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IMPORTANT: Book not to scale. Cakes sold separately. Offer may be void in anti-cake regimes worldwide.
[Lesley wrote this beautiful and important book. I had such a hard time picking an excerpt of it to run here, because every bit of it is so excerpt-worthy. So the wise Lesley helped me decide on this bit (I am in England right now, so excuse the Britishisms, you lot). I hope you will all read the rest of the fantastic Two Whole Cakes and get as much out of it as I did. --Jane]
In January of 2001, I was beginning the final semester of my first master’s degree. One wintry eve late in the month, I started to feel unwell. Six hours later I was in such indescribable, excruciating pain that I thought I was dying. Or else about to end a brief sojourn as host to a baby alien growing inside the right upper quadrant of my torso. Having spent several hours vomiting bile and doubled over in an unusually precise sensation of abdominal pain, I finally realized something was very wrong. Around six that morning, I woke my partner and told him to take me to the hospital. I was seen right away. The emergency room doctor took one withering look at me, curtly pronounced the culprit as “gastroenteritis,” and left. I knew he was wrong but lacked the ability to argue. I spent a few hours being rehydrated by IV, the doctor visibly annoyed by my insistence on vomiting up even water. It’s just gastroenteritis, you big baby, I imagined him thinking, disgusted.
I went to my primary care doctor the following week to discover what had really happened. She sent me for an ultrasound, and there I saw my blurry gallbladder, filled with stones rattling around like bits of gravel as I shifted position per the instructions of the ultrasound technician. It gives me a shiver even to remember it—there is an unnamable horror that goes along with seeing things happening inside your own body, things going awry that you cannot control. So it was gallstones. The gallbladder had to come out.
I was confused by my apparent need to exorcise my gallbladder. I was young, only 24 years old, and gallbladder problems requiring surgery are uncommon in those under 60. I was a strict vegetarian and had been for several years, and vegetarians virtually never get gallstones (fiber is an enemy of gallstones, and the typical vegetarian diet is fiber heavy; diets high in animal fat and cholesterol are gallstone-friendly, and vegetarians consume little or no animal-based foods). The only clue as to the cause of my condition came from a nurse who asked, “Have you done a lot of dieting?” The answer was yes.
Due to the vulgarities of health insurance, I could not have this procedure done in Boston, where I was attending that all-important final semester of my master’s program, without which I would not get my degree. I had to have the surgery done in Florida, where my father still lived, off whose health insurance I was sponging as a full-time graduate student. I needed to graduate on time, so I would have to wait to have my gallbladder exorcised until the semester was over. I would have to live with this problem for four months, which required me to learn what it was that angered my rogue gallbladder and avoid those things at all costs.
Turns out, there are many foods that can upset dodgy gallbladders, and they are often different for every body. Dietary fat is often a common culprit, as the gallbladder is the body’s bile warehouse, and bile is instrumental for the digestion of fats. Thus, when we eat fatty foods, the gallbladder gets worked up, and if you have the misfortune of playing host to a sadistic jerk of a gallbladder, pain of varying degrees can result. Hence, the thing that most enraged my gallbladder was, predictably, fat. As a vegetarian the only fats I ate were plant-based, but apparently that was also a problem. It was, in fact, a meal of zucchini roasted with a bit of olive oil that triggered the first attack. While my gallbladder could peacefully abide the fat on my body, it violently revolted against any fat I swallowed, inhaled, absorbed, or otherwise inserted into my digestive tract. This much was clear.
I don’t exaggerate when I describe how painful this first attack was. It was a memorable pain. The kind of pain where one longs for unconsciousness. Seared-into-your-mind-for-all-time pain. Later, I would observe that I’d always assumed there was a limit to the degree of pain a person can feel before they pass out. This limit may well exist, but it is much less conservative than I had thought. The memory of that pain is no small thing.
Because I so desperately feared a repeat performance of what brought me to the emergency room, I decided that for the next four months I would go on the most fat-restrictive diet I could muster. I would eat no fat at all. I subsisted for that period on apples, potatoes, brown rice, various beans and legumes, and tomato-and-lettuce sandwiches on fat-free bread with fat-free mayonnaise. I fell back into the routine of food restriction easily, robotically, as though the programming was still there, the discipline had never left. It was merely waiting to be reactivated.
I was always a very good dieter, at least until my efforts stopped producing a measureable effect. In this case, however, the desired outcome was not weight loss, but rather a lack of debilitating pain. With that for motivation, I was monk-like in my restriction: dedicated, single-minded, chop wood, carry water, eat before you pass out. I ate as little as possible and what I did eat was swallowed with all the pleasure of shoveling coal into a furnace. I ate purely for the purpose of surviving long enough to have my surgery and regain the ability to eat normally again.
I finished my degree four months later. I went to Florida the following day.
I arrived at the hospital in the morning and underwent the necessary preparations. There was an unexpected delay, during which I lay in the pre-surgery ward for two hours, terrified, wearing only a hospital gown, my resolve melting, my partner trying to keep me engaged, a nurse having drugged me with something—valium?—that she said would make me feel as though I’d had a glass of wine. It did make me drowsy, but my anxiety skyrocketed, adrenaline surging, realizing if I had to fight my way out of the hospital (I might!) then it would be all the more difficult to do with this slow muck in my veins. (When she came around with the syringe a second time, I declined.)
Eventually I had to go to the bathroom, and there I was, a freeze-frame from a million sitcoms, wobbling unsteadily down a corridor, carrying my IV bag in one hand and with my bare-ass behind swinging in the sterile air, defying the weak protestations of the open-backed hospital robe.
My partner helped me, but stopped at the bathroom door to give me some privacy. I did my business and when I rose to flush I realized I’d been holding the IV bag too low, causing my blood to back up into the long and narrow connecting tube running from the back of my hand to the bag of fluid, turning it from clear and antiseptic to red-black and ominous. I nearly lost my bearings then, seeing my blood snaking in wisps into that IV bag. I opened the door and told my partner, “I messed it up,” or something like that and then wordlessly showed him the tube with my blood in it, where it wasn’t supposed to go. My partner gallantly took the IV bag from me and hefted it high, and my blood came back in. he walked me back to the hospital bed where I would continue to wait.
There was a point, minutes before they brought me in for the surgery, at which I could not manage my fear and rage anymore, and I cried. I said, “Why can’t they just get on with it?”
The anesthesiologist, whom I’d met a few days before, told me that once I was put under, there’d be no time, no awareness. I’d had tubes in my ears twice as a kid, and I remembered the vivid dreams I had during those minor procedures. But no, with this sort of anesthesia there’d be none of that. He said, “It will feel as though you’ve just closed your eyes, and then opened them again.”
They wheeled me down the hall to the operating room. Things seemed to go very fast, and I felt very slow. The mask came down; it wasn’t secure on my face and I tried to tell him, “It’s not...”
I closed my eyes.
I opened my eyes.
Well, except I didn’t. I tried to open them but couldn’t; they were taped shut. My eyes rolled fruitlessly against my eyelids, and I could hear the room, and had an odd sensory awareness of the space, but I could not move anything else. I spiked into a terrible panic and immediately heard multiple voices telling me to calm down. It’s just the anesthesia. I couldn’t listen; clearly they didn’t understand that I couldn’t fucking move and if anything was worth panicking over, that was. But then, all at once, I could feel my muscles again.
It was only after they’d wheeled me out of the operating room that I realized the surgery must be over.
In recovery, they brought me ice and a giant white elastic band, at least ten inches wide, to wrap around and compress my midsection. It was too small, far too small, but the nurse heaved and pulled—me apologizing groggily as she did so (for my girth? my inability to assist?)—and she managed to secure it. Velcro. Another nurse came by and noted that the compression band seemed to be too small. I murmured, “I doubt I am the fattest person ever to have my gallbladder removed.” She said they’d find me a larger one, but she never came back.
My throat hurt. Someone mentioned that it was because of the tube. Why did they put a tube in my throat, I wondered. I was beginning to grasp that my body had gone on some strange adventure without me. My brain choked off, my voice eclipsed. A heap of meat on an operating table, one in an assembly line of common surgeries.
I’d begun to look at fat politics four years prior to this surgery. It’s been a long process, and if it’s not a long process for you then you may be doing it wrong, or else you just may not realize when it began. I had stopped trying to lose weight. I had come to love myself, uneasily, and to live in a truce with my body, if not in contentment or pleasure. I was tolerant of my body; we shared a loveless marriage that was nevertheless comfortable and secure.
But lying in the recovery ward, I realized these things had happened to my body and I hadn’t been there. It was as though the whole of my history of body-hatred and self-punishment rose up on me like a towering black monolith, all at once, and I came to realize the immensity of the damage I’d done, the disdain I’d held for myself, my body, my health, during my years of self-induced deprivation. The only real risk factor I had for the gallstones was a long history of weight cycling and yo-yo dieting. I thought, What did I do all that for? Why did I work so hard to beat up the awesome vessel that brings me to the world?
My surgery was straightforward and complication-free. I had expected, hilariously in retrospect, that this was an outpatient procedure, that I’d have the surgery and a few hours later I would go home. I don’t know why I believed this. I don’t know why no one corrected me beforehand. I was never told anything, in advance or after, about what to expect and I never asked.
Overnight I would face gruesome pain as the anesthesia wore off, but my pain tolerance is legendary and I knew that all I had to do was hang on until the morning. My partner stayed with me, sleeping uncomfortably in a chair beside my bed, heroically ignoring his own fear of hospitals born of childhood operations. I could be strong for him. I watched television. When it got so late that nothing was on, I read Maya Angelou’s "I Know Why the Caged Bird Sings" for the first time, straight through, and when I finally nodded into light sleep I dreamed of my gallbladder literally sprouting wings and taking flight from the cage of my body.
Around 10:30 that morning, a little more than twenty-four hours after I’d arrived, I was sent home to my father’s house to convalesce for a full week, which I did with all the patience and care that you might expect—that is, none at all. But I healed and returned to my home in Boston and, most importantly, returned to eating normally.
I had a follow-up appointment with my local primary care doctor a couple of weeks following the surgery, by which point I’d been easing myself back into eating my usual array of foods—cheese had never tasted so good. I attended the appointment like the dutiful patient I am, but it was primarily because I was curious about one thing: I wanted to see how much weight I had lost on the gallbladder diet. I presumed that four months of extreme restriction had to count for something and I was curious to see what effects the most radical diet of my life would have. I was aware of the little self-destructive impulses this sort of thinking fired off in my brain but I ignored them. I had to have lost weight, surely! I mentioned this to my doctor as I approached the scale. She smiled and nodded and I stepped up.
I’d lost three pounds.
Four months of the most restrictive diet, a diet conceived in terrifying pain and reinforced by the fear of that pain being inflicted again. A diet I did not even for a moment contemplate cheating on, or deviating from. Three pounds. It wasn’t that the diet should have “worked.” It was that I still believed it would work for me. I still thought I could diet myself skinny, if I just had the discipline to do it. But those three pounds were a revelation—it was in that instant that everything crystallized. I got it. I got fat politics, like some folks get religion. All at once. I see it now. I am fat.
And as this realization was swirling around in my head, I could hear my doctor speaking, as though she was far away, her voice saying brightly, “Well, I think that’s a great start on the road you have ahead of you.” The road to slenderness, to a “normal” body. But I was off to a different start.
I still feel sad for my gallbladder, a lost child forever wandering the bodily organ version of Neverland, maybe hand-in-hand (duct-in-duct?) with the other innocent gallbladders parted from their abdominal homes too soon. I never meant to hurt myself so badly. At the time I thought of my compulsive crash diets as open-handed slaps to my hated fatness, not the kind of deep trauma that could ever result in long-term damage. I made mistakes. I suffered the consequences.
More than that, however, I emerged from this experience more ferociously in favor of body acceptance and self-love than ever before. I felt, vividly, the importance of owning one’s body and living in it fully, and realized that all the abuse we heap upon ourselves does take a toll, be it emotional or physical. I came to understand for the first time ever the importance of being healthy, and I don’t mean the universalizing and troubling concept of “diet conscious” our culture currently prefers, but the kind of healthy that encourages and cultivates a knowledge and awareness of your unique body and what it can be reasonably asked to do, and to never feel shame if your body does not operate by the same rules as someone else’s body. I’m talking about a "healthy" that is rooted in self-determination and individual autonomy, and is thus applicable to a spectrum of bodies, including professional athletes, cancer survivors, gym rats, the doctor-phobic, the poor, joggers, and folks with a limited supply of spoons, a healthy that excludes no one and that is specific and relative to the individual.
Why did I starve myself? Why did I diet? Why did I relish deprivation as the source of my salvation? Because I thought it would make me happy. It did not. It took a childhood and adolescence of failed diets and a surgery that I might have avoided to make me see that this was not the road to contentment. It was a vicious cycle of the same shit, the same failures, the same guilt over and over again, never going anywhere but around and around.
Finally, I was able to say: no more.