09 August 2009

There's safety in thin patients

As M. and I settled in to enjoy a rainy Sunday morning with the paper, coffee, and twelve friends from the Dunkin family, she stumbled across a "Hey Marge!" story.

(If you don't know the "Hey Marge!" story, it was defined by David Lee Roth as a story on the TV so shocking that it causes one to yell out "Hey Marge!" and call in his wife.)

Apparently, a 500 pound man was arrested in Harris County, Texas, searched several times, but when he arrived at the prison he was discovered to have hidden a 9mm weapon between folds of fat.


It made me feel somewhat thankful that our patients at the combat support hospital in Iraq were too thin to try and get away with such a trick. In fact it was unfortunate that the majority of the Iraqi children we treated were in a state of malnourishment. They often looked years younger than they actually were because of a chronic want for calories.

We had procedures in place to be certain that no patient arrived at the hospital still armed with a weapon. In spite of this level of confidence and safety, our team still performed our double checks and triple checks to ensure that all staff and patients remained safe.

Early on, some of the insurgents we treated were mildly obese, but still nothing compered to the levels of superobesity we are capable of here in the US. I asked the interpreters about this phenomenon and they explained that many of teh insurgents had been active Baathist party members and enjoyed a relatively greater share of riches and feeding.

As the war progressed, and greater numbers of the insurgents turned out to be foreign fighters, this difference in body mass index when compared to Iraqi soldiers and civilians faded away.

I do recall one incident comparable to the skin-fold weapon concealing prisoner, but I experienced it years ago in the US when I was a surgical resident. The ED staff called me in to consult on a school-age girl who whose diagnosis had eluded them. Her mother brought her in because she "smelled funny" and no matter how many times she bathed her daughter, it wouldn't go away. The child was a pretty and friendly girl, but was obese to a level that threatened future health risks if she didn't get some sports and outdoors into her life. There was a smell very much like an abscess, but the child was happy and healthy with no pain or visible signs of infection. My examination of her belly must have been a bit more thorough than the ED resident's because I discovered a remnant of a tuna fish sandwich tucked into a skin fold near her right flank. When the child's mother saw it, she burst out "Is that tuna? I gave that to her over a week ago!" We were all pleased that we had found an explanation, and no serious trouble had been unearthed.

There is beauty in the women Rubens painted, but we have gone far beyond that archetype.


For both health reasons and keeping contraband out of prisons we need to find a happy medium between impossibly anorexic fashion models and superobesity.

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