From the Bedside to the Bed and Back Again: A Bariatric Journey

For over 20 years, I had gone to work at a large academic medical center as a critical care nurse. However, on August 25, 2009, I entered the doors of that hospital not as a nurse but as a bariatric patient about to undergo laparoscopic gastric bypass surgery. How does a nurse whose job it is taking care of everyone else realize that, at 5′4" and 275 lbs, it is finally time to take care of herself, and how does it feel to be on the other side of the hospital bed? Like my nursing colleagues, it was always easier to take care of my patients than it was to take care of myself. As a healthcare professional, there is a false sense of security that we are strong and healthy, unlike the weak and ill patients for whom we care. We often think we would never allow ourselves to succumb to the preventable health problems we treat every day in our patients. We can tell patients exactly how to improve their health and decrease their risk factors, but it is always harder to do the same thing for ourselves. After all, we are the experts in how to get well and stay well. So how could a nurse like me end up as a bariatric patient? When I traded in my scrubs for a hospital gown, I was about to embark on not only a new chapter in my life, but also a whole new way of life. It was to become a journey where I would literally lose half of my physical self but would gain so much more in self-esteem.

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Then and now

Morbid obesity is not something that happens overnight. It is not just a physical state; it is also a state of mind. I was getting accustomed to gaining more and more weight and compensating for the everyday activities for which I was increasingly having difficulty. I would often think that the joints that hurt must be arthritis, or me getting older, or just the toll that being a nurse for 23 years takes on your body. Why should I take the stairs and become short of breath when there is an elevator? Instead of kneeling down to mark chest tube chambers or empty foley bags, I found myself bending over because it hurt too much to try to kneel and then get back up without extreme difficulty. As a nurse, I learned to do what many of my patients had often done; I compensated for the things that I could no longer do by finding other ways to do them while denying the underlying truth that my weight was the real problem that needed a long-term solution. I had tried to lose weight many times in the past and had varying degrees of success, but somehow the weight always returned, with me usually gaining more than I had lost. I tried everything from diets, weight-loss pills, liquid fasts, working with a personal trainer, to sheer willpower, and none of them provided me with the long-term solution that I needed.

As I cared for obese patients throughout my career, I always thought “thank goodness I'm not that bad” or “how could someone allow that to happen to them?” Whenever I cared for a gastric bypass patient or met someone who had the surgery, I was always curious as to how the surgery turned out and how much had their lives changed by their dramatic weight loss. Moreover, I was interested to know how much better they felt and how much more energy they had acquired. In the final analysis, however, I was never sure that this life-changing surgery was necessary for me. Now I realize that the hardest thing I had to do was to think of myself a few years from now, lying in a bed with all the comorbidities that obesity causes being cared for by someone like myself—a patient now, instead of a nurse. I knew that if I did nothing to change my situation, I would become a self-fulfilling prophecy.

Hence, the nurse in “me” started planning the best options for “me” the patient. I started to do my homework. What type of surgery? Which surgeon? Who had the lowest complication rates? What kind of outcomes could I expect? I spent hours searching for information on the Internet, spoke with colleagues and friends, some of whom were former gastric bypass patients, and finally decided on a plan of action—trading in my scrubs for a hospital gown.

After working a 12 h shift and still dressed in my scrubs, I went to a bariatric seminar at my hospital. There I sat with the rest of the morbidly obese patients listening to the details of all the unpleasant tests that were required before I could even have the surgery, and all the hard work that would be expected of me after the surgery. I sat among other patients who were better or even worse off than me, but who all had the same desire—to lose weight and regain the health that we had all taken for granted.

The surgeon first showed a slide of an obese woman. His next slide was of that same woman looking slim and wonderful after she had lost all her excess weight. He said to us that if this was the reason why we wanted the surgery, then it was the wrong reason. The next slide showed the woman's nightstand full of bottles of medications for diabetes, hypertension, and other problems, which she had been taking before surgery. That same nightstand was then shown, a year later, when she had lost the weight and no longer needed the medications. The bottles were gone. The message that the surgeon was delivering was quite clear to me: this was the reason to have the surgery.

During my consultation, the surgeon estimated my ideal body weight to be 130 lbs. I joked that the last time that I weighed that amount was in grade school. It was overwhelming to me that I had to lose more than half of my body weight. I remember feeling nervous thinking that I might not be a candidate for the surgery. I felt like I was waiting for my college acceptance letter all over again. I was no longer the confident professional always in control but, instead, had become the scared, insecure patient wanting to get better. Fortunately, I was in luck and was told that I was a candidate for the surgery.

In preparation for the big day, there were two pages of preoperative testing required before I could even have the surgery. This included an upper GI series, an abdominal ultrasound, a sleep study to diagnose obstructive sleep apnea, an abdominal CT scan, a psychiatric evaluation, and fasting blood tests that required 15 tubes of blood to analyze my blood for any existing deficiencies. In addition, I was required to attend 6 months of nutrition counseling. Altogether, this process took almost 9 months to complete. So much for thinking that I had done the hard part by making the decision to have the surgery. I looked at all of these tests as “rungs on a ladder” that I would have to climb, and the “golden ring” that I was reaching for was to regain good health.

Finally, the day of surgery arrived and I was happy, yet fearful. I did what all patients do, fully trusting that the staff would do their very best job for me, just as I would do for my own patients. I endured the missed IV sticks, IV infiltrates, and postoperative nausea and pain that all of these patients experience. I remember hearing the staff apologize for any pain that they may have caused and encouraging me to mobilize independently just hours after surgery, so that I would not have complications such as DVTs and pneumonia. They said all the things that I would normally say to my patients, but perhaps the nurse in me appreciated hearing them more because I knew of the consequences that could follow if I did not listen.

Although I am a nurse, the staff never assumed that my family benefited from understanding what I already knew about the surgery and the recovery period. Instead, they took their time to educate and answer any questions that my husband had about my care so that he knew exactly how to care for me at home after surgery and throughout my recovery. After I was discharged and sent home from the hospital, the adventure continued for the next year. My challenges were many. I had to relearn what to eat and how to eat, measuring out my food, and balancing it with daily exercise. I faithfully filled my pill boxes with my twice-a-day vitamins and, slowly, I rediscovered how to appreciate my steady return to good health. My husband's support was a vital part of this process, and he had been well prepared by the staff to meet my many needs and challenges.

It has now been just over a year since my surgery, and I have lost 133 lbs. I have gone from a size 3x to a size small in scrubs. More importantly, though, is the fact that I have regained my good health and a new lease on my old life. I appreciate looking better, but I appreciate feeling better even more. Now I don't give a second thought to kneeling down or climbing several flights of stairs, which has become a normal part of my healthy new life.

Throughout this entire process, from the beginning to the end, the thing that I was the most grateful for was, perhaps, the thing that I took for granted the most as a nurse. I was very grateful that everyone from housekeeping, to the patient care technicians, to the doctors and nurses came in every day and did their jobs to the best of their abilities. All of them treated me not as a nurse, but as a patient. They all understood that no one wants to be a patient or be in a hospital, but that when it is necessary, a trained professional will be there to care for them, explaining with compassion what they are going to do and how they are going to help the patient get better. What matters the most to a patient is being able to get to the point when he or she is no longer a patient and dependent on others. It doesn't matter why a person becomes a patient; what matters is how the staff helps the patient regain their former health through encouragement, through teaching patients and their families how to navigate the healing process, and caring for them during a time when they don't know how to do these things for themselves. I thank all of the staff that cared for me with the professionalism they brought to work each day, so that I can now pay it forward to my patients.