Not Until We Are Lost Do We Truly Find Ourselves: Thoreau

August 20, 2018

10 months have passed without my ability to touch this blog. I’ve been giving excuses to myself as to why I haven’t written. I blamed it on lack of time because of a job change, lack of emotional energy due to many deaths in my family, and lack of readership.

The real reason why I stopped writing this blog is because I’ve been afraid to talk about what it means to have each passing day bring me closer to my 2-year surgery anniversary. I’ve been afraid to face my behavior since meeting my one-year mark, to face the ramifications of significant weight loss in my life, and to face failure, in many forms. Every day that has passed without writing, I’ve been plagued with guilt that has fed into my fear, depression, and anxiety.

At my year mark, November 17, 2017, I gave up. I had “made weight,” and was praised and accepted by the people whose voices had echoed and tortured me every hour of every day from July 2016 to that year mark. I had many visits with the weight loss clinic that first year, so I became the embodiment of their threats and negative reinforcement. I was terrified of every piece of food I put into my mouth, every missed opportunity for physical activity, and breaking any rule from the contract I signed to enter into this form of madness that “making weight” had become.

In order to make weight, I postponed activities, such as going to movies, having dinner with friends, and eating certain foods until after the weigh-in mark to make sure I made it to their, once again, unreasonable number on their scale.  I worried every day about a number on a scale, not because I was unhappy with how I looked or felt, but because I didn’t want to be reprimanded and dehumanized more than I had been by the people at the clinic.

In preparation for the weigh-in, I weighed 2 very cute dresses to find out which one weighed less, to make sure I met the goal. Never mind the fact that I had not just 1 cute dress I loved but 2, or the fact I was completely comfortable at the weight I was at or that I knew the cute dresses made me look cute.

When the date arrived, and I stepped on the scale in their office, I made weight. I was now worthy of their praise and acceptance because I had moved into their successful surgery weight loss column.

Back at the very first doctor assessment appointment where I had to choose between the two surgeries, I was told that the average weight lost by procedure was 100 pounds over a year with the gastric bypass and 60 pounds with the gastric sleeve. I had chosen the gastric sleeve, and even with the 60-pound information, the goal that was set for me was 127 pounds in the first year.

I met the goal.

I made weight.

I lost 127 pounds AND myself in the process.

I’m not suggesting that I had any idea who I was before the surgery, but once I had the surgery, I became Becky, the bariatric surgery patient. But, when do you stop being a patient? Who are you when you cross back over? What does cross back over even mean? Do you ever stop? I have no idea.

This blog’s goal and purpose has not been lost, even though I have been for a long time. It will continue to address the “reality” of my bariatric surgery experience, but it must include my own vulnerability and humanity as I fight for self-worth. At the very least I owe myself that.

Selling My Soul

July 6, 2016

After the bariatric clinic weighed me in at my first appointment, I was handed a patient contract by the nurse. As she was taking my vitals, I was to commit to activities I would perform FOR LIFE before I had even seen the Physician’s Assistant. Looking back, I should have asked more questions, or at the very least, waited to see the doctor before making any lifetime agreements. Like Robert Johnson, I had no qualms selling my soul to the devil. But, instead of earning the ability to create the blues, I earned the ability to jump through hoops to become thin.

I’d like to blame the information session’s brainwashing for my instant disregard for what “the rest of my life” is, but this one was all on me. I had 35 years of conditioning to get to this point, and I handed my soul right on over to the clinic, who would become my own personal devil in the upcoming months.

Below is the patient contract.

Patient Contract – Patient Copy

The purpose of this agreement is to ensure your understanding and commitment required to produce a successful outcome with regard to your bariatric surgical procedure.

Instructions: Please read each paragraph, and once you agree to the contents of that paragraph, please write your initials on the line next to each paragraph. If you have any questions as to the meaning of any paragraph, please ask your physician to explain it to you.

I understand that this Agreement is essential to the trust and confidence necessary in a physician-patient relationship.

I understand that if I do not follow through with all of the terms of this Agreement that my physician may refuse to perform the bariatric surgical procedure or may discharge me as a patient from the practice at any time.

I understand that my care and treatment may include use of prescription drugs such as narcotics for pain control. I agree that if I misuse the drugs prescribed for me, my physician may terminate my care and treatment. Misuse includes altering prescriptions, taking other than the prescribed dosage, or using fraudulent or illegal means to obtain drugs.

I will fully communicate to my physician any concerns and will also communicate to my physician or other applicable healthcare provider any suspected complications after my surgery.

I agree to comply with the pre- and post-surgery protocols, which includes following the diet(s) provided and behavior modification.

I agree to abstain from the use of nicotine products for three months prior to surgery.

I am aware of the increased risk of ulcers and bleeding post operatively with nicotine use and commit to avoid smoking and nicotine use lifelong.

I am aware of the increased risk of ulcers and bleeding post operatively with NSAID use and commit to avoid NSAID use lifelong.

I agree to keep my follow-up appointments as recommended by my surgeon and or PA-C.

I agree to take vitamins, and calcium and other supplements for life as directed by my surgeon and/or primary care physician. (monthly average cost $55 – $60)

I agree to have blood work done for life on at least an annual basis.

I agree to see my surgeon and family physician as directed. It is my responsibility to provide my surgeon and family physician with records from these visits.

Any medical condition that exists or may develop, not in direct relationship to my obesity surgery, must be treated by my primary care physician (and/or appropriate specialty physician), and I agree to coordinate my care with my surgeon. I understand my surgeon may not be able to treat me or fill prescriptions for other medical conditions.

I agree to have a support person available to help me for the first two weeks post op.

I understand that successful long-term weight loss depends on following the principles and guidelines of my surgeon’s bariatric surgery program.

I have read this form and discussed any questions that I may have with my provider.

The Gatekeeper

July 8, 2016:
The day of my first doctor’s appointment at the weight loss clinic began by pulling on my favorite Bob’s Burgers black t-shirt and a pair of comfortable jeans, believing somehow this clothing would protect me or give me comfort.

I was anxious. I was afraid they would find something wrong with me, and I would not be able to have surgery and be stuck in my body size the rest of my life. After the education session, I firmly believed the only answer to weight loss was surgery.

Side note: Every day I am vigilant to rail against the surgery brainwashing. At the education session, and during the months of preparation for the surgery, I was told over and over again about how surgery is the only answer to “real, long lasting weight loss.” Since I became more mobile after the second month post surgery, I have become the type of person I feared — A person who looks at others as potential weight loss surgery candidates. The brainwashing is so innate and severe, when I see an overweight person, my first thought is: “I wonder if they have thought about surgery.”

Fortunately, therapy has helped me become acutely self-aware. When that first thought becomes conscious, I admonish myself. I make myself recognize how beautiful, amazing and strong that person is. They are outside the house, moving around, in yoga classes, at the coffee shop living their lives. They are doing things I found impossible for me before surgery because of physical pain and fear. I send them positive thoughts and strength for them to love themselves and find a place to exist in this world that does not make a place for overweight people to fit. End side note.

Returning to the same hospital where we attended the information session, my husband found the closest parking ramp to the weight loss clinic’s office. I was wearing the same sandals I wore the night of the information session, and the walk from the parking lot to the clinic burned my feet. My sharp back pain forced me to sit down halfway between the parking ramp and the office.

Breathless, I stepped to the front desk to speak with a thin, older woman. The woman stood up and said “Hello” with a look of recognition and through an obviously fake smile. She expressed a familiarity with me that made me uncomfortable. She asked me, “Who might you be?”

Seriously? “Who might you be?” This phrase is uttered by adults to children or animals with their hands on their knees while they bend over to look at the child or the animal.

I told her my name, and she squinted her eyes, looking at me skeptically, as if I wasn’t who I said I was. Then after several awkward silent moments, she turned around and picked up a piece of paper off a table behind her. She placed the paper on the counter between us and looked over her glasses at me. The paper was a print out of all of my information, and she slowly, very slowly went down each box reading my name, my address, my insurance, etc. She used a pen to point at each of the boxes to make sure the information was correct. Aside from the obvious violation of HIPAA as my information was laying completely printed and out in the open AND her reading my information loud enough to the entire waiting room, each answer I gave was met with the same skeptical look.

The look made me feel like she thought I was lying or confused. I felt like I was a child lost in a store and telling the security guard my mom’s information, but he doesn’t believe me when I say I’m lost. Finally she released me and told me to sit in the waiting room. This was my first day at the clinic. I was ashamed, anxious and embarrassed because I was there to ask for help. What I expected and wanted to see from the first person representing the clinic was empathy, compassion and kindness. Instead, I was treated like a child and a suspicious liar at the same time.  

As far as the actual appointment, it will be covered in future posts. But for now, I will be sticking to the gatekeeper.

GATEKEEPERS

After the appointment finished, I had to speak to her again with a green slip of paper the nutritionist handed to me to schedule the next appointment. This was another excruciating encounter, as she awkwardly fiddled with the schedule much longer than a person should. The appointment was over and all I wanted to do was get to the car before the tears started flowing. Instead, she became a roadblock; a way for the weight loss clinic to make sure I would return.

Once I finally had an appointment, using the same pen she used earlier, she slowly wrote in large, grandiose cursive writing the date and time of the next appointment, as if she was making a beautiful piece of calligraphy art.

Again, I thought this just must be the way she behaves at the first appointment. Nope. This is how she behaves at EVERY appointment. She asks for my information in the exact same way EVERY time.

She doesn’t behave this way with just me. No, this is her behavior with all of the bariatric surgery patients. Her behavior reinforces the stereotypes that fat people are lazy and stupid. Before the surgery, her behavior reinforced the treatment I received in the world. After the surgery, her behavior is a reminder that no matter how much weight I lose, I will still be overweight and stuck facing these stereotypes.