Eating To Death

He came into the clinic panting and complaining of shortness of breath. Diagnosing the cause was easy. He was so morbidly obese that his lungs didn't have room to expand properly. Encircled by fat, his lungs could only expand enough to accommodate shallow breaths. He was no longer able to compensate by breathing faster.


He couldn't lose weight. He had tried countless times before and wasn't willing to try again. The doctor offered to give him a referral for bariatric surgery, but he wasn't interested. The doctor also recommended having a tracheotomy, so that should he suddenly go into respiratory failure, they would be able to quickly get oxygen into his lungs. A successful intubation on him seemed unlikely. He refused. He was sent home with oxygen and told to lose weight or he was going to die.


A little over a year later, he arrived in the emergency room in respiratory distress. He had gained another 150 pounds. They were unable to get a tube down his throat. By the time the doctors were able to cut his throat and establish an airway, he had been without oxygen too long and was in shock. The blood supply to his kidneys was shut off in his body's desperate attempt to maintain blood flowing to his heart, lungs and brain. He wasn't expected to survive the night, but he did.


It's been several months and the patient lives here now. His kidneys are dead, so he gets dialysis. We can't send him home to live with his mother where he lived before because he is too big to transport to dialysis. No institution will take him unless he loses 150 pounds.


The solution to our problem is obvious. He needs to lose weight. The problem is that he doesn't want to lose weight. He enjoys eating and it hasn't hurt his social life. Despite living on disability with his mom caring for him, he has two girlfriends who fight over him. Yes, if they happen to show up at the hospital at the same time, they argue over him.

He's not a pleasant person. He's one of those people we have to take turns moving around the hospital because it's not fair for one unit to have to put up with him forever. He can be verbally abusive if he gets a nurse he doesn't like. Even if he gets a nurse he likes, he is a burden because he won't stop using the call light for every little thing. The nurses fight over whose turn it is to take him. He's the cause of a lot of fights.

He finally agreed to go on a liquid fast diet. There was some delay in starting the diet because of a fight over which department was going to pay for the diet shakes. It was finally resolved and the shipment arrived and was locked in a cabinet because it is so expensive. The patient took one sip and said, "I'm not eating this shit."

For his next meal, I started to bring the shake into his room and he yelled, "If you bring that in here, I'm going to throw it against the wall". Not wanting to clean up the mess, I started to turn around. He demanded to speak to his doctor immediately about this diet. It was after hours, so he had to wait until the next day to negotiate changes.

The next day, his doctor agreed to let him have two small meals a day plus the shakes and they found him a flavor that he didn't mind as much. It looked like we had a deal. Yeah, there was a lot of begging for food and complains about being hungry, but nothing we couldn't deal with.

The next day, several empty Styrofoam containers were found under his bed. Someone, we assume one of his girlfriends, sneaked him in some food. We have been told to watch for visitors and take away food if we see any. Legally, I'm not sure we can do that. He is alert and oriented and entitled to make his own decisions, no matter how stupid. That would be an interesting legal issue to research, but I don't care enough to bother.

It looks like he is going to live with us the rest of his life. I'm guessing that it is going to be a short one.

He reminds me of some of our drug-seeking patients, except that his drug is food.