Failing the Psychological Clearance

Before I get into the heart of this story, I must first repeat the background information that I explained in the Struggling Through the Pre-Surgery Medical Clearances.  I had looked into the bariatric sleeve surgery the previous year; had gone to a few appointments; a few nutrition classes; a few education classes; but after meeting with the bariatric surgeon, I changed my mind because when I told him about my previous open abdominal surgery of 20 years ago that involved a two-year recovery beset by complications and infections, he dismissed it as inconsequential. I warned him that I had no idea what was going on inside of me currently, nor did I know how much scar tissue he was going to encounter. He insisted that he could handle anything and that he could do it laparoscopically, as was how the bariatric sleeve surgery was done. He did not seem the least bit concerned and said that if after attempting to do the surgery laparoscopically, if it was not feasible, he would do open abdominal surgery. I was extremely uncomfortable with him, his attitude, and his surgical plans for me, so I canceled everything.

Unfortunately, in the ensuing year, my eating got out of control to a greater extent than it had ever been, and I gained another 30 lbs. I knew I had to explore the surgery options again. This time it was a different surgeon, who was more understanding than the previous one. He listened to me carefully and allayed my fears by explaining the stomach anatomy to me, assuring me that he would not be going near the part the surgeon from 20 years ago had worked on. I felt much more comfortable with him, so agreed to go ahead with the surgery.

Now it was time for my psychological clearance. In the super-sized 3-ring binder that I was given during my introductory visit to the bariatric clinic, there was a list of psychiatrists and licensed psychotherapists from which to choose for a psychological clearance. Since I was not familiar with any of them, my criteria for choosing someone was that their office involve as little drive time as possible.

It was with more than a little confidence that I approached my appointment. After all, I had been at this weight loss struggle my entire life. I knew my strengths and weaknesses related to weight loss programs. I knew myself. I knew what I was capable of accomplishing and not accomplishing when it came to dieting, and I understood the surgical procedure. I did not expect it to fix any of my other life’s problems. I just knew that it was what I needed to help me stay on diet programs so I would not be starving all the time. I, therefore, went into this appointment feeling confident that I knew that I needed the surgery; I knew what to expect from it; and that my expectations were not unrealistic. I was old enough and mature enough to handle it.

Upon arriving for my appointment with the psychiatrist’s assistant, I was ushered into her office to wait for her. A few minutes later, a tall, sturdily built woman in her 40’s walked in carrying a canvas lunch bag over her arm. She was munching on potato chips from a small snack size bag. When she sat down across from me at her desk, she closed the bag of chips, put it into her zippered lunch bag, and put it to the side. I thought that was a little off-kilter when coming to interview someone about obesity and bariatric surgery, but okay, I sat and waited for her questions. I expected her tone to be at the very least, professional. But as a mental health professional, I was also expecting her to be calming and conversational to put me at ease. I was rather taken aback that her tone was none of these things. It was confrontational, accusatory, and interrogative.   

She was in high gear interrogation mode from the first question. Her tone was loud, accusatory, and rather angry. “You were going to have this surgery last year and backed out of it. Why didn’t you go through with it? What makes you think that you want to have it now?”  I explained in a very calm manner my concerns about my previous surgery, that I had discussed it with the bariatric surgeon, and that I was uncomfortable with his attitude. I explained my concern about scar tissue and not wanting to have open abdominal surgery. I explained that I did not feel comfortable and safe, so I canceled the surgery. I told her that I had gained so much weight this year that I thought I would give it another try. I spoke with a different surgeon this time who was more understanding and allayed my fears. She grumbled about that. She surely did not like that answer. I did not know why. I thought it was a perfectly reasonable answer.

Then she asked me, in the same angry tone, “Well, what diets have you tried in the past?”  I told her that I had tried every diet imaginable and none of them worked. “Well, why not? Why didn’t you stick to them?” I looked at her incredulously. I thought to myself….This is a woman who is supposed to understand obesity and the issues involved and that we CAN’T stay on diets because we’re always hungry. She is supposed to understand this. I was baffled by her questions, and particularly by her attitude and tone, but I dutifully answered that I could not stay on a diet, no matter how hard I tried because I was starving all the time. That’s the whole point of the surgery…..to reduce your stomach so you are unable to hold a lot of food and you are not that hungry. In a voice devoid of patience, she informed me that it is not that difficult to do. She  proceeded to take the bag of potato chips out of her lunch bag and said, “Well, I just opened this bag, had a few chips, told myself that was all I needed, and that was all I was going to have, and I closed the bag and put it back.”  I thought to myself – this is not going well. These are not the kinds of questions she should be asking me. Again, I looked at her incredulously and said….”If I could do that, I wouldn’t need the surgery. But I can’t. I have never been able to stop at a few potato chips or pieces of candy or any food. That is why I want the surgery.”

She said to me AGAIN, in that same angry, accusatory tone…..  “You signed for this surgery last year and canceled it. Why?” I said to her……..as calmly and politely as I could muster…….   “I just explained that to you.”  Here it comes. Are you ready for this? I surely wasn’t. She said to me, I swear to God, she said………..   “I wasn’t listening. Tell me again.” At that point, I looked around at my surroundings to make sure I was where I thought I was – in a medical office, and thought to myself…….Somewhere between the ground floor and getting off of the elevator on this floor, I must have taken a wrong turn and entered the Twilight Zone. I was stunned. I was ready to get up and leave. The crazy one was not sitting on my side of the desk.

But, I wanted to pass this test, which was looking bleaker and bleaker at this point, so I again explained what I had just explained 5 minutes before…..that I was uncomfortable with last year’s surgeon, and I felt much better with the new surgeon.

The rest of the interview did not go much better than that. She was very unhappy that I had canceled surgery last year, and bombarded me with pointed questions about what would make her think that I wouldn’t cancel it again or that I wasn’t comfortable having it or if I had it, I wasn’t going to follow through with all the requirements, such as staying on the prescribed diet.

Then she said that she did not feel comfortable clearing me; that I would have to make an appointment with the psychiatrist and discuss it with him. “But”, I said, “I have explained everything to you, and everyone else I have spoken to about this – the bariatric nurse, the bariatric surgeon, my cardiologist, my primary…………they all agreed that my reasons for canceling the surgery were sound, and my reasons for wanting the surgery are appropriate.”

Her name was Jennifer ( name changed to protect myself). She said to me…….    “Well, JENNIFER is the one who has to clear you, and JENNIFER doesn’t think you should be cleared, so JENNIFER is going to insist that you make an appointment with the psychiatrist.”

I sat there with my mouth agape. I could not believe what I was hearing. Not only that she would not clear me psychologically, but that she was nuttier than I was.

She ushered me out of her office to the front desk, where I checked out without making an appointment with the psychiatrist. If he was anything like his assistant, I wanted nothing to do with him. I went straight to my car and called the bariatric nurse in charge of surgery to tell her what had just happened.

I was practically hysterical. She told me to calm down, and that the person I had chosen to see was not one they recommended. Hmm, I could see why. Maybe she should have told me that before I took my trip to the Twilight Zone. She named one of the psychotherapists on the list and told me to make an appointment with her.

A few weeks later, I went to see Ms. P, who put me at ease immediately with her easy, friendly manner and asked all the questions that I thought were reasonable and appropriate. She wanted to know my history with weight loss or lack thereof, and why I wanted to have the surgery. We talked a lot about what I was expecting from the surgery. I said I was not expecting it to solve any of my depression problems over my husband’s death or to solve any other issues I may have had. I was expecting it to allow me to stick to a diet so that I could lose weight. She said that my expectation of losing 75-100 pounds in the first year was reasonable. We talked about my other expectations from the surgery, which were not to be model skinny but to be “normal” and be able to fit into airline seats and restaurant booths. I was not expecting to be a size 2. I wanted to reach a weight that was comfortable and maintainable for me. She seemed pleased with my answers. When we finished, she cleared me for surgery. She said I was fine psychologically. I knew I was. I would know if I was expecting the wrong results from the surgery.  I have been through so much for so many years related to my weight that I would know if I had unrealistic expectations. On to the next requirements.

NEXT: Pre-surgery education classes – the fattest one in the room