How to Lose 70 Pounds, (part 3)
Just a picture from delivering pies for the Walla Walla Thanksgiving dinner last November. At the time, i was well into my liquid diet. But I think this captures something about how I have related with food in my life.
My first (you read that correctly) surgery in early December was not only the first in the process of treating my obesity, it was also my first ever. As I indicated in previous posts, fears around anesthesia, not waking up, losing control, etc., formed the basis for the majority of the anxiety I felt heading into the surgery theater the first time. In the back of my mind, I couldn't shake the thought that the (albeit brave) decision of going through with my plan might also be my last! I usually do my best to avoid wearing my anxiety on my sleeve at home - Paige and I both feed off each other and the picture ends up not being pretty. I'm sure the weeks leading up to December 1 were about as stressful for her as they were for me.
Now -- in my limited experience, going under general anesthesia for surgery is a far more enjoyable than the corresponding wake-up process. The nurses were pleasant and humorous; the needles were tiny; I'm pretty sure they slipped me something to help me relax before hand; you are wheeled around like a king on a littler. If you can get over the smell of chemical-cleaner and the impending threat of permanent unconsciousness, it is kind of like going to the spa. On the other hand, I found “coming-to” rather less charming. It is painful, frightening, confusing, and just generally uncomfortable. I can’t say that I recommend it.
And I can definitively say that waking up from surgery to hear one’s doctor, as through a haze, explaining that the team “had run into some problems” is far from fun. Furthermore, I can reasonably predict that being in the waiting room for 4 hours over the course of a supposedly 1 hour surgery, with no explanation, might be even less enjoyable. The first of December wasn’t a high watermark day really for any of us (unless you’re talking flood waters; in which case we were paddling hard just to stay afloat).
As it turns out, the surgeon and his team discovered a rather large tumor growing on the top of my stomach. No one knew it was there. I had no symptoms (save perhaps my weight). It did not show up on any of the pre-op medical workups. Because tumors are scary and sometimes malevolent things, the doctors did their best to be very careful once they came across it. My surgeon called in cancer and pathology specialists to consult in the OR while I was still asleep; this is why Paige was left out in the waiting room for so long. My surgeon's hope was to come up with the wisest and safest plan of action before proceeding - instead of just barreling ahead with some heroic hack job without thoroughly thinking it through. I can’t tell you how grateful I am for that kind of humility and curiosity. I've not had the experience of tackling medical school, residency, fellowship, etc. But my hunch is that incredibly difficult and taxing work might lend itself to leading a person to become arrogant and closed-minded. And truth be told, I'd prefer a confident surgeon when choosing someone to poke around in my insides. In any case, looking back on the scenario, I give this doc a great deal of credit for being willing to set his ego rooted in incredible aptitude aside to invite conversation and the opinions of others. It isn't too much of a stretch to say that my life depended on it.
While I was still under anesthesia, the team came to the conclusion that my tumor most likely was a very rare non-cancerous growth; how? Study hard kids. They discerned that the most prudent course of action would be to remove it, send it to pathology for testing, but to NOT proceed with the sleeve gastrectomy as planned until they knew exactly what they had discovered. Hence, I woke up in pain with the vast majority of my old physiology still in tact.
Disappointment hardly does justice to how I felt as I slowly recovered that day. It was like a gut-punch (on several levels, haha). There was literally nothing anyone could do about my situation but wait, and wait. I really hate that feeling. I had made my bed, and then I had to lay in it. Paige took me home to recover.
Before we heard the definitive report from the laboratory, I was sent through quite the taxonomy of other testing: urged by some medical professionals in my family, I submitted to a number of radiology and laboratory studies. The final diagnosis for the mass removed would determine many things in my future; perhaps most banally whether or not I would be able to proceed with weight-loss surgery in the short term. Because I was in limbo in this regard, my surgeon instructed me to remain on the liquid diet while I waited.
“I can do anything for only two weeks” is what I had told myself going into that glorious regiment. And in one day, it magically morphed into almost five weeks -- and then ultimately about 10 weeks before it was all over. It’s hard for me to believe that I truly have poor self control after that endeavor!
In the end, my tests came out spot clean. The tumor was a manifestation of the very rare disease the team initially suspected; a non-cancerous growth that can become quite deadly if not caught — but when treated with surgical removal (as mine was) yields no negative impact to a person’s expected life span. For me and my family, who by the middle of December had been through a roller coaster ride of emotions — this was news worth celebrating. What a relief! Interestingly enough, I've learned in the past few weeks that a suspected cause of this particular disease is an inflammatory response also thought to be related to the development of obesity. Of course, it's difficult to definitely announce that these two problems were related, but it's certainly an interesting observation.
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After we got the good news, my original surgery for the gastrectomy was rescheduled for just a couple weeks later, still in December thank-you Jesus (insurance billing is its own animal!). And in the hiatus between the two procedures, as I sipped my protein shakes and jell-o cups, I had nearly as many conversations with family members and loved ones about the decision as I had had all summer long. These were by and large very helpful, and very truthfully, I'm grateful for the time spent circling the issue. Even when a few of these dearly loved and respected people questioned my plan of action (going back to surgery), their concerned interest and genuine engagement with me gave me the courage to believe that I was thinking clearly.
“Why don’t you just quit while you’re ahead?” a few said or implied in this intermediary window. “You’ve already lost 30 pounds, you feel much a lot better, just keep doing what you’re doing and the rest will go with it.” And in one sense, I felt the legitimacy in that perspective. General anesthesia is always a risk. Certainly having a portion of my stomach permanently removed is no small matter. I was certainly on a good path. Why not just see what happens?
The truth, however, was that nothing really had changed since the first day of surgery. At that point I also had lost 30 pounds. At that point, I had also enjoyed some success. Nothing was different. If I believed I needed this help to get me to a healthy weight then, I still needed it at this juncture. Nothing was different. I could’ve rolled the dice again on my then current level of weight loss. But I had no reason to expect to be able to maintain it. On the other hand, the studies and statistics I had studied were nearly unanimously in favor for going forward with surgery.
On yet another level (and on that which really sealed the deal for me), I thought about God’s voice in the matter.
The Christian and Jewish traditions speak of God’s quiet voice…the sound of a whisper…like air breathing out of one’s lungs. The story about Elijah describes him hearing God’s voice not through thunder and lightening or a storm or booming wind — but in the silence. As I considered my options in mid-December about what had transpired over the past couple weeks and months, I couldn’t help but be grateful and amazed. The truth was that if I hadn’t had the courage to go through the process up until that point, my tumor, now long discovered and treated, would’ve almost certainly continued to develop. More likely than not, it would've developed into something deadly. Of course there are logical fallacies in this argument. No one knows what might've happened if I had elected to avoid that first surgery. But if it's unreasonable to speculate in one direction, it's equally so to insist on playing it out in the other. Nothing really had changed.
The truth I came to believe in all this was that, without hardly a doubt, surgery had been the right choice for me. Furthermore, that God had been leading me all along the way. And because of this, surgery was still the course of action I should continue on.
Faith always carries with it an element of unknown. When one walks forward in faith, there’s always risk involved. We rarely know definitively or precisely how God is speaking into our specific situation. But for me, I couldn’t help but feel as though I’d be ignoring something more than ‘a still small voice’ by not going forward with round 2 of bariatric surgery.
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And so that’s what I did. In late December of '15, I went under general anesthesia once again; and that time my surgeon was able to perform the procedure as planned. No complications. No issues.
The first time, I had been immediately converted to an out-patient because of the way insurance works. I found it difficult to recover at home for a number of reasons I'll keep to myself, but it's not as though a hospital room is the Taj Majal either! My pain after round 1 was significant. My lifting restrictions were not just the doctor's way of asserting control - I was punished physically if I disobeyed. And perhaps, most challenging of all, one of my main comfort mechanisms over the past couple decades was not available to me -- I was still stuck on protein shakes (more on that in a moment).
The second time around, all bets were off. It was quite different. My pain was amped up by several notches. Everything hurt; coughing was agony. While I was very careful to care empathetically for my wife after she went through her C-sections to bring our boys into the world, after this I have to admit that I didn't take her pain seriously enough. My procedure gave me just five little incisions under an inch in length each. And yet I was truly miserable. I'm grateful she was patient and sympathetic with me through my 2-night hospital stay in Spokane after surgery number two.
While I was still stuck on my liquid diet after the first surgery, at least I could swallow without feeling horrible. After my second, eating and drinking became both frustrating and difficult. The tiniest thimble sized sip of water caused waves of discomfort. Anything thicker than water was strictly off limits. It was difficult to not be afraid about what my future might hold.
Through the initial weeks following surgery, I was on a carefully monitored plan given by the clinic. Each week or two, I was instructed to increase my food intake slightly, add more slightly more substantial consistencies, and adjust timing. It was quite the regiment. I've had seasons before in life when I approached food almost entirely as pure energy - mechanistically - a necessary evil to get me back to the project or task I had been focusing on. Instead of savoring food, I would just cram down whatever I could get my hands on while on the run -- taste or freshness or preparation the least of my concern. The first two months following surgery felt a lot like that; my body was like an engine that needed daily maintenance. I cared for it, but wasn't all wrapped up emotionally in the fixes. Luckily, I kind of enjoy tinkering and maintaining equipment.
It wasn’t until Valentines Day that I was able to eat something as simple as salad. After literally 3 months without solid food, raw carrots and spinach were a revelation :) Paige and I took some time to be up in Seattle for the One Project gathering - on that journey, I was able to reintroduce some normal cuisine back into my life. My new physiology kept me closely in check however, it became clear that I had a learning process in front of me for figuring out how to eat and not make myself sick.
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In my first post on this subject, I wrote that for much of my life I had had been stymied in poor health because of an unrealistic idealism hoping for a time when I'd never have to pay attention to my eating or body. I have given up that dream, which is part of what brought me to surgery in the first place. And in the end, it didn't create the opportunity for me to live that "dream" of unconsciousness. I still have to pay attention to how I feel, what I eat, how I eat, how I exercise, etc. - it's just that now I have a better chest of tools at my disposal to help me more consistently make positive choices. You yourself may not need these specific tools in order to do the same, and I celebrate that! Some days are difficult in this regard, others are easier. Today, almost four months after the procedure, I'm still learning to listen.
As you might guess given the above, my changed physiology has lent me the 'gift' of noticing the fact that my remaining hangups are largely between my ears. Physical hunger is more or less absent now (that's one of the noted side-effects of the particular procedure I had). The alumni (of "the sleeve" as it's called) I've interacted with tell me that hunger does come back after a couple years, but that it's different. Regardless of whether or not I feel the physical need for food, my mind is very adept at telling me that I WANT certain things. I've known the difference between 'hunger' proper and mind centered 'cravings' before -- but now that the volume of food I can eat at a given moment has been reduced to a half cup or so, the difference between those motivations are stark. I'm not convinced our bodies really ever *need* Gelato, but oh do our minds tell us it's so! That dynamic wasn't cured by my surgeon. Sigh.
Part of the reason some of us get so heavy is because we aren't terribly aware of our bodies. The sensations of hunger or desire, sadness or fear, anxiety or joy all get muddled together into a complicated cloud. I know that for many years I have unconsciously (and sometimes intentionally) used food to cover up unwanted sensations. Many are in the same boat as me - food is a go-to source for comfort and security, stress-relief and stimulation. Others use any number of other coping mechanisms just the same: success, sex, exercise, public persona, substances, detachment, etc. (I don't intend to pathologize everyone's bad habits by the way; obviously the lens I'm using to make sense of my story isn't perfect for everyone else.) My point is that by God's grace, I am still learning how to 'wake up' to some of these dynamics, to listen to what's really going on under the surface. E.g., noting that: Perhaps my sudden urge to drive to the "Ice Burg" has little to do with sustenance at all and instead is rooted in my anger about that email I just read. Hmm, maybe my body isn't really calling for that bag of chips but rather I'm unconsciously trying to cope with my nervousness about a financial question that arose.
And so this post returns to the practice of listening; paying attention.
To God's voice.
To our bodies and emotions.
To friends and trusted loved ones.
To the wisdom of those given to us.
May you slow down enough to linger with the question or the feeling. May you have the humility to submit to people in your life. May you have the courage to trust them. May you search for and hear God's voice; in the scriptures, in our world, in the 'sound of silence'. And may you be brave as you take action in faith. May you find that is indeed good, just as God declared it in the beginning. And may you be grateful.