Open Heart (22 page)

“Oh you have a mild case,” he says. “I've seen much worse. You have no pain, and you can maintain an erection, so you'll be able to penetrate.”

Saying this, he turns and leaves his office. And that's it.

Although the news he has given me is encouraging—I have a mild case of a condition that does not render me dysfunctional and that will probably improve—I leave his office feeling incredibly shaky: fearful, anxious, spent. The bill, which includes a forty-five-dollar charge for “surgery” (the rectal exam? the lifting of the penis?), comes to over five hundred dollars.

From my journal, the next morning:

“I come away
more
fearful and anxious,” I write, “and I come away thinking: I need another opinion.”

So I call the doctor Phil's friend in Denver recommended, and a week later meet with Dr. Arnold Melman, chief of urology at Montefiore Hospital in the Bronx.

Dr. Melman's nurse has me give a urine sample, after which I wait in Dr. Melman's consulting office, which is large and handsomely appointed: drawings, maps, African sculptures. Dr. Melman comes in, shakes my hand, talks with me for a while, takes a history. Then we go into another room, where he asks me to drop my pants. He
sits on a stool, examines me while I stand, and seems surprised by what he finds.

“Hmm,” he says. “You have quite a lot of disease in there.”

What he finds curious, he adds at once, is that the scarring in Peyronie's disease is usually near the outside of the penis, but the scarring in mine is near the center, next to the urethra. Back in his office, he draws a picture of my penis, and of the scarring, asks more questions about my medical history and, especially, about events of the last year or two. He is puzzled, asks more questions, looks at his notes, and then nods.

“Of course,” he says. “The bypass surgery! The scarring is probably due to trauma from the catheter they inserted during your surgery. It makes sense. That would explain why the scarring runs along the urethra.”

I tell him that Dr. Haight told me I had a
mild
case of Peyronie's, and that on Dr. Haight's recommendation I've been taking two dozen tablets of PABA a day. Dr. Melman declares that there is absolutely no evidence that PABA has any effect on Peyronie's—that this theory was disproven years ago. I tell him I am taking 400 units of vitamin E a day. He tells me to take five times as much—2,000 units a day—and he says he is going to prescribe something else: colchicine.

Colchicine, he explains, is a medication that breaks up scarring by dissipating the molecules in the collagen—the fibrous deposits we hypothesize are causing the problem. Since blood has trouble getting around these deposits, the penis, when blood surges into it and causes it to become erect, only stays erect to the point where the collagen deposits lie; the absence of blood stimulating the erectile tissue at these points is what causes the penis to bend, sometimes to a ninety-degree angle.

Frequently, the condition causes considerable pain and makes sexual intercourse difficult or impossible. In some cases, when collagen deposits encircle the penis so that blood cannot rise to the shaft's full length, the penis will balloon out to the point of the scarring, and will remain limp for the remaining portion. In such cases, the only remedies are surgery—removing the collagen and transplanting
in its place tissue from other parts of the body (a procedure that is rarely successful)—or the use of prostheses.

Colchicine is often used for gout, Dr. Melman informs me, and it has few side effects. If I start to have diarrhea, though, I am to stop taking the medication at once and to call him.

He asks if I have experienced any pain (I say no), or if my penis has become smaller (I say no again—not as far as I can tell), and he tells me he doesn't think things will get worse. He hopes they will reverse, but if they should get worse, there is an injection he can give me, or a simple surgical procedure he can perform, though he would do either of these things with great reluctance, and is inclined to wait and see if the colchicine does the job.

When, in his office, he asks me about myself—why I am in New York, why I moved down from Massachusetts, and I say that I'm a writer, he tells me about a book he has written (a woman's guide to men's urological problems) and how he is having trouble finding a publisher. He asks me to come back in six weeks but to call immediately if I notice any significant changes.

The bill for his services is one hundred and fifty dollars. When I take out my wallet, to give his secretary my five-dollar insurance copayment, she waves it off and tells me to forget it.

Six weeks later, when I return and Dr. Melman examines me, he is pleased to find that the scarring seems to have diminished. How can you tell? I ask, and he points to the drawing he made last time, after which he makes a new drawing.

“You're a very lucky man,” he says, and then: “But don't
you
think it's improved?” he asks.

I say I do, but that he's the doctor. He shakes his head sideways, tells me that I am the best judge of whether or not the scarring has diminished.

“Look,” he says. “Colchicine is a nonspecific medication. You might have improved without any medication—if we'd done nothing at all. We really don't know. Still, it's probably a good idea to continue with the colchicine.”

He asks if I have experienced any difficulties during sex, and I tell him I haven't
had
sex with anyone since the last time I saw him, but
that I have hopes. We talk about books and publishers, and he asks how my writing is coming along. I say that it seems to be progressing, inch by inch and page by page.

“I'll probably include something in the new book about Peyronie's,” I say.

“Could prove interesting,” Dr. Melman says. “It's what President Clinton has, you know—the famous distinguishing characteristic Paula Jones alluded to.”

“I haven't written this part of the book yet,” I say, “but if I use chapter titles, I think I know what I'll call this one.”

He smiles. “Yes—?” he asks.

I smile too, and give him the title: “‘They Saved My Life But Bent My Dick.'”

9

One Year Later

H
OW
CURIOUS, I THINK
when I leave Dr. Melman's office the first time: I've now seen two urologists, both in positions of responsibility at large New York City hospitals, both with significant achievements in research and with extensive clinical experience, and yet, confronted with a problem familiar to urologists, one tells me I have “a mild case,” the other tells me I have “quite a lot of disease”; one tells me I should take no more than 400 units of vitamin E a day, the other tells me to take 2,000 units a day; one prescribes 12,000 milligrams of PABA a day, the other says that PABA is useless and, instead, prescribes a medicine usually used for gout; one runs extensive blood tests, the other runs none; one wants to see me in three months, the other in six weeks…

More curious still: even though Dr. Melman has told me I have quite a lot of disease, and though he talks with me about dysfunction, impotence, and pain; injections, surgery, and prostheses—possibilities Dr. Haight never hints at—when I leave Dr. Melman's office, I feel relieved and reassured.

Ten days earlier, however, when Dr. Haight tells me I have a mild case of Peyronie's that PABA and vitamin E will probably cure, and that I should have no problems sexually now or in the future, I leave his office feeling more anxious than I was when I entered it.

On the six-block walk home from his office to my apartment, I
talk with my father, and—this is New York City, so nobody seems to notice—I do so out loud. I am awash in insecurity and self-pity, and though there is no rational basis for being as upset as I am, something about the visit has unmoored me.

Will I ever be able to love again? I ask. Will any woman on this planet
ever
love me again—ever want to love me?

The doctor said you'll be able to make love—to fuck again, right? my father replies. Isn't that what you're really worried about? I mean, I know you, sonny boy. Let's talk
tachlis
. Didn't he say that the problem you came to him for—this little bend—will probably go away?

Yes, I say. Sure. But if he told me I'm okay, why do I feel so shaken? So
abandoned!
I mean, look at me—I'm actually trembling.

My father's voice softens. I can see that, he says. But you're a smart boy, Jay. So you tell me: What do
you
think is going on?

I don't know, I say. But—okay—I was wondering: maybe what's happening in me is just a delayed reaction to the bypass surgery—some postponed postpartum displacement of the fear and depression I didn't acknowledge a year ago. Everybody tells me I was so positive and optimistic before and after surgery, but maybe I was just overcompensating and covering up.

My father shakes his head sideways and puts a finger to his lips, to shush me.

If you want my opinion, he says, you analyze things too much. The doctor said you're okay and that you have a mild case, right? Then take his word for it. And listen: I'm glad your heart is working well, and that your recovery has been so smooth, and it's nice to hear from you again. You haven't spoken with me for a long time, you know.

That's true, I say. But things have been going well.

So?
he says. You only talk with me when things are bad—when you need something from me?

But I'm scared, I say. I glance downward. I mean, this organ is nearly as precious to me as my heart. We've been through a lot together.

My father laughs, tells me to go home, to pour myself a stiff drink,
to call some of my friends, and to talk with him again soon. Don't be a stranger, he says.

When I arrive home from Dr. Melman's office, the first time, I throw out the quart-size container of PABA tablets. Then I call Dr. Haight's office and cancel my three-month appointment. The next day I start taking colchicine (one o.6-milligram tablet twice a day), along with
2,000
units of vitamin E a day.

By the time I return to Dr. Melman's office six weeks later, my anxieties have all but disappeared. I tell him that since my last visit, my hopes have, in fact, been realized, and that I have experienced no sexual dysfunction. And six weeks after my visit with Dr. Melman, and more than three months after my visit to Dr. Haight (and two months after Eli and I have returned from a ten-day trip to Israel—a trip we begin during the week of the first anniversary of my surgery), I write and ask for the results of my lab tests. When they arrive, I call Rich and read off the list of more than two dozen things Dr. Haight tested me for (cholesterol, triglycerides, albumin, calcium, chloride, iron, GGT, AST, glucose, alkaline phosphatase, et cetera), and ask why he tested for them if I only came in for Peyronie's. Is the guy running a factory?

Rich says he thinks I just answered my own question. I tell him that my PSA score is fine
(0
.87)—scores above 4.
0
are those generally considered to be of concern (PSA stands for “prostate-specific antigen” and is a measure of an enzyme made by the prostate, an elevated level of which can signal cancer)—but that I remember being upset with myself at the time of the exam for having let Dr. Haight draw my blood and perform the test.

“Then why did you let him do it?” Rich asks.

“Because he was the doctor, and he told me to roll up my sleeve, and said we should do it,” I answer. “I mean, in the moment, lying on the table with my pants down, I was mostly worried about my dick—and if I was ever going to have any sexual life again. And it all happened so fast.”

“You've got it, pal,” Rich says.

“But I also think I was a bit cowed—intimidated, hustled along
—and I felt I had no choice
but to
do what he told me to do. I mean, he was
The Doctor
. On another day, I might have protested, but—”

“Look,” Rich says. “This is what goes on all the time. You knew why he was doing it, and you sensed there was no good reason to do it, and yet you succumbed.”

“But I'm still not sure why he was doing it,” I say.

“Why was he doing it?” Rich asks, and then answers his own question: “Because it's his bread and butter. If he gets results that are out of the normal range on anything he tested you for, he can have you back for more tests and more treatment, even though you didn't come in for anything he was testing you for.”

Rich talks again about how vulnerable and defenseless most patients feel in the presence of a doctor, even when, as in my case, the patient is well informed and
knows
that what the doctor is doing or recommending is of dubious necessity; he also talks about how scandalous he believes this kind of medical practice is, and how doctors who work this way not only drive up costs unconscionably for all of us, but give other doctors—
good
doctors—a bad name.

Afterward, it occurs to me that the reason I came away from my first visit with Dr. Melman feeling reassured was this: at the same time that he was providing excellent medical care, he was also providing a human response to a human problem.

Most times no doctor knows what causes Peyronie's disease, or what treatments will ameliorate its symptoms. Dr. Haight's prescriptions might have dissolved the collagen—or the scarring might have diminished and disappeared if, as Dr. Melman suggested, I had done nothing at all. (Most medical books agree that Peyronie's disease resolves itself spontaneously about 50 percent of the time.)