Violet calls to tell me my surgery is scheduled for January 9, 2002 with Dr. Marema. After all I've heard, I feel lucky to get the master himself. Every time I hear people talk about Marema or read about encounters with him, he emerges as caring, highly skilled, tough minded, demanding, and effective. People seem to dread his directness when they don't follow the program, yet they're grateful to be told what they don't really want to hear, but know is the truth. I'll meet him for the first time on November20th for a pre-surgical consult. That will probably be the first and last time before they transfer me to the table. I know he's busy operating and administering a large and well-oiled operation, so I don't expect him to hold my hand. He's put together a strong support system with fine staff to meet the personal needs of patients.
On Thursday we drive across Alligator Alley again and into Ft. Lauderdale. Part of this trip includes scouting out the sites of the hospital, doctor's offices, resource center, and finding a place to stay. We check into the Fairfield Inn, a Marriott Motor Inn, which is less than a mile from Holy Cross Hospital where Dr. Marema will perform the surgery. Then we find a hospital parking block within two blocks of the doctor's office on the grounds of the hospital, and enough out-of-the-way to have room for the truck - very convenient. I trudge down to the cardiologist's office, as always, trying to catch up to Irene.
Dr. Font's nurse, a short, blonde, rather rotund woman, briskly leads me to an examining room. Matter of factly, she takes my vital signs and asks me why I'm there, then when my surgery is scheduled.
"January 9th," I say.
"That's too far away. None of the tests are good that long."
"I had this discussion with your office last week. Dr. Marema's office said I should go ahead and have the work done."
"Oh.well. They would," she rejoins with a dismissive wave of her hand and a shrug. I was put off by her attitude. Could she have meant that Dr. Marema's office is such a factory that there's little wonder they're willing to have a test that would be outdated by the time surgery rolls around? Or was her hostility more deeply rooted? Could she have just been hostile to a person who's taking charge of his life and doing something about his obesity? She was pretty rotund. Is it possible that obese people are more opposed to bariatric surgery than others might be? Or could it be that she was tired near the end of a long and frustrating day. She puts me on the table, attaches electrodes, and runs an EKG.
The cardiologist, Dr. Font, comes in to complete the examination. A small, friendly man, he listens to my chest, asks some questions, and starts writing orders. Chest x-ray, nuclear stress test, echocardiogram - I need to have them all. Luckily they can squeeze them in this afternoon and tomorrow. I won't have to come back for another visit. We trot down the outdoor hallway to another office where I am quickly ushered into an area filled with a maze of computers and machines for nuclear imaging and echocardiograms. I am told that today we will do the exercise component of the stress test and the echocardiogram, while tomorrow we'll do the resting stress test.
A nurse inserts an IV needle in my arm while another shaves my chest and attaches a series of electrodes. I lie down on a bed and Dr. Font comes into the room, as a nurse pushes some fluid into the IV needle. All Hell breaks loose. My heart races, my chest tightens up, a flush comes into my face. I feel like I've been running for fifteen minutes. The entire stress test is chemically induced. I don't have to move a muscle to have a great workout. I ask Dr. Font why it's necessary to have a physician present for the administration of this test since he hasn't said anything to me about the risk factors. He says that one in a thousand people have a heart attack during the test while one in ten thousand dies. Oops! Six minutes later, the nurse turns on a sonogram machine, pops a tape in a recorder, and starts taking pictures and recording sounds of my heart. The echo-cardiogram is interesting and necessary because I had taken a course of Phen/Fen a few years earlier. Pretty easy stuff. As soon as the echo is done, they take me into a room where a table runs lengthwise through a couple of large, round circles. I lie on the table and the camera moves over my heart. I lie with my arms extended over my head while the camera grinds and groans for ten or fifteen minutes taking pictures of my heart. No wonder my blood pressure is high today! Everyone in nuclear medicine has been thoughtful, light, and humorous. They've made what could be a difficult and stressful afternoon of tests pretty easy.
I am eager (anxious?) to find Dr. Marema's office, get the lay of the land, and meet some of the people I've dealt with for months now. As is so often the case, Marema's office is in a building on the edge of Holy Cross Hospital's grounds. All three doctor's offices are within a few hundred yards of the hospital but set on three different sides. We take the elevator to the third floor and walk into a large, irregularly shaped room filled with fat people. The walls are decorated with stone and huge round settees without arms fill the room. No one in Marema's office needs to worry about not fitting in the seats. I ask for Joanna Hathaway, the nurse who was one of the leaders at the support group we had attended the previous Saturday. She can't come out, but her assistant, Dee, arrives and sits with us for a couple of minutes. Almost as soon as we meet she says, "I had the surgery two years ago, and I've lost 125 pounds. I'll never regret having it done. I'm sure you'll be successful, too."
I ask to meet Violet Ferris, the voice on the phone, just to make faces,
names, and voices fit together. In a few minutes the top of a Dutch door
swings open and a trim woman sticks her head out. She smiles and tells me, "I
had the surgery five years ago, and it changed my life. I know you'll be
successful." Almost all the staff in Dr. Marema's office have had bariatric
surgery. He himself had it, his wife and family. They constitute a
remarkable support group as well as a well-oiled machine.
At six o'clock we arrive at the "Food for Thought Resource Center" for the Life Strategies meeting. The Center for Obesity Surgery charges a $600.00 program fee above the costs of medical care. This fee pays for the variety of support group and educational programs they sponsor. Having attended two different kinds of meetings so far, it seems to me the money is well spent. If $600.00 buys the effective office staff and caring support for people who have often been made to feel they don't matter, then it's a great investment in successful surgery and weight management.
The Life Strategies meeting is conducted by Joanna Hathaway, a nurse educator who has herself lost over three hundred pounds. Using Dr. Phil McGraw's book as a source, the meeting began with a rather tedious round robin reading of a chapter from his book. While the suggestions and personality characterizations were apt, we didn't stop to do the exercises he suggested or do the work necessary to make the connections to ourselves. During the reading there is little comment. However, once the reading ends, the meeting turns into a lively discussion featuring support for a troubled member and lots of shared information for us all. A pair of twin sisters who have each lost of 200 pounds talk about the similarities and differences in their experience. A woman only a few weeks post surgery agonizes about her situation, but leaves the meeting looking as if she feels much better. Irene asks some questions and several people stop to talk to her about ways to provide support. We return to our motel room tired, but I've learned a lot.
On Friday I have a visit to a Pulmonologist and the second half of my stress test scheduled. Hoping we can get under way a little early, we stop at the Pulmonologist's office and are happily greeted and told they'll fit us in early. A nurse has me breathe into a little computer three times, takes my vital signs, and says the Dr. will be right in. My blood pressure is thirty points lower than yesterday. Dr. Sorhage is a slender, pale, blonde man about the age of our oldest son. He asks me my age, and I tell him and then ask him his. He responds defensively so I say he looks about our son's age and that wisdom and age are not necessarily related. A pretty defensive response, which my explanation about our son doesn't help. He loosens up a bit when I ask him to explain the lung capacity printout from the little computer. He listens to my vital signs and hustles me out. I'm cleared as far as my lungs are concerned.
We go over to the cardiologist's, drop off my x-ray, and walk to a nearby Thai restaurant. Wonderful food, beautifully served. We return and I'm called into the back where the nurse takes a hypodermic needle out of a lead container - more nuclear medicine. After allowing the drug to circulate, I'm put back in the camera for the resting portion of the stress test. The camera moves over me for fifteen minutes, and they send me home.
The drive across Alligator Alley is boring and traffic at the Peace River Bridge has been stopped for five hours because of a deadly six-car pileup. We get home two hours late, but the trip has been useful and interesting.