The fallibility of surgeons

[Guest guest]

This will be a long-winded post, because I've had two DS surgeons,

both of whom have generated some controversy.

I've been bemused in recent months to see that both the surgeons with

whom I signed up for the operation–Hazem Elariny and

Ren–have proved to be less than committed to the BPD/DS. They're

both young surgeons who are still carving out identities for their

practices. Elariny seems uncomfortable with malabsorption as a means

to weight loss, as he is persuading more and more of those who come

to him for the BPD/DS to opt for Elariny's stand-alone sleeve

gastrectomy instead. Ren has become a proponent of the Lap Band

since the FDA approved that procedure recently. I thought that meant

that she too was beginning to prefer purely restrictive procedures to

malabsorptive ones, until the recent news that she's embracing the

BPD without the DS.

Many people have asked me how I came to switch from Elariny to Ren.

Last winter, on the night before my scheduled BPD/DS, Elariny called

me at home to tell me that he had just reviewed the pre-op tests I

had taken nearly two weeks earlier. Though I had no history of heart

trouble, the EKG disclosed that I was a possible candidate for open-

heart surgery, he said. While I was still recovering from the shock

of this, Elariny went on that if by chance I got to have my operation

the next day, I'd have to agree to have it open, rather than lap,

because of adhesions. (I had had one previous abdominal surgery, so

I didn't realize until later in the conversation that he'd confused

me with a patient who'd had three Caesarean sections.) If I insisted

on having it done lap, Elariny said, I'd have to be willing to wake

up with " just the top " of the operation done–which was my

introduction to Elariny's stand-alone sleeve gastrectomy. He tried

to sell it to me as a " superior " operation to the DS, but I was in no

shape to process the information.

Having received lots of sweet e-mails from fellow members of AMOS

wishing me well, I thought it was only fair that I let them know that

my surgery was canceled the next day as I lay on the table (Elariny

did not show up at the hospital, choosing to deal with the

anesthesiologist and the cardiologist by phone instead). It was

the " surgery canceled " post to AMOS that brought about my parting

from Elariny. He didn't appreciate my telling other pre-ops that he

had waited until the night before my surgery to review the pre-op

tests, and told me to find myself another surgeon. (He had also, by

the way, left me on my own, without map, suggestion, or referral, to

figure out whether in fact I had a heart problem. A stress test by a

cardiologist found no abnormality and cleared me for surgery, meaning

that had Elariny looked at my tests even a few days earlier, my

operation could have proceeded on schedule.)

What continues to baffle me is the reaction of my fellow Elariny

patients to my news about Elariny. Many of the same people who had

embraced me so warmly before, with the empathy that is so evident on

this list and others, now attacked me–there's no other word for

it–for saying such mean things about their savior. Elariny

couldn't have acted like that, spoken like that; I must be a liar, I

must be crazy. I was called a psycho on more than one Internet

site. A member of this list with whom I had commiserated in a

private e-mail used the matter as an excuse to betray a confidence.

And then there were those who lined up to " take credit " for blowing

the whistle on me. Each Elariny loyalist was serenely certain that

it was her exposure of the " incriminating " Internet posting that had

put me out on the street to find another surgeon. I suppose they all

must have wanted me to post their names publicly, so that they could

win the applause of their fellow Elariny devotees. I denied them the

publicity; I didn't even respond to their e-mails. I simply deleted

their messages and blocked their addresses.

This surgery is no mere operation; it's the Holy Grail. Between the

night of Elariny's dire pronouncement and the day I was cleared for

surgery, I daydreamed about digging my " defective " heart out of my

chest with a dull knife (if it was keeping me from having the

surgery, I wanted to be rid of it). How could anyone believe that I

had just " made up " a set of circumstances that caused me to have to

start this emotionally draining process all over again?

I was ready to go to Dr. Baltasar in Spain on a raft if I had to,

rather than get in line for another U.S. surgeon. Dr. Ren's office

penciled me in immediately, and for that and much more I am and will

remain grateful to her. Some will say I should I have waited for a

more experienced surgeon, and maybe they're right; but at that point,

waiting was intolerable. To those who poo-poo the importance of

bedside manner, I must say that the warmth and empathy that my family

and I found in her was therapy in itself, a huge factor in getting us

all to and through the surgery. And the BPD/DS she performed on me

would appear at this point to be flawless. At nearly eight months

post-op, I have had no pains, no gastrointestinal distress, no

vitamin or mineral deficiencies, no problems of any sort, and my

weight loss is proceeding on schedule.

Deb Mullen's surgery with Dr. Ren preceded mine, but I heard nothing

of her difficulties until well afterward. I'm not qualified to say

whether what happened during Deb's surgery was inevitable due to

Deb's anatomy, was the product of the surgeon's inexperience, or was

some combination of the two. I don't need to know the answer to that

to empathize with Deb's pain and feelings of betrayal and violation.

That my experience with Dr. Ren was almost the antithesis of Deb's

never led me to believe that Deb must be deluded, dishonest, or in

need of psychiatric care. I will never say that Dr. Ren " couldn't "

have made the statements Deb attributes to her, even though they were

so different from what Dr. Ren has said to me. Deb still has my best

wishes; Dr. Ren still has my gratitude.

I am a firm believer in malabsorption as a means to permanent weight

loss and therefore no fan of any purely restrictive surgery. Dr. Ren

has taken heat on this list for advocating the Lap Band, but at least

it offers enough restriction to do some good to the more moderately

obese among us, it's adjustable, and its minimal invasiveness means

that it will be undergone by those who otherwise would be unwilling

to try any weight-loss surgery at all. I still doubt that it will

prove to be the answer for a significant percentage of the morbidly

obese. Dr. Elariny's stand-alone sleeve gastrectomy has come in for

comparatively little criticism on this list, even though it tries to

force the reduced stomach to carry the full burden of weight loss and

maintenance, a function the BPD/DS's creator says it can't carry by

itself. If we care that people who come to Drs. Ren and

for the BPD/DS will now be offered only the BPD instead, we should

care that Elariny is persuading increasing numbers of those who come

to him for the BPD/DS to opt for the unadorned sleeve gastrectomy.

Some of them (as I've seen on the Elariny list) even come away with

the impression that the sleeve gastrectomy is " minor " surgery, which

it is not. And if we care that the BPD leaves the patient without

the pylorus, we should care that Elariny is reported on the DS-

Elariny list to be offering his sleeve-gastrectomy patients the

option of intentionally disabling the pylorus. If there has been any

discussion of that on this list, I've missed it.

Meanwhile, I'm loving malabsorption. It has set me free: free from

stuffing myself beyond satiation today because I must begin the diet-

to-end-all-diets tomorrow. No more dieting for me. I love the

feeling of being satisfied with little food. I love being able to

stop with " just one " of a sweet treat without feeling deprived.

I feel smug when a package of cookies or candy lasts for weeks or

just goes unopened. At eight months out, I've lost more than sixty

percent of my excess weight. Bones are bursting out all over me.

And I'm glorying in the unfamiliar lingering glances of men.