I feel for him because it's clear that the fats are pushing him to leave the field. He sees teenagers with livers scarred so heavily they resemble those of 50 year old alcoholics, and when the family is called on it, they justify it by saying "everyone in the family is big." They can be told, plain as day, that their children are dying and they will still come up with excuses and lies. It used to be that renal disease was mostly a function of underlying diseases or maybe substance abuse, but now, he estimates that at least 25% of all the patients have simply eaten themselves into disease. And they are the ones least likely to fight back.