Fat Writer Running – Condescension in a White Coat – or – I DID IT YOU GUYS I BEAT THE DIABETES 

Fat Writing Running here with a very special blog. I started FWR to be excited and positive about running and writing and life and good stuff but life is not all those things. This blog is about the impact of doctors have on our narratives and the ways they help and hinder us. I have a great story about it and then I have a not-great story about it. Because this is going to deal with serious things I’m going to get our obligatory otter photo out of the way up front to ease us in.

So, I was diagnosed with Type II diabetes about 7 years ago. Since that diagnosis I have worked with a team at the Portland Clinic Diabetes Services and they’re awesome. I’ve had good health care experiences, bad healthcare experiences, meh healthcare experiences, and enthusiastically great healthcare experiences. The team at Portland Clinic are enthusiastically great. They answered questions when I was confused, supported me when I needed new solutions, and were generally rad people to interact with. About two weeks ago I had my most recent check up- my second in the last 15 months since I started eating well and exercising- and I was greeted with the amazing news that my Hemoglobin A1c, a blood test that measures an average glucose or sugar level and a primary metric for diagnosing Type II diabetes was not only really good but notably below diabetic levels. The target for a Type II diabetic to be considered “controlled” is 7. Anything above 6.5 is indicative of diabetes and anything 5.7 up to 6.4 is pre-diabetic. My latest A1c was 5.5.

I DID IT YOU GUYS I BEAT THE DIABETES

Seriously, this is tremendous news for me and my pancreas. I did it with a sustainable diet, regular exercise, and the lowest recommended dosage of one diabetes drug, Metformin. The first question my diabetes nurse asked after telling me about the results is if I wanted to stop taking Metformin. I told her I didn’t want to do anything that could compromise my ongoing health. She said that with my A1c results (my test from 6 months prior was also very low and under diabetic levels) and my current running regimen, I should go ahead and stop taking it. She said that Metformin stops your liver from generating glucose from “emergency stores” and that at my activity level that was a detriment. Basically, all the running I’ve been doing I’ve been doing it without the benefit of my body pitching in energy reserves during and after. I agreed to this and agreed I would monitor my sugar levels with my meter at home regularly. She left my prescription active so if I noticed an uptick I could start the medication again.

And then I went to my car in the parking lot and I cried because I DID IT YOU GUYS I BEAT THE DIABETES AND THIS IS ALL A GREAT HAPPY STORY AND EVERYONE HIGH-FIVED EVERYONE ELSE THE END!

Except that’s not how it went.

Two things followed. First, I didn’t believe it. I still struggle to. I have been testing my blood sugar constantly. I have been anxious that the test was wrong and this condition that I always believed was going to kill to me was just lying low and it would pounce when I let my guard down. Honestly, I will probably always worry about this, and I will test my sugar levels and I will consult with my doctors and I will do what I have to do to stay healthy and stay alive because I’m enjoying it and I recommend it. My meter readings have been just as great as my A1c even without the minimal dose of Metformin. I test before meals, after meals, between meals, when I wake up, in the middle of the night – and the results are consistently the results of someone who would not be diagnosed with Type II diabetes right now. This makes sense. I’ve spent the last 15 months not doing a crash diet or workout craze or taking drugs or getting surgery. My diabetes nurse had me do the body fat test and my results show that even though I’ve lost over 110 pounds it hasn’t come at the expense of muscle development. In fact, I have gained muscle and gaining muscle is sustainable. Every single thing I did, I did it the “right” way and my diabetes nurse in her white coat assured me as much. Her confidence in me- her educated and credentialed confidence- helped me to have confidence in myself. So much of this process is changing the story I told about myself and my healthcare team at the Portland Clinic contributed to a triumphant new one.

The second thing that happened was the opposite.

I’ve been wearing glasses for near sightedness since I was 11 years old. I’ve always wanted to do laser corrective surgery and I’ve talked to every single optometrist or ophthalmologist or street corner monocle vendor about it for years. My eyes are perfect for the procedure they’ve told me. I know that Type II diabetes can hurt your eyes so I had diabetic eye exams and I asked them about it and they said my eyes were great – there were no indications of damage from diabetes and as long as my A1c and sugar levels were well-managed (and they have been – even before they dropped to non-diabetic levels, I’ve been diligent about my health for 7 years) I should have healthy eyes and should be a good candidate for LASER EYES.

Anyway, the stars seemed to align and I had a great opportunity to get it done. I actually had to schedule the initial consultation with the Casey Eye Institute over a month in advance but it was worth it. I told them during the phone screening about my health history but at the time I was still on Metformin. There were no red flags or concerns because I had been diligent and thorough and earlier this week my appointment came and I made the trip down to the office. I filled out the medical history form in advance- clearly indicating my diabetes and all of the medications I was taking/not taking. No big deal, I thought. They should be thrilled that I DID IT YOU GUYS I BEAT THE DIABETES right? The tech asked me more about my recent A1c and medication change. I answered her questions. No worries. She started with a series of exams to confirm that my eyes were good candidates. They shined lights into my eyes for over an hour and then she excused herself to check in with the doctor. She came back and informed me that the doctor was not going to do the procedure because he felt that my medical condition was unstable. He was concerned that I had recently stopped taking Metformin and wanted to wait 6-12 months to see what happened. I was caught off guard. If there was some medical justification, I could resume taking the Metformin. I still had a prescription. But they didn’t ask to see my medical records. They didn’t show any interest in 7 years of diligence with regular appointments and evaluations at the Portland Clinic. My Portland Clinic diabetes nurse (and the optometrist that did my last diabetic eye exam) were thrilled for me. The doctor didn’t even meet me before deciding I was not a valid candidate. I was told that another doctor at the Casey Eye Institute might be willing to do the surgery but I would need to schedule a later visit to find out. I was offered a refund for my non-refundable $100 evaluation fee and told I could either wait to see or, essentially GTFO. 

Look, consumers are entitled. I get that. We want what we want and if we go to the LASER EYE store and they are all out of LASER EYES we can be whiny obnoxious jerks about it. I felt that entitlement and fought with it in that appointment. The tech could tell I was upset though and she went and got the doctor so he could talk to me directly (a real standup move, I’m sure). The doctor came into the exam room and tells me my tests look great. My eyes look great. But he doesn’t do surgery on diabetics. He gives me this long speech about how diabetes works (pretty remedial stuff that my actual diabetes docs covered better) and how he thinks diabetics shouldn’t get laser corrective surgery. And I tell him I don’t understand. Why did he tell me to come back in 6-12 months then? Whey did they schedule my appointment in the first place? Why did they just do over an hour of exams? I told him if he was worried about me not taking Metform, I could resume taking Metformin – my diabetes nurse had made it clear it was my choice. He kind of waved his hands around and said “no – that would be going backwards and I would less likely to do the surgery.” Then he asked to look at my eyes with a bright light thing and I said okay and he nodded and said they looked good and then asked me some weird loaded question about how it was a good thing for him to not irreparably damage my eyes wasn’t it? And he made some comments about how I “seem to be on the right track” and how “most people can’t do that” and then walked me out into the front of the clinic and the full waiting room and told the woman at the desk that I didn’t meet the standards for his practice and that I should schedule some time with the other doctor but I probably shouldn’t get the surgery and he winked and disappeared.

It was the most condescending shitty experience I’ve ever had with a person in a white coat ever. He talked down to me. His rationale seemed muddled and inconsistent and honestly, he was just a prick. Even if I met him at the grocery store and he was like “I see you have an avocado” I would probably find him arrogant and off-putting. He emanated glib detachment and smugness with rare and complete repugnance. Above all- and if you’re a white coat wearer or know a white coat wearer please note this- this doctor lacked the empathy and respect for me that I deserved as a patient and a person. In the days since this happened I’ve gone over every moment of this interaction trying to pinpoint his exact words and actions that bothered me to so much and ultimately it was just everything. If it was about my health I could have talked to him about my health. He didn’t want to see my A1c results going back 7 years. He didn’t want to see that I have literally everything I’ve eaten for the last 15 months carefully logged, that I haven’t gone a day without at least 30 minutes of exercise in that same time, because he didn’t care.

I left that appointment feeling not like a champion because I DID IT YOU GUYS I BEAT THE DIABETES but instead feeling somehow ashamed and bad about myself. What about me or my story made this doctor so certain I was unstable? The way he talked about “being on the right track” and the way he wanted to wait 6-12 more months felt like he was telling me “I know you’re going to slip up fatty- I know you’re going to fail and I don’t want my glorious LASER EYES damaged by your weak gluttony.” Because he’s wearing a white coat and because I’m already anxious about my own health, it really got to me, you guys. I’ve been incredibly lucky as a fat man with diabetes that my doctors have listened to me and considered my specific history and condition. A lot of people aren’t so lucky. They see a doctor because they’re depressed and need help and they’re told that maybe they need to eat a little bit less because of their BMI. It’s not exactly fat shaming. It’s fat blindness. Some doctors just can’t see- or don’t want to see- beyond your body shape, or your diagnoses.

Now, I’m not crazy and entitled. If I’m a bad candidate for laser corrective surgery I shouldn’t get laser corrective surgery. But my diabetes isn’t unstable. My diabetes is fucking gone.

I DID IT YOU GUYS I BEAT THE DIABETES 

I’m not going to fall off the “right track.”

I DID IT YOU GUYS I BEAT THE DIABETES 

I have data. I have the history. I have doctors that care to look at it and make informed decisions. And this jerk in his white coat would know that if he asked. This jerk in his white coat could have come in and not been a jerk and talked to me with respect. Even if he thought it was best to wait for the surgery he could have given clear reasons why and told me when to follow up instead of lecturing me about how “most people can’t do it.”

It is so incredibly difficult to tell your story triumphantly when men with bleached teeth and bleached hair and bleached white coats and bleached smug pop in for a quick 5 minute fuck you and then tell a room full of people that you aren’t up to his standards.

Fuck his standards.

I DID IT YOU GUYS I BEAT THE DIABETES

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