of violence. I even tire of bringing a soul on the edge back to life with the magic of modern medicine. My altruism becomes scarce.

But most of all I grow tired of being the bearer of bad news. I often have to make the ultimate decision when a person or family have waited far too long to face the inevitable progression of aging and mortality.

PLAYING GOD
The enduring popularity of television shows like "ER" continues to astound me. Society somehow sees these portrayals as exciting and glamorous. After all, what sensation could be more powerful than playing God several times a day? What soap opera could match the plot? What movie star or billionaire wouldn't pay a fortune to hold that sort of power? Not me. Yes, it is a noble calling. Yes, I occasionally feel satisfaction at relieving the pain and suffering--at affecting a cure. Yet, after several years I begin to see my own mortality. With every stroke or heart attack in progress, my own heart sympathetically skips beats and I imagine slipping away.

The indifference, the ingratitude and the fact that so many people take what we do for granted is not the problem. It is my aching bones and back after a long shift, my irritated presbyopic eyes after a night of delicate stitching and my burning gnawing stomach after hours of stressful encounters that get to me. Yes I am human. As with most doctors, the glamour and excitement of the job wears thin with time.

Like all of you I have regrets. I wish I had a different body, I was more intelligent, richer, more attractive. I wish I had traveled more, loved more passionately, lived in a warmer climate, owned a luxurious house, had a family of my own. I suffer from envy. I envy my sisters with their beautiful children, my brother the world traveler and corporate executive, my friend who enjoys life despite being poor, and even my dog for never having to worry about all of the aforementioned problems including her own mortality. Hopefully when my dog is about to die, she will look at me lovingly, wag her tail and pass away without the fear only we humans know. Without the look.

But most of all I wish I did not have need for wishes.

Just like the poet observed, of all the sadness I have seen, nothing is as sad as people's regrets; "What could have been." In this new year my resolution is to try to stop regretting. And although it seems impossible, I will try to seek out simple peace and contentment. There are at least 15,000 of you reading this magazine. I would be curious to know what disappoints you about your lives, what you wish for and how you strive to achieve contentment.

GUILTY
Christina Ann Corrigan's frustrations, her aspirations of becoming a Marine Biologist and any hope of finding contentment are gone. Dying at the age of twelve, she will never be able to wax philosophically as I have done. By now everyone has heard about the 700 lb. youngster who died because of her mother's "alleged negligence."

I cannot judge the mother's motives, I don't know her. She was found guilty of misdemeanor child abuse by a justice system that is supposed to be the envy of the free world. But I can venture an opinion as to what might have happened based upon what I know as fact. The child was large and had an excessive appetite. The mother consulted tens of doctors. Even when social service officials visited the home and Marlene Corrigan pled for help, the answer was familiar: "Your daughter is too fat, put her on a diet"... "this isn't our problem."

Diets didn't work. Classmates and cohorts were cruel. "Nina" understandably stopped going to school. Her life likely consisted of waking up in the morning hating herself. Her esteem plummeted. Her Barbie Dolls and pleasant reminiscences of swimming free in the ocean could no longer sustain her. She watched TV. Her loneliness and desperation likely escalated as she gained weight in a fat phobic world. The messages on the tube made her feel ever worse and isolated. Food was no longer just a comfort. She was a supersize child who ate excessively (for whatever reason) and her body demanded continuous feeding. It was a necessity of survival emotionally and physically powered by forces evolved over millions of years that are as strong as the urge to breathe. My thin colleagues who are so called scientists and experts in Bariatrics could never begin to comprehend the potency of this drive. They earn their livings trying to change human beings into being what they cannot be.

If Christina suffered from Prader-Willi Syndrome, or so called Night Eating Disorder there were no other options.

PRADER-WILLI SYNDROME
I actually see a patient in my practice with this disorder. The literature is scanty on the subject but it basically involves a genetic defect. By accident at conception, most victims are missing a piece of the genetic material contributed by the father. Others lack a whole chromosome (#15) supplied by the father and end up with two copies of the mother's chromosome. For reasons not yet known this leads to problems in development of the Hypothalamus which is a section of the brain partly responsible for regulation of appetite, emotions, intelligence, and other characteristics. Boys and girls of all ethnic and racial backgrounds can be affected.

The child is often moderately mentally challenged. Short stature, poor sexual development, floppy muscle tone, and an absolute insatiable need for food are common. Interestingly, early on excessive eating is not a problem. Because of weak muscle tone infants have trouble suckling and may have to be fed by a stomach tube. If children survive past the toddler stage they then begin an irrepressible pursuit of food. The part of the brain that normally signals satiety just doesn't work. Because physical activity is limited due to poor muscle tone and caloric intake is large, obesity is inevitable.

There are certain facial features often associated with the syndrome. The forehead is narrow, the eyes assume a sort of almond shape in their sockets and the mouth often curls down in a sort of frown (unless one is actively smiling). The genitals are frequently underdeveloped and puberty is delayed. Children maybe shorter than normal and their spines are sometimes bent. They have thick saliva, and speech may sound "odd."

JIGSAW GENIUS
Although mentally challenged, the degree of deficit is variable and children might be mislabeled as having an assortment of isolated learning disabilities such as Attention Deficit Disorder. In contrast, some researchers have noticed unusual talents such as a high degree of skill with jigsaw puzzles.

Behavior patterns vary with the level of mental retardation. Obsessive/compulsive behavior, temper tantrums, stealing, lying, and stubbornness have all been noted.

Eating becomes such a strong need that most affected children will break into locked cupboards or refrigerators, steal, hoard, and even gobble what we might consider inedible or unpalatable food.

PRESSURE SORES
Much was made in the case of Christina Corrigan of her having many pressure sores on her back. How could she have hidden the discomfort from her mother and why? Prader-Willi syndrome victims often have a decreased sensitivity to certain kinds of pain. They have a multitude of skin problems, partly because of the fat, fluid, and pressure which compromises tissue and also because they tend to pick at skin lesions.

Regardless of whether or not Christina had Prader-Willi syndrome, one must consider that many large people do not feel pressure sores, or more accurately, become accustomed to the sensation especially when they can't reach the affected areas to afford proper hygiene. Those of you who are super-sized and/or have a short arm reach can certainly empathize.

Intertrigo is a common condition of large people where fungus and bacteria cause irritation between fat folds. If ignored for as little as a day the pain often disappears but bacteria invade the compromised tissue which can develop serious friction sores. The young girl may have been too embarrassed to complain and may have avoided any exposure of her body to disapproving eyes, even her mother's.

Massive obesity and continuous eating, along with the inactivity common in this syndrome often lead to Diabetes, high blood pressure, hardening of the arteries, and failure of the heart as a pump. Christina Corrigan died of heart failure. Most Prader-Willi victims die prematurely.

WITH THIS TREATMENT WHO WANTS A CURE?
For those with short stature problems injections with Growth Hormone might help a child grow in height. Aside from this intervention the other treatment options, like limiting children to 1000 calories a day, are unrealistic. There is no cure for Prader- Willi Syndrome.

In theory if victims are kept locked up in an institution or restricted group home and forced to exist on a low calorie diet with an increased exercise regimen, a reasonable life expectancy might be possible. Exercise to control weight is a double-edged sword because poor muscle tone may produce fractures and other injuries which can cause serious morbidity. Would such an agonizing and regimented existence be any life at all?

Since the defect may occur by chance, counseling parents never to have children again because of a one percent possibility of recurrence is also unfair.

RARE?
The prosecution in the Corrigan case defended the health care and social service's lack of testing or consideration of this diagnosis because the condition was "so rare." Actually if they had done their homework they would have discovered that 1 in 10,000 people in the United States alone have the syndrome and there are likely many more conceived who don't survive to childbirth. It is one of the ten most common situations seen by genetic specialists and is the most common genetic condition known to be linked with obesity.

NIGHT EATING SYNDROME
My medical colleagues have recently spent valuable research funds to make what they consider an amazing discovery. "Late night bingeing is now known to be an excessive and compulsive component of Night Eating Disorder" according to doctors at the University of Florida. I am overwhelmed. If they had spoken to me or millions of other large people we may have saved them time and money.

At least one half of daily calories are consumed after usual dinner hours in Night Eating Disorder. Most large people know by experience that their blood sugar, Insulin, and other bodily hormones conspire in a diurnal rhythm to produce intense hunger late in the day. This is probably why most cultures on Earth have their biggest meal late in the day. Congratulations to the rocket scientists who made this discovery for which no official cause or treatment has yet been delineated. Rest assured the diet industry will pursue research of this new revelation in the hope it will pay off with a magic treatment that can be marketed.

FAT PEOPLE ARE ROYALTY
I suppose I should apologize to my scientific colleagues in Gainsville. Perhaps they mean well. I guess it is the frustration, anger, and disillusionment I mentioned earlier bubbling to the surface. Citing a new syndrome or Eating Disorder hasn't stopped the prejudice and pain I have experienced and it didn't save young Christina.

I can't say if Christina Corrigan suffered from Prader-Willi, Night Eating Disorder, or any one of the countless other conditions of obesity that are labeled and spewed forth in the annals of medical and psychiatric literature. What I do know is that fatness has evolved over millions of years, it is a powerful and unrelenting condition, and I foresee no magic situation that will alter its natural course. In fact, large people are at the top of the evolutionary chain in terms of survivability in a world that, but for man's ingenious invention of western diets and lifestyles, might have been short of food energy. In a more natural environment fat people would be universally admired or anointed kings and queens as they were in many Polynesian cultures.

We will never know if Christina had a genetic or metabolic defect because no tissue testing was done during her life and no autopsy was ever performed by the coroner.

I suppose Ms. Corrigan could have tortured the child by locking her in a closet allowing her to starve in agony. Of course, her daughter would have simply regained the weight instantly the moment she was allowed out of the closet (had she survived the ordeal). Instead, Marlene Corrigan probably realized that all she could offer her daughter was comfort and love. Comfort came in the form of lying nude beneath a sheet to keep her heavily insulated body cool. Comfort meant eating the fast food whose empty containers where found about Christina's side. Comfort meant not allowing others including her mother to view the body (excrement, sores, and all) that she was ashamed of. Her shame was understandable. For it was the appearance of her naked body that shocked the judge (and many critics across the nation) into finding the girl's mother liable for cruelty.

What did society and the courts think Ms. Corrigan, a lay person, should have done if the countless doctors, teachers, and social workers had nothing to offer? I think it is time that all parents of teenage smokers, drunk drivers, drug abusers, and violent gang members go to jail. Not only are these children harming themselves, they are a danger to society. How did Christina's obesity harm others?

I think it is time to throw the proverbial book at parents who allow their children to die of Anorexia and Bulimia. Surely the abusive parents of these children suffering from horrific eating disorders producing shocking skeleton-like figures could have done something! It is curious how the media always talk about the "poor victims of Anorexia," and the "sad casualties of Bulimia." We weep for their unfortunate parents. When was the last time you heard of sympathy for the parents of the "sad victims of fat?"

As is the fashion now in blaming the tobacco industry for the consequences of smoking, we should lock up the fast food moguls for pushing their products (the "smoking gun" evidence was apparently lying crumpled all around Christina Corrigan) as well as their counterparts in the diet industry that offer quick fixes after the fact.

Fat slob, fat pig, big fat liar... when will society finally rid itself of this last socially acceptable prejudice?

Criticize yourselves before criticizing others. Pick on someone your own size judge!

ALL YOU NEED
My colleagues have a standard cop-out line whenever they come across something they don't understand. Instead of admitting that they simply don't know what they are talking about they go ahead and label something or someone with a syndrome and quality their scientific dissertations with the caveat "fluffier research is required."

I don't know why I ruminate so much these days over what might have been heifer in my life. I don't profess to know what happened to Christina Corrigan. Further research is required. I am sad that she never lived long enough to discover that there are thousands of good people who actually admire girls and women of substance. The lyrics of a recent hit pop tune seem to be apropos; 't...where is the tow?, Its not enough". ß



Heretic Physician