Being a bariatric surgeon is not easy. The moment a patient comes to you and gets his/her stomach size shrunk, the onus to ensure that he or she should shed all the extra kilos he gained in all these years is on you. Most of these patients suffer from various health issues such as diabetes, heart disease, high blood pressure, joint pains, obstructive sleep apnoea, infertility and so on. Patients come with a lot of hope and it tends to weigh heavily on you.
The aim of all my patients is return to good health and look great. However, bariatric surgery is a two- way process with equal efforts put in by the doctor as well as the patient. Surgery gives an opportunity to the patient to make a lifestyle change and those who embrace this change are the ones who get the best results. I get all kind of patients, some who pursue their goal with utmost sincerity and then there are those who need a lot more goading and persuasion to stick to the post-operative protocols.
Indian women are twice as pre-disposed to becoming obese as their male counterparts. With rising levels of obesity in younger women in the reproductive age-group, I see a lot of young obese women who are suffering from PCOS (Polycystic ovarian syndrome) and infertility. As a society we are not very kind to women who suffer from infertility and this is the story of one such lady who overcame her fears and finally succeeded in her battle with obesity and infertility.
About two years back, a young south Indian lady of about 35, walked into my cabin with her husband. She weighed about 140 kg, but unlike most of my patients, her main concern was not her weight. As a doctor we are privy to some of the deepest concerns of our patients. I sat the couple down and asked them to narrate their story. Medicine is all about stories and as doctors we are trained to “listen”.
As she started speaking, I realized that she had been battling infertility for almost 10 years. What bothered her most was not the fact that she was excessively fat, but that she could not conceive. Like any other woman her age, she just wished to hold a baby in her arms.
Her distressed face and nervous tone of voice told me her story- In her part of the world, the pressure to have a baby soon after marriage is very high. The extended families on both sides expect a baby in the first year of marriage itself. In every social gathering this is the first question that is posed to any new bride. It had been hard for her to answer her incapability of producing a child to dozens of relatives—both close and distant. She must have gone through tormenting times.
Over the years she started avoiding social gatherings. She began to wonder if her husband would continue to love her the same way. A lot went through her mind and there was a hint of depression as well.
After a couple of years of her wedding started her visits to the gynecologists and a multitude of infertility treatments. As I flipped through her thick file of prescriptions by various infertility specialists, I realized that she had tried a number of hormonal treatments and had undergone 10 cycles of IVF in last 8 years.
It was quite apparent that the ten failed IVF cycles had taken a toll on her both physically and psychologically. Every subsequent cycle led to weight gain because of all the hormones pumped into her body. More than that, the psychological impact of continuous disappointments had led to clinical depression. She had lost all hope. She was looking into a void as I looked at her. As I looked at her husband, he was desperately waiting for me to say something positive and show them a ray of hope.
I broke the silence by telling the couple that I saw no problem with reproductive systems of either of them. I told her that most likely obesity was playing a big role in her inability to conceive, but as a doctor I could not promise a hundred percent positive outcome to her. Over the years I have seen many women with similar issues and most of them had done well.
She was full of doubts and was not fully convinced that obesity could be playing a big role for her being infertile all these years! “I have seen so many fat women becoming mothers,” she told me.
I explained the relationship between obesity and conception to her in detail. The consult went on for about an hour. I finally advised her to undergo a few tests and come back at a later date. As I ended my day after putting my son to sleep, I pondered over their case again. I wasn’t sure if they were convinced. I felt sympathetic and, as a woman, I could understand her desire to become a mother and the turmoil that she must have undergone all these years.
Never before had a patient occupied my mind so much. What if she did not conceive even after her bariatric surgery? What will she do? What will happen to her marriage? Will it last? My mind had endless questions.
Somehow I felt I could play a part in saving her life and marriage. But it had been a month and I had still not heard from them.
Then one day, I got a call from her. She was sounding low—more depressed than when she met me. Again she asked me the same questions, and I gave the same answers. She was looking for 100% assurance, but unfortunately there is no 100% in medicine.
She wanted to see me again. I readily agreed.
The next day, she came again, this time with her husband and mother-in-law. Her mother-in-law asked me straight, “If you cut her stomach, where will the baby grow?” Apparently, she had been told a bit about bariatric surgery.
I smiled and explained a woman’s anatomy with the help of a diagram. The stomach and uterus are two very different organs and the baby actually would be much healthier if the mother had lost weight before conceiving. The chances of the baby becoming obese or diabetic in future are much lower post mother’s weight loss. Finally they agreed to give surgery a try. I gave her a list of tests she had to undergo before the surgery and a diet plan she needed to follow before the surgery.
The pre-operative diet helps the patients to lose a few kgs before surgery. It shrinks the liver thus making it easier for us to operate. It is also a test of the patients willpower and gives us an idea about how compliant they will be with post-operative instructions and supplementation. I had never seen such a determined patient before. She followed everything by the book. After all, nothing mattered to her more than becoming a mother. She underwent a Laparoscopic Roux en Y Gastric Bypass a week later. Thus began her journey of weight loss. She knocked off 30 kgs in the first 3 months and continued to lose steadily. I had never kept a count of someone kilos before.
After all, alI this effort was not to make her look good –but to help her become a mother. I wanted her to succeed as much, if not more, as her family.
As she lost weight, she started transforming into a totally different person— the clouds of depression gradually lifted and she was smarter, more positive and much more confident than she was when she first walked into my cabin.
By the end of 11 months, she had knocked off 50 kilos and she became a role model for our other patients.
One day, I got a call from her and she gave me the most awaited good news—she was expecting a baby.
My joy knew no bounds and I was on cloud nine. She came to see me with the baby in her arms and I still cannot forget the delight on her face