Chasing a Light Beam – Chapter 6: “Cajun Country Surgeon”
CAJUN COUNTRY SURGEON
In the Lafayette zoo, the signs give the name of the animal, the country of origin, and the recipe.
-old Cajun joke
When Ben Bob first came to Lafayette, in 1979, it was for a hands-on interview with Dr. Ted Bascomb’s urology group. Ben was Chief Resident in Lexington, with six months to go. He had never heard of Lafayette, Louisiana, but he could see on the map that it was only about forty miles from the Gulf Coast, calling up visions of the Florida beaches of his childhood. Later, after moving to Lafayette for good, someone suggested that he take his family to Holly Beach for the weekend.
The first thing he saw as neared the “beach” was a dead cow. The “beach homes” were camps on stilts made from telephone poles, and the “beach” was a mud flat covered with beer cans, old tires, dead fish, and bubbly scum from the brown water. The news that the crabbing was outstanding lifted Bonnie’s spirits to something short of full euphoria. Someone who knew Bonnie quite well had probably coined the phrase, “when momma’s not happy, nobody’s happy,”.
Anyway, the interview week was an eye-opener. Ben Bob was accustomed to academic discussions and symposia on a regular basis. Working about one hundred hours a week, he was not exposed to anything more than his trade. He had never heard a song on FM radio, the only venue for the Allman Brothers, and so had missed an important part of baby-boomerdom. Lafayette was on fire. With an economy based on oil and gas, as Jimmy Carter guided gasoline prices and interest rates to the heavens, and the rest of country moaned, Lafayette had the highest expenditure per capita for restaurant meals in the nation. Ditto for beer consumption. You could add crawfish ingestion, but that goes without saying. Bank loans were made on signatures without collateral.
In this atmosphere, Ben Bob stepped into Lafayette Community Hospital’s operating suite with Dr. Bascomb on a Tuesday morning. Tuesday was typically the first heavy surgery schedule of the week, because the patients were admitted on Monday, making the doctors’ weekend easier. These were the days before Medicare reform, private insurance PPO’s, HMO’s, and review organizations required that the sick patient arrive at four A.M. for same-day surgery. The patient that day needed a ureterolithotomy, an operation to remove a stone from the tube leading from the kidney to the bladder. Ultrasonic lithotriptors have caused the procedure to join the dinosaurs, but in 1979, it was one of the staples of urologic surgery.
As the two surgeons scrubbed their hands, Dr. Bascomb said, “You can assist me on this case, Ben Bob, and then I’ll assist you on the rest.” Ben knew that Bascomb had reports about him from a urologist in Lexington, with whom Bascomb trained at Tulane, yet still he was surprised at Bascomb’s confidence in him, having only met him the evening before. Maybe Bascomb had the same attitude as his Lexington colleague, who often said when operating with the residents, “There’s nothing you can fuck up that I can’t fix.” And he could.
As they entered the operating room, Ben double-checked the x-ray films he had carefully arranged on the viewer for Bascomb’s convenience, and he mentally reviewed the patient’s history, to be prepared for Bascomb’s clinical questions. It was the sort of OR etiquette and academic routine that he had experienced nearly daily for the past five years. He was instilled with a sense of the pecking order in the room and the propriety that was expected. Partway through the procedure, Ben realized that there was another world outside the academic atmosphere of the University of Kentucky Medical Center, when Bascomb looked up at the scrub nurse and growled, “Lucy, would get your goddam tits out of my light!”
Without a pause, Lucy’s confident voice came back, “Fuck you, you old goat!” And the two of them continued to work together flawlessly as a team, just as they had for years.
There were no “history reviews”, “clinical questions”, or “academic discussions”. Bascomb did what needed to be done, and then they went to have a cup of coffee. Ben Bob performed more surgical cases that week that he could have imagined, his skills impressing Bascomb and his partners. He and Bonnie stayed with Ted and his wife Julia in their guest room, and the Bascombs paid for the round-trip airline tickets. At the end of the week, the group gave him a check for fifteen hundred dollars for his surgical work. Ben Bob’s salary as Chief Resident was eight thousand dollars a year, and he was overwhelmed. When they offered him a contract paying fifty thousand dollars for the first year, he thought, “Let me sign this thing before these fools wake up!” He had never had any money, and he had no concept of his earning power.
In July of that year, Ben Bob completed his residency and moved his family to Lafayette. On July 3, they moved into their first ever non-rental dwelling. The outside temperature was ninety-eight degrees. Ben clicked on the central cooling, and nothing happened. Momma was not happy. Ben began to realize Bascomb’s influence in the community when he was able to get a crew on July fourth to replace the entire cooling unit, at no charge to the Boyles. However, the dichotomy between Ben’s professional life and his family life had already begun, and he would soon go from husband, father, and surgeon to just surgeon. He would fail not only as a spouse, but as a parent as well.
He would not fail as a surgeon.
Before Ben Bob had fully learned the confusing Lafayette street routes laid out by the early Cajuns to match the meanderings of the Vermilion River, Bascomb was gone to Africa. Ben knew from his stay at Bascomb’s house that he was an avid hunter. Next to the guest room was a magnificent trophy room with twenty-four foot ceilings, and custom paneling and cabinets made from first-growth cypress obtained when Bascomb had purchased an old sugar mill, just to get the wood. Intertwined elk antlers comprised a dominating chandelier. There were numerous full-mount big-game animals around the room, some of which would have been confiscated had they come to the attention of the proper authorities. Ben’s youngest daughter would not go into the room until the head of an enormous grizzly bear rug was covered with a towel.
Bascomb’s six-week trip was to be the first of many. Ted reminded him of the hunters on Saturday morning TV adventure shows. One would say something like, “Would you look at that magnificent Urgali sheep! What a perfect example of natural beauty and adaptation to an environment! He’s one of the most exquisite animals I’ve ever seen.” And the other would whisper back, “Absolutely. Lets kill him.” It was some time before Ben Bob realized that the income he was producing for the practice far exceeded his salary, and that indeed, he and another junior doctor were paying for the vacations of the others.
On the other hand, Bascomb was larger than life, and being around him was never dull. He served as best man in Ben Bob’s marriage to Maggie, and Ben felt, however inaccurately, that Bascomb was playing the role of his surrogate older brother. Bascomb was involved in all sorts of businesses: a truck dealership, an environmental impact consultancy, an oilfield pipe-testing company, a venture to export air conditioners to the Saudis, a fleet of “cherry-picker” cranes, rental houses, office buildings, oilfield tools and patents, and any number of schemes that involved a steady stream through the back office door of individuals either about to be, or deserving to be, indicted. One common thread ran through his investments: they were all in topics where he lacked expertise. The word around town was that if every prudent businessman had rejected an investment, bring it to Bascomb.
Ben Bob’s accountant, an astute Texan whose hobby was raising and competing with cutting horses, once told him that it was almost impossible to make a bad investment in Lafayette in the late’70′s and early ’80′s. Uniform success had convinced all the local investors that they were astute businessmen. The bubble, he said, was bound to burst, and when it did, the imprudent deals would fall flat.
His prognostication proved out in the mid ’80′s, as oil rigs were brought in from the gulf and stacked in huge steel families. Lafayette attorneys practicing general law were able to specialize in bankruptcy and become more successful than ever. Although Lafayette had been the headquarters for many companies dealing in offshore oil and gas exploration and production, their parent companies began to shut down the local offices and transfer workers to Houston. Along with these thousands of employees went their health insurance policies, the lifeblood of doctors and hospitals.
Bascomb and Ben Bob were now equal partners in the urology group, but Bascomb’s outside investments had joined the Titanic. Ben Bob had never had any money to invest. Guilt feelings about his absence from the lives of his two daughters had caused him to give more child support than necessary, and that, combined with Maggie’s taste for the high life, kept him living from check to check. He discovered that Bascomb’s wealth had been generated not by the practice, but by inheritance. The practice was not the golden-egg-producing goose he had imagined.
Outside the sunroom, the rain was falling in droplets large enough to dislodge the crepe myrtle blooms from their stems. A pink shower of petals was gradually covering the cypress deck below. Ben Bob’s thoughts turned to the mid-1980′s, a time that was pivotal for him.
We had a little blond shih-tzu named Smidgen. I took her to the vet because she was scratching all the time. His office had an assortment of diplomas and certificates on the wall, just like mine. He decided Smidgen had an allergy. He gave her a steroid shot and a bottle of generic steroid pills. At the front desk, I almost dropped Smidgen on her head when the girl told me it would be two hundred and fourteen dollars. I gave her my Visa, and she printed out a receipt.
When I got home, I looked over the charges. There was an “office visit” for twenty dollars, a “small dog exam” for thirty dollars, a “microscopic fecal smear” for fifteen dollars, a “blood profile” for fifty dollars, a “potassium hydroxide micro exam of skin scraping” for fifty dollars, a “Kenalog injection” for twenty-five dollars, and “methylprednisolone tablets” for twenty-four dollars. It was all paid in cash and there were no insurance companies involved. The heading on the receipt said “Open Monday through Friday, 9-5″.
I was working about seventy hours a week. Medicare reimbursed me seventeen dollars and sixteen cents for an “established patient visit”; it took about ninety days to get this small fortune, provided all the forms were executed perfectly. Unless it was a post-op visit during the first three months: that’s a “no charge”, courtesy of Uncle Sam. “Blood profiles”? Not if I owned the lab: violates federal law. I haven’t heard of any federal programs that give dogs extra treats for dropping a dime on their vets, but the feds offer ten thousand dollars a pop to patients who turn in their doctors for Medicare code errors. I don’t know whether dogs ever sue their vets for malpractice, but people sue their surgeons all the time. And I’m sure dogs don’t complain about having to wait to see the doctor.
I pulled out a calculator to figure my hourly income. The digital display came up thirty-six dollars. I had worked the weekend on call for the group, spending most of Saturday and Sunday making rounds at four hospitals. All but two of the patients were post-op, and virtually nothing I did generated any income.
Up ‘til then, I had had only one “eureka” moment in my life: when Bonnie was bitching, and I suddenly realized I didn’t love her anymore. Well, this was my second one. Like an explosion going off in my brain, I realized I was spinning my wheels. If I had taken a job right of college selling Xerox copiers at sixty-thousand a year, by the time I’d put in the years to finish all my medical training, I would already have earned six-hundred thousand dollars. I had made seven hundred thousand my first seven years in practice, so I was still behind the sixty-a-year Xerox job by three hundred and twenty thousand! And that was a forty-hour-a-week job with no lawsuits. Right then I decided to do something that would never go out of style, and that men would always be willing to pay for.
I would be a sex doctor!
The foundation for Ben Bob’s enlightenment had been there all along, waiting for him to discover it. Surgical professors need a “niche”, if they hope to become known authorities. Most of the niches are well populated by senior professors who have published and lectured their way to fame. Two of Ben Bob’s mentors chose wide-open areas of urology to emphasize to their residents: transsexual surgery, and inflatable penile prosthesis surgery. Ben Bob participated in the conversion of quite a few men to “women”. As a result of doing surgical things to the penis that the average urologist would never encounter, Ben’s anatomical knowledge of the male package was superior. The IPP was a new device, and most residents got no training in its use at all; Ben did thirty-one cases as a resident.
Consequently, as he pondered the price of Smidgen’s itching, he realized he was already qualified in a way matched by none of his local peers. It was even imaginable that the other urologists might send their hopelessly impotent patients to him, in return for his exit from competition in the other fields of urology. It was quite possible that he could become a daytime-only surgeon, treating nothing but male sexual problems.
Once Ben had an idea, about anything, he dove into it headfirst. He spent most of his spare time the next few months investigating all the variables he could imagine. And imagine it was, since there was no precedent he could find for a private clinic dealing only with male sexual problems. By the time the opportunity presented itself, he was ready.
