Cut Down to Size

doctor-73117_1280This was not a doctor’s office. It was a medical vortex.

A geometrically surprising reception sat in the eye of the storm, with a female positioned in each of the five vertices, directing patients to their next stops with the boredom inherent to their trade. The welcome area was bordered by numerous patient destinations. From my vantage point, I could see the blood lab, Office A, Office B, Office C, and the pharmacy. But based on the size of the place, beyond those zones may have been Offices D-Z, the insurance paperwork shredder, and, inevitably, the morgue.

The last physical I had was six years earlier, when I graduated from college and didn’t know where my next source of health insurance would come from. What brought me to Mordor Medical¹ last month was a clever ploy by my present insurance company. They came to my place of employment (a college where I work in the advisement center and teach creative writing courses, two half-time gigs that together don’t make a whole. In other words, no health insurance — luckily I married a math professor) and provided blood pressure readings and lipid smears to salaried employees and their spouses. Somehow, all of my colleagues walked out with a slightly stunned expression, a few even pressing their index fingers against their carotid arteries — perhaps dubious, after such extreme results, that they might actually find a pulse. Never before had our cholesterol been so high. Never before had we been diagnosed with hypertension. I suspect the insurance’s “unofficial” instruments were finicky at best but, in any case, the first thing we all did when we arrived back at our desks was to make doctor’s appointments. The second? Wait for notification that the cost of our insurance would increase.

Standing in a medical facility after three doctor-free years of health insurance, I finally realized how poor my coverage actually was. Long Island is famous for superficial beauty: unnaturally straight hair singed by an iron, smelling of Herbal Essences and char; orange skin glowing from overexposure to a UV lamp (and, incidentally, also smelling of char); clothes as tight as sausage casing; pink glossy lips; thick black eyelashes curled up to tickle shadowed lids; breasts padded, cinched up to chins, and glimmering with body glitter; fingernails hidden by long plastic caricatures of themselves.

But these stereotypes were nowhere to be seen — I was surrounded by Long Islanders who couldn’t afford their own reputations. You don’t worry about lip balm when you have no teeth. You don’t slip on stiletto heels when you have a limp. You can’t look like a Real Housewife when you are homeless. One man wore a ratty muscle shirt with armpit stains down to his hips. And not even new wet stains. Old yellow stains.

My health insurance served the dregs of society. And professors, apparently.

I wondered how seamlessly we fit into this rag-tag group of Long Island vagabonds. Phil, my husband, a math professor from upstate New York wearing the same Life Is Good t-shirt for the fifth day in a row, and me, a struggling writer from Connecticut with three book manuscripts just waiting to be picked up — young newlyweds transposed to Suffolk County for the only professorship available in an over-saturated market.

“Remember when having a PhD meant something?” I asked Phil while looking around the room.

“How old do you think I am?” he said.

The facility itself matched its customer base. Everything from the threadbare chair cushions to the fluorescent lighting produced a bland atmosphere, bordering on dismal. This would be augmented later when I was administered a vaccine inside a utility closet while sitting on a metal chair beside the personnel refrigerator. On the bright side, the nurse would simply have to reach over my head to grab a needle from the supply shelf.

But I’m getting ahead of myself.

First, inside a typical exam room, the nurse took my blood pressure. The cuff didn’t even tighten around my bicep before she announced, “120 over 80.” Since (allegedly) high blood pressure was part of what inspired me to make this appointment, I was skeptical that my numbers happened to coincidentally be the most common reading for ideal blood pressure. But I thought, “I’m fairly young. Even if my blood pressure isn’t exactly 120/80, it’s probably fine enough.” Then the nurse asked me to step on the scale — without inviting me to shed clothing, which I found…discourteous. What had I done to offend her? As if that wasn’t enough, the slider fell between two numbers, and she rounded up. Just plain rude. It was after breakfast and I was wearing jeans. Give a girl a break. Especially considering the round up landed me in a higher bracket. There is an entire identity between 149.5 and 150.

The doctor arrived. She skimmed my chart and then peeled back the sole sheet of my medical cliff notes to see if anything more interesting than my weight and profession was hiding on the backside. Disappointed, she said, “You’re a writer, huh?” She motioned for me to lie back on the table and parted the paper gown to check for breast lumps. I stared at the ceiling, trying not to feel like cake batter. The doctor said, “My son’s a writer. An excellent writer. He has a gift, really. He got it from his father, and he from his father. All excellent writers. It must be in the genes. Not everyone can choose the right words and put them together in just the right way, you know. It can’t be taught.” I was glad, at that moment, that I hadn’t included in my medical history the fact that I (try to) teach writing. The doctor was satisfied with my left breast and shifted to the right. Her eye twitched, for the second time within two minutes. You really should get that checked out, I thought.

“So there was something I wanted to talk to you about,” I said, directing my stare above her head until my nipples were no longer exposed. “I’m really tired. I often struggle to stay awake until 8pm, and then I’m out for eleven or twelve hours. Easy.”

“It’s nothing,” she said and waved her hand. Now there were three boobs in the room. She stepped back to indicate she was through; I sat up and I tightened the gown in front of me.

“I sleep a lot,” I said, in case she hadn’t understood what twelve hours a night really meant.

“Hormones,” she said, and scribbled on my chart. What is she writing? I wondered. That I have hormones?

“Maybe,” I said.

“My son doesn’t write professionally.” Her pen stilled on the paper and she looked up at me with a fond smile. She was remembering something — a child’s poem written inside a red crayoned heart, a short story marked with an A and stuck to the fridge — not the lethargic half-naked leg-swinging patient on her table. “He’s an investment banker on Wall Street. He travels a lot, so doesn’t write as much as he used to. It’s hard to keep up with hobbies when you work. You know?”

I didn’t, since I dedicated countless hours to my “hobby.” I pressed my lips together and opted against informing her that those of us who try to make a living out of a hobby prefer to call it a vocation. It would only confuse her, because once her investment banker son, an excellent writer from a long line of excellent writers, cranks out a novel and makes a million dollar book deal over a weekend and starts lunching with Nicholas Sparks and Dr. Khaled Hosseini, she’ll jump straight to calling it his second career. No need to learn new terminology. Besides, she was disinterested in me and my opinions. Her indifference was off-putting, but all her son-talk was just plain cliché for someone named Rosenberg. And, as I’m sure her future Pulitzer Prize-winning son would agree, clichés are as dull as dishwater.

She took a brief family history, and when I named Addison’s disease as one of the various ailments plaguing my father, she said, “Oh, I feel sorry for him,” and sounded like she meant it. For that moment of sincerity, I almost forgave her for dismissing my earlier concerns. But then her lips turned up in a sly smirk. “Do you know which American president had Addison’s disease?” she asked as if the answer might win me an all expenses paid trip to Hawaii instead of an ounce more insight into a genetic disorder that has the potential to progress into something called an Addisonian crisis.

“Kennedy,” I muttered.

“That’s right! It’s why he was always so nice and tan.”

Your dad risks falling into a coma, but at least he’ll have a nice glow about him!

Then, somehow, it got worse.

She faced her computer and reviewed the facts the nurse before her had inputted. “150 pounds?” she said. “You’re overweight. People who are 5’6 should only weigh 130. You need to lose 20 pounds.”

My stomach contracted. I hadn’t been told to lose weight that bluntly, that irrefutably, since I dated a Brazilian. And it had been that long since I felt ashamed of my body. I knew I wasn’t skinny. I’ve never been skinny. But twenty pounds overweight? How hadn’t I realized that? Sure, I prop my hand on my waist for photos and I don’t like to look at myself sideways in mirrors. But I rock climb and kayak and play tennis. A folding chair collapsed underneath me once, but that was shoddy craftsmanship. Wasn’t it?

I crossed my arms over my torso. The gown crinkled against my apparently pudgy thighs and tears pricked my eyes. I hadn’t cried in six months — not since my first book was released and only purchased by people who shared my last name. I gritted my teeth to keep control.

But the not-so-skinny-herself doctor just wouldn’t shut up.

“So smaller portions, stop eating fast food, and start working out. We have weight loss classes here. You should join one,” she said.

I swallowed down the knot in my throat. There was so much to contest in her prescription. She hadn’t even asked me about my diet, my lifestyle. Admittedly, she was spot on about the smaller portions (a serving size of ice cream is half a cup. Who eats only half a cup?!). But I never eat fast food and I workout four times a week. I’m not a confrontational person, but I had to say something. I had to defend the self that had taken me twenty-five odd years to feel somewhat comfortable with.

“I exercise,” I managed to say, just above a whisper.

“Oh,” she said in an exhale — a sort of laugh. “I guess it would have been a lot worse.”

Not everyone can choose the right words and put them together in just the right way, you know?

Emotion rose thick and hot up my throat.

No matter my weight, I’d always thought I needed to lose ten pounds, even when I actually was 130 — a number I only hit the year I was depressed (dumped by that Brazilian) and not eating. But ten pounds seemed a reasonable goal. Manageable, but also a dream, because I never successfully lost ten pounds, despite my ambitions. But twenty? Impossible. I tried to imagine that amount of weight. Twenty boxes of pasta. Four bags of flour. The sack of Carolina Rice Stop and Shop keeps on the bottom shelf — a quantity I never buy because I’d struggle to lug it up my apartment stairs.

I needed to lose more weight than I could comfortably carry.

I nodded through whatever the doctor said next, forcing smiles and grunts of affirmation. When she finally left, I pushed myself to my feet and yanked on my clothes, feeling large and clumsy, a great big fleshy monster. I stumbled into the hall, desperate for the exit. Shamu on the loose.

But I was entrenched in the maze.

I staggered in one direction that ended in a cul-de-sac of offices. Medical personnel looked up at me from their desks, the lost patient, trembling inside a too tight t-shirt. I gripped the ends of my ponytail. My hair looked better loose. Why hadn’t I let it hang loose? I spun and retraced my steps back toward the exam room, praying the doctor had already left. I couldn’t bear to see her face again. You’re overweight. Lose 20 pounds. I swung a left and sped down a corridor that brought me to a bathroom. I stared at the faceless figure of the restroom female, her stick legs emerging from beneath the dress that began narrow in the waist and flared in the skirt.

I can’t stop exercising. I can’t ever stop exercising.

I rushed back down the hall, took another left, and grabbed a woman in scrubs by her wrist. “How do I get out of here?” I asked, frantic.

Phil was sitting in the waiting room, having just finished with his own physical. (No weight loss necessary, by the way. Damn high metabolisms.) As I escaped the labyrinth and reached him, tears streamed down my face.

“What happened in there?” he asked, his eyes searching mine.

We hurried out of the center and across the pavement toward my thirteen-year-old Honda. The rusty door screeched its hostility as I jerked it open. And I blurted it out. All of it — the bad health insurance I couldn’t even earn myself; the Long Island we didn’t want to be our home; the over saturated market for academics; the writing that can’t be taught; the investment banker who was sure to be a bigger success than me; and the twenty pounds. The twenty freaking pounds.

I was a different person after that appointment. I don’t know whether the doctor distorted my vision or focused it, but I felt decidedly unlike my pre-appointment self. My body was heavier. I took up more space in a room. I saw how wide my thighs spread as I sat in the passenger’s seat of my car. I watched my belly collapse forward. My swollen face appeared in the rear view mirror, additionally puffy and red from crying. It grossed me out. I averted my stare.

I remained weepy for the rest of the day and mopey for about a week. My husband’s reassurances were rational — the doctor was just another factory worker in that complex. She didn’t even take the time to look at you. Not all women of the same height should be the same exact weight. You’re active. Healthy. You’re beautiful — but they didn’t make a difference. My reflection took up more of the mirror than it had before. I felt slower, clunkier. Chunkier. I studied my bellybutton: the top sagged like a deflated tire. How I wanted a perfectly round, perky bellybutton! I saw how wide my upper arm looked when it expanded against my side, the faint shadows of cellulose dimples emerging. I had noticed all those things before, but only in passing. What had been in my peripheral vision was now the focal point of my attention. All images were a portrait of my newfound weight problem, and what I saw disgusted me. A self-loathing that had dissipated long ago flared up like the symptom of a disease that lurks in the shadows, dormant, but never really gone.

Low self esteem herpes.

And the doctor is fortunate it was just that — a bout of uncertainty she flicked on like a light switch. She didn’t know me. Her knowledge was limited to a sheet of paper marked with 150 lbs, writer, and checks in the family history column beside diabetes and cancer. If I were a different person, a different patient, the damage could have been far more severe than a battered ego. I wonder if she’s given our visit a second thought. If she’s given any of her visits a second thought.

It’s been a month now. Long enough that I can bring myself to write about it, but not so long that I’ve felt pretty again. I’ll get there. But I’ve been reminded that insecurity doesn’t end in our teens. It doesn’t end with marriage. It doesn’t end when you finally, consistently, feel good about yourself. That wound is profound, carved deep by years of Victoria Secret catalogues, cover girls, and cultural norms that perpetuate comments like, “You’re much prettier in person than in your author photo.” (Okay, but what did you think of the book??) Its scar tissue is a thin membrane, subject to tearing. When it rips, the pain is sharp and familiar.

That throb has subsided, or receded, anyway, into the background of other pulsing concerns. Issues that take precedent over beauty: questions of identity and purpose, career considerations, and the well-being of those people represented in columns on my family history page. But when the world quiets, when its hum stills, I feel the ache of her insult.

But, if I didn’t admire my physical self at 130 pounds, if there is going to be the same dull dissatisfaction about my appearance no matter my weight, I might as well be 150 and enjoy chocolate, right?

The medical center mailed me a questionnaire about my experience. It was the first time I’ve been surveyed about a doctor’s visit — although, as I mentioned, I don’t have much practice. I evaluated that physician just the way she deserved.

And she thought I was soft.


1 Mordor Medical is a fictitious name, which the author assigned to the real clinic referenced in this story for the purpose of protecting the clinic’s reputation. 


Alena Dillon’s work has appeared in publications including The Huffington Post, The Rumpus, The Long River Review, Squalorly, and Pithead Chapel. She earned her MFA from Fairfield University and teaches creative writing at St. Joseph’s College in Long Island.