The official congratulations came in a thick white envelope delivered to Emmett’s home. The trial would
commence with the inpatient gene therapy procedure, provisionally scheduled for May 8—just a few
days away—at the Cronus Health Medical Complex in San Marcos, pending timely receipt of his signed
paperwork. Reams of it were enclosed: enrollment forms, medical waivers, a compensation contract,
direct d eposit forms, a nondisclosure agreement requiring his notarized consent.
Emmett would be k ept under strict confidentiality—no social media posts mentioning the trial, not a
word to friends or family. He was permitted to confide in only one emergency contact, in case he should
find himself in capacitated and unable to communicate details of the trial to EMTs. They too would have
to provide a notarized signature.
He thought about it overnight and asked Lizette (leaving out the bit about in capacitation). He probably
should have chosen a family member, but he still couldn’t bear the thought of their judgment or, worse,
their support. It would only heighten their disappointment when it all went to shit.
So that he could say he’d done his due diligence, he paged through the enclosed seventy-page r eport
disclosing the results of the Phase I trial, which had taken place the previous year and in volved
twenty-eight participants between the ages of eighteen and seventy-four. The r eport was written in dense
scientific prose presented in lengthy single-spaced paragraphs broken up only by the odd line graph or
scatter chart illustrating fluctuations in this hormone or that triglyceride. One graph seemed to show a
gradual decline in participants’ blood sugar levels, which Emmett took as good news for his diabetes. So
much so that he gave a pass to the less auspicious findings, for example that participants had
r eported “increased incidence of short-term memory loss” and “side effects including nausea, vomiting,
abdominal pain, diarrhea, IBS, and IED.” Emmett recognized the acronym for irritable bowel syndrome,
but IED? Improvised explosive device? Industrial emissions directive? Intermittent explosive disorder, a
“condition marked by frequent impulsive outbursts of anger, aggression, or violence”? That couldn’t be
right, could it?
None of it sounded great, but every drug had potential side effects, and only a handful of participants
seemed to have been affected. Measured against how much better his life would be if Obexity really
worked, the potential side effects were barely a consideration.
Having flicked quickly through the rest of the r eport, he completed his signatures, went with Lizette to
get the NDA notarized, sealed the forms in the provided envelope, and dropped them into the outgoing
mailbox. It was a weight off his shoulders.
Another remained. So far he had told only two people about his diabetes. His mom had been
compassionate and sympathetic on the phone, reminding him that there was so much good medicine out
there these days, that it was perfectly manageable. “It’s not like it used to be,” she said.
“When Sylvia was diagnosed, you mean?” His father’s late sister had been playing on his mind ever
since his mom had dropped the bomb in his Instagram comments that diabetes ran in his family. “Why
didn’t you tell me before?”
“I did.” “No you didn’t. I’m terrified of diabetes, I would’ve remembered.” “I did, Emmett,” she insisted,
an edge in her voice. “I’m sure I did.” Lizette, frustratingly, had treated the diagnosis like a rite of
passage.
“Welcome to the club,” she said, working at her sewing machine as Emmett stood in the doorway of her
bedroom. She’d been diagnosed with type 1 at the age of five. “Don’t say that,” he snapped. “It’s not a
joke.”
“Sorry.” She didn’t sound it, turning the garment and feeding it back through the machine she controlled
with a foot pedal. “I just think you’re taking this a little too seriously.”
“And maybe you’re taking it too lightly. Should you even be drinking that?” Emmett nodded at the
half-empty Vitamin Water bottle on her sewing table. “Girl, you’ve been diabetic, what, all of a day? Get
back to me in twenty years and tell me how easy it is to live sugar-free in this country.”
The disagreement left Emmett more determined than ever to improve his diet and set the right example
for Lizette. He took Dr. Halleck’s advice and went off sugar cold turkey: no sweets, no sugary drinks or
coffees, no breads, soups, sauces, or salad dressing that contained added sugars. He cut way back on
carbs and dutifully filled the pantry with raw almonds, canned tuna, and bland whole wheat crackers. He
anesthetized his sugar cravings with apples and berries and artificial sweeteners, and made filling dinners
packed with vegetables and lean meats and reasonable quantities of extra virgin olive oil.
But though his belly was full, he finished each meal possessed of a chemical urgency that begged at him
like a wound in need of closing. He almost couldn’t tell where his physical hunger ended and the other
began, the dissonant cries of his body, mind, and heart harmonizing in a single, terrible scream.
Anyway, who cared if he was “bad” for a few more days? The Phase I documents said Obexity lowered
blood sugar. Even Dr. Halleck had agreed it would probably help. Everything would be fine. The most
important thing was to ke ep up his strength before the procedure.
It wasn’t long now. The pr eparations were all made—he’d managed to bribe Jazz into covering his shifts
while he was out, and Lizette had agreed to drive him —but he realized he knew virtually nothing about
the procedure itself. Maybe he had missed it in the paperwork he’d received. But even as he scoured the
documents, he couldn’t find more than a sentence or two about what he was in for.
He left a voicemail with Monstera’s participant hotline, but no one called him back. Cronus Health
claimed the details were “proprietary” and told him to get in touch with Monstera.
Researching gene therapy procedures online, Emmett learned they typically in volved a vector—a carrier
of therapeutic genetic material—being administered
to the patient either by injection or IV before going to work on the patient’s cells. So, worst-case
scenario, it was a shot. That didn’t sound too bad. But what kind of shot required an overnight stay?
The night before the procedure, Emmett was restless, adjusting the tube of his CPAP with each toss and
turn. He couldn’t settle. Bella moved down to the corner of the bed, practically giving him side-eye.
After drifting off sometime around 4 a. m., he dreamt vividly. A r epeat of the nightmare from weeks
before, in which he’d lain awake on an operating table as surgeons hacked away his fat. This time it
culminated not in the removal of his brain, but his still-beating heart. Emmett begged them to put it back.
“Don’t worry, sport,” r eplied the masked surgeon, the organ pumping in his gloved hand. It was
thick-walled and cancerous with fatty d eposits, oozing blood between his fingers like red velvet syrup.
“You won’t be needing this much longer.” Sliding a finger under the top of his mask, he pulled it down
over his gaping mouth and sank his teeth in—a de ep, squelching champ.
He chewed and gulped, blood leaking from the corners of his grin. “The trial’s about to begin.”