My Sister

People who follow my blog regularly may recall that my sister has been battling uterine cancer for the past half year or so. Since being treated with radiation and chemotherapy, she has been in a holding pattern waiting for the date of her surgery to come. It was several days ago and she had a full hysterectomy.

The surgery went fine, but not without some peripheral issues thrown into the mix. They suspected she had type 2 diabetes because her blood sugar was 187, but her HbA_1C test was 5. For those who don't know, fasting blood sugar numbers, which are considered "normal" as long as they don't exceed 100-110 (depending on who you talk to), measure one day. The HbA_1C test measures over the last 3 months and is a stronger indicator. 

My guess is that the number was abnormally high because of stress, saline solutions with glucose that were given and somehow not factored into the situation, or the fact that she may have eaten some liquids within the time frame and no one realized it (or she forgot). I don't know, but I do know that a patient recovering from cancer doesn't need to have additional false information heaped on her while she's spending her first day with a big incision in the stomach and having had a bunch of her internal organs cut away. It is irresponsible, in my opinion, to even speculate to someone at that point in time. Do the test and be sure, but don't push her into another hole before she's had a chance to climb out of the one she's in.

The other bit of bad news they gave her was that they suspect she has sleep apnea. They did this based on the fact that she wheezed as she as coming out from under anesthesia. I don't know if a snore or breathing issue when you've been under general anesthetic can be interpreted so broadly or not. I suspect the answer is "not", and that they are diagnosing by her weight (around 400 lbs., possibly a bit more), not by anything scientific. 

The good news is that the cancer has been carved out along with her reproductive system. They discovered that she had a severely malformed uterus which was nearly in two parts as well as two giant cysts on each ovary. One was the size of an orange and the other the size of a grapefruit. She also has a conjoined kidney and there was concern that if anything went badly during the surgery, this single kidney may fail or be damaged and things would be very bad indeed. 

My sister has to do many more prophylactic rounds of chemotherapy, but this crisis seems to be coming to a close. As I have mentioned in other posts, I strongly believe she did not seek routine pap tests because of her weight (and economic issues) and the humiliation people often face when they are obese and visit doctors. The level of difficulty and pain she has endured could have been greatly reduced had this been discovered much earlier. The lesson to take away is not that fat people are at higher risk of cancer so don't be fat, but that fat people need to get the same level and type of treatment as those of average weight or they are at risk of dying from diseases that are detected too late. 

Medical Roller Coaster

I haven't written about my sister's cancer situation much lately because it has simply been too hard emotionally to talk about it. As some readers may recall, she hadn't had a pap test for over a decade, possibly as long as 15-20 years and I suspected it was because of her weight. She suffered from anemia for years and eventually nearly blacked out and it was finally discovered (after much other testing), that she had a large tumor in her uterus that was causing internal bleeding.

Since the initial finding, she has been told various things. You'd think that medical technology would be advanced enough to give proper diagnosis of her issues, but, no. First she was told she had cervical cancer or possibly ovarian. The tumor filled her entire uterus and would have to be shrunk with an intense sequence of radiation treatments (24 in 6 weeks). The news was bad at this point, but the cancer had not metastasized and it seemed that after a lot of suffering, she would get better.

Later, she was told that the tumor may be inoperable and unshrinkable and that she may have to live her life in a disabled state. She was told she had both uterine and cervical cancer. Essentially, she was being told that the best they could do for her was try and keep it under control because it would threaten her life if they tried to remove such a huge tumor. I'm not sure how that works, but I assume they were afraid she may bleed to death as merely touching her to examine her caused her to bleed a fair amount. The doctors haven't exactly been forthcoming with precise details.

My sister was devastated by the news that her life as she knew it was coming to an end if the tumor was not shrinkable. She was told, and this made sense, that her body can only take so much radiation treatment and if the first round wasn't relatively effective, she'd be disabled and essentially take treatment as needed to try and stop the tumor from spreading. She'd never be able to freely move again without pain or risk of bleeding. Absolutely, working would be out of the question. She was already stuck in her upstairs "apartment" (the upper level of my family home) and depressed at her limitations and now they were saying this would be the rest of her life. Of course, the unspoken addition was that, "the rest of her life" would be shorter as holding cancer at bay is always a waiting game. Eventually, it would spread.

I talked to her about this and tried to reassure her that this would not be the end of her life. The truth is that, yes, she would be limited, but her sole purpose in life was not to drag herself off to the job she had held for so long. She wasn't happy in that job in the last year or so (since her hours were cut to part-time) anyway and felt stagnated before. I told her that she had more to offer and that I would help her find it if it all came down to the worst. There was more she could do within whatever limits she would have to live with and I'd be there to help her find that path and start down it. I believed it then and I still believe it now.

After letting her stew on that for awhile, they gave her an MRI which (supposedly) revealed that the tumor was not as large as they thought. Now, they were saying that it was a smaller tumor with fluid trapped above it and looked more operable. They expect that once it is shrunk by radiation treatments, the fluid will drain off and she will experience less pain. Both of us were elated at this information, but I am cautious about reaching any conclusions. It seems that the doctors may be doing their best, but they really don't have a clear idea of what is going on as the story keeps changing.

The lesson I learned from this, and I'm sure others will as well, is that weight shaming is incredibly destructive. It's not as if I was oblivious to this before this awful situation with my sister. It kept me from seeking pap tests for about 12 years, after all. However, the only one who suffers when we give in to it is us. My sister is suffering horribly now for having avoided such testing and, while I still am not sure that she didn't get tested because of her body, I'm pretty sure that is a big part of it.

The "C" Word

My sister told me today that she has cancer markers in her blood, so I can no longer live in the fantasy that her tumor may be benign. A successful tissue sample for a biopsy to determine if it is cervical or ovarian cancer has not been completed. I suspect some of the issues may be related to her weight, but I do not know. My sister and I talk about many things, but her weight and up until the last three years, mine, were always the elephants in the room. She pretends her weight isn't a factor in her life, and I never address it.

As I said before, I strongly suspect she avoided routine screening because of her body size (as that was the reason I avoided it and many women do as well). I could be furious that the world encourages morbidly obese women to put their heads in the sand with their behavior, but there's no point in directing my energy so uselessly. My energy is directed toward my sister's well-being, supporting her, and understanding that things just happen. I don't have a need to "blame" anyone or anything. This is what it is, and I hope that she is going to be okay at the end of all of this.

Not everything is about weight in my life, but this thing may be about hers. I wish that I could help her more, or had helped her better, but I know each person has to help themselves. I don't even look back on the last 6 months or so when I advised her to get a gynecological exam and be checked for uterine tumors and think, "I was right" or "I told you so." I really don't. I just see this as a part of a pattern that many fat women are in and the way life works. It's sad. I'm sad, but I'm not mad. I just hope, again, that she doesn't pay a huge or the ultimate price for waiting. Right now, I just love her and appreciate her without any dialogue about "could have been/done" or "should have been/done."

Respecting and Facing Fear

In the television series "Buffy, the Vampire Slayer", one of the characters is Willow, a formerly mousy nerd turned witch who spends most of her time on the show doing good things to help people. When her lover is killed as collateral damage by a murderer intent on killer Buffy, she goes crazy and turns bad. In her fury to exact revenge on the man who shot her girlfriend, she kills other people and eventually skins her prey alive.

By the end of the small arc in which Willow's character goes bad, she returns to her true self, but is afraid to use magic again for fear that she'll lose control and her sense of self again. In one of the follow-up scenes in a subsequent season, Willow is seen causing a small candle in a ball-shaped holder to hover over her hand with magic and repeats, "I'm facing my fear." Over the past two and a half years, I can't tell you how many times that scene has popped into my head and I have actually used that phrase.

Part of being fat is living in constant fear. Since I've spent the vast majority of my adult life between 300-400 lbs., I've lived with that fear more than without it. That fear is of both small and big things that diminish quality of life from fear of seats that are too small and not traveling to eating in restaurants to going to movies to the fear of social censure and ridicule to the fear of medical treatment. It extends into every nook and cranny of life. It keeps you off of scales and away from shops with narrow aisles. It keeps you from changing jobs and finding a significant other. It keeps you from getting regular testing like pap tests and mammograms. 

For quite some time, my sister has had anemia. My sister also weighs slightly more than I did at my highest weight and is two inches shorter than me. I'd guess that she weighs around 420 lbs. at 5' 2" (157.5 cm). The problem (her anemia) got so bad several years ago that she was put through a large battery of tests including copious testing for bowel and stomach cancer. The thing she did not get, however, was a pelvic exam or pap smear. Though she did not say it, I'm pretty sure that part of the reason she avoided those tests was her weight. 

Very fat people avoid medical intervention unless their circumstances are dire because there is so much fear involved. Will the doctor weight shame you? Will they complain about tests they cannot do or difficulties treating you due to weight? I know this fear because I avoided such tests for over a decade due to such fears. Mine were based on experiences in which I was treated horribly during one exam in particular. I didn't have a pap test for over a decade and had never had a mammogram. However, I was lucky. I gambled by not getting tested for a long time, and I won. I had no problems. 

My sister has not been so lucky. She has an enormous tumor which fills her entire uterus and her OB/GYN believes it is cancer. The test results won't be in for awhile, but all signs point to malignancy at this stage. I can't help but wonder if this wouldn't be happening if my sister had not been afraid of such tests because of her weight. I can't help but think that fear of fat shaming may result in her death, but I can't blame her for avoiding what she was afraid of. After all, I did it, too. Though I don't "blame" her at all, I'm deeply, deeply afraid of losing her. I'm very close to my sister, and this news has been extremely hard for me, though not nearly as hard as it has been for her. 

Fear is supposed to be an extremely potent as a motivator. You hear a lot of people try to push themselves to lose weight through fear of possible health problems. You also often hear about people who already have health problems, but can't lose weight despite dire consequences like having limbs amputated due to Type 2 diabetes complications and uncontrolled eating. The thing about fear is that it can motivate, but, in my experience, more often than not, it paralyzes.

Understanding that fear is more likely to cause inaction rather than action is the first step in dealing with it. If you realize it is holding you in place rather than pushing you forward, you can stop berating yourself for not moving and explore how to break out of the ice that holds you in place. This is what I started to do in 2009. I had lots of fears, and I started facing them one by one. It was horrible and overwhelming. Sometimes I felt like I was tied to the back of a moving car and being dragged along at a pace just a little faster than I was capable of running. Dealing with my fears constantly wore me out and made me want to slow down or just stop. 

The truth is that, had I not been on a concrete timeline, I'm not sure if my pace would have been as fast. I knew I'd move someplace in which I wouldn't have health insurance to pay for testing by the end of March of this year. I knew I had to be ready and face testing at least by the end of 2011 or possibly end up with a health condition and no insurance for treatment. Maybe I would have done it all anyway after losing enough weight, but I can't say for sure. The only thing I can say is that I faced those fears, but first, I regarded them with the respect they warranted.

Most people are dismissive of their fears and encourage "bucking up", "growing up", and "grabbing ahold of those bootstraps" and "bullying through". I didn't do that. I considered my fears and how they were based in real concerns and consequences. There were elements of irrationality, of course. With all medical tests, for instance, fear of a bad outcome is somewhat irrational because knowing the result doesn't change the underlying issue. Most of my fears, however, were related to very plausible circumstances - fat shaming, censure, humiliation, physical difficulty, and pain. All of these are absolutely rational fears based on personal history. 

A lot of people advise those wanting to lose weight to just ignore such things and get on with it. If you think that those feelings are not potent motivation for remaining stuck like a fly in amber due to fear, then I will kindly ask you to mail me a picture of yourself in a bikini or thong with your real name attached so that I can post it and strangers can pick you apart for your body flaws. It matters. It is real and painful and frightening, so respect your fears and validate them as absolutely justifiable.

Once you validate them, you are then ready to face them. For me, this started with going outside more to walk. I hated going out when I was in the range of 230-380 lbs. in weight. People stared, pointed, laughed and said unkind things. What was worse was that I had to stop and sit down every few minutes because of my back pain so people would see me walk a short distance and sit to rest. I'm sure a flood of judgment went through them as I stopped so often (like I'm so fat I don't have the stamina to walk far before I need to rest). Since I couldn't go far, they could gawk and make fun of me while I rested and there was no real escaping them because I had to wait for the pain to fade and the muscles to relax. I had to face the real fear of physical pain as well as the humiliation again and again, day in and day out.

When I was out walking, I would tell myself that I was facing the fear so that I could do things I wanted to do in life (like the relatively mundane pleasure of walking out the front door without fear of being in agony). I had to remind myself that I could only get from where I was frozen by moving through fear. Yes, it was incredibly stressful and tiring, especially at first when I was thinking so much about it. I repeated the mantra, "I'm facing my fear", and told myself that this hard and scary road was one that I had to pass through in order to get to where I wanted to be. 

In the end, I learned to just say that I was worth enough to continue on despite the difficulties and that the actions of the people that acted to make my progress difficult had to be something which I would have to regard as not mattering to me. My progress mattered. Moving on with my life rather than held in place by fear would be the thing I'd ultimately end up living with, not the words and actions of those people. Facing the fear eventually made it disappear. The more I acted in spite of it, the less I felt it.

The same applied to every situation that I had to deal with that I feared. I feared going to the doctor, the gynecologist, a restaurant, unpredictable social situations, and getting interviewed for a new job then starting that job. Every time, I validated then faced my fears and they slowly diminished. It's a little easier for me to talk about this now because I've both lost the weight that inspired many of my fears and have already faced so many of them down. However, I remember many times in the past several years when I told my husband that I was exhausted by going out every day and facing my fears. I felt like all was doing everyday all day was battle psychological demons.

Losing weight was supposed to make my life easier, but it very much felt like one challenge after another was being put in front of me because there was a domino effect of new fears to face once I faced the first few. It felt like a treadmill of stress and difficulty and that I was actually happier when I was 380 lbs. (and in some ways, I was... but that's a topic for another post). Losing weight was making my life harder and harder because it kept opening doors to things I was afraid of rather than keeping them firmly shut. This is a reality of weight loss and one reason that it is so hard. It is actually de-motivating "in the short run", where "short" means years and years of changes. 

It's important to note that I only lost weight because I faced my fears. Some of those fears were of being hungry, failing to lose weight, and loss of something (food) that was a huge comfort to me. Losing weight didn't make most of my fears vanish, not by a long shot. Most of them were faced as part of that process. There was no shortcut and being lighter didn't solve problems. I still had a tumor in my neck and needed surgery after facing a doctor's examination. Ultimately though, I was lucky. Nothing was cancerous and the surgery wasn't incredibly serious. I hid for years due to my fears and didn't pay a price.

My sister, on the other hand, is going to pay some sort of bigger price than me. The question isn't "whether" she will, but "how high". Even if the tumor she has is benign (my greatest hope), she will need at least a partial hysterectomy. If it is cancer, it will mean a far more complex and life threatening course. I'm hoping that she gets lucky, like I did, and doesn't pay the ultimate price for living in fear for so long. 

It's Not About How Badly You "Want" It (part 3)

part 1 is here
part 2 is here

Last night, I was talking to my husband about how I was feeling regarding my sister's circumstances, which are inextricably linked to her weight. Because of a slip of the tongue, he said that she couldn't change because she didn't "want" it badly enough. As is so often the case, we sometimes over-simplify what we mean to say with words that distort what we really mean. Even though it wasn't what he meant, it did get me thinking about how we often talk about how people have to "want" something badly enough to start taking action toward change.

A lot of people talk about "wanting" it enough to change when it comes to weight loss. I'm here to say that every fat person in the world "wants" to change. Most very desperately would like to lose weight, but "wanting" something is not the same as being able to acquire it. This is a critical mistake that people make when they either fail or decide not to even make the attempt or when they see others doing so. The reason that this is so important to distinguish from "want" is that not knowing the real cause leaves people feeling as though their motivation is what is missing rather than what is really the issue.

I discussed my sister's situation in the other parts of this sequence and I know that she would like to lose weight and speculated that she probably has secretly tried on occasion and failed. I know that I tried and failed on a small level so many times that I ultimately decided that it was inevitable that I would always weigh well over 300 lbs. Here is how it works:

You are at the bottom of a deep dark well and would like to get out. You search around for places where you can grasp the wall and start climbing out. Occasionally, you see a depression or a jutting rock and you grab at it and try to haul yourself out. Sometimes, it isn't deep enough and you can't get enough of a hold to pull your body up. At others, the rock crumbles in your hand. Sometimes, you can get a good grip and start lifting yourself out and make a little progress then you slip and fall back down again. After each effort, you find yourself back at the bottom in a sense of deep frustration and anguish. Sometimes when you fall back down, the ground gives way and you're in even deeper.

After some time has passed, you've got years of attempts under your belt. You're now an expert at recognizing what will not work. You've tried to use that stone over there or that depression here dozens of times in conjunction with other strategies and every time you have been unable to get out of the well. You are expert at what isn't going to work because you've tried and failed so many times. After awhile, you simply see no point in trying. You still want out of the well very, very badly, but can see no way to escape. Attempts to try just increase your sense of hopelessness. It's easier to simply stop thinking about escape and make the best of where you are. This includes no longer trying to get out because the failure only reminds you of how trapped and helpless you are.

This is the story of a fat person. What you "want" has  nothing to do with it. Fat people want to be thinner. They simply cannot find a way out and many eventually stop looking. This analogy fails to impress thin people or successful losers of weight because they were never stuck in that well or the one they were in was one they personally could climb out of. Each "well" is mental and unique. The sides are steeper, smoother, etc. based on the life experiences and personality of each person. Judging others by their inability to escape simply because you could get out is an act of rampant narcissism and a need to elevate oneself above others. It's just not that simple. It's very complicated.

For me, I spent nearly two decades not only sliding down to the bottom of that well, but watching the ground open up under me and swallow me a little deeper each year. From 1989 to 2009, I not only could not find a way to lose weight, but steadily gained despite wanting to lose. In 2009, the thing that changed was my strategy. Being expert at what had never worked (rigidity, exercising a lot, "dieting"), I decided that this time it had to be very, very different if I wanted to escape. This time, I had to try tactics that were atypical because "typical" tactics didn't work for me.

This time, I ate chocolate. This time, I put no food out of bounds. This time, I focused on portions over food types. This time, I didn't castigate myself for eating certain foods or for eating "too much". This time, I wouldn't worry about how fast I lost as long as I was moving in a behavioral and cognitive direction which I felt was "right" for my future. This time, I was going to work hard on my psychological issues with food rather than view it all as simplistic "choices" divorced from my psyche. This time, I wasn't going to assign value judgments to how and what I ate and I was going to focus on eating "normal" rather than "healthy" or "perfect". This time, I wasn't going to hate myself thin.  This time, I was going to tunnel sideways using a spoon rather than try and just climb straight up. And, this time, it worked... for me.

The problem is that what works for one person doesn't necessarily work for others. That being said, I think that we can see that the "tried and true" methods do not work for many people in the long run. It is unsustainable to live the path of righteous eating and rigid control for most folks. I can't say that I'm thin (yet, and may never be), but I can say that I've done this for two years and two months now and it isn't an obsession and I don't feel trapped. I absolutely do not feel like what I'm doing is a burden anymore and can happily say I'm good to live this way forever. It's amazing how not denying yourself anything makes it easier. Of course, reframing food mentally in the fashion I have done is far from "easy". I had to learn to be satisfied with one cookie, a few bites of chocolate, or a small handful of pretzels, but the mind can be tuned to be satisfied with less once the psychological issues that compel us to "need" more are dealt with.

In my sister's case, the well she's in is deeper, darker and more intimidating than the one I was in. I like to believe that, if I were there with her, I could help her the same way I have helped myself. Deep down though, I think that's ego speaking. I think the only thing I could do for her is share my cooking and role model my eating patterns to her and she could then attempt to emulate them or not. I think the psychology of her relationship with food is too deep and hidden for anyone to access, including her, and I don't know that that aspect is something she has the capacity to address emotionally. And I understand that completely. It's painful, scary, and harder than most people can possibly imagine. And, what is more, except for the part of me that wants her to have a higher quality of life, less fear, and better health, I don't care. I love my sister no matter what and know that she's an intelligent, kind, caring, and worthwhile person. I just wish that she could have the type of life she deserves and weren't so much a prisoner of the body she's in that she will be denied the type of life a truly good person deserves.

Body Prisoner (part 2)

Part 1 of this post is here.

My sister has always been heavier than me. In pictures of us as children, she was always just a little chubby whereas I spent at least a few years as a skinny child. It wasn't until around 4th grade that I started to put on weight and start my lifelong "career" as "the fat girl". Of course, in my rural town, with a class of around 30 students, there were far fewer of us fat kids than there are these days.

As she got older, my sister gained weight as well. She was "the fat girl" in the class two years ahead of me. To that end, she was tortured and tormented in the same fashion as me, though her responses were somewhat different. I acted out emotionally and tried to excel in various ways in order to prove my value. Getting straight A's, proving how smart I was, exercising my creativity in art class and being unafraid to be friends and make friends with people despite my "handicap" socially was part of my process. For my sister, the path she chose was complete withdrawal.

My sister is intelligent, but she has spent more years being crushed by her weight issues than me. It isn't only that she was fatter earlier, but that she grew larger faster. She also has never spent any time in "remission" by losing weight. I'm not sure if she has ever made a concerted effort to lose, but I'd be surprised if she didn't privately make some attempts. I know for a fact that she has never made any organized effort to exercise though, or to substantially approach food differently. That's okay. I don't judge her for anything. It's just something I note because I think that my having lost a lot of weight twice in my life fundamentally alters how I view the experience of being very overweight compared to how she may look at it.

In addition to not having had success at weight loss, my sister has also never had a boyfriend and is not married. It's pretty safe to say that she is still a virgin. She has expressed on multiple occasions that she has no interest in relationships. I don't know if that means she is asexual (I doubt it), but rather that watching so many bad relationships around her has made her quite jaded at the prospect of being in a good one. There is also the almost certain factor of her weight making her believe she would never get a decent man. I believed that was also to be my future, but things turned out quite differently for me.

My sister also continues to live with my parents, who are elderly and rely on her. Their relationship with her has always been corrosive and destructive. She has spent years in a state of depression and even now is probably in one. Her economic circumstances went from difficult to dire last year when her work was cut from full-time to part-time due to the ongoing economic issues in the United States. She is now essentially at the mercy of my childish and emotionally abusive mother and socially terrified and emotionally stunted father. They consistently demand that she exhaust herself meeting their needs, and they have her in a bind because she can't afford to move out.

I don't know what my sister currently weighs, but I'd be shocked if her weight was under 400 lbs. Chances are she's in the 430ish range, possibly a bit more. She suffers from persistent anemia, low blood pressure, and fatigue. She also has serious skin infections at the drop of a hat and is sensitive to nearly every type of soap and lotion on the market. When she still had health insurance, she was tested repeatedly to determine the cause of her problems with no results. She takes a lot of supplements and has even been hospitalized for her anemia, but nothing seems to help.

With the loss of her health insurance, which got jettisoned when the full-time job was taken away, my sister now has no means to deal with any health issues that may crop up. She can barely pay her bills and only survives because of living under my parents' roof. Today, she was telling me about the hardship of dealing with my mother when she insists my sister take her shopping. These trips involve hauling my mother all over creation (often 4 stores), pushing her in a wheelchair because she had knee replacement surgery and refuses to do therapy properly or wait to heal, and lugging around her groceries in the heat. My mother is blind and quite overweight. I believe she also suffers from Pickwickian syndrome (OHS), though it has not been diagnosed as such. She merely has difficulties with blood oxygen and has to haul around an oxygen tank to breath.

Because of my mother's special needs, these trips leave my sister physically overwhelmed and exhausted. This is certainly due to the stress in dealing with my demanding and emotionally volatile mother, but it could also be exacerbated by her weight, anemia, and the summer heat. If she refuses to help, both my mother and father scream and verbally abuse her until she capitulates.

My response to this was sympathy, and also to say I wish she'd find a job outside of the tiny rural neighborhood she lives in so that she could escape my parents. In the past, when she still had full-time work, my sister had told me she couldn't leave because my parents couldn't survive without her. Now, she can't survive without them unless she gets a better job. I told her that if something happened to her tomorrow, my parents would learn a way to cope. They could get by, but they wouldn't try unless they had to. I believe this for a fact. If my father had to pay his own bills, buy his own groceries, and make his own bank transactions, he would. If my mother had to remember when to take her own medications because me sister wasn't around to dole them out, she would. She already has some assistance to go shopping, though she demands more than is provided by social services because she is easily bored and wishes to run around outside the home as much as possible.

In the past, I have suggested for her own psychological health that she needed to look outside the immediate area for work and she said that she'd have to go at least on an hour-long commute to find work and couldn't pay for the gas. This time, when I said she may need to go where the jobs are, she said she'd have to go very far afield indeed and she couldn't afford to move. I told her that if she found such a job, I'd give her the money to move. My sister has immense knowledge about computers and networks and has been a system administrator for decades. To this, she responded by saying she couldn't get any decent job because she had no concrete certifications.

As we spoke, my sister became increasingly agitated and angry. Though I was trying to be supportive of her by saying she might want to seek an escape route and that I would help her do so and that she had good skills that would be of value, she responded as if I were personally pressuring her to do something she couldn't possibly do. I felt very bad after the conversation because my aim was to make her feel less trapped, and her responses indicated that she felt more so.

In retrospect, I realize that, though she does have skills and could seek a job elsewhere, she can't. The reason she can't isn't that she has no value as a worker, but rather that she is a prisoner of her body. She fears putting herself out there for work in an alien environment because she'd likely be rejected because of her body size. All evidence that I've read about obesity, women, and hiring (as well as wages) would suggest that her fears would be valid. For her, it's better not to try than to try and fail. She is stuck waiting for something better to fall into her lap, because she literally cannot choose to do anything else. She lacks the psychological strength to escape, no matter how hard she may want to.

A lot of people might feel that my sister has choices, but simply refuses to make the hard ones. She could do what I have done and lose weight, but that's not a choice she is capable of making. I know because it's one that I could not make for a very long time. Of course, she wants a better life, better health and a better body, but mentally, she is trapped. Her circumstances are very much worse than mine in that she has no loving, supportive environment to back her up and she has no history of success either in regard to altering her body or achieving her goals. My sister went to junior college and university and was one class short of completing her degree at either of those institutions. I have my university degree and have a body of work on various blogs (including this one) with which to recommend myself. She lacks these things and it undermines her capacity to put herself out there. I know where she is coming from mentally. I've lived there for most of my life, too. It's not that simple to change.

After my conversation with my sister, I had a profound sense of concern and a little frustration. I don't want her to be trapped and I don't want her to suffer ill health. I want her to be able to start taking baby steps to improving her life and have even recommended that taking just a little walk for 10 minutes might help her feel better. At present, she sits in the upstairs part of my parents' home, which she occupies alone almost like an apartment and avoids contact with my parents as much as possible. She essentially hides there and feels depressed and that life is stagnant.

Suggesting she get out for a walk was not meant to encourage exercise, though I'm sure that'd help her, but rather to change the circumstances a little. She said she can't because cars drive fast up and down the dirt road they  live on and it's too dangerous. I suggested she try to get back into cooking to eat more healthily (which she claims she wants to do), but she says she can't because my parents will not eat what she prepares and will nag her if she goes to the downstairs area with the kitchen. She refuses to make the smallest change, or perhaps I should say, she cannot make those choices at this point in time. Her current psychology limits the number of options she personally is capable of pursuing. This is not her will, nor her "fault". It simply "is".

For the first time, I understood from the other side what it must have felt like for my husband, who loves me so dearly, to sit by and watch me destroy my body and sink into greater physical pain, depression, and negative thinking. I knew very clearly what it's like to love someone and not be able to do a thing to help them and that sometimes the best you can do is be patient, kind, loving, and supportive, and yes, possibly even contribute to their destruction by giving them things which introduce a little happiness into their misery. I went form knowing intellectually to deeply understanding emotionally what he must have felt for all of those years. That feeling is impotence and deep concern, but coming to terms with the fact that any effort to intervene will likely be more destructive than constructive.

I can't help my sister. She has to help herself when she is ready. The truth is though, that I don't think she will ever be able to change because whatever it is that it takes to turn the corner is not in her. She's suffered far too long and too deeply and I think she's given up. Life has defeated her and all she knows how to do now is to sit by and wait to see what fate's dice roll for her. I know she has the ability to make those changes, but she doesn't, and that's what really matters.

There is one more part in this sequence here.