“No Fatties”: When Health Care Hurts - Longreads

Kasey Smith began gaining weight as a teenager. The numbers on the scale started increasing overnight, and no matter how few calories she consumed, they continued to go up. "It will even out," she thought, crediting the change to puberty and hormones. But it didn't, and her hair and skin began changing as well. "Something was definitely wrong."

Each medical appointment, and there were many, concluded with doctors telling her to go on a diet. Smith (not her real name) remembers telling the endocrinologist about her frustrations with burning off the 900 calories she consumed each day and still gaining weight. "He looked at me and said, 'Maybe you can cut back your McDonald's to twice a week.' I was stunned silent, and I went into the bathroom and broke down. 'He doesn't believe me. He thinks I'm just fucking with him.'"

As Smith's weight went up, her food intake went down. Her mother signed her up for Nutrisystem, and her diet hung on the fridge for everyone in her family to see. Shame and humiliation narrowed her life down to three questions: what to eat, what not to eat, and how to burn more calories. She began to form dangerous habits, sometimes eating little more than lettuce.

Smith ultimately received a diagnosis of polycystic ovary syndrome, a hormonal disorder that can lead to excess male hormones, irregular menstrual cycles, and weight gain. She was prescribed Metformin and quickly began to lose weight, but the damage had been done. The 18-year-old developed anorexia, leaving for college at 130 pounds and coming back four months later and 30 pounds lighter, her hair falling out in clumps.

No one thought anything was wrong.

"I would go to the doctor, and there were no red flags. It was 'You look fantastic!' Not 'This is alarming.'" Smith continued starving herself for another year until she ended up in the hospital, undergoing a colectomy to remove a foot and a half of her intestines, which had twisted as a result of her severe calorie restriction.

One year after the surgery, her worst nightmare returned: She was gaining weight. Celiac disease was the cause this time, but it wasn't diagnosed until after Smith was in the habit of purging the little food she ate every day. She would regularly run in the park and pass out afterward. "I would starve all day, then I'd eat something at night, then I would purge it. In my head, I'm thinking, 'I'm literally not consuming anything. The weight has to fall off.'"

She realized she needed professional help, and Smith found a therapist who specialized in eating disorders and began treatment at The Renfrew Center, a residential facility in Pennsylvania. She continues to struggle with discussing her weight at medical appointments. After she told her endocrinologist about her treatment at Renfrew, his reply was "I see you need to lose some weight."

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https://longreads.com/2017/10/26/no-fatties-when-healthcare-hurts/

How to Feign an Illness - The New York Times

"Research your symptoms," says Eve Muller, a Los Angeles-based actress who has been working in medical schools as a simulated patient since 1990. Bodies manifest ailments in recognizable patterns that medical professionals are trained to observe and diagnose. It is not enough to say your belly hurts; exactly where and how does it hurt? Stomach pain could be food poisoning, an ectopic pregnancy, pelvic inflammatory disease, appendicitis, twisted ovarian tubes or something else entirely. Know your malady's pathology and describe it with specificity. "You need to know anatomy," Muller says.

Before she interacts with students, a medical school gives Muller a detailed case study outlining the pretend patient's medical history, biography, symptoms and sometimes even scripted lines. Be similarly thorough in your preparation. If the condition requires a repeated physical action, like a limp or the trembling associated with Parkinson's disease, watch videos of real patients online and mimic their behavior in front of a mirror or on video. Use makeup, hair and clothing to help tell your story. "Look the part," says Muller, who paints bruises and rashes onto her body. She drinks yogurt smoothies to sound phlegmy if she's portraying someone with congestion. Sometimes she wears business attire; for other characters she jams dirt under her fingernails and rubs oil in her hair.

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https://www.nytimes.com/2017/11/03/magazine/how-to-feign-an-illness.html?