March 22, 2006 - As Erich Covey drifted to sleep, the green-masked woman who was stroking his hand told him, "You're going to be really good. This is going to make a really huge difference in your life."
Covey was about to have gastric bypass surgery, a procedure that often is a patient's last hope for achieving freedom from serious weight-related health problems. The surgery promised immediate recovery from Covey's hard-to-control diabetes, but it also came with risks and required major lifestyle changes.
"I want to run away from it, and I want to run into it," Covey had said two days before Gayle Duke, the bariatric surgery coordinator at his Northwest-based hospital, had offered reassurance in the operating room.
Northwest Medical Center La Cholla is the only spot in Southern Arizona that offers weight-loss surgery, and it does a rousing business with often four surgeries a week. In about three years, 231 patients there have had their stomachs surgically reduced. Before the procedures became available in 2003, prospective bariatric patients had to drive to Phoenix.
Tucson's entry into the field of weight-loss surgery makes sense given that the demand for it has increased steadily. In 1999, about 30,000 were performed nationally. Last year, that number grew to more than 175,000. One reason for the growing demand is that new techniques developed in the past decade make the procedures minimally invasive.
As hospital employees who work with bariatric patients learn, though, weight-loss surgery is not simply an easy out for people who don't have the self-discipline to diet. Patients undergo a series of tests on their hearts, lungs and even psyches to qualify, because insurance companies want assurance that their financial investment will not be in vain.
"Even patients that don't have to get approved through insurance have to go through all the criteria," Duke said. "So it isn't that you just show up and say, 'I think I want that surgery.'"
After weight-loss surgery, which has a mortality rate of anywhere from .5 to 2 percent, patients have to reinvent the ways they eat, switching to several fist-size meals throughout the day and cutting out foods that, because of the surgery, make them sick.
Dana Rambow, a Tucson nurse and entrepreneur, decided to have the surgery several years ago in Phoenix. Although her weight wasn't causing serious health problems at age 49, she assumed that would come, and she wanted the surgery while she still had health on her side.
She has had to adapt to not being able to eat raw vegetables because they irritate her new fist-size stomach. She can't eat a dry pork chop, a course of swordfish or any food too dense or fibrous. She can't handle much sugar, and she must take small bites and concentrate on chewing or she gets sick.
"I know if I don't stop and let it filter through, I will definitely throw up," she said.
Despite the hassle of having to focus much attention on her delicate digestive system although she runs a small business and is on the go, Rambow said the surgery radically improved her life.
Back when going anywhere meant lugging around more than 400 pounds, she had to opt out of skiing and scuba-diving adventures with her family. Life is much easier, she has found, when you're carrying only 170 pounds.
"I lost an entire person," she said. "If you had to have that person draped over your back and had to carry them up stairs or fit them into a tiny chair with you, all those things would limit you."
Rambow said she has become an enthusiastic advocate of the surgery, though as a nurse she's well aware of its risks. As someone genetically predisposed to have weight-related health problems, she now sees the other side of how life can be.
"I have to really curb my own enthusiasm about it," she said. "I want to go up and tell every morbidly obese person I see about it, but I don't want to offend them. So I talk about it in their presence. If they're interested, they will ask questions."
Rambow's sister, Marilyn Jacobson, also had the surgery and went from 300 to 120 pounds. She said people used to remark that her thin children looked just like her thin husband, and now they say her children look like her.
Patients who undergo weight-loss surgery at NMC La Cholla find a bariatric department that is designed to make them comfortable before and after their procedures.
The hospital renovated six rooms to make their patients comfortable, giving them showers instead of tubs for easy access, beds with extra room, and no roommate. The patients encounter armless chairs everywhere they go, and their gowns are roomier, as well.
"The last thing we wanted was one last humiliation of things hanging out in the back," said Duke, who knows about weight-loss surgery intimately because she has gone through it herself. "The hospital went to great lengths to make sure these patients are taken care of."
After the surgery, which requires just three incisions on the abdomen so surgical equipment - including a tiny camera - can slide through, patients quickly lose their dependence on a cornucopia of medications.
Complications of being excessively overweight include diabetes, dangerously high cholesterol and blood pressure, arthritis and sleep apnea, a condition that causes people to stop breathing while asleep. Many overweight people sleep with machines that prevent them from ceasing to breathe altogether when they develop this problem.
James Leos, a Tucson resident who had the surgery done several months ago at NMC La Cholla, was taking medicine for blood pressure, cholesterol and diabetes before the procedure.
Leos, who had never been overweight until he had to face the emotional stress of his sister's death, had tried every combination of diet and exercise but he couldn't lose weight. Now he takes no medications, save the vitamins that must be taken after the surgery because the body absorbs nutrients differently than before.
He has gone from 286 pounds at the time of the surgery in November to 200 pounds.
A dietician will be around to answer any questions Leos has as he continues to adapt to a smaller stomach. He and others who have the surgery will find, Duke said, that the stomach stretches, and changes in eating habits must stick or the weight will come back.
"At first it's 90 percent surgery and 10 percent you, and then later it's the other way around," Duke said.
Post-operation patients can attend a support group that holds healthy potlucks and invites speakers to talk about questions that come up after the surgeries. It invites plastic surgeons to talk about options for tightening stretched skin and plays host to a clothing swap, since its members lose weight rapidly.
Also, Duke still checks up on patients years after the surgery.
"I need them to know we really care how they do," Duke said.