My (way overdue) six-month checkup with my surgeon was just a few days ago, and I was dreading it. I also dreaded my three-week checkup, my one-month checkup, and my three-month checkup, so much so that I almost didn't go to any of them, and wouldn't have, if Guy hadn't been steering me up the street with a finger in my back and a very stern expression on his face to all my previous appointments.

"I don't wanna, I don't wanna!" I wailed, and he punched the elevator button and marched me into the elevator. "Why?" he said. "What are they going to do to you? You're doing so great." But the problem was, I didn't feel like I was doing so great. I felt like I was the failingest failure to ever fail at gastric bypass surgery, and as punishment, they were going to be very disappointed.

My surgeon, he has perfected the disappointed look. I saw it just once, many years ago, when I came back for my follow-up appointment and had actually gained five pounds instead of losing the 15 he had asked for. He looked at the number on the scale, and then he looked at me, and shook his head, pursing his mouth, and it was textbook perfect, and designed to slice straight to your deepest core of shame. And for this, I kind of hate him.

I also respect him enormously, and desperately didn't want to disappoint him. In weight-loss surgery boards and e-mail lists, there is a lot of debate about how some people use their surgeons as inappropriate daddy surrogates, and pin all their hopes and dreams and aspirations and need for approval on their doctors, and I didn't think I'd ever be one of those sad people, because the guy just did me a favor, right, and he's a talented surgeon, and he's my "Partner in the Journey Towards Health," not my pop who will whip my big ass behind the woodshed if I act up.

Except I was terrified of him seeing through my brave façade and my giant bottle of water, and seeing that I was totally fucking everything up. That I was destroying my body, and doing everything wrong--especially things I didn't even know were wrong and bad--and just I couldn't stand the idea of sitting and having him ask me probing questions about every single thing I had done in the past three weeks, or four weeks, or three months or six months and find out that every single move, evaluation, choice, has been the stupidest thing anyone has ever done.

"He's going to call me stupid. He's going to reverse the surgery because I don't deserve it," I told Guy "Do you really think he's going to think you're stupid?" he asked me skeptically. And I realized no. That it has nothing to do with my surgeon, no matter how good his disappointed look, and everything to do with my own guilty conscience. His little moue of disappointment didn't shoot into the place where I keep my guilt about hurting other people (a cavernous, echoing, never-ending space filled with the shame and misery of decades), but that little part of me that whispers the nasty things that you are always so good at saying to yourself. It is a true and incontrovertible fact that no one can be as mean to you as you are, effortlessly, to yourself.

His little doctor face was like a mirror being held up to that nasty, dark place filled with slimy things that can choke you if you are not careful, and that is the last thing I wanted to deal with, in the middle of being in pain, of healing, of trying to make the right choices over and over again and realizing that this was harder than I ever, ever thought it could possibly be.

I couldn't move without wanting to die; I couldn't eat without feeling nauseous; I couldn't drink water without gagging, and I thought it was my fault. That all of it--every single part of it that was hard, that was challenging, that I couldn't do, every time I failed to follow the textbook example they gave me (the literal textbook example, my post-surgery guide all bound up for my reading convenience)--was my fault. Entirely, completely and utterly my fault. But I didn't want to say it out loud. If I said it out loud, then everything I kept so precariously balanced would come tumbling around my ears. I sat in my doctor's office and said, I'm great! I'm doing so great! I am so great! And he nodded and said good job, and recorded my weight, and I was off again on my own, feeling unmoored and scared.

And stupid. How stupid of me, not to have confided in him. How stupid of me not to have said, please tell me I am doing okay. How stupid to have turned this into another test of my will, as if I were dieting and all alone, struggling, instead of a choice I made, looking for help and support. I turned my back on all of that without even thinking about it, or realizing what I had done. How very, very stupid.

I realized that, on the way to my six-month appointment, on my own because Guy had to work, but doing okay, because physically, I am (usually) so far past those early, terrifying months, I can't even remember what it was like to be hurting and weak and scared anymore. I walked in realizing that I was doing beautifully. That I had a handle on things, finally, my fist on the rudder, steering straight ahead into clear waters, out of the bayou. I had things to report--I am running, doctor, and how awesome is that? Soon, I'll be swimming on my off days. How awesome am I? So awesome. There was nothing to confess.

"You're doing so great," the doctor said. "The exercise--it's so good for your metabolism, and the ratio of fat to muscle." "It's also good for getting totally hot," I said. And he looked at me blankly. He is good at disappointed looks, but not so much with the comedy.