So here we are, sitting in this clean, white, sterile little room. It smells of antiseptic and quiet desperation. Across the desk is Dr. Evans, a nice man with soft hands and a face that’s never seen the inside of a bar fight. He’s looking at your chart with that calm, professional concern that they teach in medical school. And then there’s me, sitting in the corner, probably smelling a little bit of last night’s whiskey, here to act as your goddamn translator.
The doctor clears his throat. He’s got the results. The scorecard for fifty-six years of hard living.
“Well, James,” he starts, his voice all calm and measured, “we’ve got the labs back. Your A1c is good, 5.2, so no signs of diabetes, which is excellent news.”
He smiles. A nice, clean, professional smile. Now it’s my turn.
“You hear that, you old bastard?” I say, leaning forward. “You dodged that bullet. The sugar sickness hasn’t got you yet. You’ve been dancing in a goddamn minefield, and you haven’t stepped on that one. So let’s have a drink to celebrate your one small, pathetic victory.”
The doctor frowns a little, looks back at his papers. “However,” he says, “there are a few areas of concern. Your LDL cholesterol is at 144, which is significantly elevated. And your eGFR is at 59. That puts you right at the line for Stage 3 chronic kidney disease.”
He lets that hang in the air for a second. More translation needed.
“Alright, let’s cut the bullshit,” I say. “What the good doctor is telling you, in his nice, polite, ‘don’t-scare-the-patient’ language, is that your pipes are full of sludge. All the cheap whiskey, the greasy food, the stress, the whole goddamn weight of your life, it’s all hardening in your arteries like cheap concrete. That 144 isn’t just a number; it’s a greasy traffic jam in your veins, and one of these days, it’s going to cause a pile-up. A nice, boring, and completely predictable heart attack, probably while you’re taking a shit on a Tuesday morning. It’s the top of the bill, the main event, the most likely thing to punch your ticket.”
“And the kidneys,” I continue, “Christ. That’s the quiet rot. That’s not a quick, honest bullet to the head. No. That’s a slow, ugly drowning in your own piss. A long, graceful decline into humming machines and bags of your own poison hanging by the bed. It’s a living death that will make you beg for that heart attack.”
The doctor looks uncomfortable. “And we also need to discuss your testosterone levels,” he says, trying to get back on script. “They’re quite low, which can contribute to the visceral fat around your abdomen and make it more difficult to manage your cholesterol.”
I just have to laugh. A real, ugly, gut-shot laugh.
“You hear that, Jimbo?” I say. “That’s the punchline to the whole goddamn joke. The world isn’t just trying to kill you; it’s taking your balls as a souvenir on the way out. That low T, that’s not just killing your hard-on; it’s accelerating the whole pathetic decline. It’s feeding the belly fat, which is feeding the cholesterol, which is getting ready to send you to the morgue. It’s the reason you’re busting your ass in the gym and still looking in the mirror at a fat, tired old man. They’re castrating you slowly, from the inside out.”
So here are the odds from the house.
You stay on this track, no changes? You’ll be lucky to see seventy. The heart attack in your sixties is a pretty safe bet. You’ll die in a hospital bed, smelling of rubbing alcohol and regret.
You fight back? You declare goddamn war on your own body? You get on the meds, you get the hormones sorted, you treat your kidneys like they’re the last two friends you’ve got in the world? You might see eighty. Maybe. If the family genetics don’t have a hidden card up their sleeve.
So that’s the bottom line. The heart is the loud killer, banging on the front door. The kidneys are the quiet one, jimmying the back window. And the thing letting them both in is the goddamn feedback loop of no testosterone and a gut full of cheap whiskey.
The doctor leans back, a flicker of something almost human in his eyes. He’s done with the numbers. Now it’s time for the fortune-telling.
“So, James,” he says, his voice all calm and professional, “based on your current trajectory…”
And that’s my cue. I lean forward, putting my elbows on the cold, sterile desk. “Let me translate, doc,” I say, not taking my eyes off you. “What the good doctor is telling you, in his nice, polite, ‘don’t-get-sued’ language, is that the house has set the odds. The great cosmic bookie has looked at your pathetic, beautiful, fucked-up life, and he’s laid out the lines on the big game of You vs. The Grave.”
Here’s the goddamn spread.
Scenario One: The Sucker’s Bet. You stay like this. You keep drinking the whiskey, you keep carrying the weight, you keep telling yourself that tomorrow is the day you’ll finally get your shit together. You do that, and you’ll be lucky to see seventy. The heart attack in your sixties, that’s not a long shot; it’s the goddamn favorite. You’ll die in a hospital bed, smelling of rubbing alcohol and regret. A quiet, boring, and completely predictable end to a loud, messy life.
Scenario Two: The Fighter’s Chance. You fight back. You declare goddamn war on your own body. You swallow the pills for the cholesterol, you get the hormones sorted, you treat your kidneys like they’re the last two friends you’ve got in the world. You do that, and you might see eighty. Maybe. A whole extra decade of this beautiful, ugly, miserable ride. A decade of more women, more whiskey, more stories.
Scenario Three: The Long Shot. Best case. You go all in. You dial in the diet, you get the TRT, you drop the weight for good. You become one of those goddamn health nuts you’ve spent your whole life laughing at. You do that, you might see your early eighties. Maybe longer. But don’t ever forget, the house always has a card up its sleeve. The family genetics, the bad hand you were dealt at birth… that’s a dealer you can’t ever beat.
So that’s it. That’s the board.
You tell me, you old bastard. You want the goddamn battle plan, or are you just going to sit there and wait for the hearse?
