The following article describes one individual’s medical experience. It is not intended as an endorsement or recommendation of any pharmaceutical or course of treatment. Always consult a physician before beginning any new medication.
A methylprednisolone medrol pack is just a flimsy foil case of 21 little, sour, white pills. If someone would have asked me a few weeks ago which prescription would be the key factor to beating pneumonia, I wouldn’t have pointed to that dinky pack of steroids. The loud roar of my nebulizer with its heavy, stable base, sterile tubes, and burdensome mask seemed more official. The indestructible metal canisters of my brand new inhalers looked more impressive.
I felt sick on March 10, a Tuesday. It wasn’t the kind of sick that anyone takes seriously. It was a shruggable dry cough in late winter. Yes, there were some articles floating around about some distant virus, but it was on the West Coast. It was overseas.
By Wednesday, I was pretty sure I had a fever, and my coughs became more painful, noisy and dramatic as the day continued. I lost my sense of taste almost completely and was short of breath. My spouse ran out and got the only flu medicine still available at our local CVS where no thermometers remained on the shelves. While I rested at home, I navigated emails and decisions about canceling meetings, classes and other plans.
By Thursday, I couldn’t take more than a shallow breath and I was spitting up globs of mucus into washcloths multiple times per hour. By Friday morning, it was challenging to eat without becoming fatigued ― without losing too much air to manage chewing. I finally queued up in a three-hour virtual waiting room to speak with a doctor via a telemedicine app. She diagnosed me with viral bronchitis in less than five minutes. I was quickly prescribed multiple medications to combat my worsening respiratory symptoms with instructions to check back if I did not improve.
I’m newly 29 without any high-risk diagnoses, but even with a pharmacy at my bedside, pneumonia developed in less than two days. With scarves wrapped around my face, I ventured out for an X-ray of my crackling chest and additional testing that was uploaded to the remote doctor. She decided I should be monitored more regularly while self-isolating and continued my treatment as a presumed positive for COVID-19, the disease caused by the coronavirus.
By the last day of my steroids, improvements were obvious, but the progress would be short-lived. My steroid pack finished its course on the morning of the 18th, and within 24 hours, I began to regress. The mucus in my chest grew darker and thicker again, and inflammation made me gag and choke as I tried to expel it. My chest rumbled on every exhale, and breaths became almost as shallow as they were before I sought treatment.
Because it wasn’t time for my scheduled check-in with the same doctor, I had to wait in another virtual line to speak with whoever became available if I wanted to avoid the emergency room.
After a few hours, I was finally connected to a provider who checked in with me about my medical history. She told me that she’d reviewed the notes and watched the recordings from my previous visits, then asked about my vitals ― which can be monitored through the app ― before getting to my reason for the visit. I explained between achy pauses that I was going backward ― and quickly ― but she shooed away my complaints.
I was more direct. “Can you extend my steroid prescription for another week? I think that was key to helping push through this.” She immediately shook her head and interjected:
“I don’t recommend that. That medication could lead to weight gain.”
I asked again. She declined, shifting the conversation toward the steps I could take to limit the spread: hand-washing rituals, daily disinfecting routines, social distancing.
When the session ended, I felt abandoned, furious and confused. While my mom and spouse networked so that I could find a new provider, I started researching the intersections of viral pneumonia, steroids and weight. I couldn’t even find concerns about weight gain for short-term users ― but I wouldn’t have cared if I did. I knew this drug was treating the inflammation associated with my most severe respiratory symptoms and shifting my immune response, that this steroid was helping some patients with COVID-19-induced pneumonia recover more quickly. I posted to Facebook about my frustration.
Comments were mostly supportive ― with face-palming gifs, shocked and angry emojis, words of solidarity. One mentioned malpractice; a few noted that they now opt out of weigh-ins for check-ups; some people told their own stories of medical and mental health providers bringing up weight when it was irrelevant and inappropriate. Another shared their fear that heavier people might not receive access to ventilators during shortages because they’d be misperceived as having poorer prognoses.
A few more friends chimed in to play devil’s advocate ― trusting that there must be a reason for the doctor’s comment. A relative explained that although it may have been poor bedside manner, the doctor could be worried about weight gain leading to future health issues, such as Type 2 Diabetes. A nurse mentioned that people with a body mass index (BMI) over 25 have worse outcomes and higher mortality rates ― but a recent study asserts that those categorized as “overweight” (with a BMI of 27) are at the lowest risk for all-cause mortality. Additionally, obese patients have better outcomes when being treated for a variety of ailments ― including significantly lower mortality rates when treated for pneumonia ― the illness this doctor should have been focused on.
Fatphobia will continue to negatively impact the quality of care all people receive if providers are distracted by weight standards or cultural ideals.
People with higher weights receive a lower quality of care from their providers ― including delays in access to treatments ― due to cognitive bias. This could be the cause of those worse outcomes and comorbidities my friends are worried about. During this pandemic, when health care providers are deciding whose symptoms are most urgent and severe, lack of access and decreased quality of care will cost lives.
The comments in the doctor’s defense point to the internalized belief that being fat is bad, that being fat leads to other bad things. They point to subconscious patterns of thinking that guide flawed decisions, such as placing too much concern on some future weight rather than recovering from a tangible virus. We must stop justifying the health care industry’s obsession with weight ― and that starts with combating our own tendencies toward the same beliefs.
I didn’t include my weight in the vitals connected to the app, so this doctor didn’t actually know that number or my BMI. She could only see my face on the screen. I suppose it’s possible that she made an inference about my weight based on a bad camera angle ― but her statement was more like a reflex, absent of considerations about my own body or experience.
Since she couldn’t actually size me up with her eyes or a number, she made the assumption that any gained pounds wouldn’t be OK for anyone ― no matter their shape or weight. In that moment, she projected a cultural ideal onto my treatment ― encouraging the belief that it would be better to maintain my size than conquer life-threatening pneumonia.
If you are a patient whose treatment is being stifled by a biased provider, you should seek care elsewhere ― but that’s easier said than done. My call wasted $50, and a second opinion would cost another ― or a much more expensive trip to the ER. What will happen to those who don’t have that kind of cash? Or time?
Fatphobia will continue to negatively impact the quality of care all people receive if providers are distracted by weight standards or cultural ideals. During a global pandemic when actual or virtual lines for health care consume hours and providers are even more overworked than we’re used to, we cannot delay treatment due to cognitive bias.
This doctor did not allow me to advocate for my needs, even though I was an informed patient. Her unwillingness to extend the use of a crucial medication during a pandemic demonstrates just how pervasive our cultural obsession with thinness has become.
It took a few more hours for me to find a new provider, who proved glad I reached out and helped me find the right dosing to extend the steroids a few more days. My most severe symptoms have dissipated, and I know that I’ll be OK in time. I trust that these providers will help me make decisions about my health based on preserving my life rather than my waistline.
But this experience serves as a reminder that if we hope to survive this pandemic, we must become fierce advocates who hold the health care industry to our own standards, unafraid to challenge the status quo.
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