Failing The Pre-Bariatric Surgery Psychological Exam

Part 1 - The Life That Led Me to Bariatric Surgery

Part 2- The Road to Bariatric Surgery - Full of Potholes

Part 3 - Struggling Through Bariatric Surgery Pre-Clearance Medical Clearances

With all my medical clearances checked off and passed, it was now time for my psychological clearance. Since I was not familiar with any of the psychological providers listed in my Bariatric Information Binder, I chose someone whose office involved as little drive time as possible. Considering how this story progressed, I really should have done more thorough research.

It was with more than a little confidence that I approached my appointment. After all, I had been at this weight loss struggle my entire life. I knew my strengths and weaknesses related to weight loss programs. I understood the surgical procedure. I did not expect it to fix any of my other life’s problems. I just knew that it was what I needed to help me stay on diet programs so I would not be starving all the time. I, therefore, went into this appointment feeling secure that I knew that I needed the surgery, knew what to expect from it and that my expectations were not unrealistic. This was going to be a breeze.

Upon arriving for my appointment with the psychiatrist’s assistant, I was ushered into her office to wait for her. A few minutes later, a tall, sturdily built woman in her 40’s walked in carrying a canvas lunch tote over her arm. She was munching on potato chips from a small snack size bag. When she sat down across from me at her desk, she closed the bag of chips, put it into her zippered lunch tote, and put it to the side.

I thought that eating potato chips in front of someone you were about to interview concerning obesity and bariatric surgery was a little off-kilter, but I sat and waited for her questions. I expected her tone to be at the very least, professional. But as a mental health professional, I was also expecting her to be calming, conversational, and to put me at ease. I was rather taken aback that she was none of these.

She was in high-gear interrogation mode from the first question. Her tone was loud, accusatory, and rather angry. “You were going to have this surgery last year and backed out of it. Why didn’t you go through with it? What makes you think that you want to have it now?”

I explained in a very calm manner, my concerns about scar tissue from my previous 20-year-old strangulated hernia surgery, that I had discussed it with the bariatric surgeon last year, and that I was uncomfortable with his attitude. (Click here for complete information. Scroll down to paragraph 8.) I explained my concerns related to surgical complications. I explained that I did not feel comfortable or safe with his answers, so I canceled the surgery.

I told her that I had gained so much weight this year that I thought I would give it another try; that I had spoken with a different surgeon this time who was more understanding and had allayed my fears. She grumbled about that. She surely did not like that answer. I did not know why. I thought it was a perfectly reasonable answer.

Then she asked me, in the same angry tone, “Well, what diets have you tried in the past?” I told her that I had tried every diet imaginable and none of them worked. “Well, why not? Why didn’t you stick to them?”

I looked at her incredulously. I thought to myself -This is a woman who is supposed to understand obesity and the issues involved and that we stay on diets because we’re always hungry. I was baffled by her questions, and particularly by her attitude and tone, but I dutifully answered that I could not stay on a diet, no matter how hard I tried because I was starving all the time. That’s the whole point of the surgery - to reduce your stomach so you are unable to hold a lot of food and you are not that hungry.

In a voice devoid of patience, she informed me that sticking to a diet was not that difficult to do. She proceeded to take the bag of potato chips out of her lunch bag and said, “Well, I just opened this bag, had a few chips, told myself that was all I needed, and that was all I was going to have, and I closed the bag and put it back.”

I thought – this is not going well. These are not the kinds of questions she should be asking me. Totally bewildered at this point, I looked at her and said, "If I could do that, I wouldn’t need the surgery. But I can’t. I have never been able to stop at a few potato chips or pieces of candy or any food. That is why I want the surgery.”

She said to me AGAIN, in that same angry, accusatory tone, “You signed for this surgery last year and canceled it. Why?” I said to her, as calmly and politely as I could muster - “I just explained that to you.”

Here it comes. Are you ready for this? I surely wasn’t. She said to me, I swear to God, she said - “I wasn’t listening. Tell me again.”

At that point, I looked around at my surroundings to make sure I was where I thought I was – in a medical office, and thought - Somewhere between the ground floor and getting off of the elevator on this floor, I must have taken a wrong turn and entered the Twilight Zone. I was stunned. I was ready to get up and leave. The crazy one was not sitting on my side of the desk.

But I wanted to pass this test, which was looking bleaker and bleaker at this point, so I repeated what I had just explained five minutes before - that I was uncomfortable with last year’s surgeon, and I felt much better with the new surgeon.

The rest of the interview did not go much better than that. She was very unhappy that I had canceled surgery last year and continually bombarded me with pointed questions about what would make her think that I wouldn’t cancel it again or that I wasn’t comfortable having it or if I had it, I wasn’t going to follow through with all the requirements, such as staying on the prescribed diet.

Then she said that she did not feel comfortable clearing me; that I would have to make an appointment with the psychiatrist and discuss it with him.

“But”, I said, “I have explained everything to you, and everyone else I have spoken to about this – the bariatric nurse, the bariatric surgeon, my cardiologist, my primary - they all agreed that my reasons for canceling the surgery were sound, and my reasons for wanting the surgery are appropriate.”

Her name was Jennifer ( name changed to protect myself). She said to me, “Well, JENNIFER is the one who has to clear you, and JENNIFER doesn’t think you should be cleared, so JENNIFER is going to insist that you make an appointment with the psychiatrist.”

My mouth agape, I could not believe what I was hearing. Not only that she would not clear me psychologically, but that she was nuttier than I supposedly was.

She ushered me out of her office to the front desk, where I checked out without making an appointment with the psychiatrist. If he was anything like his assistant, I wanted nothing to do with him. I went straight to my car and called the bariatric team nurse to tell her what had just happened.

She tried to calm my hysteria by informing me that the person I had chosen to see was not one they recommended. Maybe she should have told me that before I took my trip to the Twilight Zone. She named one of the psychotherapists on the list and told me to make an appointment with her.

A few weeks later, I went to see the recommended Ms. P, who put me at ease immediately with her calm, friendly manner and asked all the questions that I thought were reasonable and appropriate.

She wanted to know my history with weight loss or lack thereof, and why I wanted to have the surgery. I said I was not expecting it to solve any of my depression problems over my husband’s death or to solve any other issues I may have had. I was expecting it to allow me to stick to a diet so that I could lose weight. She said that my expectation of losing 75-100 pounds in the first year was reasonable.

We talked about my other expectations from the surgery, which were not to be model skinny but to be “normal”, meaning being able to fit into airline seats and restaurant booths. I was not expecting to be a size 2. I wanted to reach a weight that was comfortable and maintainable for me. She seemed pleased with my answers.

She felt that my reasons for canceling the surgery the previous year were sound and valid.

When we finished, she cleared me for surgery. She said I was fine psychologically. I knew it! Now I was starting to get excited. It looked like this was really going to happen.

On to the next requirements.

NEXT: Pre-surgery education classes – the fattest one in the room