Chapter 9
The morning of the medical assessment arrived overcast, with a sickly chill of dread.
Emmett’s gut churned with nausea as he punched the address of the medical office into Google Maps, partly because he’d obeyed orders to fast beforehand and partly from fear of the assessment.
How long had it been since he’d seen a doctor?
Three years? Four? How long would he have let it go if Monstera wasn’t forcing him?
Twenty minutes later, he took the off-ramp for Bonita Road and turned into the parking lot of a decrepit two-story commercial building. It was vaguely Spanish in style, mucky brown and sagging around the edges.
“Emmett Truesdale.”
“Sign in, please. I’ll let Dr. Halleck know you’re here.”
Emmett sat down a moment later with the clipboard of medical questionnaires.
The questions were endless, intrusive. Do you have any conditions?
Had any surgeries? Take any medications?
Do you smoke, drink, use marijuana or cocaine?
Emmett answered no to pretty much everything.
On a checklist of some forty medical symptoms, he marked just one: Weight gain.
Fifteen minutes after his scheduled appointment time, a nurse came to take him back.
She took his weight—323 pounds, a staggering number even to him—then led him into a small wan exam room and measured his blood pressure.
The cuff bound his arm so tightly it seemed possible that it might crush his bones to splinters.
The Velcro crackled as the nurse detached it. She’d barely spoken, her eyes matte and empty as she lumbered for the door. “Doctor will be right in.”
Emmett sat, fingers laced between his jittering knees.
A clock tick, tick, ticked on the wall. Beneath it, a row of laminated medical posters.
Diagrams of skinless musculature and viscera, caterwauling the devastating impacts of smoking, hypertension, and high cholesterol.
One, focused on diabetes, depicted an obese man, his organs and arteries visible through transparent skin.
Each was affected by the disease in a new, more heinous way.
Vision problems. Cardiovascular complications.
Kidney damage. Nerve damage. Stroke. Amputation.
Even death. The man’s round face smiling all the while, dead-eyed and oblivious.
A knock at the door. Emmett put his phone away, and a gut-wrenchingly handsome man came in—thick hair swished back, bronzed skin stark against the whiteness of his coat. Emmett smirked, reminded of Joey Tribbiani as Dr. Drake Ramoray on the Friends version of Days of Our Lives.
“I’m Dr. Halleck.” His tone neutralized Emmett’s amusement at once. His eyes conveyed a combination of seriousness and censure, despite having not yet seen Emmett’s medical chart.
He grabbed it from the back of the door and flipped through it. “You’re here for a clinical trial assessment, yes?”
“Yes.”
The doctor shook his head minutely as he scanned down the page, exuding a kind of bored, emotionless disgust. “Very heavy. I’m sure you know that. BMI of forty-three. That’s Class Three obesity. Do you know what that means?”
“I—”
“Morbid obesity.”
Even death.
“Hopefully the trial will help with that.” Emmett’s insides were a cold soup of shame. Halleck looked at him askance, as if he didn’t totally approve of miracle weight loss solutions.
“Are you aware you can lose weight through diet and exercise?”
Emmett almost laughed; was that a joke? “I have heard that, actually.”
“You’ve tried?”
“So many times.”
“What went wrong?”
Emmett knew this was the part where he was meant to blame himself: his inability to grasp the fundamentals of good nutrition, his dearth of willpower, his superhuman love for the taste of high-fructose corn syrup.
“I have an eating disorder,” he said.
Halleck paused, taken aback.
“Sorry,” Emmett said. “It wasn’t an option on the questionnaire, but—”
“Which disorder?”
“I don’t know, it’s never been formally diagnosed. Binge eating maybe? Compulsive overeating?”
“If it’s never been diagnosed, then how do you know you have a disorder?”
“Because my eating is,” Emmett said, “disordered?”
The lack of diagnosis bothered Emmett as much as it clearly did Halleck.
Back when he was still going in for checkups, he’d asked several times for help controlling his eating, only to be referred again and again to nutritionists and dieticians, to be treated each and every time to the same lecture about healthy choices.
More lean meats, fruits, and vegetables.
Less refined carbohydrates, saturated fats, and sugar.
Salad, nuts, and whole grain good. Burgers, pizza, and ice cream baaaaad.
Did they really think he didn’t know that?
Or did his doctors simply think he was incapable of understanding, that the vessels of his brain were too gummed up with accumulated fat for the information to reach the processing centers of his cerebral cortex?
On a good day it was irritating; on a bad day, he craved violence.
The problem wasn’t that he didn’t know that an apple was healthier than a Snickers.
His problem was the Hunger that didn’t care.
This was not to be confused with the little-h hunger, the body’s signal that it required sustenance.
This Hunger was not physical at all, but a compulsion fired straight from the synapses of his brain.
It repeated every few hours whether he was hungry or not—typically manifesting as a one-two punch of craving: for salt and fat, then sugar.
Burrito, then cereal. Pizza, then gelato.
Tacos, then churros. Cheeseburger, then birthday cake.
Never just a little bit either, never a bite or a taste.
It had to be enough to fill him, stretch the walls of his stomach, even make him feel like he was going to be sick.
Like at Harper’s party. What started as a gentle nudge of desire would steadily ramp up the longer he held out.
Eventually it was throwing itself around his head, a wild, thrashing animal of a thing.
A thing not just to be placated, but feared.
At the worst of times, Emmett felt like if he didn’t eat, he would die.
But mostly it never got to that point. If he wasn’t actively dieting, he’d satisfy his cravings as soon as they came, usually every two or three hours, snacking, sipping, feeding the beast. At times he ate so consistently he rarely felt physically hungry at all.
He might not binge like he had at Chris’s house for weeks, even months at a time.
In a way that was worse. The mindfuck of it.
He’d find himself questioning whether the Hunger was still there, whether it had ever been real in the first place.
Maybe he’d imagined the whole thing, he would think.
Maybe he didn’t have an undiagnosed eating disorder.
Maybe he was exactly what the world insisted he was: lazy, mindless, braindead, weak-willed. Lard-ass. Slob. Fat shit. Monster.
Whatever Emmett was, he was desperate for help.
Even more than a diagnosis, he’d begged his doctors for a referral to an in-network eating disorder specialist. He’d seen therapists on his own, as many times as his employee assistance program would allow, but even the ones claiming expertise in the subject had only worked with patients with anorexia and bulimia.
Emmett had been excited to identify one LMFT who actually specialized in binge-eating disorder—whose “calling is to help people struggling with intrusive, food-related thoughts and compulsions find relief from the mental burden of preoccupation about food and their bodies”—until he learned she charged $400 per hour and didn’t take his health insurance.
So much for her fucking calling.
The doctor before Halleck had been the first to grant Emmett’s request, albeit reluctantly, and after two months of dithering, the health system had at last given in and scheduled him with one of their clinical therapists.
Sandra was gentle and kind, maybe too much so.
When Emmett complained he wasn’t making any progress with his eating, she responded with reassurances like “You have to stop being so hard on yourself” and “Just the fact that you’re here shows that you are making progress.
” Required to keep notes of everything he was saying, she didn’t stop typing the entire session, her eyes flitting between him and her monitor as he recounted the traumatic incident he had rarely spoken about before, and which she didn’t seem to know what to do with.
She urged him to attend their healthy-eating support group, but he didn’t want to be supported by fat people and the average-bodied White women who shouldered their way in; he wanted to be supported by the medical community who never stopped making him feel like he was on the brink of death and bringing society down with him.
It didn’t surprise him to eventually learn that Sandra wasn’t an eating disorder specialist at all.
The health system had decided that because his BMI was then under forty, he didn’t warrant specialist help, just had “poor dietary habits,” just needed “education.” The therapy lasted all of two months.
Another weight loss failure to add to the list.
In the exam room of Cronus Health, Halleck glossed quickly over the topic of Emmett’s disordered eating. “Research shows sugar can be as addictive as opiates. If you’re struggling with cravings, you should get off it.”
“Just ‘get off it’? Like, cold turkey?”
“Sooner the better.”
“Is there anything you can give me to help with that?”
Halleck snorted. “What, like methadone for sugar addicts?”
Emmett faltered, first embarrassed and then annoyed. Was that so crazy? Hadn’t he just said sugar was as addictive as opiates?
The doctor dropped his gaze back to his clipboard. “If you’re craving sweets, try plain yogurt with fruit.” He flashed a smile. “I like strawberries.”
Yogurt with strawberries. Thanks for the pro tip, Doc.
Emmett had noted on his questionnaire that he had no family history of heart disease or diabetes that he knew about.
“You’re lucky,” Halleck said. “Genetics are one of the highest risk factors for those conditions.” He dismissed the occasional prickle in Emmett’s feet as the product of low-quality shoes and ordered him to sit on the exam table.
The wax-paper covering crinkled underneath him. Halleck examined Emmett’s heart, eyes, ears, and throat. Asked him to lie back and dug into his abdomen with the gloved spade of his hand. “Fine,” he said, stepping back and peeling off his gloves. “Do you check your testicles for lumps?”
Emmett sat up. “Not—not regularly, no.”
Halleck sighed, rolling his head. “Pull down your pants.” He gloved up again.
Emmett froze in the glare of Halleck’s cold attractiveness. Not because he feared becoming aroused. He didn’t need to get a boner for his body to humiliate him.
He got to his feet, unbuckled his belt, and pulled down his shorts. When Halleck nodded impatiently, Emmett slid his boxers down too.
He couldn’t see his penis over his belly, not without bending forward, but he could feel it: scrunched, sluglike, stuck against his scrotum. He could smell his sweaty musk. Fat boy stinks.
Halleck turned his head away as he conducted the examination. He couldn’t rip the gloves off fast enough once he was done.
“Have you been fasting?”
“Yeah.” Emmett cinched his belt, avoiding Halleck’s eye.
“No food? Nothing but water for the last twelve hours?”
“I’ve been fasting,” Emmett said.
“Fine. While you’re here, we should take some blood. Monstera wants to run a full panel. We should probably also check your A1C to make sure you’re not diabetic. Someone will be in.”
“Hopefully with warmer hands,” Emmett tossed out. To his surprise, the doctor looked back and laughed.
Emmett’s satisfaction curdled as he noticed Halleck’s teeth: stained red at the gums, bloody, as if he’d been flossing. Or like the receptionist, eating raw meat.
Strawberries, Emmett told himself. He said he likes them.
But the initial shock of it remained, his appetite gone.