Fat (8 page)

     “C’mon, Dr. Grant, that’s just stupid.  And I’m not even close to being that ripped.  I look barely muscled, much less over-muscled.  And who wants a pizza for a back and a pair of honey roasted peanuts for testes?”

     “Hey, I have to ask or I wouldn’t be doing my job, right?” Xander smiled with a shrug.  “Have you ever been sexually active?”

     “Yes.”

     Whoa.  Looks like Xander’s weight loss really opened a lot of doors for him.  He was a pretty good looking kid with his extra weight gone.  Seems like that is how most overweight people are: attractive people hiding underneath layers and layers of adipose.  Watch the mommy weight loss episodes of
Oprah
, or read the weight loss human interest stories in
People
, or turn in for the entire arc of
The Biggest Loser
– usually the people that have to lose over fifty percent of their body weight in order to return to average turn out to be good looking people.  Of course it helps that those publicized images tend to have good lighting and makeup and editors, a tight selection process, access to photoshop and a horrible “before” comparison image, but regardless, these once obese people could easily be a cast for a potential GAP ad.  It seems like Xander was living the life of an attractive person now.      

     “How many partners for you, Xander?”

     “Forty.  Forty-seven if you count prostitutes.”

     “What?”

     “Ha, ha, gotcha doc.  I’ve never been sexually active.  Did you see what I looked like before? Not many girls want to get boned by a beanbag chair with a little smokie sticking out of it.  Plus, I don’t think mom would be cool with becoming a grandmother right now.”

     Xander has gotten hilarious.  A new physique, a new personality – Xander was on his way to becoming a heartwarming story.  Though under the mesh of his jersey, I could see he was wearing a T-shirt with an Emperor penguin on it.  It was even more impressive that he still held true to his geeky interior while changing his exterior.   He was still holding onto the remnants of the old Xander, but he played football now, so who cares?  A fat kid with a marine animal shirt is a flaming nerd, but an athlete with a penguin on his shirt is cool because he’s a brainiac meathead – a guy that could wear something other than popped Lacoste polos and loose Buffalos, and by seemingly not caring what other kids think, he was actually making them think sea mammalian tees were approaching kitschy cool.  His confidence could make him a trendsetter in his small teenaged world.

     “Well if you ever decide to become sexually active, you know you can always come here to talk about it.  Anything you say will be confidential.  By law, your mom will not hear about anything from me.” 

     I never thought I would ever need to give Xander a sex talk.  Morbid obesity is the ultimate birth control.  Sure, a few obese girls and boys sometimes get opportunity to act really slutty to even out the playing field, but morbidly obese people have such a limited selection of potential suitors, that natural selection usually takes care of their teenage pregnancy rates.  But, this new Xander is now high risk.  Improving his chances to get his pig-into-a-blanket was obviously part of his drive to lose weight, so in that end, Xander, mission accomplished.

     “That’s good to know, Dr. Grant.  What if I said all I fantasize about is that while I’m boning some chick, I slowly put a pillow over her face so she’s trashing for breath when I climax?”

     Holy shit.  “Well, uh, in that instance…hmmm…”

     “C’mon Dr. G, I’m joking.  Oh man, you should have seen the look on your face.”

     This kid is my kind of kid, now.  I looked down at his vitals in the chart: good heart rate, good blood pressure, weight trending down towards a normal BMI.  Nice.  His physical exam was largely normal, save for a few fading stretch marks around his abdominal flanks.  He had markedly better strength and flexibility than I remembered from his physical last year.  He could do a duck walk across the exam room without breaking a sweat.  He looked well-built for football.  I guess that makes sense: how could he not have had some baseline muscle mass after having had enough fat draped on him as to basically be in a constant state of weightlifting?

     “Xander, I have to tell you, this new you is really, really great.  You’ve lost weight, gained muscle mass, you seem happy and look healthier – just fantastic, little buddy.”

      Xander just smiled.  “Thanks, Dr. Grant.”

     “What has your diet been like recently?”

     “Well, like I told you before, I cut out all drinks except for water or diet soda…”

     “Awesome.”

     “…but I guess my diet is still pretty typical teenager – still some junk.  Like the whole team goes to grab pizza and burgers after almost every practice and game, and you know how it goes, eating a lot is a male pride thing.”

     “Well, just be careful with that, because your metabolism is the best it’s ever going to be right now, so you can eat total garbage at this age and your body will just burn it.   But, if you keep with the bad eating habits, as your metabolism slows down as you get older, your body is not going to be able to burn it all and you will put on weight.  You are not going to be doing two-a-days when you’re fifty.”

     “God, I hope I don’t still have to do those then.”

     “I am not saying you can’t eat some junk, but do it in moderation, and try eating some more fruits and veggies.”

     “Alright, doc, I will try my best.  Junk tastes so good, though.”

     “Yeah, I know.  But the key words here are “in moderation”.  A life without some junk would not be too enjoyable.  Sometimes, nothing is better than a good bacon cheeseburger.”

     “Or an Italian beef with giardiniera.”

     “Or a deep dish Lou’s pizza.”  Imagining that cheesy deep dish pie was making my mouth water.  I suddenly got depressed thinking about the sack lunch I packed today of turkey and swiss on whole wheat with a side of sliced apples.  “Anyway Xander, you’re going great, just keep it up, and try to do a bit better on your food choices.”

     “Will do.  And no more ‘tutes, eh?”

     “What?”

     “Prosti-tutes.  I should cut down on handies from them too, right?”

     This kid was downright hilarious.  As he left the exam room, my pen bounced from line to line in his chart and every other word seemed to be “good” or “improved”.  His change happened in such a relative blink, to the point of puzzlement that it did not happen sooner.  With so much abject failure in the practice of medicine, even a glimmer of possible success makes for rainbows and bunnies.  Today’s Xander is what makes the slog through the hellhole of clownish patients worthwhile. I saw him now going on morning runs with his wife, hiking through the Grand Canyon, chasing kids across greenery, chasing grandkids across greenery, and spryly hopping into a hover car.  Before today, it seemed I wanted that long life for him more than he did.  Long live this new Xander.                     

WATERMELON TOOTHPICK

     Every Fourth of July, the country club holds a barbeque for all the members and their families.  It is always a great spread, great fireworks, and a good time.  I haven’t been in attendance for a while, but somehow all my other plans fell through this summer holiday, so I went.  Albert, Kate and Xander were there as usual.

     “Dr. Grant!  Great to see you!”  Kate ran over from the buffet line and gave me a hug. 

     Albert and Xander were just finishing loading their plates, and they headed over towards me, faces lighting up and waving.  Xander was balancing two plates heaped with pulled pork and ribs peeking out under coleslaw, corn-on-the-cob and beans.  He was waddling.  It looked like every step was a battle of leg and ground, and the jackhammer shocks of his foot strikes unable to be dissipated by the matted grass seemed to be sending reverberations of pain back up to his already damaged joints.

     I hadn’t seen Xander in a few years.  He was old enough now to be able to decide to ignore the recommendation to see his doctor once a year, and certainly he’s old enough to not need a pediatrician.  Seeing him heavier and hobbling was surprising, considering the last time I saw him, he was an emerging jock and turning his way down a healthier path.  Usually high school football players add the pounds gradually after they stop playing, trading muscle for fat by continuing to eat and drink as if they were still in practices every day and with a teenager’s metabolism.  Xander did have an elastic brace on his right knee.  It was probably the result of an old football injury.  Probably the reason he had to stop football.  Probably the reason he was able to put on so many pounds so quickly.  Though probably not that serious of an injury because the brace he was wearing was only adding a whisker of additional support in relation to the body mass his knee was supporting on a step by step basis.  That injury had to have happened years ago in high school, so why still with the ineffectual brace?  Maybe for placebo effect?  More likely for show to provide an excuse and point of sympathy for being sedentary.  The injury was moot.  It was his obscene body habitus that was making him gimpy now.  

     Imagine supporting a marshmallow on a couple toothpicks – easy.  Now try balancing an apple, then a cantaloupe, then a watermelon on those same two toothpicks.  Joints and cartilage and bursas are amazing feats of anatomic engineering, but they are missing a weight limit sign, so people assume the sky is the limit.  Pain starts from weighted bone grinding away all the cushioning in between bones, in the way of mortar and pestle, and pain pathways become exposed and persistently agitated because the weights of five average people are abusing a single joint.  With every step, his joints scream out in throes of spikes underneath fingernails torture.  Pain prevents exercise.  Pain prevents even walking.  Pain is eased with barbeque.  More pain is eased with more barbeque.  The apple becomes a cantaloupe becomes a watermelon.  Then snapped toothpicks.  This is a twenty-eight year old guy looking like he’s going to need a Rascal in a couple months.  Xander had already started to wear out his joints before reaching middle age.  But, I guess the way he’s going, this could be his middle age.

     “Hey Dr. Grant, great to see you.  You should really try some of this pork.”  Xander had enough pork on his plate to re-form an entire pig.  Lunch time with the obese.  Very rarely have I seen in person someone obese put down a full extra-large sausage and pepperoni pizza or four Big Mac meals in one sitting.  Usually the amount of food I observe being consumed is at the upper limits of a reasonable portion – of course that portion already having been arbitrarily bloated by mass consumer gluttony – but still, all I have ever seen one person put down live is a super-sized value meal plus a few dessert extras like a sundae and an individual apple pie.  Most consume the additional calories by in-taking constantly throughout the day or with more substantial amounts in solitude.  Even gluttons realize outsized gluttony in public will elicit circus side show stares, so they attempt to avoid the murmurs by making their gluttony a private sin.  Not Xander anymore.  Xander’s plate surpasses the threshold of a reasonable portion, easily.  He had gotten to the stage where if anyone watched him eat any meal, they would understand how he was able to achieve and maintain all his adipose. 

     “I sure will, Xander, that looks real good.  Hi Albert, long time no see.”

     “It has been a while for sure, good to see you.”  As Albert extended his hand for a shake, his cell phone started ringing.  The ringtone was the Notre Dame fight song.  He unlatched the phone from his belt and looked down at the caller ID.  “Ooh, sorry, I have to take this.”  Albert excused himself and took the call.  Meanwhile, Xander was already chewing away, in between heaving breaths.  Breathing seemed to be a nuisance to his eating.  He had let his hair grow to shoulder length, and it looked like his mop had never met comb.  He looked like a lazy roadie.  He also looked seven months pregnant.  All his overeating and fat storage in the past had made it too easy for him to pack the weight back.  All those extra fat cells created from years of massive calories, then being continually filled to the maximum had set him up for effortless obesity for life.  Even with those cells being emptied through a comparatively brief detour towards fitness in high school, the infrastructure was always in place for a quick refill.  How much easier is it to refill pre-existing containers than to get the raw materials to make containers, make new containers, and then fill them? 

     Kate just frowned.  “Xander, slow down, you sound like you’re choking on your food.”  

     It didn’t sound anything like choking.  It sounded more rhythmic, like air escaping from an over-inflated air mattress as grandma tosses and turns to sleep.  He was literally out of breath just standing there eating, almost gasping, as if air was just another piece of pork needing to be gorged.  It makes sense; try breathing with a fifty pound weight on your chest.  Try breathing after letting your conditioning decline to a point where eating becomes aerobic exercise.  Try breathing while your heart and lungs struggle to meet the demands of an ever-expanding body.  Even the simple act of breathing becomes exhausting, making for more exhaustive breathing.