Monthly Archives: June 2012

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Recovery Stage Two

Two weeks and two days post-surgery and I’ve felt (right at the two week mark, actually) that we’ve definitely entered the next stage of recovery.  I’m not exactly sure what that means, but let’s talk about it and find out!

A few things ushered in the new stage:

  • The last two drains got a little unhappy over the weekend and they had us come in on Monday morning.  They ended up whirling around me, taking out the drains, clipping external stitches, packaging me back up and sending me on my way with full confidence.  It was just that my body was done with foreign objects, I guess!  So – drains out after 10 days!  WOOT!
  • A little glimpse of shopping and future.  Being less encumbered, we went to get a few things – some support clothing (tank and spanx underwear) that we’d heard could gradually take the place of the surgical binder and bra, plus some house shorts and t-shirts that fit me.  It was a thrilling experience!  I could really see my body and how changed it was and was just so excited to be in that situation after a whole lifetime of dreaming and wondering if I’d ever get there.  The couple of times that I’ve worn what we bought – just full of awareness and awe and adjustment!
  • Mom went back home.  I want you to imagine everything that the ideal Mom could be during this period of time…every way in which you might want that kind of care…that’s my Mom.  She fills that role to overflowing!   She took care of me, my partner, my dogs and our house.  She takes care of the physical and the emotional.  She is present at every moment, but never in the way and never overbearing.  She took care of herself too and we had a good time with conversations, movies and small adventures.  She didn’t step on Nelson’s toes or make him feel like he couldn’t or wouldn’t have taken care of me.  She’s just amazing!  And…it was time.  Dad missed her and things were coming up for them.  I had met the list of milestones that she had in her head…it was time.

So, stage two begins.

Physically, it’s just about good care and the passing of time.  All of the incisions except for the two tiny places where the last drains came out just need massaging with vitamin lotion 2-3 times a day (which is a LOT of surface!).  No more padding or gauze.  A good combination of taking it easy and moving about – slow but a good amount.  Sleeping is getting easier – I can be in our bed the whole night and find comfortable enough positions on my own.  Experimenting with various binders and compression garments to balance good support and a little more comfort.  Overall – still full of restrictions, but definitely improving steadily.  It’s a balance of pushing the envelope (which is inevitable for me) and being incredibly mindful.  No stupid moves.  No stubborn moves.

Emotionally, I’ll have to work harder in this stage to really start bringing to fruition the unique time that I want this summer to be.  The physical recovery won’t demand as much focus and I want to have and follow inspirations to work with music and writing in ways that I have not had the time to do.  I also want to balance my want/need for engaging with my family/friends/community with more options for spending time with myself.  I don’t want to feel bored, restless or impatient if I can help it.  I want to recognize opportunity to both relax differently and do different things.  And this stage is a real crux.  No driving yet.  No shopping yet (which could serve as a symbol of getting everything prepped to dive back into normal life).  Really just existing with all that’s around me!

A friend asked me last night what I’m playing while I recover – as in what computer game can I totally sink into to pass the time.  I could do that – get back into a World of Warcraft phase or pick up something new.  But I really don’t want something to take over my time like that.  I don’t want to just pass the time.  I want to live it and do something different with it.  I don’t want to dull it out!

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Beautiful

Simply.  Beautiful.  Could I be that?

I’m not asking you.  I could never ask you and then draw much meaning from your responses.  Just now, I’m asking me and I can feel that my answer may be changing.

Beautiful has been a hard word.  I have been told that in a personal way only a couple times in my life and my initial reaction to it has been to cry and shove it away.  It’s a trigger word for me.

Selectively beautiful I can handle – how many times have I been told that I have “such a beautiful face” or eyes or voice. That something I’ve done is beautiful or even that I look beautiful (though that hits a little closer to home).  I can accept those remarks – either because they are targeted enough or because I hear the selectiveness of them.  Or I just let them roll past me and say “thank you” the way a performer learns to say thank you and be gracious.

And now, actually, I feel like my relationship with that word is a little complicated by this huge physical change.  In my outlook on the world and other people, I don’t believe that beauty comes from having the perfect body.  I just don’t.  The people that I describe as beautiful (and it is not a word that I use with abandon) – I do believe are beautiful in both spirit and body, but as I picture them, I see there is a whole range of shapes, sizes, ages, colors, etc…  There is definitely a body component to this word for me, but it’s not body perfect (when applied to others).  And as I struggle with the word for myself, I know that the physical change is not a simple thing….like,  I am smaller and therefore I am closer to beautiful…

Wait.  Stop.  God, do I love to intellectualize the hell out of a concept.

Here’s what happened – I looked at myself a couple times yesterday and I caught a glimpse of beautiful.  And I loved it.  And as I try to write about that – I’m wishing that I could have seen that before I got to this place with my body.  And I worry that others will think that I equate beautiful only to smaller.  Was I beautiful before I lost weight?  Before I had this last surgery?  For myself, I couldn’t see it – wouldn’t let it in.  Undoubtably, and unfortunately, my physical change is a big part of being able to let it in – but I know that this change has come from and through a much deeper process and I think that maybe the physical “is the least of it.”

The glimpse that I got was of “simply beautiful.” Maybe I should just stop there and see if I can take that in.  I say this to my voice students ALL the time.  We work in glimpses.  The first time that something beautiful pops out of you, you may not recognize how to keep it and do it again.  But if you relax and get more glimpses, you might trust it more and figure out how to keep it around.  A glimpse is not something to dismiss!

So, Jennifer, don’t dismiss it.

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The 321lb Girl – Part Two…the Repost

Here it is – my blog from several months ago that started to explore the contents of my head on my way to 321lbs.  You’ll see some repetition – starting to identifying that I monitor everything and actively replace my negative with huge personality positives.   I’ve said some of this on this blog too – but, well, it’s pretty much the hugest of conclusions for me and the pieces of this are what I’ve met in the mirror many times – so, it’s pretty much why I’m here.  Here’s the repost…

“Let’s start further back:

I am very, very proud of and very, very grateful for my family.  My childhood has been described by many people as Pollyanna – and it’s easy to see why.  Two functional, smart, loving parents with 3 healthy girls, the requisite cat and dog and single family home with money enough to get by with good management.  We communicate and express ourselves well.  We have good ethical and moral upbringings.  We are untouched by significant disease, injury, disability, abuse and hardship.  We had chores, curfews and expectations, camping trips, good grades, a home church, manners and scrapbooks to document it all!  And, today, we are successful, interesting, active people.  My parents have crafted their retirement beautifully and are truly present and engaged with their own lives and the lives of their children and grandchildren.  Us girls are happily and healthily married and successful in our fields of medicine, theology and the arts.  My niece and nephew are healthy and beautiful.  My dogs have a perfect dog life.

I don’t feel this as Pollyanna – because that word smacks of artificiality and this has all been my real life.  Not fake.  Not crafted.  Just hugely fortunate.  And still, somehow, I managed to get to 321 lbs and not really be able to effectively deal with that until I was 30 years old.  I find that I can’t say a whole lot (I don’t consciously know a whole lot) about where/how the failures happened in that process.  I could probably make a decent record of what programs we tried, but that’s the logistics, not the emotion. There is probably more exploration there that would be useful – looking at scrapbooks and trying to remember how I felt as I grew up and grew larger.  I know we talked actively about it through the years and struggled with the attempts fairly openly – at least while active attempts were happening.  And I know some of the last triggers that led to reversing the process:  not physically being able to keep up with my impression of myself or all that I intended to experience and having the stability of schedule/job/home to have it take over with full intensity and support.

When I sat down to try and say what I could about my teens and twenties, I started with what was obvious to me.  In short, for a long, long time I have been very mindful of how I frame and present myself.  I choose when and how to look at my reflection.  I often balance negative feelings and thoughts with good counters or with plans and resolve to fix them. I started to list some of the self-dialogue that I know has been with me for these last 25+ years.  I thought, at first, that these were just the expected things – comparing myself to other overweight people, being aware of myself in space – fitting in chairs, holding my posture, etc.  But pretty quickly, I realized that my inner dialogue goes WAY beyond a healthy awareness and observation.  It goes WAY beyond my physical weight.  And way beyond equipoise.  I leapt on the word equipoise earlier this year – the mind’s ability to serenely monitor one’s thoughts and actions and correct for bias and shortcoming.  There is not as much serenity in my usual monitoring as I’d like to think.  To repeat some of what I find that I *constantly* have thought about:

  • constant comparisons to overweight people I see – if they are bigger or smaller than me, if they hold themselves better or worse, what I think of them, what they radiate about themselves, what I think others think of them.
  • how I sit, how I hold my arms, my legs, how far my stomach sticks out, how tall can I make myself in my seat, how my clothes drape on me, how much room I can create for others sitting next to me, how engaging and bright can I make my face….
  • how I might react (retort?) to any given situation.  At first, this was if someone were to address my weight – either in a casual way (a look, an off-comment) or a personal way.  But now I realize that I do that for more than weight – I look to react in the “right” way to anything – employing humor, kindness, smarts, whatever – to be the way that I want to be in relationship to the people around me.  To make the situation a good thing for everyone involved  (fix it, encourage it, whatever).  AND – to emerge successful and well-thought of.
This last part is the important one here.  There are lots of good things about being aware and responsive to the people and situations around us.  I pride myself on that and don’t want that mindset to go away.  BUT, I am realizing that there are some very not good sides to this.
I have developed a way to feel that I ensure an impression of me that I can live with – and this same method has likely helped to push away dealing with what wasn’t good (my weight) and, in the process, build some pretty cemented defenses. Emotionally – I constantly monitor and control how I respond to any situation – let’s just go ahead and call it hyper vigilance.  Making sure that what was noticed about me was my energy or humor or competency or talent or organization or my beautiful voice or my bright face.  Trying to make sure that the impression of funny or kind or smart or capable was the only impression I would make and it would outshine anything that people might remember or say about my weight and, eventually, I think that’s become about what people remember/say about me period.  Lifestyle-wise – this same control has been the thing to prioritize my actions and my focus.  If it looked like something that I wasn’t going to be successful at (dating and weight-loss for two primary earlier example), then I focused my time and energy on what I could ensure – my artistic pursuits, management/leadership/organization, great friendships and family relationships.
And from this carefully chosen positioning – I could convince myself and others that I was open, trusting, successful, balanced, healthy, etc., etc., so forth and so on.  And – in many, many ways, I am those things – plus the creative, smart, kind, funny, capable…
But I have also spent a great amount of energy – a HUGE HUGE amount of energy – shoring up my positioning, monitoring everything and talking myself out of the pieces of that that weren’t so healthy – including, for 20 years, the elephant in the room – literally.  This on-her-way-to-321lb girl.”
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The 321lb Girl – Part One

See that 3rd picture from the left – the biggest girl with the smile almost lost in all that face? How did that happen?  I *know* that this is the question that every overweight person asks themselves.  Even if they can answer the question, I guarantee that looking in the mirror the words will spill out…”How did this happen?”

And the turning and facing of weight is just riddled with complication – when inspiration meets up with means – the effort can renew again and again.  When a last straw meets bad timing, it doesn’t end up being a last straw.  I am completely convinced that it is a RARE occurrence to find an overweight person who is “just lazy” or who “just doesn’t care.” Oh we care.  We care so much that there are times when the only thing to do is act like we don’t care.  However that plays out – using humor and being the funny girl that is so amazingly comfortable in her skin, embracing the “love yourself as you are” mentality with fervor, reassuring friends and family that you’re working on the next plan, or…simply ignoring it.  Simply refusing – at least for a small moment – not to see.

Of course, I can’t tell you how many of those moments got rudely, cruelly interrupted by an unfortunately placed reflective surface.  You’re just trying to have a day and that stupid store window snags your attention.  And it’s immediate damage control.  Everything from confirming or ignoring what you saw to the lock down of horror…which includes the self-talk of all the things that are going right and all that you hope and plan to do.  This can happen in the space of a second.

The smoke in the mirror is the thought that I kept these moments from impacting me too much.  Of course they impacted me and each one got added to the reference file in my psyche!  Sometimes I would have to swallow a scowl and a descent into a bad mood (sometimes unsuccessfully).  More often, for me, I would respond with something extra positive.  Say something nice to someone, be extra witty or extra patient.  That’s just how “my thing” played out.

I’m trying to decide how much time to spend in the going back and piecing this together – and I think it will end up being a fair amount of time …especially if I choose to write about it.  But, I don’t want to reframe my life in the negative when that’s not how I lived it.  Even with demons underneath – I didn’t know they were there and I lived as fully as I could – planning how I would overcome my weight as often as I could.  I don’t want to re-remember my life as though I’m watching the demons put on a puppet show.  This is tricky, though, because now that I can see them – I can see how influential they were.  The solution for me – is to also see the person that they built…and, again…say “thank you” and good-bye.

I blogged through a couple of significant times during this last phase of the weight loss – just a private blog to express some thoughts.  I’ll pull in a couple sections from that blog now and again and it’s time for the first of those (to follow this post).  The one where I did try to go back and ask how I got to 321lbs and ended up first recognizing how many layers of control freak were there to sort though.  So, the post doesn’t necessarily stay to the pursuit of the question, but it does really dig into the things that would go on in my head…constantly!

And here’s my conclusion about that…like with ANY other situation in life – you don’t know unless it’s you.  You can’t look at anyone you see and have the context for how and where they are.  And our brains can’t help but try to categorize and understand.  I see a fat girl who is jolly, who is unsure.  I see a single woman who is flirtatious or who is bitchy.  I see a macho man or a gentle, androgynous man.  Someone having a bad day, someone being nice and cheery,  someone radiating health and well-being, on and on…

You don’t know…just as they don’t know all that goes on in your head.  But I hope that I’m learning not to assume.  For those I just see – I will try not to assume.  The big girl that walks into the restaurant.  The slow, erratic driver in front of me.  The exasperated hospital admissions clerk.  And for those that are in my life – even closely in my life – I will still try to check my assumptions.  Ask them before I try to “help” them.  Give them space for their own perspective on life – including their perspectives on me.  And open those lines of communication so that they can let me in too.

Because part of “how this happened” was the stacking and winding tight of many little layers of impact and many assumptions.  All of which I thought I had a handle on and it was the true letting in of vulnerability that showed me how my control on the situation had gone very awry – and, in fact, wasn’t good control at all.  Too much control = wound too tight = rigid and unyielding.  More emotionally vulnerable = more loose (and maybe unsure?) = more open and pliable.  Imagine each of these taking a blow – which is more likely to break?  Hmm….lesson to be learned in my book!

 

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The Home Update and a Full Body Tour

This post will bring us up to current from arriving home from surgery (last Friday, 6/15) to today – with another long recounting of medical details.  Then, I hope to feel freer to tackle any of the other subjects that are waiting – more of the emotional impact, some history and lots of looking forward!

As we go along – I’m very happy to engage in conversation through this blog – answering comments or questions and expanding on topics or parlaying them to not just my life.  I don’t know if the comment structure through WordPress is the best, but if there is trouble with it – let me know!

There are two parts to a medical update – what I feel like and more describing of what my new body looks like.  Let’s do the new body first!

So…here I am at my post-surgery best!  We’ve been joking that it’s almost reminiscent of a quaint 1920s swimsuit.  Let me give you the tour:

First – my  6 little friends – the drains.  They look like clear rubber grenades attached to tubes which are attached to, well…me.  Two of them go into my breasts, two into my front abdominal area and two into my back.  The tubes are long enough that we can pin them all in front.  We keep them in this middle position that we’ve found – away from the sides so that I can try to sit/sleep on one side or another and not directly in front so that I can have my computer on my lap.  We empty and record the volume of them 2-3 times each day, which is really nothing more than tedious.  Yes, the concept of what’s going into them and where that is coming from is not very pleasant, but it’s relatively easy to ignore.  So – the big news!!!! – at my first post-op appointment this past Thursday (one week and one day out from surgery) – they were able to remove 4 of the 6 drains!!!  That’s more than we dared hope!  And the final two hopefully will come out next week.  you’ll hear more about the difference that this makes!

The tank top goes over the surgical bra (which is a velcro opening in the front) which goes over a layer of thick padding that protects my new boobs.  My new boobs (which I will not be displaying pictures of other than clothed!!) have an incision around the nipple area, vertically down the center bottom and then across the bottoms all the way over to the sides of my body.  I have NO IDEA what size they are – but not more than c-cup now and that’s a big difference.  We’ll talk more about that later!

The tank mostly serves to keep the abdominal binder (the white bottom piece) from riding up and creating an uncomfortable relationship between bra and binder.  This is especially important in the front center of my body – where I have my own version of the Mixing Bowl (if you are familiar with Washington DC traffic) – it’s where all kinds of roads meet up – mainly the incisions across the bottom of the breasts and the top of the long center vertical incision.  There is a small area – about 1″ x 2″ where it’s just a hot mess.  The skin is all bunched and stitches going everywhere.  Some of this will calm down as the swelling decreases and the incisions heal and then I guess we’ll see how it ends up and they may need to tweak it a bit.  More about that later too – I was not prepared to talk about tweaking!!!

So, yes, there is a long vertical incision down the front of my body where they both pulled and tightened all the skin, but also went deeper to tighten up the front abdominal muscles.  This part could easily have been the hardest to recover from – I might have felt so tight in that area that I wouldn’t want to stand straight and would have to retrain myself to do that.  Luckily, that’s been a fairly minor problem.  I have to work to straighten only a little bit.  The other fun thing about this incision is that it is pretty crooked!  And – I’m not exactly sure what the long-term fate of my navel will be.  There is a small area with more stitching around it that is supposedly where they saved the navel (and it’s connection down into my body?) and pasted it back on.  I, however, can’t yet see through the stitching to determine if there’s really much there.  Good thing I’ve never considered myself much of a navel-gazer!!  HAR!  Alright, whatever, back to the straight up reporting…yes, the incision is quite crooked.  At this week’s appointment, the surgeon said that they talked a lot about that in the operating room.  It came down to either being able to get a better “landscape” – meaning more excess skin removed and a leaner contour – or having a perfectly straight incision.  She’s a perfectionist and I think she regretted not being able to have both, but they went with the better landscape.  I’m fine with that – wasn’t planning on becoming a bikini girl.

Okay – and down to the bottom.  The incision goes 360 around my body.  Very low (at the junction of torso and hips) in front and then a little higher around my low back.  It’s just a single line all the way around, but from there, they were able to remove and shape my body pretty much everywhere.  My butt is WAY flatter/tighter and the fronts of my thighs.  Of course the huge pouch of skin is gone – both the primary one and the smaller one above that.  In the pre-surgery appointments, she noted that the secondary roll presented one of the biggest challenges.  It’s just hard to get all of that surface smoothed down.  They did a great job – that’s very apparent.  And…there are places that aren’t exactly ideal.  Again – we’ll talk later about tweaking.  Apparently, they expect for there to be a tweaking process (!!!!!)

Right now I have padding over all that incision and then secured by both the tank top and the binder.  Soon, I think, I could just wear comfortable underwear and that will be the case then for six weeks.  Binder and surgical bra for SIX WEEKS – I think that will be half security blanket and half chomping at the bit to be done with them.

To end the body tour – of course the extremities beyond the torso are unchanged.  The extra volume on the thighs, the flaps under the arms.  I think we’ll just have to see how that all plays out.  I have had no intentions of being a surgery addict.  I don’t want the physical experience and I don’t want the emotional need either.  But it is a reality that my body will have different issues and different proportions than it would normally and I’m sure that I will have a host of reactions to that.  I’m a conductor and I don’t want to worry about how my arms look if I wear something sleeveless.  Right now, I don’t really worry, but I also have to tell myself not to worry.

Okay – to finish the update – just a bit about the physical experience and challenges in the first week after the surgery.  For the most part, it’s just about negotiating movement and energy.  Everything feels fragile at first – will I feel pulling on the stitches?  How can I pull or push myself in and out of chairs and such (and accept any help offered!) without something pinging. Can I move around – particularly up or down stairs or at any length and not feel dizzy.  Well, this all changes and improves every day.  I’ll give you a couple bookend examples:

Day One at Home – in the afternoon we decide to do the first changing of the dressings – maybe a modified shower – and let me see my body in the mirror for the first time.  And we decide that the place to do this is upstairs in the bathroom – so first time up the stairs too.  BUT…surely we will take this all very slowly and Mom and Nelson will do most of the work around me.  So it will be okay, right?!  Not so much.

I take a couple percocet and head upstairs (not thinking to take time to let the percocet have it’s impact – both for pain lessening and the dizziness that we weren’t really realizing could accompany it).  Mom is imploring me to stop after every few stairs, but it feels fine and I just keep going slowly and steadily.  My legs are very strong (thanks to all the climbing and such pre-surgery!) and the stairs are all about the legs.  W e get into the bathroom and start gingerly pealing the layers back.  The bra and binder, the pads, the drains – which have to be constantly paid attention too – Good GOD don’t drop them!!  So, we’re basically there with me in the nude, someone holding a collection of 3 drains on each side and we’re about to start figuring out how to proceed.  I can see everything for the first time – all the angry incisions – the immense bruising – dark brown along the whole underside of my breasts – the hot mess referenced above – tightness – boobs I don’t recognize.  Mom and Nelson have seen this a couple times and they are beyond the harder impact of these things.  They see the huge change in shape and are excited for me to see that and they see improvements in the incisions and bruising from what they saw in the hospital.  They ask me what I think.

I’m not exactly sure of the sequence of events after that.  I did realize that I wasn’t responding and I did realize that the room wasn’t quite clear. I heard Mom say, “Oh my God” and I felt a little stumbly.  Apparently I went completely white and somehow my husband dimension-blinked into the next room and got a chair under me as I started to go down.  I know he moves fast – but I had no idea!  But it’s a very good thing – because there is NO good place to hold onto me if I go down.  That’s a sure call to 911.  So – the next 45 minutes were simply spent putting everything back together and getting in my face and telling me I was okay.  We decided that a shower would wait for at least a couple days!

Today (Day 8 at Home) – Mom and I walked around the block for the first time – slow, but pretty steady!  Then, on a bit of a lark – we got me ensconced in Nelson’s

convertible – with pillows around every side of me and went out to the bank, the Farmer’s market and Starbucks.  I got in and out of the car 3-4 times on my own, walked around the market and in and out of Starbucks.  I was definitely tired and my body was pinging all over the place, but no pain and energy level was still pretty good.

As for the in-between, well, there’s a lot of course.  The worst is at night when I end up feeling like a stuffed burrito – all stiff and round and immobile.  I spent the first few nights downstairs – switching between the couch, the recliner and the big chair – surrounded by pillows of all sorts and getting assistance for any major move.  Now, I’m sleeping in the bed and gingerly switching my own position every couple hours.

The only other thing to talk about, most unfortunately, is the other scary set of moments at home.  I think I really must choose to generalize this for you – I just can’t go into details.  But for 18 hours I experienced the most painful and scariest physical period of my life thanks to a single, ugly word – constipation.  We knew what it was, we knew it was a possibility and we had taken some proactive measures (Colace) but had we known what would happen – we would have taken far more proactive measures.  Probably too many and I would have been miserable in another way, but I just can’t see how it could have been worse.  All I can say is – you can know what’s going on, be reassured that you’re doing the right thing and that everything will be okay – and still be completely convinced that a horrible, embarrassing, disaster is in your future and your body is, in fact, going to rip apart.  And you say “for better or for worse” to your husband and that your mother has been through it all with you, but still have to work really hard not to die of embarrassment before the aforementioned ripping apart takes place.  If you are going to go through this surgery – please, PLEASE consider your proactive measures seriously!

Okay.  That’s done.  I knew I had to include it, but I was dreading it!  Maybe I’ll ask you not to bring this one up in polite conversation.  If you must ask questions – I’ll entertain those individually!!  And – after just sleeping and existing for a day after all that resolved – we’re back to steady improvement – including convertibles and farmer’s markets!

And…we’re caught up!  Finally!!  Did I mention that you should expect details?  Read of your own volition.  All 487+ of you…which jumped from 8 followers just a couple days ago…which is freaking me out…but I’m determined to write this blog the way I want to!  I’m sure I’ll blog about that later.

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BLOG ADDRESS WILL CHANGE!!

Hi all –

I just attached a domain to this blog and the address will be http://www.jeninthemirror.org – change should take place sometime today!  I’m assuming that the address you know and all “follow” subscribers will just work auto-magically, but you never know when you mess with technical details that you only know enough to be dangerous with!

Thanks for following!  If you don’t see the change and/or stop getting notices – be sure to go to the new address and follow again from there.

Now – lemme get posting!

-Jen

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Second Update Post Surgery

Okay – this is a continuation of the physical details of going through the surgery.  The first update really just recounted details in getting to the surgery itself and so now we’ll pick up from the actual post-surgery.  These blogs, again, will be much more about reporting and less reflective, though I will report both physical and emotional process.  I want this information to be available to others who go through this!  And so – more impolite details…just warning you!

I have a couple flashes of the various stages of post-surgery.  I remember seeing Dr. Lenert briefly in the recovery room – just telling me that all had went well and that I’d lost 18.5 lbs that day.  Then she was headed down to my family.  They say that I came out of anesthesia quickly – which they had kept as close to waking as they could and did so successfully.  Nelson and my Mom came in for a few minutes – very relieved since the surgery had taken significantly longer than estimated.  In the weeks before, we had heard 8-9 hours, then 10 hours from Dr. Lenert in the pre-op appointment and 11.5 hours was the final number.  THEN the waiting for the recovery and room transfer, etc.  We had started our day at 4:45 to be at the hospital by 6:30 and it was past 10:00pm before Nelson and Mom were seeing me in my room.  Midnight before they were back home.

I didn’t have to deal with movement or food or really anything that first night.  I had the techs checking vitals and drains, the nurse giving me heparin shots.  And I had my morphine PCA – the little button for pain meds that I can click as often as I like but will only deliver every 8 minutes.  And so began a really interesting and really kind of wonderful night.  I would awake – feeling like I must have been asleep for hours, but it would only have been somewhere around 45 minutes.  I would click the pain button and get a spoon of ice chips and then fall into a bizarre sleep-wake state where there were tons of things going on – but I don’t remember any of them.  I only know that every time I would click the pain button within the 8 minutes again and hear the beep that said that nothing was delivered.  Then, as soon as I could get a true second dose, I would fall asleep for another 30-60 minutes.  Each time I woke up from those longer periods, I would feel these huge rushes of positive emotion.  Relief, accomplishment, excitement – all felt very deeply, not just thought.  I felt the 10 year task of losing 150 lbs and the hugeness of being on this end of it – and having coming through this surgery and all that was ahead of me.  I smiled a lot through those hours.

Then, things turned as we went towards morning.  I think because the night felt like it lasted a week – I finally began to wonder and worry about what was coming next.  When would I have to move and how would that go?  When would Mom and Nelson get there and could I wait until then to try anything?  I realized that while I had all these complete thoughts – my verbal communication was very poor.  The nurses would ask if I needed anything and I couldn’t think of what to say or what to ask – so I thought they weren’t communicating very well.  When I talked on the phone (including mom and Nelson to ask where they were!) – all I really could convey was scattered anxiety.  I ordered breakfast.  I think, in the end, we concluded that the Morphine was contributing a lot to this.  It definitely made me foggy and I know it helped with the pain, but it would fairly quickly make me anxious and unable to communicate well.  They wanted me to get through the lunch meal and keep that down before switching over to Percoset.

So, we endured the morning – me using as few pain clicks as I could.  The getting up was definitely a process, but it went without incident and we were all surprised to see that I stood straight right off – not hunched over as they said I likely would be from the abdominal tightening.  I got through lunch and was able to switch the pain meds – and that was a relief.

So, the big question to address – what about the body!!  Did I see it?  What does it look like?  Well, we’ll report on this in stages.  In the hospital is a very different experience than home.  As first the doctor and then the resident/interns came in to check and change my dressing – there were various reactions.  Their reaction was very technical – they were pleased with the incisions and the state of them.  My mom and Nelson could see everything and it was hard to read their faces totally, but their general reaction (and Nelson’s verbal reaction to me) was that it was a huge change in the shape and they thought I would be really amazed.  I couldn’t see anything below seeing the breast shape and nipple and the skin in between the breasts.  And there were so many things to take in – the fact that the breasts were small cones – no sagging – not even softness, really – just triangles sticking out.  The fact that the meeting of incisions between my breasts is a mess that the doctor says will calm down – that’s always a complicated spot.  And just seeing stitching and bruising everywhere.  I think I kept myself pretty neutral for these viewings.  The most emotion was when the residents and interns whirl winded through their mid-day check and moved WAY too fast for me – taking of the binder and the bra and whipping dressings off and on.  It was good that they felt so confident about the incisions, but it ramped me way up and after that, I was determined to just have everything go at as calm a pace as it could.

And, in that mindset, we passed the rest of that day – getting up a couple more times and I decided to stay the second night.  I just went with the flow through that and into the morning and was ready to make the trip home and stay calm!  We were out by 10:00am – and getting into the car was nowhere near the difficult event that I had worried about.

That’s a good place to end this portion – hospital and surgery are done and the reality of home and recovery begin.  Let me know if you have questions that I haven’t addressed or if there are things you wanted me to talk more about!

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Layers of Demons

It’s hard to know where to start to explain the “demons” that have become apparent to me through this process.  They come in several forms – from little instincts that make me change my behavior to fully-integrated personality traits that started as good things but now really get in the way.  They have been the back-seat drivers of my life and, in some times, I think they outright took the wheel.

Until 6-7 months ago, I wouldn’t have been able to name anything that I would have called a demon.  I  wouldn’t have said that I had “a thing” either – emotional baggage, something to overcome that was holding me back.  I could easily joke about my propensity to be “a little intense” – over-controlling of logistics and details.  My penchant for doing 400% of the work until I couldn’t sustain it anymore.  My lack of delegation skills and pickiness about the small stuff.  Sure, it would cause working dreams and moments of exasperation among my friends, colleague and family.  Stress?  Yes.  Demons?  No.

Demons are way underneath all that.  For example – I carried around  disgust, infuriation and embarrassment about my weight and as those feelings became ingrained (became demons), I shoved forward everything that I wanted the world (and myself) to see instead – a bright, funny, kind, talented, competent, successful woman.  Now, I hope and trust that I am those things.  In fact, I need to say that it was my passionate focus on those things that built so much of who I am and who I want to remain.  It’s the ensuring and shoving and maintaining of those things that creates the problem.  I realize now my demons of disgust, infuriation, embarrassment (and more) – nearly had me convinced that it was how I acted in the world  – how I displayed those good qualities and how I convinced people of them – that were why people responded to me so well.  Being those things could make them overlook my physical body and the ways that I had failed there.  People loved me for the reasons that I made them love me.  And from here, the demons can choose lots of different places to go – that I need people to love me.  That it’s my strength and success that they love and therefore vulnerability and failure become opposite and now we’ve set up absolutes and black/white, good/bad parameters.  And we’ve set up doubt that it’s any other way.  That people could just love me – all of me and even the parts that I’ve locked away.  That Nelson married a woman that he loved – not parts of that woman.

There are many, many blogs that could come from here – and some of them will be written.  But here is the other thing about demons.  They live underneath and they can find many, many ways to stay in the shadows so that they can hang around.  When my demon of disgust was brought into the light in December – it took a big hit just by being seen and named.  And, as I’ve come to face this demon over the past many months, I’d like to think that I can say “thank you” for being a driver of “how I am” and then let it go.  I’m finding, though, that I have to be pretty deliberate and firm about that.  If I keep talking about it or get at ease with that word, “disgust” and use it lightly – that’s a way for that demon to stay around.  As I’ve been looking at my new body – all stitches and bruises – I find I have to bandy with that word.  Is my new body disgusting because it’s now unnatural?  Oh demon…good try!

I think this is a place for some wholesale attitude adjustment – not to shove those feelings down…but to make that demon unwelcome.  This change in my body has been fought for long and hard.  The methods that I used were researched, debated and decided upon with great care and enormous effort – never the easy way out.  The state of my body – with so much excess skin – was already “unnatural” and this surgery gives me the freedom to use and enjoy my body in the way that I have earned.  It is nothing but a positive!   Entertaining this demon of disgust – even arguing with it – keeps it in play.  Clearly, we have identified one antagonist who is not going to leave gracefully.  And it’s time here is done.  No more negotiating.

So if you hear me talk about disgust – feel free to get up in arms with and for me.  Help me turn that cold shoulder and don’t be too nice about it!  And for those of you in my life that are holding up this particular mirror – I am so grateful for you!

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First Update Post-Surgery

There are so many angles that I want to write about that it can be a little overwhelming about where to start at all.  So, let’s jump in with the easier – the more technical update.  It, of course, also has the most amount of pure detail – so may be a couple long posts!

The right place to start – well, I’m still here!  Of course we knew that this was the likely outcome – but this surgery, as with most, certainly had it’s one-liner of mortality and the signing of the Advance Directive and that should always catch one’s attention!  Actually, the Advance Directive is an amusing (if morbid) place to start.  We had assumed that we needed to have my signature witnessed at the hospital and missed the well-buried sentence of instruction that said that neither employees of the hospital nor family members could sign as witnesses.  The admissions employee who was helping us (who was already very distracted, angry at the couple who was admitted before me, and totally uncommunicative) – said that it was very normal to just go out into the waiting room and ask for a couple of witnesses to sign.

Okay, think about this – this a very legal document – the one that turns over durable power of attorney to my husband and states my position on life-continuing care should I be incapable of making decisions or communicating my wishes.  I throw myself at the corner of the waiting room with the most people – all of whom are there for surgical procedures and who knows what state they are in for themselves – I tell them that I need two witnesses to sign my Advance Directive – simply stating that this is my signature and that I am of sound mind which, really, how do they know!?  I tell them that family member and hospital employees can’t sign it and they told me that that this is what was often done – to ask you fine people if you would be willing.  They all stare at me.  I say, “Please” and someone invites me to explain it again.  And then two people are willing to sign – with addresses and everything!  It may be among the most ridiculous things I have ever had to do.

By the way, the phrasing that I formulated for the Advance Directive ended up being what I wanted with the help of my sister, Becca – who is the doctor in the family. I offer it in case it’s helpful to anyone else.  “I wish for any and all life-continuing efforts to be made unless or until there is no reasonable likelihood of the return of my cognitive functionality.”  That way I don’t need to talk about specifics like resuscitation, brain death, coma, etc.  and I was assured that Nelson would be the one to decide (in communication with my doctors) what defined “reasonable.”

So, I head up (rather abruptly) to the surgical reception area – on my own – and Nelson and Mom are told that they will be called up to see me before I’m taken in.  The first thing I’m asked is if I need a restroom and, already, things are complicated.  Because – I started my period late on Tuesday night – of course!  OF COURSE!!! I knew it was going to be close and I was worried about it, but REALLY!?  So – I’m sorry to drag you into this – but it’s definitely a factor.  You see – first off – all kinds of things happen for me during this time of the month – sometimes really bad pain, sometimes dizziness and energy issues (possibly it makes me borderline anemic), sometimes cramping and vomiting – none of these things are going to combine well with a lot of incision in and around my abdomen!  Not to mention how…erm…maneuverable I’m going to be to deal with those supplies.  The only good news here is that I’m likely to FINALLY have pain medication that can handle it!  So – the nurse says no problem –  they need to give me some mesh underwear and a pad and that’s what I’ll wear through surgery.  She also says that I’ll now just sign a document that says that I refuse a pregnancy test since I clearly won’t need one.

Mesh underwear.  This has got to be the next trend on the street and I will have been on the front cusp of stunning fashion!!  She hands me a square of mesh – alright, it’s a rectangle – but it doesn’t look like more than a single sheet.  She says that they are underwear.  I am dubious to say the least.  And she hands me a pad that could absorb the Potomac – these two things are supposed to go together.  I believe that this is quite funny.  Enough that I take the time to lay out the little rectangle of mesh to take a picture of it – had to be done.  You try “putting these on.” :

So – then – it’s a series of preparations – get into the gown and socks – see the anesthesiologist – who is fantastic.  I have to have the singer conversation with him – please use as small a tube as you can and be extra careful – and he gets that completely.  He asks who I recommend for listening and I say the first name that comes to mind – Eva Cassidy – and when he comes back in, he’s already gone to look her up and has the information for “Songbird” in his hand – I was very impressed!  I asked him about some of the things I’ve heard – that prolonged anesthesia can lead to depression and had greater risk with great amount of time.  He’s very soothing about this – first off, saying that the whole swing of emotions is possible – including all the happy ones.  Then using a driving analogy for risk.  First you look at you as the vehicle – if you have a lot of risk factors (age, health, smoking, etc) – you are rather like a moped and if you are young, strong, healthier – you’re more like a hummer.  Then you look at the level of the surgery – major surgery being brain, heart, internal organs, etc..  I may not be a hummer, but I’m at least an SUV (and my doctor would say hummer) and this surgery is a city street, not the beltway.  The length is due to the complexity and the amount of surface work, but it’s not very invasive – so he’s very reassuring.

Then, Mom and Nelson are invited in (after an hour of waiting) and then Doctor Lenert and her crew.  And here’s where it really get interesting and so surreal – the marking!

She asks if I mind if I want to have the room be private – but really, Mom and Nelson have seen everything there is to see and it’s a teaching hospital, so we’ve had the bevy of students, interns, residents and such…I just don’t care now!  Especially since we’re there to change it – if I was in for another surgery and so self-conscious about the extra weight, it would be different.  (By the way – little flash forward…I’m thinking that will be different again once I’ve recovered into this new body.  I think I’ll want my privacy back!)  But – for this…heck no…just do what you need.  So, she gets out her purple sharpie and starts going to town.  I mean…GOING to town!  We start with a few center lines and the lower incision line, but then there is a grid of sorts for reference purposes and then a little specific compass for the nipple shape – something for her to trace and shape the areola and then get the angle of the breast. They talked about where the fold of the breast should be compared to where it was and as I sat there, my breasts looked like they could just keep going down to my knees – they were so LONG!  And then she starts putting her initials everywhere (JL) and I gotta laugh!  Turns out she’s required to by the hospital!  So – after being her coloring book (she definitely was one who stayed in the lines as a kid) – the anesthesiologist was back offering to be my personal bar-tended and announced that happy hour had begun.  I said my good-byes, they wheeled  me away and I don’t remember anything else until I saw her again in the recovery room.  11 and a half hours later!  And she told me I lost 18.5 lbs that day and all went well.

That’s a good place to stop for this update and then we’ll start tackling post-surgery.

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Just a Wake Up…

We are down to no days to go…only 6 hours sleep and a wake up…and the surgery adventure begins!!  After coming through a landslide of extensive to-do lists (oh, you will get to know my penchant for a good list well!!), culminating events (usually involving a swirl of emotions and send-offs), intimidating pre-op exams, a brush with pre-surgery illness and a huge roller coaster of emotions (both mine and everyone around me) – I have landed in a place of readiness.

Does this mean that I know what is about to happen?  Not really.  Probably not at all.  But I’m as ready as I can be to go into it.

Does this mean that I am no longer nervous?  No.  Nervous!  But also excited to be here – finally!

Does this mean that I have a grand plan for my post-surgery time?  Nope!  I have a good set of guidelines, one of which is too avoid a specific grand plan.

Does this mean that I have control-freaked my way into a private utopia where only crossed “t”s and dotted “i”s dwell in perfect harmony and it is a beautiful site to behold?  Oh you damn well betcha!!!!

I mean, please, I can’t abandon all my old ways!  There’s no need to chastise me – just nod, smile and tell me I’m cute.  Please?

To document a few things about the lead-up to surgery:

I had the pre-op with my primary care physician first who did a bunch of bloodwork, an EKG and assessed my general health then cleared me for surgery.  In his words, this surgery is not quite on the low-risk list (I think because of the length and the amount of incision), but not on the high risk list of brain and heart surgery, etc.  The biggest concerns are infection and bleeding and both are well managed before and throughout the process.  He said that I could not be in better health going into the surgery and so my risk should be very low.

Then came the pre-op with the surgeon – mostly me asking a huge amount of questions and then signing the informed consents forms.  The nurse went through how the drains will work and how I will need to care and record them – it shouldn’t be messy or anything, but I have to say I’m a little squeamish about that.  And the care of the incisions (of which there are miles) is just going to take patience and layers of process.  Every day, we take off the binder and surgical bra and all the dressing, rinse in the shower, apply antibiotic, dress with pads, then underwear/bra, then protective tank top, then the abdominal binder – and all this with 6 drain tubes to manage.  Then, I believe, it will likely be time for a midnight snack and up and do it again?!

Some sobering realities from the surgeon – binder and bra are worn 24/7 for 6 weeks.  Won’t drive for 3+ (until I’m comfortable making a sudden move).  Drains may be in for 3 or more weeks – at least some of them.  It’s going to hurt to stand straight and I’m not going to want to, but then my back will start to hurt, so I’ll decide that I’d better work on standing up straight.

Switching over to the emotional lead-up…it so hard to not be struck by the bigness, risk, and just the mortality of a 10-hour surgery.  Combine that with the fact that this is a finishing move on a 10-year epic march and coming out of the most vulnerable state that I have ever been in – physically or emotionally – over the last 7 months…well, it’s hard for me not to be struck by that and it’s impossible that all those around me won’t respond from that place.  I have had just a staggering amount of emotion focused on me.  Mostly in love, care, support , hope and appreciation.  Also tinged with fear and risk and what ifs.  So many amazing things have been said to me and there are so many people sending their thoughts and energy in my direction it’s impossible not to think that it makes a difference!

Part of my being ready, though, was also to have to make a small climb out of the bigness of all this emotion.  Let the excitement back in and breathe a little lighter than it feels in the middle of that.  I can’t take the worry away from you all, but I can learn how to lean on where it comes from rather than let it stack my own worries higher.

And somehow, as I write this last thing before trying for 5 1/2 hours sleep – sitting in my all-clean bed, with my clean clothes and my Hibiclens antiseptically scrubbed body – looking at my completely checked and allocated to-do list – thinking about all the conversations and exchanges with my community of people — somehow, I know that I have become ready.   I am in a state of readiness.  Doesn’t matter what for.  Ready is ready.