Tales from the office


I saw Marshall last year as a new patient who needed a physical. He had no other medical complaints. On exam I observed that he was sixty pounds overweight. And his blood tests showed the beginning of diabetes and high cholesterol. Moreover, his blood pressure was on the border of being high. At the end of our visit, I had a conversation with him about his problem: obesity. By losing fifty pounds, he could get rid of all his medical problems.

I didn’t see him for a year. This week he came back for his annual physical. He had lost sixty pounds. His blood pressure was normal. And he no longer had the beginnings of diabetes or cholesterol. He was in excellent shape.

I realize that I have the obesity conversation with at least 25% of my patients during their annual physical exam (because that is the national average for obesity, as measured by a BMI score over 30). In a non-judgmental way I try to bring the obesity problem to their attention and help them come up with solutions, then I express support for their choices. But I generally wonder if I should even spend any time on the discussion. The reason: futility.

I can count on one hand the number of my patients who have used diet and exercise and successfully reduced their weight from obese to normal. I consider that process a modern miracle. I say that because I’ve had more patients fight and beat cancer, than fight and beat obesity. And the sad thing is that obesity is within their control (while beating cancer is usually due to fortuitous circumstances—location of the tumor and earliness of diagnosis). When my patients get diagnosed with cancer, they generally change their lives. They typically eat well, exercise more, keep all their medical appointments, and pay lots of money for any treatment with any remote possibility of making a difference. But my patients that get diagnosed with obesity (with the knowledge that they are more likely to die from the complications of obesity than of cancer) generally do nothing. They know there is a cure. They know the path to wellness. But they don’t choose to make the life-altering decisions to heal themselves. To me, the “obesity survivors” are today’s real heroes. Congratulations, Marshall.


Although she was ninety-eight years old, Madeline could still walk on her own. And she had generally good mental function. But she had lost most of her hearing, sight, bowel and bladder control. And her autonomy. I had been taking care of her for three years and during that time she continued to decline. Finally, last year she needed full-time home health care. She had expressed to me many times over the last three years how frustrated she felt about losing control of her life. At each office visit she verbalized loudly that she wanted to die. She was perplexed that she had lived so long.

When a patient says she wants to die, for any reason, I have to consider the underlying reason and try to help. Depression is an obvious cause. So, I sent her to a psychiatrist. We tried many different medicines and mental health counseling. But Madeline claimed she wasn’t depressed, she was just frustrated. At each office visit, she looked at me for some sort of solution. She wondered if it was bad to want to die. I wondered if her problem was something that could be treated with medicine or therapy. I felt impotent to help her as her doctor.

She eventually stopped her antidepressants and therapy. She didn’t seem any different with or without them. She continued to decline. I got a call from her home attendant last week that she had died. I felt relieved that my helplessness was over as well.

2 responses to “Tales from the office”

  1. hey cedric. i found this to be a pretty moving set of anecdotes. it was encouraging to see a patient report with a happy ending — two, i guess. you seem like such a good doctor i think it’s a crying shame you keep refusing to be mine.

  2. PB says:

    Your office posts are just getting better and better, I am really looking forward to them lately.
    My (M.D.) sister told me a story once about a mother and daughter in her office. The mother was in her 90’s, the daughter was her caretaker. The daughter was annoyed that the mother was always asking for milk shakes and food that was “bad” for her. “tell her doctor, tell her that she needs to eat nutritious food!” My sister looked at the daughter and said (I am sure in some professional way) “she’s ninety x years old, let her eat whatever she wants.” I can see myself being this old raging lady, we can only hope that it hits at 98 and not next week because we are drinking too many milk shakes at 40.