I've gained ten pounds in the past two weeks. Since my friend Steve's arrival we've been eating out more and I've allowed myself to stop swimming. A pre-Thanksgiving weekend in Pennsylvania has capped this off. My mother-in-law decides to treat us all by ordering a restaurant quality standing rib roast from a caterer. It arrives, a huge piece of meet, wonderfully pink on the inside with succulent fat and well-cooked regions on the outside. I stuff with this magnificent beef, which tastes better than any beef I've eaten in twenty-five years. I don't walk or swim or ride, I just move from the chair to the table and back for two days. We spend two more days in airports and on crowded airplanes, arriving at Ft. Myers near midnight. I make all this worse by deciding to save time by not setting up my CPAP machine. I lose two hours sleep trying to breathe before Irene wakes me to stop my snoring. As soon as I set up the machine I fall into a deep sleep.
We arrive in Fort Lauderdale just in time for the 10:15 appointment with Dr. Marema. I'm pleased that he's doing the surgery since I understand it's not always easy to get him. Shortly, we're called back to begin. I expect to be taken to an examining room right away. However, this is to be a much more elaborate day than I had expected. The first stop on this odyssey is the measurement room. Used to small examining rooms, the spacious room we start in surprises me. It contains a scale such as I've never seen. The scale features a yard square platform almost flat on the ground, two handles for balance, and a digital readout. You could probably weigh an elephant on it. I step on and weigh in at 360 pounds, more than I've ever weighed and I feel a deep disappointment. The pleasant attendant then sits me in a wheel chair wide enough to accept the biggest butt imaginable. She takes my vitals. Then she measures my height on the most precise gauge I've ever seen, made of metal and measured off in tenths of an inch (maybe centimeters too) it is set on the ground rather than on the top of a scale. I am 5' 11" tall, a little taller than I expect. Finally, she takes a couple of weigh-in digital pics. I've now given the BCOS (Broward Center for Obesity Surgery) a baseline against which to measure the success of my surgery.
Vicky picks us up in the hallway
and moves us into a large examining room. She gives me hospital gown that
actually fits
,
perhaps even hangs
off
me. I recognize Vicky immediately from her picture on the BCOS website. She's
had bariatric surgery herself and has gone from looking like something of a
blimp to being a pixie. Several people in Dr. Marema's practice have had the
surgery, adding to the sense of commitment and understanding permeating the
offices. I don't see Vicky again, but I've been glad to interact with her, if
only for a few seconds.
There's a knock on the door and in comes a nurse names Theresa to take my history and ask questions. I give her my photocopied list of drugs and she takes down the information. She goes out. Maybe the doc will be next. There's a knock on the door and in comes a tall, lithe woman named Francine who introduces herself as the exercise physiologist. Francine gives me a printout with some exercises on it, demonstrates a couple and tells me that I'll need to walk at least an hour a day post-operatively. She also says that any exercise I get during the next six weeks will contribute to making my surgery easier. I'm beginning to wish I hadn't scheduled the surgery for immediately after the holidays as maintaining an exercise and diet regimen will be particularly difficult during this period. Irene sees ways she can help me with the exercises. I, of course, resist. Francine goes out.
The door starts to open and a
hand reaches through. There are voices in the hallway, and the door closes a
little, then opens again. A tall, thin distinguished
man
in a lab coat strides energetically through the door. I' ve been a patient in
this practice for three months a
nd
this is the first time I've laid eyes on Dr. Robert T. Marema, the surgeon. He
walks over to Irene, bends over, and sticks out his hand.
You must be Ted," he says with a big smile.
He walks over to me. "And you must be Irene."
Having established a relationship, Marema shows why he's so successful. As he looks at my records and examines me, he chats away, always talking and watching. He asks to see my gall bladder scar and tells me to forget laproscopic surgery. Irene comments maybe he can improve my scar. We talk briefly about RVing. His magnetism radiates through the room. Others have commented on this at the Association for Morbid Obesity web site, but since I think of myself as relatively immune to pizzazz, I'm somewhat surprised how taken I am with this man. I like him immediately and trust myself under his knife. I had had no expectations for a long or deeply thoughtful interchange here and I wasn't disappointed. He palpates my abdomen and tells me I've been celebrating too much. He suggests I start on the Atkins diet for six weeks and loose a little weight. The Holidays loom before me. Within about ten minutes he breezes out and I get dressed again.
We are ush
ered
out to some seats in the back corridor of this rabbit warren suite of offices.
We go from the insurance office where our real vitals are checked to an office
where they make certain we have jumped through all the right hoops. Of course
we had missed the "nursing education" session so the three-hour meeting is
scheduled for two days before the surgery. I had thought I was excused from
this meeting, but no luck. We sit back down only to be ushered into Mike's
office. Mike turns out to be a pastoral counselor who tells us he's available
for prayer and spiritual support as long as we're associated with BCOS. I tell
him I always appreciate a prayer and will look forward to seeing him while I'm
in the hospital. Gently, he raises the issue of a living will. While we both
think we have one, I fill out the form to allow the docs to let me go if
necessary. Pastor Mike reassures me that Holy Cross Hospital is willing to
follow these dictates. While the hospital is Roman Catholic, he's a Baptist
preacher and perfectly comfortable being associated with Holy Cross. He's now
the full-time pastoral counselor for BCOS.
During our discussion it emerges that BCOS is in the process of becoming the American Centers for Bariatric Surgery. I tell him how impressed I have been with the process of the Center. He says that it has become internationally well known and is now functioning as a model for other centers. They've decided to take the model national. He's vague about the details, saying only that they don't exactly plan on becoming franchises, but.. While presenting a face of helpful caring, BCOS is also a very well organized machine for generating lots of money for four surgeons working very hard. The process seems almost seamless, allowing us get support, education, and encouragement from a very well trained and highly motivated staff without taking too much time away from the surgeons doing what only they can do - cut. Irene expresses a sense of slickness, for me it's more like solid professionalism, but the process sure makes you feel like things will work out and the people here care. Nevertheless, Dr. Marema's patients express great affection for and trust in him.
Next we're taken to Dr. Parrish's office. Parrish is a slight, gentle man with a white beard. He looks like what he is - a shrink. He ushers us into a comfortable office. The furniture is again oversized. No one need feel uncomfortable here. He asks about my feelings about the upcoming surgery. I tell him I lied to Dian Propis about my reactions to stressful situations. He said, "It's called denial and everyone does it." He talked about some eating behaviors, which would make it possible to stretch three ounces of food into twenty minutes of eating. Beats me. After about twenty minutes in the shrink's office we were trundled back into the hall and were done. What I had expected to be a twenty-minute exam and consultation had taken over three hours and we had more on our plate.
After spending a couple of hours
finding a room for the time of the surgery and grabbing a quick lunch, we
returned for the "nutritio
n
education" session. Abbe Breiter is a young blonde woman who has a self-assured
manner and a New York attitude. Very refreshing. Her Power Point presentation
covers lots of ground about the hospital stay, the period immediately after the
surgery, food choices, food preparation, the chemistry of the program, labeling,
maintenance, food supplements, and other important nutritional elements. People
ask lots of questions, which Abbe handles with wit and what seems to be a
complete absence of defensiveness. She shows some concern when people indicate
they have been hearing different material from her than they had from other
people. She is realistic in her assessment of how much people can retain,
saying that there will be another meeting in six months for transitioning.
It has been a full day. We've seen the Broward Center at its organizational best. It seems to function like a well-oiled machine, inducting and educating patients, bringing them on board and preparing them for life-altering surgery. We head home, skipping an evening meeting, confident that we're ready for the next steps to come. We won't return to Fort Lauderdale until January.