…the ICU’s O2 sensor alarm sounds like the battle klaxon on a Klingon Bird of Prey.

I wake to a ridiculous beeping.

“Breathe deeper, hon. Your O2 stats aren’t high enough.”
I breathe as deep as I can; it starts to hurt.
“Deep and regular, there you go.”
The beeping stops, and nurse turns away to the patient in the next bed.

I’m in the Recovery Area. It’s a huge, open floor with multiple stations for gurneys. It’s pretty full. I wonder what time it is.
“2:30 PM, baby.”
Apparently the morphine has directly wired my brain to my mouth – and my nurse is definitely a mother in her spare time.

I doze; the beeping starts again.
“OK, you have to breath deeper. Are you supposed to be on a CPAP?”
I nod, focusing on breathing just until it hurts.
“Oh. Well, let’s get one down here.”
She makes a call. “Roger, I need a CPAP at bed 11 in Recovery.”
“Do you have your own mask?”
She taps my hand. “Do you have your own mask?”
That was for me. I nod.
“He’s got his own mask.”
They exchange a few more details, and she hangs up. “He’ll be down in a few minutes.”

The O2 sensor goes nuts 4 or 5 more times before Roger finally shows up, rolling a gigantic CPAP machine obviously designed for elephants.
He starts things off with a breathing treatment; it’s a nebulizer full of Albuterol and water, and makes me giggle because it gets everything wet.
I realize that I am giggling, which means I’m definitely high.
He wrestles my mask over my face; I try to be helpful. He’s very patient.
As soon as he’s gone, I’m off to La La Land again. The O2 sensor keeps quiet, and though I sound like Darth Vader, I manage to sleep for most of the next 8 hours.

A stylized CPAP mask.

I slowly return to consciousness, and look over at the nurse. She grins, and puts a glass of ice chips on the tray table beside my bed.
“You might need these.”
I realize that my tongue has transformed into 80 grit sandpaper, and I nearly knock the glass off the table in my haste.

Ice chips are amazing.

I am in a bit more pain than before.
“Just push the button right here.”
Yep, brain is still hardwired to my mouth.

I click the button a few times. The nurse smiles, the pain recedes.
Morphine rocks.
The nurse laughs.
“You should have been in the ICU by now, but there was some big trauma event, and they’re full, so you get to stay here with me.”
I smile. As long as she gives me ice chips, that’s totally fine.
She laughs.
This brain-mouth thing might get awkward.

A few hours pass. I know this because I can only have ice chips every hour. Apparently Morphine wreaks havoc with my perception of time.
The nurse comes back from doing something, and lets me know that an orderly from ICU is on his way down to get me.
I feel bad for taking up a bed in ICU just because I’m fat.
“It’s ok, hon. You’re on the right track now.”
Damn it. Stupid brain mouth thing.
She laughs.

I have a perception of Intensive Care Units as dangerous places, but that changes after just a few minutes in GW’s ICU. There is one nurse assigned to do nothing but watch my vitals and the vitals of the patient in the room next to me. The nurse is very attentive; I know this because he’s telling me to “Breathe deeper!” every time my O2 stats drop below 95%.
Of course, the attentiveness might have something to do with the fact that the CPAP machine hasn’t made the trip up to the ICU with me, and the ICU’s O2 sensor alarm sounds like the battle klaxon on a Klingon Bird of Prey.

It takes the CPAP almost 2 hours to follow me up from Recovery. The respiratory therapist is apologetic; he’s working by himself at the moment, and it’s pretty busy.
I forgive him, and fall asleep.

Time’s up.

My gurney begins rolling toward the OR, and now it feels real.

The George Washington University Inn shouldn’t be difficult to find, but my nerves are in overdrive. I scan the street numbers on both sides of the street to make sure that I don’t overshoot. I have a moment of not-quite-panic as I come to a building that just has to be the Inn, but only has an entryway for a tiny Italian Trattoria.
A few more steps reveal a drive-in courtyard just past the eatery; I sigh in relief and slowly make my way along its narrow sidewalk toward a secluded entry, mildly regretting that I can’t stop for a glass of Chianti.
It’s an old Inn, but having spent time in a few very questionable establishments in New York during my days traveling for business, I can tell the difference between just “old” and “old & dirty.” I check in with little hassle, and make my way up to my suite. It’s spacious, with a kitchenette, dining area, living area, and a bedroom with a king bed. The bath is huge, and I decide that a relaxing shower before bed is definitely the plan.

Carefully laying out my clothes on an armchair becomes a subconscious assertion that I’m in control, and that all of my planning is coming to fruition. When I start lining up my toiletries on the bathroom sink, I realize that I’m definitely wound up, and decide to skip directly to the hot shower.
Forty-five minutes later I’m lying on the sofa in my sleepwear, feeling a bit more human, but no less nervous.
Eight months of doctors’ visits, paperwork and planning all culminates in the next eighteen hours. In twelve hours I’ll walk into George Washington University Hospital alone, check myself in, and be prepped for RNY Gastric Bypass surgery. Eighteen hours from now, it’ll be over, and I’ll be in recovery.

Or you’ll be dead.
My subconscious is being maudlin again tonight; the memory of my friend Eileen’s sharp retort jumps to the forefront, and I rally.
Don’t say that. Don’t even put that thought into the Universe. You will be fine. I know it. I believe it – and so do you.

I walk into the bedroom and set the alarm clock on my phone, then think better of it, and call the front desk.
“Can I have a wakeup call at 4:45 AM?”
“That’s quite early, sir!”
“Yeah, I have to check in for surgery at GW tomorrow morning at 6 AM.”
“Oh my! I wish you all the best; we’ll call at 4:45 AM. Have a good night!”
I lay down, just hoping that I can actually sleep, and the universe sees fit to grant my wish, immediately.

My phone alarm rings before the wake-up call, and I’m instantly alert. I lay staring at the darkened ceiling until the phone rings.
“Mr. Akins, this is your wake-up call. It’s 4:45 AM.”
“Thank you. I’ll be down to check out in about an hour.”
“We’ll see you then, sir.”

Another shower, a few moments re-packing my bag, and I’m heading to GW Hospital. The District is deceptively calm at 5:45 AM – the panhandlers are all still asleep, and the only traffic around GW seems to be a trickle of doctors, nurses and medical students.
The Surgical Admitting area is terrifyingly busy for 6:00 AM, but the orderlies and staff have their routines down to a science. Twenty-five minutes later, I’ve changed out of my sweatpants and into a gigantic bariatric patient gown, laid down on my gurney, and am about to be poked.
The nurse is not a vampire, and I get stuck about 5 times before she finally gets a vein that works.
The anesthesiologist comes to talk to me, and for once, I feel like I’m actually giving informed consent – he’s incredibly thorough, patient, and professional.

Dr. Afram pops through the curtain.
“Are you ready! You’re ready! You’ll be fine, this is a great hospital!” He has entirely too much enthusiasm for this hour of the morning.
It occurs to me that this man will literally have his hands inside me within an hour, and I have a moment of nausea.

A stylized image of an operating theater.

My gurney begins rolling toward the OR, and now it feels real. My heart is thumping, and the nausea returns. We roll into the OR; the lights are dimmer than I thought they’d be.
“Mr. Akins, let’s get you up close to the table, and then just scoot over from the gurney onto the table.. Yeah, just like that. Great! Ok, lay back…”
There is a giant bundle of towels in the middle of the table, and I twist in confusion, trying to figure out how to lay down on them.
“Yeah, those towels are going to help us position your insides for easier access. Just go ahead and lay back, like that… yeah. Perfect. Oooooh-kay.” I am sorry I asked.
“I think I’m going to have a backache when I wake up.”
“Trust me, you won’t feel it. We’re giving you the good stuff. As a matter of fact, I’m going to give you something to calm you down right now…”
A feeling of lassitude seems to spread from my chest into my limbs. I relax.
“Yeah, I feel…”

I cease to exist.

Pain. Pain more intense than anything I have understood was possible. I want to scream, but I can’t breathe deep enough for anything except moans of agony.
“Hold on. Hold on, Mr. Akins. Just a minute. Hold on.” A prick of pain, someplace else.
I cease to exist.

I wake again; there’s pain, but it’s distant. It’s almost someone else’s pain. I look at the nurse sitting at a computer beside my bed. She sees me move my head, and glances at me.
“How’s the pain?”
“I’m ok. Am I OK?”
“You’re doing fine. You woke up on the way down here, before we got the morphine pump hooked up, and we had to give you a shot of Dilaudid.”
I smile. “I’m ok.”

I fall asleep.

T-Minus 48 Hours.

…he makes a comment about how cute another participant’s handbag is, I complement her matching scarf, and it’s a girl’s night out.

I walk over to the “Bariatric New Patient Seminar” at GWU Hospital with another patient from my surgeon’s office. He’s a good looking guy that I just can’t see “needing” the surgery. Somehow, in the moment, I’ve forgotten how many people have told me that I “carry [my weight] well”.

We sit down in the seminar room, and are joined by other surgeons’ patients. We are the only men, and for a few seconds it’s weird. Then he makes a comment about how cute another participant’s handbag is, I complement her matching scarf, and it’s a girl’s night out.

The nurse giving the seminar can barely keep control of the room – we’re like Jr. High kids on our last day of school, cracking jokes and laughing at things that totally aren’t funny.

When she finally gets us to shut up, we do around-the-room introductions.

“Aaron Akins, with Dr. Afram. I’m having an RNY the day after tomorrow.”

“And you’re just now taking the seminar?!”

The nurse is surprised.

“Uhm, yes?”

“Well, I guess you’ve already done your pre-surgical blood work, then?”

“Uhm, no..”

“Oh dear. Well, I’ll call down to the lab real quick and ask them to squeeze you in before closing. You can’t go into surgery without a CBC, CHEM-7, O2 and Typing!”

Now I’m feeling nervous – what else have I missed, and what the hell is CBC and CHEM-7? I’m attentive for the rest of the seminar, and ask all sorts of annoying questions.

A drawing of a blood vial.

The receptionist at the lab is irked when I walk in at 1-til-5.

“Why didn’t you come in last week for this?”

“No one told me I needed to, I’m sorry.”

“Who is your surgeon?”

The nurses make up for it.

“You’re not gonna pass out on me, babe?”

“Nope! I just don’t like to look.”

“Oh, don’t worry, I’m a vampire!”

“I don’t see any sparkles…”

“We only twinkle in the son, darlin.”

We discuss Taylor Lautner’s abs.

On the way home it occurs to me that I never said anything about being gay. I wonder how she figured it out until I remember that I’m the one that brought up sparkly vampires.

There is one more day.

A New Ritual

The daffodils are just beginning to pop from the ground, the trees and brush are greening up rapidly, and I am beginning to realize that I enjoy exercise.

The Capital Crescent Trail is the amenity that seals the deal on my move to The Seasons Apartments in downtown Bethesda. The trail is a 10-mile long paved, mixed-use trail that arcs down from Bethesda into Little Falls Park, passes the Dalecarlia Reservoir and traces between the Potomac and C&O Canal on its way to the Georgetown Waterfront. For a just-3-months-post-RNY patient, having that trail 200 yards from my front door seems of inestimable value.

A picture of the Capital Crescent Trail, in early spring.

It’s no surprise, then, that a beautiful, sunny weekend afternoon in early April finds me out on the trail, walking in my brand-new Nike Air Monarchs. The daffodils are just beginning to pop from the ground, the trees and brush are greening up rapidly, and I am beginning to realize that I enjoy exercise.

I walk in the gravel on the side of the paved trail, because the cyclists have a tendency to assert their ownership of the paved part by brushing very close to pedestrians. As I scuff along, trying to pretend that I belong amongst the flood of people exercising on the trail, I am performing an long-standing mental ritual. It goes something like this…

A petite bottle-blonde jogger in pink Nikes and a black halter-top zooms past, legs pumping in perfect rhythm.
“You are in great shape, girl, but those roots! Honey, you need to fire your stylist.”

A senior gentleman, short of breath, with snowy hair waving in the breeze overtakes me, and slowly passes, pace uneven, eyes determined.
“You got it, old fella. I guess it’s good to stay active as long as you can.”

An obviously well-off couple in matching running gear lopes past, guiding matching strollers loaded with matching tow-headed toddlers.
“Matching Jawbone bands? Seriously? Give me a break, already!”

I’m particularly hard on the guys my age…

A shirtless wonder flits by, seemingly unaffected by friction or gravity, trapezius muscles flexing in counterpoint to really-quite-shapely thighs.
“God, those are beautiful legs… but that is a nose only a Grandfather could love, buddy.”

A well-muscled Adonis sprints past, gaze intent, pushing himself toward some limit still far in the distance.
“Can you say gym bunny, dear? But hey, tell me where you flip burgers, and I’ll drop in to admire that ass sometime.”

I see him in the distance, loping toward me, red short-shorts flexing around toned thighs, sculpted torso gleaming in the sun.
“God. I wish I had those abs.” 

My eyes search for the flaw that I know will be there, because everyone has them.

“So, what’s wrong with you, gorgeous?”

And it hits me – almost physically. The realization is so shocking that it feels like I’ve run into a gust of wind. I literally stagger with the impact.

“This is sick! What am I doing?
He is beautiful. He is everything I wish I could be – and all I can do is try to find something wrong with him!
This is wrong!”

I wonder if he sees it as he passes me. Do I look as disturbed as I feel? Or does he just pass me, like he passes everyone else on that trail – all the other people like him, just out trying to be healthy, trying to enjoy the outdoors, trying to soak in a little bit of a perfect spring day?

Epiphany isn’t a word I use lightly or often, but this moment meets all of the criteria. The realization is visceral. The impact is instant, and enduring: that habit, born of illness and shame, is utterly destroyed in a moment.

In that moment I choose a new way of living – to lift myself up, rather than tearing others down.
In that moment, I choose a new ritual – to seek inspiration in those worth admiring, instead of finding a way to even the score.