Hospitals don’t have evacuation plans in place to care for fat and disabled patients in the most disastrous moments.
TW: mention of “ob*sity,” murder, and general anti-fat anti-Black violence
Earth’s climate is changing. Drastically and rapidly. Glaciers are melting; ecosystems are shifting; temperatures are changing and sea levels are rising. But what is perhaps most relevant to this current moment is that “natural” disasters are becoming more frequent, much more intense, and are lasting longer than they used to.
Hurricane Ida recently swept across Louisiana, leaving the state with devastating damage, sixteen years after Hurricane Katrina. In the midst of the storm, one of Thibodaux Hospital’s backup generators failed, causing ventilators to stop working. This forced the hospital’s medical staff to manually pump air into patients’ lungs through a method they called “bagging.” With limited staff and supplies, this would ultimately mean that staff would have to choose who lived and who died. After being made aware of this, I immediately began to reflect on the ways fat and disabled people were abused in this very same state 16 years ago, and what implications that reality holds for fat and disabled people moving forward as the Earth’s changing climate makes us all more susceptible to a rapid increase in disastrous weather.
As Hurricane Ida continued to rip through cities across the South, and made its way up to the Northeast region of america—states not typically known for experiencing hurricanes and tornadoes—I couldn’t help but fear for the lives of fat and disabled folks. I asked myself: what would the lack of preparedness by the states’ leadership mean for patients who have unequivocally been deemed “least likely to survive”? While there are several triage systems in the world, if the general triage standard in crisis is to treat the patients who are most likely to survive, then as states experience more of the worsening aspects of climate change, it’s safe to infer that more fat and disabled people will die unjust deaths—and, perhaps more accurately, will be murdered by the state.
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One could argue that it’s imperative to discard of those who are least likely to survive due to a shortage in medical supplies, but my counter-argument would be that not only are fat and disabled people deemed “least likely to survive” just because they are fat and/or disabled, but a shortage in medical supplies is a byproduct of capitalism, profit-driven healthcare, and a commitment by the World to killing the Black/fat. As I define in my book, Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness, this world—one in which the Slave / the Other / the Black are produced—is the only World to have ever existed. It is true that beings lived and breathed before this moment in time, but it is anti-Blackness, colonialism, and capitalism that form and shape the place we now refer to as the World. This is to say that a shortage in medical supplies is, at least in large part, an issue created by capitalists and major healthcare companies; it is not something inherent or an issue that cannot be solved. The monopolization of necessary supplies and resources is perpetually killing us precisely because World is predicated on Black (fat) death, and there is no other way to phrase that.
Anti-fatness is/as Anti-Blackness. Which is to say that it is the condition under which the Black fat, the Slave, is held captive to/by the World. Anti-Blackness creates the World and gives meaning to everything in it. This means that anti-Blackness functions as a schema—outline or paradigm—of the (il)logical production of Black flesh, Black (as) pain, Black (as) trauma, Black (as) suffering. In other words, anti-fatness is the framework by which the (Black) fat subject is forced to be inhuman; an object; the beast. It is the cosmic, universal, intercontinental structure that determines how we are engaged in life and D/death, as well as who lives and who dies. In this way, fatness—just as Blackness—is always and already criminalized, penalized, objectified, marginalized, and defined by the libidinal economy (or the collective unconscious (or by society)).
You have to hope that there is medical staff fighting in these situations to not discard their fat and disabled patients just because they’re fat and/or disabled. However, if what happened in the midst of Hurricane Katrina is any indication, there aren’t. And we are in this alone. Many hospitals don’t have plans for moving fat patients mid-crisis. And, in some extreme cases, they have opted to literally murder these patients. Emmett Everett was a fat Black man who was alive, alert, and enthusiastic about the prospect of being rescued from the dark, musky halls of Memorial Medical Center (MMC) in 2005. He was admitted to the hospital for a non-life threatening ailment that he was scheduled to have surgery on to resolve. Medical staff determined he was too fat to rescue and, after days of watching others get chosen for rescue over him, he pleaded with his nurse—on several occasions—to not let them leave him behind. To no avail. While he was fully alert, led by Dr. Anna Pou, nurses dosed Everett with a lethal injection of a cocktail that combined morphine and midazolam. According to Kristy Johnson, a LifeCare director of physical medicine, Pou told Everett that the medicine he was being administered would “help him with his dizziness.” An iteration of these words were spoken to each person Pou euthanized. When the cocktail didn’t kill Everett, they smothered him with a towel. His official cause of death was listed as “Katrina.”
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According to Sheri Fink, a Pulitzer Prize winner and author of Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, Pou and the rest of MMC’s staff had no training in any triage systems. She and her team weren’t using any specific triage system, but their actions were aligned with many of the triage systems used throughout the world—especially in war zones. These triage systems, in fact, are unreliable. To this day, there is no universal agreement on how to triage patients. Fink notes that in one study of triage, “experienced rescuers were asked to categorize the same patients and came up with widely different answers.” It is impossible to determine how well a patient will or will not do just by looking at them; that decision is made by individual biases, created by a global anti-Black structure.
Pou was not alone in making these decisions. Dr. Ewing Cook, Susan Mulderick, and many other physicians and nurses whose names have been left undisclosed joined Pou in making the choice to euthanize at least 21 patients—many of whom were Black, fat, and disabled. Patients like Jannie Burgess and Rodney Scott. Their reasons varied. Some said it was to put the patients out of their misery; some said it was to “hasten” the process of their looming deaths; others, like Dr. Cook, stated that it was simply because the nurses were needed elsewhere and that the hospital—which was essentially an “island”—was at risk of being overrun by people in the neighborhood searching for “drugs” and other supplies. On some of the patients who weren’t euthanized, and were instead just abandoned, Cook was quoted saying, “We didn’t [kill them] because we had too many witnesses. That’s the honest-to-God truth.’’ (And despite that fact, Cook nor any of his peers were indicted for the murders of any of these patients). Fink shared this of John Thiele, a pulmonologist who insisted on assisting Pou with the lethal injections:
“[Thiele] was terrified … of what would happen to them if they were left behind. He expected that the people firing guns into the chaos of New Orleans — ‘the animals,’ he called them — would storm the hospital, looking for drugs after everyone else was gone. ‘I figured, What would they do, these crazy black people who think they’ve been oppressed for all these years by white people? I mean if they’re capable of shooting at somebody, why are they not capable of raping them or, or, you know, dismembering them? What’s to prevent them from doing things like that?’
The laws of man had broken down, Thiele concluded, and only the laws of God applied.
‘Can I help you?’ he says he asked Pou several times.
‘No,’ she said, according to Thiele. ‘You don’t have to be here.’
‘I want to be here,’ Thiele insisted. ‘I want to help you.’
Thiele practiced palliative-care medicine and was certified to teach it. He told me that he knew that what they were about to do, though it seemed right to him, was technically ‘a crime.’ He said that ‘the goal was death; our goal was to let these people die.’”
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Katrina isn’t where stories of intentional, unethical, violent murders of fat and disabled people begin and end. In 2012, New York was ravaged by Superstorm Sandy. All but two patients were evacuated from america’s oldest public hospital, Bellevue Hospital Center (BHC). One was said to have been too high risk to move “due to his cardiac status.” The other was described as a danger to herself and to staff who would have to move her “due to her body mass index (BMI).” Despite having been deemed “stable for movement,” hospital staff decided that the woman’s size, shape, and weight was enough reason to leave her behind.
These are just two glaring examples of a long history of fat people being disregarded, discarded, and euthanized in the midst of crisis. Hospitals don’t have evacuation plans in place to care for fat and disabled patients in the most disastrous moments. I fear for what this means for the days, weeks, years to come when we’ll be experiencing a heightened level of crisis, especially while navigating one of the deadliest and costliest pandemics in the past decade. Anti-fatness, ableism, Anti-Blackness are all so pervasive. The medical industrial complex is quite literally killing us. Health at Every Size (HAES) and body positivity are becoming more-and-more mainstream concepts by the day, but will they be enough to save the Black fat in the moments where it matters most? In that it will disrupt the cosmic structure under which the Black fat is engaged, no. But what I am certain of is that we desperately need more people advocating for fat and disabled people in times like these, or we’ll have to prepare to watch bodies pile up in the name of anti-fat anti-Black violence justified by the medical industry.
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