Unintentional Weight Loss

I held my grandmother’s arm
to steady her
as she wandered through the aisles of the outlet store
proudly picking out
clothes in smaller sizes.

But her weight loss was not a sign
of health, vitality, youth.
She was dying
of breast cancer.

I had seen the PET scan with its bright spots of metastatic disease everywhere —
bones, liver, lungs, brain.
I had seen the Kaplan-Meier survival curves
projected on big overhead screens
in large, dark lecture halls
– rational, numerical data, devoid of human suffering.
I had covered her nearly bald head with scarves
and emptied the chamber pot next to her bed
when she was too weak
to make it to the bathroom at night.

I knew this weight loss meant
the cancer was consuming
all the nutrients and energy
she needed to live
and chemo, with its accompanying nausea,
made it nearly impossible for her to replete this energy deficit.

I knew she was dying

As she scrutinized button-downs,
I steadied her, looking on
with a mixture of respect and embarrassment,
surprise and guilt and heartbreak.
I couldn’t blame her; I didn’t judge her
for the pride she felt at finally
shrinking her body.

I was well acquainted
with that aching,
longing-to-be-smaller-
body-too-big-never-good-enough-
feeling.

The first time someone told me I was fat,
I was eight.
The shame and humiliation I felt
drove me away from my beloved leggings
and into the dreaded stiff, thick fabric of jeans.

This was my first lesson in dressing my body not for myself, but for others.

The first time I counted calories I was 12.
I hid my sweaty middle school body in oversized hoodies
that I refused to take off no matter how hot I got.

By the time I reached medical school, I had engaged in a spectrum of disordered eating behaviors,
had internalized all the stereotypes (like a good little fat girl)
“lazy, weak-willed, uninformed, no-self-control”
and had learned to blame myself for others’ unkindness
people would treat me better when I was better (thinner), I told myself
(an irrational reclamation of control)

So, when the nutrition education came with a healthy side of fat-phobia
and dietary log assignments brought back destructive thought patterns
and fat jokes about “double deuces” and “Utah Units”
came over microphones from the mouths of professors

I knew how to endure. How to avoid scrutiny over my eating and my body
how to shrink myself
to package my personality for maximum tolerability
to make up for my physical intolerability
how to turn all the of hurt and frustration and feelings of injustice
inward – how to hate myself
so no one else could hurt me like I hurt me – how to protect myself

Now, in my third year, I’m continually meeting new residents, attendings, and patients
who have just moments to size me up
and decide if they find me worthy or wanting.
I have no way of knowing for sure how their unconscious biases impact these evaluations of me

I also see first-hand, how
the system of medicine (drenched in the cultural narratives
which hurt me so deeply)
harms patients every day
I’m feeling
inspired
to unlearn and relearn the stories
I know about health and size and weight.

I’m discovering small ways to let my personality shine
and finding, in the process,
that I am done
allowing others to dictate my worth
to shame me into shrinking, hiding

I alone define my worthiness
and I say, “I am worthy.”

worthy of leggings
and clothes that fit
worthy of mac-and-cheese
and dessert and love
worthy of taking up space
and of being heard
worthy of shedding the burden of others’ opinions
and feeling that weight lift off my shoulders
worthy of an MD behind my name.

My grandmother died last year, on hospice at home in her bed
She was feisty and funny,
and a little high maintenance – the way only the best people are
a teacher to the end
and absolutely worthy of taking up space,
worthy of acceptance and love.