Fly Girl

I’m all in my feels today. Let me count the ways:

1. I went back to work and I worked three in a row with some of my closest friends. They made it easy on me cuz they are all the strongest of nurses. It’s easy to be in charge when you are surrounded by experienced RNs. We get it done and we laugh while we do it cuz if we ain’t laughin’ we cryin’.

And we aren’t afraid when we are together.

I have now worked on the same unit for the same hospital for 11 years. Some of us take turns being in charge and we train the newer nurses. You can be strong and new, don’t get it twisted. And let’s face it, some people are the ones that run into the fire and some people are the ones that are more cautious. It’s good to be a little of both when you are an RN, to be real. Even when you are new. So although they all worked harder than me, overall it was a good weekend. People were still smiling at the end and once again my tattoos broke the ice in a difficult situation and I like that. They give me street cred and something to talk about with someone I might have very little in common with- aside from our tattoos.

Being a nurse fills my cup when we do it right.

2. This morning I weighed 185 lbs. with a BMI of 31.8. By definition, anything above 30 is Obese. I’m still obese and I hate that fucking word. I have been obese almost my entire adult life. When I lose 11 more pounds I will no longer be the O word. And that, my friends, gets me all emotional.

Those of us that are heavier people but have also been relatively healthy know that BMI alone is a poor gauge of health. It’s bullshit, really. But every time you go to the doctor, they calculate it. Hell, they don’t even have to calculate it, the computer does it for them as soon as they enter your weight. They use this measurement against you, to decide if you are worthy of praise or if you need counseling. Some MDs feel the need to discuss healthy lifestyle choices at every appointment, even if you are there for a sinus infection. I literally had a dermatologist tell me “you are a beautiful woman, you just need to lose weight.” This was said to me after I stood in front of the old white man naked, for him to inspect my skin for signs of skin cancer- at a time when I couldn’t even look at myself naked in the mirror. Vulnerable. Ashamed. Disgusted. Embarrassed. Judged. And then shamed by him. Insulted. Demeaned. Sexualized. Violated. By an old white man who was supposed to keep me safe. I should have reported him. Asshole.

So, as much as I would like to tell the inventor of the BMI to fuck right off, it’s stigma has some meaning to me. 11 more pounds will bring my BMI below 30, and although that’s still considered “overweight,” it’s not “obese.” When being obese has just been part of who you are, it seems unattainable to blast through that definition and no longer associate it with your own descriptors. To take it out of your own vocabulary, the one that tells your story.

So, I am 11 pounds away from what has seemed an unattainable goal for all these years. And the idea that with the help of my doctor and science and plastic surgery and my own effort I may actually get to that elusive place seems big. It seems monumental to me. It still seems unreal, though.

I’m scared.

I’m afraid that none of this weight loss will stick. I’m afraid that at the end of June when my Eli Lilly coupon for Mounjaro expires, that I won’t be able to get my insurance to cover the only tolerable medication that has ever been able to really help me. I’m afraid that I gave in to my own resolution to never starve myself again and to accept my plus size body the way it was after plastic surgery and to stop beating myself up about a fucking number that has defined me even though I should be strong enough to not give a fuck. Even though I should love this body no matter it’s size or shape.

I am afraid of gaining it all back and feeling like shit again. Like I have every other time I have lost any significant amount of weight.

This time it’s supposed to be different because the science has proven that obesity is a chronic disease that should be treated as such. Even the American Medical Association classified obesity as a chronic disease back in 2013, and yet a majority of doctors and insurance plans still don’t recognize it as such. They still don’t recognize that for some people it takes more than diet and exercise to win the battle. To maintain the loss over time. To fix a broken brain. To give someone like me the power to control my cravings and quiet the “food noise” and ignore the psychological drive for filling my body with too many calories in a fucked up attempt at filling the emptiness of that little girl lost.

Run, little girl, run.

I’m afraid that even though I am more consistently active than I have been since I was in my 20’s, and I know how to feed my body and have portion control and make good choices, that those things alone will not be enough to maintain this loss. Because it was never enough before Mounjaro. Not for me, anyway. Will power can fuck right off.

So, I have to put my trust into Dr. Spielvogel and hope he writes the best gotdamn request for prior authorization he has ever written and that the right person evaluates it at my insurance company. And if they deny it this time, as they did the first time, I have to trust that Dr. Spielvogel will write an even better request for prior auth on appeal and a more educated and empathetic person approves it because I have jumped through all the hoops. I have paid all the dues. And I have done all the work.

My list is long. Back in 2010 Dr. Ramos diagnosed me with PCOS and pre-diabetes, with labs that showed my hyperinsulinemia and insulin resistance. He put me on Metformin, and I took it for two months in an attempt to get past the debilitating gastrointestinal side effects. I had abdominal cramping and gas, nausea and vomiting. I had to stop taking it, with no back up plan. Over the years I have taken so many drugs for weight loss, and they were either intolerable or not safe to take long term. I have taken Phen-Fen, phentermine alone, Meridia, Topamax, Qsymia, Contrave, metformin, Wellbutrin. I have done Weight Watchers, over and over again, never reaching my “goal weight.” I have done every diet under the sun: Atkins, Beach Diet, HCG, Jenny Craig, Dr. Hernreid’s protein shake aka starvation diet. And let’s not forget that elevated a1C that for years has been in the pre-diabetic range. I have several family members with diabetes. I do not want diabetes, nobody does. Mounjaro has helped to lower my a1C, showing that my glucose levels over a three month period are lowered by taking it. I am no longer pre-diabetic, on Mounjaro. My risk factors for so many other chronic diseases have been significantly lowered by this weight loss. If one medication and it’s effects can decrease the risk of heart disease, hypertension, diabetes, joint injuries, and more importantly, detrimental self hatred aka self inflicted psychological abuse, why wouldn’t our insurance companies see the huge fiscal impact one medication can make? Why are they continuing to ignore the science in justification for denial of coverage? It just doesn’t make sense anymore.

Have we come a long way, baby?

Or have we not?

I really like this new feeling of lightness I carry with me wherever I go. I finally feel normal, or at least what I always thought “normal”would feel like. But that feeling is contingent and fleeting, and I’m just trying to hold on for dear life.

So let’s hope my health insurance gets with the program. It’s literally called “health insurance” so why doesn’t it ensure my health by covering this particular medication?

3. As I sit in my hot tub, all alone, in my beautiful backyard that I paid for with my little ol’ Associate Degree job, I am grateful. Grateful to live in California where nurses are valued and paid well. Grateful that I can choose to be surrounded by friends that are like family or be completely alone and content. Grateful for social media as a means to express myself and fill my empty nester time instead of wallowing in the misery of my children’s absence. Even though their absence is the hallmark of their growth and my accomplishments as a good mom, sadness could prevail if I let it. I miss them and yet, I was a steadfast and present mother, and it’s my fault they left. I was a foundation builder and they jumped off into the sort-of-unknown, but with a great big safety net.

So go ahead and jump off. We meant to do that. I am just going to keep myself busy by living out loud without the shame of a lifetime. I’m going to be who I always was but lacked the confidence to be.

Fake it til you make it and then be as you are.

And I am grateful for this blog as a replacement for talk therapy and as a means to let go of the shame I have been burdened with, whether I write about my traumatic GenX childhood or of my plastic surgery or weight loss or my own personal growth. If I write it and post it I don’t have to keep telling the same story over and over again, to a therapist that can’t fix it no matter how many times I tell it. If I write it and post it and you read it, my truth is validated and I am set free.

And I fly.