Antoinette Polito reviews Dr Heidi Edmundson’s unflinching account of working as an Emergency Medicine consultant in a London hospital, and her embodied reflections on life in the NHS.
What would it mean to be so focused on the physical health of others that you nearly lose the ability to experience your own body? Part memoir, part gentle polemic, Heidi Edmundson’s Belly Full is a narrative of one physician’s work in a London emergency department (ED) and the toll it takes on her mind and her body. Dr. Edmundson loves her work as a consultant in a busy ED, so much so that it takes her years to come to terms with the mental, emotional, and physical toll the long hours, high expectations, and literal life or death stress have on her. Medical training has prepared her to work hard and to prioritize caring for others over herself, but her NHS team is chronically short-staffed, with little time to recover from the daily traumas they encounter. They struggle to stay effective in a system that continues to demand more and more from fewer and fewer. After almost two decades, our doctor is no longer able to deny that her motivation is slipping away at the same time her own body is changing so unexpectedly as to become unfamiliar.
Alternating chapters contrast her early career experiences with her current day to day. Across time and place, we see her develop as both a professional and as a person. Most of her personal relationships overlap with work and it is her colleagues who receive the bulk of her time and affection. The book opens shortly after New Year’s in 2022, when we are introduced to a weary healthcare team who have survived the initial nightmare pandemic only to run head-on into the overwhelming demands of the Omicron variant. Dr. Edmundson begins her story not with an anecdote from patient care, but rather with a moment tin which her coworkers are seen engaging in that staple post-holiday performance of diet culture in which everyone is once again resolving to “eat healthier”. She seems more self-aware than most but does tell us that she is feeling worn out, her clothes no longer fit right, and she is determined to start a “diet-which-was-not-a-diet” in an effort to make things right. At once we are introduced to a devoted doctor whose passion for work in trying circumstances leads her to seek a solution in losing weight.
She describes herself as having been one of the overweight children; she shared the generational horror of being weighed in front of the entire class in PE. Growing up, her mother and her doctor told her to try harder to lose weight, while her own body told her to eat delicious food. She found profound comfort in her grandmother’s Irish stew with its ability to turn “the mundane into a celebration.” It turns out her parents were the Boomer version of foodies, and she thoroughly enjoyed accompanying them to restaurants. In a chapter focused on her current experience, we see her trying on all her clothes, finding they no longer fit, and resigning herself to a capsule work wardrobe of baggy black t-shirts and stretchy pants. She looks in the mirror and says she genuinely doesn’t recognize her reflection.
Her narrative focuses on a workplace that continues to be so overcrowded that hallways have become examination rooms. The pressure to see more patients, in less time, is ever-present. She and her team are the front-line troops and the cavalry isn’t coming. Fatigue becomes normalized, wanting to quit becomes less rare. While less able to cope with her work, Dr. Edmundson continues to notice—on those rare times she makes the effort to look in a mirror—that her body continues to change shape. She pushes herself to eat less and less, and yet her weight doesn’t budge. Her belly becomes larger and more lumpy (her word) until several acquaintances ask her if she is pregnant. She becomes reticent to go anywhere but work and home, hoping to avoid further speculation. At the same time, she is functioning as a lonely champion of staff wellness. Advocating for mental health support to address workplace demands, she finds professional satisfaction in the small dent she can make in the despair of her colleagues. One of her great loves had always been moving her body to music; Zumba class was her happy place. Her rock bottom is close when she decides her growing body is no longer willing or able to participate in this collective joy.
She continues to “try harder” and buys some online diet supplements that she knows are “too good to be true.” She’s a physician and yet she is as able to suspend the disbelief as any of us. She starts keeping her head down and walking past anyone she might know at work. Her self-diagnosis? Lack of will power. She tells us:
When I was younger, I could push through anything and just keep going. I never had problems with doing more of anything: more work, more going out or more exercise. I could always reach inside myself and work harder. Now, I seemed to have lost that ability. It was yet another thing that made me no longer recognize myself. (Edmundson, p. 61)
This trained medical professional calls her reflection “grotesque,” and goes along her way. When she describes feeling a prisoner of her body it’s clear she has lost her agency.
It isn’t until February 2023, when pleading from her mother and sister, along with her own exhaustion, shortness of breath, and the confusion of her hard lumpy belly lead her to swap the familiar role of physician for that of patient. The memoir traces her diagnosis, treatment, and its aftermath over the next six months. Suffice it to say this involves beaches, naps, and a return to her beloved Zumba class before going back to work in September. Everyone agrees she looks wonderful, and it is hard to determine the extent to which that is true versus the equally likely option that her colleagues were simply still burned out and it shows. She no longer carries a belly that looks as if it were ready to birth a baby, but she does say she feels as if she has “given birth to herself.”
Memoirs of work and/or illness by physicians are not rare and this one is more charming than many. It is also, at times, more frustrating. Dr. Edmundson’s inability to recognize her own illness, or the power of her denial, almost doesn’t ring true. She is literally existing in a body that is changing in ways she ought to recognize, given her professional knowledge; to the medically trained reader she could be a case study. On the other hand, it is impossible to deny the power of diet culture and its ability to warp our minds and our bodies. We can learn something from anyone’s lived experience. It surprised me that the author was void of the anger that might rightly (or righteously) have been directed to the healthcare system or the national government, rather than to what she calls her “jelly belly”. Rather than opting to protest a system gone wrong, a system that is literally abusing her, she—and most of those similarly situated-choose to internalize their frustration, blame food, and turn their attack inward on their own bodies.
Anyone working in healthcare, dealing with professional burnout, or navigating a serious illness will find moments in this memoir that resonate. Clinicians and others employed in this work may even recognize parts of Dr. Edmundson’s journey before she does. Her time spent recovering her mind and body is particularly well described; it is a pleasure to read her when she is a bit more vulnerable and willing to share her emotional reflections. Her narrative ends in the present day, begging the question of how her return to the emergency department will go. Can she remain healthy while helping others? Will her work on staff wellness continue to bring her satisfaction and make the impact she is hoping for? Can one person create meaningful change in a system that is so far off kilter? We can hope so, and we can hope too, that the future brings Heidi Edmundson the personal and professional rewards her strength of conviction and dedication to others deserve.
About the Author:
Antoinette Polito, EdD, PA-C is an Associate Professsor in the Elon University Department of Physician Assistant Studies in Elon, North Carolina, USA. Her clinical background includes working in gastrointestinal oncology. Some of her current research addresses weight stigma in the practice of healthcare.
