Supersize It

You remember that joke from the House of God about the patient who had a blood pressure of “Patent Pending/150”? For those who never read the book (You better read it): The words “Patent Pending were written at the top of the mercury column used to measure the blood pressure. Since the column would go no higher than this then the man’s blood pressure was “Patent Pending/150”.

So when I walked in one morning and checked my census it was no surprise that there was an extra patient or two, there usually are as the admissions that came in over night get assigned. Looking over some of the information available on the system I noticed something peculiar, and frightening. The official weight of my new admission was “>800 pounds”.

I know, you curious as to why use the “>” sign as opposed to an actual exact weight. In short, our beds can only record weights up to 800 pounds, anything over gets recorded as “Who knows, god help you” or “>”.

At first I was sure it was a mistake. Must’ve been someone who was trying to enter 80 and simply, mistakenly, pressed the zero an extra time. Could this be real? Can any human being really be bigger than 800 pounds?

When I arrived in the vicinity of the room I could already smell the stench. There was a smell that was slowly charging upon the ward and it was terrible. At that moment I had a bad feeling that this was probably the real thing. And it was.

Laying in bed, in moderate respiratory distress, was the biggest person I’ve ever laid my eyes on. His bed took up the entire room, it was the width of one and a half hospital beds and it was barely holding his massive thighs from unhinging the railings. Mr. Micheal K. had a very bad case of asthma. He was wheezing heavily. I could hear him from across the room.

I introduced myself to the giant who quickly turned out to be a gentleman of large proportions and I told him the treatment he would receive and that I hope that he’ll respond quickly and that we could return him to his home as soon as possible. I proceeded to do a physical and had to change sides of the bed to finish my abdominal exam. Palpating anything in his abdomen was impossible. My note said something like “Wheezing bilaterally, cannot effectively examine rest of patient”. I hoped to get him out fast.

Boy, little did I know.

Later on that day Micheal had a massive upper GI bleed. Finding veins for a large bore IV was impossible. Central lines were too difficult but luckily some poor surgical intern was finally able to do it, somehow. We began repleating blood. “Page GI! STAT”.

Micheal was getting worse by the minute. He had multiple large black bowel movements and was vomiting blood by the buckets. Getting a blood pressure was also impossible. Even our largest cuff didn’t come close to being appropriate. Any CT scans were out of the question since Micheal would probably break the machine and certainly would have severe difficulty fitting in the CT machine.

Due to his severe asthma, doing an Endoscopy was very dangerous and the Gastroenterologists would only agree to do it if he as intubated and only if it was done in the operating room. Somehow we pushed the bed through the halls and up to the operating suite. ENT came to do a nasotracheal intubation which was nearly impossible. It took the chief ENT resident nearly five minutes to find his trachea. Micheal couldn’t be anesthetized due to his pulmonary status and was writhing in pain from the intervention. Finally, he was intubated, awake, and bleeding.

The Gastroenterolgists went in. It took a little time but eventually we found the bleeding Duodenal ulcer that was causing the mayhem. It was cauterized and the bleeding stopped. Micheal was extubated and in severe respiratory distress.

He somehow came out of it after some asthma treatments. The rest of the hospitalization was unremarkable. He left three days later. I don’t know where he is or if he is. Hope his situation had improved but I’m a pessimist.