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Monday 19 August 2013

A patient's perspective - Not a Guilt Trip

A Guide for Doctors - How to really screw up an Eating Disorder Patient's Appointment .....

"When walking into the Doctors surgery – my heart is beating fast. I’m nervous, anticipation high and feeling like this is the last place on earth I want to be at this moment in time. 

My name is called and I stand up, greeted by a smile that seems sympathetic. I follow the GP down the corridor and into her room. The door closes and I sit down. The familiar words of ‘how are you today?’ roll off her tongue like clockwork, followed by a rehearsed smile. The response of ‘fine thank you’ is automated and untrue. 

Awful: how would you feel if you had a constant battle with a voice in your head that you couldn’t run away from?’ would be a more appropriate reply but I keep my mouth shut – she doesn’t, and probably will never understand.

‘Are you eating?’ is the next enquiry. A valid question, yes but still evokes emotion.

‘Course I’m eating. I’m trying to recover from an Eating Disorder with my Mother hot on my back – not exactly going to get away with not eating.’

Perhaps the more appropriate question in this situation would be to ask what my meal plan was. Was I sticking to it? ‘No.’ A lie might try and creep its way in here. 

‘Have you been having your ensure?’

‘That disgusting tasting, taxing drink that brought tears every time I was faced with it the first couple of days?’

‘Yes – not the nicest tasting drink in the world though!’ Trying to add some light relief to this uncomfortable situation was the least I could do.

‘Well, that doesn’t really come into it – do you think we could do two a day?’ Insert friendly smile here.
Shot down and laid out on the torture table. 

‘No. I don’t want to. Can we wait to see how I’ve done first?’

‘No I want you to have it.’

‘I thought you’re trying to get me back to being normal? I want to do this with food, not multiple cans a day that makes me feel sick after. Who knows what that ensure has done to my weight yet anyway?’

‘I would much rather try and do it with food.’ Calm, breathe. She won’t listen to you if you panic.

I can sense by the pause and the glance at the computer screen. I know what question is coming next. 

‘Please don’t say, please don’t say...’

‘May I weigh you?’

Boom. There it is. Heart pacing, dry mouth, the intense fear crashes down like water – drowning me. However, I want to get better – this is why I’m here. I want to be free; to live a happy, healthy life so I nod and compliantly stand up and remove my shoes.

No word is said about my jeans, belt or purposely placed phone in my pocket.
Deep breath before stepping onto the scales. My heart is in my mouth as I look downwards towards the reading.

‘Oh well done! Oh I am pleased!’

I’ve gained. Obviously.

‘45kg. I make that a gain of 2.5kg!’

Emotions are everywhere. All my hard work has paid off, yes. But too much. Too too much. This number is too big. I can’t deal with it. 

I walk away from the scales, almost in tears. She doesn’t notice – course she doesn’t.

I sit and reluctantly draw my eyes up from the floor and am met by a beaming face. 

‘Oh are you pleased? You do look better - your face is fuller.’

There it is – the worst possible thing that she could have said. Cue Ana. 

You’ve gained. You’re so huge– everyone can see how fat you are now. The doctor said it herself, you’re chubby, big, ugly.. fat.’

I want to run out of the room – hide as far away as I can from the scales, the number, the doctor – everything. Trying to listen to her voice over the horrendous shouting and deep emotion that I was experiencing was proving impossible. I knew she was waiting for an answer so I guess a nod in response will do? 

The conversation in my head was much more important than anything that she had to say right at this minute.

No, you want this. You need to put on weight and you should be proud. This is just a result of all the hard work that you put in. You did so well these last few weeks.’

No, you missed snacks last week, you were so active, it shouldn’t have been that much. You’re never going to eat like a normal person again.’

‘You ate all that scary, fatty food and now look what’s happened – I told you you shouldn’t have eaten them. You should listen to me’

‘So I’ll see you in a couple of weeks. Keep eating!’ The friendly smile that followed that comment was the last blow. She was trying to be nice, 

‘come on, let her off.’

I managed to force a half-smile before getting up, walking out of the room and into the bathroom where I proceeded to sob. I’m now stuck with this battle for the rest of the day – trying to convince myself that this weight gain was ok, that she didn’t mean the horrendous comments that were produced in that consulting room. That the sudden tightness of my trousers and over hanging stomach was in my mind and the ED was lying to me yet again. 

Whereas you the Doctor – you can move on – and go home at the end of the day, voice-free, having no idea how much suffering you caused me today.

Not a guilt trip; just the truth."

(With a million thanks to the patient who sent this in to me)

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