The Medicine

by Karen Hitchcock

  I once worked with a doctor who spent six months preparing for her high-school reunion. She went on a diet, joined a gym, had her boobs done, got her face resurfaced, filled and botoxed. She experimented with eyelash and hair extensions. She’d detail her endeavours to anyone who’d even half listen and wrap it up the same way every time: “I’m gonna show those bitches.” She was deaf to exhortations, blind to our looks of horror and discomfort. She’d entered some kind of mad alternative universe. Her party came and went and she was satisfied she’d shown them, those ageing horrors. She said she needn’t have bothered trying. I know, right? No one told her that that’s what everyone thinks.

  Full-blown neurosis and benign protective delusions aside, it’s arguably getting tougher for the average woman to embrace her deepening wrinkles and slackening skin. We watch celebrity faces stay smooth as photoshopped cream, rich with the possibility that we too might escape the spoil. Aesthetic procedures are on the rise. In women’s magazines, plastic surgery has become the new cold cream. They say you should start young. Take Madonna: a ton of work, a bit of make-up and a pair of gloves have kept her sort of thirty-five for more than two decades.

  I used to think plastic surgery was all boob and nose jobs, face lifts and tummy tucks. But in the public hospital, plastic surgeons treat burn victims, skin cancer sufferers and people with disfiguring, function-impairing injuries. They reconstruct, reattach and graft.

  In medical-school interviews, prospective students are asked to explain why they want to become doctors. A friend of mine who grew up in rural New South Wales intended to return to his hometown and work as a general surgeon. Tough gig. Mending all those stoic late presenters and farm accident victims, working horrific hours, being constantly on call with little back-up. Declaring this ambition in his interview probably gained him instant admission to the course.

  Midway through his training he fell in love with a beautiful GP, who wore icepick heels and emerald-green silk dresses to work. “As soon as I clapped eyes on her,” my friend said, his hand kneading his forehead as if divided loyalties could be massaged away, “I knew I’d be staying in the city.”

  My friend married the GP, dropped out of surgical training and became a “cosmetic physician”, performing all the minimally invasive procedures: office-chair injectables and laser treatments, day-case fat removal and silicone implantation. This causes him terrible periodic guilt. He could have completed real plastics training and done stints in developing countries fixing cleft palates. I like him and always feel an urge to defend him against himself. It’s not like he’s performing labiaplasty on porn-normed young women. He’s just the product of our medical system and society: consumer-centred, fee-for-service and privatised.

  Psychology and surgical journals are full of studies trying to measure the success of aesthetic procedures, with titles such as “Objective Assessment of Perceived Age Reversal and Improvement in Attractiveness After Aging Face Surgery” and “The Effect of Incobotulinumtoxin A and Dermal Filler Treatment on Perception of Age, Health, and Attractiveness of Female Faces”. They tie themselves in knots trying to work out what they are measuring and how. Unknowingly, they’re attempting to reduce complex philosophical matters to empirical equations – beauty on a scale of one to ten – believing that human perception can be rendered objective. Researchers have groups of “raters” estimate the age or the level of attractiveness of people from pre- and post-surgery photographs. One study determined that a face lift “objectively” saves 3.1 years on average, but doesn’t improve scores of attractiveness. Another study found the average number of years saved to be 4.6.

  My grandmother would have been an enthusiastic rater. When I was a teenager she’d tell me, at least once a week, “Remember, you never see yourself as others see you.” She usually said it in an attempt to get me to use less eyeliner or remove my leopard-skin coat. I thought it was her only dodgy aphorism: the last of the Victorians versus Gen X. It turns out she was right. But wrong about what should follow.

  What all the plastics research proves is that how you think you look has very little to do with what those others might think. Despite woefully modest improvements in how a group of strangers reckon you scrub up, studies pretty consistently show that when people have their face nipped and tucked, paralysed and filled, they experience major decreases in physical, emotional and social distress.

  My friend feels guilty for saving skin-years rather than lives, for helping to promote a ludicrous and no doubt sexist aesthetic regime. But the aesthetic surgeons and cosmetic physicians are ultimately operating on their patients’ (or customers’) internal portraits, on their fantasies, on self-perception. The operations work in much the same way as placebos or luxury brands do. Big fantasies hinge on tiny things: sugar pills, waitlist handbags, heavy watches, three fewer wrinkles. And buyer beware: Michael Jackson’s slowly butchered face probably made him feel better and better.

  Recently I was onstage with author Renata Singer and stand-up comedian Mandy Nolan. We were discussing societal attitudes to ageing and how unfortunate it is that we eschew its visible manifestations. Singer turned to Nolan and said, “Well, what about make-up? Where’s the line, Mandy?” Nolan raised her eyebrows. “Where’s the line? I know where the line is.” She struck her finger to her forehead. “The fucken line’s here.” A shallow crease on the forehead, a ravine in the mind.

  Sex and Pharmaceuticals

  Towards the end of 2015, in a third-time-lucky bid by Sprout Pharmaceuticals, the US Food and Drug Administration (FDA) gave its tick of approval to a new drug called flibanserin. It was the first drug approved to treat “female sexual interest/arousal disorder”. The following day, Valeant, a major pharmaceutical company, acquired Sprout for $1 billion. Flibanserin – colloquially known as “the female Viagra” and marketed under the trade name Addyi – had been twice rejected by the FDA, due to its dangerous side effects and minimal efficacy. The drug was a failed antidepressant shown in trials to increase the number of “sexually satisfying events” by about half an “event” per month, when taken daily. Fainting and sedation are common, and complete abstinence from alcohol is necessary while on the medication. Upon the drug’s FDA approval, Dr Irwin Goldstein, a sexual-medicine expert and paid consultant for Sprout, said, “If you have a broken leg, a broken toe, or a broken libido, you can now go to a doctor and get help.”

  Studies show that about 40 per cent of women report some sort of sexual problem, and that about half those women are distressed about it. The numbers aren’t dissimilar for males. When a man goes to a doctor with a troubling sexual problem, it’s usually because he can’t get or maintain an erection, or because he prematurely ejaculates (officially defined as “less than one minute of penetration”). The most common distressing symptoms reported by female patients are painful sex or a lack of interest or pleasure in sex. Male patients want to, but can’t. Female patients don’t want to, but want to want to.

  The story behind the final FDA approval of Addyi is noteworthy. Sprout spun the issue of the FDA rejection from one that rested upon efficacy and safety into one focused on gender inequality. It provided funding for the “Even the Score” campaign, which signed up large feminist organisations and politicians to support the claim that the FDA had turned the drug down due to underlying sexism. Even the Score paid for the travel costs of patients and activists to attend FDA meetings, where they gave positive testimonials. It was perhaps the first drug trial where the final outcome was determined by a highly manipulated and terrifically ignorant public.

  Addyi is no “female Viagra”. Addyi is a modern-day would-be aphrodisiac, although it is interesting that none of the marketing so much as whispers the word. Viagra and the other drugs like it aren’t aphrodisiacs. They act to dilate the blood vessels of the penis and keep them full of blood, so that – when aroused – a man can get and maintain an erection. When Viagra was launched in the US market, half a million scripts were written in the first month. When Addyi w
as launched in October 2015, it was only prescribed to a little over 200 patients in the first month. Given it had arguably been cleared for market on the strength of a gender equality campaign, the pills were priced accordingly: the same as Viagra. (Despite the fact that, unlike Viagra, which you take thirty minutes before you need it, Addyi needs to be taken every day.) Turns out there’s not that many women who are willing to completely abstain from alcohol, tolerate myriad side effects and spend $800 a month for the chance of six extra orgasms a year.

  Drugs (particularly the licit ones) are rarely successful at increasing or decreasing desire for anything – be it for food, other drugs, sex, change, leaving the house or hard work. And an understanding of human desire is not really part of the modern medical paradigm. The only reliably aphrodisiac drug is methamphetamine, which, besides being illegal and addictive, has its own host of side effects. So other than prescribing a pretty-pink, ineffective, risky and expensive drug, how might a doctor help her patient who wants to want to? Most medical guidelines suggest sex and couples therapy (which has a 65 per cent success rate), new partners, erotic literature or vibrators as the most successful ways to increase a female’s interest and pleasure in sex. The start of 2013 saw the biggest UK baby boom in forty years. The most convincing reason sociologists have come up with to explain this boom is the huge sales spike in copies of Fifty Shades of Grey in May 2012. And the book costs less than a single dose of Addyi.

  Late last year, five girlfriends and I went to Sexpo with tickets we pilfered from the ABC. Dozens of complimentary tickets had been distributed to ABC staff, most of them theatrically abandoned on tearoom counters or pitched off like rattlesnakes. That sort of sealed it for me. And all the friends I asked accepted with glee. It was like a huge indoor market where the stallholders only sold things to do with sex: vibrators and other prostheses, cheap lingerie, instruments of torture, and multi-flavoured, coloured or glow-in-the-dark lube. It was mostly hetero-norm in its focus, and mostly crowded with heterosexual couples in their thirties to fifties.

  There were (very sad) live peepshows that still haunt me, and two main-stage performances. The first was a dance routine performed by two women, who by the end were completely naked, covered in wet silver paint and simulating what seemed to be sensationally satisfying lesbian sex. The second was a group of six muscle men, dressed as tradies, who never laid so much as a finger on each other, and for the grand finale revealed only their arses. Talk about gender discrimination.

  And, look, I could give a scathing feminist critique of Sexpo. But in the end I was happy for everyone in the festive crowd negotiating their way up and down the aisles, unashamedly looking for ways to increase their pleasure. The women were far more likely to find their get-off there than in anything dispensed to them by a pharmacist.

  High Times

  After lunch at my mum’s house the other day, my brother and I walked around the corner to visit an old schoolfriend we hadn’t seen for years. Pete had moved back into his childhood home when his parents left for a retirement village. He answered the door pelvis first, the stance he’d had since he was a kid, one that looked slightly obscene now on this old, bald stranger with wild eyes and an open mouth, his lower jaw gyrating rhythmically. He grabbed me in a bear hug and kissed me fat on the lips.

  “Kaz! Great to see ya, mate!” My brother and I exchanged a glance as Pete ushered us into the kitchen. He offered us a drink of “activated” water from a row of bottles on his windowsill. As he paced, flicking his fingernails and scratching his shoulders, Pete told us how he bought the house real cheap, what activation does to water, why he had never had kids. We nodded politely, laughed in the appropriate places and said we had to get back for dessert.

  I waited till we were halfway down the street. “What the fuck? Speed?”

  “Ice,” my brother said.

  I have a talk I give to the junior doctors about taking a patient’s drug and alcohol history. I knew there was a need for the talk when a registrar asked me what a bong was. I thought she was joking, but when I saw the look on her bright red face I stopped laughing and explained that it was a water pipe used to smoke marijuana. Growing up, I learned a lot from Pete and boys like him in our neighbourhood. Things like how to make a bong out of a juice bottle and just how many cones it was possible for a human to smoke in an average day. As a result, I can extract a pretty accurate drug history, and it’s always useful to know what you’re dealing with. I start the talk by telling the fresh-faced doctors, “You are not normal.”

  Of course, no one’s normal. Everyone is exquisitely weird. Everyone has secrets. And there’s only so long a body can hide its secrets. Some people are better at hiding them than others, or have larger compensatory mechanisms. Pete’s jaw gyrates, and his fingers twitch and pick. A professor of medicine’s belly grows bigger each year, his nose reddens, he develops a wide-based gait. The secrets aren’t always about drugs. A young professional faints at the photocopier, and blood tests reveal electrolyte abnormalities that can only be caused by weeks of dedicated vomiting. A barrister comes in with a deodorant bottle wedged in his colon. Secrets are ritually unmasked in the hospital.

  The surgeons once asked me to see a guy on the wards as his blood pressure was high. He was a full-time tradesman in his forties and had three kids. I glanced at his notes and saw that he drank “socially” and smoked “a bit” of pot. His blood pressure was normal for someone who smoked, drank, ate crap and didn’t exercise, and it was nothing that a handful of pills couldn’t fix. I asked him about his work, his family, his health. His social drinking tallied up to a few bottles of Wild Turkey a week. I asked him if he smoked his bit of pot in joints or bongs.

  “Bongs,” he said.

  “Would you say you smoked more than forty cones a day?” I asked casually.

  He laughed. “Not forty, doc! Maybe thirty? Thirty-five max, on the weekends?”

  He’d done so since he was a teenager and told me a fascinating story about how he managed it at work. I told him an equally fascinating story of the barotrauma that years of deep bong inhalation was causing his lungs, and what the near future likely held for the rest of his body.

  “Face the facts, mate,” I said. “You’re not seventeen anymore, and you should stop acting like you are if you want to see your kids grow up from anywhere but the window of a nursing home.”

  We stared at each other for a minute. I asked if he wanted an appointment with our drug and alcohol service.

  “Nope, not necessary.” He leaped out of bed and grabbed his backpack. “That’s it. I’m gonna quit. I swear to you, doc, I’m gonna quit. I’ll prove it.”

  He unzipped a side pocket and pulled out the biggest bag of weed I’d seen in a long time. The registrar’s eyes bugged. The patient held it out for my inspection.

  “See, I’ve been here five days and I haven’t touched any of it.”

  “Good job,” I said. “See if you can keep it up.”

  “Doc,” he said nervously, as I made my way to the door, “can I smoke one joint at night” – he held his fingers 2 centimetres apart – “just to help me sleep?”

  I laughed and told him he could smoke as much as he liked – I wasn’t the police – but if he kept smoking thirty-five bongs a day he was fucked. He nodded solemnly.

  “Hopeless case,” I said to my registrar as we climbed the stairs.

  About a year later, I heard a wardsman inform a nurse that the lady in bed seven was desperate for a cup of tea. The wardsman turned around: he was my marijuana patient.

  “Doc!” he cried out cheerfully. “How’s it going? Remember me?”

  “Of course I remember you,” I said as we shook hands. “But what happened?” I gestured at his uniform. “Weren’t you a panelbeater?”

  “I quit,” he said. “All that dust, no good for the lungs.” He leaned forward. “I quit everything, if you know what I mean. And I thought to myself, I’ve gotta change my life and I know exactly what I’m going to do.” H
e straightened his back like a soldier, looked around proudly. “I’m going to work at the hospital.”

  Drugs: On Medication, Legalisation and Pleasure

  In Year 12 a new girl joined my class in a school way out west of Melbourne. Her hair was bleached platinum blonde, we liked the same music, and I shared her periodic inclination not to attend school. She came less and less – floating down the halls, speaking in an ironic monotone – but turned up one day bearing tickets to hear Timothy Leary talk. She’d won them from a radio station dial-in. (She won lots of the dial-ins, being at home so often.) It was 1989 and I wasn’t quite sure who Leary was beyond some vague idea he’d been into LSD and was cool.

  I don’t remember a word Leary spoke. (I remember feeling like an impostor, sitting in the small lecture theatre full of appreciative sophisticates.) But on our way there my friend told me why she didn’t come to school. She was addicted to Valium and spent many afternoons seeking new doctors to whom she told the same fiction: she couldn’t sleep, her mum and dad had just broken up, and she’d found relief in the past, after her boyfriend died, with a week of Valium. She said the story was very effective. Later that year, a local pharmacy called the school after she presented an obviously doctored script (she’d changed the quantity of pills prescribed from five to fifty). The school cut her a deal: a regular, medically supervised supply of the drug on the proviso that she told no one, turned up every day, and went straight to rehab at the end of the year.

  The school had also saved my life, many times, in particular by sending me on exchange to the US for a year when I was fifteen, after I was caught smoking on campus, again. I didn’t want to go. My homeroom teacher looked to the heavens and then back at me. “Hitchcock, you’re going.” And set up a meeting with my parents, to tell them too. By a further miracle I landed at one of the most progressive private schools on the east coast, stayed with a classics teacher, a famous YA author and their two children, and was seamlessly taken under the wing of the artsy hardcore-music crowd. These were kids filled with curiosity about themselves and the world. Thus began my foray into illicit drugs.