Necessary Mutilation

Please don’t call in sick, Dr. C!  Even his health has become one of my worries!  And what if he retired before summer?!  I wonder how old he is, anyway!

Well — I’ve made out my list of medications for the appointment as asked:

• Paroxetine, 40 mg (Paxil/depression)
• Nabumetone, 500 mg (Relafen/arthritis)
• Metrotoprol, 50 mg. (Toprol/high blood pressure)
• Metformin, 850 mg. 3x a day (diabetes)
• Plus vitamins, calcium + D, cinnamon, fish oil, 81 mg. aspirin, chromium picolinate

And I’m sure I have my new insurance card, so that better not present a problem.

And, my list of questions:

1. What is the area sutured with (inside and out)?
2. Why “open” instead of laproscopic?
3. Expectations; guidelines for recovery.
4. How long is the average hospital stay?

Many issues are covered in the literature I’ve been given or information off the net, but I need to hear him say it.

Someone on a TV show about Bariatric Surgery recently said what an odd construct this surgery is.  She noted that one must “risk their life to save their life” - and I see all too clearly now what this means.

What a sobering experience today’s surgical consult was!

First of all, I was underwhelmed by the bland, bored demeanor of the little young woman behind the desk that greets and processes you.  Although I had called yesterday to say that I’d like to come early to tour the facility (gym, etc) and they suggested one hour and would provide me a packet of paperwork to review prior to my meeting with the Dr. - she knew nothing of this as evidenced by her monotonic “sit down, you’ll be called soon.”  When I explained, she shrugged and said “okay.”  I had to explain that I didn’t know what I should do or where I should head having never been there before.  She then apathetically pointed me to the left, with no explanation or help.. So much for my introduction to the place I’d looked forward to visiting and touring.

Left to my own devices, I wandered an empty gym and empty snack type bar set up like a little café with a menu of health shakes and other bariatric surgery friendly concoctions.  Sweet!  I also read every flyer, brochure and poster I could find, before settling into the overly small wait area to go through my packet.

That’s when the creeping, skin crawling, apprehension and then “gak” set in.  What serous stuff this surgery is!  What strict and complex “instructions” and necessary - (pre and post-operative) information this packet held!  And on the cover sheet with my name on it, a list of steps to yet be taken/appointments to attend, prior to my MAY surgery.  May !!   Here I’d been gearing up for likely June or maybe even July.  Although, Ms. apathy explained that May is just an approximate/guess at this time, even if a little premature, it’s a sobering combination of yippee and “gak!” news. 

One of my first thoughts was that now the eating with increasing frenzy will have to end early.  I’d better step it up and use the really good Entertainment Book Coupons at least, ASAP.  Really!

Not - oh good, one less month to wreak havoc on myself.  Or - what about work or I have a lot to do to get my ducks in a row.  Sure - these thoughts and more came later (in stereo!) but honestly, anticipating grief over the loss of overindulgence remains right up there!

Anyway - continuing on with my journey - next I was called by a voice I couldn’t see, as the door is around the corner from the wait area.  I hurriedly grabbed my coat and purse to follow voice lady, only to find her barely visible as she ran down corridors and turned corners, not even checking to see if I was in pursuit.

C’mon lady -we’re fat here, slow it down!  It reminded me of those times in busy restaurants when a waitress calls your table and then disappears into the crowd and you get stuck behind, leaving you unsure just which waitress to follow (even my analogies are food oriented!)

Anyway - Marathon lady finally stopped at a hallway scale, barked orders for me to take my shoes off and step up.  Where’s the warmth I read about on the internet? The caring team approach?!

Oblivious to my windedness from the tour de Bariatric Center, she then told me to take a seat on the little chair I had just hastily dumped my coat and purse on (”excuse me - Is there somewhere else I can put these?” Shrug.), She proceeded to then take my blood pressure and pulse.  She whipped out the world’s largest cuff (reminding me that I’m not at Club Med) and shock - my blood pressure and heart rate are gasp - elevated!  136/82 BP - not horrible, but do you think maybe related to my 300 pound jog to the bowels of the Center in hot pursuit of Marathon Lady?  Sigh.

Next, Mrs. Efficient, but with glimmers of personality and humor nurse, briskly asks a questionnaire full of medical questions, reminding me that in addition to High Blood Pressure, Sleep Apnea and Diabetes, I also have PCOS and Adrenal Hyperplasia.  I briefly tell her about these.  She was humorously complimentary that she is impressed by a woman who knows here C-PAP Level (”18″), though clearly invested in the same degree of efficiency as everyone else.  She left, reminding me to disrobe except underwear and bra and put on thin (paper) gown with the (paper) pad to cover up further if need be.  How refreshing that for once the gown was bigger than me - but how REFRESHING that the room was like 20 degrees and I was wearing paper and sitting on a slab of paper covered plastic.

Mercifully, Dr. C. came soon- smiled and said he recognized my face (really?!) from my 10 year ago surgery with him - and was a ray of personality, warmth and humor not yet seen by others.

Unfortunately - the news he told me made my lip quiver and my eyes well up, and caused me to make Quasimodo faces at him as he shared excruciating detail about my need for a vena cava filter due to my supposed elevated risk for a blood clot.  He said that he had done research and presented a lecture on the triad of increased BMI (mine’s in the 50’s); sleep apnea and fatty liver (oh year, I have this too), and the greater likelihood of lower body clots due to this.  As a result the filter plus two times daily shots of heparin must be given for three weeks in my abdomen to decrease the risk!  Aacchkk!

My assumption had been that “don’t most people who get gastric bariatric have all these things…I mean, why wouldn’t your liver be fat if the rest of you is too?”  His immediate retort was - “9% !”  You’re kidding?!  So I’m in the lucky 1/11^th of fat people who might be clotty and need be sent home with instructions for heparin administration AND have a pre-surgery surgery to install a vent!

Well - I wasn’t born with Arab blood for nothing.  Bartering and negotiation are (also) in my blood.  I told him about last years colonoscopy and my successful quest to find probably the only doctor willing to both do the procedure without an IV (no anesthesia) and locate a site that would tolerate this risk.  It went swimmingly despite my oral valium wearing off long before they finally got to me, and I told Dr. C. all about it to help him understand how great my needle phobia is and how much I value doctors who are willing to consider this/other options.

After considerable discussion and compromise, ending when he said “I’m not willing to compromise anymore and put you at risk (and increase his low mortality and incident statistic(s).) 

So now, here’s the plan.  Rather than days before, the Vena Cava filter will be installed (in my leg/abdominal) artery while I am already under and during the main surgery. Phew - I don’t care what anyone wants to do to me once I’m under!  However, I will need to have a “trap” placed in my arm days before that will act as an IV line (okay, good, I won’t need to suffer repeated sticks, I think?) and perhaps keep it in for weeks past surgery so I can have repeated blood draws to check my oral Coumadin levels regularly - a concession he was willing, but not overly thrilled to make.  He said that he preferred the heparin (shots) and I still would have to have these while hospitalized - but would allow for Coumadin to replace this at home.

I forgot to ask when and how the trap then comes out.  Yuck!

In any case, it was all I could do to refrain from running, screaming out of the door in my paper gown - as reality of every kind suddenly sank in.  Let’s see - grosser than I imagined; riskier than I’d thought; more efficient but less “cuddly” staff than I’d hoped; need to prep and plan in more complex way than I’d considered.  So what did I really think I was up for -club med?!

Later, at home, I whined my way through several telephone calls to close girlfriends, seeking reassurance, support and sympathy.  Thank God for mortified friends!  Perversely there is something reassuring in sharing the goriest of details with someone who truly appreciates the magnitude of yuck and doesn’t just try and placate it away.

My one bizarre telephone call was to Pete - best male friend, previous landlord and cohabitant for 20 years, and supposed-to-be sensitive gay man. Strangely, when I asked if we could set a date for him to come over so I could share some important news (I hadn’t yet told him anything) - maybe the cryptic nature of my request sounded alarming or suspicious, because his response was:  “Why, what are you setting me up for?!”

So great, now when he does come over he’ll be anticipating an Intervention or blind date or something.

I guess that’s what happens when you don’t want to share sensitive information on the phone.

Hallelujah — tomorrow is finally my surgical consult!  I called the office yesterday to ask if I came early if I could tour the facility (gym; nutrition department, etc.) and was heartened by the welcoming response.  I feel ready to leave now!  She said that I will also be given a full packet of information to read that includes a time line of requirements (bloodwork, dietary consult, etc., I guess) between tomorrow and bariatric surgery day.  I love that they sound organized and planful, like I am.  Just the same,  anxiety about everything continues to make my skin crawl, and I doubt much of anything can ameliorate all aspects of it.  There’s enough to cover every step and stage for before, during and after surgery!  So many what-ifs that even if I had 24-hour access to past patients and unlimited opportunity to ask everything my heart desired, I think I’d still wonder, worry, fret, ponder….

I must admit that Tom’s stance is not helping my process, although I realize he has his own share of thoughts and worries.  Lately I find him increasingly sarcastic (like today he actually “joked” that he planned to eat all kinds of favorite foods in front of me afterwards!) and superficial if I bring any aspect of weight loss up.  He also never initiates this subject and still looks at me in a way that reinforces my suspicion that he thinks I may not really go through with it.  Although I have never waivered in my intention and have said nothing to indicate doubt, all along Tom has said either to me or to others in my presence things that indicate that he either believes or secretly hopes that I will “change my mind once I see the needle or once she sees what she’s in for”.  I’ve tried to discuss all aspects of this process with him especially out of fear that such a radical change may grow a wedge between us.  Let’s face it; our marriage has thrived on the presence of a third partner called “addiction”, and the bonding of man-woman and cannoli. I worry as much about what he will eat and how, for his sake, as I do about my diet.  We eat out nearly daily - is he really ready as he says he is to alter this, especially in my early days on Ensure and Jell-O?  What will HE eat; where; how and with who if not me?  Don’t other people wonder this, or is food so much bigger a focus here and between us, than with others??

If the psychologist wasn’t such a dork it would have been nice to have run such questions by him.

Maybe therapy will become necessary in time…?

Especially after tomorrow’s appointment!