Hey there, sweet thing...
To say "Bertha" was the homeliest patient I had ever doctored would be putting it mildly. Picture Ursula (the evil octopus in "The Little Mermaid") with a badly cropped haircut and enough facial hair to border on being called a beard and mustache. She waddled into the exam room attired in a drab green mu'u mu'u (unless it was really a family tent altered by a seamstress.) Bertha would win the blue ribbon among all those YouTube videos of gross and inappropriately attired (or more commonly, half-attired) shoppers who grace the doors of Wal-Mart. Bertha topped the scales at well over 450-pounds and huffed and puffed just walking from the waiting room to her exam room. Her nails were caked with dirt, and ripples and rolls of fat and body odor greeted me when I performed her physical. Her hair, oily and thin, looked like it hadn't crossed the doors of a beauty shop in decades. Judging from the uneven bangs, she probably cut it herself with kitchen scissors.
Were this my entire story you would mutter, "Big deal! We've all seen fat, ugly people before."
After all, in this day and age of "super-sized" burger, fries, and sodas, morbid obesity is no rarity. But unlike the majority of my obese patients who still maintain personal hygiene and an effort to style their hair attractively, and who still choose clothes that don't belong on a camping site, Bertha couldn't care less. Clearly, she had given up in the looks department years ago.
Judging from her acanthosis nigrans (a dark pigment under the armpits that is a marker of insulin resistance) and hirsutism (excessive facial hair in a woman), she likely suffered from diabetes mellitus and polycystic ovary disease. Underactive thyroid, adrenal imbalance, high blood pressure, and high cholesterol also sprang to mind.
Noting she was unmarried, I inquired what she did for a living. (I couldn't imagine any job that required dealing with the public!)
Without missing a beat she said, "I'm a phone sex operator."
I had to force my jaw to remain closed. "You mean you're one of those women that men pay by the minute to talk dirty with them?"
She grinned with her mouth full of decayed teeth. "Yup! And I make a darned good living at it, too!"
I asked her to demonstrate for me.
She immediately put on a husky, sexy voice and crooned, "Hey there, sweet thing. I'm feeling awful lonely tonight."
Unbelievable! If any of the hundreds of men she had flirted and talked dirty to over the years had any idea what she actually looked like, I'll bet their libido would take a precipitous nosedive. Ironically, Bertha told me one of the reasons she did phone sex was to seek revenge on all the men who had catcalled and hurled cruel remarks at her over the years. "They think they're talking to some sexy, busty, size two Dallas cheerleader type. Instead, they're talking to me," she said, gesturing toward her belly, a huge grin on her face. "I'm laughing my way to the bank!"
While I didn't think much of her career choice, I did secretly admire her spunk at retaliating at all the shallow people (like me!) who were too often unable to see beyond her pounds of excess blubber and facial hair. Homely, yes, but Bertha was still a child of God and deserved to be treated with kindness and respect.
I think I may have come up with a cure for internet and telephone porn addiction! Make every man who is into that stuff stare at Bertha's picture instead of all the bodice ripping, hot pants-clad flirty young things that normally advertise phone sex on TV or the internet! I'll bet sales would plummet!