'There's no turning back now'

Laura Helms lies unconscious on an operating table Jan. 31, 2008, at the University of California, Davis Medical Center.

Medical staff move quickly about the white room, surrounding the 399-pound woman as they prep her for gastric bypass surgery — the Gridley woman's latest, and most dramatic attempt yet, at losing weight.

Helms is here roughly a year after a roller coaster journey that has seen the 41-year-old wife and mother of three dramatically change her diet and her lifestyle by forfeiting favorite foods and start exercising. Her burning desire: shed the weight and the "fat girl" image she's carried around for as long as she can remember.

For years, Helms endured teasing from her peers and stares from strangers. She enrolled in Weight Watchers as a young teen, then tried illegal drugs in her early 20s. Nothing has kept the weight off. She is hoping surgery will jumpstart her to a happier, healthier lifestyle.

In the pre-op room, before being wheeled into surgery, Helms tries to relax on the oversized patient bed. She glances around the room and twiddles her thumbs.

Outside the room she sees another bed marked with her name. She knows it's time.

"It has my name on the chart," she says. "Here we go."

Leaving home

At 7:47 a.m. on this windy, cold January morning, anxiety runs high in the Helms household. The family dogs bark as Helms, her husband Rick and 17-year-old daughter Chelsea convene in the family room, making last-minute checks to be sure they have everything needed for Helms' overnight stay at UC Davis in Sacramento. She will stay at least one night after surgeons cut her stomach and small intestine to a smaller size. The changes will diminish the amount of food she can intake and the organs' absorption capabilities, resulting in rapid weight loss.

Helms helps Chelsea with a necklace, pats the dogs on the head and heads out the door.

"I'm OK," she says as if to reassure herself. She takes a deep breath.

Surgery is scheduled for 1:30 p.m.

To prepare for the big day, Helms underwent medical, physical and psychological testing to be sure she can handle the changes that she will experience.

She's expected to lose 60 percent of her weight — about 220 pounds. It's a size Helms says she hasn't seen in years.

Though she's done her research and followed doctors' orders, Helms looks worried as she leaves home. She doesn't second-guess herself, though, but goes with the motions of the day and heads toward Sacramento almost absentmindedly.

With Helms behind the wheel, Rick, Chelsea and Helms' mother, Rosetta Kilgore, are on the road to UC Davis by 8:23 a.m.

Though Kilgore worries for her daughter, she admits surgery may be the right choice.

"I want what's best for her," she says. "But it doesn't just affect her. Everyone has to make changes."

No going back

For a split second, the patient is nervous on the drive to Sacramento.

The usual chatty Helms, falls silent as she tends to do in stressful situations. The thought of backing out now, though, seems wrong.

"I've learned how to eat healthier," she says. "I'm seeing myself different. Why stop now?"

By 12:30 p.m., they've made it to the hospital. Reality sets in for the anxious family members who wait in a pre-op wing one hour before scheduled surgery.

To pass the time, the family engages in small talk, discussing everything from new TV shows to Helms' new position as assistant to the editor at the Appeal-Democrat and family and friends they know who have already undergone gastric bypass surgery.

One person's bowels had closed up. Another is still on a complicated series of medications several years later. And a cousin who had died from a surgical infection 20 years ago.

The woman was a nurse, Kilgore explains.

"We knew her quite well. It was a shock when she got sick," Kilgore says.

Doctors say the benefits of this procedure now far outweigh the risks.

At one time Helms weighed as much as 450 pounds. Doctors wanted her to weigh less than 400 pounds before they operated on her.

She finally reached that goal - 399 pounds - the morning of surgery.

In the bare, cold patient room, Rick becomes visibly nervous as his wife gets closer to surgery.

He readjusts his position in his seat several times, tries to control his bobbing leg. He holds his head in his hands.

Helms asks Rick if he's OK.

Rick responds by saying he might cry if they continue to talk about surgery.

"I'm fine," he says slightly annoyed. "I don't want to think about it,"

The conversation falls silent. By 1:25 p.m., registered nurse Mike O'Neill comes to give Helms a shot of Lovenox, a blood-thinning drug required for most surgical procedures.

Helms clenches her teeth and cringes as she takes the injection.

Meanwhile, the family studiously avoids the subject of the surgery itself.

They discuss photographs a cousin entered into the state fair and won. And they talk about Kilgore's apprehension to the surgery because of the death in the family.

But Helms is ready.

She's cut out sweets and fried food from her diet and started walking around the block every day for exercise. She's had blood drawn to watch her minerals and vitamins and even underwent a sleep apnea test and stress tests.

"It's been a long process," she said, "but it's been worth it."

When the bed to transport Helms to surgery arrives, the family follows her path to the second floor.

Helms can't help but cry.

She grabs her daughter, hugs and kisses her. She says goodbye to her husband and mother by holding their hands and blowing kisses before the doors to the operating department close.

It's 2 p.m. now. Rick breathes a heavy sigh and holds back tears as he waits for the elevator to return to the main floor.

"It's a waiting game now," Rick says before walking onto the elevator. "There's no turning back now. It's a done deal."

Rick, Kilgore and Chelsea must find ways to occupy their time and thoughts while Helms undergoes her three-hour surgery.

In the operating room

Down a winding hall in one of the hospital's 20-plus operating rooms, a team of eight doctors and nurses, work on Helms.

Dr. William Fuller, lead surgeon, creates six incisions in Helms' abdomen and uses plastic circular discs to keep the holes open.

This procedure is done laparoscopically, meaning doctors do not need to "open" Helms; instead, they use long rods with tiny cameras attached to guide Fuller through her organs. The images captured by the camera are displayed on two flat screens near Helms' head.

Helms' belly jiggles from the contact.

Fuller's eyes are fixed on the screen in front of him. He moves organs and cuts scar tissues in his search for the stomach and small intestine to make the necessary changes.

He tests a surgical resident who is in the room on her knowledge of the anatomy during the surgery.

Rock music plays softly from a radio in the background. The oxygen and EKG machines connected to Helms beep as work is done. The metal tools used for the procedure clang against one another when assistants hand them to Fuller.

The surgery goes forward in three parts. The first creates a smaller stomach pouch capable of holding only 30 milliliters of food, the size of an egg. The original stomach can hold 400 milliliters of food, which is roughly the size of a football.

The second stage then cuts the small intestine from 150 centimeters in length to about 40 centimeters.

The final stage connects the two together. This manipulation diminishes the patients size and intake of food, resulting in rapid weight loss.

The remaining stomach and intestine are left inside the patient as they are still used by other organs.

By 4:03 p.m., the first two parts of the procedure are complete.

The final stage begins as Fuller looks to create the bypass.

Like an extension cord that had unraveled, Fuller quickly pulls the small intestine up and down in search of a plastic marker he left near the stomach so he can find the organ quickly.

Helms' body shakes with the motion.

After surgery, Helms will spend two hours in recovery before her family can see her.

Anxiously awaiting

Downstairs in the waiting room, Rick stares into space, Kilgore dozes and Chelsea sends text messages on her cell phone. The three wait patiently to find out any news of Helms and how she's doing after surgery.

"I don't know what to think," Kilgore says. "Is it going to be successful? There's always that one chance. I still prepared for the worst, you just never know."

It's 6:35 p.m. when Fuller appears at the end of the lobby to tell them surgery went well and Helms is in recovery.

"She was a smooth case," Fuller says.

Fuller expects Helms to remain in the hospital two nights. Before her release from the hospital, Helms must prove to the nursing staff she can walk for 10 minutes straight, use the bathroom and keep down four one-ounce cups of water in one hour.

Rick is anxious to see his wife.

"I don't like waiting," he says. "I want to know she's OK."

Moments later, Chelsea and her grandmother rush to the recovery room to see the groggy Helms. She recognizes them, but doesn't say anything. They only have a few brief moments together.

Rick, meanwhile, waits his turn outside. His leg begins to shake and he rubs his hands together.

His face shows relief when he is finally able to see his wife.

"She's awake, but not awake," he says on his way out of the hospital. "We'll be back in the morning."

The series

Over the past year, Appeal-Democrat reporter Andrea Koskey and photographer Nick Adams followed colleague Laura Helms during her weight-loss journey as a bariatric patient at the University of California, Davis Medical Center in Sacramento.

The three-part series being published on consecutive Sundays looks at Helms' decision to undergo surgery, the procedure itself and the long recovery.

• Nov. 30: Helms recalls the torment she received as an overweight child, among the events leading to her life-altering decision.

• TODAY: Inside the operating room: anxiety levels are high for the patient and her family.

• Dec. 14: A look at how Helms is doing today — the goals she's achieved, where she's failed and the road ahead.

Contact Appeal-Democrat reporter Andrea Koskey at 749-4709 or akoskey@appealdemocrat.com