A week after the physical he had put off for a year (he’d actually been putting it off for three years, as his wife would have pointed out if she had still been alive), Richard Sifkitz was invited by Dr. Brady to view and discuss the results. Since the patient could detect nothing overtly ominous in his doctor’s voice, he went willingly enough.

The results were rendered as numeric values on a sheet of paper headed METROPOLITAN HOSPITAL, New York City. All the test names and numbers were in black except for one line. This one line was rendered in red, and Sifkitz was not very surprised to see that it was marked CHOLESTEROL. The number, which really stood out in that red ink (as was undoubtedly the intention), read 226.

Sifkitz started to enquire if that was a bad number, then asked himself if he wanted to start off this interview by asking something stupid. It would not have been printed in red, he reasoned, if it had been a good number. The rest of them were undoubtedly good numbers, or at least acceptable numbers, which was why they were printed in black. But he wasn’t here to discuss them. Doctors were busy men, disinclined to waste time in head-patting. So instead of something stupid, he asked how bad a number two-twenty-six was.

Dr. Brady leaned back in his chair and laced his fingers together on his damnably skinny chest. “To tell you the truth,” he said, “it’s not a bad number at all.” He raised a finger. “Considering what you eat, that is.”

“I know I weigh too much,” Sifkitz said humbly. “I’ve been mean ing to do something about it.” In fact, he had been meaning to do no such thing.

“To tell you more of the truth,” Dr. Brady went on, “your weight is not so bad, either. Again, considering what you eat. And now I want you to listen closely, because this is a conversation I only have with my patients once. My male patients, that is; when it comes to weight, my female patients would talk my ear off, if I let them. Are you ready?”

“Yes,” Sifkitz said, attempting to lace his fingers across his own chest and discovering he could not do it. What he discovered-or rediscovered, more properly put-was that he had a pretty good set of breasts. Not, so far as he was aware, part of the standard equipment for men in their late thirties. He gave up his attempt to lace and folded, instead. In his lap. The sooner the lecture was begun, the sooner it would be done.

“You’re six feet tall and thirty-eight years old,” Dr. Brady said. “Your weight should be about a hundred and ninety, and your cholesterol should be just about the same. Once upon a time, back in the seventies, you could get away with a cholesterol reading of two-forty, but of course back in the seventies, you could still smoke in the waiting rooms at hospitals.” He shook his head. “No, the correlation between high cholesterol and heart disease was simply too clear. The two-forty number consequently went by the boards.

“You are the sort of man who has been blessed with a good metabolism. Not a great one, mind you, but good? Yes. How many times do you eat at McDonald’s or Wendy’s, Richard? Twice a week?”

“Maybe once,” Sifkitz said. He thought the average week actually brought four to six fast-food meals with it. Not counting the occasional weekend trip to Arby’s.

Dr. Brady raised a hand as if to say Have it your way…which was, now that Sifkitz thought of it, the Burger King motto.

“Well, you’re certainly eating somewhere, as the scales tell us. You weighed in on the day of your physical at two-twenty-three…once again, and not coincidentally, very close to your cholesterol number.”

He smiled a little at Sifkitz’s wince, but at least it was not a smile devoid of sympathy.

“Here is what has happened so far in your adult life,” Brady said. “In it, you have continued to eat as you did when you were a teenager, and to this point your body-thanks to that good-if-not-extraordinary metabolism-has pretty much kept up with you. It helps at this point to think of the metabolic process as a work-crew. Men in chinos and Doc Martens.”

It may help you, Sifkitz thought, it doesn’t do a thing for me. Meanwhile, his eyes kept being drawn back to that red number, that 226.

“Their job is to grab the stuff you send down the chute and dispose of it. Some they send on to the various production departments. The rest they burn. If you send them more than they can deal with, you put on weight. Which you have been doing, but at a relatively slow pace. But soon, if you don’t make some changes, you’re going to see that pace speed up. There are two reasons. The first is that your body’s production facilities need less fuel than they used to. The second is that your metabolic crew-those fellows in the chinos with the tattoos on their arms-aren’t getting any younger. They’re not as efficient as they used to be. They’re slower when it comes to separating the stuff to be sent on and the stuff that needs to be burned. And sometimes they bitch.”

“Bitch?” Sifkitz asked.

Dr. Brady, hands still laced across his narrow chest (the chest of a consumptive, Sifkitz decided-certainly no breasts there), nodded his equally narrow head. Sifkitz thought it almost the head of a weasel, sleek and sharp-eyed. “Yes indeed. They say stuff like, ‘Isn’t he ever gonna slow down?’ and ‘Who does he think we are, the Marvel Comics superheroes?’ and ‘Cheezis, don’t he ever give it a rest?’ And one of them-the malingerer, every work-crew’s got one-probably says, ‘What the fuck does he care about us, anyway? He’s on top, ain’t he?’

“And sooner or later, they’ll do what any bunch of working joes will do if they’re forced to go on too long and do too much, without so much as a lousy weekend off, let alone a paid vacation: they’ll get sloppy. Start goofing off and lying down on the job. One day one of ’em won’t come in at all, and there’ll come another-if you live long enough-when one of ’em can’t come in, because he’ll be lying home dead of a stroke or a heart attack.”

“That’s pleasant. Maybe you could take it on the road. Hit the lecture circuit. Oprah, even.”

Dr. Brady unlaced his fingers and leaned forward across his desk. He looked at Richard Sifkitz, unsmiling. “You’ve got a choice to make and my job is to make you aware of it, that’s all. Either you change your habits or you’re going to find yourself in my office ten years from now with some serious problems-weight pushing three hundred pounds, maybe, Type Two diabetes, varicose veins, a stomach ulcer, and a cholesterol number to match your weight. At this point you can still turn around without crash-diets, tummy-tucks, or a heart attack to get your attention. Later on doing that’ll get harder. Once you’re past forty, it gets harder every year. After forty, Richard, the weight sticks to your ass like babyshit sticks to a bedroom wall.”

“Elegant,” Sifkitz said, and burst out laughing. He couldn’t help it.

Brady didn’t laugh, but he smiled, at least, and leaned back in his chair. “There’s nothing elegant about where you’re headed. Doctors don’t usually talk about it any more than State Troopers talk about the severed head they found in a ditch near the car accident, or the blackened child they found in the closet the day after the Christmas tree lights caught the house on fire, but we know lots about the wonderful world of obesity, from women who grow mold in flaps of fat that haven’t been washed all the way to the bottom in years to men who go everywhere in a cloud of stench because they haven’t been able to wipe themselves properly in a decade or more.”

Sifkitz winced and made a waving-away gesture.

“I don’t say you’re going there, Richard-most people don’t, they have a kind of built-in limiter, it seems-but there is some truth to that old saying about so-and-so digging his grave with a fork and spoon. Keep it in mind.”