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