The Tennessee sun sliced its way past the shade in my examination room, across my newly framed diploma and disappeared down in the thick stack of Bobby's medical records on my desk. I picked up the latest test results, and the charts showed a red line dive to the 150th percentile below healthy insulin levels, the celebrity signature of diabetes.
I'd felt a sense of levity that morning at the gym, sailing through the air on the treadmill, and my post-workout Guatemalan roast tasted sweetly of bergamot and cashew. My travel mug was still by the sink, and I wanted to tip back the last gulp in the mug and savor its final stimulating warmth.
"Bobby, it's not looking good," I had to tell him, tapping the scale weights up to 255, more than thirty pounds since the last read on the charts. "What's Annie been cooking up there?"
My sister-in-law had a heavy hand with the bacon grease. The stuff found its way into the most unlikely meals, lunch sandwiches and dinner salads.
"Oh, ya know Annie. Greatest cook on Apple Mountain. Her fried chicken and grits brings all them boys to table. Say, Doc, when's the next time you're planning to grace us with a visit?"
I ignored the sarcasm, though my facial muscles twitched involuntarily... an old reflex. It had been a good while since I'd been back to the homestead. The last time, July 4, 2007, my first year of residency, I'd seen enough lewd and illicit behavior to swear off a return. Bearing witness to such wanton drug use, especially around young children, also presented a serious professional concern.
"Get up on the table," I pointed to the stepstool. As he climbed up, his morbid obesity nearly burst my examination gown. I didn't want to see Bobby this way, or at all really, but the bastard had lost his job and let his COBRA expire.
"Listen, tell Annie to cut the grease and to serve more fresh vegetables," I ordered.
"Ha! Good luck with that Petey,” he replied with his usual contempt. “You know she's angling for a big summer cookout season."
"Bobby, we're talking about life and death here." I shoved the chart in front of his face. "Do you see this? It's the insulin level of a normal, healthy adult male."
I drew my finger across the chart and his squinting eyes followed. "Now look here. This is your insulin level... it's dropping off a cliff."
I drew back the clipboard and his brow furrowed. "Bobby," I said, "it's almost certainly the case that you have diabetes."
My brother is not an idiot, but like so many from this rural corner of Tennessee, he is lazy and carries a sense of self-entitlement as it were a badge of honor.
"Diabetes? This mean you can get me on disability?"
I'm not a man that's prone to fits of rage. I pride myself on maintaining a high degree of professionalism, even in difficult situations. But I have never wanted so badly to take my clipboard and slam it down over someone's head.
"Doubt it, Bobby," I managed to reply, somehow accidentally slipping into the Southern stage accent he'd cultivated since high school. "Uncle Sam's been cutting back."
The irony, of course, is that I'd come back to our corner of the country after Vanderbilt, when I could have gone anywhere in the world, specifically to tackle the epidemic's impact on rural populations.
I handed him a fresh yellow pamphlet off the wall: "You've got diabetes. Now what?"
"Take this home and read it to Annie," I told him, "and tell her to read it."
"She is going to kill me," he replied.
She already is, I was about to say, but kept the fact to myself.