The patient is large. Very large. At more than 600 pounds, he is a mountain of flesh. "My stomach hurts," he says, his voice surprisingly high and childlike. It is 10 p.m. in the emergency room, and I am already swamped with patients I'm trying to move through the ER before my shift is over. Asked if he's ever felt this kind of pain before, he says, "No, never. At least, not like this." "Well, what'd you expect?" the unit secretary mutters, only half to herself. The patient is in his 40s. He spends his days on the sofa at home, surviving on disability checks related to his back pain.