I thought that as a surgeon I might be able to help with this issue of death. Believe me, I am also in a very real way helping myself. I find that the idea of going under the knife, as we call it, the most frightening thing I have ever contemplated.
I have done hundreds of amputations on diabetics. They often come into the hospital very sick, often with gas gangrene, and with very little choice as to how much is coming off. Often they end up with no leg. And down the road, they inevitable lose their other leg, develop kidney disease, lose their sight, become very debilitated and eventually die. I have seen numerous patients who I have become friendly with pass in their fifth decade of life.
I have started to become diabetic. All because I have a BMI of 67. I have watched my life slowly become less and less of a life as my weight has gone up along with debilitating comorbidities. I have become more and more a spectator, and less and less a player. The idea that I am heading to becoming a salami for some surgeon like myself is also an overriding fear. I understand that I am at that upper end of the scale for obesity, so my medical condition demands radical answers and very fast. That is why I am opting for what I consider the last chance I will ever have to get my life back.
Regardless of individual circumstances, I believe the reasons for having the surgery are pretty much the same for all of us. We want to live. Not watch, not be excused, not be compensated for, not be laughed at, not be loved, not be a slave to a substance, not be embarrassed for our addiction and loss of control, and not to succumb to the depression, the debilitation, and inevitable consequences of obesity. It's human nature to strive to fight nature, fix what's broken, struggle to get to the surface, and choose life over death. That is why we take the CHANCE.
Picking a surgeon is defiantly the same for all of us. Part of the surgical consent we all will sign will come a written and spoken admission by the medical community that we can die from complications due to surgery. As I explain to my patients so they understand fully, that if everything goes wrong, they can even die from a cut by a kitchen knife. It's unlikely, but it can happen. And I also add that there are no guarantee's of success. I'll do what needs to be done, your body, fate, and time will determine the end results. I'm not a magician, I can't make you 16 again, but I have the experience and expertise to do the job, I care, and I will do my very best. If they sign the consent I believe that the patient and I have a deal. I'll bust my butt doing everything for the patient to give him a successful outcome, and he has chosen to take the CHANCE with me. It's called a doctor patient relationship. I often tell my residents that it is the man with the knife who is the state of medical art for the patient. Maybe off in the distance somewhere there might be better place or surgeon, but once the surgery begins you are going to be the best that is ever going to be. You and the patient have this relationship to take this CHANCE, and work together toward a successful outcome.
Well, none of us want to die, all of us want to reduce our risk, and none of us are going to get any guarantee. We are all going to take that Chance. My advice toward getting as close to the best CHANCE is as follows. In this day and age, it is harder to find a poor surgeon at any major medical center. That in no way means that you won't find a really competent practitioner at a small medical center, but a major medical center has a lot more fail safes, if you will, for avoiding less accomplished practitioners. Also, major medical centers have all the other medical fields available if you need them, and fast. No good surgeon will give you any guarantee of success.... If he does....run. No good surgeon will in any way deter you from getting a second opinion. In the surgeons mind your satisfaction that the right procedure is being done is more important than who is doing it. A good surgeon knows that having the procedure done by someone you trust is also more important than weather or not he personally is the one. No good surgeon will mind you asking how many procedures he has done, or over what period of time. I personally like to see a surgeon with a good hundred procedures behind him. Although with the high learning curve the LAP procedures have, I may want to see five hundred or so. A good surgeon won't mind telling you how many deaths he has had and why. It seems to me that one death over four or five years should be about right given he does average patients at 100 cases or so per year. However if he does patients with higher comorbidities than normal he could have a higher number and still be extremely competent. You are going to have to listen to his reasons and make your own judgment. If it is something the patient did, well ask him what it was so you don't do it too. If it was a complication ask him what modification he has taken to make sure it doesn't happen again. He will be willing to give you referrals from patients who he was successful with and some he wasn't. If both patients trusted him they won't blame him and be honest with the limitations of the procedure. A good surgeon should be able to explain the whole procedure to you and why he chooses to do what he does to your satisfaction. The moral demands of our society make it necessary that you know everything that you are getting into and what the complication are. There are a lot of different decisions he is going to make during the procedure. He has his own way of doing the procedure based on what works for him. But he should be able to explain why he champions the procedure he chooses and why he is not in favor of other procedures. And it is perfectly all right for him to say he doesn't know how to do another procedure... If you want the other procedure, find someone who does it. He should be able to give you data. Legitimate published studies in medical and surgical journals that have been done. I look for five year or more outcome studies...having published these myself ..... They are the most reliable out there. Ask for them. Have someone translate the data for you if you don't understand it. If your surgeon has changed the procedure he does he needs to produce reasons why and back them up with statistical data or explain to you that he is using a new procedure that "HE" thinks will work better. Then it's up to you. I hate to let you into a little secrete of surgery.....They don't all work. Sometimes for reasons surgeons don't know. As a surgeon I will also tell you, we don't know everything. We are confident that we can help, proud that we do help, but we can't guarantee any outcome. But we owe it to you to give you everything and anything we can. And we must care.
In picking a surgeon I look for three things. First, does the surgeon understand my problem? Second, does he care that I have this problem and understand what I am going through. Third, does he think he is the one who can help me. You have to be aware that this is a CHANCE, a good chance. A CHANCE that you need to take, in a way like going out in the car for groceries. What you need to believe is that the surgeon will do his best and give me everything society and modern medicine has to offer right up to the moment of death. You need to trust that if anything goes wrong, your surgeon will be there giving his or her best.
Once you have formed your doctor patient relationship, trust that he understand your problem, cares about you, feels that he has the solution, has given you answers you trust, helped you to understand the procedure and why he is doing what he is doing, and again you trust him, then you take the CHANCE.
For me, I have chosen DR Patty Byres, at Jackson Memorial Hospital, in Miami. It's the largest medical center in the Southeast. Lots of medical specialties if I need them. Are there more prestigious places...yes. But I really want to be close to home. In my fear I want to wake up and see my kids faces very badly. Dr. Byres is a trauma surgeon who has been doing this for years, has a large number of surgeries to her credit, has done cases far worse than mine, she does open RNY, has explained to me her reasons why to my satisfaction, and has gotten across to me that she understands my problem and what I am going through, cares for me, and has the answer. I also work in the same medical center area and have access to her residents, anesthesiologists, and fellow surgeons who have seen her work and all recommend her without reservation. Are there better surgeons who do a better procedure? Maybe. But in my scared to death, anxious, depressed, Prozaced out mind, I feel that she will do her best and go to any lengths for me. DR Byres will be the state of medical art for me. I am going to take my CHANCE with her.
Well, that's my opinion