Desperate Patients

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Something is really bugging me.

Today we had a morbidly obese 20 y/o female come into the ER via ambulance c/o severe lower abdominal pain, bloody diarrhea 20x/day for 2 days. She was stable (140/90, 100, 20, 99.0).

Come to find out she was giving herself enemas 2 days ago alternating with Rum and Isopropyl alcohol. She read in a "homeopathic" book that this was a good method of weight loss. She was under the impression that in order to cleanse her liver and "rid herself of toxins" that it required multiple enemas with various types of alcohol. I'm not really sure if the book actually suggested alcohol enemas or if that is what she understood it to mean by "cleansing".

At this point it was shift change so I don't know what the diagnostics showed.

It bothers me that someone would go to such drastic measures to lose weight. While I fully understand the desire to lose weight, I don't understand the desperate measures.

I've seen people come in after trying to cut out their own fat, I've seen them almost die from the effects of water intoxication, I've seen women who attempted to do their own breast reduction because they couldn't afford to have the procedure done, I've seen too much.

Couple of questions... I've been in nursing for 20+ years. Mostly ER, Trauma, ICU/CCU. I'm not sure I want to keep doing this. Most times I can deal with it through dark humor or sometimes a bubble bath, a glass of wine, and a little time does the trick. But I go through these times where nothing makes me feel better about these people. These are intelligent, reasonable people that are simply desperate.

How do others deal with this?

And this girl has me bugged. What happens with someone who for 12 hours repeated Rum/Isopropyl alcohol enemas? I've heard of wine enemas, but never Rum and Isopropyl alcohol for 12 hours.

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I think people like quick, cheap, and easy. Quick-fixes don't require a lot of effort or challenge on the part of the person doing them. Kind of like how I don't believe in dieting, because dieting is only a part-term solution to something that requires lifelong commitment to a change in eating habits.

Believe it or not, I think the "drastic measures" that you speak of are easier for the person to handle, rather than going about doing things the right way (the way that doesn't endanger the person's health). It's harder for them to do the thing that's better for their health. Going about things the proper, healthy way is too much of an obstacle for them.

People hate making changes in their life that mean that they will have to stop doing what they are currently doing, because they enjoy what they are currently doing too much to give it up! I think people are afraid to give up their status quo, because that is what they know and what they're comfortable with.

In other words, they want to keep their current lifestyle, but have a different outcome than what their current lifestyle will result in. For example, it's like a person who wants to smoke a pack of cigarettes a day for 30 years with no adverse effects. It's not realistic.

Does that make sense?

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...People hate making changes in their life that mean that they will have to stop doing what they are currently doing, because they enjoy what they are currently doing too much to give it up! I think people are afraid to give up their status quo, because that is what they know and what they're comfortable with. ...

While I really do understand what you are saying, there are patients that no matter how hard they try they just can't lose weight. Sometimes it is a metabolic issue, sometimes ... call it a lack of will power. I don't know. But there are people that don't have that "thing" it takes to lose weight. This gal tonight strikes me as one of them. I really don't think she was trying to take the easy way out. Running Isopropyl alcohol up your butt has got to be painful. She can take that kind of pain but not hunger? I don't know about that. Something, whatever it takes some folks just don't have it.

I'm not really convinced it is a lack of will power. I think it is more.

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I fully believe people will put themselves through a great deal of physical pain in order to avoid dealing with change. Look at how many people get cosmetic surgury to get rid of wrinkles and saggy skin, and bring back some of their youth. They're afraid to look old, apparently. Becoming old is a gradual change. People will try to halt it any way they can, rather than accepting it as a natural part of life.

Another explanation is, maybe she doesn't have enough money or insurance to pay for gastric bypass surgury, or isn't aware that something like that exists.

Edit: [again] People w/bulimia purge their bodies, such as through use of enemas.

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Some people seriously want to make changes but there is the infamous "thing" that is preventing them. Nobody WANTS to weigh 400 pounds, that's just not how it works in life. If they could lose the weight, they would. It just isn't as easy as you make it sound.

I hope you never have an issue that you can't overcome. And if you do, I hope only people who actually care and understand are around you at the time.

So, I think we are going to have to agree to disagree on this one.

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Specializes in Cath Lab, OR, CPHN/SN, ER.

I wish folks would realize it took several years (probably) to get that size, it isn't going to melt away that quick. How sad for her to put herself in that situation.

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I am going to present this from the other side. I have been very overweight the majority of my adult life, dealt with and treated for an eating disorder. It is not always fear of change or looking for a quick fix to lose weight when people do things like this (I will agree that sometimes it is). It can be DESPERATION, feeling that you have tried everything else and you will do anything to lose weight because you are so miserable and think you have no way out. When you get to that point you will try ANYTHING even though you know that it is wrong to make yourself feel better. (you are talking to someone who drove their potassium down to 2.8 doing something similar). Try living in a world that is very judgemental about appearance. Bathrooms that are too small, having to buy old lady clothes because that is all that is in your size, try having people assume that you are poor or on welfare because of your weight. Add all of that on top of how you feel about yourself and tell me how desperate you would feel. These people need our support, and KIND education, not assumptions and judgement. Fortunately I have been able to get ahold of it and have lost a significant amount of weight.

As far as the OP, I think the side effects are alcohol intoxication and irritation of the mucosal lining of the intestine. This is very scary to me that this information is out there for people to see.

I wish I knew how to deal with desperate patients, I just try to understand where it comes from due to my personal experiences and try to support and educate.

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I hope you never have an issue that you can't overcome. And if you do, I hope only people who actually care and understand are around you at the time.

:chuckle Why, thank you!

I've heard being overweight is a combination of genetics and learned eating habits. One is not exclusive of the other. I do believe that being overweight is at least partly a choice. And some people are more predisposed to it than others.

My views.

Edit: I also think that *continuing* to be obese can be a choice, once the detrimental effects of lifestyle choices has been consciously realized. Remember that I said I also think that genetics plays a role, so it's not totally a choice to be obese. Also, I think if your hormones are in an unusual state, such as when you're pregnant, you can gain weight and keep it for a while even after the baby is born. I'm sure there are also other reasons outside that people have obesity other than it just being a choice.

Obesity is certainly a complex issue.

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Specializes in Everything but psych!.

This is potentially a lethal argument. No one will win. IMHO - a person is the sum of everything they have been given: genes, environmental, learned habits, experiences, and knowledge. I also have it weighted so that the most influential is first, down to the least influential - last. :o

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((It bothers me that someone would go to such drastic measures to lose weight. While I fully understand the desire to lose weight, I don't understand the desperate measures.))

Have you [anyone] ever been trapped in an elevator long enough to pea in the corner? Been in an abusive relationship, fearful for the lives of your children, yourself, yet having nowhere to go nor even the means to leave? That it may be outside of our experience (even outside our [rational?] comprehension) makes it no less real. No less tragic. No less desperate.

Somehow we are supposed to figure out how to help.

That is how I got on this path. And is what keeps me going. So far, anyway......

Believing in FreeHugs,

Sarah

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There are so many reasons people become obese, and it can't just be wrapped up as simplisticly as saying it's a "choice."

Sometimes there are complex psych. issues going on, including a hx. of being sexually abused. Just as people medicate themselves with ETOH or drugs to relieve emotional pain, for some people food is the drug of choice.

I wish there were more understanding, too. Some of the comments I hear from people who are supposed to be healthcare providers are truly depressing. I can't imagine the desperation this woman must have been feeling, let alone how humiliated she was to have to explain what happened. I find it hard to believe she went to such extremes just because she was looking for a quick fix to her weight issues. It sounds ot me like there was a lot more going on there.

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...It can be DESPERATION, feeling that you have tried everything else and you will do anything to lose weight because you are so miserable and think you have no way out. When you get to that point you will try ANYTHING even though you know that it is wrong to make yourself feel better.

My point exactly! I don't feel sorry for this patient because she did something stupid, I feel sorry for her because she was deperate enough to do something this stupid.

I'm glad you got a grip on your issue and that things seem to be looking up for you. Sure wish you could talk to this young lady.

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