Marisette Edwards-van Linden van den Heuvell

Making the outside match the inside

The other day at work I walked past a couple of women talking on my way to the printer. As I was operating the printer I overheard snatches of their conversation: “my two ex-wives didn’t like that…” and “my boyfriend is older. I like older men.” Both of these comments came from the same woman. I had heard that there was someone at work who was trans-gender and had gone through gender transformation, so these comments were not completely surprising, but they still struck me. Glancing at the two of them, it was hard to tell which one had been speaking – they both looked like normal women.

I mused that this person must have been intensely uncomfortable in their own skin to voluntarily go through the pain and expense of surgery to drastically rearrange their anatomy. Especially since the results would be more or less invisible to the general public.

Then I realized that I had gone through something extremely similar. Looking at me now, you see a normal woman. But people who have known me for decades know I wasn’t always this way.

Thirteen years ago I was morbidly obese. I hated my body, I was embarrassed by how I looked, strangers looked at me with disgust, and nothing I could do as far as clothing and make-up could come close to making me feel comfortable in my own skin. I spent many years trying to “fix” myself through various means: diets, therapy, diets, hypnosis, diets, prescriptions, diets, extreme exercise. I was able to effect only temporary changes at best. It took me years of failure to accept myself as I was before I decided to pursue the only option left: gastric bypass surgery.

This surgery radically rearranges the anatomy: the stomach is permanently separated into two pouches. The bottom of the stomach is left inaccessible, while the top part, about the size of an egg, remains attached to the esophagus as part of the digestive system. The small intestines are cut and brought to a new exit from the top portion of the stomach, called a stoma. The other end of the cut is reattached to the small intestine further downstream, so that any secretions from the old stomach still have an exit. This is called the Roux-en-Y procedure.

I remember when the surgeon asked me before my procedure whether I had any questions. I responded that I felt like I might be doing the wrong thing going through risky elective surgery when there wasn’t really anything wrong with me. He looked me straight in the eye and said, “This is not your fault.” Then he went on to explain that obesity had a host of related morbidities that would be cured by this surgery. That was why it was called “morbid obesity”, he told me.

The surgery was a success. Over the next six months I had no appetite and lived on the tiniest meals imaginable. 1/4 cup of cottage cheese made me uncomfortably full. Then my appetite returned, my stomach and stoma stretched, and once again I had to work hard at losing weight. Weight loss surgery support groups call the new anatomy “the tool” to help you lose weight, and I used my tool well. But make no mistake, this is not “the easy way out”. It takes a lot of effort to keep weight off even with “the tool”. I have had to completely change my diet, and, if I eat the wrong thing or something gets stuck in my stoma, well, I may end up throwing up in a restaurant parking lot. Most of my friends have had to witness that. I’ve also had to deal with episodes of severe hypoglycemia, where I almost faint from low blood sugar. This is a side effect that is known to occur in a small percentage of post weight loss surgery patients.

13 years later I have managed to keep off 90 pounds. Unless you look at me closely, you can’t see the scars that point to my changed anatomy. The shame and self-disgust are now old emotional scars that only flare up at really bad times.

In spite of some of the negatives, this surgery was worth the pain, risk and effort. It helped me to match my exterior to the person I felt I was on the inside.


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