The 38 stone woman.

In these days of political correctness, we now have a new name for an old medical condition, Bariatrics. This has become a whole field of treatment, and a speciality, attracting large budgets, and a great deal of attention from the media. It is very much the latest craze in medicine, and encompasses  a range of surgical, medical, and psychological treatment options.

For those who have never heard of this, and for others less politically concerned, this is the term for people who are grossly obese; in other words, immensely fat. TV programmes regularly follow the progress of such individuals. We see their surgery, their follow-ups, and every detail of their personal care procedures. They have become the new darlings of reality TV, the superstars of a population who are dangerously on the way to joining them. They are the ultimate consumers, in this case, of food. Those who choose to watch are spared nothing. The grossly swollen limbs, useless joints, and ulcerated rolls of flesh, are paraded for the morbid delight of the viewer, apparently in the name of Science. They are always shown continuously eating, and the food is always ‘bad’ food; pizza, cakes, chips, crisps, and burgers. We are authoratively informed that this condition is a result of social problems; traumatic background stories abound, and we are encouraged to show real concern for the plight of these human pachyderms.

Well, I am here to tell you, from experience, that this is nothing new. The term Bariatrics was coined as long ago as 1965, and forecast the problems we are experiencing today, as this condition becomes increasingly commonplace, and strangely acceptable. When I was young, I was never far from chubby myself. There were a few ‘large’ people about, and one or two who might have weighed close to 20 stones. (280 pounds). By the time I was operational in the Ambulance Service, around 1980, I had still never seen anyone much bigger than that. There was a reason for this; they were ashamed. They stayed at home, and never ventured out, usually because they were unable to do so anyway. No tabloid newspapers, trash magazines, or TV medical programmes sought them out, because their condition was rightly regarded as self-inflicted. They chose not to work, and to sit at home, supported by others, so that they could stuff their faces all day and night, and not have to face any responsibility.

I well remember the first time I saw one of these people, and how quickly I realised that there were hundreds of them; tucked away in small flats, trapped in beds, or on sofas, eating and eating. They were unknown to those outside ‘the system’ that had to deal with them. District Nurses, Home-Helps, Doctors, and Ambulance Crews, all of these were keepers of the great secret. There was even a handy acronym, used as a shorthand; F.L.U.B. This stood for; Fat Lazy Useless Bastard. If this sounds unacceptably cruel, well so be it. They had to be washed by others, so they never dressed, outside of scanty nightwear. They would use a bucket or commode chair as a toilet, as they could not fit on a conventional lavatory. And, for some reason that I never investigated, they were predominantly women, between 25 and 50 years of age. They were also all from poor working class backgrounds too. I never met any woman in a house worth over £100,000, who weighed more than 14 stones. ( 190 pounds) One thing was a common denominator, that they were all completely in denial. I never encountered one, not ever, who admitted that they ate too much. Surrounded by discarded fast food containers, empty pizza boxes, and plastic cake wrappers, they would assert that they hardly ever took a bite of anything.

I had a job to do, and had to consider that the causes were perhaps socially-derived, and the condition should be treated like any other. However, I came from a much poorer part of London, as did my friends and family, and we had not gone down the route of comfort eating, until we were trapped in our own accommodation. We had lived our life, gone to work, and tried our best to make a go of things. After a very short time, I became increasingly frustrated and annoyed with these hugely fat people, as did all my colleagues. But we never let on. Not until now, anyway.

One afternoon, we were called to a basement flat in Westbourne Park, West London. We were told that a female required assistance, and that we should enter through the window, as she could not open the door. We were assured that the bottom sash would be open, affording easy access. On arrival, we entered as directed, calling as we did so. The atmosphere in the room was eye-wateringly fetid, as the smell of urine, and resulting ammonia, were at the highest levels that I had experienced. On a large bed across from the window, was a massive lady, dressed in a floral nightdress that barely covered her. She completely overwhelmed the king-sized bed she was on, and she was calling ‘help’, in a tinny voice. I went around the side, to be able to see her face. Her neck and facial features were so disfigured by fat, her eyes, nose, and mouth appeared to be stuck on. The converging double chins had become one, as large as a ship’s lifebelt; and she could not see over it, if she lay flat.

She explained that she wanted help to turn over, as she had been on one side for over a week. She told us that a kind neighbour helped out, by getting her benefits from the Post Office, buying her food, and leaving her meals to eat on a side table. She also occasionally helped her to wash, and emptied the commode, which the caller had been unable to use, for over a week. The results of this particular problem were more than evident around the bed. The neighbour received a small payment for this, and other duties, but she had not been able to help her turn, so had finally suggested that an ambulance be called. Despite suffering with Diabetes, and having seriously high blood pressure, the lady had declined the attendance of a District Nurse for over two years; and her weight had made it impossible for her to go to the clinics at hospital as well. A brief examination confirmed my worst fears. In addition to unstable Diabetes, she had infected ulcers on her legs and feet, and an open pressure sore on her buttock, large enough to insert my entire hand, if I had chosen to do so. I also suspected a slight stroke, as she had obvious weakness on one side, as well as slurred speech. We would have no alternative, she had to be taken to hospital.

What followed, was an operation that would have done credit to a military unit. I first requested two additional ambulances, which would give us six strong staff to carry her. There was no chance of getting her out via the narrow staircase from the basement, so it would be through the window, which would need to be completely removed. The Council were called, and asked to attend as a matter of urgency. With all the vehicles in the small street, and a lot of attention generated by the comings and goings, the road would have to be closed, so the Police were also called. In the meantime, we set up an intravenous drip on the lady, as she was dehydrated. We also gave her oxygen, though the elastic strap of the mask would not fit around her face, so it was taped to her head. We also attempted to bandage some of the open sores, to help when we moved her out; and luckily, we got the two extra vehicles in good time, with only a fifteen minute wait.

Our troubles were far from over. The mattress had been so compressed by years of her weight, that it was now no thicker than a waffle. We tried to get our carrying sheet underneath her, but even six of us had great difficulty turning her from side to side, so we could get the canvas carrier under her body. After a lot of pushing and shoving, and no end of discomfort to the patient, our worst fears were confirmed; the large canvas carrier was far too small to accommodate her, and would not be safe to use.  We had no alternative but to ask the Fire Brigade to attend, and use one of their industrial size tarpaulins. By now, the lady was becoming agitated, and breathless. Her pulse was racing, and her blood pressure was rising to dangerous levels. The fire engine arrived, and we now had five more strong pairs of hands. We were to need them all.

I used the short delay to obtain some details. The lady, who looked about 60 years old, told me that she was actually 38. I asked her if she knew how much she weighed, and she told me that two years earlier, weighed on special equipment, she had topped 36 stones. (504 pounds) I considered it a conservative estimate, that this would have increased by one stone per year, so judged her to be around 38 stones that day. One stone for each year of her life. She told me that she had stopped going out approximately fifteen years earlier, when her size became embarrassing. At the same time, her boyfriend had left her, and she had become depressed. At no time did she admit to overeating, and remained adamant that it was Diabetes, and an unknown glandular irregularity, that had caused her to grow fat. I explained that it was going to be difficult to extricate her from the flat, and asked her to have patience, and to try to remain as calm as she could.

The Fire crew brought a large canvas tarpaulin, and we decided to tie two of our carrying canvases together, and place one inside the other. With the extra help, we were able to get her slid onto the contraption a lot easier than before; but it meant that she had to lie flat on her back, and this was going to make it difficult for her to breathe properly, as the huge roll of fat around her neck would move upwards as we lifted, effectively suffocating her. One person was designated to keep hold of her chin, to stop this happening. It wasn’t going to be easy. We did the lift off the bed, and over onto the floor, near the window. The council workers had not arrived, so the whole frame had been removed with a crowbar, and carried out into the street. We split the team in half, and some went outside the window, into the small front basement entrance, ready to stabilise the patient, as we lifted her through. This failed to work on the first try, and they all had to come back. We then managed to all get a hold on the tarpaulin, and had to step over the low window ledge as we went through.

We still had the worst part to come, and the lady’s condition was not improving. We had a rest, mainly to calm her down, and to change the oxygen cylinder. It was obvious that we were not going to be able to haul her from basement level, up and over the railings onto the pavement. We had to attempt the narrow staircase, and a final lift over, once we got to the gate at the top. This did mean that we would have to divide the team, as well as bringing in the two Policemen who had been closing off the road. With six on each side, and one trying to hold the chin, we finally managed to get over the fencing, and put the lady down onto the pavement near the ambulance. The effort had been enormous, and it had also taken its toll on the patient, who was now semi-conscious.

She had to be taken to hospital as a matter of urgency, but it was pointless to attempt placing her on the trolley bed, as it was too narrow; so we took out the bed, and left it outside the house. As the Police were awaiting the Council workers, to secure the window, they would look after it for us. With the lady as comfortable as possible on the Ambulance floor, we informed the hospital of our imminent arrival, and set off. The Fire Brigade crew had to go on to another job, but the other ambulances accompanied us, and porters assisted at the hospital entrance. They had to bring a full-size bed down from a ward, as an examination trolley would not suffice. After almost two hours, we handed over the patient, and returned to collect our trolley bed, completely exhausted.

Three ambulances, a fire engine, a police car, and a total of 13 emergency workers; all this to take one woman from her bed, into the care of a hospital.

She died later that night, without regaining consciousness.