Anna MacAvoy

                                                Anna MacAvoy

        I had been working at the John Geetz Clinic for only a few months when Anna MacAvoy was admitted.  Dr. Geetz always welcomes new patients, though his age limits his functions in the clinic itself.  Head Nurse Diedre Daye however, doesn’t often come on these pick-ups, and simply her presence warranted a degree of interest.  This aside, she appeared her usual self; expressionless and elegantly poised.  Her smooth, brown hands lightly hugged each other on her lap, and her gaze was authoritative, but relaxed.  So I didn’t speculate too much on Anna’s case.
         All we knew about Anna was that she was thirty five years old and her mother could no longer take care of her.  Essentially, John Geetz Clinic is a nursing home for the elderly or ailing who can no longer receive care from their family.  We’re the only clinic in Georgia that could facilitate the likes of Anna MacAvoy, who was an extreme case of morbid obesity.
        Anna’s mother, Maria MacAvoy, met us at the door.  Her eyes flipped around the scene, wide in judgment.  Her white hair was pulled tightly into a bun at the back of her neck, and her wrinkles were tensed in anger.  Mrs. MacAvoy was about 5’ 3”, but stood so straight and proper she seemed to tower above us all.  She did not say hello or even nod when Nurse Daye squeezed out a smile and greeted her with, “Good afternoon Mrs. MacAvoy, how are you?”  Instead, the woman squinted hard  at the head nurse, turned and walked into the house mumbling “Anna is this way.”  Nurse Daye took a deep breath and followed Dr. Geetz into the house.
         Quite quickly, Daye stumbled out again - her dark skin having lightened two shades from mocha to latte.  She walked over and opened her lips to speak, but closed them, sucked them into her mouth, and simply shook her head before climbing into the front of the ambulance.  I wondered if it was our new charge, or her disapproving mother that evoked such confusion in our secure superior.
         Most of our morbidly obese patients have been bed-ridden for years, allowing themselves to grow and morph into stagnant globules of asthmatic flesh.  They’re always completely dependent on their family, though relationships suffer greatly.  Adults are generally expected to maintain some degree of self-responsibility before senility, so it was shocking and at times pathetic when these people were squeezed into our care, downgraded by their BMIs to helplessness and complete lack of control. 
        And then there was Anna.  It was inconceivable that there was a head on top of all that flesh.  There was no suggestion of a human form at all.  Her leg alone dwarfed me entirely, shaped like a huge, horizontal ice cream cone; massively round at the top by the hip gradually stretching towards the swollen foot.  Anna was stark naked, laying on her stomach and left hip, leaning slightly on one arm to favor the side of the bed where people would visit.  A white sheet stained with sweat and lunch was draped over her backside, the corner tucked under what I presumed to be her thigh. 
        To indicate where the head was, Anna had a thick, short helmet of matted brown hair, which followed the slight twists in her neck.  Her thin brown eyes were running around the room in concern, and she panted heavily through open lips.  This woman had not left that bed in over seven years.  Her bed was her life at the age of thirty five.  It was her castle, and the swamp of candy-bar wrappers, Pizza boxes, chip packets and diet-coke cans which surrounded her bed was the moat. 
        The Queen was not pleased.  This mass of a woman seemed a child in her tantrum.  When Nurse Daye walked in a second time, with myself and four other nurses following, Anna grabbed a half-eaten full-sized bag of Doritos and launched it, beaming Daye on the breast, and scattering chips at her feet.  Mrs. MacAvoy smirked.  Jacking herself up onto a shaky elbow, Anna screamed her protests.  She called her mother an abandoner, playing the ‘You never loved me’ card appropriately, before turning to Nurse Daye who was thusly given the nickname ‘Black bitch’.  June, Danielle and I were labeled ‘Skinny whores’.  The two male nurses and Dr. Geetz were ignored of course.  This grown woman in her thirties, and I guessed 800 odd pounds, then began to shift her weight up and down skillfully as she continued to rant, giving the appearance of shaking the bed, when it was mainly her rolls which shook as the mattress-springs squeaked in time.  The bed itself was a mattress on a wooden frame held up by a solid rectangle of cement blocks stacked in fives.
        In his soft, refined Southern Accent, Doctor Geetz tried to reason with the monster we were facing, “Anna, you must see you are in danger, we can...” 
“I’m not going to no nursing home!  This is my home right here!  You see this bed?”  Anna grabbed the scuffed and worn wooden headboard and gave it a little shake, “This is my nurse!  You got it!  I ain’t going nowhere and nobody is gonna make me!”
“Your mother has taken care of you now for seven years, and she needs a little help.”
“Taken care of who!  Who’s house is this she’s stayin’ in?  This is my house and she’s lucky to be here!  She’s taking from my bank account, so I am the one takin’ care of her!”
“I take from your bank account to take care of you Anna.”  Interjected her mother with a whisper which challenged even Nurse Daye’s authority on iced words.
“For myself I rely on my own savings account and pension.”
“Then how come I ain’ got no money left!  When I stopped working, I had a good $300,000 in there.”
Mrs. MacAvoy picked up the Doritos bag at Nurse Daye’s feet and dangled it delicately in the air.  “$300,000.  Seven years.  Plus half the rent on this house, and only half.  And this house belongs to Mr. James - Mr. James who last week ended our lease with no chance to renew.”  She promptly dropped the bag and locked her fingers together in front of her, waiting for Anna’s reply, knowing it wouldn’t come.  Anna just glared out of the corner of her eye at Doctor Geetz. 
“Anna,” Doctor Geetz gently put his hand on her shoulder, startling the woman to near death.  She said nothing more, but looked at the hand as if it were an ugly yet endangered animal. 

        Half an hour after the tantrum, a large canvassed truck from the Georgia Zoo arrived.  Lending us what they politely called an aquarium harness, which everyone including Anna knew was a whale sling, as well as a few trainers and operators, Anna was moved carefully and uncomfortably into the cave of the truck, which reeked of animal waste.  Anna was in tears the entire lift, and the entire ride, and not too shy to cry out loud and demand relief.  Seven years in a bed means seven years of constant bed sores and blisters, which are rubbed or broken individually from time to time, but all of which suffered irritation in her transportation. June and I nursed what bleeding sores we could and made sure Anna was as comfortable as she would allow herself to be.

        Anna was not adjusting well to the Clinic, and the clinic was not adjusting well to her.  Our physical therapists were often forced to sulk off after mere minutes of violent refusals to try sitting up or turning over.  A young nurse, Andrew, quit after emerging from her room soaked in tears and urine, humiliated by Anna while trying to make friendly conversation.  Daye was on edge, but couldn’t really do anything but dismiss Anna, which she was not too inclined to do, figuring she would come around soon.  I tended to avoid Anna as much as I could, fearing both for my physical and emotional safety.  I have always been good at taking care of others, I took care of a sick mother and aging grandparents for years before I made it my profession.  But Anna made it especially difficult to care for her, in any way.
             We did not offer offenders such as pizza, French fries, cheesecake or soda on our meal plan, but patients still refused our chicken breasts, salads, fruit bowls and lemonade, strongly suggesting we make an exception for them.  Most of our morbidly obese patients are pleasant, and I reinforce good relationships with a ‘treat’ every now and then.  In general, I feel sorry for them, both because of their condition and the treatment process, which involves a lot of painful sacrifices for them.  Allowing the patients a snack every so often is fine, and helps keep their morale.  However, in demanding too much, a patient is showing a reluctance to commit to recovery.  Anna was reluctant right off the cuff, and tended to demand rather than request extreme alternatives to her meals.  After a fortnight, Anna MacAvoy had had enough of the Geetz meal plan entirely.
        When I brought in her club salad, sugarless iced tea and low-carb cookies for lunch one afternoon, she was suspiciously silent.  Usually she would call me a name or two - her favourite was “Barbie skank”, while I preferred when she would call me “breakfast”.
        This afternoon however, there was no sound from her.  I placed the salad on the bed-side tray, poured the tea into her cup and pushed on the sipping lid.  “What kind of dressing would you like?”  I asked.  Her little head was turned down toward the salad, but her sharp brown eyes glared up at me.  She said nothing.  “We have Light French, Balsamic Vinaigrette, Light Ranch, or Light Greek.” she quickly glanced at her salad, and returned her glare to me.  She was not pleased, and my heart was pummeling my chest (though it usually was when I was on Anna Duty).
“I could check in the back again - we may still have some Italian, though I doubt it.” Anna transformed her face into a giant smile and in a most cheery and enthusiastic voice replied, “That would be great!" and then backhanded the salad off the table.
        I was stunned.  She lifted one eyebrow at me, picked up the cup of iced tea, flicked off the lid and dumped the contents onto the floor.  I was used to protests or even small fits from patients, but they normally gave me an opportunity to convince them into eating the salad at the very least.  Never before had anyone ever redecorated their room with lunch. 
        Calmly, I took the cup from Anna’s chunky paw, snapped the lid back on and with Daye-like reserve half-whispered, “Would you prefer I bring you something else to eat?”
“Yeah.  I want a hamburger.”
“A hamburger.”
“Well hey.  It ain’t a cheeseburger!”
“We don’t have hamburgers.”
“Well that’s what I want!”
I turned and walked out of the room.  I did not go back, not with a hamburger, nor another salad.  Anna went without lunch. 
        An hour later, when Anna  finally realized I was not coming back, her shouting could be heard clinic-wide.  I hadn’t told Nurse Daye what happened, but she sure found out. 
        I had done nothing wrong; I had brought the woman lunch, and after she destroyed it offered her something else.  Anna, however, was so offended that she demanded I be fired.  Daye half-smiled and said I would definitely be punished. 
As punishment I had to stay behind after hours to clean up the salad and tea.  I figured it was more of a punishment for Anna - after all, I had a twenty minute chore after hours, but Anna had to live for five more hours watching lettuce wilt and still didn’t get her hamburger. 
        While I was cleaning, Anna was again strangely quiet.  She stared out the window, pulsating with laboured breath.  Her head was squished into her neck, and she lay mainly on her stomach, as usual. The visible skin just around the portion pressed into the mattress was grey and flaky, like a dry dessert in texture, but oozing weak blood or puss between some of the larger, more irritated cracks.  1015 pounds of human flesh lay in that bed, hardly able to move; hardly recognizable as human.  Yet, unable to walk, dependent on others for food, drink, cleaning and other basic privileges, her sores oozing blood and her breath weak, Anna still wanted a hamburger. 
        “What are you looking at?”  I twitched when she spoke, but she didn’t look over at me.  “Wh-what?  Nothing, I was just thinking that, that we should get you cleaned up.  I mean, your sores.”  Still she did not look up.  I finished gathering the last of the lettuce and went for water and soap to take up the sticky tea. 
        When I returned, Anna turned and looked at me - really looked me up and down.  At John Geetz I was of course conscious that I was miniscule in comparison to the obese patients, but I had never felt as guilty about it as I did then.  The sheet we had went over Anna, and her flesh bulged off of the queen-sized bed, forming a low tower of rolling fat that pointed up to a cushioned thigh at the top.  All bed-ridden, morbidly obese patients lay in the same position, balancing on the fat of one hip and abdomen, leaning slightly over as if on their stomach, but twisting their upper body to appear as if laying on their side.  It’s most comfortable and doesn’t put the pressure of their weight on their chest, but still allows them to use their hands and face people straight.
        “Do you run?” Anna asked randomly.  I smiled a little at the thought of me running.
“I hate running. I don’t really do anything.” I paused, suddenly feeling the red being sucked up from my blood by my skin, “I just, basically, eat right.”  I smiled at her.  She snorted in return. 
“I used to run.” She began, “I was on the track team in school.  Was pretty good too.”
“Really?” I sounded so shocked that I blushed even more.
“I was good at short distance, but amazing at long distance.”  She said nothing more.  Remembering Andrew, I didn’t press her to continue the conversation, and I scrubbed another five minutes at the crystallized floor before saying goodnight to no reply.  I never asked her about it again.  I was always curious, but even more cautious. 

        Every few months, we weigh our obese patients; it’s a pain task for them, and a difficult one for us.  The scale used for weighing the morbidly obese is basically a strong harness lifted by a machine that takes the measurement.  According to Nurse Days, we had never had a patient more than 600 pounds before Anna, who when admitted weighed 1015 pounds.
         After three months of Anna MacAvoy’s diet and physical therapy plan, nurses Danielle, Carl and I spent several hours rolling and twisting the harness under her, and Anna spent those several hours in ceaseless tears as her chapped skin was constantly ripped and covered in stinging antiseptic gel. 
        The scale lifted her two feet off the bed so no dangling foot or heavy hand was touching the mattress.  It held her weight for about ten seconds before the metal lifting arm snapped, plunking the screaming blob of Anna hard onto the mattress,  collapsing all the springs and the underneath support, and sinking her in the frame. 
Danielle darted out of the room screaming for all hands and setting off the emergency call-light.  Carl and I were frozen.  I had not seen a patient die yet at that point, neither morbidly obese nor elderly.  All morbidly patients laid on their side for a reason, and I knew that reason, but I had never seen it before, and I hope I never have to see it again.
        The snap was uneven, and had dropped Anna onto her back. 
        Anna tried to suck in air with the strain of a dying vacuum, but her lungs couldn’t expand under the pressure of her chest, and she started to choke.  Her arms flung wildly, banging on the wooden frame around her.  She couldn’t speak, she couldn’t scream, and she couldn’t breathe.  I didn’t know what to do.  She was a fish flapping helplessly on the dock.
        The emergency beep started to pulse throughout the building.  I took a step towards the bed, holding out my arms, though I knew I couldn’t do anything.  Anna swatted me on the shoulder with a flailing right hand, sending me flying across the room to crash into her small dresser.  I bashed my head hard, blinding myself momentarily.  My head was spinning, but I was conscious.
        In a flood of nurses the room filled with commotion. I crawled as far back into the corner and out of their way as I could.  My shoulder was dislocated and I couldn’t focus.  I shut my eyes.  Daye barked out orders.
“To the right side of the bed.  NO.  Her right!  Over there, EVERYONE.  Try to hold that side up!”  I heard the nurses scrambling, opened my eyes and saw them about to push up Anna’s right side.
        Just as the team got into position, there was a huge CRACK, followed immediately by another - like tree branches being broken at the middle.  With no air, Anna managed to howl, swinging her left arm up to grasp her chest.
“Shit!” Daye blasted, “No, come over here!  Everyone lift her from her left!”
The nurses scrambled to the other side, jumping over each other.  I stood up and nearly crumpled back down, but caught myself on the side of the dresser.  All I could do was watch.  Anna was suffocating in front of me.
        A few nurses tore away the left side frame which trapped Anna inside.
“GENTLY!  Don’t put any pressure at all on her chest!  Lift from the bottom.  All together!” 
The nurses heaved - the males skillfully shifting all their weight under the helpless woman.  Slowly the fleshy mound rose, and Anna began to twist against the right frame, crushing it as she was rolled onto her right side.  Anna gasped and yelled.  Half of the nurses held her upright on her side, while the other half reached under her as much as they could and pulled her skin towards them from below.  She settled into the standard position, but was wailing wickedly.
        Nurse Daye pointed at me and, composed once more, quietly ordered, “Oxygen.”
With one good arm and forcing at least half a normal performance from my injured one, I rolled the oxygen tank over to Anna, and snapped the band around her head, securing the mask to her face.  She heaved a few breaths before passing out, her head falling onto the cushion of her right shoulder.  She was breathing, but barely.  Everyone was panting, trying also to catch their breath.
“1013.” Carl said.
“What?” Daye hissed at Carl’s random comment.
“1013. She now weighs 1013 pounds.  The machine took the reading.”
Daye’s lips broke open in disbelief. She smoothed her graying temples back and rested a quivering hand on her brow.  A month and all we lost was two pounds. 

        Nurse Daye examined my shoulder in Anna’s destroyed room.  We had relocated her to the general medical room for the time being.  I scrunched my face when Daye put her hand on my shoulder.  She smiled, and vibrated in a low chuckle.  “You’re cute honey, and I like you, but I don’t know if you’re built for this job.”  Her voice was soothing and rich in that classic Southern twang.
“Funny, I was just thinking the same..AH!  ow.”  She gripped my shoulder blade and yanked my arm with her other hand.
        As Daye fashioned a sling around my arm, I noticed a figure at the window.  Daye saw me staring and turned.  Someone was fingering the small opening, slowly nudging the window up.  The Head Nurse soared over and flung the window up, staring hard at whoever was there.  She did a double-take and balanced a fist on her hip. 
“Boy, what are you doing here?” she asked.  I hopped up out of the chair and closer to the window.  A young boy, maybe eleven or twelve, with a scruffy clump of blondish hair stood at the window, his blue eyes wide and his hands suspended by the window.  He was absolutely stunned by Daye’s presence.  I looked closely at him, and recognized him as the grandson of Winry Scott, an elderly patient nearly paralyzed by arthritis.  The boy hadn’t come to visit often, though Winry’s daughter did, and I knew they didn’t live too far away.  I think his visits to his grandmother will be even fewer now.  Daye didn’t recognize him then though, and I never told her, not wanting to make things any worse for anybody. 
        He flicked his eyes around the room.  “Geez-Louise, the football team come ‘round?” he whispered, mainly to himself. “Where Anna is?” he asked nervously. 
“Where is Anna.” Daye corrected, “And what do you want with Anna?  Do you know her?” she was cocky and almost sarcastic, bobbing her head slightly from side to side with skill.
“Well……. yeah.” he said.
“Then why are you poking your finger through her window instead of coming through the front door?”
The confused kid shuffled a step or two, trying to think of something good to say.  He couldn’t.  “ … ‘Cause I got her stuff.”  The boy sounded as if he was Anna’s dealer.
“Her stuff?”  Daye lashed at him without raising her voice.
“Yeah.”
“And, what ‘stuff’ might this be?”
The kid knew he was caught.  He hesitated a moment, and then looked off to his left as he counted off his delivery.  “Oreos, KFC, her chips.  Wendy’s is closed for construction or something, so I got her McDonald’s instead.  Um, cookies, I have more cookies.  There’s some cheap coke and some chocolate and some other stuff.”  Nurse Daye was silent and livid, staring at the underaged calorie dealer.  The boy drew in his lips and smiled apologetically.  He bent down and picked up the ‘stuff’.  He gently shoved a bag stuffed with snacks at Nurse Daye, who took it and stood in utter disbelief.  He then rose up and leaning into the room placed two grease dripping plastic bags carefully on the floor. 
        A few seconds of uncomfortable silence broke when I poorly stifled a giggle.  The boy awkwardly and slowly, as if thinking hard about it, shoved his hands in his front pockets, repeating small, embarrassed nods with his head.  “Well, tell Anna I said ‘hey’.  I gotta go now – dinner.  Peace.” and he turned, rapidly sprinted across the yard and hopped over the low wall.  Nurse Daye turned to me in horror.  I didn’t even make an attempt to stop my giggling.  “Two pounds.” I said. 
        Needless to say, Anna’s calorie dealer would not be making any more deliveries. 

        Anna was in such poor health that her body would not heal the broken ribs.  As a result, it became harder and harder for her to breathe.  About 95% of the morbidly obese are asthmatic, including Anna, as well as diabetic.  She began having at least four asthma attacks a week, and was placed on oxygen.  It became a struggle to control her diabetes, and after a few months her liver stopped functioning, forcing her onto dialysis.  Whatever she had in the way of health was in rapid decline.
She was weak and miserable, and dialysis was painful and draining.  After a few months, she refused it.  “Fuck it.” She said, smiling, “We all know I ain’t got long anyways so what’s the point.  It’s a waste for you and a pain in the ass for me.  I’m not gonna do it anymore.”  It was her choice.  I almost couldn’t believe it when she said it.  Danielle and I were hooking her up to the machine, but she shook her head and swatted us away.  Tears were hot in my eyes, but still I felt it was the most mature thing Anna had done since she came to the hospital. 
        The next day, Anna’s mother came to see her for the first time in her six months at the clinic.  I was reluctant to let her in, angry that she hadn’t come earlier.  I let her in anyway, unable to logically justify refusing her.  She stayed for about fifteen minutes, and then just left, shedding frost in our hallways.  I asked Anna later how it went, but she just snorted and stared out the window.  I was mad at myself the rest of the day for letting that woman in.
        Nurse Daye did not agree with the decision to stop Anna’s dialysis.  She argued with Dr. Geetz who felt the same, but could do nothing about it.  Daye often stood outside her door, watching Anna sleeping.  It was hard for her to give up on a patient so easily.  She would stand expressionless, but when I asked her why she was watching Anna sleep, she simply said that she wanted to make sure she hadn’t stopped breathing.  About two weeks after terminating her dialysis, Anna MacAvoy did stop breathing. 

        I wanted to, but never quite cried.  I considered speaking at her funeral - not as a planned speech, but when I saw there were so few people there, and no-one, not even Maria was going to say anything about her, I considered hopping up next to the tacky copper urn and saying something.  All that could really come to mind though was the bag of Doritos she threw at Nurse Daye and how she called me “breakfast”. 
Mrs. MacAvoy had managed to find herself a one bedroom apartment, which she bought a few months before Anna died.  I don’t suppose she was planning for her daughter to move in with her again.  We took her to storage where Anna had put most of her things that she didn’t have a use for while in a hospital bed.  She riffled through a box or two for ten minutes, and came out with a few items, but nothing significant.  She said to donate the rest.  Nurse Daye shook her head and looked as she was about to give Maria  the finger as the woman strutted out of the clinic doors. 
        Daye had a charity supported by her church she wanted to donate to, so I helped her transport Anna’s things to their centre.  As we dropped off the boxes, I noticed a trophy in one of them.  It was a first place award for a 1984 inter-school long distance championship.  Anna would have been about fourteen years old then.  I didn’t find any others in any of the boxes, and I did search.  Nor did I find any second or third place trophies, or medals or plaques or the like – just that single, cheap, gold-painted plastic trophy of a girl running through a ribbon, throwing her hands up.  One of the hands was missing though, and I couldn’t find that in the box either.  There wasn’t even a name engraved on it.  Obviously the trophy wasn’t from a major competition.  Still, I took it, and put it on the shelf behind the reception desk at the clinic.  Some thought it was hideous and ridiculous and wanted it gone, some though it was sweet and gave the place character, others never even noticed the trophy at all.