Big Data Is Coming to Take Your Health Insurance

Hey people! I’m back to business, with a new Bloomberg View column about healthcare:

Big Data Is Coming to Take Your Health Insurance

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Update: off pain meds!

I’m happy to report I’m off pain meds, which makes thinking enormously easier. I want to share observations and comments I’ve accumulated while high over the past week before I forget them:

1. Pain

  • There are lots of online resources, like this one, which tell you what to expect after bariatric sleeve surgery. When they talk about pain, they get everything wrong.
  • In particular, they act like the five little incisions on your tummy that correspond to the laparoscopic tools entry points (and ex-stomach parts exit point) are the main sources of pain.
  • WRONG! In the past week, I have experienced no pain from my incisions except one time when I was turning over badly at night.
  • The vast majority of my pain, say 99.5% of it, came from the insides. Namely, I had most of my stomach yanked out and the remainder tied together with twine. All of my nerves inside my body are well aware of this fact and stayed busy for at least five days continuously notifying me of this act of brutality.
  • So, long story short, the first real observation about my bariatric sleeve surgery is this: it’s a crude and unsparing act.
  • I think, when you first hear about it, you know that. But then you get used to thinking about it, and you hear the risks are low, and that it’s laparoscopic, and that you only stay in the hospital one day, and you end up – or I ended up – thinking it was no big deal. And websites telling you your incisions will be slightly sore don’t help. But friends, I know better now. This is for real.
  • Also, it’s possible that other people don’t have tons of nerve endings in their insides like I do and actually only feel pain on their tummy incisions. Good for them. They’re the same assholes who talk about how they orgasmed during childbirth.
  • But I think the actual situation is that those websites are written by people who haven’t actually experiences the surgery themselves.

2. Regret

  • Next observation: I don’t think I’ll regret this.
  • I had moments, especially right before I went in to surgery, where I was thinking, why would I put myself at risk like this?
  • I also had moments, especially when I got home from the hospital in the taxi that should win the highest award of New York City’s Worst Shocks, where the pain meds – which involved narcotics, mind you – were insufficient to my internal turmoil. That made me wonder what I’d got myself into.
  • And there was one other moment, in the middle of that first night home, when I woke up extremely nauseous and the mere thought of throwing up threw me into a panic. At that moment I thought I might even die. But I didn’t. Instead I lay down on the bed and pointed my fan at my sweaty body and my adoring and wonderful husband called the doctor and by the time he called back I was actually fine.
  • As I said, I’m off pain meds now. That’s because, since that horrible first night home, I’ve had four more nights home, and each of them has been tons better than the night before.
  • Tons. Better.
  • It’s amazing, actually, how quickly we can heal.

3. Advice

  • I have advice for anyone considering this surgery:
    • Give yourself a full week post-surgery to get absolutely nothing done.
    • Make sure you have helpful people around you for that entire week.
    • Bonus if there are multiple helpful people around you so they can work in shifts.
    • Accept all help and gifts of food (thank you Elizabeth, Laura, and Mel!) so that your family is fed while you’re not up to cooking and so there are loving people around you who can remind you how quickly you’re healing.
    • Also, give yourself the two weeks beforehand to get nothing done while you’re on the pre-op starvation diet.
    • For that matter, give yourself a few more weeks afterwards to get pretty much nothing done.

4. Going Goth

  • So, I’ve lost 20 pounds since I started the pre-op diet, and the dress I’m currently wearing is already too big for me.
  • All of the clothes in my closet will soon be too big for me.
  • I have no idea what my final weight will be.
  • I don’t care. The point of this was to avoid diabetes and be able to stay healthy and exercise, even in the summer.
  • But it’s a once-in-a-lifetime opportunity to actually decide what my wardrobe should look like
  • I’m going goth. Blue hair stays, clothes are entirely black.
  • I already bought myself some amazing platform combat boots. Black, obviously.
  • Exceptions to the “all black” will be made for hand-knitted or otherwise handmade garments, which I will allow or indeed insist that they be colorful.
  • Comments about how awesome this goth thing will be are welcome. Also, links to stretchy black clothing between the sizes of 12 and 20. Bonus if they would look good baggy and/or with saggy skin.


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I’m alive!

Made it through surgery and I've already walked around.

I love the pain control button.

Home tomorrow!

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Surgery tomorrow!

I’ve been scheduled for surgery tomorrow. That means I’m super excited and somewhat nervous. We met with the surgeon last week, and he seemed very smart and good at his job by all accounts, which is to say online searches and word of mouth.

In order to prepare for surgery, I’ve been on a liquid diet except for some very low-carb raw veggies since the moment I heard I was cleared, July 13th. The drinks I’m allowed to have are all “meal replacement” high protein, low carb and low fat drinks. They’re very disgusting, being chalky and sickeningly sweet, but I’ve been extremely diligent, learning to drink them quickly and try not to gag.

Since my overall calorie intake has been less than 800 calories per day, I’ve been in ketosis since around the 15th, which means I have been burning body fat (it also means I’m not exactly starving – appetite is subdued in ketosis). This is exactly why I’m on the pre-op diet: to get rid of the extra fat hanging around on my liver and around my stomach. This will make it easier for the surgeon to get to my stomach laparoscopically tomorrow.

One thing that upset me a couple of days ago is that I was feeling very weak, confused and disoriented. I could barely walk around after waking up. I guessed that simply being on such a low calorie diet might explain such symptoms, but I also started desperately craving salt, to the point where I cheated: I ate two small pieces of grilled skinless boneless well-salted chicken. I simply couldn’t resist the saltiness. Then I looked into the salt content of the “meal replacement” drinks: they don’t have enough salt, even though they’re supposed to provide all the vitamins and minerals my body needs. What?!

When you add to that the fact that it’s extremely hot outside, so I sweat profusely every time I take a walk, I realized I was sodium deprived. This could actually be very unhealthy and possibly dangerous. It’s upsetting that I was making myself sick by following directions carefully. I modified my diet to include chicken broth and now I feel perfectly fine, but it made me wonder how the directions could be so badly off. Wouldn’t other people have noticed this defect?

Well, that brought me to a google search, with the result that I found an online bariatric pre-op diet forum which explained to me the following:

  1. there are lots of different pre-op diets
  2. some of them tell you to have chicken broth or even lean meats or even crackers
  3. nobody, or at least very few people, seem to actually follow these diets
  4. some people are hilariously bad at following their diet
  5. or maybe it’s really sad, but I chose to find it hilarious
  6. except for the crazy people who are eating sandwiches right before surgery and planning not to tell their surgeon
  7. that could actually kill you
  8. yes, I realize that the people on a forum like that are self-selected, but even so

Long story short, I think I’ve been more than sufficiently compliant on my diet, and I will tell the nutritionist at Columbia Presbyterian to add “broth” to the daily schedule.

Today it’s all liquid, I’m not even allowed to have raw veggies. Tomorrow I don’t get to eat or drink at all in preparation for the surgery.

Wish me luck, friends!

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Criminal Algorithms

A piece I wrote for the Observer over in the UK just dropped, as part of my book’s softcover launch over there. Here it is:

How can we stop algorithms telling lies?

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Cleared for Surgery!

Happy birthday to me, folks! I’m 45 today and my present was that I got the call I’ve been working towards for 6 months, since January: my insurance company has cleared me for the bariatric gastric sleeve surgery I’ve been talking about.

In fact, I’m likely to get the surgery in about two weeks, before the end of the month, or soon after that. In preparation I need to start a strict “pre-op” diet consisting of protein shakes and nothing else except possibly celery. That means no coffee until a couple of weeks after surgery, and no carbonated beverages for pretty much the rest of time.

Wish me luck, friends! I’m super psyched.

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Going to London!

I’ll be in London next week for my WMD softcover launch with Penguin UK. They’re having me do a bunch of stuff, and they even gave me this promotion card to show you:


Please come by if you’re in London next week!

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