The Psychological Evaluation

We pull up to a tiny ranch style house with a professional sign on the lawn announcing the offices I'm seeking.   I maneuver into the parking lot and go to the door to make certain I'm at the right place.  Anxious to make sure we find the right place, we're more than an hour early.  The receptionist answers the doorbell and says I can come in after I park the truck a little straighter.  There really isn't any room inside for Irene, so she goes back to wait in the car.  In re-parking the truck, I manage to knock over the plastic trash bin belonging to the CPA across the street.  After parking, I cross back over to apologize.  He just looks at me angrily, replaces his bin, and stalks back into his office.  It's not even tax time yet.

I sit in the comfortable little office and read volume IV in the Ramage series while I wait.  About five minutes after our scheduled appointment time of 9:30, my therapist walks in.  Diane Propis is a very thin, toothy woman. We shake hands.  She is very business-like.  First the insurance card, then the check for $300.00.  I comment that the cost of office visits has gone up in recent years.  Diane assures me the fee covers all pre- and post-op psychological needs.  She says the staff is available on an on-call basis for me.  She especially notes that once food can no longer provide comfort, many post-op bariatric patients become depressed and need help.  She emphasizes the on-going support provided by Dr. Marema's large staff.  I sign papers and write the check.

Diane gives me a couple of little self-assessments to complete.  One seems to focus on how I feel about myself right now, perhaps a way to measure whether I'm depressed and how much.  According to me, I feel pretty good. The second one focuses on my feelings about being fat.  According to me, I feel moderately bad.  Diane reads Part I of my journal while I'm completing the tests.  She then begins to work through a rather lengthy questionnaire examining my weight history and my attitudes and feelings about being obese. Sometimes I stumble over answers and she suggests responses, almost as if she wants to help me get the right answers to make sure I qualify.  She asks questions like, "When I'm angry I.." Or "When I'm frustrated I.." Or lonely, or frightened. I, of course, give bland answers like shout or go inside myself and conveniently forget the truth - I eat.  I head for the refrigerator and stuff the hurt, anger, frustration, or loneliness away.

Later, we begin to talk about what I'm going to do to deal with those feeling once I can no longer count on my old friend and enemy, food.  She becomes both more supportive and caring while presenting more information. She warns me that giving up my friend food will be difficult and simultaneously reassures me that men lose weight more easily than women and that bariatric surgery is about reaching ideal weight.  She talks about eating only protein for at least six months - that means no carbs and emphasizes the importance of sticking to the diet.  Since the people on the WLS web site talk about eating anything they want, but in severely limited quantities I discern mixed messages.  The surgeon and his staff emphasize reaching ideal weight by adhering strictly to the program of diet and exercise.  Some of the on-line community appear to be continuing to play the same games we obese people have always played, but now they're getting away with it because the cannot gorge.  Diane's sincerity and seriousness are alarming.  I'm eager to have the surgery and frightened to give up food.  I keep trying to tell myself that eventual moderation will sometime allow me to enjoy treats without penalty.  However, short-term full cooperation makes lots of sense.  How much pain can a year of eating bland protein without feeling hungry generate?  How much will my eating patterns and preferences change after a year of that, especially if I've lost over a hundred pounds?

I mention discovering Dr. Marema's practice on the Internet.  She says that he now has three other surgeons working with him and that he's not only a fine bariatric surgeon but a national authority on bariatric surgery, too. She says Dr. Morehead, the name on the sign outside the building, is also a national authority on weight loss.  An hour's search for either Propis or Moorehead on the Internet yields nothing, but the search doesn't mean much since I don't know Moorehead's first name.  Propis appears as part of a University of Wisconsin alumni group, but I decide she would probably not want me to e-mail her directly.  Having a national authority, which means spending time at academic meetings and writing for publication, carries less importance for me than clinical expertise.  While I believe the two are related, I'm not sure I think the time spent doesn't detract from clinical practice.

I've been in Diane's office for nearly ninety minutes, and it's clear we're winding down.  I stand and we shake hands.  Once more she assures me there will be support available for me when I need it.  I walk out to the car. Irene's sitting in the back seat and there's a shade in the front window. She's hot and tired of waiting.  I try to arrange a visit to the Resource Center of Dr. Marema's practice, but they really don't want me to just show up.  After lunch, we drive west across Alligator Alley.  Irene sees an Alligator just as I'm waking from my nap.