I must go to the doctor again. This particular appointment is with the endocrinologist, but I realize that the feelings I’m having are not specific to her. They are part of a pattern existing throughout my adult life: a visit to the doctor is a visit to the land of judgment, silence and apologies.
There was a span of years when I was making this worse because of my active addiction to painkillers. Some doctor visits were preceded by anxious reviewing of my desperate exaggerations or even outright lies, combined with the ever-present shame. One of the blessings of recovery is freedom from these dishonest machinations.
There are also times when my apologies are about not taking my meds properly, as during a severe depressive episode, or failing to carry out some other assignment designed to help me.
However, for most of my adult life, the dragon I face in the doctor’s office has been the same one: being fat. Fat, whether to a greater or a lesser degree, in a medical climate that places almost any ill at the door of one’s weight regardless of other health parameters (and it must be admitted that, although I believe in the Health at Every Size philosophy, it is usually clear that my body would be happier near the lower end of my weight range.)
No doctor, be they primary care or otherwise, has ever failed to inform me that I should lose weight, with the exception of the rare few I only met while at the extreme low end. They tell me this as if I do not know it; as if I have somehow managed to reach middle age without being aware that I am overweight.
Any explanation I might give about why losing weight is not working out at the time, or about regaining it following a loss, sounds like excuses. And I don’t want to make excuses, anyway. I’d really prefer it to be taken as read that I’m aware of the issue and doing my best, even if my best is not what they would like. Still, not an appointment passes–no matter what the presenting problem or how unrelated it might seem–without me having to answer for the size of my body.
This problem is neither new nor unique to me, and I know many awesome people who could give me advice on how to stand up for myself more effectively. I realized lately that much of the problem resides in myself: I don’t present my situation unapologetically because I have not come to terms with it. I haven’t unpacked and dealt with a lifetime of internalized fat prejudice I didn’t realize I was carrying.
The doctor I’m going to see, who wanted me to have lost weight since our last appointment, is one for whom my weight really is a relevant parameter: we are dealing with blood sugars, hormone levels, and other things that are affected by it. I can’t present her with the results she hoped to see. I have to show up as I am and ask her to treat the patient she has, not the patient she wants. I have to be honest with her, and ask her to ally with me in treating my conditions on the assumption that my weight is not going to go down right now.
I would like her to give me advice about focusing on fitness, with the understanding that I may or may not be able to do as much as she wants. I’d like her to pleased with what I do accomplish, even if it’s only managing to take my meds properly and go on a few walks.
Yeah, and I’d also like a pony.
Some of what I want isn’t going to happen. My longing to be understood and respected by those in the medical profession could be a classic example of going back to that dry well. Even as I long for it, I identify with the doctors themselves and the frustration they must experience when patient after patient sickens or dies for lack of following a few “simple” instructions. I feel unworthy of their time. I feel unworthy of the medical care I’m privileged to have available. (The fact that they are providing a service for which I’m paying gets lost in this self-recrimination.)
There’s one thing, however, over which I do have power. That’s the baggage I mentioned above. It’s time for some major unpacking, and the more I think about the topic the clearer and more extreme some of the buried core beliefs are becoming.