06x10 - Nothing Is Impastable

[bunniefuu]

Ready or not,
here we come, London.

[Chris] Previously on


[Tammy] Hey, how are you?

Ooh.

[Amy] Hey, can I take
a picture with y'all?

[Tammy] Amy, [bleep].

[Amanda] She's loud.

b*tch, we are
in a foreign country.

Get your act right
out your pocket

and hold on tight
to that mother[bleep].

Shut the hell up.

Our people was
on the Mayflower?

-Dun dun dun.
-[Amy snorts]

[Chris] Two more, girl.
We got this.

[Tammy grunts]

[Amy speaking]

[Amanda] Amy, stop.

-I ain't even done nothing
and y'all are getting...
-Okay. Stop.

[Amy] ...on to me
for bull[bleep].

[Misty] Amy...

-[Chris] Amy.
-[Amy] I'm done.

I mean it this time. I'm done.

[Chris speaking]

[Amy speaking]

I got told multiple times
to shut up,

and that last time
was my [bleep] breaking point.

There's only so much
one person can take.

[sniffles]

[Chris]
Because you're overreacting.

[Chris] You're yelling
at me right now.

[Amy speaking]

[Amanda] Is that Amy?

-She's outside, though.
-[Brittany] I can hear her
outside, yeah.

[Amy speaking]

-[Chris] No.
-[Amy speaking]

[Chris] Come on.

You're going the wrong way.

We came to The Mayflower

just because our nine times
great-grandfather

drank here.

And it should be a big moment
for the whole family.

But I feel Amy's being
kind of a little bit childish.

Like a spoiled brat.

You went
off the handle in there
in front of everybody.

And we're better than this.

[Amy speaking]

[Chris] All I see you doing
is showing your butt, girl.

[waiter speaking]

It's okay, honey.
It happens all the time.

You're okay.
You're doing a great job.

Poor guy.
Damn Americans are crazy.

[laughs]

[Misty speaking]

[Tammy speaking]

Some of them don't. Caspe...
Are they the dark ones?

-Mm-hmm.
-[Tammy] Yeah.

[Birttany] Those are Kalamata.

This one has a pit.

Hey, bubbe.

You want an olive?

-[Tammy chuckles]
-[Misty] They taste

totally different
than the ones that
Grandma used to buy.

At this point, we're gonna
pretend like this [bleep]
didn't even happen.

So we gonna talk about
whatever we gotta talk about

to get past
this little blow-up.

[Misty] I hate olives.

But I'll talk about olives
all g*dd*mn day if Amy...

Okay, guys.
Your food is ready.

That's the fish and chips.

-[Tammy] Thank you.
-Fish and chips.

-[Amanda] Fine. Thank you.
-You're welcome.

Enjoy. See you in a bit.

-[Misty] Thank you very much.
-[waiter] You're welcome.

[Chris] The fish is wonderful.

-Yeah, it is good.
-The fish is wonderful.

[laughs]

[Brittany chuckles]

[Chris] After Amy eats,
she cheers up significantly.

[laughs]

[Brittany speaking]

[Chris laughs]

And you're supposed to be
the nice one out of all of us.

-[Chris] She is.
-[Brittany] Eh.

[Amy speaking]

But it's our last day
here in London. And...

[Tammy speaking]

-[Brittany laughs]
-Well, this is better
than the d*ck.

And I'm saying that.

[Tammy and Brittany chuckle]

[Amy] Come on, y'all.

Let's go.

After we got done eating
at The Mayflower,

we walk up
the little cobblestone street

to this little garden
that's overlooking...

Overlooking the river
that runs through
the middle of England.

How about that? [laughs]

[Misty speaking]

[Chris] You go ahead, girl.

And my question of the day is,
they got catfish here?

'Cause that look like
good catfishing water to me.

[Misty laughs]

As this vacation
comes to a close,

I'm just ready to go home.
I want my boys so bad.

I love London.

But I want my boys.

[Chris]
It's just been a great trip.

-[Misty] Yeah, it has.
-[Chris] I mean,

I know we don't get along
every second of the day.

But the bottom line is,
is we're a family.

And we're a family strong.

Now we know
a little more about ourselves.

[Misty] Where we came from.

I think that we should
start being courageous,

just like our ancestors,
and just living life...

-[Chris] To the full.
-...to the best
of our ability.

Now that I've got
my life back,

I mean, that's what
I'm trying to do.

[Amanda] You just wait
until the skin is removed

and you're healed,

because life
is gonna change again.

Tammy and Chris,
for each of you.

[Chris] Back in Kentucky,

my surgery is literally
right around the corner.

Amanda is
the only one in the family

that's had
skin removal surgery...

Am I worried about it?

My recovery time could be


if I have bad healing.

It's gonna be
the worst thing you've
ever been through physically.

Tammy, including you.
Like, you've been

-near death several times.
-[Misty] Yeah. 'Cause you're
gonna have more of it

-than the rest of them.
-[Amanda] But just be ready.

After my last appointment,

Dr. Turner referred me

to a specialist in Pittsburgh

because he has a bigger team

and a bigger hospital,

and he takes on
more complicated surgeries.

Tammy, I just want to say
I'm proud of you.

You have really done excellent

this time we've been here,

with the stairs,

climbing in and out
of the bus, the walking.

-The steps we just did.
-You have improved so much

that it's just mind-boggling.

[Amanda]
Normally you just give up.

"I can't do this."

But this time you didn't,
and you pushed through,

and I'm proud of you
for sticking with it.

I can't even put into words
how proud I am of you.

And even though
me and you get into it,

I love you very much.

And I will give
my life for you.

I think this honestly
brought us closer together.

Absolutely. Me too.

Tammy and I are
actually getting along.

I have no explanation
as to what's going on.

There was no big ta-da moment.

You know, there was
no angels singing.

It's just happening.

And I'm just letting it,
and she is too.

And I'm grateful for that.

[Chris] You know, other than
a few little hiccups,

it's been a great week,

doing what we do best,

acting fools.

[Amanda] Some of us are
not acting, and that's okay.

[laughs]

This vacation has done as good
as it could possibly do,

bringing us back together
as a family.

Now, with that being said,

I really just hope
when everybody gets home,

the peace that
we've kept in England

continues to ride the wave.

We all got some
pretty big things
coming up here real soon.

And we need to
support each other

more than ever.

-[Misty] Here we go.
-[Amanda] Perfect.

Yes!

[Amy] Today, me, Tammy, Chris,

and Brittany are gonna take
a self-defense class.

If you were going to hit
a part of the body,
what would you hit?

[all laughing]

-Today's the day, huh?
-[Chris] Yes, sir.

-Been a long time coming.
-A long time coming.

[Amanda]
With a surgery like this,

there's a possibility
of blood supply not being

sent to the right areas.

What's taking this
so damn long?

[Amy] Gagey, Gagey.

You gonna be
mommy's big boy helper?

[babbles]

I mean, I got to
see the sights.

I got to see the sounds.

Yay.

Yay.

Not my wall. On the paper.

It's all washable.

If they get it on the wall,
they get it on the wall.

But at the end
of the day, they are

making their kind of art.

They are being creative
their way.

Get it on the wall. Good job.

And he would make
a thousand bucks.

Or, well...

[chuckles]

-[Gage exclaims]
-[Amy] Are you done, darling?

-Are you done?
-[Gage babbles]

[Amy] Silly.

But when we were in London,

I was out of control.

So, it's time for me

to learn how to communicate

and not walk away. Or blow up.

I just want to be
a better mom,

better friend, better sister.

A better everything.

Be careful.

[Chris] Y'all ready to
get in there and learn how
to kick some butt?

You're gonna need it.

[Amy] So today, me,
Tammy, Chris, and Brittany
are gonna take

a self-defense class.

The last time
I broke a board is
when I fell through the floor.

[laughs]

And it was at
the yellow house, so come on.

That's why I said
I'll be nice.

[Chris]
Since we got back from London,

I've been busting my a*s

quite literally.

[laughs]

All the painting's
pretty well done
in the yellow house.

And the only thing left
to really do is clean.

And then
she'll be ready to move in.

[Tammy] I am

so freaking excited

to move into
a house by myself.

But Chris has always been...

I don't really know

what I need to

defend myself from...

[laughs]

But I'm just gonna go with it.

Okay, guys, let's go ahead
and line up, please.

[woman] Yes, sir!

[Robert] What do you think
is the most sensitive part
of the body?

If you were gonna
defend yourself

and hit a part of the body,
what would you hit?

There's no wrong answer.

-[Robert] Crotch?
-[all laughing]

Kick him in the nuts. [laughs]

And run! [laughs]

[Tammy laughs]

[Robert] The eyes.

The eyes have
so many nerve endings.

But also,
believe it or not, you can

actually rupture the eardrums.

So we're gonna go to
what we call BOB.

And those are
the body opponent bags.

Lord only knows
how this is gonna go.

Because Brittany
is a very timid person.

Tammy's kind of like a T.rex.

And Amy...

And you can't fight
if you can't see.

[laughs]

[Robert] All right,
on my count. Ready?

You just kind of step forward

and you're gonna
clap the ears.

[grunts]

Nice. Good job.

All right. Excellent.
All right, next two.

-[Amy speaking]
-[Tammy] All right.

-[Amy] Oh.
-[Tammy speaking]

[Amy] Excuse me.

[Robert] Here we go. [grunts]

[Amy and Tammy laugh]

[Robert] All right.

Ready?

-[grunts]
-[Tammy grunts]

-[laughs]
-[Amy laughs]
I can't stop laughing.

Learning the moves were
just weird and awkward
in getting the hang of it.

[Tammy grunts]

Facts.

-[grunts]
-[man] There you go.

There you go. Good.

Right there. Did you see that?

Yeah.

Yeah, yeah,
yeah, yeah! [chuckles]

-[Tammy] Yeah!
-[Robert] All right.

Nice!

Good job. Good job.

-[Tammy grunts]
-Yes!

Yes!

Good job.

[laughs]

All right.

-Would you?
-I would too.

[Tammy]
I think it's great that Amy's

found the healthy outlet.

Maybe she'll continue going
to the self-defense class...

Or we just...

[Chris] You ready to
get your [bleep] up and go?

[Tammy] Yeah.

[Chris]
After about six months,

the yellow house
is finally finished.

And we're able
to move Tammy in today.

I'm relieved

because my
skin removal surgery

is scheduled in a few days.

And I ain't gonna lie,

I'm really excited.

I finally get to have
the house to myself.

Where am I going?

Well, with me
and my wife anyway.

[chuckles]

[Tammy speaking]

[Brittany] Wow.

At least the carpet
and the lawnmower's

-not in here anymore.
-Yeah, you ain't got
no rug no more.

[Tammy speaking]

-[Brittany chuckles]
-[Tammy] I'm excited.

It's a very big upgrade.

It's awesome.

Now, we still got some
cleaning to do in here, but,

you know, it's able
to be lived in and enjoyed.

[Tammy speaking]

I could see me
living here for a while.

[Chris] Well, Tammy,

it ain't Buckingham Palace,

but you can be
the queen of this castle.

[Tammy]
In the last few months,

me and Chris
never really fought.

Did we get on
each other's nerves?

Probably. [chuckles]

So, I am ready to

have my own space

and my own independence back.

Well, as long as they
treat you fine,

that's all that matters to me.

[Tammy]
Lately, I've been feeling like

it's time for me to start

moving on,

and...

It just doesn't feel right.

I don't even
have those feelings
for a guy anymore...

[Chris] How do you feel about
taking this long trip

to see Dr. Rubin?

[Tammy] It sounds promising.

In a couple of days,

I'm gonna go see Dr. Rubin
in Pittsburgh.

See if he will take me
on as a patient.

[Chris] You know,
Dr. Turner said

when he put you
to sleep for the surgery,

he didn't want to
keep nobody under

more than eight hours.

And for you to have done
what you need done,

it would take him


And I'm sure Dr. Rubin's got
a team to take care of you.

When I was bigger, seeing
a new doctor was terrifying.

I hated it.
I still don't care for it.

I mean, the first thing
that always comes out
of their mouth is,

"You need to lose weight."

Well, clearly.

So...

before having surgery. But...

[Amy] Are y'all ready?

I've decided to create
an online dating profile.

So, today I'm doing
a sexy photo sh**t.

[Greg] Well, yee-haw!

Look at you, girl!

I'm looking for a family man,
a businessman, whatever...

[laughs]

[Amy speaking]

[woman]
No, it's gonna be fine.

We always do the most clothed
down to the least.

[Amy]
Today I'm doing something that
I've always wanted to do,

but I was
too chicken [bleep] to do it.

Are y'all ready?

[woman] Yes, ma'am.

[Greg]
What? Look at you, girl!

I'm ready to get out there.

I'm ready
to open my heart again.

I'm ready to find love.

[woman]
No, we can't see no nipple.
We'll let you know.

-And you're on cooter duty.
-I got you.

Cooter duty.

-[Amy laughs] Cooter duty.
-Oh, my God.

[Greg] Now,
here's what we gotta do.

You gotta hang on while I
photograph that fat a*s.

Poke your a*s
way up in the air. Go.

Girl, you got it. Got it.
Hold it. Three, two, got it.

-Good deal.
-[woman laughs]

[Greg] There, we did it.

[Amy speaking]

[Greg] Yee-haw!
Look at you, girl!

[Amy] Self-defense class
has got me ready

to take on multiple dates.

And if they come at me
in the wrong way,

I know how to defend myself.

Now, we're gonna
help in editing just a little.

Okay, don't move,
'cause what I'm doing
is cheating.

Don't move.

Put that arm back down.

Look at there.
Okay. All right.

Looks amazing, girl.
You do. You look wonderful.

[Amy speaking]

A family man,
a businessman, whatever...

But not no [bleep] boy man.

[laughs]

[Greg] There you go.

That's what I'm talking about.

-Say yes.
-[Amy whispers] Yes.

[Amy] It just feels good
to get out of my element.

[Greg] Awesome.
That is beautiful.

Some of these pictures
are just for me. Or...

[Greg] Look at the confidence
beaming out of you there.

[Amy speaking]

Well, you know,
it's kind of the idea.

[Amy speaking]

[Greg] There's just something
about you and that fat a*s.

[laughs]

Brittany, what do you need
to take with us for snacks?

[Brittany]
Whatever snacks you want.

Well, I'd say the whole house,

'cause I don't know
what I want until I get there.

Tomorrow is the big day.

I'm finally getting
my skin removal surgery.

Before we leave
on our road trip,

Misty, Tammy, and Amy

are coming over
to send me off.

I'm so excited,
but yet I'm still

kind of leery
of the whole surgery process.

And I'm really
not looking forward

to the pain afterwards.

[Amy] I got a question.

How nervous are you?

-I probably won't sleep much.
-[Amy] Yeah.

You know, the doctor said
it would be...

-[Misty speaking]
-And then Amanda...

And Amanda said it was worse

than anything
she ever dealt with.

[Misty] Mm-hmm.

[Tammy] I am
very proud of Chris, and...

Hell, you got, what,

a child right here

on your lap 24-7 because of

all the excess skin.

[laughs]

Amanda's coming up
from Florida

to be at the hospital
the day I have surgery.

Somebody to keep me company
in the waiting room.

Well, I'm gonna go
to Pittsburgh

with Tam and Ames
so I can, you know,

keep them out of trouble,
all that good stuff.

And who's gonna
keep you out of trouble?

[all laughing]

[Tammy]
While Chris is in surgery,

Amy, Misty,
and myself are fixing

to go to Pittsburgh

to talk about my skin removal.

[Amy laughs]

All right, be safe.

-[Misty] Love you.
-Bye, love you.

[Chris] It's about
a four-hour ride,

and hopefully
a decent night's sleep.

And then we'll be
at the hospital

bright and early just
to get my surgery started.

Getting skin removal surgery
is life-changing,

but there's always
a possibility

that something goes haywire.

So it's the what-ifs
that's in life

that's always

the hardest to deal with.

[Chris] You got everything
pretty well packed?

Yeah, I'm just
putting my fan in here.

You know, I can't
go anywhere without it.

[Chris] It's been
a long time coming,

but I'm finally getting
skin removal surgery.

I'm really excited for you.

-Appreciate it.
-I know you worked hard
for it.

[Chris]
Yeah, it's bittersweet.

It feels like I'm at
the end of a marathon...

and I finally made it.

At my heaviest point,

I was 520 pounds.

I'm gonna be
somewhere around 250.

That's what I'm
talking about, baby.

That's game over.

Hey.

You don't fillet a squirrel,
you skin them.

[Brittany] Well...

-No, not really.
-[Brittany chuckles]

[knocking at door]

Well, good morning.

[Chris] Good morning, doctor.

-Today's the day, huh?
-[Chris] Yes, sir.

-Been a long time coming.
-A long time coming.

Well, the last thing
I kind of got to do,

I think everybody's ready
for you, you know,

kind of the anesthesia team
and the surgical team.

And I just have to do
some markings on you.

-[Chris] Okay.
-And, uh,

basically kind of

gonna get you ready
and get you back.

Today, Chris is going
to receive what's called

a fleur-de-lis abdominoplasty.

It's done to
not only remove skin
in a horizontal manner,

but it's done
in a vertical manner

to remove horizontal
skin excess as well.

Chris is a good candidate
for this surgery

because the majority
of his skin excess

on his torso is in the front.

[Brittany] Hi.

-[Brad] Hi.
-[Chris] Hey, buddy.

[Brittany] Hi.

[Amanda] Listen,

this one over here,
they've been biting the b*llet

-to get in here and see you.
-[man] Yeah.

What are you doing, baby?

Some of the most
important people

in my life are here today
supporting me.

My son, my soon-to-be
daughter-in-law,

and two of my
wonderful grandbabies,

and my mean-a*s sister,
Amanda.

[Brittany chuckles]

[Chris]
It means a whole lot that

she's taken the time

and effort

to drive 12 hours
for my surgery.

[Brittany]
It means she loves you.

[Chris chuckles]

In-between bossing me around.

-[Amanda] So it's...
-Yeah.

...gonna take, what,
four to six hours

-for surgery?
-Uh, probably closer
to three or four.

-[Amanda] Three or four?
Oh, that's great. Great.
-A little less. Okay.

All right, partner.
We'll get you back here
in just a minute, okay?

-All right.
-We'll take good care of you.

-Nice to meet everyone.
-[Amanda] All right.
Thank you so much, Dr. Turner.

We'll come talk to you
right after we're done, okay?

-[Amanda] All right.
We'll be anxiously waiting.
-[Brad] All right.

He's put the work in,
and he's earned the prize.

But with a surgery like this,

there's a possibility of
blood supply not being sent

to the right areas.
If you lose blood supply,

the skin dies.

The risk of going under
anesthesia alone is great.

Chris has lung problems.

He has some
medical history there that

kind of works against him.

I'm just really,
really worried for him.

[tense music playing]

So you want
to divide and conquer,

and, um,

I'll grab her bag,

-and you can help her get in?
-Yeah.

Today we're
getting on a flight

to Pittsburgh...

Yeah.

Is there a Pittsburgh, Ohio?

[bleep], I don't know.

We're going to Pittsburgh,
Pennsylvania.

We're going to Pennsylvania.

[Amy speaking off-screen]

Yeah.

[Misty sighs]

[knocking at door]

[Misty] You ready, chick?

[Tammy] Yeah.

[Misty] You got
everything you need?

ID, meds, all that good stuff?

-Yeah.
-[Amy speaking]

Passport?

[Misty] Yeah, most current ID.

Nervous as [bleep]
and I'm ready to go.

[Tammy speaking off-screen]

I'm nervous enough.

[Tammy speaking]

[Tammy] I'm nervous enough.

That's all you need to know.

Let's go.

[Brittany] Chris has
been in surgery

for about three hours now.

Having my grandkids here
has really helped

calm my nerves,

keep my mind off of things.

But...

I'm ready for it
to be over with, and...

I'm ready to see him again.

[Amanda] My nerves are shot.

What's taking them
so damn long?

Now I'm starting
to get anxious.

He needs to come on,
Dr. Turner.

Brittany is

beside herself.

Dr. Turner said

this surgery should only take
three to four hours,

but it's been almost five now.

[tense music playing]

[door opens]

Okay, Brittany, you ready
to come on back?

He's all done.

[Amanda speaking]

[nurse] He's asking
for a cheeseburger already.

-[chuckles]
-[Brittany] He said
he was going to.

[Dr. Turner] You remember
this girl?

[Brittany] How you doing?

Tired.

We'll get you up to your room
pretty soon, okay?

Everything went
wonderfully for Chris today.

We took our time,

did the procedure

exactly how it's designed
to be done,

and he did very well.

You did great, partner.

Get some rest tonight, okay?

And let me know
if you need anything, okay?

Okay.

[upbeat music playing]

All right, well,
mother just called.

We did give her an update,
but he's doing great.

[Amy] Okay.

You update the kiddos
back home

and everybody back home,

-and we'll go from there.
-[Amy] Yeah.

All right. Well, I love you,
you guys. Be careful.

[Amy] All right.
Love you, too.

-All right. Bye-bye.
-[Amy] Bye.

Thank God, my brother's safe.

I can breathe now.

Y'all need
to quit having surgeries.

My nerves can't handle this!

One of the reasons
that you're here is

because we handle
more complex cases.

[Tammy] There's one thing

I haven't told
my doctors about.

[Dr. Turner] Good morning.

-[Chris] Good morning.
-[Dr. Turner] Doing well?

He's been running
up and down the halls.

[Dr. Turner] Running
up and down the halls,
I heard that.

Not nowhere near as fast
as I'm used to.

[Chris speaking]

But really,

with this drastic
of a surgery,

you're going to be
slow moving.

[coughs]

That hurts, by the way,
quite a bit.

Have you seen the picture yet?

No, I really--
I mean, I felt the picture.

-You felt it? All right.
-But I don't know

too much about
what was taken off
or anything.

[Dr. Turner] Let me let you
take a look at that.

[Chris] Big belly roll.

[Dr. Turner]
So that almost covered
the whole table.

[Chris] Dr. Turner shows me
a picture

of all the skin he removed.

And when it's laid there
flat out in the picture,

you're sitting there
thinking...

I estimate it was
four plus feet of skin

that we had to stitch up.

So that's why
I took a little time

to get all that stitched up.

So is he still going to have
a belly button?

[Dr. Turner] Yes.
You know, for now,

if everything heals well,

his belly button should
effectively look normal

or maybe even better
than the one you had before.

[Chris speaking]

Yeah. Now you've got
a nice little cute one.

[Brittany chuckles softly]

[Dr. Turner] I'm sure
that was a top priority.

-No. No.
-[Dr. Turner
and Brittany laughing]

[Chris] This is
the best journey

that I've ever decided
to take and stick with.

Everything that I've done has
finally paid off.

But really,

to be able to keep up
with the grandkids,

and keep up with my wife,

and to be able
to make your life better

and extend your life
by 15 to 20 years.

You know, that's just icing
on the cake.

[Brittany] Off we go.

[phone ringing]

[Tammy] Hello.

What are you doing?

[Tammy speaking]

Well, they let me out.

[Tammy] Well, that's good.

[Brittany] Did they get
the picture I sent?

-Did y'all get the picture
Brittany sent?
-[Tammy] Yeah.

[Tammy speaking]

[laughing]

[Amy speaking off-screen]

The fanny pack.

The fanny packs...

[Brittany groans softly] Oh.

[bleep], that hurts.

[Amanda] Tammy,
I'm sending you

good thoughts on this, okay?

[Tammy] Today, we are
here in Pittsburgh

to see Dr. Rubin

to see if I'm qualified

to get my skin removal or not.

Here, ladies.

[Tammy] I'm nervous
as [bleep].

I'm not ready
to do this, but...

[nurse] Hi, Tammy.
This is Dr. Rubin.

[Dr. Rubin] Hi, Tammy.
It's so nice to see you.

Welcome to Pittsburgh.

This is Dr. Frederick.

[Tammy] Nice to meet you.

Dr. Turner said

that Dr. Rubin has
a bigger team

and a bigger hospital.

He wasn't joking. [chuckles]

Dr. Joe DeRenzo,

I'm the chief
of anesthesiology.

My name is Dr. Stephen Esper.

I'm the cardiac
anesthesiologist

here at UPMC.

I'm Ashley Donatucci.

I'm a senior
physician assistant.

[Tammy speaking]

Good God, how many people are
going to fit

in this goddarn room?

Apparently 20.

[chuckles]

So let's spend
a few minutes talking

about your priorities
and your goals.

I just want to see if...

what you thought about,
maybe, do the arms and legs...

the stomach
and face right now.

We shouldn't do everything
at once.

It's a great stress
on the body.

We will break things up

into different
surgical procedures.

[chuckles]

Face and stomach, those are
the bigger things. Okay?

And to understand--

[Dr. Rubin] Absolutely.

[Tammy] It's hard to walk
because of the skin.

My belly go this way,

and I'm going that way,
and just...

[chuckles]

[Dr. Rubin] Tammy, what we're
going to do now

is we're all going
to step out,

give you a chance to change
into an exam robe,

and then we're going to do
a physical exam.

Okay.

We'll let you have
some privacy.

[Dr. Rubin] Okay. Tammy,
let me have you stand up.

We're going to look
at your back, okay?

[Dr. Frederick]
You are a tiny person

-inside that body.
-[Dr. Rubin] Yeah.

Again, I think it's going
to be really important

-that we think
about doing this in stages.
-[Tammy] Mm-hmm.

[Dr. Rubin] And I think
that what I would say

in the first stage is

-that we take care
of this apron, okay?
-[Tammy] Mmm.

-[Dr. Rubin] This is really
bothersome to you, right?
-[Tammy] Yes.

[Dr. Rubin] You can go ahead
and cover up.

Cover up there.

[Misty] I think Tammy is
extremely nervous

for this appointment,

you know, 'cause she's already
been turned down once

by a skin removal doctor.

It would be heartbreaking

if, after coming all this way,

he's like,
"I can't do it for her".

I would feel so bad for her.

[Dr. Rubin] So...

I think we can start
planning for the surgery

for the lower part
of the belly

and for the chin.

-[Amy speaking]
-[Dr. Frederick chuckles]

[Amy speaking]

[Tammy speaking]

[Dr. Rubin] With that said,

I had a chance
to get some records

from Dr. Smith

and some key laboratory tests

about your nutrition

were pretty low in January

and actually dropped lower
in May.

Uh, you need to get
your protein up.

It's so important
in terms of wound healing.

[Tammy] Lately, I've been
having a really hard time

getting my proteins in.

I haven't been like,
wanting my protein.

I don't want the powder.

I don't want the protein bars.

I don't want
none of the proteins,

not even meat.

The other
really important thing is

your medical history.

How long did you have
the tracheostomy for?

Uh, 15 months?

-[Misty]
Something like that, yeah.
-About 15 months.

Any active problems
with your kidneys, your heart?

As far as I know,
everything's good.

How about your lungs?

[tense music playing]

[Tammy] So there's one thing

I haven't told
my doctors about.

Um...

[Tammy speaking]

[melancholic music playing]

-You vape?
-[Tammy] Mm-hmm.

Is that a daily thing for you?

Yes.

'Cause I mainly use it
for, like, anxiety.

It helps calm me down.

Right now,
I am vaping every day,

several times a day.

And even sometimes,

I'll get up
in the middle of the night

and hit it--

and hit my vape
a couple times,

and I go back to sleep.

[Dr. Rubin] If you're using
nicotine products,

your risk
of wound-healing problems

and wound infection is
dramatically increased.

I know it's going
to be really hard

for her to quit vaping

because instead of turning
one addiction,

she went to another one.

She went from food to vaping.

I think
it's her security blanket

at this point.

If we were to go
and operate right now,

your chances of having
wound-healing problems

are almost 100%.

So number one,

we've got to get you
off the vapes.

Completely.

Number two,

the nutrition is
really important.

We've got to get
those numbers up.

That's going to take
about two months minimum.

So we can't schedule
the surgery now

until we can get
all these things worked out.

[tense music playing]

I don't want to talk
about vaping.

I don't give
two [bleep] about it.

[vape crackles]