This is a guest article by Silvio Aladjem MD.

I remember as it were today . She wanted to come and talk to me. I was home. Knowing Vivien, I anticipated that this will not be an inconsequential talk. I would know soon enough.

She arrived shortly thereafter. As usual, we went into the library, sat down and we looked at each other. She spoke first.

“I need to tell you something that I don’t want you to hear from someone else”.

I listened.

“I decided to have bariatric surgery next week. I gave it a lot of thought and this would be best for me”

I was shocked. Vivien was always a few pounds overweight but was not obese, and most certainly not morbidly obese. Maybe 30 to 40 pounds over her ideal weight. Nothing that diet, exercise and a change in lifestyle, would not have taken care of.

I knew right away I would not change her mind. Always, when she “gave it a lot of thought” she would never turn back and change her mind. Nevertheless I tried.

Bariatric surgery has lots of potential immediate and long term postoperative complications. It was designed for morbidly obese patients, and certainly not as a short cut to diet, exercise and lifestyle changes. Vivien was a nurse, with a BS, two Masters and was one year away from obtaining her Doctorate in Nursing. Not like she wouldn’t understand the risks that she would face in her quest for getting rid of her extra pounds.

To no avail.

“I’ll be ok dad. Don’t worry. I have decided to have a “sleeve gastrectomy. The doctor explained everything to me and I understand what I am doing”.
“You think you understand but even if you do, any of the potential complications are major risks for you. All for a few pounds that you don’t want to tackle with diet and exercise. The potential risk benefit ratio in your case is greatly in favor of the risks”.

“I won’t change my mind. Believe me, I looked at this very seriously, I know what I am doing, Dad”.

What does one do in cases like this? A parent first impulse is to protect the child, even if the child is a grown up and hard headed. Most certainly I couldn’t send her to her room and tell her that I won’t give her the weekly allowance!

“Vivien, I am praying that you are right and I am wrong”.

She stood up and gave me a hug.

“Love you Dad. I really do”

She left.

A sleeve gastrectomy removes about two thirds of the stomach, thus greatly diminishing its capacity. The stomach, however, is not simply meant to receive the food. It not only releases acid and enzymes to begin digestion. It also secrets neurotransmitters and neuromodulators that affect the function of the brain.

Her surgery appeared to be without problems, but several days after discharge she had severe abdominal pain which brought her to the ER twice. She was finally readmitted and found she had a leak at the site where portion of the stomach had been removed and staples were placed to close the line of incision. This is a known complication for the type of surgery she had. That was followed by an infection for which she received antibiotics. As a result of antibiotics, she had to fight another infection with Clostridium difficile, ( c. difficile). She developed several internal abscesses for which she had an aspiration of the abscesses formed during which, she was told, they inadvertently punctured the left lung. A rocky course but eventually she was discharged with her problems apparently resolved. She was left with persistent acid regurgitation which progressively got worse and a diagnosis of GERD (Gastro Esophageal Reflux Disease), was made. Vomiting after meals, no matter what she was ingesting and a persistent nocturnal cough had become routine.

A few months later she moved to California where she was offered a director position for Maternal and Child section of a large hospital. Subsequently, she moved to Portland, Oregon another step in her professional career

But she was not well. She was hospitalized, repeatedly, with pneumonia. In one of her admissions a diagnosis of Interstitial Lung Disease, (ILD) was made. ILD is a progressive terminal disease, for which there is no known effective treatment.

From Portland, she was referred to Washington University, in Washington State, for consultation. A pulmonary biopsy was performed and it was found that, because of her GERD, she was regurgitating food remnants and aspirating them in the lungs, hence the repeated pneumonia episodes.

The bariatric surgeon at the University of Washington performed a gastroscopy to look at the possibility of operating for the GERD to block the regurgitation, alternative was dismissed. The surgeon suggested to consider a Stretta procedure. This is a minimally invasive procedure (endoscopy) that delivers low power and low temperature radiofrequency energy to the esophageal sphincter. Its purpose is to decrease the opening into the stomach and improve GERD symptoms. Vivien’s GERD did not improve at all.

The alternative of a lung transplant was dismissed, since with her GERD uncontrolled she would have continued to aspirate food remnants into her new lung.
Eventually she returned to Michigan late in the fall of 2017. She lost her battle with ILD in November of 2017.

Losing a child, no matter what their age, is an agonizing experience for a parent. An unnatural event in life, since we assume that children should not die before their parents. During the last month my wife Judy and I went to see her daily. During the last hospitalization Vivien and he husband were given the option to transfer Vivien to a hospice or arrange for hospice care at home. I was glad they chose home. That did not make it easier for those around her, but no question it was better for Vivien. Until the last few days, Vivien was in good spirits, in spite of her continuous cough which kept her awake most of the night. She struggled while I could only look at her with teary eyes.

When Vivien was in high school, she asked me to write a song for her. I did and here it is:

I will sit by your window and sing you a song

Song of love that you sing every day

I will sit by your window and sing you that song

So you know I’ll love you till I die

The last day I saw Vivien, she was comatose. We left knowing what the night will bring. I held her hand and softly sang close to her ear our song. I Believe Vivien would have wanted that.

I believe that had I been able to change her mind regarding bariatric surgery, she would have been alive today.
——————————————————————————————————————————————————

SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so by email at: dr.aladjem@gmail.com

Be Sociable, Share!