Authors: James Keene
The next day, when I awoke, Xander was unsteadily shuffling to the bathroom with a couple orderlies and a nurse assisting him.
“Hey, Dr. Grant! How are you feeling?”
“Pretty good, Xander, how about you?”
“Much better today. I woke up today feeling as good as I have since I got here. Thought I’d try to walk to the bathroom today, but all these dang medicines they’re giving me are messing with my balance.”
It’s always something else besides the obvious. Intravenous fluids and antibiotics causing a waddling gait? How about years of de-conditioning coupled with a few days of total immobility? Even the healthiest of patients will lose significant strength after being bedridden for a few days, so that deterioration will easily push someone morbidly obese into an invalid. In his mind, he was the victim of some outside agent’s side effect. I guess that is easier to swallow than to realize that his deteriorating balance was self inflicted, that his deteriorating health was more suicide than manslaughter.
He was grunting with every step. “Dang, my legs are killing me. They’re all swollen up and red with a rash, probably from all these toxins in my body trying to get out.”
How about years of deconditioning and weight gain obliterating his lower extremity venous valve threshold? A combination of limited blood flow from a lack of activity and a constant massive downward pressure from excess mass have made Xander’s legs swell up with extra fluid that got backed up from his taxed blood return system. Back flow is the simple diagnosis, rather than some self-created, abstract diagnosis of toxin expulsion. When the veins don’t work, there’s going to be alterations in oxygen delivery to tissues, including skin, and when some of that skin doesn’t get enough oxygen, there’s going to be damage and inflammation to that skin, and a resultant rash. That swelling and redness was directly fat-related whether Xander wanted to face it or not.
Xander disappeared into the bathroom with his trio of helpers. Almost everything that someone does in the bathroom should be able to be done alone – brushing teeth, showering, urinating, stooling – but once bathroom activities need assistance, it should be taken as a sign that something has gone terribly wrong. The sound of Xander’s whistling “Somewhere Over the Rainbow” from the bathroom made me believe he was not taking it as that. Taking a piss for him was no longer the normally private show; it had become a repeating performance for a participating audience of three who were only there because they were getting paid to be there.
There was a flush and the foursome reappeared. “Dang, my knees. I can’t wait to be done with this medicine.” He leaned on each of the orderlies with each step, letting the nurse drag his IV pole, and slowly got back into bed. That bed seemed to sink a foot when he climbed onto it. “Whew, I am tired. I’m going to grab some shut eye.”
And he did. The only thing to wake him two hours later was the lunch tray. It was an impressive lunch tray. He had ordered a few meals. I compared what was on his tray to my tray of a turkey sub and green beans, and it looked like I had gotten the hospital Happy Meal. He took the napkin, tucked it into the collar of his gown, arranged his plasticware neatly to his left, then went to work. He was brutally efficient. Big bites, then fork to plate to snag another mouthful to bring up to lips just as the first mouthful chews were winding down, and then repeated in dizzyingly quick succession. The sunshine from the window skewed into rapid fire glints by his working plastic. It was strangely mesmerizing.
He paused after getting through half his food. “Ugh, this food is disgusting.” Then he kept on eating. All he left was just a pile of empty plates. He dozed off soon after.
I flipped on the TV to kill some time.
The Shawshank Redemption
was on. Unbelievable movie.
“
These walls are funny. First you hate 'em, then you get used to 'em. Enough time passes, you get so you depend on them.”
Xander had his own prison. Xander was in the hospital because of complications from his morbid obesity, yet was doing nothing to prevent another admission. He was wallowing in his excess weight. The life he knew of sitting all day, eating all day and playing the victim all day was now preferable to the possible life waiting for him after dieting and exercise.
I kept down my lunch and was feeling even better than I did when I first woke up this morning, so I got discharged home later that evening. Leaving this room imparted an odd sense of approaching more living, as if I was running a bit further from the reach of the Grim Reaper. Xander was still asleep when I made my way out of the room. If it wasn’t for his snoring, I would’ve thought he was dead the way his body was flopped on the mattress. He was still breathing. For now.
AU BON PAIN
“So you think he needs to get gastric bypass surgery?”
I ran into Kate on my day off while getting a chocolate muffin and coffee at Au Bon Pain. After being coerced to sit with her, and some mindless small talk, this is where the conversation led. Xander is thirty-eight and his mommy is still worrying about his weight. And she’s still oblivious why he weighs more than both his parents combined. But, now at least he wants to do something serious about it.
“No doubt about it, Kate.”
“He’s tried Atkins, South Beach, Weight Watchers, he’s gotten prescriptions for Meridia and Xenical, emptied out the Walgreens stock of Hoodia, HydroxyCut, Trimspa, and Alli, did some diet where he ate these weird cookies all day, and he even went to Mexico to buy some stuff which only gave him bad stomach cramps and which made him gain ten pounds.”
Xander was desperate. Not desperate enough to do the one thing that will work over the long term – diet and exercise – but desperate enough to try anything in search of the easy shortcut. Everyone wants a quick fix and have their problems fixed with just a simple pill. They want to keep eating bacon cheeseburgers and drinking chocolate shakes every meal, then watch TV all day from their lazy boys and still lose weight by just taking a bunch of herbs in pill-form. Everyone wants to be that “after” on the weight loss infomercial: to start out as a slumped blob of adipose and then magically turn into a tanned, oiled tank of muscle. As if decades of body abuse should only take days to reverse. That is the real laziness of morbid obesity: the all-out effort to avoid the guaranteed successful solution that requires continual hard work, to instead pursue the failing fads that require minimal work. Xander is lazy.
“Albert and I sent him to an obesity center in Arizona we heard about, but he only came back fifteen pounds lighter with a tan.”
Fat clinics abound like cancer or surgery centers, signaling obesity’s prominence onto the medical stage. These clinics’ advertisements saturating print, radio and television, point to the lucrative nature of obesity – a limitless patient population willing to try a never ending variety of treatments with an equally never ending drive to find an easier way to drop pounds.
There are more than enough obese in the populace to
sustain the fraud of weight loss specialists that got Cs in high school and went to school in the comparative strip mall of medical education. Chiropractors are educated in open admissions schools that teach pseudoscience and marketing to anyone that is willing to pay their tuition, yet these snake oil salesmen still have the gall to market themselves as "doctors" purporting "natural" medicine while delving into areas where they have not had a sniff of appropriate training, where scientific evidence is seen as an unwelcome foreigner and where any bit of sugar coated nonsense they are able to concoct is dispensed as cure.
These are people that make their living in the zone of anecdotes and placebo effect, and with so many targets to choose from to drive up the chance of independently random successes, they will continue to happily chicken hawk the ample supply of misguided weight loss seekers.
There are so many obese and the concept of weight loss has become so ubiquitously relatable that it has become a Nielsen ratings buster, able to drive a reality show about the ultimate fat clinic as competition,
The Biggest Loser
, to frenzied popularity as there are more and more fat people to tune in to NBC to admire even fatter people lose weight in impressive fashion, liken to how people will tune in to watch professional athletes. Fat clinics can be helpful to jumpstart weight loss, but unless someone can live at one of these centers all day every day, or at least stay for the necessary months to get their eating and exercise habits reprogrammed, these clinics are not going to be more helpful than watching a late night infomercial on a magic weight loss pill discovered by some sketchy looking “doctor” spewing nonsense while trying to look the part in a white labcoat.
“Sounds like he needs surgery. How much does he weigh nowadays?”
“Close to four fifty.”
Almost as many pounds as cents for a Big Mac meal. “Wow, that really is heavy. That is surgery-heavy, Kate.”
“Really? It’s really come to that?” Kate took a bite of my chocolate muffin and then her eyes started welling. I looked around at the crowded bakery. If she starts bawling it’s going to look like I’m breaking up with her.
“Last month I got gastroenteritis from some kid and had a week of bad diarrhea, and lost fifteen pounds, so maybe Xander can go to the local daycare and eat some dirty diapers?” Kate broke her frown and smirked a little. I continued, “Or he could do like my buddy who went on a medical mission trip to South America and got a tape worm, which dropped him about forty pounds. He kept it off for like six months because that wormy sucker in his intestine was resistant to most antibiotics. He died though. He looked great at his funeral.”
Kate now sported a full-on smile. Lame jokes always hit her funny bone. “Okay, okay, but seriously, is this surgery going to hurt him?”
It will definitely hurt. Surgery is no joke; scalpels hurt, probes hurt, having instruments inside your insides hurt, healing hurts. Pain is not the question. The real question Kate should be asking me is: Does Xander need to risk death by surgery in order to avoid death by cheeseburger?
Healthy people can die from surgeries. Iron Man competitors can die from surgery. Death is a baseline risk of any surgery, from simple face lifts to brain tumor excisions. But, performing major abdominal surgery on someone morbidly obese? Russian roulette. The obese are terrible candidates to have any surgery done to them; they are sedentary, resulting in poorer cardiovascular and pulmonary baseline functions, and likely with pre-existing co-morbid conditions like diabetes and hypertension. Even routine procedures like finding a vein for an IV, securing an airway or even listening to the chest with a stethoscope are made exponentially more difficult due to the respective obscuring, obstructing and muffling properties of massive amounts of fatty tissue. It is a desperate point to reach where the risks of surgery is far outweighed by the health risks of letting someone continue eating and living status quo, where invasive surgery becomes the most viable option to prevent death by cheeseburger. It seems like gastric banding and gastric bypass surgery should be rarer and more obscure procedures. It is not – it’s pop culture. People in the third world must marvel at our continual access to massive amount of food and shake their heads at the extent of medical care available to treat the condition of overeating, as they sit in a thatch hut recovering from malaria and about to eat a bowl of plain rice as their only meal of the day. So, does Xander need to risk death by surgery to avoid certain death by cheeseburger? Undoubtedly, yes.
“Kate, it will be painful and risky, but it’s better than Xander never being able to feel anything, ever, because he’s dead from a heart attack.”
Kate flinched just barely at the word
dead
. “I guess you’re right. He doesn’t have much of a life as it is now.” Kate’s frown had returned and she stared off blankly.
No doubt his weight has now put him in solitary. He was unable to walk more than a few steps before searing back pain necessitated a rest, unable to brush his teeth without breaking out in a sweat, having to use a cane to maneuver around even in his small bedroom, loathing to go out in public unless absolutely necessary because he feels people’s stares and hears their murmurs. The amount of calories he needed to consume to maintain his weight had probably become so massive that most of his waking hours were spent eating or preparing for eating. Xander has hit a state where he needs someone to cut into his abdomen and reconstruct his gastrointestinal tract to purposely limit and malabsorb food because he can’t put down that Twinkie on his own. There are so many horrible diseases that manifest as anorexia and malabsorption, but Xander needed to be surgically put into that state to counteract his excesses.
The really unfortunate thing was that he had a lot going for him. He had started some internet electronics company in college and was quite successful. He easily became a multimillionaire in his twenties. He bought his parents a huge house in a tony suburb and he built a custom ten thousand square foot mansion on some land neighboring Michael Jordan’s. He is a member of the boards at the local Children’s hospital and the Art Institute, and has given away ten percent of all his earnings to charity every year since making it big. He had even been able to put his friend’s dad into Washington by funding the his Senate run last year. Xander was a big fish in this big pond. Unusual for a fat, lazy guy, right?