By Diane Bracuk,
Dr. Richardson winced at the sight of Jerry’s feet.
Was it his imagination, or had they gotten puffier, leaving large, damp footprints by the deck chair where Jerry sat alone in flamingo-patterned swim trunks, sipping a giant pink Slurpee?
From the other side of the pool, he discreetly observed the young man, pretending to scroll through his phone, hoping his lounge chair was sufficiently hidden by trees and shade. A shade that was doing little to diminish the bright sunlight, seeping, like radioactive dye, beneath his sunglasses, intensifying his migraine. Earlier that afternoon, he’d gone to his clinic, usually empty on a Sunday, to go over the company’s financials. One invoice — ten grand for social media?— triggered the first jab of pain behind his left eye. After looking at a few other outstanding invoices, he decided to call it a day, and stop by the club for a quick swim to try and offset the headache. Just as he was about to dive in, he spotted Jerry sitting poolside and ducked instead over to the shaded patio area. His gaze flitted from Jerry’s feet to his face, deliberately avoiding his belly, dreading it might have become even larger since their previous encounter.
***
The last time he had looked at Jerry’s stomach was two months ago on the operating table. Inflated by carbon dioxide, his interior abdominal area looked like the inside of a glistening cave, a vaulted internal space for Dr. Richardson to work in. Guided by the giant monitors suspended from the ceiling, his surgical team maneuvered the gastric band through the key-hole incisions and placed it around the neck of Jerry’s stomach. On the monitors, the images were so magnified you could even read the tiny brand name on the instruments, which were longer than average to reach into the larger spaces of an oversized body. Out of sight and seeming far away in the outer-worldly surgical space, lay Jerry’s other organs, packed by pillows of hard adipose fat. Biologically active fat, secreting its toxic stew of inflammatory chemicals, potentially sending insulin production haywire, the damage of which Dr. Richardson hoped to curtail by installing the band.
It still pained him to think of how clueless Jerry had looked when his mother Diana had dragged him in for a consultation. He’d known him ever since he was a boy, one of those big boned, happy-go-lucky kids who would have been affectionately termed “hefty” back when he grew up.
As a teenager, Dr. Richardson had been a lifeguard at a summer camp that specialized in trimming down overweight adolescents through fishing, swimming, and canoeing. Guys like Jerry wouldn’t return home with ripped abs, but they would be in the healthier zone of husky, hearty, and hale.
He hadn’t seen Jerry for a few years, and had it not been for that goofy grin, he would barely have recognized him. Stripped down for the examination, a prickly red ridge around his waist from too-tight underwear, he sat with his legs apart, letting his pendulous belly sag between chunky thighs. Dr. Richardson tried to keep his expression neutral as he looked at his chart, showing a staggering BMI and pre-diabetic blood sugar numbers that no 17-year-old boy should ever have.
“Gastric band surgery is a little controversial in teenagers because their stomachs are still developing,” he had told Diana.
“He needs something to make him stop eating!” she said, as if Jerry wasn’t even in the room. “Like it shows in your TV commercial. Where the band stops the food from going down.”
Ah yes, that commercial, which they had recently taken off the air. For anyone who had tried and failed repeatedly to lose weight, it must have seemed miraculous. It started with a close-up of a woman biting into a sandwich, the particles of food hurtling down an animated esophagus toward the stomach, only to come to a sudden stop when it reached the gastric band. Now caught in a small stomach pouch created above the band, these food particles dribbled in hypnotically slow motion down to the lower stomach, while a reassuring, almost priest-like male voice-over described how this would curb appetite. “When the band is filled with saline water, it squeezes the top of the stomach, restricting the amount of food you can eat in a single sitting. So you get full faster and don’t overeat.” The woman, now noticeably slimmer, returned to the screen, the voice over urging them to call for a free consultation.
Dr. Richardson had cleared his throat, still feeling blindsided by it all. A new 2012 study had shown, through advanced MRI screening, that the gastric band didn’t slow down the passage of food as claimed. In fact, there was NO effect in the rate of food passage at all. Nada. None. No contesting the peer-reviewed results. Had this study come out before he had borrowed heavily to buy the clinic — well, there was no point in thinking that, was there? Still not sure how to explain how the band worked (or, in his increasingly darker moments, if it even worked), he had fumbled along, parroting the press release from the pharmaceutical company that made the band.
“What they’ve found is that a looser band still works, but you have to work with it. You have to chew small bites slowly, at least 20 times to signal the satiety nerves at the top of the stomach, the ones here …” He pointed at a spot below Jerry’s chest bone, “that tell you to stop eating. When you do that, you apply a gentle pressure to the band so it sends those signals to your brain faster, telling you yup, I’m full. Now, most people can expect to lose about 30 percent of their body weight in the first year. But you have to make lifestyle changes. If you don’t eat properly or exercise, the band won’t work.”
As he explained this, he tried not to think of the cost of redoing all the clinic’s promotional materials, removing the miraculous term “restricts food intake” from the TV commercial, website, patient brochure, and eating guide.
The cost of the surgery was 15 thousand dollars, which he knew Diana could pay in full. Even so, he suggested that Jerry should wait a few years until his stomach fully developed. “Then I’ll get it done in Costa Rica!” she snapped, which was almost a relief, because it absolved him of any ethical wrongdoing. He wouldn’t do the surgery because of desperately needed cash flow, but to save Jerry from a less scrupulous, third-world surgeon who wouldn’t provide the aftercare his clinic prided itself on. Plus, unlike bypass surgery that removed a portion of the stomach, the gastric band was reversible. If it didn’t work out for Jerry, he could always remove it.
Still unaware that he was being watched, Jerry sucked happily on his straw, a suction tube to accommodate whatever crap they tossed into those drinks. Crappuccinos, Dr. Richardson called them. Filled with cookies, chocolate bar chunks, caramel, M&Ms and, worse, fake berries, passing themselves off as health foods when in reality, the majority of them had higher sugar contents than most candy. The “rising tide of obesity” as the medical establishment referred to it, and Dr. Richardson literally saw it as huge, foaming Crappuccino waves crashing down, leaving a residual scrim of gritty, sugary crumbs on the shore.
Was Diana — the last person he wanted to see today — here as well? Or, had Jerry come by himself to swim a few laps? Judging by the wet footprints, he had probably made some effort to exercise. He must have a phone, but unlike the other few teenagers skulking around, wishing they could be at a cooler place than their parent’s club, he wasn’t using it. No headphones either, locking him away in music. He was simply enjoying the day, his feet — yes, definitely puffier, post-operative edema? — arching up to receive the sunlight.
The pool glittered in neon squiggles, the fast lane empty. A good half hour of laps could clear Dr. Richardson’s head, stave off that almost-concussed feeling that was the symptom of a worsening migraine. But that would mean being seen by the boy and saying something like, “Hey Jerry! Remember what we said about hidden sugars?”
Dr. Richardson couldn’t trust his voice anymore. Conscious of sounding paternalistic like many older doctors of his generation, he had taken a day-long course called “Addressing Psychological Issues of Bariatric Patients.” The key, he learned, was to sound empathetic, even if you couldn’t possibly relate to how anyone could get close to 300 pounds. He thought he had achieved this, but his increasingly disgruntled band patients thought otherwise.
“Dr. Smarmy,” one of them had renamed him the other day on the “Banding Together” chatline.
“Oh, a regular Fabio. All touchy feely, pretending I was Miss Universe at my first consultation,” another client replied.
“Did his hand brush against your boobs when he was showing you where they’d make the incision?”
“No. Tried to, though.”
“Arrogant ass. Thinks he’s Dr. God.”
“Try Dr. God Awful,” someone else piped in, invoking a horde of howling emojis.
* * *
When he first started med school with the youthful idealism that he would be saving lives, he could not have imagined becoming a bariatric surgeon. Back then it was stigmatized in respectable medical circles, with procedures such as stomach stapling considered the lazy person’s way out; ineffective, slightly immoral, and potentially dangerous. Over the years, procedures had improved and so had outcomes. Now physicians had gone from scorning bariatric surgery to encouraging it for their overweight patients — especially the less invasive, reversible procedures such as the gastric band.
He supposed he had turned into that cliché, the middle-aged surgeon re-evaluating a life that seemed set and stale. Grown kids. Wife more pal than lover. A steady job at a hospital, but burnt out from the endless paperwork, petty politics, and ongoing performance indicators that made a travesty out of patient care. At 55 years old, he wanted more. He wanted to leave a legacy, as foolish as that sounded; to make his mark on the world. When an invite to the 2010 World Obesity Conference in Montreal popped up on his email, he signed on. There he listened to galvanizing speakers, with their dire predictions that the obesity epidemic — with its co-morbidities of heart disease and diabetes — could eventually cripple Canada’s care system. At a trade booth for the leading gastric band company, he met Katerina, a young sales rep. She was now his new fiancé, and true soul mate — the one who had encouraged him to reclaim his idealistic core self that he had abandoned with the responsibilities of his first marriage and follow his passion.
The best clinics were defined by the patient’s needs, and in the case of the bariatric patient, the needs were literally that much larger. Safeguarding the health and well-being of these patients was the primary concern. Operating tables with 600-pound limits. Five-foot-wide corridor doors. Bathrooms with reinforced grab bars. All of this had to be done as discreetly as possible, so patients didn’t feel penalized because of their size.
They bought a handsome, turn-of-the-century building nestled in an exclusive, leafy enclave off Avenue Road. Three walls had come down on the top floor, and in that vast, gutted space, working from floor plans drawn up by a top bariatric design expert, he and Katerina had created their ideal clinic, with dignity at the forefront of every design decision, big and small. A major expense was the plush, ivory wall-to-wall carpeting with extra thick under-padding that would cushion heavy steps. It will be difficult to keep clean, he had joked, but Katerina said it would be worth it, amplifying the promise of transformation, the sense that all that lightness would seep into their clients from the ground up.
One large section of the first floor was left empty, designated for Phase Two: the installation of the clinic’s fitness centre. Many of their clients felt stigmatized at regular gyms, so this centre would be a haven where they wouldn’t feel judged. Katerina, who was studying to become a personal trainer, would supervise these exercises, along with a team of instructors carefully trained in bariatric fitness techniques.
There would be none of that drill sergeant bullying seen on shows like “The World’s Biggest Loser.” Instead, patients would feel empowered and spread positive reviews on the website, boosting enrollment. In Phase Three, he saw it expanding into the idealized fitness camps of his youth, where overweight teens like Jerry would hike, swim, and eat fresh, grilled fish they had caught themselves. With their damaged satiety systems repaired, they would be forever free of the compulsive need to gorge on junk food.
“Yes, it was challenging at times,” he would say when he accepted the award for best-designed bariatric clinic in North America at a prestigious international conference in Paris. “But our goal was always to help our patients achieve sustainable healthy habits, and we are happy to say we accomplished it.”
***
Enter Donald, his new partner. He had met the 39-year-old angel investor at a dinner party the previous year, during a rocky period for the clinic when the banks wouldn’t extend further credit. Like him, Donald had been a lifeguard at a summer camp, and still proudly maintained his college weight.
“I’m looking for things that will excite me, make a difference in people’s lives, not just another tech startup,” he had rhapsodized, proposing a partnership as part of the investment. The prospect of giving up control did concern Dr. Richardson at first. But he reasoned, doctors went into the field to help people and weren’t natural businesspeople. Wouldn’t this partnership allow him to better focus on the well-being of his patients, rather than the financial end of things?
Donald had gotten down to work immediately, cordoning off one half the proposed fitness centre for his office, the other half for his marketing gurus, a speedy, buzzing lot of millennials. People Dr. Richardson didn’t know, who didn’t know him, and whom, he suspected, viewed him as one of those old-timey doctors from the era of bow ties and crew cuts.
At one brainstorming session a few weeks back, Donald had proposed bringing a genetic nutritionist on board to offer clients a DNA diet as part of their weight loss tools. “HUGE!” he said. “Genetic diets are going to be HUGE!”
“We should be careful about that,“ Dr. Richardson had cautioned. “This is still in the realm of pseudo-science. The data on genetic profiles isn’t conclusive yet, and we don’t want patients expecting another miracle.”
Donald had turned to him, his upper lip curling with a contempt that still stung.
“You don’t get it, do you? Those fat fucks don’t want to work at it! They want miracles, and if something else comes along that promises a miracle, they’ll buy it!’
To Dr. Richardson’s knowledge, the word fat had never been uttered at the clinic. Clients were described as overweight, having a high BMI and less frequently, obese, a word spoken in a respectful half-murmur once used for the disabled, a word so pressed into neutrality that it had lost all its meaning. It made Donald’s crass disregard of the politically correct even more palpable. He should have chastised him right there and then, set an example for the minions who were stunned into silence. But he just sat there, cowed like the rest of them, speechless with disgust that this was the kind of man he had gotten too hastily involved with.
He avoided Donald as much as he could now, sequestering himself in his second-floor office, feeling like a soon to be deposed king in his castle turret. As to who would do the actual deposing — Donald, or himself by resigning — was something he was still grappling with. His intention in going into the clinic earlier was to get a better idea of the clinic’s financials, the market value of its assets and what his personal liabilities were before seeing a lawyer.
Walking through the patient lobby, he saw a mushroom-coloured splotch on the white carpet; another outrageous steam-cleaning bill they could ill afford. So far, he had been shielding Katerina from the clinic’s most recent financial problems, not sure what her reaction would be.
The pool took on a strange, hallucinatory quality, as if it were constructed with underground tunnels that led out to sea, which sparked a sudden yearning to be swept away and cast onto a distant, tropical shore.
What would he do if he left? Where would he go? There weren’t many jobs for 57-year-old surgeons, outside of consulting work as medical directors of nursing homes and, apparently (for he had been discreetly asking around), even those were getting scarce. God help him if any of the band patients reported him to the Canadian Medical Association for misleading advertising, as some of the band patients were already threatening to do.
He looked at Jerry again, taking what appeared to be the last sip of his slurpee. Whatever crap was in it seemed to have put him into a state of bliss, his body softening into a warm, euphoric satiety that no kale salad could ever provide him. Then, in a couple of hours, his blood sugar levels would plummet, and he would be ravenous again. But for now, there was a near beatific peace.
Or was it mere passivity? A helpless surrender to the irrepressible pull of the crappuccino tide, one that seemed to draw Dr. Richardson as well? He saw his clinic, diminished to a tiny dollhouse, being swept up in the gooey foam and then crash landing onto the gritty shoreline scrim of M&M’s, chocolate chunks, and fake berries. Failure was something he always railed against, would refuse to accept, but at this moment he entertained its prospect. Failure to become a successful bariatric surgeon? He supposed he could learn to handle that in time. But unethical? Greedy? One of those shady weight-loss doctors? No, he couldn’t leave on that note.
Jerry was too young for the band. Whatever self-discipline was supposed to kick in hadn’t, and probably never would. If he left the clinic, Dr. Richardson would do the right thing by him and remove the band free of charge. Seeing himself performing the surgery, going into the dark cavern of Jerry’s abdominal cavity, lifting off the band, and pulling it through the tiny incision in his chest felt like a self-release of sorts. Liberating, even exhilarating, loosening the constriction behind his eyes.
Then the person he had been dreading appeared. Diana. Coming out of the clubhouse, spotting him and waving. Jerry turned towards Dr. Richardson, breaking into an ecstatic smile at the sight of him. The pain snapped back as Dr. Richardson got up from his chair.
“Hey Jerry!” he heard his smarmy voice saying. “How are you doing?”
Diane Bracuk is a Toronto healthcare writer whose fiction and essays have been widely published in Canada, the US and Great Britain. Her short story collection, Middle- Aged Boys & Girls, published in 2016 by Guernica Editions, was nominated for the Ontario Library Association’s Evergreen Award, and shortlisted for a ReLit Award. “Doughnut Eaters,” one of the stories in this collection, won the 2015 PRISM international grand prize for creative non-fiction. Additionally, an excerpt from her novel-in-progress, The Slim Friend, which centres on a gastric band clinic, was published by Inanna Publications & Education Inc. in their Canadian Woman Studies: Women and Fat Studies issue in Spring 2023.
