Half-Assed

by Jennette Fulda

  I’m lucky my gallbladder didn’t burst and become infected before my diagnosis. Then the doctors would have had to slice me up the side like a sea bass to repair the damage. Instead my surgery would be done laparoscopically, a tiny camera snaked up my abdomen. The surgeons would make four tiny incisions, inflate my belly like an air mattress, and cut the pouch of stones out, sucking them up with a vacuum. They would even give me pictures of the procedure, though the photos looked as if they could have been faked with a pound of boneless chicken breasts and a scalpel.

  My mother drove me to the consultation with the surgeon. I sat in the white office with my feet dangling off the end of the firmly padded table, feeling like a child dipping her toe into a potentially deadly ocean. The doctor came in, tall, dark, and friendly, and went over the procedure, accidentally tickling my belly as he showed me where he’d make the incisions. Then he mentioned the elephant in the room. It wasn’t Dumbo.

  “I know this is probably a sensitive topic, but as your doctor I have to tell you that your current weight is cutting off at least seven years of your life. This puts you at extra risk during surgery.” He looked down at his clipboard and back up directly into my eyes. “If you’re interested, we’ve got an excellent weight-loss center with nutritionists and dieticians that can help you lose weight. You might also want to consider weight-loss surgery.”

  Uh-oh. He’d noticed I was fat. Wasn’t it just like a scientist to be observant? At least he was polite, never condescending or judgmental, a hard tightrope for a doctor to walk when confronting a patient about a weight problem. I knew some fat women who avoided going to the doctor because they didn’t want to be lectured about their weight, as if it were something they could fix as easily as dinner. His good manner could almost make me forget that he probably had incentive to recommend me to the in-house surgical center.

  I could feel my cheeks and chest heat up, reddening as they always did when I was anxious or embarrassed. Yet I was oddly relieved. Someone had noticed my problem. We didn’t really talk about fat in my house. The closest I’d gotten to having a conversation about obesity with my mother was when I’d snuggled against her cushy body during a long car trip as a kid and told her she made a good pillow. This was before the phrase “obesity epidemic” was in every other health news story. Almost everyone in my family had a weight problem and none of us wanted to talk about it, because none of us knew how to fix it. I certainly never wanted to approach my parents and ask them, “Hey, why’d you guys let me get so fat?” We weren’t oblivious to the issue. My mother joined Weight Watchers once, though I didn’t know it at the time, but the points system couldn’t fix this problem point in my family.

  Almost no one outside of the family was bold enough to confront me about my fat either. The only person who had done so was Gladys. She was the elderly woman at the phone survey job I had quit the month before, my only legacy a TV dinner forgotten in the refrigerator. Gladys worked in the booth next to me and had a son who was morbidly obese, so she took it upon herself to tell me that one of the reasons I couldn’t find a better job even with my college degree was because people discriminated against morbidly obese people like me. Perhaps being old gave her more leeway to speak her mind, but I couldn’t deny that she was right. It was amazing how many of my coworkers at that deadend minimum wage job were obese. One woman looked like she’d had liposuction on her tummy and then regained weight. She looked like an upside-down mushroom with hips of bulging fat. Ironically, Gladys also offered me crackers and cookies during every shift. If she believed in nurturing with food, her son must have been well loved.

  I was waiting for an intervention. Surely if I were drinking myself to death, someone would get my friends and family together, sit me down on the plaid couch in the family room for a good talking-to, and then send me off to a nicely landscaped facility for twenty-eight days. Why wasn’t anyone ganging up on me because of my weight? I could guess it was only because weight is inexorably entwined with identity. Drinking and smoking are things that you do. Fat is something you are.

  It was silly to wait for someone to fix me. I needed to fix myself. I knew what my problem was. I could no longer buy pants at the fat-girl store. And now, a doctor was offering weight-loss surgery as a serious option.

  Weight-loss surgery. The “cure” for fatness.

  It was the 99 percent guaranteed escape from morbid obesity. Thin chicks in infomercials may try to sell you diet pills as magical as Jack’s beans or exercise devices that resemble alien machinery, but surgery is the real deal, no imitations or substitutions. You will become thinner. Or dead. Either way, it will change your life forever.

  There are several types of weight-loss surgery. The kind my surgeon was pushing was called duodenal switch. To qualify for the surgery your body mass index had to be over forty (mine was over fifty).1 It could also be lower if you had certain comorbidities. The word “comorbidities” sounds morbid in itself, but it refers to coexisting problems in addition to obesity, such as high blood pressure. The procedure reduces your stomach to the size of a baby’s fist. Your small intestine is rerouted and shortened to inhibit the absorption of calories and nutrients. You have to take vitamins and drink protein shakes to prevent malnutrition. You can never eat a dozen donuts again without vomiting. Pop rocks and soda could actually make your stomach explode.

  And you might die. Out of 16,155 cases studied in a 2005 article in the Journal of the American Medical Association (JAMA), 2 percent of the patients studied died within thirty days of weight-loss surgery and 4.6 percent were dead within a year.2 Many more suffer complications such as staple leaks, infections, and ulcers.3 Risks decrease if you are younger and have an experienced surgeon, but the risks still exist.

  A commercial for weight-loss surgery used to air frequently on my television. The sales pitch didn’t focus on becoming thin but instead sold you the fabulous new life you would have once you became thin. Your wardrobe would contain only designer clothes. Suitors would duel with pistols over who could take you to The Olive Garden. Unicorns would follow you to work. You wouldn’t just be thin; you would finally be happy and loved. The commercials sold you hope, just like the state lottery commission did. Buy a ticket and you too might become a millionaire. Rich, thin, either one would solve all your problems. It was all your dreams come true.

  But what if it were a lie?

  I knew thin people with perfect skin and perfectly miserable lives. It was easy to blame the fat for everything. It may be one reason I stayed fat. But could snipping and sewing my internal organs as if I were altering a dress really solve all my problems? Wasn’t fat just as much a behavioral problem as a physical one? Was the threat of an exploding stomach really the only way to teach me discipline and follow-through?

  The prospect of surgery was scary. I didn’t consider it the easy way out. Brushing my teeth was easy; gastric surgery was not. I’d heard the stories. I didn’t know what would be easy about endless phone calls with insurance company drones fighting to approve the procedure. Or recovering from surgery with plastic drains sticking out of my flesh that would make me look like a science fiction creation. Or taking pills for the rest of my life and drinking vile protein shakes that still might not prevent malnutrition. Or facing bouts of vomiting or diarrhea, codenamed “dumping,” if I ate two slices of cheesecake. I didn’t know what would be easy about slicing through unblemished flesh, having my stomach rerouted so food permanently bypassed part of my intestines. It would be permanent construction on the highway of my gastric system. No exit ever again.

  Not to mention the headtrip I’d be on after changing my body so drastically so quickly. Many weight-loss surgery patients reached their goal weight within a year. Scuba divers have to decompress slowly when moving from areas of high to low pressure. Going to sleep fat one year and waking up thin the next would probably give me a case of the bends in the brain.

  When people said weight-loss surgery was the easy way out, they meant it was cheating.
I don’t consider life-saving medical procedures cheating, but not everyone agrees with me. If I had the surgery, I’d be physically changing my body so it would be nearly impossible for me to overeat without dire consequences. I would get thinner, but I would have to live with the implication that I didn’t earn it in the same way as someone who ate cottage cheese and grapefruit and spent enough time on the Stairmaster to climb the Empire State Building. It certainly undermined the American dream that was hammered into me from youth, that if I worked hard enough and long enough I could do anything. If I lost weight via surgery there would always be the unspoken implication that I hadn’t earned my thinness, that I hadn’t done it the “right” way, that I would still be a weak and lazy fat person inside despite my smaller dress size.

  I’d read blogs by people who’d considered the procedure or actually gone under the knife. They all recognized the gravity of the decision. It was heavier than I could ever be. In essence, I would be trading one set of health problems for another. Instead of heart disease or diabetes behind door A, I could choose dietary restrictions and possible malnutrition behind door B. I might also reach into the grab bag of horror stories: stitches bursting, leaking, abscesses, pulmonary embolism. It was the vocabulary of complications. The fact that people even considered undergoing such an extreme procedure was a testament to how much suffering morbid obesity could cause, mentally and physically.

  There is another, less invasive form of weight-loss surgery called adjustable gastric banding surgery. A silicone ring is inserted around your stomach to create a small pouch at the top, making you feel fuller faster. The band can be adjusted by filling it with saline. This surgery is gaining popularity, especially in Australia.4 It was not yet popular in the United States at the time of my attack, and I was unaware of it as an option. I have no idea if I would have considered this procedure at the time, and I guess I never will.

  I can only hope that a hundred years from now there will be better treatments for the severely overweight. I propose a virus that rewrites your brain cells to give you good exercise habits. It’s sad that the only guaranteed method of weight loss available to me involved altering organs in my body to make them less efficient. There is something medieval about the procedure, a soul sister to the lobotomy. But what else is there? Is the cure worse than the disease? Disappointingly, most patients don’t even become completely thin, just significantly less fat.5 As many patients say, the surgery is just a tool, not a true cure.

  I hope our fat descendants will laugh at the weight-loss treatments that are now in vogue. If people are still trying the grapefruit diet hundreds of years from now, God help us all. Nonetheless, I understood why people chose to have the surgery. Eventually the weight is just too much. You can’t carry the load anymore, and not just in your joints. Ultimately, you do what you have to do. I wasn’t going to judge anyone. One thin person wasn’t superior to another just because one took the expressway and another took the scenic route. Most people spoke happily of the changes surgery had brought about in their lives, but I doubt a single one of them would have chosen it unless it was the absolute last resort.

  Luckily I wasn’t at my last resort. There were still several resorts on this highway—a Holiday Inn, a Days Inn, and a Motel 6 around the curve. On the ride home my mother and I talked.

  “So,” she said.

  “Yeah,” I replied. The dashboard rattled in time to the vibration from the engine as we waited at a red light.

  “What are you thinking?” she said. I doubt she was any more eager than I was to have half my stomach removed. It’s not as if I could sell it as tripe at the deli counter.

  “I guess, after I have the gallbladder removed, I’ll make a really serious effort to lose weight.” I had never thrown myself completely gung-ho into an effort to become thinner. I couldn’t let someone remove most of my stomach before I could honestly say I had tried everything else. “After a year, if that doesn’t work ... maybe then I’ll start considering surgery.”

  This was the wake-up call I’d been waiting for. Lightning had struck. If I had been an alcoholic, I would have been on my way to rehab. If I had been a shopaholic, I would have been freezing my credit cards in blocks of ice in the freezer. I’d had my moment of clarity.

  Only I didn’t. I stayed fat for at least another year. Wake-up call received. Snooze button pushed.

  I was wheeled into gallbladder surgery on a gurney. They put special pads around my legs that squeezed and released my legs like a massage. This was to prevent clotting, something I was at a higher risk for since I was so fat. I’m sure I must have paid extra for them, one more line item on the bill, hundreds of dollars farther away from paying off my credit card debt and enjoying a vacation in France.

  I sat in bed in the pre-op room and tried to watch television. My mother tried distracting me with conversation. My mind couldn’t focus on anything. This was a routine surgery with little risk, but people died during procedures as routine as face-lifts. There could be a fluke accident. I could die. This could be the end of the story of me and I’d never gotten around to writing it down. I was embarrassed that I’d let it come to this. If something went wrong, my life would come only to this.

  Attendants wheeled my gurney down hallways, through double doors, and into the sterile operating room. I felt so vulnerable, lying on a rolling bed as nurses towered above me. I stared at unfamiliar ceilings. Fluorescent lights left dark shadowy impressions on my eyelids when I blinked.

  I was conscious when I scooted from the gurney onto the operating table. I felt bad for the medical staff who would have to lift me back onto the gurney after surgery. Would the words “Shamu” or “Jabba the Hutt” be bandied about in jest? What did people use for fat metaphors before Sea World and George Lucas? Would my unconscious mind be able to remember their comedy selections when I awakened in the recovery room? I should have hidden a recording device up my ass. Obesity made me paranoid about what everyone thought of me, but was it paranoia if it turned out to be true?

  The anesthesiologist stood by my right side and asked me to give him my arm.

  “What will this feel like?” I asked him, focusing only on the pair of eyes peeking out over the surgical mask. I can’t remember if they were blue or green or brown.

  “I don’t know. No one’s ever told me before.”

  He inserted the needle into my IV.

  “Oh, it’s like a muscle cramp in my arm. It feels kind of—”

  Then I was staring at another unfamiliar ceiling, waking up in recovery.

  One advantage of having the surgery so young was that I recovered quickly. I didn’t just bounce back, I ricocheted off the walls. My weight loss was off to a great start. I had lost several ounces when my gallstones and organ tissue were pitched into a biohazard waste bin. When I looked at superthin supermodels in magazines, I wondered how they could possibly cram all their internal organs and bones into the slender envelope of their skin. Could there be a secret supermodel organ donation cabal?

  There’s never a good time for surgery, but the timing was particularly terrible for me because I had gotten a real job as a web developer only a week before my attack. I was still on my college’s severely inadequate health insurance plan. After surgery, I threw billing statements back and forth with the HMO for more than six months, which I magnanimously refrained from folding into deadly ninja stars. Ultimately I ended up paying 70 percent of the total bill. You can make money by selling a kidney, so why did I have to pay so much to have this particular organ removed? My dreams of LASIK surgery, a shiny new car, and a trip to Europe would have to remain a byproduct of REM sleep. I was doomed to be a blind homebody whose car rendered abstract art on the garage floor with transmission fluid.

  A blind, fat homebody.

  CHAPTER 4

  No Epiphanies

  I kept my promise about losing weight ... at first. The fear of death was fresh and the scars still pink and raised above my skin. I didn’t want to put my family t
hrough the affair of tracking down an extrawide coffin. I was filled with hopeful trepidation. This could be it. For real. The start of a remarkable transformation that would completely redefine how others would see me. I took the “before” picture.

  I called a local gym and got a quote on what it would cost to join. Then I hung up and called the YMCA. Then I hung up and decided to walk around the block.

  I started a food diary, which, like all of my previous diaries, was abandoned after three days. The only thing more boring than writing down every item of food I’d eaten was reading every item of food I’d eaten. It was supposed to shock me into realizing I was consuming the gross national product of Ecuador daily. Mostly it just made me crazy trying to remember if I’d had a soda with lunch. I started a secret weight-loss blog. No one read that either.

  After two days I fell off the wagon and into the chocolate stash in my bottom desk drawer. There were chocolate Riesen and mint chocolate cups hidden behind my file folders of credit card statements and medical bills, forming a diorama of cause and effect. I hadn’t trashed the candy because I thought it would be wasteful to throw out food. My parents had never made me clean my plate as a child and they’d never lectured me about starving kids in Ethiopia, but it seemed wrong to throw out something edible instead of eating it. Food didn’t grow on trees ... except when it did. I had to find my chocolate bars a good home, like placing unwanted cats or puppies.

  This was, of course, ridiculous.

  There are not homeless people lurking outside fat girls’ kitchens waiting to devour unwanted baked goods. I wasn’t running a bundt cake relocation program. My brother had worked in the fast-food industry, and the amount of burgers and fries they tossed out at the end of the day was worse than a year’s worth of my foodwasting sins.