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Dr. Roll is an elderly, amiable man. He explains the procedure and asks me why I'm 372 pounds. I tell him I eat too much and I do not exercise.
 | From http://www.niddk.nih.gov/health/nutrit/pubs/gastsurg.htm: Roux-en-Y gastric bypass (RGB). This operation (figure 4) is the most common gastric bypass procedure. First, a small stomach pouch is created by stapling or by vertical banding. This causes restriction in food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum (the first segment of the small intestine) as well as the first portion of the jejunum (the second segment of the small intestine). This causes reduced calorie and nutrient absorption. |
Dr. Roll tells me that a nurse will call me when the insurance clears. We shake hands and end the meeting. I meet Sally Myers the nutritionist on the way out. She's happy and thin, like you'd expect a nutritionist to be.
I call Dr. Roll's office in the a.m. and the nurse tells me that my insurance has approved the surgery. They give me a list of the appointments I have to make: Blood work. Blood gases. Gall bladder sonogram. Something called a "nurse interview." Four nutritionist appointments. Psychiatric screening. By the time I get to O.R., I'll be authorized to carry the nuclear football for the President in my colon.
My surgeon requires a pre-op psychiatric screening. The psychiatrist asks me about my family: I tell him. My dad is not fat. My mom is not fat. My sister is a warrior princess. My brother is a piece of steel shaped like a man.
He asks "What does the phrase 'Strike while the iron is hot' mean?" Apparently, crazy people don't recognize or understand epigrams, and they respond "I don't know" or "It's a phrase used by blacksmiths." I tell him that 'Strike while the iron is hot' means that I should get the surgery before I DIE.
The psychiatrist asked me if I had bouts of depression or entertained thoughts of suicide. Yes; no. I mentioned my ADD and the psychiatrist said that the ADD might cause a problem in that the nervous, gotta-be-doing-something energy might cause me to overeat and get sick. Talked about my longstanding obesity symptoms of sleep apnea, acid reflux and arthritis, plus the onset of new scary obesity-related symptoms - diabetic neuropathy in my fingers and toes, high blood pressure.
The psychiatrist thought that gastric bypass surgery was an excellent move for me. He also warned me about what he called "reverse bulimia," where big guys who lose weight have an irrational self-image of being tiny, even though they're still relatively large people. We also talked about my fear that my wife will question the longevity of our relationship after I lose the weight. The psychiatrist warned, "Some men, after this operation, find themselves much more appealing to the opposite sex than before, and sometimes they can get a little...excited." This originally gave me a dose of fetal-ball anxiety. Then I remembered that my wife's already beating the ladies off with a stick. This is good, because she'll need that training when I become even more devastatingly handsome.
I meet with Sally Myers the nutritionist in Dr. Roll's office. Sally shows me a blue plastic disposable plate with rubber simulacra of a slice of baked chicken, a small scoop of plain mashed potatoes and a small scoop of peas for an entire meal volume of two ounces. She says, "This is what you'll have to get used to eating." I pick up the rubber chicken fillet and slap it against the edge of her desk. I consider making a joke about eating molded rubber, but I haven't gauged her sense of humor yet.
Sally tells me that gastric bypass is serious surgery and that my wife will need to be with me for the first week, and I can't go to work for another week after that. I'm really worried about a post-op hernia, because I'm hernia-prone. Sally tells me not to lift more than 25 pounds the first three months and to begin lifting weights after that. This means that I'll have to use a redcap for my standup comedy trip to Orlando and Austin, and my wife will have to carry our luggage for our weekend trip to London for my friend's wedding.
Sally tells me I'll be on pureed food the second day after surgery. I told her that I heard a rumor that some patients have a colostomy bag for a week or so after surgery. She says, "oh, no, we don't do 'central-line' anything here." Apparently that refers to feeding people through a tube. She also tells me that when I wake up after surgery, I'll have a tube down my nose to drain fluid out of my stomach. I'll also need to wear slip-on shoes around the house because I won't be able to bend over for two weeks. The morbidity of the post-op experience is beginning to sink in.
I tell her that I'm worried about losing weight and having big flaps of skin like the photographs I see in the National Enquirer.
Sally tells me that I can start lifting weights after six months, which should help. I'm going to start swimming again after two months. She asks about my diet. I eat healthy food, but I complain that my wife is trying to kill me with chicken. Sally promises to bring me a list of lean cuts of beef to our next meeting. She tells me to drink water between meals but not with meals, because drinking water flushes food through the stomach, depriving people of the sensation of being full, and encouraging overeating. She also warns me that some post-surgery depression is common. She tells me I'll have to sip water from now on: 1 cup every hour for six months, then two cups an hour after that is the guide, but she reinforces that I should just sip as I am able. I tell her food is my enemy, and I won't miss Thanksgiving dinner, but I'll miss being able to turn over a bottle of cold spring water.
She tells me no liquor for a year. She says I'll also need a pill crusher to crush any prescription medications, a pill splitter to split the vitamin and mineral supplements that I'll be on for the rest of my life, and I'll need tomato juice or apple sauce to cut the bitterness. Six months later I'll be able to just split the meds too. I tell Sally that my wife has questions about what I should eat and avoid, and Sally sells me a book for eighteen bucks with her assurance that it answers all her questions. I buy it. I ask Sally about her patients who had the surgery and gained the weight back. She tells me that some people lose weight and realize that they've been using the fat to insulate themselves emotionally.
She tells me that half of her female patients were sexually abused as children. This depresses me. I'm reviewing the filmstrip in my mind of obese women I've known and wondering which ones were molested: "Probably; doubtful; maybe; no." I tell Sally that I read something about a neurochemical similarity between hunger and libido, and that maybe people who are molested become obese because they shut off the erotic component of their psyche and still have to satisfy those preconscious firings in the brain. We theorize some more and conclude the appointment.
The Day of Lists. I turn in my three-day food diary: no junk, no sugary stuff. Just lots of food. Because I've already asked Dr. Roll and the psychologist, I ask Sally if she has worked with anyone for whom the surgery has failed. Surprisingly, she says yes, and promises to give me some names so I can talk to them before my surgery. I ask her about the traits of the people who didn't succeed with the surgery. She tells me that they:
My wife and I go to the outpatient testing center at Fair Oaks Hospital. My wife reads a copy of People magazine while I complete a long form about my obesity-related symptoms. The radiologic technician takes me into a darkened examining room for my gall bladder sonogram (Appointment #1). I take off my shirt, and she pours warm gel on my stomach and runs a light pen around my abdomen, concentrating on the soft spot just under my ribs. This happens to be the most ticklish place on my body. I flail involuntarily and almost hit the technician in the head with my forearm. The doctor, blonde, pretty, and younger than I am, comes in and scans some more. I look at the image of my gall bladder on the screen. I finally get to play the prank I've been waiting to play for a month when I scream, "MY BABY!" The technician tells me that she's been doing sonograms for seventeen years and she's "heard them all." Deflated, I dress myself and return to the waiting room to wait for my nurse interview (Appointment #2).
I meet nurse Carole Bergin. She's nice. She has a great hairstyle, and I tell her so. She goes over my list of symptoms and writes some special pre-op and post-op instructions for me about what to bring to the hospital and how to prepare my body for the surgery. We're running late for my nutritionist appointment, so my wife leaves for Dr. Roll's office in the next building to wait for my nutritionist. The nurse tapes contacts to my torso and takes an EKG. Nurse Carole tells me that my heart has a non-specific T-wave abnormality, but that she has it as well, and it "won't get you a day off of work." Then she leads me into a changing room where I leave my things, and shows me the urine cup in the bathroom and the instructions on the wall. I successfully interrupt the urine stream and hand the cup to a technician. Another nurse with a tattoo on his arm draws a couple of vials of blood from my arm. I confirm that the USS NASSAU coffee mug that I saw in the window sill is his. I walk down the hall toward the X-ray machine, deliberately wandering like a stray until a technician takes me into an X-ray room. I instinctively lie on the examinating table, but she uses another x-ray machine against the wall which I lean against. The technician tells me to wait until she makes sure that she's done with me. I'm sure that she's done with me, and I'm late for my nutritionist appointment (Appointment #3).
Sally the nutritionist has been reading my web site: she greets me with a list of corrections. She also shows me a list of web links that she provides to her patients, and tells me that she's building a web site for her post-op support group. I promise to make her changes and make any future changes if she promises to link to my site from her handout and upcoming site. We pinky-shake on it.
This appointment is about the dietary changes: she arranges her desk with fake rubber jelly, crackers, peanut butter, margarine, protein supplement cans, vitamin boxes, yogurt cups and milk cartons. She gives me lists of nutrient suppliers and photocopies of the nutrition information for the supplements she recommends, so I can compare them with my own to make substitutes. I write down the names of the supplements I want so I can order them later. My wife arrives with a boxed lunch for me. Sally gives me a card that I'm supposed to present to restaurant wait staff, asking to be served from the children's menu.
Sally shows me a one-ounce plastic cup that looks like the cups that are blister-packed with cough medicine. She tells me, "This is half of the volume of what your stomach will be." I'm really worried about eating too quickly and vomiting: Sally tells me that the number one reason people vomit is because they eat too fast, and that everything has to be chewed to a "tuna salad-like consistency." Sally talks about two artificial sweeteners: Splenda (sucralose) and Stevia. I confess to Sally that I'm going to miss our special times together. Many busy medical enterprises seem very hurried and objectifying. Dr. Roll's busy enterprise does not.
My wife and I leave for the hospital next door and give the outpatient ID card the nurse gave me to the front desk clerk, who tells me that someone will come and get me from the pulmonary lab in five minutes. Twenty-five minutes later, I tell the clerk that I'll go to the lab myself (Appointment #4). I find a separate waiting room devoted to the pulmonary lab and greet the woman behind the information desk. She is the most beautiful hospital employee I have ever seen. In fact, she's the most beautiful woman I've ever seen in any desk-job capacity. I tell the waiting room goddess who I am and that I'm supposed to have blood drawn from my artery to check my arterial blood gases. My wife is next to me, so I don't want to seem like I'm hitting on Waiting Room Goddess, but I want to let the Goddess know my feelings, so I tell her, "You're the most beautiful hospital employee I have ever seen." She says thank you.
Tammy The Pulmonary Nurse arrives and takes me into a room with a treadmill, and a heart rate machine that looks quaint thanks to its 5 1/4" diskette slot. A technician walks in and fiddles with a machine while the nurse starts to soothe me with conversation. I mention that I play ComedySportz, and the technician tells me that he's seen the show. The nurse keeps talking to me while she rubs my wrist, looking for an artery. Finally she apologizes while she drives the needle into the juncture between my wrist and my arm: it feels like she's driving an incredibly thin wire four inches deep. Very weird feeling. It's not as painful as people suggested it would be, but it hurts longer than a draw from a vein. Tammy explains that they need to know the levels of oxygen and carbon dioxide in my blood so they'll know how much anesthesia to give me (oxygen) and how long it'll take me to awaken (carbon dioxide).
After all my appointments are done, I go to Staples to laminate my Kid's Meal card. Then I go home and eat a lot of Girl Scout Peanut Butter Do-Si-Dos. They're sold by kids, so that kind of counts.
Sally talks about exercise and gives me a narrative of what'll happen in OR and post-surgery recovery. Tube down my throat to drain liquid, Demerol button, staples in my stomach to hold in my innards. I have to start walking immediately to help blood circulation after the surgery. We talk about confronting my dad, who defines family harmony by eating. We also talked about how slowly and surely my weight has increased. Ten pounds per year for fourteen years equals 372 pounds. Sally and I end our meeting and the pre-op appointment with Dr. Roll begins.
I check in with Nurse Barbara. All nurses named Barbara are Nurse Barbara because the name compliments the occupation so well, e.g., "Doctor Bob." Nurse Barbara takes my measurements and my photograph. 372 pounds (an estimate: oddly, Dr. Roll only has a 350-lb. scale.) 16 1/2 inch arm. 60 1/2 inch waist. 56 inch hips. BP of 128/80 (the BP med is working.) Dr. Roll asks me if I have any questions. I ask him if I need to stage a room on the ground floor so I don't have to climb stairs after the surgery. Dr. Roll says no. I ask him about bile salts to cut down the chance of gallstones, but he tells me the side effects aren't worth it. We talk some more about exercise and cut it short.
Sally the nutritionist moderates a support group on the third Monday of every month at the auditorium of Fair Oaks Hospital in Fairfax, Virginia. I'm glad I'm able to attend tonight because I wanted to attend at least one of these meetings before my surgery.
The auditorium is almost full when I arrive, and is at capacity by the time Sally starts talking. Virtually all of the attendees are obese: I find out later that this is because a third of the attendees haven't had surgery and almost no one in the room has had the surgery for a year or more. Many of the attendees have water bottles.
The subject of tonight's meeting is questions and answers with Dr. Roll, my surgeon. Dr. Roll is late, so Sally has each person announce whether they're here to support someone or are a patient and how much weight they've lost. Lots of supporters and spouses. Out of 48 people, 32 are post-op and have lost a total of 2,620 pounds for an average of 82 pounds over my wild-ass guess of about four months post-op time per patient.
Dr. Roll arrives and the questions begin. How long before the weight loss plateaus? About 18 months. I ask him what nutritional deficiencies he's seen in his patients. Protein malnutrition and some peripheral neuropathy because of vitamin A deficiency.
Dr. Roll says there's about 250 doctors in his professional society. I'm not sure which professional society he's referring to, because he's not listed with the American Society of Bariatric Physicians. I find out later he's in the American Society for Bariatric Surgery. My bad.
Dr. Roll asserts that the size of the stomach pouch (20-30 cubic centimeters) is the same for women and men. He says that he started performing weight loss surgery in 1984 with vertical banded gastroplasty. Dr. Roll answers a question about the behavior of people who beat the surgery. He says that some people outeat the surgery by eating all day, by packing their esophagus with food or by drinking with meals, which empties the stomach too fast.
Some patients discuss their ongoing fear that they'll gain the weight back, and that they still see themselves as fat despite their thin appearance. A thin, two-year post-op patient asserts that those fears and perceptions do not go away.
A father of a curious attendee explains that he doesn't understand the necessity of the risk of surgery to combat the obesity, and asks if there's anything less drastic. The patients assert that they tried every other weight loss method and that they didn't work. I understand the father's ignorance, because it does seem odd that there's no other treatment more drastic than diets and exercise and less drastic than surgery. The man's daughter is explaining that she goes into work early every morning to get a good parking space because it's too painful for her to walk from the third floor parking deck to her office. She's crying as she explains this. I consider telling her dad that if there were such a less drastic weight loss method that worked, he would have heard of it already. Dr. Roll asks the group if the surgery is an easy way out. The group assertively responds in the negative.
More Q&A. No bowling for 6-8 weeks post-op. People with desk jobs need to stay home from work for 2-3 weeks after surgery. There's a loss of energy after the surgery, but that comes back after 6-8 weeks (this is due to ketosis, or the burning of fat instead of sugar for energy, which is more difficult for the body). Ten percent of patients get hernias. A bulge in the stomach is often the first symptom you'll notice. Patients who get exterior staples instead of the "through-the-bellybutton" laproscopic surgery will get an elastic binder that wraps around their waist while the exterior staples heal. Binders don't help hernias: they're there for comfort.
The meeting ends. It's a windy March evening, so people are putting on their coats. Only then does it become apparent to me how much weight some of these people have lost: We had a warm winter this year in D.C., and no one bothered to buy new winter coats. People a hundred and thirty pounds lighter than me are walking out in trenchcoats that scrape the ground and wrap around them like a sarong.
Due to a series of confusions and my demand to play musical instruments on Sunday night one last time before my potential accidental death due to surgical complications, my wife and I have my first last meal on Saturday night. Our special place is the Russia House in Herndon, VA, but I thought that it would be more fitting to have a last meal similar to the meals that have contributed to my morbid obesity: the Texas-sized chicken fried chicken at Black-Eyed Pea. We wait in the waiting area of Black-Eyed Pea to be seated. Several minutes pass as waiters walk by us and no one acknowledges our presence. We leave and notice a server looking at us as he runs toward the waiting area. I wave him off. This restaurant closes a year later, probably from people reading this account and boycotting in protest. My agents are everywhere. Become one at 
We go to The Russia House and sit in the section of our favorite waiter, who brings us black currant flavored vodka, mushroom soup and escargot in butter as we wait for our Chateaubriand for two to arrive.
Sunday, my wife and I have another last meal: breakfast at the Virginia Kitchen. 10:00 a.m. and there's still a 20-minute line for breakfast that stretches out the door. It's worth it. My wife orders an omelet, grits and Earl Grey tea. I order coffee, an omelet with cheese, green peppers, bacon, mushrooms and onions, which comes with a side order of home fries, and a separate order of biscuits and gravy.
I leave for a rock jam session, hosted by Steve, a friend of mine who happens to weigh exactly as much weight as Dr. Roll predicts that I'll lose: 160 pounds. I'll lose an amount of weight equal to the mass of Steve. For the first time since I was a teenager, I try my hand at drums with the other musicians. I've been practicing the drums at home with an office chair: It actually works, with a little visualization (hi hat is the left armrest, snare is the seat, cymbal is the back of the seat, tom is the right armrest, bass is the floor.) When I played the bass, Smoke on the Water was a big standard for me. Now, Dirty Deeds Done Dirt Cheap is now my favorite song. The medium is the message. After the jam session, we go to Applebee's and I order what I missed at Black-Eyed Pea: The Texas-sized chicken fried chicken. Applebee's is two doors down from Krispy Kreme Donuts, and their HOT DONUTS NOW sign is lit, so I go and wait in line for a dozen donuts as an appetizer for our meal at Applebee's. My friend Steve chides me for bringing donuts into a restaurant and eating them as an appetizer. "Hot now, Steve!" He doesn't understand.
On Monday, I don't eat a thing until I call the doctor's office and confirm what I am to eat. The office nurse says I can eat until midnight, so I go to the office cafeteria and order the special. It's chicken-fried steak. Tonight will be my last last meal, and I'm having something I will truly miss: red beans and rice and fruit punch at Popeye's Chicken and Biscuits. Hell yes.
My wife is becoming angry because her new high-speed Internet connection isn't working, which she ordered so that she could work from home. I can't get her connection to her office to work and she starts acting curt and intolerant with me. I throw it right back at her. She tells me to take a cab to the hospital.
I can't sleep the night before surgery. No surprise. I review my pack list for the hospital: books. Percoset. purple gown. Funky massage sandals. song lyrics. bracelets. business cards. methylphenidate. camera. gifts. headphones. kerchiefs. local maps. Scripts and jokes to study. playing cards. snacks. swim trunks. tickets. timer. Recent performance videos. water. CDs. Signs that say "Please wash your hands before you touch me." It's obvious that this list has become mixed up with the pack list I use for my business trips: swim trunks?
As per my wife's instructions, I take a cab to the hospital. I check in at the emergency room. A nurse takes my insurance card, and leads me to the surgery waiting room and enters my name in the book at the window. I have my suitcase with me. I walk into the chapel next door and pray for myself and for everyone else under the blade that day. I have the chapel to myself and the sun is rising into the thin windows behind the lectern. It's pleasant and serene.
I go back to the waiting room and my wife shows up and takes my suitcase to the car. A nurse calls my name and leads me to a room with lots of beds and perimeter draperies a la ER. The nurse hands me a hospital gown and a plastic bag marked PERSONAL EFFECTS and tells me to go into the bathroom, put my clothes into the bag and put on the gown. I'm perturbed by the bag: my clothes are my clothes until I die; only then do they become PERSONAL EFFECTS. Of course I put the gown on backwards. She helps me with the gown and I get into bed.
My wife comes in and sits by me. Various nurses come and ask me questions. I get two hospital bands around my arm: one for my name and another that says LACTOSE INTOLERANT. I meet the anesthesiologist, who gives me a shot. I ask him if he can give something to my wife. He says no, and then says, "well, I could, but I won't."
A few minutes later the anesthesiologist puts a shunt into the back of my left hand, through which all kinds of drugs will be administered to me over the next four days. Across the room from me, a middle-aged Latino lady is howling in pain. Eventually, a cute lady in flare pumps, leather skirt and a tight green blouse comes over and starts asking questions of her daughter. I realize a few minutes later that she's the attending physician. Rowr.
My wife is crying. I suggest to her that a lot of the emotional pain of seeing me in a pre-op hospital bed is due to her life experience that hospitals are where you go to see your sick loved ones die, an assertion that isn't relevant in this particular case. A bit too logical, but I think it helped her a bit. A natty African man in a double-breasted suit comes over. I'm a little high at this point, so I ask him, "Hello. Am I being audited?" He explains that he's Dr. Roll's assistant for my surgery today. He's nice.
The anesthesiologist comes back and gives me one more chance to back out. I say no. He tells me that I'll be falling asleep in a few minutes and that I might remember being picked up and put on the operating table, but I won't remember anything else until after the surgery. He also tells me that I'll wake up with a tube in my throat to vacuum the excess fluid from my stomach. This conversation is the last thing that I remember.
I wake up in what I think is the same room. I hear my wife say, "I think he's waking up." I am in no pain. I tell her I'm fine. I think to myself, "I hope I've had the surgery already." We talk about things that I can't remember. There's another patient next to me behind a curtain who moans occasionally. Staff come in and explain that there's no room for me upstairs with the other gastric bypass patients. My wife asks them some questions. I'm very high, and don't see what the big deal is: I'm happy right where I am, la dee da. My wife spends a long time sitting and reading in a chair against the wall across from my bed. I keep sleeping for unknown periods of time, waking up, seeing her there, smiling, saying hello, and going back to sleep.
Dr. Roll comes in and tells me that they're going to move me upstairs. I say okay. A staffer tells him that there's no room for me upstairs and he says nonsense, he's just been up there and there's plenty of room. Several people come in and move me and my IV out of the room. Several times, my tubes barely miss being pulled out by door handles or from friction against the bed. I tell them to watch out. They attempt to reassure me.
We get to my private room. TV, bed cart, big window, nice. My wife posts the signs for me that I made that read "I am very susceptible to infection right now. Please wash your hands before you touch me. Love, Basil." I got this idea from an article in Bottom Line Magazine warning about post-surgical infections. The article also mentioned that eating protein helps to fight these infections, so I'm pleased when I find out later that all of my hospital meals are protein-fortified.
Dr. Roll checks on me again. My abdomen's been cut open and restapled, I'm weak, in pain, and on drugs. I feel like the last Thanksgiving turkey right before the whole world goes vegetarian, and they're using all their advanced medical science to save me. Now it's time to go for a walk. I hit the Demerol button. I lean on the IV cart, hold a pillow against my stomach and walk about fifteen feet. I come back to my hospital room feeling exhausted and defeated. I experience another example of how men are cowards when it comes to pain. Women who have had the surgery on the same day as me are going for their brisk happy walk through the ward, sailing by my hospital door, smiling, "Hello, Basil! Go for a walk with us!" I hate them.
Dr. Roll comes to check on me the next morning and takes the tube out of my throat. It's about three feet long and coated with coagulated blood. My wife helps me into the bathroom and I urinate maybe a tablespoonful. The nurse asks me if I've passed gas yet. I say no. She tells me that I'll have to pass gas before I leave the hospital to make sure that my gastrointestinal system is online.
I have my first post-op meal. The food isn't bad - a high-protein beef-like broth, and high-protein orange gelatin. The gelatin is fantastic - like orange Jell-o made with orange Gatorade instead of water. That's about all I eat during my four days in the hospital. I am not hungry. I'm thirsty all the time, though, and I eat ice and drink water constantly.
Other gastric bypass patients come around as a group and ask me to walk with them. I can't walk the first time they ask me, but I accompany them from then on. I seem to be regaining my legs at a slower rate than the other patients, and this worries me. One patient, a man in his late thirties that weighs about 460, can't walk at all.
Recovery often involves new tasks that provide reward and encouragement. For example, today I measured my urine. Then I got to sit on a stool in the shower while my wife bathed me. In any other situation, getting my wife to bathe me would be erotic, which is why it will never happen in any other situation.
Dr. Roll checks on me and removes the bandages from over my staples. This hurts, and he acts surprised that it hurts. The nurse asks me again if I've passed gas. I say no. She tells me that she'll have to give me an enema on Friday if I haven't passed gas by then, and suggests that it would be best for us both if I redouble my efforts. In any other situation, being threatened with an enema by a nurse might be considered erotic, which is why it will never happen in any other situation.
The third day, I'm walking around with minor discomfort. My buttbone hurts because it's braced against the hinge across the center of the hospital bed. I try to read, but I can't read anything more complicated than an Entertainment Weekly article about the show Iron Chef.
I wake up and urinate into the bottle. I pass gas and rejoice proudly. They take out the IV and give me some pain pills. My wife's been searching for a used La-Z-Boy chair since yesterday, so I'll have a comfy chair I can get in and out of easily. Dr. Roll comes in and tells me that there's nothing else they can do for me in the hospital, so I'm checking out that afternoon. I'm wearing the binder, an eighteen-inch high elastic band that wraps around my waist decrease the discomfort of the exterior staples. I ask the nurse to give me a second binder. Originally, Dr. Roll resisted on this, but the binder is a little short on me, and I want some support for my lower abdomen after all the shots they administered there. I highly recommend the second binder for anyone who's long-waisted. Don't wrap them on top of each other, though. Just a little overlap will do.
The nurse rolls me out of the hospital into the warm April air. I realize that I'm going to miss the pampering: Fair Oaks Hospital is the nicest hospital I've ever visited or occupied. I'm pretty afraid of the ride home, but my wife does a fine job. Thank God we're in her Beetle instead of my Ranger pickup.
At home, my wife has prepared the living room as my living quarters while I recuperate. Two friends, Dave and Greg, show up to deliver the chair. I get in the La-Z-Boy. No problem. I try to get out of the La-Z-Boy. I have to shuffle down the length of the chair, unwittingly exposing myself to Dave and Greg. Ironically, the La-Z-Boy is the only chair in the house that I can't get out of.
The rest of my living quarters are outstanding. Full-size color television connected to the Dish Network. PC with broadband Internet access. Philips CD burner. Outside deck furnished with brand new spring flower boxes, all courtesy of my wife. I highly recommend getting someone like My Wife™ before any invasive surgery.
I start the regimen of drugs and vitamins. I take painkillers throughout the day. Before bed, I take a painkiller and a Zantac, along with B-12, two Centrum Kids multivitamins and Vitamin C, all crushed and mixed with no-sugar-added applesauce.
The next day I begin my two walks a day. I walk about thirty yards the first two times. The next day, I make it to the corner, then a little around the corner, then the end of the parking lot. By day five, I'm walking a fifth of a mile, twice a day. My buttbone still hurts, so I've taken to laying on the floor with a yoga block under my butt.
I have a stack of books to read, but I'm too high to care and lose myself in satellite TV. It's tough to find programming simple enough for my mental state that doesn't insult my intelligence. MTV2 is running a New Year 2000 special of every video in the MTV library called "MTV A2Z": they're up to Eddie Money's "Walk on Water." I'm fascinated by the cavalcade of bad 80s hair bands and low-budget rap videos. I watch every second of the History Channel's "Life of Coco Chanel." Twice. When you're high, everything is new. Turns out Coco was a Nazi. Who'da thunk it? I watch not a single moment of morning talk shows. I am very proud of this fact.
My wife comes home from the store with a variety of baby food. The most striking thing about baby food is the extreme duality of quality. There's no such thing as an okay jar of baby food. The beef and carrot medley is vomitous. The applesauce is masterful. Why doesn't grownup applesauce taste like this? Why are they saving the good applesauce for the only people on the planet who won't remember how it tastes? Throughout my recovery every jar of baby food is either appalling or inexplicably delicious. I'm drinking diluted low-sugar fruit punch and eating no-sugar-added fruit juice and chocolate ice bars. The ice bars work like magic on my stomach pains.
I'm getting a lot of visitors. Most of them seem surprised that I'm not lying in bed with a wet cloth over my forehead. They bring me stuffed animals and toys. It's all new to me: I've never been very sick before, and this doting and compassion is a new experience for me.
(Note: Schedule all future surgeries for spring or early summer so you can enjoy the weather on your recuperative walks.) I can walk about 50 yards now. My sinuses are remarkably clear. The flowers are in full spring bloom. I can smell everything. I realize how much my sense of smell has been weakened because of my obesity-related congestion. My acid reflux is gone.
The Twist-Free Wipe functions with zero defects.
I wait prone on a table for Dr. Roll. When he shows up, I ask him if he's going to the bariatric surgery conference in my hometown of Memphis with his nutritionist. He's a master at displacing a patient's attention from the immediate medical experience at hand. Dr. Roll starts griping about my hometown as he removes my 28 staples with a pair of forceps: "Yeah, I went to Memphis once (plink). Went to Graceland (plink). Worst nine dollars I ever spent (plink). Had a nice dinner, though, on a riverboat downtown" (plink). Then he gives me a handful of Tylenol. Tylenol? I've been on Demerol all week. Where's the love? I didn't go through all this for Tylenol.
My wife sends me to Potomac Mills Outlet Mall with a friend to buy things at IKEA before my wife's family arrives. I can only walk for a few minutes at a time. We shop a little, then walk to the food court. I'm wearing the elastic binders around my abdomen. My friend leaves me at a food court table to buy food. My ass hurts.
I feel very vulnerable and alone, and the ten minutes that it takes my friend to come back seem like an hour. This is what it must be like to be elderly: to be frequently, publicly abandoned while the more agile members of the group run brief errands.
I try on the jeans I was wearing when I checked into the hospital. They actually fit properly. My wife tells me that I don't snore anymore. Peripheral neuropathy is gone. High blood sugar is gone. High blood pressure is gone. Skeletal pain is gone. Knee pain is gone. Sleep apnea is gone. My sinuses have been clear since the surgery. I haven't breathed or slept this well since childhood.
I feel ten years younger.
I've been cured of my "Dunlop disease", e.g., "Your waist has done lopped over your belt." My abdomen still sticks out, but no longer hangs over my waist. My buttbone still hurts from the hospital bed. I'm still eating the no-sugar-added ice bars for evening stomach pains.
Lots of stomach pains. Zantac does the trick again. I'm afraid I'm losing weight too quickly.
Every dress shirt buttons all the way to the collar now.
Last night was my first band practice since the surgery. Played drums and sang. Aerobic capacity high, energy level low. I can sleep on my stomach now, which I haven't been able to do since college.
Too bored to stay at home and recuperate. I go out and sing karaoke on Friday and go to Game Night at my friend's house on Saturday and check out the comedy show at a local club after that. It's no wonder that I'm exhausted all day Sunday. I'm getting busy with living.
299 pounds. I'll never see the three hundreds again. I'm shopping on my day off. I've been having cravings for specific foods for a few weeks now, but I have a few bites and I'm fine. Today, I'm hungry for a barbecue sandwich. My calendar says that I can start eating normal food as of today, e.g., salads, green beans, potatoes. I go into Wal-Mart. In a moment of weakness and bad judgment, I order a barbecue sandwich at the Wal-Mart lunch counter. It's very dry. I attempt to doctor it with ketchup. I take three bites and I feel like I might throw up, so I go to the bathroom. The paltry hygiene of the Sterling, VA Wal-Mart men's room takes me over the edge and I toss the three bites of dry ketchup doctored barbecue sandwich.
I experience a strong reality check when I go to a surplus store to buy two military-style web belts. These should give me years of service, since you can cut them to size behind the buckle and adjust them as small as you like. I buy two of the larger of the two sizes, the 54-inch belt. I take out the belt I'm wearing and try one of the web belts on. It's too small. 73 pounds later, and I'm still too fat for a 54-inch belt. My waist must have been five and a half feet around before the surgery.
My wife accompanies me to the support group meeting. I'm scared because I've put on two pounds. I get my chance to take my turn as we go around the room and share our weight loss successes. I realize that I'm losing weight about twice as fast as most people. A lot of people ask me about the online diary.
Sallyreally goes out of our way to help us. She's steaming samples of some prepared pureed foods she's found for us while a eleven-month post-op patient shares her Marine Corps Marathon training experiences and her recent tummy tuck surgery.
I see a couple of my hospital ward colleagues. Both of them have lost weight. They tease me about my new figure. Their new nickname for me is "Sexy." We talk about some protein sources because it's obvious that I'm not getting enough protein. They ask me about my standup show, and a lady next to them brightens up and asks, "Yes, tell us about your standup show." This lady is curvy, and has the Native American hair, clothes and jewelry that I associate with the erotic film actress Hyapatia Lee. This is of course all in my head, and I'm sure this lady whom I've never met before is a respectable paragon of virtue. I'm aware of the increased attention that I'm getting from women these days, so I immediately notice the jealous glare I'm receiving from the man sitting next to her. I deliberately avoid eye contact with the Native American lady.
The next day I go into GNC and buy the most concentrated vanilla protein powder in the store, Meso-Tech™, 52 grams per package, and mix it with Sugar-Free Tang®. Yummy.
Three pounds to the halfway mark. Big comedy show yesterday. Drank lots of water with no complaints. Lots of energy then, but today I'm exhausted. Went to Sutton Place Gourmet in Reston, VA. I go over to the prepared foods counter. There are several entrees with one price if you're getting an entree and sides and a separate price per pound. I tell one of the staffers that I've recently had stomach surgery, and ask him for half of a chicken fillet. He says he can't do that. I tell him that I can't eat an entire fillet. He says that he's sorry, but that they're part of a meal.
I say, "But you have a price per pound for them. I've just had gastric bypass surgery. If I try to eat a whole one, I'll vomit. Can you cut any of the entrees for me?" He says no. I go to the counter and ask for a manager. The manager breezes over and asks in a singsong voice, "And how are we doing today?" I tell the manager that the deli won't give me half of the precut pieces of any of the entrees and I ask him why.
He says, "Do you mean the (insert French euphemism here for "prepared foods counter")? I say, yes, whatever euphemism you use for that part of the store." He says, "Right, because the deli's over there," indicating another part of the store. His grin is even wider now, and I realize that he's rubbing my face in the fact that I don't know the Sutton Place Gourmet euphemism for the prepared foods counter.
I ask him why they have a policy of not selling smaller portions of food despite the fact that they price it by the pound. He tells me that he'll give me a smaller piece of chicken. I explain to him that giving me a piece of chicken does not answer my question. He tells me that the entrees are part of meal packages. I respond that what I want has an a la carte price per pound on it, and explain why it's deceptive to price an item by weight in a grocery store and force people to buy it in portions.
I know that I don't appear physically disabled, but how would Sutton Place have treated an elderly person or someone else who couldn't eat a standard portion of food for a similar reason?
Just back from a business trip to Orlando. First time in recent years that I've disembarked from a plane without bruises on my hips from squeezing my fat ass into the airplane seat.
Hungry all day yesterday. Ate six times. Craving for tomato soup. Craving for cheese. I still lose two more pounds. It's strange that I eat all I want and still lose weight, but I feel like I've traded an inability to lose weight for an inability to stop losing weight. It's sobering that I've lost 83 pounds and I'm still morbidly obese by U.S. Government standards. In fact, even when I get down to 215 pounds as Dr. Roll predicted, I'll still be just below the standard for "Severely Overweight."
My back feels great. The weight loss has lightened the spinal load, and now that my clothes are loose, I can stand up straight without my shirt pulling out of my pants, a curse of the long-waisted. I've been receiving a lot of mail about the online diary, thanking me for explaining everything about the experience in detail. I have Sally and Dr. Roll to thank for that. They were so good at predicting and explaining the procedure, recovery, and my potential reactions that it was obvious that they had taken great effort to DEBRIEF THEIR PATIENTS (clinicians take note).
I now refuse to believe that any clinician who doesn't ask me about my experiences with a procedure has any actual concern about my well-being. How do clinicians expect to improve the quality of care if they don't debrief people?
I take one of my suits to the Men's Warehouse to be altered. Ninety-six pounds and three months later, it wraps around me like a bathrobe. Fortunately, Men's Warehouse gives free alterations for life, so I recommend them to any men who are planning gastric bypass surgery. I tell them my story, and they alter my suit without cost or complaint.
Another follow-up appointment with Dr. Roll. He gives me a slip to have my B12, iron and other nutrient levels tested to see how well my supplement regimen is working. Because Sally the nutritionist told us at last month's meeting about the danger of blood clots, I show the discoloration in one of my veins to Dr. Roll. He says it's just a varicose vein, and that the dangerous clots related to this surgery are arterial clots that cause discoloration and swelling. "So, this is just my first varicose vein," I asked him. Ever the scientist, he responds, "It's the first one that you've noticed." We shake hands and I go next door to the lab to get my blood drawn for the nutrient level test.
The Staple Club meeting is a few days later. We exchange nutrient supplement information. A lot of the women at the meeting give me compliments for my success. It's nice, but I'm still afraid that their boyfriends are gonna assault me in the parking lot.
Bought a pair of swim trunks the day before yesterday - size Large. It's a strange feeling to buy clothes in sizes that don't have any X's in front of them. Practiced my occasional habit of going through my stack of clothes too small for me and taking down the clothes that I've become small enough to wear. I'm now small enough to wear everything I own.
Received an e-mail message from Men's Wearhouse today:
|
Dear Mr. Basil White, Thank you for your email, and for taking the time to share with us your experience with the Men's Wearhouse. Mr. Zimmer forwarded your correspondence to my attention, and has requested that I contact you. I would like to congratulate you on your significant weight loss. I am thrilled that the Men's Wearhouse was able to assist you in altering your wardrobe. I did have the pleasure of checking out your web site and found it to be very interesting and I wanted to take the time to thank you for mentioning the Men's Wearhouse. Your kind words are very much appreciated. Take care, and we will be looking forward to another opportunity to offer you the service, selection, and product that you deserve - I guarantee it! Sincerely, |
Exactly three months. Exactly one hundred pounds. I've lost an amount of weight equivalent to my son. A stranger who rides the bus with me but has never spoken to me introduces herself and asks me for my weight-loss secret.
My necktie that I bought at the Big-And-Tall shop is too long for me to wear. It drapes over my crotch like a loincloth. I never thought that I'd lose too much weight to wear one of my neckties.
Last year, I took my son to Kings Dominion, but I was too fat to ride any of the rides. Last week, I accompanied him on every ride he took, including the artificial rock climb. I now weigh what I weighed when I graduated college. I've erased ten years of weight gain in four months.
There were lots of teenage employees from former Soviet Bloc countries. Every one of them was sharp as a tack, except for this one kid at the taco stand who took several minutes per customer as he struggled with the vagaries of making tacos and nachos.
My pants are really starting to look stupid.
I went to Sears and bought a new pair of black jeans. My first major clothes purchase since the surgery. For the first time since childhood, I have to unzip the pants before I put them on, because my hip bones get in the way. I have hips. How odd.
I've gained some weight back. Very strange. I've been snacking because I've been losing weight a bit too quickly, so now I'll stick to three meals a day, which is fine with me. I'm considering going back to the protein as well, because that's pretty filling.
Sally and I have started a peer visitation program called the "Angel Group", so I agreed to visit some people at the hospital who had gastric bypass surgery the previous day. They all looked great. I met the father and sister of one of the patients. They looked a lot worse for wear than their relative in the hospital bed. I tried to reassure them and gave them my website address and phone numbers. One of the patients was already off of her intravenous pain medication. In all my visits, everyone who's well enough to walk looks better than me, including people one day out of surgery. I try to be helpful and humble when I talk to patients so I wouldn't come off as being authoritative or self-important. They'll all nice to me, even the ones Nurse Barbara says are gonna be jerks.
I felt this weird bump in the center of my chest the other day. I kept rubbing it until it was sore, wondering what it was. I finally realized that it was the bottom of my sternum, the bone in the center of the ribcage. I've been too fat to notice it before.
I use an adapter that allows me to play my CD walkman through my cassette deck in my truck. I've always anchored my walkman between my stomach and my leg for convenience. My stomach is now too small to hold my Walkman. What shall I do?
I tried to scratch my shoulder with my chin and bruised my chin on my clavicle, that bone that now sticks out under my neck at the top of my ribcage. I don't remember having a clavicle before. I never realized the useful functions of fat until it was gone.
I walk into an office building for a meeting. The female security guard says, "Hi, handsome." I assume she knows me, so I ask her how she's doing. She tells me, "It's a beautiful day. Just by walking in here, you brightened up this place with your smile." I then realize that this is a stranger who's just hitting on me. That hasn't happened to me in years. What a weird feeling.
I finally start using a few bits from the diary into my standup comedy act: the discovery of my hips, sternum and collarbone. A nice foreshadowing for my demonstration of the at-home breast cancer self-exam that I use to wrap up my October shows. Hey, October is Breast Cancer Awareness Month. I'm just doing my part.
Sally tells me that some of the post-op people in the Staple Club are getting divorced.
It's cold now, so I went through my coat closet for a coat. I'm wearing the cashmere longcoat I bought six years ago. I've been too fat to wear it for five years. I wore it to work and saw myself in the bathroom mirror. I now look undeniably trim. I buried my face in my hands and cried.
I lifted weights for the first time since the surgery. I'm still sore three days later. When you hurt yourself doing squats, you hurt yourself everywhere.
I'm a Federal employee. I had to get a new ID badge because I don't look like the guy on the badge anymore.
I've gained two pounds in the last week. I'm paranoid about gaining the weight back, although I know I won't. I look at the photos of myself just after the surgery. I don't recognize him.
Dr. Roll's office. No more peeing into a cup for me. According to Dr. Roll's scale, I've lost two-and-a-half pounds in the last five weeks. Dr. Roll says he's happy with the weight I am now, but losing ten more pounds would be fine.
I visited two of Dr. Roll's patients in the hospital. Two ladies. Both of them look better than I did in the hospital. I still remember cursing under my breath at the ladies waving at me as they passed my hospital room, asking me to join them in their trot around the hallway. One of the ladies I meet today is about 6-8 hours post-op. She looks fantastic.
Having some ongoing knee pain. My friend tells me that it my glucosamine levels might be low because I'm not eating enough sugar.
My shoes don't fit.
Many people have asked me for my protein supplement regimen, including people who want to lose weight who aren't contemplating the surgery. Here it is. I think it tastes like chocolate cake batter.
Two of these shakes gives me the 60 grams of supplemental protein a day my nutritionist recommended for male gastric bypass patients (50 grams for women). It's very yummy, and eliminates all of my desires for food for about two hours. It's even better if you mix it with an electric "boat motor" hand blender. Add a banana if you have one.
I've regained five pounds. Getting nervous. I feel really fat.
I was sitting on a power transformer halfway through my afternoon walk when a man of about 16 or 17 with bleached hair, studs in his lower lip and eyebrow and hip-hop clothes walks up to me and says, "This is gonna sound like a strange question."
I figure he's going to hit me up for money, so I take control of the conversation by saying, "Well, I'm a standup comic, so I doubt it, but go ahead."
"Really? Cool. Well, my friend owns an escort agency and I was wondering if you wanted some work."
I said, "No, thanks. You wouldn't have asked me that 10 months ago. I used to be 372 pounds." Besides, I'm not that kind of a whore. I only sell myself on stage.
I introduce myself to him. He tells me his name is Eric. I showed Eric my driver's license photo and told him about the surgery and recovery and invited him to my comedy show that night. He didn't show up. I guess he was busy.
Started climbing stairs at work. Still gaining weight. Pants are tight now.
Back at Potomac Mills Mall. Very reminiscent of my April 8 entry. I'm a lot stronger, and my ass doesn't hurt like it used to, so I try red beans and rice for the first time since I had it at my last meal Mar. 27. I'm staying honest and not drinking with my meal, and I get a few bites of the red beans and rice down. I eat it too fast, though, and lose it. It's only the rare restaurant meal that does this to me anymore. If I drink something with my food, I'm cheating the surgery and will gain weight. If I don't drink with my food, it's painful to eat. I walk around with a mouthful of chewed-up Popeye's Fried Chicken in my mouth like a wad of tobacco.
Dr. Roll's nurse takes my one-year measurements and takes photographs of me to add to Dr. Roll's before-and-after photo album.
| March 17, 2000 | March 9, 2001 | |
| Weight | 372 | 242 |
| Arms | 16 1/2" | 15" |
| Waist | 60 1/2" | 41 1/2" |
| Hips | 66" | 44" |
I don't recognize the person in my pre-op photo. The nurse gives me photocopies of my before-and-after pictures, which I show to my wife and my friends. They don't recognize the person in the pre-op photo either.
Now that my first year is up, I can now drink again. My fellow comedian Carl Carter had a tequila shot with me. I had forgotten the salt-lime drill. Very embarrassing. the tequila hurt, then it didn't hurt anymore. Then nothing hurt. Then I had to go to the bathroom. I need remedial tequila consumption training.
I've gained ten pounds in the last three months. I feel like I've gained a lot more. I'm constipated a lot and take fiber and Milk of Magnesia. I met with Dr. Roll last Friday and he told me to eat bran in the morning. He's moved me to a 2-month appointment cycle instead of the 3-month cycle which would be typical at this stage.
Despite my wedding and the feasting associated with that, I've still managed to lose five pounds. I've learned some of the discipline about eating that I didn't have to learn before because I had lost weight so fast. My wife and I went to Ontario and drank a lot of dessert wine. No digestion problems.
Went to see Dr. Roll for a checkup. According to his scale, I've lost 1/2 pound in two months. Considering that during those two months I played innkeeper for eleven people, got married, spent two nights at a five-star B&B, and spent eight more days eating and drinking my way through southern Canada, an eight-ounce weight loss is a miracle on the order of the fish and the loaves.
I sit in the waiting room and talk shop with other patients about protein and coffee and sugar. I talked to Sally and she asked me to tell my wife to mention her water aerobics classes at the Staple Club meeting the following Monday.
Staple Club. Auditorium packed to the walls with extra chairs. The first speaker is the founder of a wellness spa. She talked about the advantages of healing in a natural setting, and mentioned the availability of disposable panties and bras for self-conscious patrons. Every man in the room is squirming like a kid in the principal's office.
My wife talked about her water aerobics and kickboxing classes. One patient talked about his post-surgical complications. After the surgery, his stomach bled out and he was told that he had twenty minutes to live. His doctors induced a morphine coma and gave him seven more surgeries, during which he had a heart attack.
He's out of the woods now, and doing fine. Sally said that she wanted him to speak because she didn't want to hold anything back from people's perceptions of the risks of gastric bypass surgery. I'm mentioning this because I don't want to hold anything back either.
There's a cafeteria in the basement of my office building. The food has made me ill on several occasions. Ever since I started at this office, there's been this morbidly obese African-American employee there named André, weighing in at about 390 lbs. I'd see him waddling behind the food counters. He'd smile at me and stutter a greeting, ask me how my comedy was going. Real nice guy.
André died August 16th, 55 days before his 41st birthday, six months younger than my wife. I found a funeral program in a colleague's office and photocopied it.
Turns out that André was an art student at UDC and was still drawing, a hobby that probably got him a little ribbing from the cafeteria employees. He was a responsible single parent of two, and had opened a restaurant with his former wife in New Orleans.
I didn't have the courage to ask anyone how André died. I don't want to know if it was from obesity or not. All I know is that from André's obituary, I don't think he had a single moment in his brief adult life to be lazy or suffer from a lack of willpower. If he hadn't been morbidly obese, I doubt anyone would have accused him of either.
Dr. Roll keeps telling me to make appointments every three months, but I'm making them every two months. Major shock when I discover that I've only gained a half-pound in two months. Dr. Roll says that I don't need to take the protein anymore, but I notice that I keep the weight off if I snack on a protein shake at night instead of eat a meal or snack on something else. I get up at 5:00 in the morning, so if I eat dinner, I'm still digesting it when I'm trying to go to sleep, which contributes to fat storage.
A friend of mine who had the surgery is acting out sexually, I think to pacify the cravings previously satiated by food. I'm worried. I remembered what Sally said about how some of her patients are going through post-surgery divorces. I also think that a lot of obese people lose the weight and discover that they were using the obesity to shield themselves from accepting their sexuality.
Tonight's Staple Club meeting is questions and answers with Dr. Roll, my surgeon. He says that calcium supplements might help with the hair loss as well as the default regimen of protein. He says zinc might help as well. Some of the reported post-op changes in blood pressure aren't accurate 'cos it's hard to get an accurate reading on obese people. We talk about some of the psychological effects of the surgery: body image (tiny man syndrome), sexual insulation, dialogue between the patient and food and how that dialogue changes, and talking to your family about food. Once you learn that eating large portions of food is painful, the desire for large portions of food vanishes accordingly. I truly at the core of me don't want to overeat. I was afraid I'd miss big meals. I don't.
I was featured in a student film about my standup comedy career, and saw several other films for the class. One student director did a film on a transgendered person who had a friend's child refer to her as "gender-blessed." From now on, I decree that people shall refer to me as "fat-blessed."
Still gaining weight. I now have a stack of clothes too small for me to wear again, an old obesity habit I thought I had transcended. Dr. Roll wants me to see the psychologist to evaluate me for depression, which might be causing my weight gain. He also wants me to complete a food diary for Sally so she can evaluate my food intake. Same useless tools doctors and nutritionists tried with me before the surgery. If depression therapy or food diaries would have eliminated my obesity, I'd have been thin ten years ago. Same old cycle of treatment and blame. You're fat. Do this. You can't do that. Well, then you can't expect to be thin. Hey, we have this medical procedure, so now we can help you. Hey, our surgery isn't working. It must be your fault again.
That's what medicine has to offer, treatment and blame.
Visited some gastric bypass patients in the hospital. One was a 17-year-old man whose mother asked me to convince him that the Staple Club meetings were a good idea. I think he was too embarrassed to listen to me about anything. They all looked better than I did at similar stages in recovery, including the lady in the Critical Care Unit.
My wife and I arrive at Coolfont Resort late on Friday night. Nice digs, but there's a lot of little maintenance issues with the room, e.g., power, lighting, ventilation, wood rot. My wife and I go into the lodge for breakfast the next day. I meet Russell, a large man of formerly gigantic proportions, who told me that he decided to get the surgery after reading my weight loss surgery diary. I am one of three male patients at the retreat.
We meet in a meeting room (fancy that) where Michael the Massage Therapist lectures and demonstrates massage. Several patients have posted their before and after pictures on the easel boards in the front of the room. Michael massages my gnarled, keyboard-damaged hands. He tells me I have "mouse arm" from using my big shoulder muscles for the discrete motions of moving a mouse. I learned a good trick for head massage: support the forehead with the other hand so the massaged person doesn't have to hold their head up.
We talk about clothing and plastic surgery and food, and I realize that weight loss surgery is a kind of rebirth. There's absolute physical dependence on others immediately after surgery, eating pureed baby food, an adolescent awkwardness as your body changes, learning how to eat, how to dress your new body, and changes in social interactions in both you and others. I also realize that some of this is relearning, but some of it is remedial learning of developmental skills retarded by a lifetime of obesity.
I tell the retreat therapist about some of the psychosexual issues that Sally the nutritionist had mentioned. She tells me that some of the people who have the surgery disclose that they're still virgins. I have no intelligent response to this. I think a lot of these people who are looking at clothes and plastic surgery are adjusting to the new reality of having emotions about their appearance other than embarrassment. I know I have been accused of narcissism and vanity since I've had the surgery, looking at myself in every mirror I pass. It's not pride or vanity, it's wonder and assimilation of the fact that the person in the mirror is me.
A nutritionist talked to us about successful weight loss strategies, and the familial indoctrination to food as a source of love and nurturing, especially in response to loss. This method of food as consolation snowballs because consolation eating increases weight, which feeds the need for more consolation. Too bad naturally fulfilling experiences don't take off the pounds as effectively as consolation eating puts them on. An interesting cultural perspective on weight gain is the increasing discrepancy between the American social criteria for success and the real day-to-day existence of most Americans, suggesting that obesity is consolation for unrealistic expectations of achievement.
The nutritionist asks us about our good eating habits, which she affirms or discredits. A good nutritionist, like a good comic, develops advanced nonsense detection skills. She shared with us the reality that the food industry DOES NOT CARE about the health of its customers beyond their legal liability and the perception of the quality of its products. This is expressed in the American Food Guide Pyramid, a rank-ordering of the relative importance of types of foods, amended and ratified by the U.S. Government with the consent of U.S. corporate agricultural interests. The priority of the categories of food is in perfect parallel to the ability of the U.S. agricultural industry to produce each category, e.g., the U.S. dominance of grain production equals a Federal recommendation of ten servings of grains a day. I'm convinced if the U.S. produced two hundred million tons of caviar a year instead of grain, the government would be telling us to eat ten servings of fish eggs a day. Don't take my word for it: take the food guide pyramid to your nutritionist and ask them if they think ten servings of grains a day is a good idea. For the latest information on food programs, see the Links section.
Here's the U.S. Food Pyramid, issued in 1992:
Alternative to the Food Pyramid: The Harvard Diet (I don't recommend this diet, I'm just making the point that the jury is out about what diet to follow.)
The nutritionist also said that alcoholic recovery programs coupled with therapy increase their success rates from 22% to 78% when coupled with a nutrition program that reduces carbohydrates and sugars and boosts protein. There is, in fact, an "AA diet" that is markedly similar to low sugar and low carbo diets that are based on a return to genetically traditional diets. It's possible that some alcoholics are "yeast alcoholics" in that yeast is actually living in their digestive tract, manufacturing alcohol all the time as they eat sugar. This theoretical phenomenon might even explain spontaneous combustion, where people seem to ignite from the abdomen outward. There is an apparent link between carbo consumption and depression as well, and the anti-depressant diets also keep the carbs down. Sure, you need carbs, but it's really hard to get below the minimum anyway.
The nutritionist mentioned the effectiveness of protein at fighting food cravings. This supports what other patients told me at the retreat that if they don't take the protein, they gain; if they take the protein, the maintain; and if they take more, they lose.
The nutritionist recommends twenty or more grams of protein in three supplements a day. I'm going to split my supplement into three doses a day now, but I need to go back to the Sugar-Free Quik instead of the regular Quik. The nutritionist also mentioned that anti-perspirant can hold dangerous toxins in your skin and actually exposes the glands in your upper torso to aluminum exposure, a known cause of Huntington's Disease and a high correlative for some types of cancer. From now on, I'm sticking to deodorant. Watch the anti-perspirant people sue me like the cattlemen sued Oprah after her comment about poorly-inspected beef. She talked about cranberry helping the urinary tract, so I'm sticking with the cranberry no sugar added fruit juice bars.
The next speaker was a stress-management specialist. Obligatory pastel jacket and multicolored scarf. Just once, I'd like to meet a chain-smoking stress-management specialist in a black leather jacket.
She talked about the shifting realities of being a human being, where the priorities of life change like a moving target, preventing us from maintaining permanent control over any dimension of reality.
Well, alert the media. Maybe it's the comic in me, but I accepted a long time ago the idea that control is illusion we invent to insulate ourselves. There's no control. There's dominance, submission and compromise, sure, but that's different.
She talked about the stress of the additional social tension of people paying more and different kinds of attention to the thin than to the obese. She also talked about the analogies of weight loss to rebirth - You start out like a helpless baby, then you learn how to feed and clean yourself, then you get this adult body. This gets me to thinking about the therapeutic function of comedy - fans of comedy shows get to confront little doses of reality and laugh at them, which opens them up to considering that little piece of reality that they might have never considered otherwise. I'm convinced that humor is the spoonful of sugar that God adds to the medicine of truth.
There's an interesting quotation that the stress-management lady gave us about the bliss of forgiving ourselves for being unique. It's occasionally attributed to Nelson Mandela, but my research suggests it's originally from Marianne Williamson.
Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that frightens us.We ask ourselves, who am I to be brilliant, gorgeous, talented and fabulous? Actually, who are you not to be? You are a child of God.
Your playing small doesn't serve the world. There's nothing enlightened about shrinking so that other people won't feel insecure around you.
We are born to make manifest the glory of God that is within us. It's not just in some of us. It's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our fears, our presence automatically liberates others.
--Marianne Williamson
I'm excited about what I'm learning. I'm talking too much. I'm taking sinus medicine that's making me drowsy and drinking coffee to stay awake, so I can't sit still.
I go to the one-year-post-surgery meeting. A woman talks about losing her husband after the surgery. I go to a meeting for patients one year or more out of surgery. The therapist running the meeting mentions that a lot of patients get divorces. I share that obesity shelters people from having to address emotional needs that they'll never be able to fulfill because being obese degrades their ability to bargain with others for what they want, so they sublimate those wants. I speculate that maybe some people who enter in relationships with the obese are also unfamiliar with the demands of a mutually responsible relationship, so they gravitate toward people who won't make the typical demands of a shared responsible relationship because obesity lowers their partner's relative value as people. Somebody, please prove that I'm wrong.
The psychosexual upshot of weight-loss surgery seems to be that people who have been obese all of their lives and acquire a thin body have to endure another sexual adolescence, as they are empowered to demand more from their partners and ask themselves what they want from themselves and from other people, introspections that obese people don't often make. I've heard several obese people explain how their personality is all driven toward the pleasure of others and the sublimation of their own pleasure -- kind of the opposite of the traditional definition of gluttony. How ironic.
The Saturday night entertainment was me: I give a comedic speech about my surgery and recovery. I'm a professional standup comic (http://www.basilwhite.com), and I talk about my obesity and recovery at shows and lectures. The surgeon who organized the retreat said that he'd like me to give the speech at the conference of the American Society of Bariatric Surgeons. We'll see. Giving this speech reminded me of going to recovery meetings with my dad when I was a kid and watching him emotionally capture, inform and entertain a room of people with his personal story of recovery. After my speech, I retire to the bar and meet the plastic surgeon scheduled to speak the next day. He's the guy who performed plastic surgery on Linda Tripp's face.
As a standup comic, I'm obligated to ask everyone who has a unique job what the weirdest thing was that he ever saw at work. His story of the documentary crew and the famous supermodel concealing the fact that she's a pre-op transsexual and the surgeon's discovery of this fact is almost as funny as how the doctor kept this secret from the nurse until she found out on the table. Propriety forbids me from describing this tale any further other than that this secret was maintained by the application of tucking and tape, and that this supermodel's secret was gigantic.
Many people have asked me the name of the supermodel. I don't know. Stop asking.
The plastic surgeon explains in his presentation that many people who get weight-loss surgery have to get plastic surgery, 'cos they got 400 pounds of skin on 160 pounds of body. The plastic surgeon has a slide show of breast surgery photos. Before and after. Every patient in the room is female except for me. To be honest, I preferred some of the before pictures, but I didn't wanna hurt his feelings.
The women start askin' me for a man's opinion of the photos. Dangerous ground. "Basil, you like those breasts?" "Sure, I like those just fine." Then I decide to do the whole room a favor by offering my unsolicited opinion about every slide.
"Aw, she's uneven."
"Goooooooood MORning!"
(applaud) "Now those are worth five grand apiece."
A woman shares her anger.
"God, you're a pig."
"Hey, Droopy, you want my opinion or not?"
You share your true feelings, people stomp all over you.
Featured last Friday and Saturday nights in Hagerstown, Maryland. Pre-op and post-op gastric bypass patients showed up at both shows. That's eight shows in a row with gastric bypass patients in the audience. They follow me from show to show. I call them the Grateful Fat.
Two-year anniversary visit. Still fighting the weight. Can't believe I actually lost weight since my last visit. More evidence that I have no idea what my body is doing. I start asking difficult "what-now" questions of Dr. Roll. He tells me that he only wants to see me every six months from now on.
I meet with Sally and show her my three-day food diary. She tells me to get some protein snacks and B-50 complex. The novelty of the surgery is definitely gone now, replaced by a preferable, mundane reality.
Back down to size 36 pants. This is good enough for me. The post-weight loss emotional challenges have erupted into my conscious, and now they're being resolved. I'm no longer retreating to things. I'm no longer motivated to retreat. What I get from retreating is not worth the retreat.
Met with Dr. Roll. Can't poo without fiber supplements and laxatives. Dr. Roll tells me to eat fiber cereal in the morning and drink my water. I have been slacking on the water. I lectured him for only having a scale that only goes up to 350 pounds. He said he'd get Nurse Barbara on it. He also said I gotta wean myself off the Ex-Lax, and that not all post-op patients go to the bathroom every day. This offends me as an Englishman. A day without evacuating one's bowels is a day without moral profit, what what.
I never shoulda told him I was a standup comic. He kept bringing the conversation back to my comedy. "How are the shows going?" "Fine, doc, fine. Now about my pancreas."
The weight-loss and the psychic healing have improved my posture, and my improved emotional state is physically apparent. Middle-aged gay men stare at me now.
And no, I don't encourage them.
I keep forgetting to wear a belt, because my fat used to remind me to wear one.
Al Roker, the weatherman from NBC's Today show, admitted his recent gastric bypass surgery. It's a real professional risk, because he's almost certainly forfeited his chances of inheriting that lucrative cheese endorsement from his predecessor Willard Scott.
"This is Al Roker. Forget the cheese."
I'm working a booth at an IRS health fair. They wanted me to distribute samples of my protein shake recipe, but the IRS wouldn't pay for it, so the employees held a bake sale for the explicit purpose of buying the ingredients.
Everyone from the security guard to the show greeter refers to me as "the guy who makes the shakes." When I woke up this morning, I was just Basil White. Now I'm The Guy Who Makes the Shakes. What a responsibility.
Only one negative comment from the participants. A curmudgeonly old man drinks the shake and says "That doesn't taste very good." I tell him, "It's better than bein' fat." Then he talked to me about his love for pineapples. I smile politely. Hecklers are everywhere.
Four shows in Charleston. GB patients show up at the show. That's 26 of the last 27 towns where GB patients have shown up. I have weight-loss surgery patients follow me to standup shows like I'm the Grateful Dead. I refer to them fondly as "Stapleheads" or "The Grateful Fat." Actually, we're the Grateful Alive. Some of them come back for multiple shows.
Standup comedy diary at http://www.basilwhite.com/diary.htm.
I get the following e-mail message today.
My best friend had a body image problem and is now dead from this surgery! I am appalled by your candor, Sir.
Here's my response.
A lot of people take dangerous risks for inappropriate reasons. Human free will often prevents us from saving people from their own misguided priorities. I always tell people to consult their doctor and make their own decision. GBS is a clinical solution to a clinical problem. If your friend didn't fit the clinical criteria for GBS and wanted surgery for only body-image reasons, I'm confident that my surgeon's psych screening would have kept your friend off the table.Other surgeons aren't so ethical. I can't control that. As far as finding a competent surgeon, I recommend that people stick with a proper bariatric surgeon (http://asbs.org), so at least they're dealing with a surgeon with bariatric credentials.
I thank God for my candor. It's taken a lot of emotional work for me to be frank with people, to be sincere and straightforward in my words and deeds. I know that people give weight to my GBS opinions, and I do my best to tell the truth free of impartiality or prejudice.
-Basil White
She responds that her friend died from liver complications that existed before the surgery that she concealed from the surgeon out of fear that her surgeon wouldn't perform the surgery. Denial kills.
I got some insight with Dr. Roll about the responsibility I take on when I make recommendations to people based on their questions about gastric bypass surgery. I mention the patient I met at a retreat who told me that my diary gave him the courage to have the surgery, and the person who indirectly blamed me for her friends' death due to my "candor."
Dr. Roll can smell that I've been smoking, so he prescribes Zyban. It's time-release, so I'm concerned, because I know that my altered gastrointestinal plumbing can affect time-release medicine. He says the typical dosage of Zyban should work despite my weird plumbing. It's a 7-12 week cycle during which I have to lay off the booze, so that's a bonus. I talk to Dr. Roll about telling my story at conferences. He recommends that I go to obesitysurgery.com and contact them about appearances. He also mentions that my old nutritionist Sally Myers is writing a book: maybe I can use her publisher.
People keep sending me e-mail telling me I'm a "roll model." I can't tell if this is a pun or a typo.
I go to Dr. Roll's office to see what patients would like an Angel Group visit. Nurse Barbara tells me a lady called from Texas because of my diary. Nurse Barbara has Carnie Wilson's book. I want a book deal. Funny that I can't get a book deal, when publishers have sacrificed thousands of trees to disseminate the wisdom contained in "The Complete Idiot's Guide to Beanie Babies." No, I'm not bitter. Nurse Barbara tells me there's only one patient at the hospital, and that his wife called Nurse Barbara a moron.
I visit the guy. He had the surgery yesterday morning. He's a nice guy, and looks great. Unlike me, he was able to get out of bed immediately and walk, without even using a pillow to brace his abdomen. He hadn't even used the button to administer any narcotics. I hate him.
I've gained 19 pounds in 5 months. I'm having trouble sleeping and I've been eating to stay awake at work. Dr. Roll recommends lab work to see if the surgery is still working, and puts me on medication to help me sleep and minimize my anxiety. The medicine works.
I've lost 11 pounds in 6 weeks. Got a nice hold on the ADD, the weight and the sleep. I feel like I'm spinning plates.
Dealing with a lot of self-care issues that I neglected from years of obesity-related distraction from my body. Flu shot, dentist appointment, finally medicating my ADD. It took courage and emotional growth for me to perform these tasks. Many people won't understand that. I envy them.
A lady writes in her live journal that I'm the celebrity she'd most like to meet. That feels nice.
People tell me I've lost weight. They're wrong. I'm just happy.
A priest in Texas thanked me for getting him started on the road. He's lost 200+ pounds and said he can't have more than 1/4 oz. of liquor before getting loopy, but the chalice wine has no effect on him. Hmmm... He said that after mass he has to do the absolution (cleaning) of the chalice with water, 'cos if he does it with wine he'll pass out on the floor, then the custodian gets to do an "absolution" of the floor.
A weight-loss drug company offered me a lot of money to advertise their drug here. I said no. You're welcome.
Went to the GB support group alumni reunion. Sally Myers was there and had the group introduce themselves. Some patients have taken to referring to their surgery date as their birthday. I understand why, especially since your diet resets from infancy with liquid food, then minced food, etc. People mentioned the little quality-of-life differences: Throwing away the seat belt extender, sleep apnea machine and insulin, their kids being able to reach all the way around their parents for a hug, shopping for clothes where you like instead of the Big and Tall stores.
People liked to talk. I think it was because they were enjoying the empowerment of demanding to be heard. You think fat people wouldn't be so invisible.
April 24, 2000, front shot.
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After you lose 100 lbs. or more your husband might want to find ways to spend his time other than Everquest. Not a sermon, just a thought.
In fact, anyone who thinks that their partner's obesity makes them undesirable to genetic competition is fooling themselves. Think about it: I see something I like. What's more likely: 1) that my desires are unique in all the world so that no other human being would compete for what I want; or 2) that humanity consists of 7 billion individuals, each of whom like to fool themselves into thinking that their desires are unique? The money's on #2.
There is no "safety net" of unique desire. It's an egotistic delusion. I suggest that you encourage your husband to talk about his concerns with you from a perspective of helping him with the adjustment that you are already making.
I had a nutritionist and a psychiatrist within the bariatric surgeon's team and had to meet with them as part of the pre-op. I recommend that you work with your surgeon to find a GBS nutritionist and psychiatrist and bring your husband to talk about the transition. Tell your husband you want the psychiatrist to help your husband help you in your transition. Machismo makes men easy to manipulate, and the ruse of helping our women is a good deception to get us to do something that would otherwise provoke our macho insecurities.
Dammit I am well-trained.
Before: chicken-fried chicken with biscuits
Now: (censored).
I don't know, but when I rule, believe me, all will be remade in the Basilian Order.
You won't know the answer to that until you lose the weight and the needs that your soul has that you're nurturing with food come erupting to the surface.
Many people, including myself, discover after gastric-bypass surgery that the food was a way to sublimate deeply-suppressed emotional problems. That does not mean that obese people are obese because they have emotional problems; to me, it means that the psyche does what it needs to do to survive, and if someone's obese, the psyche exploits that obesity to suit its aims.
Our Staple Club includes group support and therapy to aid in the recovery from the issues, whatever they are. Unfortunately, suppression with food prevents you from knowing what you're suppressing, 'cos, well, the suppression works.
I thought I'd read or do some writing in the hospital to keep me occupied, but you know what really kept me occupied while I was in the hospital? Demerol.
None of your business. Ask your doctor for advice, not some redneck who puts weight-loss photos of himself in his underwear up on the Internet.
No. I am young, and my skin is naturally taut and virile, with the tone of a monkey warrior.
The Button is an intravenous medication system that lets you administer narcotics to yourself as you need them. Oh, sweet bliss and heaven.
Here is a link to help you find your own wife: http://search.ebay.com/search/search.dll?MfcISAPICommand=GetResult&ebaytag1=ebayreg&ht=1&query=wife&ebaytag1code=0&SortProperty=MetaHighestPriceSort
The "Twist-Free Wipe" is not a product, but the skill of wiping one's own ass without twisting the abdomen. But you're thinking, and I admire that.
I stopped eating lead and began a regimen of yummy chocolate protein shakes. I've included the recipe at http://basilwhite.com/gastric/default.htm#recipe.
No, I don't know if it's unsafe to smoke pot post-op. My layman's understanding of the medical effects of marijuana is that marijuana is unsafe to smoke, PERIOD. As to whether it's MORE hazardous to smoke pot after gastric bypass surgery, I don't know a doctor in America who'd answer that question, either. My guess is that gastric bypass surgery doesn't make it any safer to smoke pot. Some people who smoke pot have muscular spasms, which can't be a good idea after open-lap surgery where they split the muscle wall of your stomach. My guess is that the comparative marijuana-related morbidity of laparoscopic versus open-lap gastric bypass patients is yet to be determined. Obviously, we need to pull some of the research clinicians off of cancer and AIDS and tackle this dilemma immediately.
Yeah, but that's not because I was obese, that's because I'm a man. Fat men can't buy drag any easier than thin men can. But we've come a long way, baby!
Note to my mother: No, I am not gay. No, I do not dress in drag. It's just a joke, mom.
You're very happy about dumping syndrome? Well, okay! To each their own! To encourage dumping syndrome, eat sweets or drink alcohol after your surgery. About an hour later, you'll feel like you're gonna die. About an hour after that, you'll defecate like an insulation blower.
Don't eat sweets. Don't TOUCH anything alcoholic. Check out all of this with a doctor. PLEASE PLEASE PLEASE go to a nutritionist who works with GB patients.
When my little stomach rumbles, it does so at a higher, more audible pitch. I love it. It makes people think that I haven't eaten in days, and they offer me food for free.
If I "smell funny," it's not because of the surgery.
I do not claim to be hot. I simply report the unsolicited hottie-related statements provided by others.
Gerber Blueberry Buckle is the BOMB. Go get some now. Why are you still reading this? Go now!
Call the surgeon and your doctor immediately.
I don't "do anything" with these people. I can't control what other people say and do, but I can control what I say and do.
I can ask them, sincerely, "Why are you telling me this?"
I can ask "What do you want me to do?"
This last question puts it on them. This usually exposes these people for what they are.
Sometimes, friends become angry that you've changed yourself for the better and they can't change themselves. They feel left behind because you've changed who you are, thus changing the nature of your relationships with everyone.
Change makes some people very uncomfortable. Some people can't deal with it. Your friend may feel that he or she has lost control of the relationship (not that anyone can ever control a relationship).
What you have to ask yourself is, "Am I still getting anything out of this relationship except for insults and snide remarks?" If you're not, then maybe it's time to get some new friends who will treat you with respect.
All humans deserve respect. You should demand respect for yourself. If you're not getting it, it's up to you to work it out with your friend or move on if you can't.
GBS is a clinical solution to the clinical problem of obesity, so the only opinions that should matter are those of the patient and the doctor. People still try to tell me how to eat, and I tell them that I'm a GB patient and I eat the way my body, my nutritionist, and my doctor tell me to eat, and no one else's opinion matters anymore. Sometimes maturity means learning how to say (expletive) with love.
I have a question for you. These people telling you not to have the surgery: Are any of them doctors? Thought not. I have another question: what the (expletive) do they know? Even if they're obese, they're not a doctor, and they're not you. Granting medical authority to nonprofessionals is insane.
Are they gonna help you get out of bed for the rest of your life? Are they gonna help you breathe while you sleep? Carry your oxygen tank for you when you walk? Feed you ice for your reflux? Lithium for your panic disorder? Paxil for your depre