Tuesday, July 27, 2010

Days 20 - 28

'Dieting has taught me that good girls are thin and that sex is naughty and powerful. I learnt that my thin body held magical powers with devastating consequences. If sex is bad and being thin is good then why do only good girls get sex? I asked. I thought it must be a double sin to be both fat and sexual. To be fat and sexual was just plain greedy.'
Rachael Oakes-Ash, Good Girls Do Swallow.

Food, fat and sex. I first orgasmed at 5. I first felt fat at 6.

There’s a fiction you construct where you are not naked. At the waxer, lying down, shirt on, no pants, you somehow pretend you are not naked in front of a stranger and make small talk. If you are not looking at your own nakedness, it’s not happening.

Lots of professions are based on fictions. In hospo the customer is always right. Similarly, there’s nothing you can tell a lawyer that will shock them – rape, paedophilia, physical abuse, simple manipulations of the people you love – your lawyer has heard it all before.

It’s the same in healthcare. I lived with a girl who was a theatre nurse in obstetrics. She would come home and debrief. Everyday mothers and babies were dying and it scared the shit out of me. I had to remind myself that any patient she had was already in trouble – if they were in the obstetric theatre it meant they couldn’t have a natural birth for whatever reason. The same thing applies in legal practice. I have to remind myself that some people do manage to hold onto their love and that if I’m talking to a client it means their family relationships are already in trouble. I remind myself that my client base is not representative. I’m still terrified of having children or getting married.

My housemate would come home and debrief and to a large extent I thought her stories were delicious, scandalous, glamorous (?) She caught me relating one of her stories to a friendly acquaintance at a party and she pulled me up. It was important, she said, that I didn’t retell her stories. It’s one thing for her to tell me about her patients in our home. But it’s another for these stories to do the rounds because it undermines the faith people have in healthcare professionals to maintain confidentiality as well as the faith people have in healthcare professionals to provide non-judgmental services.

In the same way that it’s important for my clients to feel comfortable telling me about the regretful things they might have done without concern that I give a shit, it’s important for healthcare professionals to maintain the fiction that nothing about my body or its functions could or would gross them out.

We’re talking about a girl who would come home from work and tell me how obese people and smokers should not have access to free healthcare because they have made lifestyle choices that have increased their need to access tax payer funded health services. It should be noted that I was experiencing substantial duromine fuelled weight loss at the time I lived with this girl. One might concede that these comments were a little insensitive. She got a pass because she was also on the fat side. Whatever.

I wonder how the surgical staff at the clinic feel about fat people. The same gripes, same stories, same excuses.

At intake I was asked if I had been abused. I said yes, physically.
‘I knew it! …Sexually?’ the inevitable follow up question
‘When you were hit… did you have clothes on?’
‘Uh, yes?’
‘I just wanted to rule something out’

Have we (fatties) all been abused? Maybe.

Back to my ability to pretend I'm not naked. On my back, getting my first fill, the pretty new dress I bought on the weekend bunched under my breasts. Not so pretty now. My tights are down. An unfamiliar surgeon I’ve met only once before while conscious is pressing my larger incision. The scar tissue knits deep and hard. It’s desensitized, someone else’s flesh. There’s the distinct sense of strangeness that comes with new awareness of structures existing in your body that you don’t think of day to day. The strangeness of a breast exam, or of having a tooth pulled under anaesthetic. There isn’t pain but my fingers are tracing the curves of my face and I am looking at the ceiling. I can taste the inside of my mouth – hot, red, fleshy, salt. It’s like tasting someone else’s mouth instead of my own.

The surgeon is speaking to a med student with him today. Fucker’s probably the same age as me. He’s watching the surgeon locate my port. The surgeon is talking about how injurous the incision is and how it makes it hard to find the port. That’s strike one, buddy. He’s put the needle through my skin and he’s moving it around.
‘Maybe’ he says.
Strike two. I don’t want my abdominal cavity filling up with 100ml of unwanted, useless saline. Would it fester in there?

The med student takes over to put the saline in there. He is sprayed tanned to within an inch of his life. He sports a spiffy sweater / collared shirt combo. He has Hugh Grant’s hair from the nineties. I don't find him attractive myself (hardly surprising being that he doesn't have long hair, a beard or visible tattoos) but he has facial symmetry and is well groomed. I wonder if he's ever seen a fat girl with her clothes off before today.

The surgeon looks like the crypt keeper from Tales from the Crypt. He asks me if I am happy.

‘Pain,’ he says as he pulls the syringe out. It feels like he’s pulling a boot out of mud. I’m the mud.

‘Good luck’ says the med student. Thanks old mate.

I forget to ask if I can go on rollercoasters. Fuck.

I talk to the dietician about food choices. I am not on a diet.

I talk to the psychologist. Food is pleasure. So is sex. Pleasure is not happiness. Food and sex are fine, they feel good. But once you’ve stopped eating, once you’re done having sex, the pleasure is over. Happiness is lasting, pleasure is fleeting. Concentrate on the things that make you happy and the other things will come. The end point is 75kg but it is counterproductive to focus on success or failure in terms of the speed of my movement towards the goal. Weight loss is a process. Portion control is the number one objective. The implant provides forced behaviour modification. Exercise and choices will help but portion control is more important.

So I come home and eat curry until I can’t move anymore. I’m such a badass.

Start weight: 112.5
Last recorded weight: 107
Weight lost: 5.5
LT goal weight: 75
ST goal weight: 99

Sunday, July 18, 2010

Days 16 - 19

The least I’ve weighed as an adult was 82kg.

At 7 years I was 52kg and twice the size of the other children. At 12 years I was 63kg, an inch shorter than I am today and I felt twice the size of the other children. By the start of my first year out of school and out of home I was 106kg and I looked like the love child of Roseanne and Santa Claus (in my mind). I couldn’t close the tray table of a university lecture hall seat over my stomach and I would grip it with one hand, white knuckled, and take notes with the other. In that year I reduced myself to 86kg and started in earnest a cycle of yoyo dieting that ends with me here, now, telling you about it.

The stars aligned in 2007, my first year living off campus, and I found myself working in hospitality, in an emotionally abusive long distance relationship, with access to Duromine and Reductil. I was studying, working, gyming and slowly isolating myself from the people around me as I let my boyfriend grind me down by oscillating between lavish praise and gentle criticism of my body or sexuality. He was addicted to pornography. I think he hated women. Days off I would spend alone, shopping, reading, and sitting in coffee shops nibbling on tiny beautiful cakes. Being absent, my boyfriend had no negative influence over my eating habits and being on my feet all through my working hours in addition to the time I spent in the gym I shrunk to 82kg. I fit into size 14 jeans for the first time and I felt amazing. And terrible. But beautiful. And desired.

We can talk about sex and men another time.

When S went back to Germany I was back to 102kg. Around the highest it had been since my first year of university. I’d been close to this point before and desperately terrified I would retreat into diet and exercise. I saw S’s departure as an opportunity to recreate the set of circumstances that had taken me to 82kg. My memories of that time are all cast in shades of rose. I remembered how beautiful it felt to be wrapped up tight in denim, the feeling of a lover’s hands on me. I remember how it felt to inhabit less space.

So I got a prescription, a second job waitressing and gently let my social life run through my fingers like water. Apple for breakfast; work at 8:15am; 2 boiled eggs, carrot and celery sticks for lunch; work at 6:30. Did I eat dinner? I don’t remember clearly. I remember once standing next to the ironing board in the stifling heat of the unventilated staff room, peeling a boiled egg. I remember having trouble finishing it. Often there were chips, sushi, noodle boxes or other things left over from functions in back of house that I picked at like the rest of the wait staff. Lemonade and diet coke would get me through to 11 or 12. I would walk half an hour in the cool night to my car parked on the edge of the city. This is the loneliest I can ever remember being. Walking alone led to my car by golden pools of street light punctuating the dark quiet. My chest and throat constricted in grief.

I told S that I was feeling lonely. That I was feeling very lonely and I thought it might be a side effect of the duromine. Never mind that the person I loved was in another fucking country. That couldn’t have anything to do with it.

S asked if I thought it was worth it. Duromine is not prescribed in Germany and S had concerns. I told him I would think about it and then I didn’t talk about duromine or my loneliness to him again. I made it through by promising myself it was only for 3 months.

I loved and hated this time. The depth of sadness I felt told me that my efforts were working and I saw the numbers on the scale falling away. I lost the first 7 kilos in the first 2 weeks. Eventually it stalled and I found myself double dropping someone else’s prescription; 60mg of duromine, 20mg more than the highest legal dose. By 3pm I would experience something not unlike a speed come down at work. I would walk to my car with my head swimming. I sent Br picture msgs on my way home so I would be easy to locate if I passed out. By the time I went to visit S I was 92kg and my clothes were fitting again. Duromine and coffee in the morning and I was euphoric. By the time I went to bed I was choking on my sadness.

Happiness gave me 6 kilos in Germany. Happiness was chocolate, jubes, fruit juice, pork ribs and roast chicken, fresh rolls with remoulade, kraut salat and smoked salmon or ham, pizzas, sausage, cheese fondue, homemade jam, cold cuts, booze. On my return to Australia my sadness gave me another 6 kilos. I don’t even remember the food. Then I decided I was angry and stopped caring and I went up to 109.

It didn’t feel like my body anymore. I felt betrayed by my hunger.

When I was younger the first few weeks of weight loss were an exciting time. Enthusiasm and motivation was peaking and I was able to watch my weight slide down as a clean function of my effort. Over time I’ve come to trust my body less and weight loss is accompanied by a feeling of dread. How long will it last? How long until I plateau? How long until I won’t care what I put in my mouth or how often I go to the gym?

In a perfect world I wake early to go to the gym and it elevates my mood and clears my mind. My body and digestive tract feel clean and hunger is an uncomplicated physical feeling. I reward and care for my body with good, clean, simple food. I eat until I am satisfied and I think nothing of putting leftovers away for another time. Food is not the focus of my social life and I think little of it. Hunger does not terrify me. I love my body and though it is not perfect I feel affection for my imperfections. My body is my home.

The implant has taken away my brain hunger to a large extent. I know I need to eat when there is a gnawing in my stomach and I start to feel lethargic and a little grumpy. Hunger lives in my body and not in my mind. I don’t exactly know how a kilo of saline next to my stomach can make this happen. I don’t care too much really.

Now that I can eat solids I do need to plan for good choices. Cereal, lean meat and vegetables. I think I’ll be able to exercise again soon.

There is little dread this time. I’m hopeful.

Start weight: 112.5
Last recorded weight: 105
Weight lost: 7.5
LT goal weight: 75
ST goal weight: 99

Wednesday, July 14, 2010

Days 10 - 15

Initially I was pretty useless. Most of my non-working life was spent on the couch. Every wobbly ascent from a sitting position was greeting was rapturous applause from those around me. Being unable to lie comfortably on my back, or side, or front, I slept on the couch. Wedged amongst cushions, half sitting up, half on my side, I was able to find a position where my awareness of the implant was minimal. Flat on my back I felt a terrifying pulling sensation. I was haunted by thoughts of this kilogram weight hanging precariously from the inside of my abdominal wall. ‘Will I ever ride a rollercoaster again?’ I asked myself. Standing up hurt, sitting down hurt, lifting my legs up to let Br sit on the couch hurt, shifting position hurt.

They sent me home from the hospital with tramadol and digesic and this made life bearable. I was somehow able to get through my 7.6 hours at work, place myself on the couch and then generously allow K and Br to take care of everything else.

Br was worried and spent every night at our house, sleeping on a camping mattress on the floor next to me. He would bring me shakes, juice and drugs. When I was tired he would rub my hands and feet until I fell asleep.

On Wednesday I ran out of tramadol. The clinic said by this time I should only need over the counter meds. What a pile of shit.

Wednesday night I woke hourly, to sit and mewl at late night tv. Of course, I wanted to wake up Br, but I didn’t want to explicitly do so. That’s a bit bloody soft. It only works if he accidentally wakes up and then keeps me company while I’m in pain and can’t sleep. There’s nothing worse than sleep-envy.

Things were worse for N and she wanted the implant out. The clinic said no and so did her GP. She asked him if she could take it out herself.

‘What? With a knife?’


‘No, don’t do that.’

By the end of work on Thursday I was feeling quite sad and sorry for myself. N called and she was elated. She told me to come over. Her GP had prescribed her oxycontin, endone and voltaren and she was over the moon. Let’s not talk about the legal, ethical or safety issues involved in taking someone else’s prescription. Let’s just concede that I was pretty desperate.

That night I had the best sleep of my life. Not really, but life before pain had ceased to exist.

N has such a fucking comfy couch.

The joy of pain free existence! Oh, to be able to turn my body and reverse my car without threat of hitting dogs, children and old people! I was actually functional again. I could wipe my bum! I even did some washing up.

I rang the clinic hoping they might be willing to prescribe me hardcore pain relief over the phone. That’s how you can tell I had gone crazy. There were no doctors in so fortunately there was no professional staff available to say no. I had been gently fobbed off. I didn’t mind.

Turns out my GP had moved to Melbourne. This is a shame. I like my GP and she likes diet pills. This means she will prescribe them to me. For a number of years this has been the true measure of a great GP in my eyes. If I couldn’t get duromine or at least reductil out of someone they weren’t of much use to me. Who else will facilitate my yoyo dieting with such efficiency?

So I left work to go to an appointment at a medical centre in the burbs – the other centre was in the city (read: no parking) and doesn’t bulk bill me anymore. This GP advised me that if I had pain I should present to Emergency. I pointed out to this professional that I had just had a surgery and was expecting to experience pain – I simply required medication to manage my pain. Between waiting, seeing the GP, the GP placing a call to the clinic, waiting more, and the GP receiving a return call from the clinic I found myself, two hours later, crying in my car, in the car park of this godforsaken medical centre, on the phone to N with nothing but a bill for $62 and a prescription for voltaren I could easily have obtained from the clinic over the phone.

N’s GP wanted to help but it is illegal to prescribe the drugs I needed on first presentation to a clinic. Moral: Keep tight with your GP.

N came with me to an appointment at my city medical centre to make sure I was advocating for myself properly. I know this is absurd given I’m a lawyer. Let’s just say that N is a very different lawyer to myself. Excluding waiting time it took no more than 10 minutes for me to secure the prescription. I almost scored a bloke’s prescription for valium when he left it at reception.

Maybe a little bit too much valium…

But you know what? The pain is almost gone now. It just started lifting on Sunday.

I can even sit straight now and stick my tits out. Hello boys!

Start weight: 112.5
Last recorded weight: 106
Weight lost: 6.5
LT goal weight: 75
ST goal weight: 99

Friday, July 9, 2010

Day 9

You would think that the 5cm incision would cause me some hassle. You would be mistaken.

A lot of the pain is in my left shoulder - this is caused by gas escaping my body (maybe not directly through my bloody shoulder - they say it's 'referred' pain). When they operate, they inflate your abdomen with CO2 to make room for instruments and to separate your organs. Delicious! Wouldn't you know, Voltaren have a suppository that will fix that right up. It looks a bit like a tiny chapstick. But you put it in your bum. I will tell you now, it is amazing.

The majority of my discomfort comes from the implant site. As you might imagine, I'm not used to having a kilo or so hanging from the inside of my abdominal wall. It's hard to describe what this feels like. Suffice to say that everytime I cough, burp or hiccup I hit the ceiling. Let's remember also that a girl with a fair amount of gas leaving her body might burp a lot too. If I do need to cough, which I often choose not to (easier than you thought), I need to stop, brace myself, and cough in a delicate way, beftting a lady. Otherwise I'd probably fall on my ass with the shock of the unimaginable pain. Maybe that's a bit of an overstatement. Periodically, and when I try to lie down the wrong way, I experience a strange, rhythmic clutching at the implant site. It's easiest to call this a cramp. This is amazing and takes my breath away. But in a bad way. As I heal, more tissue will knit into the attachment and the connection between the implant and my abdominal wall will become stronger and this will become less of an issue. Painkillers help for now.

  • Morphine - Decent. Sent me to sleep. Don't hope to get access to it outside hospital and don't really want to.
  • Oxycontin - Great. Lasts 12 hours. Leaves me pain free and actually functional.
  • Endone- Also great. Same drug as oxycontin, but lower dose and quicker release. Works in duo with the oxycontin to take care of break through pain.
  • Tramadol - Ok. Takes care of enough pain for me to be functional but uncomfortable. Makes me dopey as hell. Improves my ability to keep my trap shut during meetings at work and thereby expedite their progress.
  • Digesic - Works in duo with the tramadol. Really just a liferaft to get me through the last 2 hours before my next tramadol.
  • Over the counter codeine and paracetamol mixes - Terrible. Almost not worth bothering.

Without effective pain relief I have trouble with: walking; breathing; talking; dressing; showering; carrying things; bending; turning; shifting in a seat; sleeping; finding any comfortable position to sleep in; driving; wiping my butt.

The toiletting aspect of my pain issues wasn't such a big deal, more just a worry until recently. That's because I wasn't going twosies. Apparently this is relatively normal after a surgery - your body wants to keep whatever it can onboard to help with healing (ummmmm? twosies contain useful things? ok, if you say so...). But then, last night, like a lover returning from war, I felt the call of nature. As if by siren song, I was drawn to the throne. You might easily think there would be an issue in terms of my colon making up for lost time. Let me allay your fears - all was (relatively) normal. And, having taken endone and oxycontin, I could wipe.

Life is beautiful.

Start weight: 112.5
Last recorded weight: 107
Weight lost: 5.5
LT goal weight: 75
ST goal weight: 99

Thursday, July 8, 2010

Days 1 - 8

In short, the surgery involves attaching a saline filled implant shaped liked a big jelly bean to the front interior wall of my abdomen. It presses against my stomach, reducing its capacity and creating early and lasting feelings of satisfaction. There's a port under the skin on my stomach to increase or decrease the level of saline. There could be some advantages over banding - less likelihood of tissue erosion because there is greater surface area; no slipping like with the band; and, you won't be able to cheat it as some bandits do by drinking while eating to push food past the smaller pouch the band creates at the top of their stomach.

I do think a lot about the potential for it to pop or detach if I have a car accident.

It was clear fluids at the hospital but I'm back onto full fluids. 3 shakes a day, 3 cups of V8, 1 cup of prune juice, 1 of pear, 1 multivitamin, 6 fish oil caps, and a bumload of painkillers - begged borrowed and bought. I've been very surprised to find myself relatively satisfied with this diet.

Cognitions about food have been few and far between:
  • 3 cognitions re biscuits: Saw a volunteer at work with a biscuit. Mmmm biscuit. I have made sexy eyes at the biscuit tin twice since this first cognition.
  • 1 cognition re japanese curry: Br and K went to the Japan takeaway around the corner and got chicken katsu curry for dinner. Br let me put a spoon into the sauce and I sucked the spoon. I did this 3 times.
  • 1 cognition re burgers: Br and K made chilli burgers for dinner with salad and fried onions on those nice mighty soft hamburger buns. Smelt amazing. I considered whether it would be satisfying to press my tongue against the patty but conceded I would probably want to go on and bite the thing... It was little effort to move on and think about other things.
  • 1 cognition re sushi. I was leaving the office to go buy some more painkillers and as I crossed the road I thought to myself 'oo sushi would be nice for lunch...' Wrong. No food for you.
I had a suspicion that the surgery might leave me in an eternal state of blissful nonchalance to food, much like with duromine. I'm starting to think I might be right. Let's talk more about the pain another time.

Start weight: 112.5
Last recorded weight: 108.5
Weight lost: 4
LT goal weight: 75
ST goal weight: 99