Confessions of a Park Avenue Plastic Surgeon. Cap Lesesne

care.

      Mary Lou came to the Stanford Clinic with an infected breast implant. She was the first breast implant patient I’d ever seen. I looked at her in the examination room, with an attending resident present. Mary Lou described her problem. I prescribed antibiotics and told her we’d probably need to replace the implant.

      As I walked down the hall afterward, a group of senior residents surrounded me, laughing.

      “Clueless,” said one.

      “What?” I said.

      “What’d you think of Mary Lou?” one of them asked me.

      “What do you mean?”

      “Well,” said one of them, “would you ever date her?”

      “Huh?”

      “Would you date him?” said another.

      “What are you talking about?” I asked.

      “Cap,” said the first, “exactly how clueless are you?”

      Very. Had they not chided me, I would never have known that she was in fact a he, probably in the final stages of sexual reassignment, prepenectomy.

      The more senior residents would play a joke on interns. We’d all go to a Palo Alto bar popular among many groups, including postoperative transsexuals. The residents would buy a few beers for the intern, then elbow him to hit on one of these great-looking women – and some of them were truly great-looking. The poor intern was as clueless in that trannie bar as he was his first time in an OR.

      In fairness to the residents, they always yanked the intern away before things went too far.

      At least, that’s what I was told.

      

      Our parotid glands are just in front of and below our earlobes. They secrete saliva into our mouth. For the plastic surgeon, they are particularly important because they wrap around the nerves that move the muscles of the face.

      The attending surgeon, nurse, patient, and I were in the Veterans Hospital in Palo Alto. Millimeter by millimeter, I was removing a superficial (closest to the skin surface) lobe of the parotid, a gland full of invasive cancer. All surgery requires concentration, of course, and can turn disastrous if one misses by the slightest amount – too deep, too far right, too far left. But this operation was more than usually treacherous. Total and permanent facial paralysis awaited just this side of a mistake.