He rises at 4 a.m. after only an hour of sleep.
He doesn't bother looking in the mirror as he dresses, feels no need to say goodbye to the 400-pound body he hates.
"You ready, big guy?" his mother asks a short car ride later as they walk toward the hospital.
Matt Strollo, 17, has been ready for months, since he set the most important event of his life in motion.
"I'm not scared of death," he has said all along. "I'm more scared of living a life where people don't see the real me."
This morning, his answer lacks such bravado.
"I'm just tired of waiting."
Soon Matt lies in his hospital bed, his surgeon scrubbing up down the hall, his mother, Robin Faircloth, trying to stay calm at his side.
"You keep going back and wondering if you could have done this any other way," she says, voice wavering.
"I just have to keep telling myself: `This will be good for him.'"
Matt hugs his family goodbye and is wheeled away, disappearing down a hall into the room where he will undergo a gastric bypass. The procedure produces miracle-like weight loss but, despite its growing popularity, can be deadly.
About 140,000 Americans had the surgery last year alone. The vast majority were adults. Even if the surgery is successful, the long-term side effects for patients as young as Matt are largely unknown. Some doctors refuse to do the procedure on minors. Matt found one in Fort Lauderdale who would.
He is tired of the teasing, of not being able to fit into the desks at school, of constantly being sick, and the worst: being ignored.
"I made this decision," he says before the anesthesia takes effect and he loses consciousness. "I just need to get this over with."
Open just about any newspaper these days, or turn on the TV, and there is a story about Americans' growing obesity problem. At 400 pounds, 6 feet, 1 inch tall, and only 17, Matt is on the extreme end of this epidemic.
In the fall of 2003, he decided surgery was the solution. For months, Matt's family, doctors and health insurance provider struggled with whether he was right, whether he had the maturity to make such a decision and see it through.
Matt says no one would ever question him if they knew the life he has endured.
At 6, Matt's school photograph showed a smiling boy with strawberry blond hair. His parents divorced when he was 3. Each year after, the pounds packed on.
At 9, he weighed 147 pounds.
By 10, it was 172.
Matt felt like a failure in the eyes of his father, a fit former PE coach. His mother took him to doctors.
"Don't worry," they assured her. "He'll grow into it."
By middle school, the teasing started:
"Fat Matt! Fat Matt!"
Matt did his best to hide the hurt he felt when other kids at school didn't want to sit with him at lunch. He found comfort every afternoon, leaning into that fast food menu.
"I'll have a Big Mac and a Chicken McNuggets. ... "
Faircloth would come home late from her new job as a marketing representative, carrying takeout for dinner or ordering a pizza. As a single mother, she had little time to cook, let alone encourage her children to exercise.
As a teenager, Matt began to be plagued by nightmares. That's when the midnight binges began. His sister learned to hide her leftovers if she wanted any in the morning. Matt learned to hide the evidence of his compulsion -- leaving empty boxes of his favorite crackers and cereal on the shelves -- in hopes his mother and sister wouldn't realize just how much he'd eaten.
"What's wrong with me?" he wondered in disgust.
People began to stare or act as if he didn't exist. A girl he thought was his girlfriend didn't want to be seen with him.
"He's no one," Matt overheard her say.
At home, Matt locked himself in his room and played dark, brooding music.
You will never be strong enoughYou will never be good enoughYou were never conceived in loveYou will not rise above
The operating room is icy.Matt lies unconscious, a blue paper drape spilling over him, a portion of his stomach exposed like a square hole in a doughnut.
Technicians have cleaned his flesh and laid surgical instruments in neat lines. The room is silent except for the sound of his heart monitor, slow and steady.
Beep ... Beep ... Beep.
The surgeon enters.
His name is Dr. Robert Marema and he performs as many as 1,000 bypasses a year. He has a unique perspective on the procedure: He has undergone it. So have his nephew and niece.
He is confident it will save Matt's life, not end it.
Dr. Marema picks up a scalpel and makes the first cut. Then he switches to a tool that cuts and cauterizes skin at the same time to prevent bleeding.
With the help of assistants, he inserts a camera just above Matt's belly button, deep into his abdominal cavity. The tools to do the procedure follow.
An image leaps onto two computer screens and a large, flat-screen TV, revealing a pulsing, glistening mass of red. The picture represents only two inches of Matt's insides, but on the screen, it intimidates.
"How's that?" the technician asks.
"Not sure," Dr. Marema says, clipped and businesslike.
The technician moves aside some fatty tissue. Yellow and slippery, it has the texture of lumpy rice pudding.
"This is where the esophagus comes out of the chest and the stomach starts," Dr. Marema explains. "Just to the left of that, we're going to start dissecting."
In simplest terms, a gastric bypass takes a patient's stomach and cuts it in two. The larger part is never used again. The other is formed into a small pouch that is reconnected to the digestive system.
A normal, empty stomach is about the size of a fist. When the surgery is over, Matt's will be the size of a thumb. His appetite will be reduced, perhaps nonexistent at first. For the rest of his life, he'll be able to eat only a few ounces at any sitting. He will never absorb vitamins normally again. Without supplements, he could develop osteoporosis and nerve damage.
To dissect Matt's stomach, Dr. Marema uses the cutting and cauterizing tool. Each time he uses it, it sears through flesh.
As Matt struggled through high school, he avoided mirrors, especially when just stepping out of the shower. He slouched in his seat, so all his fat rolls would lie flat.
He stayed inside his Margate home, playing video games, surfing the Internet or watching horror movies.
"Going out means I have to deal with their stares, their comments," he said. "It's hurtful. Sticks and stones may break my bones, but words can kill."
When he did leave the house, Matt pretended he didn't care about his weight, then well over 300 pounds. He hung out with the kids who didn't mind, the "freaks" who dressed in a style known as goth. In addition to black, baggy clothes, Matt wore spiked jewelry, chains dangling from his jeans and big buckled boots. He dyed his hair green, then fuchsia.
If people wanted to stare, he'd give them something to stare at.
His mother remained in denial until Matt had to be rushed to the hospital his sophomore year. Matt's body was so overloaded he'd developed gallstones.
After he had surgery to remove them, Faircloth pushed Matt to lose the weight.
She got him a gym membership. But after a few visits, the gawking members drove Matt back into seclusion at home. Matt tried every diet he saw advertised, but nothing worked.
The desks at Coconut Creek High grew tight against his stomach. Gym class seemed a cruel joke.
"I'd rather fail this class than change out," he hissed.
Even worse, Matt missed school because of health problems.
His joints ached. He was easily winded. Acid reflux burned his throat. He munched on Pepto-Bismol tablets like candy. He developed irritable bowel syndrome, rushing to the bathroom after meals.
Matt's grades plummeted.
Faircloth grew desperate and, one day, saw a TV show about gastric bypass surgery.
Matt agreed to go to an information session. It had all the fervor of a religious revival, people searching for salvation by scalpel. Matt left disgusted.
"I'll never be that weak," he thought.
Still, over the next few days, he kept thinking about the surgery. One morning, he woke to the sensation that he was suffocating under his own weight. Then he began coughing up blood. Something clicked.
"If I don't do this," he thought, "I'm going to die."
The surgery is in full swing.The doctor cuts and burns, cuts and burns. A small amount of blood wells; the technician suctions it up.
"Everything out of the stomach?" Dr. Marema asks.
"Yes sir," the technician answers.
The room fills with the metallic crunch of an electric stapler as it forms Matt's new stomach pouch.
"Move that up a bit," Dr. Marema says. "Stop. Whoop, move it back a bit."
Crunch. Crunch. Crunch.
The surgeon's eyes focus in concentration. Any wrong move can lead to side effects. Complications emerging from this surgery include respiratory problems, blood clots, uncontrolled bleeding and hernias. People take the risk because of the promised benefits: Massive weight loss and the elimination of obesity-related conditions that shorten life in the long run.
But that doesn't make the mortality statistics any less stark. A recent study by the University of Washington found that as many as 1 in 50 people who have gastric bypass surgery die within 30 days. Other studies put the number closer to one in 200. A lot depends on the surgeon.
Right now, Matt's surgeon searches for Matt's small intestine, flipping through the fat and blood vessels. He cuts a hole through the yellow-orange layer, and the intestine appears.
Following the stapler, a cutting and cauterizing tool slices the organ in two.
Next comes the most delicate part.
The doctor takes the lower end of Matt's dissected intestine and pulls it up, connecting it directly to the new stomach pouch. This part of the surgery shows exactly how the gastric bypass earned its name.
Normally, food exits the stomach and travels the twists and turns of the intestine, like a car through a tunnel. This new connection creates a straight line for food to travel, an express lane. A bypass.
A shorter trip means fewer calories absorbed, which means weight loss. It also restricts digestive hormones, reducing hunger.
In the fall of 2003,Matt dropped out of school.It was a tough decision, but Matt, his mother and counselor agreed he needed to focus on his health. They planned to apply for the surgery by the end of the year and have the procedure by early 2004.
They underestimated the battle they faced.
As the number of Americans fighting morbid obesity has soared, the demand for gastric bypasses has, too. Dr. Marema once scheduled as many as five surgeries a day, each costing about $20,000.
Then the insurance companies began to contain costs by limiting the number of patients they approved. Now some won't cover the procedure at all.
Matt faced an even tougher road because of his age, 17. Some doctors won't do the surgery on patients that young, for ethical or practical reasons.
"A lawyer would just love to have a great big blown-up high school picture of the kid in the courtroom," said Dr. Jefferson Vaughan, a bariatric surgeon in Jupiter.
Matt's application stood more than an inch thick when his mother first faxed it to his insurance provider that December.
Weeks passed as she argued, sending more records, more test results. January became February became March.
Finally, after spending long hours and about $4,000 for Matt's medical exams and consultations with out-of-network physicians, Faircloth submitted her final plea in April. They waited, exhausted, for the reply.
It came swiftly: Denied.
Faircloth broke down.
"My son is getting sicker and sicker!" she yelled as she begged yet another insurance official to approve Matt's surgery. "My son is messing his pants, coughing up blood and is on so much medication -- and he begs for more! Please ... please! I'm fighting for my son's life!"
Her pleas did nothing to persuade her insurance company. So she gave her lawyer the go-ahead to enter the fray, accepting that they might have to go to court.
About a week later, she got a call out of nowhere, with no explanation: Matt had been approved for the surgery.
Matt and his mother stared at each other, mouths agape. Then the tears started.
"It doesn't feel real," Matt murmured.
Matt's mother sits in the waiting room while her boy is in surgery.
"It's taking longer than it should," she worries.
Then there is movement down the hall, someone being rolled on a hospital bed. Faircloth's hopes rise.
It is Matt. And he is alive. She rushes toward him, elated. But then Faircloth sees all the tubes, and her son's pale face. She stops and the reality hits her: Matt's battle is only beginning. She can't let her guard down yet.
Matt wakes and moans:
The first thing he feels is pain.Then thirst.
The nurses give him ice chips and a morphine pump.
Matt has survived the weight loss surgery that could have ended his life but now may save it. He lies on the hospital bed, all 400 pounds of him, and tries to imagine himself thin.
"What did I do to myself?" he wonders, barely able to move.
Three days after his procedure in May 2004, the nurses at Holy Cross Hospital in Fort Lauderdale bring Matt his first "solid" meal: eggs that have been pureed to the consistency of baby food. It's one of the few things he will be able to eat for some time.
"Disgusting," he declares.
For two nights in a row, he spikes a fever. An X-ray comes back unclear, and the doctor says Matt must stay in the hospital to make sure he is not developing pneumonia. Since the surgery, Matt's mother has slept next to him on a cot. Shadows hang under her eyes.
Matt is antsy. He tries not to think about the holes healing in his abdomen. He feels itchy and dirty.
Slowly, Matt notices he has no appetite. It's the first good feeling he's had in awhile.
"I feel content," he says, a mystified look on his face. "I don't need to eat, but I have to eat."
Matt is home from the hospital.He had the surgery, but it's his mother who is in shock.
Faircloth is running out of adrenaline and realizing how much work it takes just to feed her son. She spends more than half her days planning, measuring and preparing his meals.
For now he can only eat soft things, nothing with sugar, and only the tiniest of portions -- a meal of two bites, maybe three. He has a long list of vitamins he must take because his stomach no longer absorbs them correctly, to be taken at certain times in certain combinations.
"It's like I have a baby again," she sighs.
The good news is, about a week after the surgery, Matt is already losing weight. His body, once shaped like a balloon about to burst, looks like a bit of air has been let out.
Matt lumbers over to the mall one day, to a store called Hot Topic that sells the goth clothing he likes. Matt still won't try to fit into any of the T-shirts, but he goes to a display and selects a black wristband covered in studs that normally doesn't fit. He places it around his wrist and hears the glorious snap of it closing.
"It's not even tight," he murmurs in awe.
Matt can't stop throwing up.It's a few weeks after the surgery. The doctors warned him to stay away from sweets or any carbohydrates, that they cause many bypass patients to break out in a sweat and throw up their food -- a reaction so common it is known as "dumping." Matt has followed these instructions and still, for four days, he hasn't been able to hold much down.
Maybe it's the temperature of his food. Cold is supposed to make his new stomach tighten up. Maybe it's the pills. They nauseate him.
"It dry-heaves," he whimpers. "It hurts."
Later, Matt finds the energy to go with friends to the mall again. They want to go to the food court. He watches them eat.
"If I hadn't done this," Matt grumbles to himself, "I could be having pizza."
Matt comes home, spent. He shuts himself up in his room, blaring dark music as he collapses on his bed. The lyrics taunt him:
I tried to kill the pain, But only brought more.So much more, I'm dying,And I'm pouring, crimson regret, and betrayal. Am I too lost to be saved? Am I too lost?
In June, the world is wonderful.Matt has stopped throwing up, he is feeling better and, most important, he has lost 40 pounds in the four weeks since the surgery.
Matt has never lost that much weight. His double chin is fading. His belly is big, but not huge.
He and his mom have gone to the doctor, who has assured them the extreme ups and downs he has been feeling are normal.
"There are a lot of hormone changes going on," Dr. Marema says. "The most dramatic thing isn't the surgery, it's the behavior changes he'll go through. He's losing one of his best friends -- food."
Matt's metabolism is changing too. Before the surgery, Matt was always exhausted. Now he's having trouble sleeping at night.
He spends more time with a girl friend -- a girl who is a friend, not a girlfriend, Matt enunciates carefully -- but his mother notes with a smile that the girl's boyfriend is getting jealous.
Matt goes with her to a party and, as he watches everyone devour chips, cake and soda, finds it doesn't bother him. He pops a grape and a slice of bell pepper into his mouth and is full.
Matt feels so good he wants to get out of the house and get a job. He dyes his hair brown, hoping it will appeal to employers more than his usual green or purple. He puts in applications.
Then disaster strikes.
At the doctor's office, Matt steps onto the scale. Last time, he weighed 357 pounds. He's hoping to have lost a lot since then.
Instead it reads: 359.
He stares at the numbers and controls himself long enough to get home. Once inside, he breaks into sobs.
Matt feels better in July.Regardless of what the scale says, Matt has proof he is doing well: He now fits into a size 2X. Before the surgery, he was a 6X.
In fact, Matt is so high on success, so invincible, he's stopped taking his calcium pills.
"I drink milk," he says in his defense.
His mother overhears and glares at him. "Are you telling me you're not taking your calcium every day?"
"I'm not 40 years old, Mom."
"You told me you've been taking all of your vitamins," she frowns. "Don't you know why you need it?"
Matt sighs dramatically. "Because I'm being nagged to death?"
Matt's mother is on his case about a lot of things. She let him drop out of high school once he could no longer fit in the desks and his health problems forced multiple absences. The plan was for him to get the surgery, recover, go back to get his GED and go to community college.
But Matt is stalling, spending the summer as he always has: on the couch watching TV and playing video games. His job search never panned out. Instead, he locks himself in his room, composing soulful but depressing lyrics for a band he's started:
You sit there with a straight face and ask me why,You write a prescription with such haste and leave me with a bottle.No amount of pills will take it away ...The pain, the strain -- It reminds me I'm alive.The tears, the leers -- Keeps me from becoming you.I don't want to belong.
He's also exercising, although not exactly the way his doctors have prescribed. He buys a video game called "Dance Dance Revolution" and a mat on which he moves to the computerized music.
At the end of the month, Matt goes to his first big concert, for the group Evanescence. Months ago, his body would never have been able to stand up for so long. Now, he stands for hours, surrounded by a sea of people, letting the waves of music crash against him, face upturned to the sky, heart soaring.
The pharmacist is close to tears.
Back before Matt had the surgery, when he weighed 400 pounds, he popped six pills four times a day, rushed to the bathroom after meals to keep from soiling himself, and stayed up most nights as stomach acids ate at his throat.
Since the surgery, these symptoms -- "comorbidities" the doctors call them -- have lessened to the point that now in August, he no longer needs most of those pills. Today, he fills his last prescription for potassium.
"Oh, my God, look at you," the pharmacist cries. "I can't believe it!"
Matt can't either.
When he looks in the mirror now, he has cheekbones. At the movie theater, he has room to cross his legs. When he sits in the car, his stomach no longer touches the glove compartment. He can buy clothes at regular stores.
But every time he thinks he's done well, something happens. This time, it's another teenager. Through the grapevine, Matt hears a boy he hardly even knows has been making fun of him. The boy supposedly says that Matt is making too big a deal about his weight loss, that he's still fat.
A few days later Matt goes to his monthly support group meeting and gets on the scale. It reads 308.
He has lost nearly 100 pounds.
September blows by.Matt spends most of the month like other Floridians, dodging hurricanes.
Things are going almost too well. Matt now weighs 279 pounds, wears size XL shirts and pants with a 38 waist. And he has energy.
But Matt still hides under baggy clothes and his favorite black trench coat. He noticed at his last support group meeting how many of the longtime bypass patients were starting to gain back weight.
"I'm terrified I'm going to eat something and wake up and be how I used to be," he says, voice tight.
Some days he eats only a Wheat Thin and water for each meal. Sometimes he has nothing at all.
"You're such a fat ass," he tells himself. "I'm never hungry and tortured myself to get to this point, so why am I eating again?"
He sets a new goal weight: 220.
He later admits: "It's like I'm schizophrenic with food. The doctors are like, `You have to eat,' and I'm like, `I took my vitamins.'"
But Matt isn't taking all his vitamins. Besides the calcium pills, he's also stopped taking his iron. Instead of the super-multivitamin recommended by his doctor, he's taking Flintstones vitamins from the grocery store.
Dr. Marema lectures him during his October checkup, Matt complains, warning him that he's going to sabotage his own health. But Matt doesn't listen. When it's time for his end-of-the-month support meeting, he skips it.
"I don't need support," he declares.
Matt made a promise to himself before the surgery:His outside might change but his inside wouldn't.
He might lose weight, but he wouldn't transform into some annoying, plastic teen like those on the TV show The OC. He might wear a regular-size large, but he wouldn't be caught dead in khakis.
Matt is keeping his promise -- mostly. Shortly after celebrating his 18th birthday, he gets a job at Hot Topic, his favorite store in the mall that sells goth and punk items. He gets to wear all the black, metal-studded clothing he wants, offsetting the fact that he's shedding more of his dark-and-depressed demeanor by the day.
"How can I help you?" he chirps to mothers who enter the store, mystified by their children's Christmas requests.
His bosses have him juggling multiple shifts. Matt, who used to be bored at school and lonely at home, shines at work. His mother notes that he is becoming increasingly social, always off to somewhere or running up the minutes on his cell phone.
A week before Christmas, Matt throws a party. The theme is a "Dark Noel," and so is the dress of all those who attend. But no amount of black can obscure Matt's megawatt smile. The teens gather in a circle to lift their glasses of nonalcoholic cider in a toast.
"To best friends!" Matt bellows.
Matt has hit his goal weight.Matt has lost almost half of his body weight in the eight months since the surgery. On a whim, he heads to a local tattoo parlor. There, a longhaired artist inks a Celtic symbol called a triquatra on Matt's forearm. It represents life, death and rebirth.
"I didn't feel human before," Matt says. "Now, I can breathe. I have a lot more energy, so at my job I can run around the store and make sure no one is stealing, go to the register. I love it."
But, as usual, Matt's good days are followed by dark ones. There is no end in sight to this cycle. While Matt's physical transformation is nearly complete, his mind and emotions are still playing catch-up. When he looks in the mirror, he sometimes still thinks he looks fat and ugly. Now that he leaves the house more often, he constantly worries about what other people think of his appearance.
"You can't take 18 years of thinking and change it in eight months. I've tried, but you just can't," Matt sighs.
His mood worsens when he and one of his best friends get into a fight. She tells him he's changed, that he's always working and too busy to see her. Part of Matt worries that she is right, that he should never have had the surgery. With all the changes going on with his body, Matt isn't sure who he is anymore. He softly quotes a line from an Evanescence song:
I've been looking in the mirror so long, that I've come to believe my soul is on the other side.Matt, now 220 pounds, feels better than he did before the surgery, but does not have the perfect happy ending that so many people expected.
"It's great not to be coughing up blood, to be able to do things," he says. "But it's not a quick fix. It's so weird now to go into a social setting and eat. I used to never look in the mirror, and now I look in the mirror and have all this self-doubt. If someone were to ask me if they should get a gastric bypass, I'd tell them to just exercise. It's been very hard on me."
And it could get much harder.
Dr. Marema is increasingly concerned by Matt's failure to exercise and take most of his vitamins regularly. It's exactly the pitfall that causes some doctors to refuse to do the surgery on young people.
"That's the naiveté of the immature patient. He's looking good and feeling good, but his body is still on borrowed time," Dr. Marema says. "He will cause progressive bone loss and be at risk for fractures. Eventually, he will become anemic. A lot of vital bodily functions won't work right. We'll have to get him back on track."
During his next visit to the doctor, Matt is given a free bottle of multivitamins, and he says he will start taking them again. But privately, he insists he doesn't really need them. He's thin now. He's healthy now. He does not have the benefit of a medical degree, or years of experience, to understand the danger he faces. He's a teenager who doesn't want to think about the next 20, 30 years.
Dealing with the present -- with all its upheavals -- is enough. The future, he says, can wait.
"Right now it's the furthest thing from my mind."
Jamie Malernee can be reached at firstname.lastname@example.org or 954-356-4849.Copyright © 2014, Los Angeles Times