"Mr Constantine, I am very sorry to inform you that your vocal chords are damaged beyond repair," the surgeon reported earnestly to the silhouetted figure who sat before him, enveloped within a dense cloud of smooth-filtered Camel cigarette smoke.
He examined the stitching of the 4-star baseball cap that his patient had offered to him as a gift, as if he was willing it to transform itself into a bottle of single malt whiskey.
"In fact, Mr Constantine, in over 40 years as a surgeon (ten of those professional), I have never seen such a gruesome, none-oral sex related injury to the human voice box, I cannot even begin to imagine how you came to sustain such a terrible wound."
In a flurry of sign language, bolstered by elements of interpretive dance, learned under the tuition Ms Sylvia Styles, at the Manhattan Academy of the Non-Culturally Appropriated Social Sciences, Jim described to his medical carer the bizarre chain of events that had led him to his current predicament: How he had fucked his voice, possibly forever, by repeatedly yelling the word: "SUEIEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE!" in exchange for small donations, as a means of owning (or in his words 'pwning') an Internet personality by the name of Ethan Ralph.
The surgeon, whose name was Cavendish, nodded sagely:
"I can see how a 'Sueieee' with that many 'e's added to the end of it could lead to your present injury," he acknowledged. "The recommended medical limit is five 'e's, and even that is considered dangerous in high volume. If I was granted the power by YouTube to permanently strike three words from the English language, those words would be the extended 'sueieee', along with 'kike' and 'amazeballs.'"
In the corner of the surgeon's office, the sound of slow handclapping began to echo from behind a pleated privacy curtain. Ethan Ralph waddled out from behind the screen. He was naked. He wore his oiled gunt in the classic Roman style, wrapped around his midriff and tucked into itself, like a fleshy toga.
"Well, I think that successfully concludes today's ruse," he gloated.
Jim hastily scribbled down something on Mr Cavendish's notepad, which he thrust before Ethan Ralph's boss-eyed, piggy gaze.
Ralph, what happened to your voice? Why are you talking like Barry White after swallowing an entire pill bottle of Viagra?
"Well, a measure of confusion is to be expected when your opponent fails to recognise that you have engaged them in a game of ten-dimensional Buckaroo!" crowed Ralph, in a sexual baritone that instantly moistened the panties of every female within a five mile radius. "I guess you could say that it started when I began to consider how to silence you, my most vocal critic. Clearly a simple flagging campaign would be insufficient. I needed something more permanent. Something like, I don't know, convincing you to make prolific use of an insult that I knew would cause permanent damage to your vocal chords."
The Camel cigarette smoke was beginning to settle around Jim. For the first time in recorded history, elements of his features, that had once been as mysterious as the bottom of the Mariana Trench, were visible to the naked eye. He was not the chaotic-neutral, high elf warrior-mage that he was so often depicted as in fan art. Nor did he possess an actual third eye located where his pineal gland should have been. He was just a normal man. The kind who you might see in any branch of Walgreens or Taco Bell.
"Of course I had some assistance," elaborated Ralph.
The door to Mr Cavendish's office opened. A gaunt simpleton, sporting a well-trimmed beard, entered the room leading a horse by its bridal.
"Presenting two-times Academy Award nominee, Mr Robert Downey Jnr," announced Ralph, proudly. "He was so committed to playing the role of my supposed Portuguese nemesis, Mr Adam Warski, that he voluntarily contracted full-blown AIDS on no less than three separate occasions. And I think that you already know my other half - May, the mother of my pig-foal, better known as Winning Colors, who romped home to victory in the 1988 Kentucky Derby. Sadly my younger biological sibling, Joshua Moon Ralph, who also helped out, cannot be with us this evening. By the way, have you met my accountant?"
Mundane Matt sidled genially around the door to the office.
"Actually my real name is Steve and I am considered to be quite an interesting guy by my peers," he said.
"The thing that surprised us all really," said Ralph, "is how you never realised that Jade was an inanimate doll, manufactured entirely from felt salvaged from rescued Las Vegas Blackjack tables."
Jim stared across the room at his wife who was in the midst of streaming a degenerate, 600-episode anime on her Huawei phone. Suddenly the 'Dealer must draw to 16' tattoo on her arse made sense. In hindsight he should have realised that something was amiss when he was forced to attach Velcro pads to his ancient penis, so that she could maintain sustained contact during their customary Wednesday evening hand job sessions.
He scribbled something on the Surgeon's pad and showed it to Ralph.
The cancer?
"Well, about that Jim," gloated the morbidly obese manlet. "Short-sighted medical professionals, like Mr Cavendish here, might categorise what you have as cancer. More enlightened gentlemen, who have embraced the realities of an advanced technological age might describe it as a gunt transplant. That's right, Jim. I had a piece of my gunt removed and implanted into your body. It was the least that I could do for an old friend."
In a sudden burst of movement, Jim's arm shot over the desk. His fingers fumbled to open the top drawer, where he knew Mr Cavendish kept the gun that he used to shoot out tumours. As he held the revolver to his head he caught sight of Ralph shaking his head. His finger tremored millimetres from the trigger, unable to pull it. Finally, he put the gun down on the desk. Guided by a primeval and malevolent force, that was millennia older than his dick, he approached the TV mounted on the wall. He flicked through the channels until he found one that was screening live Indian Women's Tennis.
Ralph waddled over and handed him a mobile phone with the betting app open.
"Who do you like?" he enquired.
Jim took a few minutes to follow the action unfolding on the court, assessing the form and relative merits of the two players. Eventually he bent down over Cavendish's notepad and wrote:
I don't know. They both look they should come into the bathroom with me right now and suck my dick like the dirty whores they are.
He handed the pad to Ralph, who nodded his approval.
"That's mah daddy Jim," he said.