mahiwaga

Being a Person of Greater Mass™ myself, I understand the discrimination against fat people. (I think the epidemic of anorexia nervosa and body dysmorphic disorder among women is another thing entirely, and very bizarre and disturbing, but that is another tale in the telling. Seriously, though, there are way too many women who are either healthy or dangerously underweight who continue to claim that they’re too fat, and sometimes I have to repress the urge to send them all to the inpatient psych ward on the grounds that they are a danger to themselves.)

On the other hand, being a health care professional, I can’t deny the reality that being overweight or obese puts you at higher risk for deadly diseases such as diabetes mellitus type II and coronary artery disease. Too many studies show time and time again the definite association.

Part of the problem is the crap that is cheaply available in the U.S. Starting with the bizarre farm subsidies from the USDA where the government actually pays farmers not to grow food, the food pyramid is completely inverted in this country. Whereas in most of the world, red meat is sold at a premium and is not frequently indulged in, we eat entire cows for breakfast. It is the unfortunate truth that the poorer you are, the crappier you eat. In developing and undeveloped countries, if you aren’t starving or malnourished, you’re typically eating basic staple foods: unprocessed grains, vegetables, maybe fish or even chicken if you’re lucky. In the U.S., you’re eating hamburger meat, McDonalds or Burger King, and it’s still cheaper for me to buy a big slab of beef that to buy decent vegetables.

The big problem with obesity is that, genetically, many of us are cursed with metabolic efficiency. Meaning, some of us tend to store calories more efficiently than others. In prehistoric times, before the Agricultural Revolution, this made a lot of sense. You would eat meat rarely, but when it was available, it was important to eat up as much as you could and store it up as fat, and try to subsist on grains and roots and whatever fat you managed to buildup until the next major kill came along. The less efficient metabolizers would tend to die off during long, hard winters. But in the age of fast food and being able to order pizzas without leaving your computer, this will kill you.

The group of people where this seems to be the most evident are the Pima Indians in the American Southwest. Straddling the U.S-Mexican border, there have been studies that have demonstrated that, despite sharing the same genetic predisposition to obesity and diabetes mellitus type II, Pima Indians in the U.S. are fatter than Pima Indians in Mexico and it seems that the more sedentary lifestyle and unhealthy diet available in the U.S. is what literally kills them.

Efficient metabolizers. What can I say.

Now the discrimination thing sucks, because it’s about the disease, not the person. (There’s that damned Calvinistic thing going on again—this disturbing propensity for teleology and relating it to spiritual salvation that is what is completely wrong and un-Christian about religious fundamentalists in the U.S.—blaming the victim for their suffering, essentially, but I digress.) But the thing that’s different about obesity than, say, being dark-skinned, or being female, is that you can actually change the fact that you’re obese. (OK, sure, you can change the color of your skin or switch genders, but those are honestly quite extraordinary cases.) Sure, it’s not easy to lose weight, exercise, and eat healthy—far from it, and who am I to talk—but, come on, there are people out there who have given up smoking crack, people out there who have given up shooting heroin, hell, people who have given up cigarettes (nicotine being the most addictive substance of all these drugs.) It can be done. You just can’t have an all-or-nothing attitude. There’s no need to lose 30 pounds in a week (unless we’re talking about morbid obesity here, but honestly, that’s not that common.) Seriously, just losing 5 lbs in a year decreases your risk for stroke and heart attack by an impressive margin.

Interestingly, this comes on the heels of reading about why motivation by external rewards does not work. And negative feedback—motivation by threatening consequences—certainly does not work. The example of how the threat of death rarely motivates patients with terrible cardiac disease to change their lifestyles is invoked as well. It is impossible to motivate someone. Motivation comes from within, end of story.

So for all those fucked-up people who think that fat people need to be told repeatedly to lose weight and who deserve dirty looks for being large, give it up. Live and let live. Or mind your own damn business. You’re just lucky you have a wasteful metabolism that manages to burn up all that extra fat and sugar you’re eating, but, guess what, unless you actually eat healthy all that shit will still clog up your arteries, and you can still get Mad Cow disease, so there.

I read an intern’s blog post about a patient dying, and it sort of recentered me.

How do my trifling tragedies compare to the aching drama of death?

I’ll tell you the truth. I don’t like people dying. I intellectually recognize that death is a normal part of life, that death is not pathological, that death is not the enemy. (The enemy is suffering. There is no such thing as necessary suffering, only sometimes you can’t avoid the cold, hard facts of physical law. All suffering is tragic. I’m sure there are plenty of people who would disagree with me, though, especially on religious grounds.) But death still gives me the heebie-jeebies. It’s the whole mortality thing. You weep not for the dying, but for yourself, knowing that you’re going to die sometime too. At least that’s one way to interpret it.

There is also this: someone you love is now gone, and isn’t it natural to miss someone you love? Especially since were talking forever here (or at least for the rest of your life, if you believe in an afterlife.) To miss someone forever has got to rank up there in the top ten examples of extreme suffering.

Sometimes I recognize it’s a good thing that we are mortal, and that life is finite.

It’s also a good thing that the average human brain can’t really even imagine eternity. It is literally incomprehensible. Try it. Not just the word “infinity,” but the actual infiniteness (or apparent infiniteness) of the universe. Try to imagine the trillions upon trillions of stars. Even “trillion” is pretty much an abstract concept. No one really experiences the world directly at that magnitude of order. We can only work through abstractions of theory, using indirect tools. Sure, you and I are each populated by about a trillion cells, but could you actually physically count every single cell that you are comprised of? And we’re populated by even more bacteria than that. And then we get into metaphysical things, like the national debt. What does it mean to owe trillions of dollars?

So today started out well enough. It was, for the most part, a good day. And then I decided to read my evaluations, and I was dismayed.

There is a sad, pathetic part of me that always wants to be liked, that crumples at the sign of the least bit of criticism, no matter how warranted.

Another aspect of this patheticness is that, really, my only source of satisfaction is my work, and to be described as lacking in that makes me wonder what the hell I’m even doing with my life.

That lasted for no more than an hour though. I cheered up watching a Flash Animation of a cartoon character blowing his brains out. (Yes, I am a sick monkey.)

But what we are talking about here is resilience. Something that I severely lack. That one-hour episode of soul-searching and wallowing in self-loathing cost me.

I’d like to ascribe it to the depressingly short days. I hate going to work when it’s dark and then going home and it’s dark again. And this is pretty much as far south as I can get in California. I can’t believe I actually contemplated staying in Chicago for another four years. I’m not sure if I could’ve survived another winter, let alone four.

Clearly there is something wrong with me.

They say depression has cumulative effects. Your first episode of depression may be the most profound, the most disruptive, but what it does is predispose you to the next episode, and the more episodes you have, the easier and easier it is for you to get depressed.

The thing that kills me is that it’s stupid little things that pull the rug from out under me. I mean, come on, it’s an honest evaluation, and while I thought I was doing OK, I know I wasn’t doing stellar. Inside me is that kid who still needs to get all A’s on his tests, and I haven’t completely managed to snuff out that self-destructive tendency towards perfectionism.

What I need to learn is the concept of enough. I don’t have to be the best. I don’t have to be the brightest.

Or, in computer programming philosophy, ”Worse is better.” Something that works almost but not quite perfectly, but can be done relatively simply is far superior to something that is perfect, but requires a horrendously complex pathway to achieve. You will actually finish the former, and if my life thus far is any indication, the latter usually just turns out to be a pipe dream. Hell, even something that works 75% of the time, but fails the other 25% of the time, as long as that 25% isn’t completely fatal, is probably still superior to a method of perfection.

Some things, I’m a lot less forgiving. For example, my writing. Except for blogging (which is generally recognized to be throw-away material), I can no longer write. It’s not because of a lack of ideas, well, not because of a lack of vague ideas. I just can’t flesh out the details. And I don’t want to even try because I know it’s going to suck.

Maybe the problem is that I have some sort of kinesthetic learning disorder. I can seem to learn book knowledge, and in particular, useless facts quite easily, but I can’t seem to put together complex actions in a meaningful way. Things that require more than 2 steps will frequently screw me up.

Surely part of this is evidence of some subtle, undiagnosed executive dysfunction, some nearly imperceptible damage of sort to my frontal lobes. God only knows when this happened. Whether it was actual transient hypoxic injury from when I got my tonsils removed, or whether it’s just well-described sequelae of depression (the first part of the brain that falls to pieces is the frontal lobe), in practical terms, it just doesn’t matter.

The question is: can it be fixed? And if it’s like most medical problems, the answer is no. I just have to live with what is essentially brain failure. It’s like idiopathic dilated cardiomyopathy. No one knows why some otherwise completely healthy people develop enlarged hearts, which eventually fail. The money is on the idea that it’s simply some subtle ischemic process that can’t be detected by coronary angiography, but I digress yet again.

Most people, when they think of brain failure, generally think about (1) CVAs (cerebrovascular accidents, or, colloquially, a stroke) or (2) dementia. The popular conception of dementia is probably focused mostly on memory problems. This is the symptom that frequently raises the concern for Alzheimer Disease, when in truth, there are a lot of other subtler abnormalities that begin to develop.

But I’ve got to say, not being able to sequence things in a logical order is pretty damn disabling. In retrospect, it’s so damn obvious. This is why I always end up procrastinating and fucking myself over. Sure, I can ascribe it my despairing perfectionism, or my chronic depression, but the symptom that I have the biggest problem with is making plans.

I think it must be sheer serendipity that has allowed me to get as far as I’ve gotten despite this particular handicap. The flipside is, however, this: Imagine what I might have accomplished with my life if I had a functioning frontal lobe? Then again, maybe my propensity for learning is simply a compensatory mechanism, maybe my wide range of interest is yet another manifestation of my primary problem.

Prioritizing has always been a big problem for me. It’s weird to ascribe this all to subtle brain damage, but I can’t figure it out any other way. I mean, I’m no dummy. I’ve figured out harder things than this. I’ve managed to obtain an advanced degree. (Luck? Perhaps. Better lucky than good, right?) But for some reason, order and sequence continue to elude me.

I don’t know what else to say. It’s once again midnight. I should just go to sleep.