Fat (11 page)

     Looks like Xander and his lady were leaving.  Xander grabbed the leash off the corner of the bench with his left hand, patted his crotch downward and gave one of his lady’s front boobs a playful squeeze with his right hand.  They went off hand-in-hand down the sidewalk, two asses shifting side to side like a couple bean bag chairs on a see-saw.  They were no doubt en route to his house to advance their play to the next level; flaps slapping on top of a stressing mattress finishing in a pile of sweaty, sticky flesh.     

     Hey, it’s been forty minutes.  That went by quick.  The best part of the workout is right now, when the body is recovering in endorphins with the memory of the comparatively extended discomfort still fresh.  Thank god, I am done for today.  

     Thank you, Xander. 

BIG HOSPITAL

     Doctors get sick too.  They are terrible patients.  They know too much medicine and can play armchair quarterback with every decision made by the medical staff.  I am a terrible patient.

     I got a bad stomach bug from some kid I saw at the office who spent the entire visit directing coughs into my mouth every time I opened it to talk, and so I urinated from my colon for a couple days straight.  I got a little lazy in my hydration, mainly because I could barely muster the strength to get out of bed, much less keep drinking Gatorade, so I started falling behind in my fluid replacement.  My sister came to check on me on the third day of my illness after a phone call with her where I barely made sense – she said I was talking how my old stuffed bear was scratching at my door wanting to borrow a cup of honey and a can of tuna -- and when she tried to help me to the bathroom, I passed out face down onto tile.  Next thing I know, I’m laying in a hospital room with an IV in my arm.  I’m feeling much better now after getting a few liters of fluid, good enough to be home, but the ER doc didn’t feel comfortable letting me go, even after I called him a wuss to his face, so I had to stay overnight.  And my roommate was a familiar fat guy.

     Xander didn’t look too good.  He looked like an enormous egg laying on a gurney, right down to the shade of white.   He was definitely sleeping not as routine, but as a vitally needed rest to heal.  

    When the nurse came in to change my IV bag, I whispered to her, “What is going on with Xander over there?”

     “Cellulitis.  In between his rolls.  Diabetic.”

     I nodded. 

     I can only imagine it started as just a little irritation.  Just a little redness from some of his overabundant skin to skin friction.  Then it progressed to a little fungal infection.  Here was someone whose every redundant flaps of tissue became a nutrient rich petri dish for organisms that should normally only be thriving on a pathologic athlete’s foot.  I can’t even imagine the stench he was emanating up close -- a two week old dumpster raccoon decomposing in his folds.  Sweat, scum, and skin constantly rubbing on skin combined with the ignored task of hygiene had to have made for some odor – it must’ve gotten pretty cheesy too, and separating the rolls must’ve looked like the mozzarella stringing behind after taking a slice of hot pizza.  That’s fairly easy to treat initially, though – some cream and maybe a soaped rag on a stick for preventive cleaning.  But Xander must’ve let it fester – maybe due to embarrassment, maybe because it was so common a condition to him as to be ignored – that the fungus ate away the skin, breaking down the key barrier to keeping bacteria out of the body, and so a raging staph infection settled in for laughs.  Then add in that his body is not in optimal shape to fight off bacteria because of his diabetes, and Xander being laid up in a hospital for IV antibiotics is no big surprise.

     “Is he doing okay?”

     The nurse nodded.  “He’s a lot better today.  He was close to getting transferred to the University Center when he came to the ER a couple days ago, but the antibiotics seemed to have turned him around.  Maybe this will get him to lose some weight.”

     “Yeah, maybe.” 

     The nurse did have a point.  What has a reasonably good chance of getting a morbidly obese person back on a healthier track?  Some life threatening event related to their obesity: heart attack, stroke, diabetes-related amputation, or maybe even a skin infection gone crazy.  They spend their lives daring death, and when it gets close enough to nip them in the heel, they might decide to snap back some sense.  It is a bit of sad human nature that the normal course is to consume, consume and consume until the bubble pops; hopefully this skin infection is the bubble popping for Xander. 

     But, not likely.  Smokers smoke through their tracheostomies, people still drink after liver transplants and Xander will go right into an Italian beef joint straight from the hospital after discharge.  The only snap for him will be when the coffin lid is finally shut.    

     Change is the exception to the rule.  When weight is a problem, it will always be a problem.  Look at Oprah; she has always struggled with weight, and she still struggles with weight.  And she has a personal trainer and personal chef.  And she is a billionaire.  And she is on TV every day being watched by millions of other women.  If anyone was going to crack the case, if anyone had incentive to crack the case, if it was able to be cracked, it would have been Oprah.  So she still has to fight the battle, with all its ups and downs, slims and wides. 

     The January issue of
People
magazine always highlights stories of successful weight loss, or inspiring follow-ups of the past season’s contestants on
The Biggest Loser
, I guess to inspire readers to start the New Year striving to get fitter, but those stories of people winning the battle against obesity chronicle a lifestyle where eating and exercising have become a regimented, military-like schedule.  Egg whites and wheat toast at 0700 hours, coffee with skim milk at 1030 hours, grilled chicken on spring greens with a tablespoon of balsamic vinaigrette at 1200 hours, an apple and 4 oz. of almonds at 1500 hours, fifty minutes of cardio and twenty minutes of free weights at 1700 hours, 6 oz. grilled miso salmon with a cup each of wild rice and steamed green beans, 4 oz. of red wine and a fat free chocolate pudding cup at 1830 hours.  Maintaining a healthy weight for these obese people had become so foreign that it only became possible with rigid obsession.  And the process to get to that point is obscenely painful: even on
The Biggest Loser
, where these people are on an isolated ranch with nothing to do but work out, eat right and lose weight, many weeks are a disappointment of weight loss and some even put up a weight gain – even the prospect of nationally televised failure and the potential to win two-hundred and fifty thousand dollars are sometimes not enough motivation to lose weight.   I guess the
People
human interest stories are trying to inspire that facing challenges can lead to a happy ending, though in trying to do so, those articles only show that winning the perpetual fight against morbid obesity is only possible with meticulously instituted change, and ultimately, the prize is simply the opportunity to continue fighting.  The war is never won for most; the problem just never goes away completely. 

     Xander’s main issue fueling his obesity is that he has never even shown up to fight.  Not even when his joints turned to mush to make even walking an exercise in pain, or when he developed type 2 diabetes in his thirties, or even when he had to start strapping on a breathing mask every night to force air down his trachea while he sleeps because his neck fat was so obstructive to his upper airway that it was causing periods of apnea.   And now he almost had lost a fight for his life from an infection facilitated by rolls of fat.

     The nurse quickly went from my bedside to Xander’s.  She continued with her patient assessment at a brisk pace.  She lifted up his bed sheet and then his gown to clean his abdominal dressings.  I craned my head up and took a peek.  Xander’s belly looked like it had just taken the brunt of a savage slapping fight and then someone spilled peach jelly all over it.  The nurse lifting and replacing Xander’s gown sent a waft of his infectious gas towards me.  It smelled like grocery store garbage left out in the summer sun for a few days.  She stepped to the open door and signaled for help.  Five burly orderlies walked in and settled around the bed sheet.  They all grabbed a chunk of sheet and the nurse started a quiet count.

     “One, two, three.”

     And with six grunts, the nurse and orderlies turned Xander about thirty degrees from his left side to his right.  A corner of his gown snagged on a bedrail and flipped up towards his abdomen.  There were no genitals visible, just hanging skin and thighs, with the nether regions buried in the netherworld underneath all that extra tissue.  The nurse quickly flipped his gown back down, then readjusted pillows, sheets, and IVs.  Then she shrugged.  The orderlies nodded and left.  A reasonably well performed production of “As Xander Turns”.

     The nurse stood back to examine her work.  “Tomorrow is going to be a bitch.”

     “What’s tomorrow?”

     “He’s going for a CT.”

     “Oh.”

     “The doctors don’t think he’s even going to fit in the machine.  We may have to send him to the zoo.”

     Patient list for the Brookfield Zoo CT machine tomorrow: Grizzly Bear, Sperm Whale, Xander, and a baby Elephant.  What the hell.  I guess when you reach a point where simple medical imaging needs to be done behind the Pachyderm House, you don’t give a crap about appearances too much.  Being half naked in a XXXL hospital gown where half the staff has ogled your raging rolls of infection while marveling at disappeared genitals is comparatively the Mother Theresa of dignity. 

     The nurse wrote a few things down in Xander’s chart and walked out the door.  Xander started shifting a bit.  Then he farted.

     I have to get out of here.                   

     Part of the reason I loathed to go to the hospital was the cost.  This stay is going to cost me at least a few thousand dollars.  If I could’ve just toughed out a few hazy and diarrheal days at home without risking death, I would have done it to save the cash.  Why does it cost me, a healthy never before hospitalized patient, a couple thousand dollars to just get some fluids dripped into me?  Looking over at Xander’s face suck in air, his arm IV suck in fluids and antibiotics, and his mattress suck down towards the floor made me want to switch off his bed’s brakes and shuffleboard him out of the hospital.  I have to subsidize Xander.  All of his semimonthly doctor visits to manage his diabetes, blood pressure and cholesterol, all of the times he says fuck it and eats an Italian beef and chili cheese fries instead of taking his insulin and wakes up in the Emergency Room, all of the times his comorbidities force the Emergency Room doctors to give him the million dollar heart attack workup for any chest pain because it would be malpractice to ignore the fact he is a morbidly obese diabetic, and now a two week stay to treat a skin infection caused by redundant skin and poor hygiene topped off with a trip to the zoo to get a damn CT scan have to be paid in part by people like myself.  The cost of insuring Xander’s medical care has to be shared, like how turning him in his hospital bed needed to be shared by the efforts of six people, or how I imagine his casket one day needing to be shared by a baker’s dozen of pallbearers.  Other people’s premiums have to cover the potential cost of their own medical care as well as the losses from this guy’s obesity-related, chronic medical issues.  There is no way Xander’s own insurance premiums could ever cover all of his medical care.       This guy eats even health resources at such a rate to affect everyone’s insurance premiums.  People always rail against the government or insurance companies or doctors to blame them for the high cost of health care, but never is any connection made with McDonald’s 1 billion served. Drinking too much, smoking too much and certainly eating too much cause most modern day health problems, and these are all preventable, but because people don’t suffer instant morbid consequences from these habits, they continue to suck back tobacco, booze and grease, and eventually become train wrecks of failing health that suck down most of society’s health resources.  No one wants to look at themselves as the culprits to rising health care costs, they much rather blame some faceless corporation or system, so the underlying reasons of poor individual health decisions go unchecked and perpetuate.    

     For hospitals, Xander is a goldmine.  A fat guy with a scrolling strap of chronic medical problems with good private insurance.  The profit generated from his insurance company’s good reimbursement rates for his numerous hospitalizations probably allows the hospital to absorb the losses from the capped reimbursements of a dozen public aid patients.  Hospitals can count on the fact that once a morbidly obese person comes in with a complaint, the medical machinery has to get started and there is no release home until everyone is reassured that this person won’t drop dead in the next few days.  That always takes a few thousand dollars of tests. 

     But, it is not money spent to cure.  That would be impossible.  No amount of medicine will ever get the obese to become skinny without the active participation of the individual.  Instead, it is a few thousand dollars of medical interventions towards the goal of just getting that fat guy off a runaway death train and back onto the more tolerable track towards early death at the slower pace of one fried chicken bucket at a time.  That medically assumed eventual outcome is the reason no one is too surprised when someone morbidly obese needs medical attention, though sometimes the hamburger fed march towards death jumps ahead a few quicker steps at a time.  Chest pain?  Tell a doctor the sufferer is morbidly obese and the doc will think, “Hmmph, figures.”  Now doctor has to rule out a heart attack even though the pain is probably due to just eating four Arby’s roast beef sandwiches drenched in horsey sauce.  A little short of breath?  Hmmph, figures.  It could be a pulmonary embolus from massive gravity slowing his lower extremity circulation to the point of syrup, then tossing a few resultant clots to his lungs, so doctor has to spiral chest CT this guy, even though it’s more likely just a fat guy sucking air from simple deconditioning.  Back pain?  Hmmph, figures.  Better make sure this guy didn’t crush a few vertebrae from his mass shifting in his sleep even though the pain is likely from his spine being maximally taxed supporting superhuman weights all day, everyday.  Knee pain and can’t walk?  Hmmph, figures.  Lower legs are swelling?  Figures.  Getting pneumonia a few times a year?  Figures.  Boil on the ass?  Figures.  It doesn’t matter what the ailment, obese persons getting sick are accepted as the norm, and death is known to be always hovering over their masses.