My Subconscious Wins: Interesting Cases Are More Important Than $$$

This story tells me that all persons are people; and that we all have human DNA in common. This DNA similarity is the passport to “access to medical attention” and the expert care of the highest order available.

Dear Senor/Senora reader: I ask you to give your opinion on 3 actual cases which captivated and indeed captured me. Here is how the stage was set: back in January, 1967, on the day that father Robert A. Chase (RAC) asked me to take over and run the Division of Plastic Surgery for him (he was the Chief of all surgery, so that Plastic Surgery was a small unit of his empire), I quickly ran through the decisions which confronted me. The process of choosing the direction of my future life was instantly before me.  The alternative to that of Chief of Plastic Surgery at a university would be private practice with Dr. Avery in southern California in general surgery.

Dr. Roy Cohn, leading veteran general surgeon, most experienced, brazen, confident, steadfastly loyal to his friend and adopted professional progeny, all selected on the basis of being real people, had offered to get me the job with one of the most busy practitioners in general surgery in southern California. In my mind this was a heavenly dream. The dream would be fulfilling my preconceived notion of the success which I was seeking after 23 years of education through an overly competitive pyramidal system. 

The timing was so rapid. My subconscious knew the answer before my conscious mind. My subconscious had been fed all the information needed to decide previously, but my conscious mind was not aware of it. But when the need to make the decision consciously came about, the subconscious took over. The opposite of the way it usually happens. This refers to the hidden brain of Dr. Verdantam’s research. [1]

The practice with Dr. Avery seemed to offer success in the 3 preconceived parameters: (1)owning a house on the hill,making a hell of a lot of money,
(2) being able to educate my children at top schools,
and (3) having a nice reputation among peers.

The one flaw in Cohn’s offer was that it was in general surgery, which was a specialty of doctors known for being personable with those under them. And the second alternative to Chief of Plastic Surgery at Stanford in the university practice, was private practice with the absolute paragon of plastic surgery, that of private practice with Robert Berner. Berner was the pioneer (who ten years before had been only the second plastic surgeon between San Francisco and Los Angeles), and whose practice was top by every criterion you might apply to it. Berner had been doing 8 rhinoplasties each morning, twice a week. His wealth, and therefore my potential wealth, if and when I joined him, was easily calculated as $1,000 x8 x44 (operating days per year) – $352,000 (1963), $2.7 million (2015) – factoring in the 677.2% rate of cumulative inflation. However, at the university I potentially would be able to acquire more interesting challenging cases, not immediately, but in a year or two, with personal hard, hard work and recruitment of patients with my “university credential” and investing my total being “in serving all.” 

I had learned the hard facts, as they say, which showed me that academic practice is “better” by my personal criteria. This knowledge was acquired in 1964. Chase invited me to a lecture of his given to the Plastic Surgery Research Council, at their meeting in Kansas City. He lectured on the advantage of “university vs. institute.” I put 2 and 2 together during that lecture and made out the mental theorem that “money is poison.” The many supportive perks of group practice vs. the psychological advantage and disadvantage of having the decision making ability and responsibility all to yourself were considered with care. 

I chose the gratification of the interesting and challenging cases, because my value system happened to lie in that direction. I was 28 years of age, but the decision actually fit into the later “adulthood” stage of Erik Erikson’s psycho-social development for age 40 years to 60 years in that stage of development which Erik Erikson labelled: stagnation vs. generativity. For example, the top rung of the surgery ladder at that time was cardiac surgery; however the heart surgeons practiced in the area of stagnation; repeating the same coronary artery procedure, the same repetitive surgery over and over daily. General surgery, also as rewarding financially as cardiac surgery, lacked the perfection of personality development which the plastic surgeon enjoys. Plastic surgeons were more amicable and outwardly caring and lived life to the fullest in a philosophical sense. 

Therefore, it took me only 3 minutes to decide, “Yes. I’ll be your Chief of Plastic Surgery.”

A take home parable here is to have your value system ready, ready so that you can make any life decision within a 3 minute period. The short time of contemplation is handy to have and can be available to your prefrontal cortex in a “split second” (15 seconds actually) if you have values in order, readily available. The hidden mind, the subconscious should be “aimed and ready” for any decision. 

As alluded to above, my professional career at Stanford University School of Medicine Text Insert 1immersed me in an area of patient care and clinical experiences of high value, but which had been largely free of investigation in regard to the outcome/results in several lines of therapy which were being attempted by myself and others at different centers. The diagnostic category with which I was concerned at that time was 302.85 in the APA American Psychiatric Association hand book categorization of diagnoses, Gender Dysphoria Syndrome. This diagnosis was assigned to the patient who fulfilled a “short list” of signs and symptoms: those whose body-anatomy, hormonal secretions, and phenotype was of a sex (i.e. male or female) opposite that to which the person’s brain and behavioral pattern was. In other words, those persons whose consciousness had already assignation of the gender, the behavior of which was opposite their anatomy and hormones. That is, corpus of a female, but “thinking” from birth that they were male, or for example, corpus of a male and from birth “believing” (or rather, knowing) the self to be female.

post therapy (1)

I studied these patients by interviewing and/or treating two thousand (+/-) as patients, and eight hundred (800) operations on patients with the syndrome 302.85. The treatments consisted of psychology and psychiatry visits and counseling, over a 2 year period. We trained their behavior at the “finishing school” in Sunnyvale, California. The treatments included administration of hormones consistent with the gender of choice (not their anatomy), and bringing in a well informed endocrinologist.

Previously, treatment had been behavioral modification. It was directed at the text-insert-1-1-e1496500961999.jpgpsyche/brain with the objective of adjusting the brain to be compatible with, or the same as the body; this behavioral modification even included electrical stimulation as well as chemical (i.e. hormonal) adjustment to that which was “compatible” with the body. We would later see that surgical adjustment of the body was necessary, changing the aesthetic characteristics. That is changing the body to fit the behavior. The mind always wins over the body. [2]

The advice from the extant world authorities, the National Institutes of Health, as well as academic science, did and still does demand an academic control group if approbation or approval is sought from them. The control group would imply withholding treatment, albeit it being “experimental” or not “best available” to succeed. Ultimately, the rate of suicide of those unable to receive their desire of surgery (either for monetary reason or otherwise) suggested to us that it would be unethical to withhold treatment to the control group, and the study was terminated. In retrospect, a control cohort may perhaps be designated as “patients who are unable to afford surgery or those in countries where transportation was unavailable to travel to centers of surgery.”

The results of the 2,000 hormonally treated patients were they were sympathetic toward the surgery; that is, patient outcome indicated that palliation of the condition began to happen when gauging by a psychological criteria of subjective happiness, or by variables of economic independence, passability, behavioral science, evaluation of suicide rate, drug abuse, escapism tactics, and social acceptance. We applied a moderately serious measure of compassion as defined by taking many of their problems onto our responsibility

Happy Professionals

The life of the professional person making the diagnosis and carrying out the treatment on these patients was noted as well. The category of professional whose life was directed preponderantly toward service was fulfilled by this work in spades. The experience with the types of human gender pathology described above was immensely rewarding to the practitioners from the standpoint of being an interesting, happy experience, as well as providing the knowledge of intricate pathology management in my chosen field of work, working with each single human patient. The definition of medicine is just that, particularly for the physician/educator who is highly compelled to excel in a small niche on a worldwide basis; to be the world’s best. The treating behavioral scientist with a happy, positive, anything is possible outlook on life has a certain advantage to be successful when treating a largely untreatable diagnosis.

And I was, I believe, difficult to surpass. As you may recall [or “will learn,” depending on placement in blog], my way of life and my upbringing indicated that I should excel, to be the world’s best in a narrow niche, and also to have a great grasp, at least bordering on mastery, not only of the narrow niche but also of the entire field. This gender change knowledge and skill fit the bill in regard to personal goal and individual success, as it did in regard to the  other , the Interplast program — to be best in the world in the niche of voluntary surgical interchanges — and also in knowledge which completely covered the wide variety of plastic surgery. It also fit the bill for the use of powerful chemicals to improve the facial skin, regarding cancer genesis, regarding cancer prevention, and in regard to improving appearance, as did the application of calorie restriction to the human to achieve longevity through freedom from disease. This was the essence of the out-of-the-box [“OTB”] era of the surgical sciences. The attitude of unstoppability helped in the attraction of training malleable (young) “haves” from the developed cultures toward helping others in the developing countries with their skill and knowledge. I was an active participant in the advances of the plastic and reconstructive surgery field in poco loco evaluations, as well as enjoying the fruits of being a part of interesting events and colorful incidents associated with new and possibly good, possibly crazy, introductions.

In order to validate this decision to stay at the university, I was soon lucky enough to become physician and surgeon, doctor and technician, the most interesting job in the world. To prove it, following this post are 3 introductions, fantastic cases:

  1. Case #1: Ronald Schmitt
  2. Case #2: Molly Evans
  3. Case #3: Tech Sergeant McMurry

All were at least “1 ½ standard deviations” from the “usual patient” and were carrying fantastic diagnoses and were fantastic humans.

***

[1] Roberson, Lynn M., Paul Sullivan, and Shankar Vedantam. “The “Hidden Brain” and How It Can Make You a “Clutch” Player.” (n.d.): n. pag. Web. <http://dri.org/docs/default-source/dri-online/course-materials/2012/annual-meeting/2012-annual-meeting—43-the-hidden-brain-and-how-it-can-make-you-a-clutch-player.pdf?sfvrsn=4&gt;

[2] Milton, Edgerton

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