The Scale

After waiting several minutes in the waiting room for my first doctor visit on July 8, 2016, my husband was escorted to an exam room, and I was escorted to a scale.

Side note: When I was 7, and I had “gotten fat.” I knew I gained weight because I had this awesome orange sweater with a penguin on it.  It fit perfectly at the beginning of 2nd grade, and by the end of the school year, my mother told me to put it in the “garage sale” box because I was too big for it.

I remember the exact moment the scale changed from a simple, subjective object to an emotionally charged monster that measured my self worth. We didn’t have a scale at home, and we were weighed twice a year. At the end of 2nd grade, I emotionally connected the scale in gym class with the loss of my favorite sweater.  My first diet came in 4th grade, or when I was 9. My parents gave me a product called “Get In Shape, Girl.” I had the ribbon edition, see below:

Get In Shape, Girl came with an audio cassette that would shout out the exercises I was to perform with my ribbon. In the upstairs hallway of my childhood home, I ran back and forth with my ribbon several times a week for months. This product didn’t teach me that exercise is important; it taught me that because I was fat, I didn’t get to have real toys or have real fun. Nope. Being fat meant that your “play” was exercise.

But, the diet didn’t work. My parents felt it was important to humiliate me for my weight but did not feel it was important to educate themselves on proper nutrition for their children or themselves. When I stepped on the scale at the end of school that year, I hadn’t lost any weight. Instead, I gained a pound. I worked so hard. My mother told me my weight was good because at least it was just one pound unlike the other years where I had gained so many. When I got home that day, I put the damn ribbon and the cassette tape in the “garage sale” box. End side note

The gym scale eventually turned into a bathroom scale in my childhood bathroom which turned into my own scale in college and graduate school which turned into a scale at my husband’s house when I moved in. That was the end of scales in my life until after the information session. We brought a digital scale into our apartment that was not wide enough for me to stand on without squishing myself onto it performing a feat of balance. I was too fat to fit on a scale purchased at Target.

The first time I stepped on the scale the number appeared was the largest number I had ever seen or will ever see again. The number was terrifying; I instantly screamed and cried. I didn’t have a penguin sweater to tell me about the weight I had gained. I had simply filled out my big and baggy clothes a bit more.

I knew I was going to be weighed at this first appointment, so I wore my favorite blue jeans, my Bob’s Burgers T-Shirt that read “Tina is my animal spirit,” and sandals. I made sure both my stomach and bowels were completely empty. As I look back on the decision of what to wear and being completely empty for that weigh in, I wish I had made a different one. I would have worn a coat, kept my shoes on and eaten a massive meal beforehand. This would have given me a bit more ammunition in the fight against the weight loss war that was to come.

I was scared. I was afraid the doctor would reject me for the gastric sleeve surgery. After I had accepted this was the path I was going to take, I feared the doctor would block my entrance. I made sure I was as light as I could be in order to get clearance to begin the journey.

The scale, much like the chairs at the weight loss clinic, is an exaggeratedly large size. It is double the size of the scale at my primary care doctor’s office, which doesn’t sound odd upon first glance, except that the scale at the primary doctor’s office is handicapped accessible to accommodate people in wheelchairs. The scale at the weight loss clinic can accommodate at least 2 people in wheelchairs.

I was told to remove my shoes and step on the scale. As I did this, a new ritual was born. Every single time I stepped on the scale in front of these people, I was greeted with a “mmm-huh” noise and a loud pen scribbling down the number. The number was clearly visible to me, as it was also much larger than necessary.

This scale became my enemy and my obsession. That number was the number they would use to calculate my pre-surgery weight loss requirement.

Every weigh in is a nightmare on this scale because no matter how large my obsession with that number was, it could never outweigh the clinic’s. You were “good” if the number was the right one, and “bad” if it wasn’t. To them, I’m a statistic. My success with the number on the scale means one more notch in their belt of one more person either becoming a success story or a failure.

Even when I hit their goals, they do not praise me in any way. They never tell me I’m doing a good job with my weight and obviously following their program. I wonder what they are striving for. What sort of “perfection” do I need to be?

I was escorted back to the exam room where my husband was sitting on a giant chair, his hand open so I could put mine in his.

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 these articles of 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 the 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 due to fear of people or due to the pain walking caused before surgery. 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 that day 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.

Now, I work every day to not allow people to make me feel like a lazy, stupid child. Some days are easy, other days suck. Weight loss clinic appointment days are one of the latter. I have hope that one day they will be the former.

Thou Shalt Never

Once I was sold a weight loss surgery, the information session continued on and on. Two women who didn’t understand the concept of presentations – the presenter talks and only the presenter talks – provided constant commentary on each slide, and they also fell into the category of heckling like Statler and Waldorf from the Muppet Show.

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The doctor explained the 3 surgeries the weight loss clinic will provide in high school health book detail. Then he moved on to the list of activities we could never do again if we chose surgery. According to the presentation,

WE CAN NEVER:

  • Drink Soda or any other “fizzy” drinks
  • Use a Straw
  • Chew Gum
  • Drink Caffeine
  • Drink Alcohol
  • Eat Hard Candies
  • Eat Coconut
  • Smoke
  • Snack between the 3 meals per day
  • Drink less than 64 ounces of fluid per day
  • Drink less than a ½ hour before a meal and after a meal
  • Skip Vitamins
  • Drink Very Cold Fluids

This list took a very long time for the doctor to explain due to the confusion from the crowd. One woman asked, “What do you mean I have to give up Diet Coke?” And the doctor’s response was, “Some of the fattest people I know drink Diet Coke.” Why didn’t he treat her like an adult and explain the carbonation in Diet Coke will cause her pain once the surgery is performed? Another woman asked about the no alcohol, and the doctor backed off on this rule. He said, “It’s something you can enjoy occasionally. Like champagne at a wedding.” This seemed to satisfy most people in the audience, including me. However, at my first nutritionist visit, she said she wished the doctors would stop using that example because champagne is “fizzy” so technically we couldn’t have that type of alcohol.

The presentation continued with more rules. A bariatric surgery patient has to meet guidelines before they can be considered for tho it out of the way to perform the operation. He stressed to the group if we don’t lose the weight, we will not be cleared for the procedure. We were also told we would be weighed on the day of operation to make sure we hadn’t gained any weight from being cleared for surgery to the actual surgery date. He said if we are even 1 pound over our required weight loss on surgery day, he would cancel it. “I’ve done it before, and I won’t hesitate to do it again.” This statement haunted me as I tried to lose my required weigh throughout the gastric sleeve preparation process. Every time I stood on a scale at home that didn’t say what I needed it to, I imagined myself standing in a blue surgical gown on a scale and refused the surgery. But his threat threaded its way into the lobes of my brain to become the first fear I would visit when my mind was quiet. It fueled my depression.

The entire process for this clinic usually takes AT LEAST 4 months to get the surgery. Like a fool, I took comfort in this time frame. I thought it was going to take 4 months or less to get approved and onto the operating room table. The four months were filled with many hoops, it will take another blog post to properly list them. For now though, it’s important to note all these hoops had financial repercussions as well.

We hit our out-of-pocket insurance requirements for the year in August, and my goal was to complete the surgery before the end of 2016 and the surgery would be free. My husband tried and tried to convince me it would be ok to have it in 2017, but I just couldn’t figure out how the bills would work out with our 2017 budget. I was determined to get it done before New Year’s.

No matter how many times I went to the clinic, or how far I came in the process with the checklists, when I asked the question “When do you think we can schedule the surgery?” The answer was, ALWAYS, “We’ll have to see.” Each hoop I jumped through, there were no encouraging words, no estimate of a possible surgery date, no indications as to when the hoops would come to an end, or even if I could get through all of them and have the doctor turn me away for some random hoop they never mentioned. Instead, I was always greeted with the “We’ll have to see” and the vision of me cowering, cold and vulnerable on a scale to be turned away at the very last second became clearer and clearer in my mind. The hoops, the uncertainty, the self-consciousness about my body, the pain to move, the desperate attempt to lose the required amount of weight, kept me up at night and sent me spiraling.

Side note: I was diagnosed with depression when I was a freshman in college. I should have been diagnosed much, much earlier, but that isn’t how my family worked.  All my family members had untreated mental illnesses of their own when I was younger.  It was too difficult to see outside their world to see mine. Interestingly enough, once I began my treatment for depression, many of my family members followed suit. It was like I was giving them permission to get help. I do not know a lot about how depression works in other people, but for me, it ebbs and flows. It seems to heighten in intensity for a period of time, usually a month or two at a time, but I think the intensity helps me recognize that I need to focus a bit more on self-care. In this heightened intensity stage, logically you know the sea of depression will subside. For me, incredibly difficult, stressful circumstances push me into the depression sea to drown. I’m dropped into the “Pit of Despair.” My depression moves me into darkness where I don’t have hope or believe the depression will ever subside. I look back at times I was in that pit, and I survived, but I do not remember how I functioned. I think about those times and all I see is life shaded black. It’s like depression redacted whole months of my life at a time. End side note.

Those months when I was hoop jumping for the weight loss clinic and for my insurance company is a portion of my life when I was drowning in the sea of depression or the pit. After the info session, I can’t remember day to day, ordinary activities through the black marker redaction.

Once the presentation concluded there was time for questions. I sat in a trancelike state, unable to focus on the doctor, the women or my husband. The women launched questions at the doctor that  sounded like a quiet buzzing in my ears. I wanted to leave, I wanted to never lay eyes on the doctor or these women ever again, and I wanted to run to the car and hide. After the doctor finished his presentation, the women rushed the doctor to ask him questions, my husband and I made our way out. Even though the car was in the farthest possible parking lot, I managed to make it there. Once inside the car, the emotions stuffed into my chest exploded. I cried, I yelled, I screamed. But I knew there was no choice for me but the surgery. This was the path I had to take because nothing else had worked.

When we got home, I shoved my shame into ice cream and planned to make an appointment at the clinic the next day.

The First Step

When I decided to write this blog, I did a lot of research about what it means to produce “good” writing. The theme of the research was that “good” writing should be both authentic and vulnerable. I’m not sure what that looks like or what that means. When I write about my story, it physically hurts. Sometimes the tears from pain, sadness, and heartbreak spill down my cheeks, and I can barely see through them. I just keep writing because I want to be authentic and vulnerable. This blog post is the beginning of the “official” bariatric weight loss journey, so the tone is going to change a bit. The first three posts were the multi-path journey that led to the decision to have the surgery.

The first step in having an elective surgery was finding out if our insurance company would approve or cover the procedure. On his birthday, my husband received word from the insurance company: “Weight loss surgery including the gastric sleeve procedure is eligible for coverage under your plan.” The letter continues by providing a link to a list of “designated weight loss surgery providers.”

Although the “designated weight loss surgery providers” came directly from our insurance company and we were told that we were covered, still the letter, strangely and a bit unsettling, came with a caveat stating: “Please note that a provider appearing on the list above is not a guarantee that they are in-network for your specific health plan.”  The insurance company says: Yes, the procedure is covered. AND here is a list of people who we want to do your surgery, BUT make sure that the provider is “in-network” for your plan. My question is, we went directly to the insurance company to make sure everything was covered under OUR plan, why would they give us providers who would be “out-of-network?” These logical questions, as well as future ones, I didn’t ask. Once I make a decision, I push forward with that decision against all logic, setbacks or roadblocks. Looking back, jumping in with both feet without looking for sharks, was negligent on our part. But after Chicago, there was no turning back. I was going to do this!

We chose one surgery provider out of the 12 listed. We chose our provider because this was the same hospital system where our Physician’s Assistant works.  I wish I could say my husband and I did research on the providers or thought about how this would be a good place because they could share my information with my primary doctor through their software systems. But none of this crossed our minds.

I called the “Surgical Weight Loss Clinic” located in one of the stereotypically richest areas in the city. Maybe for some people this would mean quality or extravagance, and in some ways, it did. I have to say, several times we enjoyed the valet parking service the hospital provided.

On my first phone call with the clinic, I was scheduled for an “information session” on June 28, 2016, at 7:00pm. The only question she asked was, “What kind of surgery are you hoping to have?” “Gastric Sleeve” was my response. The person on the phone didn’t ask why I chose this procedure; she just said I was to bring my identification and health insurance card. I thought this was really strange for something called an “information session.” Blindly, I followed their instructions. We were to meet in the Au Fait room. I had never been to this hospital, and I should have asked for directions on how to get to the Au Fait room. I didn’t.

I was nervous on June 28th for this hour long presentation. I dressed in my cutest clothes: black skort, sheerish red tank, and a black, short sleeve, cotton, lightweight cover-up jacket. I wore a pendant with a fake red stone in it, and my only pair of sandals. I thought I looked adorable, but I hardly ever looked in the mirror before surgery. Sure, a glance here or there to make sure something was on straight and nothing in my teeth, but I never REALLY looked into a mirror.

My husband and I work about a mile away from each other and often carpool to work, so instead of going home, we went out to dinner at a sushi bar, Nakamori. My husband and I walked in just in time for happy hour. We both had 2 glasses of plum wine and several rolls of sushi. I’m not good with chopsticks, so I dropped a piece or two on my shirt causing some stains. After we finished, we had time for dessert. We shared a Tempura Ice Cream and a Cheese Cake Tempura … basically deep fried ice cream and cheese cake. It was all delicious, and we were in high spirits from the food and the drinks.

I remember every moment of this meal.

This was the last one I ate for pure pleasure.

I wasn’t worried about the consequences; instead, I was in the moment, enjoying each bite.

The sushi place is about 6 blocks from the hospital, and neither of us could find a map of the inside of the hospital. I allowed my husband to just park in the parking ramp he figured would be the closest. Once we were in the parking ramp, I took off my shirt and turned it inside out to hide the soy sauce stains, touched up my makeup and lipstick, and we were off.

We walked in the closest door to the parking lot and it was a door at the corner of two empty hallways, with the exception of a bench. I promptly sat down on the bench and my husband wandered off to find a map or something. He managed to find a volunteer information person. He asked her where the Au Fait room was, and she said she didn’t know. They both looked at the map she had, and the Au Fait room was not marked on the map. Instead, she simply pointed to where it should be: on the far end of the hospital from where I sat on that bench.

My husband offered to go get the car, pick me up and drop me off at the closest door to the room. I thought that was absurd. I knew if we took it slowly, I would make it there. The problem was that I was anxious now because we were going to be late. The bottom of my feet rubbed against the leather of the sandals and began to burn as we walked. My lower back cramped up, and I was forced to sit down every chance I got.

By the time we made it to the Au Fait room, I was hot and out of breath. My feet burned so badly, I was anxious to sit down and take off my shoes. Instead, I stood in a line where a nurse, who I would come to recognize as the only “nice” nurse in their organization, checked my insurance card and ID. I was handed a pale-yellow packet, “Gastric Sleeve Surgery and You,” and was told to sit down for the presentation.

The first thing I noticed as we were finding seats is that every person (but my husband) was a woman, and they were all dressed in black. The chairs were extra, extra large, looked a bit like this one:

:chairs

and were incredibly uncomfortable.

As I sat down, I heard a woman whisper, “Wow. You’re not as big as her.”

This was both the end and the beginning for me.

Terrifying Words & Shame

The path to bariatric surgery all started at a doctor’s appointment in April 2016. Sadly, all of our doctors at our regular clinic left within months of each other, and we had to find another doctor. Living in an urban area, the choice of doctors becomes so distant, so cold, that if you are lucky enough to have a friend who has a recommendation, that doctor is usually not taking patients. Instead, my husband and I relied on which one didn’t look like a serial killer in her professional photo. I found myself half naked on a strange doctor’s exam table.

Side note: In the months between January and April, I needed to get a pelvic exam due to excessive bleeding, and I need to have one done every year because my mother had uterine cancer when she was 40. The first doctor only discussed my vaginal pain and heavy periods and didn’t check any private parts during my yearly physical. “They” say you don’t have to have a pap smear every year if you have never had an abnormal one. However, you should have pelvic and breast exams every year, no matter what. I then went to another doctor in the same clinic. This time, she just gave me a pap smear and nothing else. She told me I had to go somewhere else to get a pelvic exam. Note: she also did not check my breasts as well. End side note.

Back to Half Naked on the new doctor’s table. Amazingly, she did her job. Who knew it would take 3 doctors to get them to shove their hand up my vagina. I had better luck in grad school with random boys than this. But quite quickly she changed the topic from my concerns about bleeding to how everything was normal to weight loss surgery.

I’ve had a weight problem / been on a diet / hated my body and myself since I was in 2nd grade. At this time, that meant 29 years I have been battling my self worth, trying diets, succeeding on some, overcame anorexia, overcame bulimia, but everything failed. At this point in April, I thought it was the heaviest I would ever be. I read and tried every weight loss book out there. I tried everything.

Returning to vulnerable and half naked, this doctor suggests the gastric sleeve, a new procedure- where they remove all but a banana size section of your stomach. I told her I didn’t trust weight loss surgery, and what about all the extra skin, and she told me the percentages. Less than 10% of people who try to lose 100+ pounds or more do not gain it back. She also spoke about how she attended a conference about women’s reproductive health where they cited a statistic that women with a BMI higher than 35 have a 9x greater chance of having uterine cancer. She handed me a brochure and disappeared to have me clothe myself and get ready for another A1C (a blood sugar test).

I don’t think there are more terrifying words anyone has ever spoken to me. But, my husband and I were in the middle of a strict diet at that point, and thought, we can do this, we can defy the odds. We decided that we’d try to do it on our own until January 2017, and then, if it didn’t work, we would look into weight loss surgery.

I wasn’t sure if I could ever stop feeling that weight loss surgery is a shameful thing. That “How could I allow myself to grow so big that I would need weight loss surgery.” But when given the chance to look at others who have had weight loss surgery, I do not feel as though they should be ashamed. I think the shame should only belong to me and me alone.