If you listen carefully you will be able to hear what they are saying. “I am worried that she will not be compliant.” “I am afraid that something might happen to him.” What if she won’t take her vitamins and minerals or make the necessary office appointments.” “Will he still love me when he loses weight?” “Will she go to support group meetings?” “Things will change and may never be the same.” Do we listen carefully?
Needless to say for those of us who work with bariatric surgery patients we hear these comments and even more. We soon realize that we are not just working with the individual who suffers with the disease of morbid obesity but we are also working with the family members sometimes friends and most significantly the significant others. On occasions this might be more than what we were actually bargaining for. After all isn’t dealing with one individual who will be going through an often roller coaster physical and emotional process enough?
When each potential patient enters the office, even if they come alone, outside of the office setting there are many people who will likely impact their long-term recovery. We would hope those who are influential to the patient in daily life will be supporters and not saboteurs. We particularly hope that those who are considered the significant others will understand the roles they will play that may often be indicative of patient success or failure.
I am seeing a patient whose husband stands close to her side. Tom tells me, “You told us what we might expect after surgery but you didn’t tell us everything. You didn’t tell me I might have to bathe her and help her shave her legs. You didn’t tell me that she might be yelling at me for not doing things just so, so. Even the smell of what I cook for myself upsets her.” Tom was smiling and joking with his wife as he was giving me a lesson in Husband Caretakers 101. I was impressed that he could cook, let alone shave legs. It was obvious that Tom and his wife had a good relationship; he was a “safe” significant other that I felt would be supportive through thick and thinner. Tom was right, I should have provided him more information about his needed postoperative assistance, but then again he might not have learned how to cook or shave legs.
What about so many of the other significant others we see? Even if they had a specific handbook about the “to do’s” following surgery would some of these husbands, wives or soul mates go along with it, let alone believe it? Might we scare them off? If there was a handbook it might include many of the changes that likely would occur but there would also be many that we would miss. Each individual is just that, an individual and will adjust to the aftermath of surgery in different ways. We know and want those who are close to the patient know that he/she will likely be going through some rough emotional changes over the next several months. Would I write in detail about the changes that will happen physically as well as emotionally? No, likely I would just include a first aid kit that would have a variety of contents, ear plugs, nose plugs (for the patient), tranquilizers, relaxation tapes, and tennis shoes. Everyone needs to escape now and then. Definitely what I do know is that the shoes of the significant others are tough ones to walk in for an indefinite period of time.
Dr. Gaye Andrews, in part one of her three part series on relationships writes, “While a total personality change is unlikely, weight loss usually changes your relationship with yourself.” Also, “A better relationship with yourself encourages enhanced relationships with others that see you and react to you more positively.” If we started the significant other’s handbook with these statements we might be confronted with a plethora of mixed emotions from both sides. Yes, bariatric surgery is done so there will be change and yes it should be done for reasons of improving related comorbidities. After all who would want the “till death do us part” occur early in the marriage? We also expect a change in relationships but will it always be acceptable to both sides? So if the frustration is more than one can tolerate is the judge going to buy the line, “So you see, I killed him/her your Honor.” Maybe that handbook should be called, “Survival of the Fittest” or “Significantly Surviving.” Needless to say Survival of the Fittest also applies to the patient as well as the significant other. The difference is the patient has something to do; they have to recover physically as well as emotionally once surgery is over. The significant other has a different task, they worry that they do not know if what they are doing is enough either physically or emotionally.
A good friend of mine answered my concerns about significant others by saying, “Encourage them to support his/her meetings and related activities including their Support Group.” Support groups will help the significant other relate to those who are or have been in the family support position. The support group is without a doubt a great foundation of learning and the best “handbook in human form” that anyone could ask for. All who attend these groups are in the process of healing and they are more than willing to share their own thoughts of survival.
For those of us who work with the bariatric surgery patient it is important to remember there is more than just the patient we have in our care. The process of recovery is multi-complex and one that must include long-term healing of the patient and the significant other as well.
Jacquelyn K. Smiertka, R.N. Program Director