Inherit the Earth (part 1) Nthposition December 2004

Originally published in two sections – “five years from now” and “ten years from now”, Inherit the Earth has it roots in Richard Klein’s Eat Fat, a book which the linked NY Times review summarises very well. One of Klein’s passing comments is the possibility that all this obesity – which 20 years ago seemed as “on the rise” as it does today – was serving some kind of counterintuitive survival purpose. Perhaps in a future society the obese will have some kind of advantage? This story, as well as trying to capture something elusive and distant in the doctor-patient relationship, tries to work out that passing fancy.

INHERIT THE EARTH

Five years from now

Fat. Fat. Fat. Fat in rolls. Fat in great rolls wedged together. Fat in great rolls lying on abdomens like piles of coins. Fat. Fat. Fat arms, fat legs, fat necks. Fat, hefty buttocks. Fat hefty buttocks and adipose-rich, bulging chests. Fat surrounded Malcolm; he worked with fat. Away from work, he began to find fat everywhere. Or rather, fat would find him.

Walking around town, he found his eyes drawn to swelling paunches. To tattoos of snakes, revealed coiled eternally ready to strike an unknown target, just above the natal clefts exposed as bulging maidens bent over, bursting out of their tracksuits. Massive children walking down the street, looking alien and sinister to Malcolm, like nightmare creatures in a horror movie or computer game. Tiny heads on vast, bulky bodies. They walked with an indestructible complacency, it seemed to Malcolm. At times the streets crowded with shoppers would strike him as an army of the fat.

Malcolm worked at one of the near Obesity Clinics, which had been the latest response to the oceans of adipose tissue that were swelling on bodies everywhere. Community sports programmes. Regulating fast food. Banning advertising for foods deemed unhealthy. Making TVs and computer games switch off after two hours, flashing exhortations to go out and exercise. Banning advertising for all foods. Banning games consoles. Banning fast food. Governments throughout the world – for obesity was no longer a problem only of the wealthy West – implemented these measures in turn. And the fat kept rising, kept adhering to buttocks and abdomens, kept doubling and tripling and quadrupling chins.

Having tried to demedicalise obesity, the fashion now was to remedicalise it. And thus a new regime of clinics and programmes swung into motion. Billions were spent on new and improved drugs, on esoteric and exotic herbal and homeopathic regimes, on individually tailor exercise programmes. And everyone kept getting fatter and fatter.

Malcolm had been pawing the fat enmeshing the feet of a female patient when Linda walked in. Linda was the other registrar in the Obesity Clinic; she must have been roughly the same age as Malcolm yet gave him the impression of being younger, more vigorous. It came as a shock to Malcolm to see her, trim and fatless. He knew that his glances at her slim waist, elegant bosom and graceful neck were partly sexual, but her figure was striking mostly because of the contrast with the patients.

All the clinic staff – the nurses, the doctors, the receptionists, the dieticians, the phlebotomists, the ECG technicians – were as thin as Linda. They were all female, aside from himself and one of the receptionists. When he had started working, Malcolm had a paunch, the legacy of weekend beers and all too many microwaved lasagnes when he got home at the end of the day. Without ever consciously deciding to lose weight, he found himself playing squash and lifting weights on Friday nights, then Wednesday nights as well, then four nights a weeks, then five, and cutting down the convenience foods, then omitting them completely and eating various pulses and lentils.

Now, three months in, he was thin. He had never felt better, physically. He got out of bed early to go for a five-mile run before a breakfast of muesli and some grapefruit, would cycle to the clinic, have a bran muffin at eleven in between patients, go for a brief, salad-based lunch in the hospital canteen, canter through the afternoon clinic, and then go for a cycle with Linda afterwards.

It was coming into September, but the evenings were still bright well into the evening. They would cycle by minor roads into the mountains, up to the Three Rock Mountain, or Kilgobbin, or as far as Glendalough. Their favourite was the Massey Woods, a thick bank of conifers sloping down to a stream, running past ruined icehouses and game lodges and the other features of the old estate. A few other walkers, briskly leading their dogs, and the occasional band of disaffected-looking teenagers, looking to find a spot for undisturbed drinking, were the only other visitors. They would walk down the slope, zig zagging so they could descend faster, leaving wakes of freshly fallen leaves. Malcolm thought back to yesterdays stroll.

He exchanged a quick, covert glance with Linda, their faces breaking into a mini smile before resuming the serious, intent look of professionals. She was waiting to say something to him. He felt the woman’s feet again, a hand on each foot trying to bore in deep enough to feel a pulse. He gave up, and got off his knees.

“Sorry. Mrs…” he looked at her chart “Reilly. I’m afraid I can’t get a pulse. We’ll have to note that and make sure they see you in the sugars clinic soon. Otherwise, things are the same from my point of view. You’ll have to wait a little longer to see our dietician and exercise counsellor, and I think you are due to attend the support group later today as well, is that right?”

“Yes, Doctor, it is.”

“Thank you. Thank you.”

Sometimes there was this awkward moment when the interview had ended, but the patient didn’t seem to realise that. She seemed to expect something more. He stood up, stuck out his hand for her to shake and, as she took it with the same expectant look, began to walk towards the door. Mrs Reilly moved a lot slower than he did, and he removed his hand so as to open the door. It seemed to Malcolm that it took her an eternity to leave, both of them thanking each other. He imagined Linda looking amused and slightly contemptuous behind him.

Finally Mrs Reilly left. Malcolm turned to Linda, feeling embarrassed. He felt he had shown some kind of weakness in front of Linda, he should have been more assertive with her. There was no trace of any contempt or irritation on Linda’s face.

“He’s here, in with me. The phenomenon.”

There was no need to ask who the phenomenon was. John Paul McCabe, sixteen years old and forty stone, would a few months later feature in suitably anonymised form as a case history in theNew England Journal of Medicine, but already his fame had spread throughout the world. At medical and even political conferences on the rising tide of fat, his photograph with naught but the poor disguise of a black line over his eyes was the highlight of many a presentation. Genetic and endocrinological syndromes had been ruled out, and he had been placed on a variety of diet and exercise regimens, but still his weight would rise. They had even tried urging him to eat the most fattening foods possible and abstain completely from any exercise at all, in the hope that by some metabolic reversal he would stabilise. He didn’t gain weight any faster, but continued to expand at the same steady, ever-increasing rate.

Malcolm went in to Linda’s room. He was there, on the floor; despite the ever increasing weight of the populace, the examining couch to bear John Paul McCabe’s weight had yet to be built.

“Hey there, Dr Kelly,” he said. He was on first name terms with all the staff.

“Hey, John Paul. Call me Malcolm. How’s it going?”

“Not too bad, not too bad.” With most of the patients, the staff had a difficult rapport. There was a continual strain, as if they were continually biting their lips and restraining themselves from grabbing their patients by the shoulders and telling them just to stop getting fatter, to just stop doing whatever it was they were doing to make themselves so vast and blubbery.

With John Paul, however, it was different. They all got on well with him. They held a certain proprietorial pride in him. He was their outstanding patient, the vastest, the most impressive. He was the Laughing Buddha of the clinic, their mascot.

“Good stuff. Good stuff. How’s the weight?” It was possibly one of the most redundant questions possible, Malcolm though as he said it.

“The same, really.”

There was a silence. Despite John Paul’s well known bonhomie, Malcolm could think of nothing to say to him.

“Keep it up, anyhow,” he said.

“Doin’ my best, doc, doin’ my best.”

“That’s all we can do.” Malcolm again wondered why he was coming out with these stupid lines.

“It sure is.”

“Be seeing you. Be seeing you.” The second “be seeing you” was to Linda, Malcolm winking at her as he retreated out the door.

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