"Anyway, tomorrow we begin. I've drawn up a schedule for meeting with you and your patients tomorrow morning and afternoon. The day after that, you will each be largely on your own, except for your continuing reports to me. Before you leave, I will meet privately with each of you to discuss your first assignments.
"Enough from me. I'm now going to bring in Gayle Miller. She was the one surrogate I used, in Tucson, before I trained you. You each met her the last week of training, when she came by to say hello. But you had no chance to talk to her. I thought it might be useful if Gayle spoke to you briefly about her own experiences and gave you a chance to ask any more questions that come to mind. Now let me get Gayle Miller."
Just before leaving Suzy's secretarial office for Freeberg's more imposing office, Gayle had hesitated to speak to the therapist once more.
"What do I do?" Gayle had asked.
Freeberg had smiled. "Stage fright? You just go in there and do whatever comes naturally. Sit down behind my desk or stand next to it, as you prefer. Chat with them casually about your work. They're waiting there, friendly but apprehensive. Whatever I've told them is one thing. But to them, I'm somewhat removed from the main scene. Whatever comes from you comes from someone who's been in the field. It'll make them feel more comfortable. Give them a few minutes from the voice of experience, and if they have any questions, simply answer them candidly. You can do it, Gayle. Good luck."
Once in Freeberg's office, Gayle decided to stand behind Freeberg's desk and talk to them. The five new surrogates appeared alert, eager, receptive, and a bit curious, too.
"You all know the procedures," Gayle began. "I can only tell you of my own experience in working with Dr. Freeberg on five cases in Tucson. Two were cases where the men suffered an inability either to get an erection or to maintain one. Two were cases where the men suffered premature ejaculation. One was a case of terrible shyness and lack of knowledge—I mean, for him the problem was not in bringing a woman home with him but, once he had her home, how to take the next step, how to get her from the living room or kitchen to the bedroom, then what to say, what to do. All these cases, I am happy to tell you, were resolved satisfactorily."
Janet Schneider interrupted. "Did you make love with all of them, Gayle?"
"Of course," Gayle replied. "You mean sexual intercourse? Yes, I eventually had it with each one. Therapists like to say that intercourse isn't the goal of the treatment. They like to say that teaching someone to get in touch with his feelings, learn to be intimate, learn to handle sex naturally is the goal. All of that is true. But the ultimate goal is successful intercourse. If a man who has been unable to complete intercourse does arrive at the point where he can do that and do it as well as almost any other man, then I feel the main goal has been achieved."
Janet Schneider's hand was up again. "One more thing," she said. "What about the transmission of the AIDS virus in our work? How much are we endangered?"
"Let me say frankly, you're in a high-risk job," Gayle answered. "The AIDS virus, as far as we know, is transmitted through bodily fluids or from the blood of an infected person. You can be infected with the virus through sexual intercourse or intravenous injection. You can't get AIDS merely by touching another person. The virus does not survive long in open air or after sterilization. But, I repeat, it can survive in your body fluids and bloodstream. Risky as your work is, there are things you can do to protect yourself. At a surrogates meeting in New York concerning AIDS, I joined a group that worked out a way of practicing safer sex. First, no deep kissing with patients—no exchange of fluids at any time. Second, permit no penetration without use of a condom by the patient. And let the surrogate doubly protect herself by using a spermicide." Gayle lowered her voice. "Confidentially, I don't insist on my patients using a condom, once I know they've had a blood test for AIDS and it's negative. To me, condoms are just too inhibiting for already inhibited people. Many therapists demand that a surrogate have a test after every penetration. That's a little antsy, and Dr. Freeberg agrees. He requires his surrogates to be tested only once every three months. Anyway, follow the safe sex suggestions I've made, and the odds are strongly in your favor that you won't have anything to fear."
Before Gayle could resume, there was another question, this time from Lila Van Patten. "I'm wondering about something else. How would you, as a surrogate, define a successful erection?"
Gayle nodded and replied, "The best definition was given by Masters and Johnson, and Dr. Freeberg concurs. If, after your treatment, a formerly impotent man can get an erection and keep it up in three out of four encounters, then he's okay, he's made it." Her eyes fell on the man in the group, Paul Brandon, and she said, "As for non-orgasmic female patients, we agree with Masters and Johnson who felt that two orgasms out of every four encounters was a sign of success."
Searching the others for more questions, Gayle heard none, so she went on.
"I've always told my patients that I am not a teacher. I am a partner . . . but a partner who knows a little more than they know and wants to help them. Some of my patients have been lawyers and computer experts. I've told them that if I had a legal problem or had to know something about computers, I'd go to someone knowledgeable to find out what I need to know. But my own specialty is sex, so if they have a problem in that area, it's reasonable that they should employ me to find out more about it."
"Have they always trusted you?" someone called out.
"Not always. Sometimes they resented me, because they needed help and felt dependent on me. Also, they often resented hiring a temporary partner they had to pay. They know they're paying Dr. Freeberg five thousand dollars for the course of treatment. They know that from that fee, he will be paying each of us seventy-five dollars an hour or one hundred and fifty dollars for a two-hour session. Sometimes patients don't like that aspect of it. One of my patients once said to me, 'You're on the payroll, Gayle. I can't see myself relating to you as a caring person.' But eventually he did, and so did the others. I learned that if they trusted Dr. Freeberg, they invariably soon trusted me. It's really not a big problem."
Then she went on again.
"The big problem is the inadequate male's attitude. Once he's had trouble, with every new encounter, he takes on the role of spectator during his own sexual act, with no spontaneity, just waiting to observe if anything will happen, if he can make it work. That's the real problem. As Dr. Masters said, 'An impotent male is traumatized infinitely more above the neck than he is below the belt.'
"I found out that most disorders began when the patient was young, perhaps in his teens. At that time, the young man realized he didn't need to give or receive any touching or caressing because he could get aroused quickly and could go right at it. He was usually able to find a willing partner who thought that was what sex was all about and was ready to reinforce his bad habits. But as our young man grew older, no longer nineteen but now forty-nine, he found that his poor training in foreplay was working against him. A woman's bare breasts no longer turned him on as they once did. Arousal and erection were more difficult to attain. Because he never depended on touching, only on what he saw and wanted, he ceased being turned on as fast. He began to panic. He began to look for younger and sexier women, and when that stimulus also ceased to work, the man's entire sexual system broke down. He became dysfunctional.
"All this can be changed, through the exercises, by getting the patient in touch with his feelings, so he enjoys the pleasures of intimacy. At no time are the exercises enough. You will learn, as I have learned, that you must communicate with the patient steadily—not as a technician but as a human being, through constant caressing, cuddling, and being sensual."
She searched her mind to see if there was more to say. There did not seem to be. From now on, for the surrogates, there remained the relationships and their actions.
"Tonight," said Gayle, "I will undertake my first case in Hillsdale. It will not be an easy one. Mine involves an adult young man who has a problem involv
ing impotency that naturally is affecting his work. The patient's impotency, I am told, grows from an obsessive self-concern that his penis is too small."
"Is it?" Paul Brandon asked from the group of surrogates.
For an instant, Gayle stopped, startled. Her eyes held on the speaker, the one male in the surrogate group. She spoke to him directly, trying to keep her tone even. "Mr. Brandon, there is no such thing as too small. Certainly you know that. I'm sure my patient will, eventually, do as well as anyone—as even yourself."
Still annoyed, Gayle turned away from him to conclude with the others.
"Tomorrow, you all begin. I hope you derive as much happiness from what you will be doing as I have. Dr. Freeberg has already wished you luck. To that I can only add, I wish you success."
At promptly three thirty in the afternoon, Suzy ushered Adam Demski into Dr. Freeberg's office.
Freeberg shook hands with the first patient who had come to his Hillsdale clinic several days earlier. He greeted the man cordially and pointed him to a comfortable chair across from his desk.
Returning to his own swivel chair, Freeberg was secretly pleased that Demski had arrived at all today, let alone promptly. After their first meeting, Freeberg had wondered if this patient, referred by a Chicago psychoanalyst, would go through with it and actually show up. In their first confidential meeting, Demski had been diffident, nervous to the point of being almost inarticulate, and only after the most artful questioning had Freeberg been able to learn the details of his patient's impotency.
At the end of the initial meeting, Freeberg had packed Demski off to get a physical examination from Dr. Stan Lopez, the general physician he trusted and intended to use in all his cases. The purpose had been to learn if Demski's condition was organic or the result of psychological factors. Demski's personal physician in Chicago had indicated that he had found no organic problems during earlier examinations. Still, Freeberg had to be doubly certain of this and had requested Dr. Lopez to reexamine the patient. If the problem did have some organic cause, Dr. Freeberg had expected to divert Demski to physicians who would treat his sexual dysfunction from a medical view. If, on the other hand, his visitor's problem were psychological, Freeberg planned to go ahead and apply sex therapy with the use of his most experienced sex surrogate.
This afternoon's second meeting was for the purpose of reviewing Dr. Lopez's report on Demski's physical condition and then introducing him to Gayle Miller and discussing with him the procedure that would be followed in surrogate treatment.
Through the thick lens of his spectacles, Freeberg could see that Demski was again exceedingly apprehensive. Demski, rather anemic in appearance, sat uneasily in his chair, his lanky frame fidgeting as he kept his gaze fixed on the carpet.
Running his fingers through his bristly, unruly dark hair, Dr. Freeberg then stroked his short graying beard as he once more scrutinized the results of Dr. Lopez's physical report.
Wearing his most engaging smile, Freeberg said, "Well, Mr. Demski, I think I can reassure you about one thing. Your disorder has no organic basis. That is something to be grateful for." He tapped the report on his desk. "Dr. Lopez seems to have done a very thorough job. I see he even had an excellent urologist, Dr. Gerald Clark, look you over."
Demski nodded. Then he said, "Yes."
"All right," Freeberg went on, "let's consider Dr. Lopez's findings together, just to be sure I've not overlooked anything."
Demski nodded unhappily. Somehow, Freeberg could see, his patient did not feel reassured.
Freeberg brought the physician's report up closer to his myopic vision. "I see you were tested for the possibility of undiagnosed diabetes. Such a condition could hurt your blood vessels and possibly make normal physical response difficult. But Dr. Lopez tells us you are not a diabetic. So we can rule that out. Next"—Freeberg's eyes ran down Dr. Lopez's report—"he looked into your vascular condition."
"Vascular?" asked Demski, puzzled.
"Like hardening of the arteries—the penile arteries—which would slow down the blood flow to the genital area and could obstruct an erection." Freeberg shook his head. "Not a thing wrong in that area. The urologist, Dr. Clark, confirmed that by testing the blood pressure of your legs and penis."
Demski nodded unhappily, apparently remembering with embarrassment that genital test.
Freeberg rattled the two sheets in his hand. "Everything else seems clear. You take no antidepressants or tranquilizers. You do not drink to excess. No mood-altering drugs, like cocaine. No amphetamines, barbiturates. No prostate or bladder surgery. No damage at any time to your pelvic area, genitals, or spinal cord." Freeberg paused. "Testosterone level, fine. You are in your forties, aren't you?"
"Forty-two."
"So your libido has not been affected at all. I see here that the urologist did not think a prosthetic implant was called for."
"No."
Freeberg dropped the report on his desk and gazed at the patient squarely. "Plainly, Mr. Demski, your condition does not evolve from an organic impairment."
"It—it comes from something."
"Certainly it does. But not from any physical cause. That has now been confirmed. Your problem, it appears, is a psychological one that continues despite your psychotherapy. Probably after your first failure, there were more failures and an inability to focus on your sensations. This is something I can likely reverse and normalize through diminishing your anxiety. It requires only your full cooperation every step of the way."
"I came here," mumbled Demski.
"You did, and that means you can be helped. As you know, insight or talk therapy can be useful, but often it is not enough. After you had such therapy in Chicago, it proved to be not quite enough. That is why your analyst recommended that you come to California to see me. I will work with you almost daily, of course, but I won't be alone. I will be assisted by a sexual surrogate, a trained woman who will guide you and teach you under my close direction. You know about these partner surrogates from what you learned at home and what you heard from me. You know the functions of a sexual surrogate, don't you?"
"I—I think so, yes," Demski said in a small voice.
"Very well. I've assigned my very best and most experienced sexual surrogate to you. Her name is Gayle Miller, a young lady you should find most agreeable and useful. She's prepared to begin your exercises with you."
"W—when?"
"This evening at seven o'clock at her residence."
Demski looked pale and stricken. "Tonight?"
"Yes. You're ready to start. Now I want you to meet Gayle Miller. She knows your case, of course. She's read the transcript of our first meeting, and I've elaborated upon it personally with her. She will join us; sit in on the rest of our meeting, as I explain to you precisely the program laid out for you and the exact exercises you will undergo with Miss Miller."
Freeberg picked up his receiver, pressed down the intercom button, and said, "Suzy, please send Gayle Miller into my office. We are ready for her now."
The afternoon had waned, and the surrogates, including Gayle Miller, had left for their homes. The Freeberg Clinic was all but empty, except for Freeberg himself, putting away his papers, and Suzy Edwards next door proofing the pages of case histories that she had transcribed from tapes.
Dr. Freeberg, his briefcase in hand, poked his head into his secretary's office. "How goes it, Suzy?"
She lifted her head from her pages, pushing the stray strands of red hair away from her forehead. "Almost done, Doctor. Just catching a few typos. I hear it went well with the surrogates."
"Very well, I think."
Suzy fingered the sheaf of pages on the desk before her. "I must tell you, Doctor, even though I knew what you were doing, I had no idea how difficult and fascinating your cases would be."
"I agree with you. They are fascinating. I never get tired of the human maze, the confusion, the conflict, even the suspense. Yes, they are difficult, every one of them, but I'm confident they'll all mak
e out."
"I'm sure they will."
"Well, I'm off to dinner. When you've finished, leave the transcripts on my desk. Before you leave, be sure to turn on the alarm and lock up. See you tomorrow, Suzy."
"Tomorrow," she said.
After he'd gone, Suzy stared at the door he had closed. Tomorrow, she thought. Why wait? There was still tonight, a long tonight, ahead. Quickly, concentrating, she finished her proofing and checked her pages to see that they were in order. Then, without hesitation, she reached for her telephone.
The decision to call Chet had come to her while she had been proofing. Only when her hand was on the receiver did she hesitate. She considered the call she was about to make and tried to imagine how he might react, not merely to her call but to what could follow.
She thought about Chet Hunter, her new boyfriend, her best, and pictured him as he'd been the first moment she had met him. It had been a month ago, in the Hillsdale Main Public Library. She had been at a reading table, going through some medical magazines to see if she could learn more about Dr. Arnold Freeberg, her new boss. This fellow, probably in his thirties, surely no more than five years older than she, was carrying some books from the shelves, and the only spot open was the chair next to hers. Apologetically, he eased into the chair tight against her own. She had been taken by him at once. He was of medium build, receding neat brown hair, high forehead, soulful brown eyes highlighted by steel-framed spectacles set near the tip of a pug nose, his manner reserved but obviously an intellectual type.
They had exchanged occasional whispered talk, mostly bookish talk, and at closing time, he had accompanied her out of the library, casting sidelong glances at her and, as they were about to part, suddenly asking if she'd like to have a cup of coffee with him. She had wanted to, indeed, and they'd sipped their coffees and become acquainted.
The Celestial Bed Page 4