Kathy Bailey hopes that her gastric bypass surgery marks the beginning of a new life. She wants to lose weight, but first must develop a new relationship with food.
By SUSAN ASCHOFF
Published June 3, 2003
[Times photos: Stefanie Boyar]
Kathy Bailey, left, recovering from gastric bypass surgery at Tampa General Hospital, and Jennifer Broder, a registered dietitian, discuss the dietary restrictions she must now follow.
To see previous stories about Kathy Bailey and gastric bypass surgery, please click here.
Dr. Rozales Swanson, a surgical resident assisting on Bailey's bypass, is flanked by medical student Rodrigo Bayon, left, and Dr. Michel Murr, right (back to camera). Surgical technician Sharon Bobak is to Murr's left. A nurse in training, far left, observes.
TAMPA - The tiny plastic cup contains a splash of amber liquid. Apple juice. One ounce. Exactly. And more than she longs to find an elusively comfortable position in her chair amid the tangle of intravenous tubes and monitor wires, Kathy Bailey wants the cup.
Now 24 hours out of weight-reduction surgery and in her room at Tampa General Hospital, Bailey is desperately thirsty. Her mouth tastes of barium, a chalky white liquid she swallowed this morning so doctors could X-ray her newly altered digestive tract for blockages or leaks.
Her lips are so dry, they stick to her teeth.
The all-clear has been given. A nutritionist reminds her of their preoperative conversations, about going slow and easy.
Bailey tips the cup to her lips and sips.
"Heaven," she says, closing her eyes in bliss.
This is the beginning of her new life. Of little bites endlessly chewed. Of vitamin and calcium supplements. Of forbidden foods and strongly encouraged exercise.
Of still needing will power to resist overeating, but with a body altered to crave less.
Of losing, for good, as many of her 327 pounds as she can to feel and be healthy.
Another sip, and the juice is gone.
"I think I need to rest now," Bailey says.
Deciding on a drastic step
Bailey's path toward surgery began almost a year ago, when she began to seriously consider gastric bypass to address the excess weight she has battled for 33 of her 52 years.
More than 70,000 weight-reduction surgeries were performed in the United States last year, triple the number four years ago. Gastric bypass dissects the stomach to create a drastically smaller pouch and reroutes the intestine, reducing capacity and absorption.
For Bailey, the pounds began to best her repeated attempts to lose them when she was 19 and could not shed 60 pounds she put on with her first pregnancy. Her obesity - her Body Mass Index, a measure of fat based on height and weight, is almost 60; 20 to 25 is normal - has caused diabetes, high blood pressure, aching joints, crushed heels, sleep apnea.
It brings disdaining looks, like the expression she sees on a co-worker's face at the Largo retailing chain where she works as a computer programmer, should she sample the Thursday treats brought by staffers.
It has outlasted dozens of diets. At one point she dropped 145 pounds in a supervised weight-loss program, only to gain it all back in a year.
It promises, statistically, to kill her.
So after months of research, group support meetings and counseling, insurance forms and medical evaluations, the Treasure Island resident and mother of two decided to surgically alter the body that will not be satiated.
Last Tuesday, at 10:30 a.m., before beginning the mandated fast for Wednesday's surgery and the ensuing three months on mushy food only, Bailey ate her last meal. English muffin. Two scrambled eggs.
That night, unable to sleep, she got out of bed and logged onto her computer, fiddling to forestall the fear, to fend off the numbers: a 3 to 15 percent risk of complications, of a blood clot forming and traveling to a lung, of her heart giving out, of an invading infection. A one-half of 1 percent chance she could die on the operating table.
A 100 percent chance that she will hurt afterward.
At 5:45 a.m., with the sky still dark and the day so long in planning finally arrived, Bailey checked into Tampa General Hospital.
The surgery begins
She is a person reduced to an abdomen.
Her body is draped in blue sheeting, with only an 18-by-12-inch rectangle of her midsection exposed to the bright lights in Operating Room 2.
She has a tube down her throat. A machine breathes for her. Bailey's body, even her head, is encased in plastic, a climate-controlled bag called a Bair Hugger. A thatch of red hair is all that is visible through the plastic at the head of the table.
Dr. Michel Murr (pronounced More), director of bariatric, or weight-reduction, surgery at the hospital's Digestive Disorders Center, will operate with a team of seven. Murr is an assistant professor at the University of South Florida College of Medicine, and this is a teaching hospital. There is a surgical resident, a doctor-in-training and a registered nurse training for operating-room duty in addition to the anesthesiologist, surgical technician and two nurses.
Murr averages five or six bypasses a week and frequently performs them laparoscopically, operating through five small incisions. Bailey's weight, carried in the middle of her 5-foot, 2-inch frame, dictates open surgery for better access.
Murr begins at 9:18 a.m. with a cut from below the breast bone to the navel. He and Dr. Rozales Swanson, a fourth-year surgical resident and Navy reservist who will specialize in heart surgery, wield an electrical tool that cuts and cauterizes to stop bleeding. The edges pull apart, a thin layer of skin atop a 2 1/2-inch layer of fat, to reveal the organs.
Murr and Swanson, assisted by Rodrigo Bayon, stand on stools. They reach into the cavity, stuffing in gauze to absorb the minimal bleeding and grasping the edges, anchoring them with spatulalike retractors hooked to a scaffolding of metal rods previously constructed at the top of the abdomen.
Like a mechanic who checks the fluids as long as he's under the hood, Murr palpates the organs, checking for cysts and other abnormalities. A piece of the liver the size of a fingernail clipping is dropped into a plastic cup for biopsy, to ensure it is disease-free. The 5-inch gall bladder is removed, to prevent gallstones, which occur in about one-third of bypass patients after surgery.
The stomach is about the size of a dinner plate, flaccid and empty.
They staple, then cut, the stomach into two sections. The top portion is about the size of a little finger. The larger section will no longer receive food from the esophagus, but it will not be removed, instead draining its secretions into the intestine.
Surgical technician Sharon Bobak, who has worked with Murr for four years, is so familiar with the surgery that the doctors rarely have to request an instrument. She stands to Murr's left, manning a long table lined with dozens of clamps, suturing hooks, plastic trays of gauze, a mechanical stapler about a foot long and clunky enough to do duty on This Old House.
"I love these patients so much," Bobak says. "They are so special. They are always so grateful."
Barely audible strains of My Heart Will Go On, from the movie Titanic, emanate from a CD player. "I like a calm atmosphere," says Murr, who speaks so softly, only those beside him can hear. The surgery is progressing routinely. Word is sent to Bailey's mother, in a waiting room across the hall, that halfway through, all is well.
A very big deal
Kathy Bailey's mother, Nancy Bailey, and a dozen others waiting for word on other patients sit in a room with a coffee machine, a tray of muffins and palpable tension. A man with a clipboard appears every few minutes to call out a patient's name and provide an update.
"I'm nervous," Mrs. Bailey says.
She recalls Kathy as a child, a girl whose distinct likes and dislikes about food ignited battles with her late father. He'd insist she eat "at least three bites" of everything. "It got so I wouldn't make some things we liked to eat because I didn't want Kathy to have to sit there," her mother says.
"She'd ask me to make the big lima beans, not the small ones, so three bites would go quicker."
An estimated 15-million Americans are morbidly obese, which means they have a Body Mass Index of 40 or above or are 100 pounds or more overweight.
Only about 5 percent of all dieters are able to maintain their weight loss beyond two years.
Dr. Michael Albrink, a gastrointestinal surgeon and associate USF professor who is on the Digestive Disorders team with Murr, says he is uncomfortable with a surgical solution.
"I can't help but think that someday, when we have better ways to deal with obesity, a pill or a drug, we will look back on this and think it's barbaric," Albrink says.
Murr agrees.
"This is one practice we would be happy to lose," he says. "It is an invasive treatment, a very aggressive approach," but the only one that has proved durable until medicine finds something better, he says.
Mrs. Bailey at first opposed surgery, worrying about the risks, but she has accompanied her daughter to group support meetings and stocked her kitchen with the powdered protein mix, sugar-free Jell-O, 100 percent juices and chewable vitamins that Kathy Bailey will need during an estimated six weeks of recovery and beyond.
"I'm very concerned," the mother says. "This is a big deal."
On to the recovery room
In the operating room, Murr and Swanson move on to the small intestine, clamping and cutting, then attaching one end to the new stomach pouch. A piece draining the larger stomach will be attached farther down. Two additional staplers are used, one resembling a curling iron and the other a skinny rubber tube that staples a circle while retaining an opening through the middle.
The intestine is then sutured back into place. Before closing, the doctors poke a tube through the skin from the inside for drainage. It will be removed two days later.
The surgery has taken about an hour and 40 minutes. Murr goes to find Bailey's mother and give her a report.
"How are you?" he asks.
"Nervous."
"I'm not," Murr says. "Everything went fine. We put the bypass in and tested it. Biopsied the liver, to see if there's scar tissue from being overweight. She lost 5 to 6 ounces of blood. No transfusions. That's normal."
"Can I see her?" Mrs. Bailey asks. No one is allowed in the recovery room. Her daughter could be there another four hours or more. "I don't care if she's groggy. I don't care if she sees me. I want to see her.
"She's mine."
The clipboard man slips her in for 60 seconds. Her daughter is disoriented. But she is fine.
New lessons to learn
The first day after surgery is Day One, bariatric nutritionist Jennifer Broder tells Kathy Bailey when she visits her hospital room Thursday. By Friday, she will be eating Jell-O. Today, she is to drink 1 ounce of juice or water every half hour. Exactly.
"It's like starting over, like a baby," Broder says. "A baby has an innate ability to regulate its own intake. (Bailey) is learning hunger and fullness" all over again.
About the third month after the surgery, Bailey will be allowed to expand a menu of canned and cooked soft foods and liquids to include raw fruits, salad and other higher-fiber choices. But she will continue to take liquids separately from solids.
Her new stomach pouch cannot grind food; she will have to chew each small bite thoroughly. High-carbohydrate, high-fat and sugary foods are to be avoided; they can make her violently ill.
Initial weight loss will be mostly water. Most patients plateau after losing 50, 100 or even 150 pounds. Exercise, their coaches tell them. Most weight loss occurs in the first 18 months after surgery.
A patient can overeat the capacity of even the egg-sized stomach permanently created by gastric bypass, typically by ingesting too many liquid calories. But researchers have found that hormonal changes stimulated by the surgery decrease appetite and feelings of hunger.
The lifelong effect on the body is unknown.
The future in treating obesity, Murr says, is "not one magic bullet, one gene, one pill."
"It's eating the right thing, changing our habits, changing our sedentary lifestyle and perhaps supplementing with medicine to help control the uncontrollable," he says.
"We have a lot of questions and very few answers."
Kathy Bailey knows all this. She believes she has found the only answer left to her.
This is, she hopes, Day One of a new life.
For more information
To see previous stories about Kathy Bailey and gastric bypass surgery, please click on www.sptimes.com/weightloss/ For more information on obesity and surgery, go to:
