Is that an otoscope in your pocket, or are you just glad to see me?

In response to the first few hundred words of my novel’s opening scene, Caltha writes:

That’s just gross. Is it supposed to be gross? I understand it’s supposed to be funny, but I’m sorry, the subject just bothers me too much. You claimed to be sensitive in a previous post, but obviously not sensitive to the suffering of this young woman. She is in an extremely vulnerable position and moaning in pain, and you just make fun of her and let your hero regard her as nothing but a pice of meat? That’s just sad and bothering. If any doctors are anything like that it’s not the subject of comedy and they shouldn’t be allowed anywhere near female patients. And just fyi, I don’t consider myself sensitive and I laugh at most kinds of sick humour, but the way the young woman is treated in this piece of text is just too sad.

Is the opening gross? Insensitive? Is Brad mistreating his patient, as Caltha suggests? I don’t think so, but I’m willing to listen to arguments.

I intended the opening to be uncomfortable for readers who aren’t accustomed to thinking of their doctors as sexual animals. I want those readers to snap out of their blinkered view, and I want them to do it quickly. The novel focuses on the suppressed sexuality of the hero and heroine, as well as their development as doctors. This suppression pops up (literally) at inopportune moments for Brad; Lori, on the other hand, isn’t even willing to admit to herself that she’s a virgin. If I’m exploring their sexual and emotional growth, the last thing I want to do is ignore their sexuality.

Medical professionalism begins and ends with our words, our actions, our facial expressions. Patients have every right to insist that we not talk about them behind their backs, treat them inappropriately, laugh at them, and so forth. But can they insist we not think about them sexually?

I don’t think so. In fact, I think it would be impossible to insist on such a thing. We docs are sexual beings, just like you are. If I’m palpating the neck of an attractive woman, I like the warmth and softness of her skin beneath my fingers. That feeling is all internal and I see nothing wrong with it. I don’t linger any longer than necessary, I don’t allow my pleasure to distract me from the exam, and I don’t make any inappropriate comments to her. I can be professional on the outside but human on the inside.

I’ll bet most people are uncomfortable with this notion. Let’s say you’re getting a pelvic exam from a grizzly old ob-gyn with bad breath. No matter what he’s thinking — whether it be, “Hmm. Nice cooch,” or “Gawd, I hate this job, if I have to look at another vagina I am going to shoot myself in the head,” you don’t want to know. Am I right? I suspect some of you would even be unhappy to hear that your doctor wasn’t thinking about anything at all. You’d rather be noticed and appreciated than viewed as just another set of genitals.

***

Like Brad, my novel’s hero, during my surgical internship I put in my time in Breast Clinic. We dealt with all manner of breast problems — not just lumps, but also mastitis, nipple discharges, breast abscesses, skin conditions, and more than a few well-breast exams in anxious women with a family history of cancer. Imagine us in that situation, a bunch of guys (we had a few women in the program, but not many) in their mid-20s. Do you really think we got through a day without thanking God for Breast Clinic?

It’s difficult, though. You’re trained to behave professionally, but no one ever tells you what to do with your internal life. You swallow hard, remember to breathe, pay extra special attention to your speech so that you don’t accidentally ask your patient to “take a few deep breasts,” and you pray that your facial expressions don’t reveal what you’re thinking. Meanwhile, you’re focusing on the problem at hand and trying to figure out what this patient needs medically. Tell me this isn’t difficult.

Here’s how Brad, our erection-prone surgical intern, handles Breast Clinic:

For the remainder of Breast Clinic, his imagination would remain hidden, thanks to the khakis and some due caution when sitting and standing. No problem at all. He would be the epitome of professionalism, not a single leer, not one double entendre. He would do his job and he would do it well. Both for him and his patients, life would go on without embarrassment, ridicule, or bloodshed, all because of one simple saving fact.

Humans are not telepathic.

Back to my opening. In this scene, Brad has to place a urinary catheter in an attractive young woman with appendicitis. The trouble is, he doesn’t know his way around female anatomy. He has this romantic notion that he should only get up close and personal with that part of a woman if he’s in a relationship with her — not the best mindset to nurture if you’re a doctor, of course, but Brad’s conflicted when it comes to sex. What else did you expect from a 25-year-old virgin? Brad’s the kind of guy who avoided pornographic magazines as a teenager and looked the other way during the practice pelvic exams in med school. He’s curious as hell but he wants to keep it a mystery. He wants to preserve the magic and yet he knows that his odd predilections are getting in the way of patient care (to wit, his inability to place the catheter).

Here’s the first bit:

Twelve inches separated Dr. Brad Berkowitz from heaven.

Twelve inches, a tightly coiled lifetime of anxiety, and a little thing called medical ethics.

Twelve inches from the loveliest vulva he had ever seen: creamy brown, just the way his cafeteria coffee looked after he’d added enough milk to make it drinkable; a miracle of perfect symmetry. God himself would weep to see such a beautiful vulva. Heat flowed from Angelica Gonzalez’s crotch, burning Brad’s face.

Heat.

He backed away from her bed, the Foley urinary catheter bouncing in his hand like an inquisitive earthworm, and grabbed her bedside chart. Last temperature, taken one hour ago: 104F. Ms. Gonzalez’s fever had spiked and the nurse hadn’t bothered to tell him. Useless!

I’m failing here if the reader doesn’t get the basic conflict. Initially, he’s responding to Angelica as any hetero young male would; and yet he’s not so flipped out by his hormones that he misses her fever. (Incidentally, I think Caltha’s charge of insensitivity doesn’t stick. Brad doesn’t see her as a piece of meat — he’s incensed that his patient spiked a fever and the nurses failed to report it to him, and later, he’s frustrated by his own difficulties in placing the catheter. No one is more annoyed with Brad than Brad that he cannot make the sexual part of himself shut the hell up so that he can get the job done.)

Read the rest, if you haven’t already (linked above). I really did intend it to be an uncomfortable scene, not just for Brad, but for most readers, too. I don’t think Brad disrespects Angelica or mistreats her in any way. All of the conflict here is internal. Some of you may find it funny that Brad’s body betrays his inner struggle by giving him a whopping huge boner, but I assure you, Brad doesn’t think it’s funny at all.

***

Are there boundaries? Of course there are. Back in residency, many anesthesia residents would uncover the chests of their young, female patients while they were awakening them from anesthesia. They didn’t feel a similar need to do so for the men or the older women, by the way. Once, when a nurse covered a young woman’s naked chest, the anesthesia resident pulled the drape back, exposing her again. With considerable anger — righteous anger, if I remember correctly — he said, “I need to see her chest!”

I’ve never encountered this “need to see the chest” at any of the other places I’ve worked. I can only assume it was a cultural thing — junior residents at County saw their senior residents doing it and figured it was okay.

But, no, that doesn’t make it okay. Slavery was once considered acceptable by our culture. In many parts of the world, overt sexism and racism are still considered acceptable. Cultural acceptance does not equal ethical correctness.

What it all comes down to, I think, is thought versus deed. As long as Mel Gibson kept his filthy, hateful ideas to himself, I liked him. Well, up until he did those silly Lethal Weapon movies, but still. You get the point. We all have less than wholesome thoughts about one another from time to time . . . maybe a lot of the time . . . but we expect each other not to act on them.

As for those anesthesia residents, it would be okay for them to wish they could peel back the drapes to look at all those glorious boobs. When they went ahead and did it, they crossed the line.

Nowhere in the opening scene does Brad act on his steamy thoughts. He may not give Angelica the best treatment (ultimately, Lori passes the catheter), but that has more to do with his technical ineptitude than his inappropriate thoughts.

So, Caltha,

If any doctors are anything like that it’s not the subject of comedy and they shouldn’t be allowed anywhere near female patients.

You had better stop seeing male doctors because I have news for you. This is how we are.

D.