Via St Catharines Standard
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Cheryl Harvey has stopped eating. She vomits white foam.
Her medications have not stayed down for days. Without the Zoloft and the Lorazepam, her depression and panic are growing.
It is 3 1/2 months since she had gastric bypass surgery.
Those around Cheryl are concerned.
Is this what it's supposed to be like after the surgery?
"She really bottomed out and couldn't eat anything," says her husband, Don. "We began to suspect the stomach was closed off. Food wasn't going through properly."
He takes her to Hamilton General Hospital. Doctors suspect there
is something wrong with her gastric pouch, but nobody there is an expert. They send her to McMaster University Medical Centre to see a gastrointestinal specialist.
It is decided Cheryl needs to go back to Humber River Regional Hospital in Toronto where she had her bypass.
When she gets there, it is determined there is indeed a problem. She has a stricture. A tightening where her small bowel joins the gastric pouch.
"It's a very minor kind of thing," says Dr. John Hagen, her surgeon. "It happens fairly often and was very mild in Cheryl's case."
Cheryl is operated on for a second time. This procedure is quick. The stricture is opened. Cheryl is sent home the same day. Everyone is relieved when she immediately begins to eat again. For the first time in three weeks, she is able to digest food.
She says she can't feel her feet. They are tingling. Her left one is worse. She is afraid to stand or walk. Cheryl has had a lifelong fear of falling. Now, having gone so long without being able to keep her meds down, Cheryl's anxiety has escalated.
At home in Hamilton, she is unable to make it upstairs to the washroom. Don puts a commode chair in the living room, next to the brown floral couch Cheryl lives on these days.
"I was concerned about her not being able to walk," says Don. "I was afraid she would become an invalid."
On Sept. 14, Don takes Cheryl to the cottage. The quiet will do them some good, he thinks. His sister is with them, visiting from New Brunswick. The problem is, Cheryl is still emotionally distraught. Although she is back on her Zoloft and Lorazepam, they haven't really started taking effect yet. It takes a while for that to happen.
"She got worse after we got to the cottage," Don says. "She reverted to a psychological state she hadn't been in for a long time."
On the evening of Sept. 17, Cheryl is sitting on her walker. She falls off it, onto the floor.
"She has a very, very serious panic attack. She thought she would never get up," says Don. "We had to call the ambulance. It took five men to get her up. There are no handles on people."
Cheryl weighs 267 pounds.
She spends the next two nights in the Haliburton hospital.
Her blood pressure is high and her vision is blurred. For a while, one eye is open, the other shut.
A physiotherapist tries to get Cheryl up and walking. She only succeeds in getting her to a commode chair. Cheryl, too afraid to fall again, refuses to walk.
Doctors in Haliburton contact Dr. Greg Curnew, a cardiologist at Hamilton General Hospital.
It is decided Cheryl needs to be closer to home. Her case is complex. She would benefit from being able to see her family and friends. Don will have support, too.
On Sept. 20, a Thursday, Cheryl is discharged from Haliburton hospital. There is a bed waiting for her at the Hamilton hospital.Don, his sister and a highly agitated Cheryl set out after dark that night for the three-hour drive.
"She had an exaggerated feeling of things happening around her," Don explains. "So driving in a car was bad."
He takes her straight to the hospital.
Cheryl gets up to use the toilet at the hospital, but that's it. She refuses to walk.
"It's like I'm on the outside, watching my life go by," she tells her husband.
On Saturday, her sisters, Mary Lou Ashcroft and Dorothy Hamid, pay her a visit. What they see scares the hell out of them.
"She looked absolutely terrible," Mary Lou says. For the first time since her weight-loss surgery, they fear losing their sister.
"The not walking was a problem," Curnew says."We needed to determine if it was a neurological problem. We had tests scheduled."
On Saturday, Curnew spends 45 minutes at Cheryl's bedside. They chat about her weight and hatch a plan to keep her healthy and on track once she leaves hospital.
"Her spirits were good and she was starting to mobilize," says Curnew, who adds that two-thirds of his cardiac patients have a weight problem. By Monday, the medications seem to be kicking in and Cheryl is a bit more like herself.
"She brightened up a lot over that time," says Don.
It helps, too, that Cheryl has a constant stream of visitors.
Don goes in for the morning, heads back home for lunch, then to his wife's bedside again in the afternoon.Her best friend, Jo-Anne Cairns, is there every day. Sometimes for four or five hours. Cheryl's sisters try to be there for meals. They believe their presence encourages her to eat better.
Today, two weeks before Thanksgiving, the siblings plan for the holiday.
Cheryl, still in her hospital bed, says she wants to host Thanksgiving dinner at her house.
Wednesday, Sept. 26, is shaping up to be a busy day.
Don gets to the hospital early.
At 10 a.m., a new psychiatrist meets with Cheryl. "She had a fabulously long record of Cheryl's history," Don says.
For some reason, nobody has called Dr. Valerie Taylor, who has been Cheryl's psychiatrist for four years. Taylor specializes in obese patients.Cheryl is cheerful. Talking about coming home. Still in bed though. Afraid to get up. She is scheduled for an EMG (electromyography) in the afternoon to look at the nerve action in her legs to find out the cause of the tingling.
At 12:45 p.m. Don slips home for lunch. Just before 2 p.m., the phone rings.
Don knows he and Cheryl are an unlikely couple.
She is 52, he is 66. It is her first marriage, his third. She is loud and boisterous. He is a loner. She, at her heaviest, weighs 421 pounds. He weighs 180 pounds.
"We are two people, poles apart, who complement each other. We mix together to make a whole unit. She was great company.... She was the social side of me. Without her, I didn't have many friends. With her, I had a world of friends."
Don is in awe of his wife. Of the way she can stand up and challenge those around her to pay attention to obesity. The way she calls for caring and compassion.
"For all the strength she had for dealing with politicians and bureaucrats, she has so much vulnerability. She could move mountains even though she was shaking in her boots."
Don answers the phone.
It is a friend, calling from the hospital. Don needs to come back in.
The friend had dropped in for a visit with Cheryl. But her room is full of doctors and nurses. Staff are coaxing Cheryl out of bed. They are trying to get her on her feet after days of lying down.
"If you're not particularly mobile, clots will form," says Curnew. As she struggles to sit up, Cheryl complains of having difficulty breathing. Then she collapses. Her vital signs are lost.
A blood clot, at the top of her right thigh, had broken off and was making its way to her lungs.
"I got there and there was a chaplain in the hall outside her room," Don says, weeping.
"I knew the chaplain was bad news. They were still working on her in the room. So we went to a quiet room at the end of the hall and just waited. It was 10 or 15 minutes before the doctor came in and said they couldn't stop it. They couldn't fix it."
Cheryl anne Harvey died four months and 10 days after having the gastric bypass surgery she hoped would save her life.
When she took her last breath, she had lost 120 pounds.
Cheryl's death is not officially considered a surgical mortality. To qualify for that statistical category, she would have had to die within 30 days of her gastric bypass.
Her death is, however, related to complications from surgery.
"It's so disappointing and so tragic when this happens," says Dr. Hagen, who performed the bypass. Despite the risks involved with the surgery, Hagen still believes it was the best option for Cheryl.
"She would have died a premature death without it," he says. "She'd done spectacularly. She was right on target. But still she was morbidly obese when she died."
"She was the perfect patient."
Dr. Arya Sharma, one of Canada's leading obesity experts who treated Cheryl in Hamilton before her surgery, sees it differently.
"I'm not an advocate for obesity surgery," he says.
Society seems to think the best way to deal with the country's obesity epidemic is to sink more money into gastric bypass procedures. "But the last thing I want to see is surgeons churning out patients with no followup care." "Patients need lifelong followup," he says. "Cheryl is not alone. She died from long-term complications from surgery. We must put out a call for more funding for bariatric care."
Sharma is now based in Edmonton, where he is professor of medicine and chair for cardiovascular obesity research and management at the University of Alberta. He is also the scientific director of the Canadian Obesity Network. Taylor, the psychiatrist, is having dinner with a woman who has started a support group for gastric bypass patients."
"Did you know Cheryl Harvey died?" the woman asks. "Two weeks ago." Taylor hadn't even known Cheryl was hospitalized.
She is so upset, she has to leave the restaurant.
Don says if someone had realized earlier there was a stricture between Cheryl's bowel and her gastric pouch, maybe she would have been able to have it fixed sooner and maybe she would have taken all her meds and maybe she would never have fallen and maybe she would not have spent days lying in a hospital bed developing a fatal blood clot.
But Don is a realist.
"It's like when my two-year-old son died. If any one of 10 different things hadn't happened that day he drowned, he'd be alive now. There is a combination of things happening all the time."
Don does not regret the surgery. Would not try to talk some other morbidly obese person out of it.
"She had to do it as far as I can see," he says simply. "She was probably looking at a dead-end street the other way as well."
"Cheryl had been looking her entire life for a way to help people," Mary Lou says. "But because of her lack of education and her size, she was limited. But this - sharing her story - this, she could run with."
Don gets the final word. He takes a moment. Head in hands. Clearing his throat. Eyes red from crying.
"They say beauty is only skin deep. Well, Cheryl's beauty ran very deep."
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