The Doctor Is In, Chapter 1
“Should I take my shoes off?” he asked me as he stepped up to the scale.
“You can leave them on for this part. It’s fine,” I told him half-paying attention, flipping through his chart. The shoes never make a difference: if you’re overweight, you’re overweight, I thought to myself as I pushed my glasses up with the back of my knuckle. It was Mr. Gunderson’s first appointment at our office. I had overheard him telling my receptionist as he checked in that he had recently moved to the area from Texas and needed an annual physical to file with his new insurance. You could tell he was nervous from the way his wide, strong shoulders were tensed up and he shuffled his feet from side-to-side, holding his coat in front of him shyly.
He was a very sweet man from what I could tell and decently attractive—in his mid-thirties with a handsome, striking face and mousy, curly hair kept short on the sides. He had a thick, well-kept beard obscuring what was likely a softened jawline. He had a broad frame and stood a few inches over six-foot (I took note of this in his chart as he stepped away from the stadiometer and I handed him his shoes back. Huh, I thought to myself, I guess he could have just taken his shoes off after all). I didn’t typically triage new patients like that, gathering their basic information and starting up their record with us, but we had lost the last of our nursing staff a few weeks prior and were struggling to find a good fit to bring in. My and all my patient’s favorite nurse, Rebecca, had taken her maternity leave and would be gone for nearly the next year, so I had picked up the added responsibilities of our nursing staff while we scrambled to hire and onboard a replacement.
He had gotten married a few years back to a woman from his church, Mr. Gunderson told me as I escorted him into the examination room and he awkwardly tried to make chit-chat. They both worked late at a pet store they owned and opened up themselves, but the long hours meant he wasn’t able to work out or eat as well as he had in his twenties. He was an athletic guy!, he assured me. They had recently had a baby, too, and naturally that was causing some issues with his health regiment. He continued with a few more explanations to excuse his weight, as if it made much of a difference to me.
There was an obesity epidemic in the country, that much was true. I hadn’t been a practicing doctor for long by that point, and I hadn’t truly believed my attending physicians in residency how prevalent an issue it would be. I had countless patients, the majority even, who would come in with some skin sensitivity on their face or a case of tendonitis in their ankle that I could easily point to their added weight as the culprit behind the pain. Unfortunately, they don’t want to hear that: “I started using a new tea tree oil I got online—maybe that’s why?” they’d brainstorm as I looked down at their chart and saw their weight history climbing and climbing over their last few visits.
I jotted ‘Additional stress in work life’ beside his first weight entry in his chart: 258. Not the worst I had seen by any stretch of the imagination. I’ve had patients younger and less fortunate in the height department who were closing in on 400 or 500 pounds—folks who really can’t seem to control themselves or exercise even an ounce of willpower against their own impulses. I just didn’t understand that mindset at all, it seemed so foreign to me to not be able to just control yourself and put the fork down once you’d had enough. Mr. Gunderson would have no problem, so long as he started making a few better lifestyle choices. I asked him to roll his shirt up and hold it at his chest so I could listen to his lungs.
He lifted his buffalo plaid flannel shirt up from under his pot belly and pulled it from where it had been tucked into his pants. A pale, fleshy gut plopped back down, giving me a quick glimpse at what appeared to have been a belt buckle underneath. He straightened his back up as his chest expanded and his stomach got mildly slimmer—the classic “suck-in” gesture I’d grown accustomed to. My male patients loved to do this as if that somehow obscured the fact that they were obese; as if I had not just taken their weight a few minutes earlier.
“Alright, let’s take a look here,” I muttered as I placed the cold end of the stethoscope between his shoulder blades and took a listen. His lightly hairy back was damp with sweat and he jumped slightly from the cool touch of the stethoscope’s bell, goosebumps cascading everywhere.
I adored being a doctor. Every day that I showed up to work, button-up work shirt over my lab coat (optional to wear, of course, but I insisted) and superfluous briefcase, it felt like a fulfillment of a dream I had held close my entire life. Listening to Mr. Gunderson’s shallow breathing and swift heartbeat (nerves, usually), I thought back to pushing the tight plastic stethoscope toy I had between my ears and holding it to my stuffed dog’s chest as a kid. I was 29 and had only been working as a primary care physician in Coldwater for two or three months. It hadn’t been the easiest transition—being a gay doctor in suburban North Carolina had some, we’ll say, unique social challenges (did all the good gay men already get married while I was in school?), but I could at least always say I loved my job. I had a deep-seated dedication not just for caring about others, but for health and wellness in general: I knew first-hand the benefits of staying healthy, eating right, exercising regularly and staying regimented. I got to wake up every day and look in the mirror to see a fit, healthy body—one that took lots of intentional care and effort to maintain. I longed to be able to show my larger patients how it feels to have your body at such a peak level, able to do anything you want it to do at any time. I had been trying for ages though—people these days are just too addicted to their sugar-dense foods, it’s a waste of my breath.
Mr. Gunderson plopped his shirt back down quickly after we had finished as he slouched back down and let his gut return to its natural position, pressing firmly against his shirt’s fabric. It’s cute that men do that—that they get so self-conscious about their excess belly fat (as if its some unique, shameful problem) that they feel the need to “suck-in” at all. Although I’m of course not blind to the fact that as egotistical as it seems, I’m sure having a young, fit doctor doesn’t help with that feeling. I felt slightly badly that my body, just by imposing itself in the room as fit and healthy, made men like Mr. Gunderson feel so insecure and ashamed.
I had him roll up his sleeve to his shoulder as I prepped the blood pressure cuff I pulled from the cabinet. I turned back around to see his thick, beefy biceps. I had to quickly jut my eyes back to the cuff to avoid staring. I shimmied the cuff up his hairy, thick forearms and around his enormous bicep. I felt butterflies begin to loosen their wings in the pit of my stomach as I pumped the cuff up with the bulb in my hand. After I had gotten his diastolic and systolic, I ripped the velcro off and tossed the mechanism to the side.
“Now listen, Mr. Gunderson, unless you have any specific issues that you want to cover, I think we’re about wrapped up here,” I explained as I wheeled my pleather stool over to the examination table. He leaned back slightly and braced himself with his hands behind him, clearly a little tired from trying to hold his breath up and suck his belly in for so long.”Now my only concern is your blood pressure: it seems to be just slightly higher than I would love to see it.” I felt myself getting a little uncomfortable along with him as I noticed me unknowingly picking at the nail on my middle finger with my thumb. He sat forward again, hands folded in his lap like an ashamed schoolboy.
I’ve had countless conversations like this by this point: one’s where I essentially have to scold grown adults for their eating and exercise habits (or lack thereof, for the latter). After just a few years, most things in this profession had grown a little monotonous and ordinary: I could tap a vein to draw blood while thinking about what I’d make for dinner that night. I could perform a breast exam while I picked between my molars with my tongue to get a rogue piece of popcorn out. These conversations had not become any easier, though. I truly cared for my patients and I wanted them to be the best, healthiest versions of themselves, but I could never shake the feeling that I was simply hurting their feelings. I imagined them leaving, upset and their confidence knocked down a few notches, slamming their car door closed and driving straight to the McDonald’s a few blocks down to console themselves. Was I really hurting more than I was helping?
“My biggest recommendation, not knowing what your diet is like, would be to look at that a bit more closely–” “Doctor, may I stop you?” he muttered, staring down at his hands and avoiding eye contact.
I stopped. My thoughts scrambled and scattered out in a thousand different directions. What the hell is happening?
I had never had a patient cut me off in any capacity—ever. People listened when I spoke, especially with my lab coat on. I wasn’t prepared and sat, mouth open, for a few moments before I looked down and recapped the pen under his chart’s clip. “I’m sorry?” I managed to say as I nervously went to scratch my neck.
He took a deep breath and finally met my eyes. “With all due respect, Dr. Sexton, this isn’t the first lecture I’ve gotten about my weight. I understand it is an issue, but I’ve explained why what’s going on in my life and where I am at,” he said firmly and quickly. “I know the right things to eat and the best exercises, and I will do my best to lose some weight. Is there anything else I should know about?”
He spoke directly and swiftly, as if he had practiced this monologue several times before. I looked back at him, dumbfounded. He wasn’t being aggressive, nor was there even a tinge of frustration or bitterness in his tone. I could sense that I was one in a long list of individuals in his life who he felt looked down on him for having gained some weight in the last few years: I’m sure friends, family, perhaps even his wife, have given him condescending lectures at length about his size. “Don’t you want to be around a long time for your kid?” “Damn man, you’ve really put it on, you look healthy.” “Why don’t you join that new gym around the block? I heard it’s nice!”
I felt a wave of guilt crash over me. I could rationalize in the moment that I hadn’t done anything wrong, per se, or at least nothing that any other healthcare professional would not have. I hadn’t called him any names, I didn’t approach him with an air of superiority, I hadn’t even used the word obese (though with his BMI, I very well could have). I suddenly felt a sense of pride on his behalf and a tinge of envy of Mr. Gunderson in that moment for having that amount of restraint and self-assuredness to say that to a doctor, much less me. A big man who is grounded enough in himself to still be nervous around me, but not so much to not stand up for himself. Interesting, I thought, realizing how long I had stayed quiet.
“Oh, er, well,” I darted my eyes back down to his chart. Additional stress in work life. I scratched it out with my pen. “I completely understand, Mr. Gunderson. I won’t lecture you or tell you anything you don’t seem to already know. Is there anything else bothering you today I should know about?”
Why am I so nervous? I thought as I drew my attention to my knee bouncing up and down restlessly, urging me to get up and leave. I felt myself getting warm, waves of sweltering heat starting to encroach on me like a tide coming in.
“I think that’s all, Doctor.” He maintained eye contact. I felt somewhat intimidated, closing the front cover to his chart and reaching to shake his hand. His hand met mine: his hands were smooth and soft, almost impossibly so, and his handshake was firm and steady.
“Well, thank you so much for Mr. Gunderson–” “Please, call me Dillon,” he interrupted. “Yes, Dillon,” I smiled. He hopped down from the examination table, the thin sheet of paper beneath him crunching as he did, and I escorted him out of the room down the hall. We said goodbye with another firm handshake and that I would see him soon as I passed him along to our receptionist, Hannah, to process payment.
I skirted my way from the desk quickly, turning behind a pillar at the end of the hall and closing the small bathroom’s door shut behind me. Pulling paper towels from the dispenser and unbuttoning the top few buttons on my shirt, I began wiping my sweaty armpits and looking at myself in the mirror. What just happened?
My face was a pinkish-red and a bead of sweat had accumulated at the corner of my brow. I stared into my eyes for a moment, reacclimating myself to the room. I’ve always been a handsome guy, or so I have been told (it can be difficult believing the guys online and their compliments after they read ‘Doctor’ under my profession). My hair was a stark, deep brown that appeared almost black in the light. I kept it well-coiffed and lightly gelled to one side—my mother called it my Clark Kent hair. I stared deep into my blue-green eyes and examined their color in the fluorescent, overhead light. I gave a quick smile, my almond shaped eyes squinting and hiding my pupils, and checked my teeth (still pearly and pristine from extensive brushing that morning). I stood back and gave the mirror a quick arm flex as I felt the tightness momentarily set in around my bicep. Damn, I look good. I stretched my arms up over my head and watched my shirt untuck itself, my happy trail peeking out over my flat, muscular abs.
It wasn’t that I was cocky or all that into myself, despite how it sounds. I had been a very thin, svelte child—being an only child to a set of marathon-running athletes meant that I always snacked on the very best that diet food of the mid-90s had to offer. My parents instilled a discipline in exercise and diet in me early on and I was very fortunate to have had that. Strictly never drinking soda at restaurants, never eating out at greasy, fast food-style places, always eating healthy, homemade meals: I was lucky that this routine had been ingrained in me so early. In the interest of full disclosure, though, I didn’t care too much about the vanity of my body.
Of course I appreciated that my physique allowed me to get a foot in the door with other guys, that wasn’t lost on me. I could step foot into any gay bar and know I’d reliably get several up-down glances from patrons. I had never had to make the first move with a single soul before: men seemed to trip over their feet to talk to me at times. I could pop my head into any one of the hook-up apps on my phone and be able to take my pick from the onslaught—but truthfully, it was just an added bonus to the workouts and the controlled diet. When I looked in the mirror, I saw a handsome, fit stud, but if I had seen myself on the street or at the bar, I don’t think I would’ve hoped to see me glance over or approach me. I wouldn’t have looked at my Hinge profile and swiped right, hoping I would message first.
I ran the faucet for a moment and splashed cold water on my face, taking a few swigs of the metallic tap to rinse my mouth out. The Mr. Gunderson altercation (Can I even call it an altercation? I thought to myself) had thrown me off. I don’t handle confrontation in social situations particularly well, as you might can tell. I don’t often get surprised like that, particularly not in this job. Working as a primary care physician is about as routine as it comes in the medical field. I took a deep breath and swung the door open, tucking my shirt back in around the back.
“Dr. Sexton?” Fuck! My receptionist was standing right outside, stack of manila folders in her hands. “My god, Hannah, you scared me!” Hannah was a small woman in her mid-20s, short mousy-brown hair at her shoulders, small, wire-rimmed glasses in front of her beady eyes. She was bookish and petite, always wrapped in thick cardigans and shawls, blankets stacked up on behind her rolling desk chair. She was a tad intense—never seeming to blink quite enough and always rigidly avoiding the discussion of anything non-work-related.
“I’m sorry, Doctor. One of the candidates for the nursing staff arrived for his interview. Are you ready for me to send him back?” she asked, staring through me.
“Sure, Hannah. Could you remind me of his name?” I asked in a hushed tone as we started toward the front. She handed me the folder from the top of her stack: “Chris Franzen, 26. He has been working in at a minute clinic in Charlottesville for some time. He’s moved back to the area after he went through some break-up, if I remember correctly. He’s a chatty guy,” she said with subtle annoyance in her voice. “He’s up at the front when you’re ready.”
I took the folder and flipped it open. “Thanks, Hannah. Oh hey, before I forget: did Mr. Gunderson seem angry when he left?”
“Who? Oh, your last patient. No, not at all. He was very cheery, told me he was going to grab lunch after he left. Why?” she asked with a furrowed brow.
“Nothing, I was just curious,” I said as I gripped the door to the reception area and swung it open.
“Mr. Franzen?”
