Friday, July 22, 2011

Keeping It Simple

On the first day of my rotation this week, I introduced myself to the dietitians I would be working with. One was significantly older and the other had recently had her second child. They were talking about the challenges of being working parents and when I said I was the new intern, a recent graduate, they recommended I "keep it simple a little while longer." The question of living simply and what that means has stayed with me throughout the week.

This first rotation, which continues for another week, is very hands-on and I am exposed to patients at all stages of the process of bariatric surgery. I observe the consult group where the surgeon explains the different types of procedures, the nutrition classes for patients about the undergo surgery, post-op visits to hospital rooms 24 hours after surgery, phone calls one week later, and follow up appointments with patients six months, one year and two years out. Eligibility criteria for bariatric surgery includes a BMI of >40 or BMI >35 with co-morbidities, such as diabetes, and nearly all the patients I observe have multiple complications and medications. And many of them are young. Younger than me. Their lives are far from simple.

Simple living has become a new aspiration in the green era. I recently watched No Impact Man, the documentary that follows one NYC dwelling man and his family as they try to live "simply," ie. in a manner that generates as little waste and environmental impact as possible. In our modern world, one could argue that living "simply" is a fallacy - in fact, living without many of the conveniences that carbon-emitting technology affords makes life much more complicated. The film reinforces this and after watching No Impact Man, I have a newfound appreciation for my refrigerator. At the same time, the family spends more time together, watches less television, and is far more conscious of the food they eat, traits we associate with simplicity.  

Somehow I felt a strong connection between this film and my work this week. I had mixed feelings about doing a rotation in a bariatric center. Like many people I wonder whether surgery is really the only option for people struggling with their weight. In the consult group I was happy to hear the doctor state that surgery is the last option when all others have been exhausted. When he insisted that the long-term success of the procedure would depend on how well patients had addressed the underlying emotional issues that had led them to this place, I was further encouraged that it was not being marketed as a quick fix surgery. And after watching a laparoscopic gastric bypass, the cynical voice in me that suggested that patients might simply opt for surgery because it was covered by their insurance, that it was easier than actually losing weight, was quieted. The surgery is invasive and the recovery takes time. Even post-op, losing all the excess weight is not guaranteed, as I witnessed in patients who had the surgery years ago and displayed varied levels of success. Whether or not I would recommend it, bariatric surgery provides a second chance for patients to simplify, to start over, create a new relationship with food and new behaviors. I found this reinforced in speaking with patients after their surgery and wished them to best of luck in cultivating new healthy habits.  Today my supervisor told me that last week a patient cried tears of joy when she learned that she could finally transition from the all liquid diet to eating pureed foods. Learning to eat all over again brings such bliss - a good reminder to enjoy life's simple pleasures.

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