8

Skulls and Crossbones

11-16-01

Dear Mrs. Joyner:

We reviewed your application for a 30 Year Level Term II contract. After careful consideration, we regret that we cannot provide the coverage as requested and as a result, no coverage exists under the terms of this application.

Insurance companies have established underwriting practices which guide them in selecting risks according to predetermined criteria. Although these criteria vary between companies, they are all developed based on actuarial statistics and mortality experience.

Our underwriting guidelines, relating to your build, will not allow us to grant the coverage you applied for because the potential for increased mortality makes the risk greater than was anticipated in our premium rates …

Wow. I know things are pretty dire, but there’s nothing quite like reading it in print. My initial application for life insurance has been denied because I am too fat and the chances of my dying are too great. You would think receiving a letter like this would be the a-ha moment I’ve been looking for, the rock-bottom place I’ve been trying to find for so long. My health is too much of a risk for the company to take on—I could die at any moment. I better do something right away to save my life, before I prove them right.

It’s a sobering notice. I cry when I read the letter, stuffing it into my purse before Michael can see it. I’m ashamed and embarrassed. Too fat to insure? Too much of a chance that I will die prematurely? I’m twenty-nine years old! For two days I keep the news to myself, wondering how I’m going to tell my husband about this latest humiliating rejection. When the insurance agent calls, I swallow hard, waiting for him to reiterate the company’s decision, but he has different news for me: They will offer me coverage, just at double the rate they are charging for my husband’s. So … I am insurable? I’m not too much of a risk? I knew it! I can’t be that bad! Never mind the coverage is going to be unbelievably expensive—that I will have to pay so much more than the average person my age. That doesn’t matter to me at this moment. All I can focus on is that I do indeed qualify for life insurance—I have not been rejected.

At this point in my life, my weight is still mostly an issue of vanity. I hate having to scour the misses sportswear area of the department stores, hoping and praying something will actually fit. I desperately want to be an on-air reporter, and I know it will never happen unless I find some way to shed pounds. My weight makes everyday breathing harder, and it compromises my ability to perform any sort of lengthy physical activity. But I’m just not ready to consider that my very life is at risk. For me it’s all about looking better—and feeling better about the way I look.

All of that will change soon enough.

In the meantime I simply nod when my doctors warn me about what my future could hold. I’m already prediabetic, meaning if I don’t do something soon, I could develop the disease. I have a family history, and my weight is also a major risk factor. The doctors tell me what life is like for a person with diabetes: medication for life, possibly having to have daily insulin shots, difficulty with pregnancies. I listen and nod, and then I promptly forget what they say. I’m in my twenties, after all. I have years to worry about stuff like that. Besides, I’m not going to keep this weight on for long! My plans will finally work out and I’m going to be slim and trim in no time. No need to worry about that health stuff, I reason. The real risks are years away, and the weight will be long gone by then.

I’m not ready to consider my health with any great urgency, but I’m more than willing to pin my problems on it. The doctor I’d gone to see in 1997, the one who initially put me on fen-phen, also ordered a round of tests to see if there was any medical reason for this huge weight gain. She called me a couple of weeks later—when I was in the middle of taking the diet drugs and loving the effects they were having—to tell me that my blood levels were borderline for hypothyroidism. She explained that it could be the reason for the weight gain, and for the hair loss. She wanted to send me to a specialist for further testing, but was hopeful for a diagnosis—and that would mean medication, and hopefully, some improvement in my symptoms.

I was overjoyed. It’s not my fault! This didn’t happen to me because I’m lazy or gluttonous. I have a medical condition! There’s a reason … and medicine! I was so excited by the news, and so relieved to get what I thought was a definitive answer from a person with authority.

Of course, I was getting ahead of myself. The doctor wasn’t sure, and that’s why she was sending me to an endocrinologist. Still, her phone call couldn’t have come at a better time. In the bathtub earlier that day, I’d noticed my first stretch mark. It was an angry crimson color, and it streaked its way down my abdomen, gnarling my skin with ragged bumps, toward my navel. It was a bright ugly reminder of what was happening to my body. I was never a fan of my naked image, and now I felt even more ashamed. I could get rid of extra pounds, but would the scars ever go away? I felt marked for life.

With much hope and anticipation, I made the appointment with the specialist, traveling more than two hours to see him the following week. His office was a two-room dump of a space, with his wife acting as both his receptionist and his nurse. I looked around skeptically as I waited. This was the answer to my prayers? More doubt crept in when I actually met him: He was no younger than eighty, with wispy, white hair standing up all over his head. He looked like a mad scientist. Still, I had a lot of respect for the doctor who recommended him, so I decided to give him a chance.

He did a brief physical exam and noted that I was starting to get “the stripes.” I was confused for a moment, until I figured out that he was referring to the new stretch mark. Great, I thought. I’m striped now. He was odd in a few other ways, asking me about the water bottle I carried with me. I told him I thought drinking water would help me lose weight, and he laughed at me. Laughed at me! He said all it would help me do was go to the bathroom more.

His wife/receptionist/nurse drew blood for a new test, and I got the heck out of there. He was strange and rude, but I still hoped he could help me. You can be quirky, but still brilliant, right? A diagnosis would mean that not only would I get the medical help I needed, but also that I could possibly start to forgive myself for letting things get this bad.

The call came a week later. My blood level was normal; I did not have hypothyroidism. You would think I would have been devastated, but I wasn’t. I was mad. I thought the guy was a quack, and there was no way he could be right. I had the weight gain! I had the hair loss! Of course I had hypothyroidism! I had to!

I couldn’t accept what this doctor had to say, so on my own I went to see an endocrinologist at Duke University, sure that the experts there would uncover the truth. I saw a normal-looking doctor with an average-looking office, and I underwent another blood test. But the answer was the same: My blood level was normal, and I did not have hypothyroidism.

Now I was devastated. Why did I go through all of that, only to be disappointed? I had hoped to learn that I was not the lazy, undisciplined freak I was starting to convince myself I was—I had almost been ready to give myself a break. I felt like all that hope had been ripped out from under me.

What saved me from being taken under by this turn of events was the fact that I was still losing weight, thanks to the fen-phen. I could face anything as long as the scales were going in the right direction. Still—it did mark how I would treat such events in the future.

In early 2001, after I’d stopped taking fen-phen and had gained all the weight back, the thyroid issue popped up again. This time I was heavier than I’d ever been and despondent about my inability to do anything about it. At my yearly physical my gynecologist ran a routine blood panel. I didn’t even allow myself to hope for an answer—I couldn’t go there. So I was truly surprised when I got the phone call from her office a few days later: My blood levels showed I clearly had hypothyroidism. No borderline results, no further testing needed. I would be starting medication right away.

I fell back onto my bed, dissolving into tears. I cried because deep down I still hadn’t believed those doctors when they said my tests were normal. I had convinced myself that my problems were medical in nature. And finally, years later, I was being vindicated. But most of all I cried with relief. I was weary from the fight, and I was finally going to get some help—assistance that would not be yanked away from me without notice, a real solution that would help rid me of this problem for life. I wasn’t bitter at what I considered to be a misdiagnosis for all those years; I was just grateful that the wrong had been righted and I was going to benefit. Finally I was going to be fixed.

The nurse called to tell me about the medication she’d phoned in to the pharmacy. She explained that it would take a little while to see any real changes, but I would eventually notice my energy level increase, my hair loss subside, and, yes, some weight loss. I choked back tears, thanking her profusely before heading out right away to pick up the medicine. I didn’t want to waste any more time.

After taking the medication for two weeks, I didn’t notice any improvement. Hair was still clogging the shower drain, my energy was almost nil, and I was just as heavy as I’d been before. I called the nurse, and she assured me that the pills would work; I just needed to give it more time. I was starting to worry a little, but I quickly brushed those concerns aside. Don’t do this to yourself, Jennifer, I said. This is the break you need.

For once, let yourself off the hook. Enjoy!

Sadly, it wasn’t what I’d hoped for. Two months went by, and there was no change. I went to see the doctor, and she was stumped. She agreed I should have seen an improvement by then, so she increased the dosage. I waited for signs of improvement, but they didn’t come. A new blood test showed the higher dosage was too much, and the doctor had to dial back my medication. The blood work did verify that my thyroid was being helped by the medicine; the pills were working. But my symptoms were as bad as ever, and now there was no way of knowing if they would ever be helped.

I truly didn’t know what I was supposed to do with this latest failure. Again all I could think of was how the medication was supposed to help me lose weight and stop the hair loss. If it wasn’t doing that, then why take it? I was angry and I was bitter … and I stopped taking the medication. What was the point? It was just empty promises to me, and I was done.

In later years, during my pregnancies, I’d read about the importance of taking medication for hypothyroidism and how if you didn’t, you could put the baby at risk. So I took the medicine religiously, every day for nine months, with both pregnancies. While the weight loss wasn’t a factor, I noticed my hair loss did not improve, further convincing me that the medication wasn’t doing me any good. As soon as I had the babies, I stopped taking it.

Any reasonable person would ask why I stopped the medication. Sure, there was no physical evidence it was helping me, but there also weren’t any negative side effects. Why not do what my doctor asked and just take the stupid pill? I really have no explanation for this—it makes complete sense that I shouldn’t go off on my own and make these decisions without any factual basis. I just didn’t want to take them—having to take a pill every day made me feel like I was sick. I knew there was something wrong with me, for sure, but if I were going to have to take maintenance drugs, then I would have to see a physical benefit. Period.

In 2007, when my health was reaching a critical point, I had a doctor question me about my latest blood work. “Are you taking your Synthroid?” she asked. “Because your levels are really low.”

Usually I would just make up a lame excuse, not wanting to admit to a doctor some of my rogue ways of thinking. But this time I was full-on depressed, and just jaded at the whole medical community. “No, I don’t take it,” I said bluntly. “It doesn’t do me any good.”

She looked baffled. “You know, I don’t think I’ve ever had to convince someone to take their thyroid medication. Usually women are thrilled to hear there’s a problem and a solution.”

I snorted. Been there, done that. I had tons of problems, and I was starting to be convinced there was no cure.

Health was hardly ever my focus. And when it was, I was usually disappointed in the outcome, as with the whole thyroid situation. I just wanted things to be black-and-white—if there was a problem, I wanted a cure. Period. No gray areas. No let’s try this, let’s see if that works. I guess I didn’t have patience for any of it, which is pretty ridiculous, seeing how I’d been morbidly obese for years. Why hadn’t I lost patience with that? Stubbornly, I dwelled on all the emotional issues, as well as the problems with my appearance, that my weight gain had brought on, and I did not devote enough time to the toll it was taking on my physical well-being.

That slowly started to change once I had children. And it didn’t change by choice, but out of necessity: For me, being pregnant meant I could no longer ignore my physical problems.

When I first found out we were having a baby, I was ecstatic. Michael and I had waited for so long, watched so many friends and family members become parents, welcoming new additions. Finally it was our turn. Sure, I would have liked to be thinner; as it was, I was still very heavy when I became pregnant with my daughter, Emma. But I had just lost a lot of weight, and I was in a pretty good place emotionally. I was coming off the daily torture that is binge eating, and I was starting to have more natural, realistic thoughts when it came to what went into my mouth. Yes, I still ate too much, and too many of the wrong foods, but hey! I was pregnant! I was with child. That’s license, right? For the first time in really my whole life, I ate without guilt. I didn’t beat myself up with every indulgence, and that was so liberating. I could go through my days feeling good about myself and my situation, something that was so rare for me, I hardly knew what to do with it. And because I was in a good place, because I gave myself a break, I didn’t binge. I never once overstuffed myself with food, making frantic promises to do better the next day. I didn’t have to live under that threat umbrella. I was free.

All of that soon came to a screeching halt.

On the day I went in for my glucose test, where they determine if you’re suffering from gestational diabetes, I clearly had no clue. I’d been at work all day and thought the hour-long drive to the doctor’s office was the perfect time to drink a nice cold twenty-ounce bottle of Mountain Dew. Um … hello? Blood glucose test? Sugar? Probably not a good idea! Still, it wasn’t like they told me to fast or anything, and I figured I should go about my normal routine. I was still drinking one soda a day, and I didn’t think much about it.

I flunked the test.

It was only then that I truly considered the possibility of diabetes. Sure, this was gestational diabetes, a condition that would likely go away once my pregnancy was complete. But until then I would have to do all kinds of special things to monitor my health and that of my baby. Plus, having gestational diabetes makes you more prone to develop the disease later in life.

I was devastated. Gone was the liberating feeling I’d had about eating; now I would have to worry over every little thing that went into my mouth. I’d have to monitor my blood sugar levels by sticking myself with a needle every day. And I would agonize about my unborn baby’s health.

Not how I envisioned my pregnancy.

I had a really hard time following the diet plan. My limited palate made it hard for me to find good foods to eat—ones that I actually liked. On a good day I was a carb-obsessed freak: breads, chips, sodas, and so on. And we already know how I felt about sugar—it deserved its own level on my personal food pyramid. This diet, however, called for no sugar and low carbs. For a person who’d gained more than 150 pounds because she couldn’t control her urges to overeat, and to eat the wrong foods, it was quite a lot to ask. How was I ever going to do this?

Slowly, believe it or not, I made progress. I learned to eat hamburgers without buns. I skipped the fries and (most of) the sodas, opting instead to snack on nuts and cheese and to drink water. Of course I found ways to cheat. I promised myself that if I was good all week, I could have whatever I wanted for dinner on Saturday, for example. I also got the hang of using the needle to check my blood sugar, and I learned to use that to my eating advantage. I kept a food diary and learned what foods made my blood sugar rise and what foods I could get away with eating. I found that if I simply scraped the toppings off of a piece of pizza without eating the crust, I was fine—or if I waited until the early evening to give in to my craving for soda, my blood sugar wasn’t so bad. I was very disciplined about finding what worked, and it paid off. My doctor was pleased with my sugar levels and with the baby’s growth. My fear began to subside, and I found an inner peace with doing what was best for my baby.

Looking back, I am proud that I was able to step up for Emma’s sake. I’d always hoped somewhere deep within me, willpower did in fact exist, and here I had some proof. But I’m a little sad that it took pregnancy for me to have the strength to finally do what was necessary. I thought my baby’s health was worth a sacrifice, but I wasn’t willing to give up things in order to improve my own well-being. What did that say about my self-esteem, my self-worth?

In the end, the gestational diabetes all but went away. My blood sugar levels stabilized, meaning I no longer had to check them daily. Emma was a robust eight pounds when she was born, perfectly healthy and normal. Getting to hold her for the first time, and seeing for myself that she was okay, I felt like I dodged a major bullet. And I was ready to indulge. I told my dad I would do anything for a Mountain Dew, and he was happy to oblige, racing to the snack machine down the hall from my hospital room. Emma was only a couple hours old, and I drank that twenty-ounce soda in what seemed like three long sips. Nothing ever tasted so good.

When Emma was about six weeks old, I went in for a follow-up with my obstetrician, and she ran tests to see if the diabetes was definitely gone. When the results came back that it was, I was so relieved. I vowed I would never, ever have to deal with that again, and I really felt as though I was on my way. Having Emma and manufacturing breast milk was having a big effect on me: I’d dropped about thirty pounds in a month. Amazingly, I still didn’t feel the need to binge eat—I hadn’t returned to my bad habits. I was finally starting to feel good about my weight-loss prospects. My doctor warned me that with a second pregnancy I would almost assuredly develop gestational diabetes, but I shrugged it off. I was going to get the weight off before any other pregnancies, so that wouldn’t be a factor.

I’m not quite sure where it went wrong. I should have just gone back to see the bariatric doctor and resumed the phentermine to lose the rest of the weight. But I’d decided not to go back to work full-time and took a huge pay cut. I didn’t think I could afford the medication and the doctor visits. Not to mention that the doctor’s office was near my work, more than an hour away from my house. I couldn’t make that commute with a newborn. Plus, I’d really convinced myself that I was now ready to do it on my own. Hadn’t I stepped up to the plate with the diabetic diet? Somehow I’d found the willpower to do what I needed to do … I just needed to find that motivation again.

But find it, I could not. I wanted to start exercising again, but as with any newborn, Emma’s sleeping was so unpredictable that I found myself too tired most of the time to do much of anything. I was stressed, trying to work from home and still make a difference at my job and trying to get the whole mothering thing down in a way that was beneficial to both my child and me. How did I usually deal with stress? This time was no different—I turned to food, slowly allowing in all the temptations I’d gotten rid of while I was pregnant. When Emma wouldn’t stop screaming, I’d put her in the car—the ride soothed her to sleep—and the next thing I knew, I was at the drive-thru window. In no time my soda habit kicked back in, and I was back to drinking several Mountain Dews or Cokes a day. Predictably, the weight slowly piled on again. Of course that was when the deal making started, which began the binge-eating-and-regret cycle. I was right back to where I had been, and this time I was harder on myself than ever before. How could I not have learned my lesson after all this time, after all I’d been through? It now occurred to me that the implications were far more serious: I had a child to consider, and my health was very much an issue. This was no longer about wanting to wear jeans again or being an on-air reporter. This was about being around to see Emma grow up.

I could always count on some illogical thinking to come into play, and this time it did, too. Michael and I knew we wanted another child, just one sibling for Emma. In the back of my mind, I wanted to see how normal sibling relationships were supposed to work: bickering, yes; daily cruelty, no. I wasn’t getting any younger, and I knew that I would need to go back to work full-time at some point. When Emma was almost a year old, we decided to get pregnant again.

It didn’t happen the first time, this go-round.

It happened on the second try.

We announced it to our families at Emma’s first birthday party. They were really surprised, and my mom, in particular, was worried. Two small children would be such a handful. Plus there were health concerns. I was heavier now than I was when I got pregnant with Emma. I was sure to develop gestational diabetes again. Would I be able to keep it at bay once more?

Again, illogical thinking on my part. Of course I’d be okay! I told myself. I did it the first time, didn’t I? When it came to my baby’s health, I was sure that I had what it took to do what I needed to do, period. I wasn’t too worried at all.

From the get-go, this pregnancy was far different than with Emma. I had terrible morning sickness—I was nauseated all the time, and smells were my worst enemy. I could barely be around Michael as he ate his breakfast or changed Emma’s messy diaper without running for the toilet. This went on for months, and it was debilitating. I was trying to take care of a toddler, I was working long hours from home, and I was trying to stay healthy, but it was too hard. The more I tried to avoid sugar, the more I craved it—and it seemed like the only thing that made me feel better, the only thing my body would tolerate. Nothing like a fizzy drink to calm down your tummy! I knew I was in trouble, but I didn’t know how to stop.

I had to have the blood glucose test early this time, and of course I failed it miserably. I had gestational diabetes again, and I had to go back on the diabetic diet. I halfheartedly pulled out my old food diaries, once more employing the strategies that had worked so well for me with my first pregnancy. Only now it wasn’t working. Foods that were okay for me to eat last time made my blood sugar soar this go-round. With my limited palate, I had very few choices, and I was always struggling to find something that was good for me to eat, that I liked, and that wouldn’t make me sick. Every single day was a struggle, and I was miserable. The more desperate I became, the more I seemed to fail. I couldn’t get a grip, couldn’t pull it together. I was drinking tons of soda and eating carbs—all things that were bad for the baby and me. On the days I managed to do well and stick to the diet, my blood sugar numbers remained high. So I figured, What is the point? Why “be good” if it isn’t working? I’d find myself drinking all the soda and eating all the bread I wanted, vowing I would do better the next day. My perverse binge-and-regret cycle had penetrated my pregnancy, and I didn’t just feel sorry for myself—I was scared to death. My baby’s health was on the line, and I felt powerless to do anything about it.

When I was about seven months pregnant, I got the news I had been dreading: I had to go on daily insulin shots. I swear, I wanted to run right out of that doctor’s office and pretend I’d never heard those words. And if it was just my health at risk, I most certainly would have done so. But I knew that my baby’s well-being was at stake. I had no choice: I had to do whatever it took to make sure he was healthy. I reluctantly attended a session with the diabetic nurse, learning how to measure the insulin into the syringe and how to give myself the shots in my thigh. Gathering my supplies, I wondered if I could get any lower than I was at that moment.

I had to check my blood sugar four times a day, and I had to give myself injections after each meal. With every shot I felt like such a failure, as if I’d done this to myself and to my child. I became really depressed, unable to believe that I’d actually let things reach this point. On my better days, I told myself that it would all be over soon; once the baby was born, I wouldn’t have to do the shots anymore—I could start to get my life back. I never thought about the long-term health implications; I simply couldn’t allow myself to go there.

I was increasingly worried about my baby’s size. We’ve all read stories about big babies at birth, seen the television news stories about the fourteen-pound newborn. I started to have nightmares that I was in the hospital when a nurse hands me a five-year-old to take home. I so didn’t want to be that mother, and with good reason: Big babies have a lot of health issues. Because my diabetes was not going away, I already knew Eli would have health concerns at birth. He’d have to go to the neonatal intensive care unit (NICU) so they could monitor his blood sugar, making sure it went down once he was separated from me. That was so hard to contemplate—that my child would need special care because of my inability to take care of myself. I wallowed in self-pity and fear.

Eli was due September 25, but I knew there was no way I’d make it that long. My doctor estimated he’d be about ten pounds, so she scheduled the C-section for the earliest possible date: September 14. I felt like I could live with ten pounds; both my father and Michael’s father were that big at birth. And thank goodness I was having a boy—everyone likes a big, healthy boy, right?

I had such guilt over inflicting my poor health onto my son, and I just knew everyone else would judge me for it, too.

Labor Day weekend was especially uncomfortable for me. I was having sporadic pains, but because I’d never had contractions on my own with Emma (my water broke, but I had to be induced), I wasn’t sure what exactly I was feeling. I called Michael’s aunt, an ob nurse. She said to take two Tylenol and take a nap. If I was able to sleep, then the pains weren’t real contractions. I took the medicine and took a nap.

I slept for four hours.

When I woke up, I was groggy and sure that what I’d felt was some sort of fluke. I still felt kind of weird, like I didn’t really want to sit down, but I just chalked it up to being big and pregnant. I had eaten dinner and started to settle in for the night when I started noticing that the weird little feelings were forming a definite pattern. I was having real contractions! But I was more than three weeks early … could this really be it? I called the on-call doctor, and he told me to meet him at the hospital.

I half expected to get to the hospital and be told I wasn’t in labor, although the pain was becoming more intense. The nurses checked, and I heard them call the doctor to deliver the news: I was almost ready to push! Push?! I was supposed to have a C-section! I’d pushed with Emma for several hours but had to have surgery because she was stuck. I was sure this baby was bigger than she’d been—how would I get him out?! Panicked doesn’t come close to describing how I was feeling.

The nurses calmly explained that the doctor was on his way and that they would do an emergency C-section. I immediately started to relax … and to get a little excited. I was so ready to meet my son, and so, so ready to not be pregnant anymore. And he was early! Maybe this meant he wouldn’t be so big after all!

It was after midnight when everyone gathered in the OR. The on-call doctor wasn’t one I knew very well, but I wasn’t too concerned. He seemed like a nice enough fellow, so I really didn’t mind—I was so uncomfortable, I just wanted the baby out, and I wanted him to be okay. As he was preparing me for surgery, the doctor looked at my previous incision. “Jennifer, I’m sorry, but because of the position of this baby, I’m not going to be able to cut you in the same place,” he told me. At that moment I really couldn’t have cared less, and I decided a little levity was needed. “Oh, that’s okay. Not much chance of me ever wearing a bikini anyway!” I joked. This doctor didn’t even crack a smile. I couldn’t believe it! I could tell the female nurses were smiling behind their surgical masks. But Michael said this is also an important part of the man code: A man should never laugh about a woman’s weight, even if she makes the joke. On second thought, I’m thinking perhaps that’s the best policy.

As they all prepared for the surgery, I warned them that I thought the baby was pretty big. They laughed good-naturedly, saying they were sure they could handle it. The C-section was different than the last one I had had. The doctor was working harder—there was more pulling and tugging. Later one of the nurses commented they’d never seen this particular doctor break a sweat before, but this time he had. And we soon knew why.

Eli’s first cry was healthy and robust. I didn’t get to see him right away, but everyone assured me he was fine … and big. “I told ya so,” I said, rather weakly. I couldn’t see anything, so I was listening as hard as I could. At one point I turned to the nurse whose only job was to stand by my head and make sure I was okay and said, “I think I heard someone say twelve pounds.”

“No, honey,” she laughed. “That’s not what they said.”

“Twelve pounds, seven ounces!” a male voice gleefully announced from across the room.

The OR erupted in applause. Several people went over to see them working on my baby. I was in shock, and I think Michael was, too. More than twelve pounds? And he was three weeks early?

Soon they whisked by me with baby Eli in the glass bassinet. He was on his way to the NICU, as promised. I got to see him briefly, and he was a sight: big, red, and wrapped tightly like a burrito. He had a shocked expression on his face, one that I was sure mirrored my own. “Look at all of that hair!” the nurse exclaimed, pulling back his cap. Tufts of jet-black hair stood straight up. So that would explain all of that heartburn! Promising I’d see him soon, they took Eli away and I waited for them to finish closing me up.

In recovery, I didn’t sleep like I had with Emma. I wanted to know how Eli was doing, I wanted to make sure he was okay. Because Eli was in the NICU, Michael couldn’t go be with him, so he was as clueless as I was. Hours later, when they put me in a room, I found a nice surprise. The NICU nurses knew it would be a while before I could go down to the unit to see him, so they’d taken a picture of Eli and printed it out for me. There he was, with all kinds of tubes and wires in his mouth, his nose, and his arm. I wept, filled with worry and exhausted from the night’s events. Michael assured me our son would be fine and I would see him soon.

Eli was born a little past 1:00 a.m., but it was almost noon before I got to see him. Michael wheeled me down to the NICU in a wheelchair—I was just starting to get feeling back from the epidural. I felt impatient as I went through the sanitizing routine before entering the NICU—I wanted to see my baby now! Michael wheeled me past rows of teeny, tiny babies in glass Isolettes—some no bigger than the palm of my hand. I was relieved my baby wasn’t going to look like that, but I was also a little apprehensive about meeting him for the first time without the haze of a C-section and the bright lights of the operating room.

When I finally reached Eli, the dam burst. He was all alone in his little glass bassinet, no baby on either side of him. Truly, in this unit filled with underweight preemies, he was in a class by himself. I stared at him, memorizing all that I could about my new baby. He was wearing only a diaper, and his chest rose and fell so quickly with his little breaths. He was sleeping, but it was fitful, as if he were missing something—or someone. He’d been here for hours without me, and all I wanted to do was take him in my arms. Only, I couldn’t. He was still hooked up to an IV, and I was scared to death I would yank something out or pull something loose. I touched his arm, my hand trembling. “I’m sorry,” were the first words I spoke to my son.

Eli was in the NICU for three days, much longer than I’d anticipated. His blood sugar levels went down to normal pretty quickly, but then the doctors were concerned about his breathing. In trying to figure out that issue, they discovered a small hole in his heart—something they told me was pretty common and would likely repair itself, but a problem that would require more monitoring. In the midst of all of it, I somehow knew he would be okay. My usual MO would be to panic and jump to the worst-case scenario, but not this time. Something just told me that Eli would be fine.

I, however, was not fine. I blamed myself for his being there, for not being in my arms. He should have been in a regular hospital room with me, being passed around by cooing family members. Instead he had to be monitored round the clock, poked and prodded with every test under the sun. I couldn’t forgive myself. When he was finally cleared to go home, when I could finally hold him and rock him and whisper lullabies in his ear, I still wasn’t okay. My inability to control myself, to get a handle on my health, stared me in the face every time I looked in my son’s eyes. And it almost destroyed me.

The hole in his heart did close. His blood sugar stabilized, and he lost weight. Every day, he proved to be a normal, healthy baby boy. I was so relieved, so thankful that he had been spared the consequences of my lack of discipline. I pledged to do whatever it took to keep him healthy, to keep him safe and happy. I became fiercely protective of him, vowing never to let him down again.

But I was letting myself down each and every day. I couldn’t get my weight under control. No longer pregnant, I ate with a renewed vengeance, to the point of bingeing. I drank soda almost nonstop. On the surface it was my usual routine: I felt bad, and the only thing that made me feel better was to stuff myself with food, even if that “better” feeling only lasted a little while. But deep down I knew this time was different. It was as though I was trying to punish myself, make myself pay for all the damage I’d done. During my worst times of overeating before, I was able to pull myself together and complete at least a couple of days of better-than-normal eating, perhaps try a little exercise. But now, I couldn’t get anything to work at all, not even for a day. I had never been this out of control, and I felt powerless to stop the path of destruction.

A couple of months after Eli was born, I got the news: My diabetes had not gone away. I was now a full-fledged type 2 diabetic. I wouldn’t be able to put away the blood glucose monitor this time, couldn’t disregard the diabetic diet. My blood sugars had improved somewhat since I’d had the baby, so I wouldn’t have to have daily insulin shots. But I would have to go on medication—pills I would have to take for the rest of my life. And I would always have the stigma of diabetes.

I just couldn’t believe I’d reached this point. I was still pretty young. I had two small children. And I was a diabetic. Forever. Suddenly I longed for the days when my weight was about looking better in my clothes or having a better sex life. Now my weight was causing irreparable damage to my body. And it was all my fault.

As is my nature, I reacted to the news with denial. Surely I could reverse this. All I had to do was lose the weight! Now that I’d had my last baby, I could focus on shedding pounds, on getting healthier. Once I got my weight under control, the diabetes, I was sure, would be a distant memory.

Surely this, finally, had to be my rock bottom. I’d had a twelve-pound baby, for God’s sake. I’d been diagnosed with an incurable disease. Wasn’t this finally the point at which I cried uncle? Wasn’t I finally at the point to take charge and do something about it, for good?

Thus started my renewed attempt at getting diet drugs, and we now know how all that turned out. The whole time I visited new doctors and started new plans, I tried to ignore the diabetes problem into nonexistence. I didn’t take my medicine, and I certainly didn’t monitor my blood sugar. Doing so outside of pregnancy would have meant I was actually a diabetic, something I just couldn’t face. In the back of my mind, I knew I was further damaging my health, but I forgave it because I felt sure I would soon get a handle on the situation—I was still deluded enough to think I would get on the right path. In essence, I let diabetes run amok in my body, unchecked.

I started to get chronic yeast infections—not just the “flesh-eating virus” ones under my stomach, but the more traditional variety. I’d never really had them before, and at first I was puzzled as to why they kept coming back. One Google search and I figured it out: Out-of-control diabetes leads to chronic yeast infections. I wasn’t monitoring my blood sugar, but these infections let me know that the diabetes was as strong as ever. I couldn’t get rid of them, and I certainly couldn’t go see the doctor. I just sort of … lived with them, which of course, was insane, but so was my very way of thinking. It had been more than ten years since I’d started gaining weight, and I had yet to find a solution that lasted. What in the world made me think I would find one now, on my own?

Reality sometimes has a way of slapping you in the face, but for me, this time, it was a slow burn. I’d seen the commercials about people losing their eyesight because they refused to do anything about their type 2 diabetes. I’d read about a young mother dying from a heart attack, leaving her small children behind. I’d contemplate, more and more, how the deck was stacked against me, health-wise. My mother had had a heart attack when she was just forty-nine. My father had died of a stroke at fifty-seven. I’d seen three uncles die too early, two of heart attacks; two more uncles were being treated for heart disease. The odds were not good, and the more I allowed time to pass by, the more I let my diabetes wreak havoc on my life, the more in danger I was.

Looking at my children took my breath away. Emma was so beautiful, with big blue eyes that showed the world every emotion she felt at the exact moment she felt it. She was by no means an easy child, and she would need a mother’s love to help her navigate her already overwrought emotions. Eli definitely had his father’s temperament: easygoing, just happy to be here. But he loved me so fiercely, always seeking me out in the room, always wanting to be held and snuggled. Losing me would mean he would never be the same. Neither of them would ever get over the death of their mother. I didn’t want that legacy for my kids. I owed it to them to find the answer, whatever it was. But how? How could I finally figure out what it would take to make it work, especially since I didn’t know what it was? I felt like I was running out of time, as though I’d run out of answers a long, long time ago.

In October 2007 something happened that I still can’t believe was real. Michael and I were in the den, watching TV. We’d already put the kids to bed, and I was doing my usual complaining about not having enough time to exercise and not making the best food choices. It was a conversation we’d had many, many times during our then thirteen-year marriage, and Michael’s usual response was to listen, but not say much. Whenever I forced him to talk about my weight, he did so with great hesitation. He was so afraid of hurting my feelings or saying the wrong thing. Truly, I should have been grateful for this; I think everyone knows a husband who is anything but supportive when it comes to his wife’s weight battle. Never in our marriage had Michael said one negative word to me about how much I weighed or how I looked, and I did appreciate how wonderful that was. But I must admit, sometimes I wondered, What if he was a little harder on me, or just held me a little more accountable? Would I be better off? At my worst, I blamed him when I couldn’t get control of myself, thinking how he was letting me down by not being more of a coach. But when I was being rational, I knew what a gem of a husband I had, and how lucky I was.

So you can imagine how surprised I was on that fall night in 2007 when Michael broached the subject, all on his own.

“I think you should look into gastric bypass surgery.”

I was sure I hadn’t heard him correctly, but I saw the conflicted look on his face. It was one of great pain and reluctance, but there was also a sort-of quiet determination. He obviously didn’t want to say this, but clearly he had been working up the nerve and had now decided there was no turning back. “You know Paul down at the sheriff’s office? He’s lost all his weight and he looks great. He said it was a little hard at first, but he’s so happy he did it.” Michael was talking so softly, I could barely hear him. At first he wasn’t looking at me. His eyes were anywhere but on me—on his hands, on the TV. And then he turned to look me full in the face, his voice a bit firmer. “I need you. We need you. I think you owe it to us—and to yourself—to at least check it out.”

There was so much I could have said at that moment. I could have told him I’d thought a lot about the surgery and had it in my mind if one day I needed it, if one day I determined I couldn’t lose the weight on my own. I could have pointed out that there were a lot of negative things to say about the surgery, how everything wasn’t as rosy as some people would like you to think. I could have listed a thousand different reasons why I thought I should have the surgery, and a million more why I didn’t think I would.

But all I could do in that moment was look at my husband, who had so much love in his eyes it nearly broke my heart. All I could do was nod my head, simply, once. “Okay.” Now it was my voice that was barely audible. “I’ll look into it.”

And that was all that needed to be said.