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Looking Through the Rear View Mirror


Jacquelyn K. Smiertka, RN

Frequently all of us have the opportunity to look out the rear view mirror of our lives. Although we should look through this “mirror” as a foundation of our learning process sometimes we focus on too many bad experiences and cannot seem to move past them.

Recently I looked out my rear view mirror and thought about the past history of bariatric surgery. I remember the Allied Health Science session that was formed a number of years ago when there were only ten or so of us sitting in a large room in such a small circle. It is now known as Integrated Health. Now membership is probably well over 800 consisting of psychologists, psychiatrists, therapists, nurses, exercise physiologists, nutritionists, etc. Most of we original ten are still around and can proudly say that we remember when, our jobs were much simpler, our knowledge was sparse; we were floundering to know what to do in this business, we were the pioneers. Now we are pleased to say that our knowledge of bariatric surgery has expanded, we feel more guided than ever about what to do and have a vast network of those who we can call upon if we do not know what to do. As far as the job being simple now, it is anything but.

With the expanding popularity of bariatric surgery we in Integrated Health are finding that we have little time to stay caught up on all of the new technology as well as the research. I personally would love to be doing more research in the area of vitamin and mineral deficiencies. How important this subject is to all of us. Others would like to know more about the psychological aspect of the phenomenal metamorphosis that happens after bariatric surgery. Many are interested in the exercise field and how we are able to help our patients become physically active. Still others are focusing on the nutritional aspect and the necessity of good quality nutrition to maintain a healthy long-term recovery. Logically it is important that all of us should have some knowledge about all of these areas. Our lives are now anything but simple.

Looking at the bad experiences through our rear view mirrors we see that we might have learned too many things too late. We didn’t know which vitamins and minerals were necessary to recommend to our patients. We weren’t really sure exactly what laboratory studies should be done or that bone densities should be done preoperatively as well as postoperatively. We didn’t know how necessary exercise really was and we didn’t have a clue as to the nutritional and psychological ramifications of bariatric surgery. Perhaps this lack of knowledge falls under the phrase of “practice of medicine”. Although I hate to think that we were just practicing, that was actually the only way that we were able to learn. We review these past experiences, learn by them and move on. Now we are more aware of what bariatric surgery is capable of doing, physiologically as well as psychologically. Do we know all there is to know? Of course not. Even after the original ten of us are long gone there will still be more to learn, the educational process will be endless.

What do the surgeons see through their rear view mirrors?

The original number of surgeons were also very few. Starting with 109 members. With the various surgeries that are available there will always be something for the surgeons to reflect upon. Why did they begin with a specific surgery and change to a different procedure? Why did they adamantly disagree with one specific surgery only to end up doing that very procedure a number of years later? What are the best instruments, best operating room tables and who are the best patients to do these procedures on? What is the best way to prevent leaks, abscesses and even death? What is the best multidisciplinary approach for the care of all bariatric patients? Even surgeons look through their review mirrors.

The knowledge that we have, although as vast as it might seem, still seems to pale in comparison to what is known in so many other specialties of medicine. Perhaps it is because we work with such a unique population of patients. Each has their own review mirror that frequently reflects a history of abuse, neglect and discrimination. Are they able to look back, review their experience and move on? Are we able to have enough resources available to help them do so?

Someone asked me the other day if I would not be working with bariatric patients what would I be doing. I had to think about that for quiet awhile. Although my life-long dream has been that someday I would like to operate a bulldozer, I still had to think about what I would really do. On my bad list and good list about things regarding my job I thought of a number of events that I could see through that rear view mirror.

I could see my trips to the “principles” office, better known in hospitals as the Chief Executive Officers headquarters. They did not always understand how valuable bariatric surgery was to the many individuals who suffered with the disease of obesity. As a patient advocate I always felt the need to express my opinion that reflected the concerns of our patients. The trips were rarely pleasant. I remembered a number of patients that gave all of us a run for our sanity. What were we thinking when we decided to operate on this rare few? I still vividly remember and know to this day the insurance hassles that we have encountered. Why don’t they see this as a life-saving procedure? What about all of the charts and that paperwork on my desk that mounds higher everyday? And what about those long hours that keeps me away from family and friends? And what about those calls at all hours of the day and night that generally have something to do with someone’s bowel habits? Perhaps my idea of operating a bulldozer isn’t such a bad idea after all.

Through that same rear view mirror I see the weddings, the new babies, the new lives. Former patients stop me on the streets and in shopping malls to tell me they remember me well, even though with their new bodies I hardly recognize them. Different ones call and remind me how much their surgery has changed their lives. Our support group who pride themselves in harassing me unmercifully energize me and remind me over and over why this business is so important. They teach me, I learn from them what life is really like to be relived again and to be enjoyed on a daily basis. They erase my bad list with the laughter, their hunger for learning and their hugs.

So does that bad list seem important? No, it is short compared to what we are able to accomplish in the long term. Those few who have tested our sanity levels keep us on our toes. The hospitals are becoming more “user friendly” because we make sure our patients share their new lives with the administrators. The insurance companies will always find a way to test our patience and the paper on my desk will always be annoying. And as far as the number of hours I spend on the job and the countless calls I receive, I imagine that I will miss that one day when I am sitting alone on top of my bulldozer. All of this for the simple pleasure of being able to say I had a small part in someone’s life that hopefully added to their quality of life. Through that rear view mirror I look back and realize the lessons of life that I have learned in the business of bariatric surgery. One day it will be sad to move on.

Jacquelyn K. Smiertka, RN , Program Director for Beyond Chance- Living a Healthy Life After Bariatric

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