“Emma! Daughter, what happened?”
“Mister Lapp, she says she thinks she broke her leg. I tried to pull her foot out of the hole and she’s in a lot of pain.”
Emma’s dat ran for a garden trowel. After digging and making the hole bigger, Jacob was able to extract Emma’s foot.
“If we all lift together, we can put Emma into my buggy. Let me pull the buggy closer.” Jacob ran to his buggy and urged his horses close to Emma’s prostrate form. Jumping back down, he wrapped one arm around Emma’s back and gripped the other hand. Emma’s dat did the same on the other side. Mrs. Lapp had to push from behind so the two men could lift Emma from the ground and into the buggy.
“Denki! We’ll follow you. Come, wife. Kinder, we have to go to the hospital. Wife, leave a note on the front door for Barbara. Just in case we aren’t back by suppertime.”
***
In the hospital, Emma lay on the hospital gurney wincing from the sharp pain in her leg. Finally, a doctor and nurse came hurrying into her cubicle. She explained again what had happened to cause her injury.
“Okay, we’re taking you to X-ray. It sounds like you broke your lower leg, at the least.” Several minutes later, the doctor carefully examined the X-rays. “Miss Lapp, your lower leg is broken. Fortunately, it’s a clean break. What’s not so fortunate...you also dislocated your knee. It’s completely separated. I’ll wrap it and give you pain medication. You need surgery for your knee. Nurse, please call up and see if we’ll be able to schedule her and when. Also, we’ll need an orthopedic surgeon.”
After several minutes, in which Emma began to feel like she was floating on colored clouds, her family and Jacob came into her cubicle. The doctor was talking, explaining the nature of her injuries.
“She dislocated her kneecap when she fell, so that needs to be corrected as soon as possible. Her lower leg is also broken. Miss Lapp, how is it that you didn’t see that hole?”
Emma blushed. It should be obvious! “Umm, I’m so big that I couldn’t see the hole when I was running after my nephew.” At this point, Barbara and Ben ran in. “Emma, what happened? What did you do to my kinder?”
Jacob’s mouth fell open. “Excuse me? She was trying to keep Michael from beaning his brother in the head with a rock! She was outside watching him. I saw her fall when I was driving up!”
Barbara realized she had gone too far in shifting the blame. “Oh! Uh, Emma, I...I’m sorry. Are you okay?”
“Nee. My knee and leg are broken. I have to have surgery.” Emma’s voice was angry. Her sister’s insulting words had penetrated the lovely medication cloud she had been floating on. She shifted her arm, dislodging Barbara’s plump hand, which had been holding it.
The phone rang and the nurse hurried to answer. After listening to the person on the other end, she hung up and turned around. “Doctor, there’s a room available in about forty-five minutes. Doctor Whitesell is on-call as well. He’s going to scrub in and operate on Miss Lapp.”
“Tonight? I... Surgery tonight?” Emma’s voice was slurred again. She felt so good! Her knee and leg barely ached.
“Mister and Missus Lapp, you and your family can stay in the surgical waiting room. Emma will be in surgery for at least an hour, if not more, depending on the damage the surgeon finds. Once she’s out of surgery and you’ve been able to see her for a few minutes, I’d advise you to go home and get some sleep. Your grandchildren have school tomorrow, right? Bring a few things for Emma— a nightgown, toiletries, things like that. A book as well, so she can pass the time.”
***
Emma slowly became aware that she was floating on a large, white, very comfortable cloud. It was warm...but what was that beeping? And why was it so hard to open her...maybe if she tried one eye at a time...there. But it closed almost immediately. Trying again, Emma was able to open both eyes. She caught blurred images that looked like her dat and mam. “Mam, did I get the surgery?”
“Ja, the doctor has been trying to wake you. He needs to explain what he found.”
Looking around her, Emma realized the irritating beeping sound was the heart monitor. Now, she became conscious of itchy sensations on her chest and sides. Squirming, she tried to relieve the feeling. “Doctor? What happened to my knee?”
“Emma, I’m glad you and your parents are here. I need to explain everything I found. The damage I found wasn’t caused only by your fall. You’re aware, I’m sure, that your weight has been making your knee joints hurt, right?” At Emma’s slow nod, he continued. “I found damage to the cartilage and other areas of your knee, from your weight. I also found how you separated your knee in your fall. I corrected everything I could for now. But it’s only temporary. Eventually, you’re going to have to have that knee and possibly your other knee fully replaced. Also, you’re going to have to—”
“Lose all the extra weight. I know, doctor. I’ve been trying for years to do so. I am grateful you’re telling me all this with my parents here. My friend, Jacob”—Emma indicated Jacob, standing at the end of her bed—“took me to the new salad restaurant last week and I learned so much about healthy eating. It can be just as tasty as Amish food, but the levels of fats, carbohydrates, and sugar are so much lower.”
The surgeon smiled. “Son, I have to say thank you for helping your friend out. It’s a true friend who looks out for her well-being.”
Emma’s mother was insulted. “Excuse me! I feed my family healthy foods! I want only the best for them!”
“Missus Lapp, I’m sure you do. I’m sorry to offend you. May I ask you a couple questions?”
Emma’s mother slowly and stiffly inclined her head, giving the doctor permission to continue.
“As your daughter said, healthy, low fat and low carbohydrate foods don’t have to taste boring or bland. There’s plenty out there that taste good without putting extra weight on. My first question: What kind of fats do you use to cook with?”
Ann was slow to answer. She felt like she was on shaky ground. “I use animal fat. Lard. Why?”
“I’m sure your meals are delicious and full of taste. But, unfortunately, animal fat contains saturated fat.”
Ann’s expression was confused. “Saturated? What does that mean?”
“Saturated fat is fat that is full of unhealthy ingredients that clog our arteries, liver and heart. Over time, that can lead to heart and liver conditions. In the short term, it’s also high in calories, and this is why you, your husband and daughter are all overweight.”
Ann was nonplussed. “But plump isn’t bad! Is it?”
“The less fat you carry around on your skeleton, the healthier you are, generally. There are other fats you could use in your cooking. Your meals would be just as tasty—”
“Nee. I am not changing. I am using the recipes my mam used and she lived to a hearty old age.”
Emma’s eyes closed in disappointment. She forced them to open once again. “Mam, I know it’s hard to think about change. But my doctors have been telling me for years that if I lose this weight, my asthma will not be an issue. My knees won’t hurt. Already, I am pre-diabetic, so I’m supposed to be eating healthy so I don’t become diabetic and need medications or insulin injections.”
Ann heard “diabetic” and “insulin.” Her dat had needed insulin and he had died at a relatively early age. Still, the thought of changing how she cooked scared her. “Daughter, let me think about it. I do hear what you are saying.”
Emma gave a tired half-smile. “Okay.”
“We’d better let her sleep. She’ll be here overnight and we’ll see if she’s ready for discharge in the morning. Missus Lapp, does your house have a second floor?”
“Ja. Why?”
“She won’t be able to manage stairs for several weeks. If you have a bedroom on the first floor, then that will have to serve as her bedroom until she’s cleared to begin climbing again.”
“Ach. Okay. I will move her things down by tomorrow. Emma, we will be back in the morning, okay?” Anna ran her hand along Emma’s cheek and into her hair. She wasn’t very comfortable with physical affection.
Emma, nearly asleep, mumbled softly.
“Missus Lapp, may I speak with you before we leave?” Jacob had something he wanted to let Emma’s mam know.
“Ja, what is it?”
“It’s a little information from my mam, about healthy cooking. Something she learned when her dat suffered a heart attack.”
“I...don’t know. It’s late, and—”
“Please. It’ll take only a few minutes.”
Ann sighed, feeling exhaustion and a little bit of fear at the changes she sensed were coming. “Okay, but only a few moments.”
“Let’s sit down. I know you’re exhausted right now. My grossdaudi suffered a near-fatal heart attack when mam was just a teenager. She had already been helping her mam cook meals and desserts for a few years, so she and my grossmammi learned new ways of cooking together. A dietician from the hospital came to their house and showed them how to cook with different oils, how to use spices in place of salt and how to use lower-fat substitutes for full-fat cheeses. And the meals tasted just as gut! We were all amazed. And now, some 30-plus years later, I can tell the difference. When I eat something cooked with lard, lots of salt or regular cheeses, it tastes...too heavy. And the oils bother my system. But, when you look at Mam, my brothers and sisters or even me, we are slender and strong. We don’t have diabetes or asthma. And that’s what I hope for, for Emma.
“She can benefit—her health can benefit—from these changes. Please, tell me. Do your knees and back hurt you? Has your doctor told you that your diet is too high in fats?”
Ann couldn’t—wouldn’t—lie. “Well...ja. She does. But I just can’t change this late in my life!”
“Ja, you can, Missus Lapp! My grandmother did. It wasn’t easy for her. But the dietician and Emma’s doctors will help you. They will give you support. My mam and I can, too. Do you remember that I took Emma out the other night? Well, we went to that new salad-and-soup place in town. Emma was surprised to find that salads, full of vegetables, can taste so full of flavor. Missus Lapp, I know how much you love your kinder. You want the best for them. In this case, slender and strong is healthier and better than being, well, plump. And Emma has told me that her doctor has used another word for her weight. She’s obese, and that is dangerous for her.”
Ann began to cry softly. “Ja, I do want the best for them. I just always thought that being plump meant that we were healthy. I didn’t believe it could cause health problems. Ja, I will work to change my way of thinking and cooking. But I will need help!”
“And we will all be there. I will talk to Mam after I finish work today. I promise.”
Ann’s smile was tired and the edges of her mouth turned down as she tried to hold back tears. “Jacob, please be honest with me. Do you think my beliefs and how I fed my family have harmed Emma?”
Jacob was silent, not wanting to lie. “You had the best of intentions for her and your whole family, Missus Lapp. But, ja. Your beliefs—not you, personally—did bring some harm to Emma. But it isn’t too late to change.”
Ann, hearing this, dropped her head into her hands and gave a huge sob. “Emma, I am so sorry!” Not able to face Jacob, she rose with difficulty and moved as fast as she could toward the exit where John, her husband, waited.
***
At home, Barbara impatiently pushed her children to get ready for bed. “You have school tomorrow morning. Finish your baths and brush your teeth. I am running out of patience with you!” Wringing her hands, she paced back and forth in the upstairs hall. Did I cause Emma’s accident? What is happening with her leg? Why have Dat and Mam not come here to tell me?
Ben trudged up the stairs, feeling tired. “What is wrong? Why are you raising your voice at the kinder?”
“They are just taking too long with their baths and getting ready for bed. Besides, I need to be in my quilting room. I need to cut out a new pattern for one of my customers. She’s new.”
“Ach, well, don’t be so loud. We are all tired.” Ben was irritated and that came through in his voice.
Barbara wanted to snap at him, but she knew he would see through her fib. He would see through her. “Kinder, are you done yet?” This time, her voice was softer.
“Ja, Mam. Michael just needs to brush his teeth,” said Annie.
“Okay, just hurry, please. I have quilting work to do.” Barbara was rewarded by her kinder coming out of the bathroom, all in a line. Seeing that her youngest still had a smear of toothpaste on his cheek, she rushed into the bathroom and, armed with a damp washcloth, she scrubbed at his face. “Okay, now go to bed and say your prayers.”
Finally downstairs, she hurried into her quilting room. Leaving the door open, she pulled down the first of several bags of cut-up fabric. Trying to focus, she worked on matching them to a few bolts of fabric standing on their ends. Finally happy with a light-cream fabric, she pulled that bolt out and set it to the side so it would be ready to cut. Now, her movements slowed. Setting the large sack of scraps down, she sat in the chair and allowed her emotions to take her where they had wanted to go all afternoon long.
Barbara had always been seen as strong and confident. Even though she was more than a little plump, a natural beauty was evident in her hazel eyes and expressive face. She had always attracted the Amish boys—and a few English ones, too—when she was a teen. I remember everyone I ran around with on rumspringe thought that I had all the answers about what I was going to do as an adult. What they didn’t know was that I was so scared half the time.
I don’t want anyone to know that I don’t know what I am doing or what I want to do. Emma doesn’t know it, but she is really pretty. If she loses all that weight, it will be obvious. She will be even prettier than I am! That can’t happen. Even though we are supposed to ignore worldly things, like our looks, I can’t help that I think about that every single day.
Ja, I comb my hair in a plain, tight bun and I have Annie do the same. I remind them that focusing on our looks is a sin and that the Ordnung frowns on that. I tell them to focus on things of Gott and service to others. I try to do that myself, but I resent the time I spend in helping others.
Barbara thought of the small square of mirror she had hidden upstairs in her and Ben’s bedroom. With a squeeze of guilt twisting her stomach, she thought of the times she had gone upstairs to grab that item, lock the door to the bathroom and just gaze at herself and how her features had been arranged by Gott. She resisted the urge to run her hands over her smooth, rounded face. She truly felt as though she was in a competition with Emma, for prettiest Lapp girl.
Nee, she can’t lose that weight. Maybe a little. But not too much. I will make it look like I support her efforts, but I’ll be stopping her weight loss. No matter what she tries, she won’t be able to lose beyond maybe fifty, seventy-five or one hundred pounds. Barbara smiled. If anyone had been in the room with her, they would have felt chilled at the feral nature of her grin.
***
After talking with Ann Lapp, Jacob drove his buggy home slowly, feeling bone-deep tired. He recalled the fright he had felt, seeing Emma falling and unable to get back up, learning that her leg injury was severe enough she needed surgery, and then the realization that, through her mam, he could help his sweet friend. Looking up, Jacob saw that his team had faithfully brought him home. Rousing from his stupor, he spoke. “Denki, team.” Driving the buggy to the lean-to, he unhitched it from the horses, then led the team into the barn, where he slowly checked their hooves and gave them food and water. Locking the barn, he went into the house.
“Son, you are home very late. I was about to go to bed. What happened?” his dat asked.
“I was going to invite Emma Lapp to join me for supper at that new salad place. I was pulling up to her dat’s yard when I saw her fall. We got her to the hospital and found she broke lower leg and dislocated her knee. She had surgery and will be fine. I had a short talk with her mam because the surgeon told her that some of the damage to Emma’s knee is from the excess weight she carries. Missus Lapp has agreed to work with Mam and the dietician, thank Gott. And I am bone-tired. I will see you in the morning.”
Jacob slowly climbed the stairs and, in his room, pulled his clothes off and fell into his bed. Just moments after his head came to rest on his pillow, he was lost in a deep, dreamless sleep.
***
In the hospital, Emma roused slowly. Stretching as she normally did, she winced as she felt a sharp response in her bandaged knee. “Oww, oww, oww!” Digging her head back into the pillow, she tried to will the pain away.
Hurrying into Emma’s room, the day-shift nurse smiled at her professionally. “Good morning! How are you?”
“My knee hurts so badly! I stretched and I think I moved it or something.” Emma’s voice was strangled by the depth of her pain.
“Let me take your blood pressure and temperature. Unfortunately, you’ll need to eat your breakfast before you can take your painkiller. That can tear your stomach up horribly.”
“When will breakfast be served?” Emma obediently extended her arm so the nurse could get her blood pressure, and then she closed her lips around the thermometer.
“In about thirty...no, I’m sorry, fifteen minutes. Can you hold on that long?”
Feeling the thermometer being withdrawn from her mouth, Emma sighed. “I guess I’ll have to, won’t I?” A few minutes later, Emma painfully scooted back so she could eat her breakfast. Looking at the bowls and plate on her tray, she saw oatmeal, scrambled eggs, two slices of bacon and two slices of toast. She sipped the black coffee and began to eat.
“Denki.” I should use today as the beginning of my weight-loss plan. I don’t know how long I won’t be able to walk, so I will need to cut back anyway. Adding pepper and a little salt to her eggs, she ate them with the toast. She looked for the jam, finding two small packets of strawberry preserves.
Gut thing I’m starting my new eating plan today. I won’t call it “diet.” I have probably been eating unhealthy amounts of food at every meal. As she spooned her oatmeal down, she shuddered. It was tasteless! She saw two packets of sugar next to her coffee cup. Sprinkling them on the hot cereal, she opened one packet of preserves and added that to the oatmeal as well. Nodding, she ate the rest of her breakfast. She was finishing the third half of her toast when the doctor and another nurse came into her room.
“No, keep eating! You need to keep your strength up so you can recover. Your surgery went well...and I hear you’re in some pain. It’s safe to give this to you.” The doctor indicated a small cup the nurse was holding.
“What is it?”
“Hydrocodone. It’s generic Vicodin. You’ll feel some relief from the pain soon. Problem is, you can only take this about every six hours, and only until the worst of the pain is gone. This stuff is addictive.” The doctor’s voice was serious.
“The good thing is that your doctor has put an order in your record that you can get injectable ibuprofen—NeoProfen. Like the Hydrocodone, you’ll only take this until your level of pain is bearable.” Working quickly, the nurse had Emma lie down and roll over slightly. Rubbing an alcohol pad over Emma’s round hip, she slid the syringe needle in and pushed the medication in slowly.
A few minutes later, Emma realized she felt no pain. Better yet, she still felt more alert than she had the day before.
“Miss Lapp—”
“Please, doctor, call me Emma.”
“Emma, you’re going to be here until tomorrow. I want to be sure that you won’t have any complications from your surgery. The hospital notified your primary physician about your accident and treatment, and she will be here before long. We want to talk to you about your recovery, physical therapy, future knee surgeries...and a weight-loss plan.”
Emma smiled, stunning the doctor.
“Why are you smiling?”
“I have so long wanted to lose weight. My friend—he was here last night—has been helping me to find different ways of eating that are healthy but still taste gut. He also told my mam, while I was still awake last night, that he could show her different ways of cooking that will still be tasty. But, I have tried traditional weight-loss methods. Some of the weight came off and my mam went back to her old ways of cooking and I gained the weight back, plus more.”
“I’m not surprised to hear that. I am gratified that your friend cares enough about you and your health to help your mother. We’ll update your doctor in a few minutes. Now...physical therapy. You are going to recover today and tomorrow. You’re going home, likely tomorrow. On Wednesday, you’ll begin physical therapy. Can you come here to the hospital every day? Or, would it be easier for the therapist to go to your house?”
Emma thought about it for a few minutes. “It’s probably easier for them to come to my parents’ house. We don’t drive and getting into a buggy with a broken leg? That will be—”
“Challenging. Ahh, here’s your doctor!”
“Emma! What happened?” Dr. Theresa Mason came rushing into the room, hugging Emma tightly.
“I put my foot into a gopher hole yesterday. Because of this stupid stomach, I couldn’t see the hole, so—”
“Broken leg and separated knee. Okay. I suppose your surgeon told you what’s going to be happening. Update me, please.”
“I go home, probably tomorrow, and then start physical therapy Wednesday. Hopefully, at home.”
“Excellent! And have you begun to discuss weight loss?”
“Ja, we have! And my friend, Jacob King, already started talking to my mam about the need for me to eat healthier foods, and why.”
“Very good. What diet would you like to try? Mediterranean? Or—”
“Mediterranean? What is that?”
“Oh, more fish, chicken, less red meat, rice, lots of fruits and veggies, olive oil, things like that.”
“Doctor Mason, my mam won’t agree to that. I still live at home. I can see increasing the fruits and vegetables and having more chicken, but the rest?”
“Well...”
“Doctor, you know that I have tried so many different weight-loss plans and the weight just comes back. Mam hasn’t been willing to change her way of cooking long-term. Even though she, my dat, brothers and sisters could stand to lose weight, they are sure that our food is the only thing that’s gut to eat.”
“Mmm. If I suggested something new to you, would you consider it?”
“What is it?” Emma was tense, not knowing what to expect.
“Weight-loss surgery.”
“Surgery! How? Cut my stomach out?”
“No, no! But we would operate and, using one of several techniques, make the space in your stomach smaller, so you could only eat a small amount of food. By taking vitamins, you would keep the level of nutrients in your body at good levels. You would lose weight, exercise and get healthy.”
Emma was quiet, thinking. “This ‘making my stomach smaller’ thing. How do you do that?”
“We have several methods. A surgeon can explain them in detail, but I can let you know that the methods used today include a sleeve gastrectomy, gastric bypass, adjustable gastric band and a biliopancreatic diversion with duodenal switch.”
Emma’s mouth fell open. All of this sounded like so much Greek to her. “That last one sounds terrible!”
“It’s fairly involved. You’re morbidly obese, but you already have the desire to lose weight. I think I can safely reassure a surgeon that you are committed to this. They would probably recommend a gastric bypass or a sleeve gastrectomy.”
“Okay. I would need time to think. This is a lot to take in.” Emma shifted slightly on the bed, pushing herself up a little.
“Okay. Think about it and take your time. A surgeon would want to find out some specific information from you before deciding on the best method anyway. I do have a question. Once you have had surgery, would your mother be willing to help you maintain your weight loss?”
Emma felt her stomach fall. “I...well, I do know she and my friend spoke last night. He’s been teaching me more about healthy food choices and showing me they can still taste gut. He told me that he could help Mam change her cooking methods. You see, his grandfather had a heart attack when Jacob’s mam was a girl. She and her mam changed their cooking methods after so her dat wouldn’t have any other heart attacks.”
“So, do you think your mother would be willing to learn and make permanent changes to her cooking?”
Emma knew her answer would affect her future. Taking a deep breath, she nodded. “If she knows my health is at risk, ja.”
The surgeon nodded, along with Emma’s doctor. “Okay. I’ll move ahead with this. Miss Lapp, it’s not final, by any means. You’ll need to undergo testing, which includes psychological testing to make sure that you’re a good candidate for this surgery. You and your whole family have to invest themselves in helping you get healthy again.”
Emma smiled. “Oh, doctor, I am ready. I’ve been ready for so long!” Then, she thought of Barbara and her heart slipped a little. I’ll just work a little harder to convince her that it’s for my health. Why is she so opposed to my losing weight?
***
That night, after coming home, Jacob trudged slowly into the house. After being up so late the night before, all he wanted was supper and his bed, but he still wanted to go visit Emma to see how she was doing. Seeing his mam working on their supper, he waved. “Mam? Do you have a few minutes?”
“Always, son, always. What is it?”
“You know that Emma Lapp hurt herself yesterday, right?” At his mother’s nod, Jacob continued. “Well, she had surgery to repair her left knee. After the surgery and seeing Emma for a few minutes, I spoke to her mam. It took some convincing, but she is willing to accept help from you and me about changing how she cooks. Emma has to lose a lot of weight, but she will need everyone’s help.”
“Ja, she will. Of course! Why don’t you and I go to visit Ann later this week? I’ll take a few pieces of food to her and she can taste for herself. Once she knows the foods will still be full of flavor, she may be more willing to take the time to learn.”
Jacob’s grin was tired. “That’s an excellent idea, Mam. After supper, I’m going into town to go visit Emma and see how she’s doing.”
Rachel looked at her son. Seeing the tiredness in his eyes, she ran a soothing hand over his cheek. “You should go straight to bed after supper. But I know how much you care for her. Just make it back early—it wouldn’t do for you to become sick, now.”
“Ja, I will.” After supper, Jacob rose. “Dat, I’m going to the hospital to see Emma. I expect she’ll know when she’s coming home by now.”
“Be home early. You look like you’re ready to be used as a washrag for the floor.”
Jacob chuckled. “Dat, you have a way with words. Ja, I already promised Mam I’d be home early.” After cleaning up, he hitched his team up to his buggy and, checking the progress of the sunset, he sighed. “I should have called a driver.” Unhitching the ever-patient horses, he ran to the phone house three houses away. Calling a familiar number, he asked his old friend for a ride. “Evan, do you have time to come over and take me to the hospital? I want to visit a friend there and I am wiped out. Ja, I can pay you that. Thank you.”