James A Vohs Award:
A Focus on Obesity, Part 1:
••Spring 2003/Vol. 7, No. 2

Soul of the Healer

The KPNW Severe Obesity Management program has provided the overweight patient a complex care pathway that includes medical, psychosocial, exercise, and dietary assessments that engage patients in a self-help process related to weight management. Physicians, health educators, social workers, dieticians and physical therapists managed this process using a TEAM approach.

The Adverse Childhood Experiences (ACE) research^a lead by Vincent Felitti, MD, SCPMG, has demonstrated strong evidence that severe obesity is a consequence of food being used as a coping mechanism. The KPNW Severe Obesity Management program explores, supports, and offers options for this linkage of food and coping.

 

Gains	Losses
Identity	Status Quo
Inertia	Avoidance Strategy
Pleasure	Food as Partner
Protection	Strength
Reduced Tension	Coping Mechanism
Avoidance of Maturity	Confrontation of Life Stress
Sedation	Excuse for Inaction
Avoidance of Sexuality	Protection from Unwanted Sexual Advances

Write Around Portland (WRAP) is a nonprofit organization that has served the underserved populations in the Portland Metropolitan area for at least four years with a process of self-expression using writing. The unique process includes a writing group that is coached by a trained volunteer for a ten-week period with the expectation and opportunity for the writer to have selected writings published in a professionally designed anthology AND the expectation and opportunity for a public reading. This combination of writing, coaching, publication, and presentation offers an incredible opportunity for individuals who were possibly previously voiceless.

The collaboration of WRAP and the KPNW Severe Obesity program was piloted in 2002 with six overweight patients. The 'work' that was produced on paper was matched by the transforming nature of the combined experience. The attached article highlights the work and feelings of the participants who provided many messages to us as providers.

^a For more information see The Permanente Journal 2002 Winter; 6(1):44-7.

Can You See My Bruises?
K Lewis ­ Kaiser Permanente

Can you see my bruises?
Bruises not of black and blue,
but bruises made of words!

Can you see my bruises?
Bruises not of color,
not by the pain of touch,
but by the pain of words.
Let the pain stop!
Take the words away!
They play in my head like a broken record.
Words, words, words!
Make them stop!
Why do I remember the hurtful ones?

Can you see my bruises?
Bruises from words heard through the years!

Can you see my bruises?
Bruises not of black and blue,
but bruises from those who are supposed
to love you unconditionally.
The empty compliments, better off unsaid.
The words never to be forgotten.

Can you see my bruises?
Bruises not of black and blue,
but caused by words.
If you can see my bruises,
will you teach my family to see them?

Please help them to heal,
and then my bruises will heal too!

For the Kaiser Permanente (KP) bariatric surgery group, the first step was simply placing a pen in the hand of each of the participants--words flowed, rushing in gushes, spurting, bubbling. For seven years I had been facilitating writing workshops with people who are often ignored by the more general community--in low-income housing, in prison, in domestic violence shelters, in recovery programs. I had seen writing change people's conception of themselves and the world around them. But an anxious energy often hangs about the room the first few days of a writing workshop. It can take two or three weeks before people reach in deep to the place where the stories and poems wait in their bodies.

That first evening with the bariatric group, I walked in the room to find eight excited faces waiting for me to explain how the workshop was structured and what we were going to do. Though they were nervous, as soon as they received their new journals and picked up their pens, the words flowed out. I found an eagerness to write that made people exclaim, push back their sleeves, bend eagerly over their journals, and write.

And from that first moment, when the participants wrote the words of their first prompt on the page, "I come from," the words continued to pour out onto the page. Over the ten weeks, each writer grew more confident in and excited about the process of writing. Writing with the KP group brought me back, again and again, to why writing needs to be an integral part of our communities. I found a creative force that grew powerfully in the minds of people whose weight had risen up to 400 pounds and had felt like "the most invisible person in the room." I began to understand the pain that many people carry around inside, in "bone, muscle, organs, tissue, flesh," in "a body that is not me." I learned that people find inspiration in the crack of a book, in muddy boots, in dance. And I found courage, the courage to say the words "how good it is to be me," to write the words, "I am whole, complete the way I am."

Write Around Portland
917 SW Oak, Suite 406
Portland, OR 97205
www.writearound.org
E-mail: wrapinfo@qwest.net

The Hands That Made Me
Caliatra Riesterer ­ Kaiser Permanente

The hands that made me must have rough calluses, as often as He has had to mold me, press me back together, start anew. I sure was lots of work. He must have known that one day it would dry just right without cracks and after the firming in the kiln, it would be rid of imperfections and ready for the final dipping of gold. He knew it would shine brightly, sparkling like the sun with rays bursting forth, so He kept working the clay, knowing soon it would be perfected.

Isn't it amazing how to one person it's art and to another it's trash? I guess it depends on who it matters to.

It's kind of like when someone says, "Look at my children's pictures, aren't they the cutest children?" We smile, because maybe they're not too cute to us.

That's how it is with the hands that made me. He thinks I'm the best, His priceless piece, even though I see all the flaws in it. But what matters most? What I see or the one who made me? I am my Father's daughter--what He says matters more than my view of myself.

---

The Path to Physical Freedom (My Surgery)
Caliatra Riesterer ­ Kaiser Permanente

My journey to physical healing these last thirteen months has sure taught me a lot. I have been so blessed! I felt such a bond with Dr Louis Kosta, my surgeon. He tried to appear at our first meeting very professional and all doctor-like, but somehow God allowed me to see past that, and I saw a different side to him. He was indeed a kind man with a good heart. I saw a man who had lots of knowledge but also lots of care and kindness. He could sometimes laugh at my stupid comments and also, I'm sure, shake his head at all my dull questions. I told him once that God had given him a gift as a surgeon. Many go to school and learn a skill, but he also had been blessed with a gift by God. I prayed God would give him wisdom in each situation as he would need it. I believe it was God who showed me this about him.

He helped me in the path of physical healing. I had gone through a lot of emotional and spiritual healing prior to the surgery, and now I was ready for the final healing of my body. Dr Kosta and Kaiser gave me a gift. I know they would say it wasn't them really, but Dr Kosta had to have discernment to see that I could walk this road. Do I think this surgery is for everyone? No! You must heal from the inside out! I believe that with all my heart!

I was ready for the body to match all the changes that had taken place on the inside, and I knew now I didn't have to believe the self-lies about what I was or wasn't. I found a different person when I looked in the mirror now. She was different from how I thought she would look, more shy in some areas, bolder in other ways. I think I like her. She can run now. She has breath and she laughs more. She plays harder and she loves deeper. She's going places now she would only dream of before.

Someone asked me once what I thought God thought about cutting up my body? I thought long and hard about this. I have absolutely no doubt God led me on this path every step of the way, right up to the right surgeon for me.

I guess I'd say God knew my weaknesses, and he still does. It was an area I needed great help in. He also saw a person who he wanted to use to help others, but she was trapped in a body that didn't move too well. Do I have any regrets? None! Well, maybe the skin not being firm, but seriously, it has given me such freedom to move physically and spiritually.

What would I say to Kaiser and Dr Kosta? How can you put it in words? I feel as if I have been given a gift, and how can you express such thanks to someone? I'm not sure you can, but I try. Maybe as they look and see my success, my joy, my desire to help others that are hurting, they will begin to understand what their gift has meant to me.

I thank you.

---

Empty Closet
K Lewis ­ Kaiser Permanente

I came home, no one was there. Walked down the dark hall and into my parents' bathroom to get something out of my mom's drawer. Nothing's there, that's weird! Next drawer, nothing there, that's weird! Walked to Mom's closet. Opened, empty! What is going on? Where are Mom's things? She said she was going to her sister's. How long?

Crying, I called my sister! Mom's things are gone. I was so scared. What is going on? She came right home.

Called Mom, said she wasn't coming home. Couldn't tell us face to face ­ would be too hard! What about us kids? How selfish of her! How dare you put yourself first!

I will never forget that night. Alone, scared, all by myself! Thank God for my sister! She was the one that held us together. Then and now! Parents incapable.

---

My Body
Caliatra Riesterer ­ Kaiser Permanente

Does my body consist of only the outer flesh, or is it something more? As I walked this journey this last year, I didn't know this outward body. It had been so long since I'd seen it like this. I was somebody else who now had to mold the inner into the outer shell. Visualize a lump of clay. Flatten it in your hand. Take a shape like a cookie cutter and place it in the clay. Oh, my! What do I now do with all the leftover clay? It doesn't all fit in the new cutter. So some may have to go.

It was hard at times as I looked in the mirror. I remember one time I sat there and cried. I didn't know that person staring back at me, and I had grown accustomed to the large lump of clay; now it was being forced to take shape. Don't get me wrong. I liked the new me; I just didn't know her. Things changed. I grew to love me over time, but still even when I sit sometimes, legs crossed (I always longed before to be able to do that), I still feel I'm looking at someone else. Almost like an out-of-body experience.

I'm more critical now of my body, yet it moves easier now, and I'm learning to know her.

But again I ask, are we a physical body, or are we not so much more?

---

Before My Surgery
Marlene Jamieson ­ Kaiser Permanente

I was suffocating. Always short of breath, and every day it felt like I could stop breathing any minute. Air was the one thing I knew would keep me alive, but my chest was so heavy it seemed to never let enough in.

Going to the bathroom is such a normal bodily function for the normal-sized individual, but it's an entirely different world when you are severely obese. For at least ten years before my surgery, I could not wipe my own bottom. I tried so hard to control my bowel movements so I would only go at home. But a couple of days a week, I wasn't successful. When you can't wipe, you run a huge risk of smelling like poop. I would wear pads in hopes of not staining my clothes or chairs, but sometimes they didn't always work.

I went shopping with my son, his wife, and their infant son. I had had a session in the bathroom just prior to our walk through the mall. My son kept checking my grandson's diaper because he thought it needed to be changed. I knew he could smell me. I was so embarrassed I couldn't even tell my own son of the problem I was having.

My doctor asked me how I cleaned myself if I couldn't wipe. This was at the appointment where I finally broke down and was in tears, asking if he would consider referring me for the bariatric surgery. I told him I couldn't even reach my bottom in the shower so I had to become "creative" with washcloths. Another doctor told me that this physical challenge was a "dignity" issue and was hoping everything would work out so that I could have the surgery to be more normal.

Putting on shoes was another problem. I could only put them on while sitting on the edge of the bed. The sofa was too soft. With my knee bent and my foot as close to me as possible, I still strained my muscles and ribs trying to lean forward far enough to reach each foot.

Driving can be a real challenge. You don't sit centered with the steering wheel. Seat belts don't always fit. Reaching the radio and air exchange switches can be almost impossible depending on the make and model of the car. I've had steering wheels that could barely be turned because my lower belly would constrict the movement of the wheel in either direction.

Entering a new restaurant is terrifying. What kind of seating do they offer? Booths only? Forget it. If they have chairs, do they have arms or not? It was very rare to find chairs with arms
that would allow my entire bottom to sit comfortably. I've spent several evenings bracing my legs to keep me in a chair. The fear of the chair breaking and collapsing would keep me from enjoying and sharing conversation. If I let my legs rest, I would slip forward and would have to reset my fanny back into the chair.

Public restrooms are another challenge. The handicapped stalls were my only choice since those stalls would be the only ones wide enough. If I had to use a regular stall, I usually couldn't get my legs wide enough apart because of all the fat on my inner thighs.

However, the lack of energy was probably my biggest problem. I barely had energy to shower, dress, get to work, and get home. Housework rarely got done, because my weekends were always used to catch up on sleep and re-energize for the next week. It seemed like all I could do was take care of bathing and doing laundry. As long as my body was clean, that's all that mattered.

If I expected company, which was rare, I would spend a great deal of energy just trying to do housework. I could do something such as washing dishes or vacuuming for no longer than ten minutes. My back would be in excruciating pain; I would be perspiring droplets of sweat into my eyes and breathing heavily. How can anyone get this sweaty in so few minutes? I'll tell you, someone who is severely obese can.

Lord, please help me get out of this world.

Suicide was usually not a consideration, but there were times I thought it would help me when I just couldn't face another day. The only thing that kept me from doing it was thinking about fitting me into a casket. Even though I'd told family members I wanted to be cremated, what if I was too big for that? What if they had no choice but to put me in a casket? At over 400 pounds, how many people would it take to carry me?

Now that I'm almost a year after surgery, none of the above issues are challenges anymore. I so appreciate the opportunity I've been given. I will never forget what I've been through, and I want to shout to the world how much life means to me now. Thank you, Kaiser Permanente, and, above all, thank you, Lord, for giving them the skills to provide this care. They are angels to me, and I know there will be a special place in heaven for each and every one who has helped others like me.

---

Changing Patterns
Marlene Jamieson ­ Kaiser Permanente

I've traveled a long distance in the last four months. The mountains of anger and pain have been hard to climb. I sit in an exhausted heap as we plod to the end of group. I came up against turbulent winds, pouring rains, earthquakes, and rivers as wide as the Amazon. I met all these problems head on, overcame the adversity, and kept going.

For me, the progress has been phenomenal. I've discovered the person in myself that had been hidden in the dark corners of my soul. I had never really known me. I didn't really like me very much. I didn't feel normal with the world, as there was always something wrong inside. I've learned strength. I'm very tired from it, but the strength is there.

The natural disasters of my feelings are slowing down. There are still small hills to climb, light winds, and periodic drizzles. I am approaching the lake on the other side of that large mountain, and the water sometimes ripples due to light breezes.

Most of the time the lake is like a mirror reflecting the mountain I have just crossed.

---

Darkness
Russell Lee Watkinson ­ Kaiser Permanente

The enemy is dark. It consumes with fear. We run but can't hide from the darkness. It blocks our thoughts and lets no light in with which to see. I feel nothing and yet want to feel something, anything. I want to see, and as I yearn for this, I see a small faint light seemingly far away. I peer through the dark and the light becomes larger and seemingly closer. I wish for more and it comes. I run towards the light but get no closer, but when I wish it nearer, it draws toward me. I feel its warmth. I can see things, objects, appearing slowly. No, people. There are other people here, and they are also wandering and wondering. Some seem blind. Others can see me and I them, and then I know. I know the darkness is my fear and my ignorance. I can run from it or toward it. I wish for change and almost effortlessly it happens. The others who blink their eyes also see through the darkness, the darkness that is in them and all around them. I don't know myself, but I know I want to understand, but the light is fading, the others are disappearing. I am in darkness once again. The moment of light is gone, and I must start again to work through the thick, black, encompassing, fearful dark.

---

Are You Sitting There?
Russell Lee Watkinson ­ Kaiser Permanente

Are you sitting there waiting for someone, or just relaxing on that bench in the shade?
Don't you love how cool and soft the grass feels under your feet?
Thick, deep green, so relaxing, the sun hides its warmth behind the clouds,
but only for a moment, then it peeks again
and you can feel its warmth.
All the while, you feel a slight breeze that cools you down.
I wonder, would you mind if I sat next to you?
Would you feel nervous or tense?
Maybe I should ask? Maybe not.
Why not? It couldn't hurt to ask, could it?
I wonder what you do for a living?
I see you wearing a suit, your coat folded neatly next to you on the bench
and your socks folded just so, on top of them.
Maybe it's your lunchtime and you want to be alone.
Maybe you're looking for a job and you're resting here, maybe you'd like some company.
Should I talk to you or not? I just don't know.
Go on. Do it. Talk to him.
Just walk right up there and say something.
"Do you have any spare change?"

 

To full contents list >>