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"I've done 3,500 cases and had three leaks in my career," Cox says. "It's a major catastrophe when it does occur." The other two patients with ruptures survived.
The problem apparently was related to Patterson's extreme post-operative thirst. "He drank a large volume of fluid over a very short period of time," Cox says. "That's something I didn't know initially. That caused his stomach pouch to rupture."
It takes up to ten days for the newly stapled stomach to strengthen, Cox says, so patients are asked to take small sips and eat only pureed food. "Even though Marc was completely provided with the information beforehand, he apparently, in his enthusiasm, [went beyond] his capabilities," he says.
Cox said Patterson was being monitored while in intensive care after his first surgery and was provided both food and fluid. "The nursing staff doesn't stand next to the person and say, 'Drink one mouthful.' We count on the person to be educated."
Pineau says he only remembers Patterson being allowed to eat ice chips. If he did drink too much water, Pineau thinks it would have been under the influence of pain medication because Patterson was well-informed about post-operative rules. "I wonder, because they had him on all that morphine, if they had (water) by him, he would just do it without realizing the time span," Pineau says.
"I think it was his personal responses," Cox surmises as to why Patterson would drink too much water. "He was a very enthusiastic person about life in general. If you asked him to get up and walk two feet, he would try to walk six feet. He was trying to be compliant. He was excessive."
Excessive but determined, his friends say. "I honestly think he was at that point where, 'It was this, and it would work, or if it didn't, I don't want to do it anymore,'" says Jeff Reed, Patterson's former roommate.
Patterson never complained to his friends. "There were things he knew he couldn't do, but he was not one of those people who say, 'Get me this,' 'Hand me the remote' -- no more than somebody in their mid-40s who's kind of tired," Reed says.
But as Patterson's back pain worsened and he became less mobile -- at times unable to work at jobs in accounting, bookkeeping, and records management -- his weight continued to rise. Ramona Eastman, Patterson's former boss at a market research firm, says he was frustrated when his first chance at stomach bypass surgery fell through.
"We'd just come in here and have a cup of coffee and sit and look through magazines and chitchat," Pineau recalled about their frequent visits to Barnes & Noble. "He'd get stares. 'Look at that' or "Isn't that disgusting!'" Pineau says his friend never reacted to the comments and didn't talk about it much. But he knew Patterson didn't get several jobs for which he was qualified.
"Obesity is the last area of social stigmatism and discrimination," Cox says. "We are very aware of that. It's looked at as a character flaw. It's not. It's a disease."
Reed says Patterson compensated for his physical appearance with charm. "He learned that if he had a five-minute conversation with them, they wouldn't even look at his weight," he says. Patterson, who was openly gay, found it easier to meet dates through Internet chat rooms for men attracted to large body types. "He entertained at home and would have people come from Tampa, Sarasota, Miami. I don't think he had a close relationship with anybody, but he did date."
Toward the end of his life, Patterson began to depend more on friends for day-to-day tasks, such as carrying groceries. "He wanted to change that," Pineau says. "He wanted to have all the opportunities of being able to be hired, to be in crisp nice clothes and be able to show his résumé and capabilities, and have a new awareness because the whole world all of a sudden would open up."
Pineau is still angry about his friend's death, but he has begun to accept the fact that Patterson himself had accepted the risks of surgery ahead of time. "I didn't see this extra-large person in front of me," Pineau says. "I appreciated him for who and what he was. But I understand this [the operation] was something that was his decision."