Friday, September 11, 2015

Fat Like Me

I wasn't going to do it.  I wasn't going to contribute to the noise surrounding Nicole Arbour and her idiotic fat shaming video.  I know that doing so just adds fuel to the fire and I don't believe someone like her should be rewarded for doing something like that by giving her the attention she so desperately wants. I did not watch the video.  I will not watch the video.  (Notice I did not link to it, either - if you want to watch it you'll have to find it yourself).  As a morbidly obese woman myself, why would I want to intentionally subject myself to her shaming. 

This blog may contribute to the noise, but I don't really want to talk about shaming (been there, done that) or "fat pride" or even, really, body image issues.  I want to talk about cancer.  Or, what I really want to talk about is how my fat relates to my cancers, and why I'm taking action.

I have had two cancers in my life so far, which is a lot  since I'm only 40.  My first cancer was endometrial cancer - it was caught very early, I had a hysterectomy, I was cancer free.  Two years later, as I was about to celebrate my two-year anniversary as cancer free, they found a cancerous mass in my kidney - renal cell carcinoma.  This was also caught early, I had a partial nephrectomy and was once again, cancer free.  Because of this second cancer, I knew I needed to lose weight.  As I said before, I am morbidly obese.  Both of these cancers are ER+, meaning that they are caused by an excess of estrogen.  And here's something I found shocking - estrogen is the main ingredient, so to speak, of fat cells (adipose tissue).  So my cancers were due, at least in part, to my obesity.  I felt like Samantha on Sex and the City when her oncologist tells her that her "lifestyle" contributed to her cancer.  Samantha is furious - feeling like she is being called a slut.  And the episode is particularly compelling because it's true - people who give birth are less likely to get breast cancer, and how is that fair?  I suppose being morbidly obese can be a gender-neutral issue, despite the truth of Susan Orbach's title Fat is a Feminist Issue. At least obese men's chances of cancer are the same as obese women's (at least in a fair world, that would be true, and I don't know that it's not).  But that doesn't make the disease being blamed on my lifestyle feel any fairer.  At any rate, I lost about 70 lbs. I felt great.  I moved to Colorado where it would be really easy to be healthy.  I gained it all back.

Two years later (this year), after going through genetic testing to try to identify why I had two cancers before I was 40, the geneticists were shocked to find that I had no genetic markers for either of the cancers that I have had, but I have the BRCA 2 gene mutation - the one that causes breast and ovarian cancer.  My mutation gives me a 85-90% chance of developing breast cancer (I don't have ovaries anymore, so I'm safe there). 

On a side note, this whole thing is rather ironic because before I ever had any cancer I had begun researching and writing a paper about female cancers and how doctors treat women with these diseases.  I had sent it out to a peer reviewed journal right before my first diagnosis and I haven't been able to make myself work on it since because it feels a little cursed, but I keep planning on it.

So I make one of the most difficult decisions of my life and decide to have a mastectomy in order to lower my chances of breast cancer by quite a bit.  My mother drove out to Denver from St. Louis to go to the breast surgeon with me. I was completely nervous for a good 48 hours before my appointment.  "It's all good," my mother assured me, "once we have a date we will have a plan and we can get it taken care of.  It will be a lot less stressful once we know."

I'm not saying that I'm psychic, but... I just knew things weren't going to go well.

The second the doctor stepped into the room, she sized me up and had a look of disgust on her face.  She asked me what was going on and I explained why I wanted the mastectomy.  "Well," she says, "I can do that.  I can give you a mastectomy, but that's not going to prolong your life." 

Stunned, I didn't know what to say.  She proceeded.  "We have to decide right now whether you want to avoid getting cancer or live longer."

"Both," I said, credulously. 

Then she stared in on her "fat shaming" lecture.  She told me that I would die soon if I didn't have a gastric bypass.  She told me that there was no point having a mastectomy because my obesity would kill me before the cancer did.  (Mind you, I'm morbidly obese, but I'm no bed-ridden person whose unable to function in life).  As I cried and cried and cried, she continued, completely unaffected, to tell me that the cancers I've had so far were all my fault and that if I get breast cancer it will be all my fault, too.  Yes, she absolutely used the word "fault."  No amount of my assuring her that I had every intention of losing the weight, and that I was not going to have surgery to do it, but I wanted to get rid of this cancer threat now could persuade her.  Even my mother interjected. "You know that she's had cancer twice.  I don't know what it's like to have cancer twice. Do you?"

The doctor just looked at my mother with annoyance and told me that surgery was too risky at my size (I've mentioned that I've had two major surgeries at this weight, right?  I've actually had three - I had an appendectomy 3 years before I got cancer.)  My mother jumped to my defense again.  "It's too dangerous for her to have a mastectomy but you want her to have a much more invasive surgery?" she pointed out wisely.  The doctor was taken aback at the introduction of logic into the conversation.

"Fine," she said, "I'll do the surgery but she needs to get approved by pre-procedural services first.  And the plastic surgeon won't do the reconstruction on her at this size, so she'll have to walk around without breasts until she loses the weight."  Then she hugged me.  YICK!!!!

Shocked, my mother and I left the hospital.  I didn't know what to do, but I knew I did not want that woman ever touching me again.

You see, Nicole Arbour, my doctor shamed me and it had the exact opposite effect of her intentions.  Let's entertain the possibility that you really were worried about people's health (it's a stretch, I know) but if that were the case, you just sent any fat person who ever gave a damn about your opinion running for the ice cream.  That's what I did that day.

Pre-procedural services said I was perfectly healthy for surgery and the woman there was an angel.  I told her the whole story about my surgeon and she empathized completely, and then in a completely non-judgmental and supportive way, asked me why I didn't want to have weight loss surgery.  This opened up a dialogue that eventually led to her getting me into a class, getting me into an early appointment with the bariatric surgery people, and getting me on the road to have a gastric sleeve (nowhere near as invasive as the bypass). 

Don't get me wrong.  In no way am I saying that surgery should solve the problems of fat people.  Surgery doesn't solve anything.  It's a tool, and it's a blunt tool, that will make me lose weight quicker, but with a lot more difficulty, with a much more restrained diet for the rest of my life, with a much increased possibility of having my gall bladder removed, and a greater risk of regaining the weight than if I did it the slow way.  The surgery is a great option for people whose lives are in danger due to such excessive weight, and while I know I'm not doing myself any favors, I also feel confident that I'm not in that kind of danger.  What swayed me to the surgery was the reconstruction thing.  It would take me too long to lose the weight by myself.  I would be plagued the whole time with the certainty that I walk around with every day, that I must already have breast cancer.  But I also want the reconstruction right away.  So, I'm doing the surgery and as a reward I'm going to get much bigger boobs. 

My point is, I made the decision to do this for my health, because my weight is unhealthy, but I did it thanks to an interaction with an incredibly kind and non-judgmental woman, not because I was fat shamed by my doctor. 

I don't think that anyone really believes that Nicole Arbour cares about fat people and wants us to be healthy.  But should anyone out there decide to take her poor advice and talk to their friends about their obesity, be warned, you will not be doing anyone any favors by taking the Arbour approach.  You'll be VERY lucky if you still have a friend.

1 comment:

Zoe said...

Wow Rachel, I had no idea this happened. I'm so glad that you blogged about it. That infuriates me beyond reason to think that a medical professional would be so insensitive to your situation. I've had my fair share of "you just need to lose weight" comments from Dr's, but I think it is completely unfair for them to blame your weight for causing cancer. I get the whole estrogen dominance thing, but it makes me think of the old chicken and the egg adage. Perhaps you have struggled with weight issues because of this excessive estrogen. How are you supposed to take care of that in your own? Lose weight? Ha! There is nothing more devastating than hearing your Dr, a person of "authority" say these words to you. Don't we go to Dr's because we need help? Anyway, I can only imagine the hurt that conversion caused. I am so so sorry friend. You are such a brilliant and talented person. I'm so proud of you for standing tall and talking about this issue. You'll have to let us know how things go. <3