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Here's a true story, happened about 10 years ago in a little nursing facility in California. We had admitted a middle-aged man who weighed 600 pounds (considered very morbidly obese). Our facility was very small at 85 beds, he required a special bed with multiple mechanical drivers for elevating different parts of the bed, and that could hold up to 1000 pounds. At this facility patients come for three reasons: to just have a place to live and retire because they need a little help or have a relative living there already, they come to get over some problem like a broken hip or medical issue that prevents them from being alone but not enough to be in a full hospital, and lastly they come to die.

At the time, we were well know with the case managers at the hospital for the dignity and respect we always had shown to all persons, but mostly to those who were ready to die.

He had been diagnosed with colon cancer, hepatic cancer, cancer of the lymph nodes and it had generally spread everywhere. For the most part, being morbidly obese prevented him from having surgery plus his insurance plan refused to cover it ... and honestly, he didn't want it. He would tell us on a daily basis he was ready to die, his children grown and wife had divorced him years previous. He was unable to work any more because of his weight and felt that his life was complete at age 50 - regardless of how much effort the psychiatrist worked with him.

His belly was extremely distended and bloated, it looked painful for him to roll in the bed or even pull his head up. The hepatic and renal failure were becoming obvious. He had been a direct admission from the local hospital. His admission notes were that he was constipated and had not had a bowel movement in several days regardless of the medications they tried on him (short of forcing pure concrete down his gullet...)

Within a week we had begun to note an odd smell about the man. The nursing care was really good, everyone liked this very pleasant person. A few weeks went by and we noted a decrease in his blood pressure, increasing smell and he was gradually becoming even more lethargic by the moment; the entire staff knew we were gradually loosing him and felt helpless except to offer support as he passed away.

Of interest is that this man kept his appetite and continued to eat three meals a day, including fruits and prunes ... he wanted whatever he could get. Plus friends continued to bring him whatever he wanted, pizza, junk food, you name it. His physician had thrown up his hands in despair as he could not get this guy to participate with the diet. The patient's feelings were that there was no purpose in dieting at this point when he was under a death sentence from the colon cancer.

Finally, three weeks after admission it was my shift and I had gone in to check on him during rounds. He was unconscious, there was black rash all over his abdomen from the death of the intestinal track, he was extremely lethargic and appeared to be going into septic shock. I reached over to shake him on the shoulder to see if I could get any signs of awareness when the man began to vomit, and vomit and vomit up the entire three weeks worth of decaying food material that was in his intestine. Believe me, I backed up to the door very quickly and yelled for help and went back to his side to elevate the head of the bed.

Eventually he choked to death on the combination of fecal material, pus and blood from the dead intestinal track. Even after we were able to confirm his death, the material continued to be forced out from the sheer weight of the fat over his abdomen for a good fifteen minutes. None of the other nurses was willing to try to slow this, we felt it better to allow it to all come forth. I had to excuse myself several times in the initial few minutes to compose myself rather than heave.

He never did have a 'normal' bowel movement. I had expected to see this after the death, but there was nothing. Apparently a complete blockage.

The funeral home was called in to remove the man's body and that required everyone to wear disposable clothing and boots, along with 3M masks and goggles ... much like trying to work in the center of a septic tank.

We had to remove patients from the entire wing of the room, open all the sliding glass doors and windows, remove furniture from the entire room and let most of the smell out before the cleaning team could get in. I've had to have my home septic tank emptied, but this smell was much, much worse than anything I had ever smelled before. This wing of the facility remained open to the air for several days, and needless to say there was some inconvenience to other occupants in adjoining rooms.

Most of us could not get near this area without feeling like wanting to retch and to this day I cannot look at a morbidly overweight person without having the telltale signs of nausea beginning.

Fortunately I've never had to go through that kind of death with a patient ever again, and this event was so traumatic to me that it is a sheer guarantee that I'll never complain about any scope any doctor wants to do. Somebody want to send a light bulb up my bum? I'll do the prep myself and hop right up on the table rather than live with what happened to this gentleman.

-- JS

credit given to original author if known

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