Chasing a Light Beam – Chapter 9: “The Office”
THE OFFICE
The first thing we do, let’s kill all the lawyers.
-William Shakespeare
The office is a necessary evil for most surgeons. Surgeons want to operate; most of their income is generated in the OR. As Ted Bascomb said, “Surgery is a license to steal. We already have the masks; all we need are the guns.” The office is usually the fly in the ointment. Ben Bob was no different from most surgeons; that is, until he quit general urology and opened the Male Sexual Center.
At the MSC, Ben was the only doctor. All the patients were men, and all had the same category of problems. This description makes boredom sound inevitable, but Ben found precisely the opposite. The men had concerns that were extremely personal and private; many had never mentioned them to anyone before, yet within minutes of meeting Ben, they would tell him things their priests had never heard. In fact, one of the older patients had joked to Ben: “Doc, I confess to my priest some of da tings you and me talked about; he say, Fontenot, I don’ believe I’da tol’ dat!” The men had issues that were especially important to them, and particularly to their self-esteem. Most had tried something or other as treatment, and the results were uniformly bad. When Ben was able to restore their sexual function, he also restored their pride and their feelings of manhood. They were grateful, with few exceptions. It was those “few exceptions” that kept Ben from thoroughly enjoying the office practice, for over the years he had developed a true paranoia about malpractice lawsuits.
Louisiana’s laws regarding medical malpractice made it very easy to file a complaint against a doctor. There were three simple steps: go to a lawyer–there are more in Louisiana per capita than any other state; pay seventy-five dollars to the Commissioner of Insurance; have the papers served on the doctor. That’s it. Notice there is no mention in these three steps of investigating the validity of the complaint; indeed, neither the plaintiff nor his attorney incurs liability for failing to do so. Then, the plaintiff can sit back and watch the Insurance Commission and a panel of doctors do all the work. An attorney who does nothing but coordinate malpractice complaints is paid about five thousand dollars to convene a panel of three doctors from the defendant’s own specialty. The first expert is chosen by the plaintiff, the second by the defendant, and the third by the other two experts. Each is paid three hundred dollars to review all the records related to the claim. They then vote as to whether there has been a breach of accepted standards. Over ninety percent of the time, they vote that malpractice has not occurred. Their joint opinion is admissible in court, but in no way does it prevent the plaintiff from proceeding with a lawsuit. In the eight or nine percent of cases where the panel finds against the doctor, a settlement for the plaintiff is a foregone conclusion. The “winner” of the Panel decision pays for it’s cost, about six thousand dollars.
From the moment the doctor receives the complaint, his insurance company’s lawyers are on the clock. In addition to reviewing all the records, they will meet with the doctor several times, write a lot of letters, send the doctor copies of even his own records for the usual charge, hire other experts to review the records, and perhaps travel to depose national experts. By the time the material is presented to the Panel, the defense may have charged thirty thousand dollars in fees. Naturally, the insurance company considers those fees losses, and the doctor’s rates are adjusted accordingly.
So, there it is: an angry–or just clever–patient goes to an attorney with a ridiculous claim that no sane professional would believe. The attorney spends seventy-five dollars in filing fees to create good will with any possible legitimate plaintiffs among the patient’s family and friends. The Panel finds for the doctor. The attorney advises the patient that it’s a “good old boy” system that gives them no chance in court against the insurance company and the rich doctors, and after two years, the case is dropped. The doctor, for reasons attorneys will never understand, has grieved over the case the entire time and has been plagued by feelings of helplessness as it drags along at the customary snail’s pace of litigation, so different from the take-charge pace of surgery. The insurance company is out thirty thousand for discovery, and six thousand for winning the Panel. The doctor’s malpractice premium increases ten thousand dollars the following year, unless he is cancelled altogether. The plaintiff is out nothing except the disappointment of holding a losing lottery ticket, paid for by his attorney.
Ben Bob limped back from the kitchen to the sunroom, newly filled glass in hand. The process of dealing with his “problem” was neither random nor hurried. It had gradually evolved in his mind for quite some time, and today it was ready to be aired. He put the glass on the lamp table first, before sitting; too many times, he had used the reverse order and lost half the vodka to the tile floor.
The rainstorm was gone. He recalled being told when he first arrived in Lafayette, “If you don’t like the weather, wait a few minutes.” He propped up his foot once again, and spoke into the recorder.
I opened a certified letter from the Insurance Commissioner about five years ago. A patient from Lake Charles, Wilson Hebert, had filed a malpractice complaint against me. I remembered him because he pronounced his name “Hee-burt”, the Texas way, instead of “A-bear”, the local Cajun way. I remember thinking at the time, “No good deed goes unpunished.” He had a really bad liver from ingesting too many short-chain hydrocarbons. No doctor in Lake Charles would touch him for a penile implant procedure. I thought I could do the procedure quickly and safely; I discussed it with our chief of anesthesiology, and we offered to do the operation for him. Without it, he would never have sex again. It went without a hitch and he went home the same day.
The next week, he returned, with an angry wife. This was a little surprising, since he had told me he was single. Surgically, he looked great, but the wife had her panties in a bunch; she demanded to know what I had done to her husband. When she found out I had implanted an inflatable penile prosthesis, you would have thought I said I put a gerbil up his butt through a pipe.
Hebert never returned for subsequent post-op appointments. The complaint in the certified document was more or less this: “First, I came to Dr. Boyle for prostate gland surgery. Instead of doing that, he sneaked a penile implant into me. Second, the implant doesn’t work because he put it in upside-down.” Now, an honest-to-God lawyer, the kind that has passed the Bar and all that, filed this document.
Later, I learned the real story. The wife’s mother was terminally ill in Nachitoches. The wife went to live with her until she died. Hebert, who had been impotent for years from all his drinking, found a girlfriend. He figured if he could get out of town and have an implant done, no one in Lake Charles would know, including his wife. He concocted the story of rejection by the Lake Charles surgeons, and lied about being single. Unfortunately, the mother-in-law didn’t last as long as Hebert planned, and the wife came home to find him limping around, black and blue in his privates. Naturally, he told her he had just had prostate surgery, and he hadn’t wanted to distract her from tending to her mother. When she found out about the implant, Hebert came up with Plan B: feign ignorance, blame ol’ Ben Bob, and throw in the part about “upside-down” installation, so the wife would think the implant was non-operational. And hey, maybe get some money, as well.
By the way, it is physically impossible to put in a penile prosthesis “upside-down”. The case was dropped after the Panel decision. The private detective in Lake Charles hired by the insurance company said Hebert’s girlfriend seemed to think the implant was working just fine. His fees, along with everything else, came to just over twenty-eight thousand dollars. The following year, my malpractice carrier left the state, and I tried to get a new policy. I probably don’t have to tell you that every company, because of the recent “loss” of twenty-eight thousand dollars, rejected me. I had to mortgage my house to put up a bond, so I could be self-insured. Why didn’t I just ride bareback? Because you can’t get staff privileges at a hospital without proof of malpractice insurance. Hebert got laid, and I got screwed.
Ben Bob’s malpractice paranoia aside, he had a lot of good times in the office. For one thing, no malpractice claim against him had ever come from a non-surgical patient; the office was actually a safe haven. It was the place where he got to see, first-hand, the results of his handiwork.
Once a man has trusted his penis to you for surgery, there’s not much he won’t tell you. Actually, there’s not much you can KEEP him from telling you. The old ones, in particular, can really change your perception of what makes us “old”. I had done an inflatable implant on Felix Pitre, a seventy-two year old widower from Breaux Bridge. His was in for his final post-op visit six weeks after the surgery. I taught him how to squeeze the inflation bulb in his scrotum to get a full erection, and how to squeeze the release valve to go back to soft. He couldn’t read or write, but he caught on in two tries. I asked him if he had a girlfriend or a potential sex partner. He said, “Mai, doc, don’ worry ‘bout me. I’ll find a lady friend.”
Felix came back after three months for his long-term evaluation. Everything looked and worked fine. He was pleased. “So Felix, did you find a woman?”
“Doc,” he said, “da same day I lef’ you office. I passed at my friend’s camp at Butte LaRose on the levee. He was out runnin’ his traps, so I turn on the TV. I’m sittin’ dere watchin’ ‘Price is Right’, and dis girl in a bikini bathin’ suit comes fru da door. “Oh,” she say, “where’s Mr. Reaux at?’ I tol’ her he out for a while. She say, ‘Well, I passed to get my money for cleanin’ da camp.’ Mai doc, me I’m sittin’ dere lookin’ at dose big titties, and I’m tinkin’, ‘I ain’ had me none fo’ ten years!’ I tell her, ‘Cher, I could give you the money, me, an’ some mo’, if you tink you could gimme a little pussy.’ Now, Doc, she’s not shy, no. She says, ‘you kinda ol’. You tink you could handle it?’ I tol’ her I taught so, an’ she takes off dat bikini bathin’ suit. Me, I’m reachin’ down to pump me up, an’ she says, ‘Whattcha doin’?’ I tol’ her, ‘Whenever I scratch my balls, I catch a ragin’ hard-on.” Mai, Doc, her eyes got big as saucers. She say, ‘Mai yeah, it’s workin’, Pitre!’ Doc, we screwed for two hours, and she ben datin’ me ever since.”
Felix Pitre had been transformed from a lonely, depressed old man to a Cajun full of vigor and confidence. I’ve seen it time after time. It’s not the sex. Sure, people, and men in particular, like to have sex, but that’s over before too long. It’s the feeling about your capabilities that persists. I always told people that I’m not in the sex business; I’m in the business of restoring self-esteem.
Relating these stories always made Ben Bob feel worthwhile, sometimes even special. But the problem is: things aren’t what they seem.
Leonce Menard is a man I can’t forget. He’s the oldest man I ever operated on for a penile prosthesis. I took a lot of flak for operating on old people. I’ve been told over and over that people “that age” shouldn’t be having sex. The message always comes from someone a lot younger than the patient. Everyone of any age considers “old” to be someone fifteen years older than himself. Leonce came to see me when he was ninety-two. He wasn’t wearing eyeglasses, and he seemed to be able to read just fine without them. He’d been a fighter pilot in WW II; he was on no prescription medicine at all.
His story was sad. His wife was eighty-nine. He said they had been married since he was seventeen and she was fourteen. He couldn’t remember when she was not his wife. She had Alzheimer’s, and it had reached the point that she recognized him only off and on. He told me he was going to keep her at home and take care of her for as long as she lived. From what he described, her temporal lobes had become dominant, because all she ever talked about was having sex. “Doc, I haven’t had a hard-on in twenty years, and I want her to be happy.” Mr. Menard had risen to the rank of Major during the war, and he spoke with much less accent than most old Cajuns.
The time was early in my practice, and the only reliable treatment was the implant. Leonce had a friend who was my patient, and I came recommended in glowing terms. All his lab tests and his EKG were normal, and he underwent the outpatient implantation of an IPP without incident. I released him after six weeks, and didn’t see him for quite a while.
Three years later Mr. Menard came back. He was ninety-five. When I asked about his wife, he teared up. “Doc, that’s why I’m here. She died a few weeks ago. I know I’ll never go with another woman, and I thought maybe I should have my implant removed.” It was a common misconception, particularly among the children of men in nursing homes. I explained that the implant had simply made his penis normal again, and keeping it was no different than keeping a healthy penis. Actually, he seemed relieved. As he stood to go, I asked, “By the way, were you ever successful at having sex with your wife?”
He finally smiled a little. “Oh, yeah, Doc. We averaged twice a day for the past three years.”
I was stunned. There is no limit to erections with an IPP, but orgasms are age-related for men. “Surely you couldn’t come that often?”
“Oh no, Doc. Only about once a week. But she could come like a freight train, and she went out happy.”
Another Alzheimer’s episode was just the opposite. The victim was the husband, who was physically strong and vigorous, far too much so for his wife to control. They had been married forty years, and he lived in a nursing home. She was a sophisticated RN, and she knew my work. She brought him in for an implant because she wanted to make him happy. He didn’t have any idea who she was. After he healed, she would go to the nursing home every week and check him out for about two hours, pump him up, and make him, and herself, happy, even if he didn’t understand why. Seemed like love to me.
Somewhere along the line, perhaps first from The Hite Report, Ben had gotten the idea that most married women considered intercourse a duty, at best. Shere Hite had reported that fewer than thirty percent of women could have orgasms though intercourse alone. The Male Sexual Center changed Ben’s opinion. He remembered one diabetic man in particular, whose wife accompanied him for every visit. When all alternative treatments failed, and the man decided to have implant surgery, his wife scoffed right in his face. “There’s never been nothin’ in it for me,” she said, “so you can get all the transplants you want; it ain’t goin’ in me!”
Ben felt very uneasy with the situation, imagining what would happen if there were complications. But the man assured him that his wife was all bark, and he could handle her. After the operation, the wife made sure she was in the room each time Ben examined him, so she could comment on the silliness of his bruises and the uselessness of his pain. When Ben taught him how to work the device, the wife watched with a little curiosity, but still insisted he’d have to find another outlet.
Three months later, they returned. The wife brought Ben Bob a bouquet of flowers from her garden. “Doc,” she said, “I finally found out what the shoutin’s all about. Thank you, thank you!” Her man could now last an adequate time for her.
In the older generation of his patients, there had been no sex education, no movies, and frequently no discussion of sex at all between husband and wife. When Ben asked a patient whether his wife enjoyed sex, a frequent answer was, “I don’t know for sure, Doc, but she never turns me down.” If both recognized that the vagina was a birth canal, and that the clitoris was the female sex organ, and they took appropriate measures to assure clitoral stimulation, the women wanted intercourse as much, or more, than their husbands.
It’s a fact that the clitoris responds just as quickly as the penis, but while intercourse fully stimulates the male organ, the female organ may go untouched. If clitoral stimulation during intercourse isn’t intense, most men don’t last long enough for their partner. Once ejaculation occurs, the game’s over. The evolved purpose of intercourse is procreation, and so long as the male has an ejaculation, evolution doesn’t care what the female feels, because she gets pregnant either way. Once a man could maintain his erection even after climax, Ben had seen many examples of women converted from “dutiful” to “demander”.
Ben Bob was relaxed, as he recounted some of the most satisfying aspects of his practice. Another sip from the martini would promote a different kind of relaxation, and he indulged himself.
Elton Meaux came in alone. He was seventy, a recently married widower, and his new wife was thirty-eight. The fact that he was a wealthy rice farmer probably hadn’t hurt his attractiveness. He said his wife didn’t seem very interested in sex, and when he finally got around to a nuts-and-bolts discussion with her, she said that she had never had an orgasm with any man. His erections were about fifty-percent rigid, and sex for him was “stuff and come”. He heard me talking about implants on television, and he wanted to know if he was a candidate. There were no effective medications at that time, and he underwent the outpatient surgery.
Three months later, he came for his last visit, once again alone. His wife was too shy to be seen in a place called the Male Sexual Center. I asked how he liked the implant.
“Doc, it’s the greatest thing since sliced bread.” It was obvious he wasn’t joking.
“And what about your wife? What does she think of it?”
“Poo yie!” he exclaimed, using one the venerable Cajun expressions. “She loves it more than me. You know she’s young, doc. She gets on top and gives it a workout. The other night, I had a big climax and fell asleep. When I woke up about an hour later, she was still goin’!”
Take that, Shere Hite.
Ben Bob considered himself to be primarily a surgeon, because he offered a treatment unavailable from most doctors. In truth, by the end of his practice, eighty percent of his patients were treated non-surgically. There were pills for better erections, injections for better erections, and pills to prevent premature ejaculation. Occasionally, he diagnosed rare brain tumors. Most doctors rarely had a male patient who was unable to ejaculate, but Ben heard that symptom from time to time, mostly in the older men whose erectile ability had been restored. By understanding the physiology, Ben had found adequate therapy even for this unusual problem. Almost none of the medications he used had been designed or marketed as treatments for sexual dysfunction. Not only were most doctors disinterested in their patients’ sexual problems; most pharmaceutical companies were as well. In the twenty-first century, there had never been a medication designed from the get-go for the purpose of improving sexual function in either men or women. What were they thinking?
Objectively, the office had provided an outstanding opportunity for Ben Bob’s personal satisfaction. Subjectively, his brain just didn’t work that way; he dwelled on the road not taken. Or perhaps it was the road not seen, as events led him to believe.
