Preparing For Gastric Bypass

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On a Friday morning in June, 2002, Charlie Weis, an offensive coach for the New England Patriots, checked into Brigham and Women's Hospital in Boston. He was nervous about his bariatric surgery scheduled for that morning, and he hoped no one recognized him. In a few hours, Weis, a self-described "pudge ball" through adult life, would wake up in the post-anesthesia care unit without a stomach and with a catheter inside his penis, a breathing tube down his throat, and a morphine pump and intravenous line in his hand.

He had tried every diet under the sun, and he was worried that his obesity would prevent him from getting a head coach's job in the National Football League.  His father had died of a heart attack at age 56, and the younger Weis wanted to be around for his own children, one of whom was developmentally disabled.

Weis's first hours in recovery went well.

At around 6:00 pm, his surgeon was comfortable enough to go home for the night.

But early next morning, Weis felt worse. His chest felt heavy. The doctors suspected a blood clot in his lungs, an embolism, but a CT scan showed nothing. His intensive care nurse later testified that a large amount of blood was coming out of a stomach tube. A hospitalist gave Weis a blood transfusion. By Sunday morning, Weis was delirious. He developed a severe bacterial infection. He went into coma. On Sunday afternoon, surgeons pulled out his stitches, found an astometis had developed between his new, tiny digestive sack and his old stomach. Pools of congealed blood in his abdomen were a breeding ground for bacteria. Weis nearly died.

Gastric bypass surgery is risky. It is especially risky if patients and surgeons think of it as a surgery, and nothing more.

A few years ago, Weis sued the surgeons who treated him. After a lengthy trial, jurors found the doctors not guilty. Weis mostly recovered but he still experiences residual pain from the operation.

To this day, he remains obese.

His story has become a talisman for opponents of bariatric surgery, who say that it shows how even the relatively healthy--and Weis, despite being obese, was relatively healthy for a surgery candidate--can experience severe complications that doctors aren't prepared to deal with.

And these critics are correct, in a sense. Gastric bypass surgery is risky. It is especially risky if patients and surgeons think of it as a surgery, and nothing more.

This is what happened in Weis's case. It turns out that he had not received, because he did not ask for, a critical pre-surgical blood test that would have indicated an enhanced risk of internal bleeding. Because he was ashamed of the stigma he hadn't told friends about the procedure, so he did not have a community of support to make sure he went to all of his preoperative appointments. His doctors worked for one of the best hospitals in the world, but they communicated poorly with each other.

As I scanned articles about the trial, I couldn't help but compare Weis's experiences with my own.

For one thing, my surgeon insisted that I understand what I was in for, what I needed to do, and what could go wrong. He would not operate on me unless I had a support system to help me prepare and recover. He required no fewer than ten separate pre-operative tests and a written commitment that I would attend post-operative counseling for the rest of my life.

I didn't care much about the stigma, so I was happy, almost effusive, to explain to people why I would be missing several weeks of work. I bought books, looked up journal articles, joined support Web sites.

A few days before the surgery, at the surgeon's insistence, I visited the hospital. I met the nurses on the ward who would take care of me, and I spoke to recovering patients, including one who had, about 24 hours earlier, been operated on by my surgeon. I was encouraged to ask her, and did, what I needed to know...what I should ask the nurses...what I shouldn't forget to do.

By the morning of my surgery, I wasn't nervous. (My mother was nervous enough for both of us.)  I knew that I couldn't control the steadiness of my doctor's hand, and I couldn't prevent a freak accident with anesthesia.  But the surgery was not mysterious to me. I knew precisely what would happen.

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Samuel T. Stanley is a pseudonymous reporter living in Washington, DC. More

Samuel T. Stanley is a pseudonymous reporter living in Washington, DC. Earlier this winter, he received gastric bypass surgery at George Washington University hospital. He is re-learning how to enjoy food.
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