Discerning readers will vaguely recall that I had my first heart attack the day before last New Year’s Eve. This surprised absolutely nobody, as my BMI is pushing 50 the way those guys on the Tokyo subways cram in the commuters. It wasn’t a BIG heart attack, feeling more like recalcitrant indigestion, but when they got inside with the widdy-bitty camera, my right coronary artery was 95% blocked. A little bit of titanium fixed that mo-fo, but in the recovery room, a nurse shared that they called situations like mine “One cheeseburger away.” (Hear that, Elizabeth? I’m comin’ to join ya, honey!)

Since then I have been on three new meds and had the dosage cranked on the Lipitor. And I’ve felt fine, except for a rather Victorian over-attention to my heart. I went in to see the cardiologist for the six-ish month check-in this Monday expecting only to possibly be released from a pill or two.

Instead, he scolded me for letting the baby aspirin lapse, and told me I was taking it for the rest of my life. And while he was on the topic of “the rest of my life,” he in so many words intimated that it would be a short story unless . . .

“Have you ever thought of bariatric surgery?”

Now, every fat person in the Western world has at least thought about it, so I parried by sharing my PCP’s aversion to the practice. (Malabsorption issues.) The cardiologist pooh-poohed this; said they had that under control, and went down the list: Diabetes, high blood pressure, high cholesterol, and the ever-looming sin of having a heart-attack at only 54.

Now, I am something of a fat activist. People were saying stupid stuff to me about my weight back when I was only 170, which is a hundred pounds or so ago. *I* was saying stupid stuff to myself back when I was in high school, at 129. I got tired of it after I had the kids and found that the baby weight had come to stay. So I left myself alone about it–started buying jeans that actually fit instead of jamming myself into a number that I thought was more reasonable than reality. I started being nicer to myself, which was groovy, seeing as sporadic attempts to Do Something about it kept putting another several pounds on, topped with the five I picked up from being sidelined by the double knee replacement last year.

I now weigh 274; been told I carry it well, but apparently my coronary artery wasn’t listening to the compliments.

The cardiologist, a former Marine, doesn’t do bullshit, but he doesn’t do fat-bashing, either. He was just laying out the facts, and this week I heard him. (It didn’t hurt that the podiatrist told me last week that my clumsy attempt to continue cutting my own toenails wasn’t gonna fly and I had to leave it to the professionals, ’cause I can’t really reach them anymore.)

I got referred to Local Hospital, which my insurance told me was out of network, and then went to (sigh) Beth Israel, where I had my knees done, so at least I know them there.

I discovered that the road to bariatric weight loss is long and dotted with hurdles: Mandatory info sessions. Psychologists. Social workers. And of course nutritionists and exercise physiologists and about a billion nurses. I need to have tried (failed) at least two formal attempts to lose weight. This is a bit of a sticking point for me, as I’ve never done Weight Watchers or fen-phen or any other fad, because I already knew what the surgery people posted in their PowerPoint: Only 5% of the people who do them succeed. At least I had a little time with a personal trainer. Sigh.

I don’t know how this story ends, but that’s the sitch whenever I begin a new book, so I guess we’ll have to wait and see. A big part of me wants to hide under the covers and pretend it’s not happening, but I know I need to be really social about this and have support. (Besides, it’s a Rule of the Blogosphere.)

Next stop for Beth Israel: I join a “new patient group.” Next stop for me: I tell my PCP on Monday. Yeep.