You made the unfortunate mistake of being in my way.

"The devil is real. And he’s not a little red man with horns and a tail. He can be beautiful. Because he’s a fallen angel, and he used to be God’s favorite."

The Skin Walker

'Of bleeding stone and tattered skin, he walks amongst the Rubicons.'

I respect your diversity to the extent the law requires.

Being contrarian while hiding behind the guise of being sensitive to others or on others' behalf is pretty annoying.

Let’s talk a little bit more in depth about how obesity affects surgical procedures.

In most serious, intensive surgeries, you’re probably going to be under anesthesia, right? And you’re probably going to have medications to take afterwards. Stuff like this filtered through the kidneys and liver.

Obese patients have much higher rates of renal hypertension, which affects the kidneys, and morbidly obese patients have a 90% likelihood of having abnormalities in their liver.

That all adds up to a really bad time, and drugs being filtered out of the system quicker and therefore not working as intended. And you really want your anesthesia to work right when people are cutting into you.

In addition to this, some weight-based drugs are affected by fatty tissue, and some are not, so this can cause problems in determining the proper dosage.

Obese patients are at a higher risk for deep-vein thrombosis – this is when a blood clot forms in a deep vein, like in the leg. Surgery is recognized as a risk factor for DVT, and so obese patients undergoing surgery are doubly at risk.

Finding veins in the patient is also made difficult – it’s the difference between finding the edge piece in a 1000 piece puzzle, vs finding it in a 100 piece puzzle.

It’s harder to monitor blood pressure in obese patients as well, as standard cuffs may not work due to there being too much fatty tissue between the blood vessel and the cuff.

When you’re performing surgery, you have to pull back the flesh and muscle to get to where you’re trying to operate on – the more you have to pull back, the more difficult this becomes.

This image shows how much more you’re having to work through when doing an operation on an obese person:



So no, it’s not a matter of doctors being bad at their job. Surgery by itself is a difficult and risk-laden process – adding obesity on top of that adds an uneccessary layer of additional risk and complexity.

Sources:

Palmer M, Schaffner F. Effect of weight reduction on hepatic abnormalities in overweight patients. Gastroenterology 1990; 99: 1408–13.

Albert S, Borovicka J, Thurnheer M, et al. Pre- and post-operative transaminase changes within the scope of gastric banding in morbid obesity. Schweiz Rundsch Med Prax 2001; 90: 1459–64.

Gholam PM, Kotler DP, Flancbaum LJ. Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg 2002; 12: 49–51.

Ramsey-Stewart G. Hepatic steatosis and morbid obesity. Obes Surg 1993; 3: 157–9.

Clain DJ, Lefkowitch JH. Fatty liver disease in morbid obesity. Gastroenterol Clin North Am 1987; 16: 239–52.

Marik P, Varon J. The obese patient in the ICU. Chest 1998; 113: 492–8.

Ribstein J, duCailar G, Mimran A. Combined renal effects of overweight and hypertension. Hypertension 1995; 26: 610–5.

Braekkan SK, Siegerink B, Lijfering WM, Hansen JB, Cannegieter SC, Rosendaal FR. Role of obesity in the etiology of deep vein thrombosis and pulmonary embolism: current epidemiological insights. Semin Thromb Hemost 2013

Allman-Farinelli MA. Obesity and venous thrombosis: a review. Semin Thromb Hemost 2011; 37:903-7.

Potatriots : "If you don't love America, why don't you leave it?!"

Everyone else: "Because I don't want to be victimized by its foreign policies."

Postulation: an educated society to vote out Republicans; replace fundamentalist evangelism with intellectualism, skepticism and advocates of science; and evolve capitalism to manufacture critical thinkers and exploit human potential, resulting in the transition of the two-party political machine to machine learning via artificial intelligence toward a resource-based global economy, ensuring the survival and longevity of the Earth’s ecosystem including but not limited to monitoring and mitigating natural disasters on Earth as well as cosmic debris from our enveloping space environment so that ultimately we and the biodiversity of life we share our existence with (and because of) may expand our knowledge of and human presence amongst the universe to truly live long and prosper.

"I'm not bitter." He says, bitterly, with a bitter expression on his face.

Why do I support raising minimum wage? Because whenever I hear "You just work retail", it's insulting. It's like saying " Truck drivers just drive around for a living " or "Computer technicians just play with computers", it ignores everything people do in their line if work.

You know what I have to do? I'm a tailor, marking your clothes so they can be fitted for that job interview. I'm a baby sitter, watching out for your kids while your busy shopping to make sure they don't fall down the escalator or eat a handful of pins. I'm a computer technician, jury rigging and problem solving to make sure the twenty-year-old computers can ring up your purchases because the multi-billion dollar company I work for won't fix our replace the broken systems. I'm a fashion critic, giving you advice on how to color match, what to wear, when to wear it, how to wear it, and how to accessorize, so that way you don't march into your new job interview wearing jeans and a juggalo T-shirt. I'm psychiatrist, listening to your problems as you rant about anything and everything and expecting my input. I'm a customer service representative, getting screamed at for problems someone else caused (or more often, YOU caused) and now I must assuage your rage to make your visit a pleasant one. I'm a stocker, putting out the mountains of product we have, organizing it, sizing it, hanging it nicely, to make everything look great so you can barge through it, fuck everything up, and leave everything a mess before you leave. I'm a checker, needing to know what everything is priced, how everything is discounted, what to order, and all the steps needed to complete your purchase.

But rather then seeing us as people in a professional setting trying to make a living and running a business, you just see nameless faces doing grunt work. And so we have to smile at you, even though you're returning fifteen items, with no tags or receipts and you paid in cash, and you're infuriated that we're having difficulty completing your return. We have to smile at you, even though you have fifty items and twenty coupons, and there is a line, but you want to do sixteen transactions. We need to be polite and helpful, even though you came in the doors ten minutes before close and are here twenty minutes after we were supposed to have locked up. I nod and tell you "It's fine" when you say you need help carrying your twenty bags to your car, which you happen to have parked on the other side of the lot. I have to apologize on behalf of the company and listen to your sneering because you can't find one item on a sale day and we didn't carry that one item in the store normally for the nationally published catalog that got sent. We need to give you impeccable service, every time, while you are rude, belligerent, and obnoxious.

I have been insulted, threatened, and screamed at by customers. I have been burned, crushed, and stabbed on this job. I have metrics to meet, clients to appease, sales goals to reach, and bosses to make happy. I'm on my feet all day, I lift, have to think fast, be creative, be well-spoken and charming, and offer you service that will entice you to come back. I have to build displays while massively understaffed. I need to listen to customers telling me that I'm an idiot because their card was declined, because they are positive they paid the card off so it must be my fault. I'm given attitude because your coupon doesn't work, even though it says quite plainly that everything you picked up won't work with the coupon.

You want to know why I support raising the minimum wage? Because assholes like you make me DESERVE it. I bust my ass, every day, all day, and the last that could be expected is a wage that I can live on. So fuck you, you uppity cunt.