Dying to Be Thin

Patterson developed one of the most common complications: a rupture

At five feet, eight inches tall, Marc Patterson weighed 570 pounds, more than 3 1/2 times his recommended weight. The 46-year-old Fort Myers man could not fit his morbidly obese frame into a midsize car or standard plus-size clothing. He could not browse through a bookstore without the ridicule of those openly scornful of his appearance.

Patterson was, by his friends' accounts, battered by employment discrimination, public humiliation, and physical exhaustion from the gravity of his own body mass.

But he thought he had found the path to a new life through surgical weight reduction.

His friend of 15 years, Michael Pineau, 41, of Fort Myers, remembers the drive last December across Alligator Alley to Holy Cross Hospital in Fort Lauderdale. Pineau had to rent a large Buick Fifth Avenue to accommodate Patterson's girth.

"I slapped him on his belly and said, 'This is our journey, and when you return to the other side, you're going to be a whole different man,'" Pineau recalls. Patterson had been planning the surgery for more than a year, but Pineau wasn't apprehensive about the risks until that trip. "There was a 1 percent risk factor. What if he was the 1 percent? Is the risk worth it?"

Just three days after undergoing Roux-en-Y stomach bypass surgery on December 6, 2002, Patterson died from complications in the intensive care unit at Holy Cross. His case sheds light on the lonely humiliating struggle against obesity, which is often viewed as a character failure rather than a disease.

As the nation watches celebrities such as weatherman Al Roker, singer Carni Wilson, and actress Roseanne seemingly melt away after undergoing surgeries to transform stomachs into tiny pouches, how many Americans hoping for a quick fix end up, literally, dying to be thin? According to the International Bariatric Surgery Registry, the death rate within a month of surgical treatment for obesity is actually only 0.3 percent, or three of every 1,000 patients (about average for major surgeries). Most of these deaths are caused by pulmonary embolism, respiratory failure, or gastrointestinal leakage.

Risky or not, the Journal of the American Medical Association reports that the market for bariatric surgery, which aggressively changes eating patterns by reducing the capacity of the stomach to about 1/8 of a cup, is huge: an estimated 6 million morbidly obese people in the United States. According to the American Society for Bariatric Surgery in Gainesville, about 103,200 bariatric surgeries will be performed this year, a disproportionate number of them in this state. Executive Director Georgann Mallory says roughly 6,600 will be performed in Florida, where 55 of the society's 860 active surgeon members reside. Statistically, 18 of those Florida patients will die.

One such surgeon, Samuel Cox, points out that the stomach bypass he performed on Patterson -- and about 100 other people last year -- is not a simple cosmetic procedure. He said his patients are counseled in detail about the risks and the required permanent lifestyle changes. "It's entirely devoted to providing for the patient's health," he says. "It's a major commitment on their part. Many, many health problems are corrected as byproducts of the surgery -- diabetes, hypertension, joint wear, sleep apnea, asthma."

In addition to orientation programs, Patterson had to undergo a battery of tests from cardiologists, pulmonologists, psychologists, and more, all of whom recommended the surgery. Cox said Patterson, who consumed four gallons of Coke a day, had a higher potential for death even without the surgery because he was "super morbidly obese," meaning more than 200 pounds overweight.

Despite Pineau's apprehension, Patterson was not put off by the possible complications, including leakage, ruptures, and organ failure. The morbidly obese "look at a piece of paper, and all they see is the reflection of what they want to become," Pineau says. "He was excited and nervous. He said, 'Can you imagine me at 180 pounds?'"

But that moment of triumph was not destined to be.

Immediately after the surgery, Pineau says, Patterson actually felt more discomfort from his long-time back pain from a car accident than from his stapled stomach. "He went from the bed to a chair," Pineau says. "His back pain was so severe he was ready to go out of his mind. So they had to move him back into the bed. It took four to five very strong men to move him."

Patterson was given more pain medication, and soon after, doctors were concerned about his dropping blood pressure and kidney failure. By midafternoon of the second day, Patterson was on dialysis, his blood pressure continued to drop, and he developed a fever. He stabilized enough on the third day to go back into surgery to deal with leakage and infection from intestinal contents spilled into his abdomen.  

"He came out of surgery and was recovering," Pineau says. "Three or four hours after surgery is when -- it was a spooky thing -- I was in the family waiting room. I knew I needed to give him time to come through. I walked up, and just as I pushed the big button and the doors started to open, the monitors went off. It was code blue. It was like a movie."

After doctors tried for more than 20 minutes to revive Patterson, he died from cardiac arrest. He had developed one of the most common complications from the procedure: a rupture.

"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."

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