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The Grace of Gastric Bypass Surgery

Last year I had a “Roux-en-Y” gastric bypass operation, but not for the usual reason.

Oh yes, I was overweight. Have been for most of my life. But I could have lived with that. My reason was something else I came across in a Los Angeles Times article—a finding in Type 2 diabetic patients who had the surgery in the past few years. Within 48 hours of the surgery, their diabetes essentially went away!  It was a startling and unexpected byproduct.

The experts won’t use the C-word—“cure.” They call it reversal. That’s because experts are scientists, and even when sugar levels go down to normal, the need for medication goes away and all of this happens almost immediately, experts want proof. They want further study and long-term follow-up to make certain the diabetes isn’t lingering somewhere in the system, waiting to pounce back in five, 10, 20 years, the result of a deteriorating immune system or a reckless diet.

But I’m not a scientist, so if it quacks like a duck, and acts like a cure, it sure sounds like a cure to me. I was diagnosed with Type 2 diabetes in October 2005 and had progressed from “diet and exercise” as the preferred treatment, to one and then two oral medications daily. In the spring of 2010 my doctor told me the two weren’t working so well anymore, and I’d need to take three different pills every day. Even though I felt fine, I knew at age 60 I was sliding down the slippery slope to insulin.

Actually, in early 2009 I had enrolled in the 6-month preparations my medical plan required for weight-loss surgery: meeting with a nutritionist every two weeks, taking an overnight sleep study, getting a cardiac stress test and a psychological evaluation. After running that gauntlet, I had put the whole process off for a few months, both to think about it more carefully and to deal with some health issues my wife was having. But finally I was ready to go under the knife.

But one of my core principles has always been the catch-phrase from an old margarine commercial on television, “It’s not nice to mess with Mother Nature.” Given the choice of irreversible bypass surgery, where the stomach is made smaller and four feet of the 12-foot length of small intestine is bypassed, and the much less invasive and reversible laparoscopic (“lap band”) procedure that simply pinches off a small amount of stomach to make the person feel fuller more quickly—well, I’d go for the lap band.

And then I met my surgeon. He is a dapper, French-born physician who runs quite the assembly-line process at a Los Angeles-area hospital, doing (with his partners and associates) 10 to 12 operations a week.  When he heard I was interested in the diabetes reversal, he fixed his eyes on mine, Robert De Niro-style, and said, “You must know this: Lap band reverses diabetes in about 44 percent of cases; the full surgery reverses it in more than 90 percent. Think about it.”

I did. And I talked with several physician friends about the pros and cons, and finally decided to get the gastric bypass. 

My surgery went well, I was home in two days, and sure enough, my sugar levels were normal again! The nurses had me walking a mile the day of surgery, by trudging around the nurses’ station pushing my I.V. pole (along with five or six other recovering patients). Thirty laps equaled a mile, they told me. I finished the marathon about 7:30 p.m. that evening, and repeated it the next two days.

My post-operative experience was mostly a comfortable one. I was back at work in a week and a half, and feeling good. Compared to others I talked with, I had far fewer complications—almost no nausea or vomiting. I was back to eating regular food (although less of it) in about six or seven weeks. The pounds seemed to just melt away. Within weeks, I was down more than 70 pounds, and I had to buy new clothes!

This got me to thinking, in a theological vein (as I sometimes do), about God’s grace. It’s a stalwart principle of Protestant Christianity—God saves us, even though we don’t deserve it. Nothing we can do can “earn” salvation. It’s a gift, and the best thing we can do is to say thank you.

After a lifetime of living with obesity, I knew something about trying (and repeatedly failing) to earn “dietary salvation.” Oh, I’d lose a few pounds here, gain a few there, and over the decades I just kept becoming a bigger and bigger boy. All the failed attempts at exercise left me frustrated and cynical, still practicing the tried and true formula for insanity—doing the same thing over and over and expecting different results. 

But now God had truly provided me with a modern-day medical miracle—deliverance from a potentially life-threatening disease, with its horrible consequences (blindness, loss of limbs) and a thinner body thrown in! This truly demands a great big thank you to both God and to modern medicine.

Now, you’ll remember that Martin Luther railed against the inclusion in the canon of the book of James, with its author’s pesky injunction, “Faith without works is dead.” It didn’t jive with his insistence on sola fides (faith only). Yes, faith is the only thing that saves us—but living a life after God’s intervention of salvation that doesn’t give back in a grateful expression of deeds is a rather bleak one. And perhaps a dangerous one!

Here’s how I understand that playing out in my bariatric case. It’s well known that patients with both bypass and laparoscopic surgery lose a great deal of weight initially, with no effort. But they can gain 50 to 80 percent of it back in five years, because the little stomach is elastic, and can expand over time. If you eat as much as you can hold, and don’t exercise, the greater intake of food can derail the patient and pack the pounds back on.

My wonderful French surgeon, the week before my surgery date, looked me straight in the eye (for the second time) and said, “You must make me a promise.” I said I would, even before hearing it. He said, “You must promise me you’ll walk one hour a day, every day, for the rest of your life.”

I was taken aback, but like a nervous groom at his wedding, I said, “I will.” And I have! To that point, exercise, like the woman in George Gershwin’s “Porgy and Bess” had been very much of “a sometime thing.”  But for the past year, I have walked for 55 to 65 minutes (almost!) every day.  This translates into walking about two and a half to three miles. If I’m particularly busy, I walk in chunks of 15 or 20 minutes at different times through the day. If I’m traveling, I’ll find a way to explore a new city.

But at home my habit is to rise at 5 a.m., let the dogs out, and then walk one hour in the dim light of pre-dawn. I enjoy watching my desert come to life, sometimes talking like St. Francis to the rabbits, road-runners and coyotes as I watch the beauty of dusty pink-tan sunlight paint the craggy top of nearby Mt. San Jacinto. It’s a spiritually wonderful time for me—one I can really enjoy, now that I’m more than 70 pounds lighter! Sometimes when I am taken by surprise with the beautiful scent of orange blossom, or night-blooming jasmine, I have to thank God for letting me be alive. Saving grace: it’s not work at all.

So I’m grateful for the reversal, or whatever it is, of diabetes. And I did nothing to deserve it; I just accepted it! That’s the beauty of unmerited grace.

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