A second patient which helped me choose the odd life of a plastic surgeon who was in part a sex change artist, was Molly Evans nee George. This nice person had been a venture capitalist expert / investment banker who had a clear cut case of Gender Dysphoria Syndrome transsexualism (302.84 in the psychiatry handbook 5th edition). The patient Molly Evans taught me that the patient, the other person, and the diagnosis of the non-glamorous conditions is actually able to teach the doctor; “The tail wags the dog.” In this case the doctor learned about the fact that all patients, all persons are equal; and some are better than most. The least human was most human. This was not only intellectually stimulating, and surgically a huge challenge, and socially – very much fun, and spiritually – enlightening.
In contradistinction to these cases, is the patient Molly Evans, a male-to-female NY venture capital type whom I had the privilege of administering a dose of Uncle Hippocrates formula for happiness and while practicing medicine as the “physician educator”. It was written by uncle Hipocrates father of medicine as follows, perfect your knowledge and skill (sounds self interested: 1st person singular), but “for the benefit of the other” (3rd person singular). Molly was a card-carrying Gender Dysphoria Syndrome “victim,” and had benefited from the special “Rolls-Royce Vagina” operation of my practice.
I had just experienced a bit of a tough day. Several perfectionist cosmetic patients were anxious to express desire to have further fulfillment of their pursuit of perfection. This perfectionist trait overcomes the patient who has already arrived at very good surgical results. I was frustrated with myself and my inability to manage the surgery situation and the psychological experience. I knew better having garnered from many, many such patients. I had always thought that in surgery I plus you, the patient and doctor combined with a common objective, are able to heal almost anybody, and also that I could manage every social interaction of pre-and post-op. I was five minutes late to see Molly but she greeted me warmly not coldly. “I’m so glad to finally see a normal patient today Molly.” Many had been complaining.
“Thank you. This is the first time anybody has ever called me normal, Doctor.”
Lesson learned: even the rich are regular humans and down to earth and very much so. Molly was a rich person who was a regular person. She enjoyed good conversation and she appreciated being spoken to with care. She was a model patient.
At $10,000 per case per sex change surgery – Rolls Royce Vaginoplasty and more for the Stanford Phalloplasty, even though I had invented the techniques for these special operations and was on the board of directors for the international society, I derived tremendous psychic income as opposed to tangible income (money) from the opportunity to get to know that an outcast, a minority in society, would turn out to be such an interesting friend. It was a joyous experience treating her. Seeing her self confidence blossom with each visit was a treat. Enjoying her conversation and appreciation for what we were doing together added to my psychic benefit.
The role of Paradoxes was again at work. The sex change patient carries the most severe diagnosis in the world, in fact worse than cancer, worse than being a torture victim, worse than lepersy. To have Gender Dysphoria, I.e not knowing what you were in all of the ramifications of that, was absolutely the worst possible thing in the world.
Molly was not in the huge group of normals; she was abnormal, in fact she was several stands deviations to one side of normal and I was an experienced clinician who thought subconsciously that she was actually a normal person. And I also realized in that moment that all the so called normals what having had successful surgery in other parts of the body many were unhappy because they had contracted the disease called “drive to perfection disorder”.
I also realized right in that moment that the best and toughest cases were actually the “good cases” and they are found when practicing medicine at a university Med school.