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Lesser Souls

Marilyn Bowes is huge, that’s all.

You dread your responses to the little frame house where she lives at 711 East Oneida, and you’re dreading this one in particular. There’s no telling how much Marilyn actually weighs. Most scales range up to 250 or 300 pounds, and Marilyn exceeds that by a lot. You’re sure she’s over 500.

Marilyn has outside help from a home health aide several times a week, but at nights and weekends she calls 9-1-1 when she has various kinds of emergencies, mostly related to her size.

You’re wishing the oncoming crew had relieved you a little early. Your daughter is graduating from grade school this morning, and you don’t want to miss her big event. You’re in no mood for Marilyn. Your partner wheels the ambulance south on Third and east on Oneida, and soon you’re retrieving your gear from the curbside outboard compartment. You grunt as you plod up her sidewalk and ascend the concrete stairs that lead to her front door. Ding, dong. You ring her doorbell, and a small, whining voice pleads for you to come in.

As soon as you comply, the unmistakable odor of melena hits you like a wave. Sure enough, Marilyn’s lying on the floor in her back bedroom. She feels awful, she says; she doesn’t remember how she got on the floor. And this time, her mucosa are as white as the linen on her bed. She’s diaphoretic, she’s confused and she’s slimy. Her big body and the carpet around her are covered with the telltale black feces, and she’s clearly in trouble. You’re relieved to hear the sound of the engine company’s Jake brake as they arrive out front. Marilyn doesn’t fit through her 30-inch doorways when you’re not traversing corners. Nevertheless, within minutes you have her on a salvage cover, and you’re sliding her down the carpeted hallway.

“I’m sorry,” she says. “I’m so sorry. I prayed to God I could die.” And you’re thinking to yourself, that could happen.

Q. We have several fatties in our service area. Mind you, they’re gigantic—not just overweight. Any one of them could be an EMS career-ender. How do you not harbor some resentment against people who take no responsibility for themselves, their diet and their need for exercise?

A. That’s quite a leap in judgment. I sympathize with your predicament; people are getting bigger, and we do seem to be seeing more today who are morbidly obese. They require bigger responses, different equipment, more advance planning and better people skills. But if there is one thing that’s sure to end your career, it’s allowing yourself to judge people you don’t know.

Q. What do you mean, judgment? I’m not judging anybody, I’m citing a fact of life. This lady didn’t get the way she is overnight. You eat too much, you lie around doing nothing all day, you ignore your responsibilities and you get fat. Eventually, somebody else has to clean up after you. People who weigh a quarter of a ton pose unacceptable risks to people who have to move them. I don’t have to like it.

A. Obesity seems so simple when you hear about it from health insurance companies. As they explain it, obesity is the product of a simple imbalance between energy in and energy out. It’s our responsibility to manage that, stay as healthy as possible and live as long as we can. And life really is that simple for an “average” person. But for so many others, it’s anything but simple. For those who suffer from metabolic disorders, depression, the sequelae of child abuse, arthritis, alcoholism, genetic anomalies, cancer and scores of other plights, life can be arduous, painful and embarrassing. Health insurance companies aren’t in the business of caring about anybody. Health insurance companies are in the business of collecting monthly premiums from a majority of people who are likely to live a long time.

Q. OK, I don’t quite see it that way. But let’s say you’re right. We’re still the ones who are faced with the prospect of handling them, lifting them, moving them and surviving the added risks they impose on us. Some of them are downright disgusting. How do you deal with them, and keep coming back for more?

A. Some people can’t. For the rest of us, it’s enough that they’re people, and they’re in trouble. Any given day could be the first time anybody’s been nice to them in years. It’s a gift. It’s our work, and it’s what we do. Every one of them reminds us, every time we see them, we’re so lucky. So lucky.

Most of us kinda like that.

Thom Dick has been involved in EMS for 41 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. E-mail

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