Gig: Americans Talk About Their Jobs Part 37

My high school was so not-it was barely college preparatory. [Laughs] I grew up in Kansas City, not the best part. And my high school, they were preparing you for UPS. [Laughs] We had a whole cla.s.s on packaging. I started out wanting to be a vet, and somewhere in there I realized I wanted to be a doctor. And I guess I excelled-I got into a good college-but it wasn't like it took a lot to stand out in that place.

College, pre-med, was-that was a big shock. It was like battle. People were so compet.i.tive. I went to Yale. And it was a little better, I think, than a lot of the state schools where they're really weeding kids out. But everything was cutthroat. You know, people were lying to you, cheating. I remember there was an anatomy cla.s.s where you walked around tables and you'd have to identify what's labeled. So one label would be in the heart, one label would be in the brain, whatever. And this guy was going along changing where the pins were. So you'd say, "Number one is in the heart." [Laughs] Well, number one started in the lung so you got that wrong. There was a lot of sick stuff like that. There was one time where there was a takehome exam and there was ma.s.sive cheating, and like three or four guys dropped out of pre-med because they got caught cheating. [Laughs] So, they're all lawyers now.

It was difficult. And med school was very difficult. And then the residency-the worst was residency. Because the hours, you know, you go into the hospital at four in the morning on Monday and you leave at eight at night on Tuesday. And you've been working all that time-and then you show back up at four A.M. on Wednesday. It's great training, you're learning all this stuff. But you have no life, and it was grueling to the point where I think it probably should be reevaluated.

I never got so tired that I wasn't competent to take care of patients, but that's only because when I was in the hospital, I was so revved, so tense, that I stayed on. It was just too important to get tired. However, I'd often be unable to drive home. At every traffic light I'd stop and have to put the car in park because I would fall asleep and my foot would fall off the brake. So I got in this pattern of I'd put the car in park and then I'd wake up to horns blowing, I'd put the car in drive, drive a little further, stop and do the same thing. I was just completely exhausted, constantly.

Luckily I stuck with it. I did the four years of college, all the premed courses, four years of medical school, a six-year orthopedic residency followed by a one-year spine fellowship for specialty training. I did it all. And now [laughs] I love it.

I don't love everything about it. I don't love the hospital bureaucracy. I don't love the insurance companies, dealing with the finances. I don't love the old-boy surgery network and being one of the only black people working in this sea of white men. I don't love that at all. [Laughs] But I really love what I do-the surgery, orthopedics.

I started focusing on surgery pretty early on, way before my residency. I chose it because it's a very concrete way to interact with a person as a physician. You operate on them. Can't get any closer than that. Your hands are in their body. [Laughs] And then, you know, getting back to that childhood thing of me being curious about how things work-with surgery, there are some very technical aspects of the procedure, too. When you're operating, the patient's not talking to you. You're controlling the room. There's not a lot of extraneous things that come in and kind of throw you out of sync. So you get a mix of patient contact and technical stuff. And I like all that.

I picked orthopedic surgery because, well, orthopods tend to be jocks, athletic guys. I think that's what first attracted me to it. I'm big, I've always enjoyed sports, you know, and I had friends playing football, baseball, whatever, who hurt themselves and they had orthopedic surgery. So I thought, "This is interesting, this is cool, I understand this." So that drew me in. And the other thing about orthopedics is that, in general, you're dealing with healthy people who have an isolated injury-a fractured bone or whatever-and you help them back to healthiness. As opposed to, say, oncology, where you have terminally ill people and you're just trying to make their trip out of life a little more pleasant. That's not my personality. I mean, I'm into life-you know, happiness. [Laughs]

My days start about six o'clock. I come into the hospital and review the X-rays of all the cases that came in the night before. We're a spinal cord injury center, so people who get in car accidents and break their neck, they come in that night, so the next morning you review their case, go over the X-rays, and talk about a plan with the other doctors. Then you start in the operating room at about seventhirty.

I operate all day. It can end at eight o'clock at night, it can end at three in the afternoon. It just depends on the case and how things are going. With spine surgeries it's difficult to do tons and tons of cases. Sports surgery-you can do an arthroscopic knee procedure in thirty minutes, so you can do ten or twelve in a day. Spines, you know, it takes a few hours to get most things done. If you get more than three or four cases done in a day, you're doing pretty good.

I think people would be surprised how physically demanding some of these operations are. There are many days I leave and I'm wringing wet with sweat. Because to manipulate someone's body- putting in metal screws and rods; you have to bend the rods and bend the screws-it's like carpentry in a way. It's really difficult. It requires a lot of physical strength. You have to move some heavy bodies around. Some of the people we operate on have not pushed away from the table very frequently.

And you really have to get into it. If someone's in a car accident and their hip gets pulled out of socket-what it requires is that, me, I have to stand on top of their bed with my legs draped around their legs, gripping their leg and pulling with all my might to try and reduce their hip. Or say, with a spinal operation, I'll have to take a metal rod that's about as thick around as your ring finger, and I'll have to bend that into the shape of someone's scoliotic spine, after it's been attached to their spine. It's very physical. There aren't many little guys in orthopedics.

It's exhausting. You have to take breaks sometimes. Just stop and stretch for a couple of minutes. Just relax. We do whatever we can to relax in the OR. There's music. And usually the music's determined by the surgeon. So what's nice is now that I'm the surgeon, I get to pick the music. So there's no more country, there's no more opera, and there's no more cla.s.sical. [Laughs] We put Snoop Doggy Dogg on every now and then. And we get to hear it. That's the way it works.

When things get hairy, you turn the music off. Most times, though, you're operating on someone-it's pretty routine. It's tiring, but it's routine. There's small talk. [Laughs] There's dirty talk-actually, sometimes it gets pretty out of hand. In fact, there's a certain issue called-I don't know the terminology exactly-but, when people are light in anesthesia and they're coming out of their deep sleep, and people make comments about someone's body part or something like that-they remember it! And that's a big problem. So, you have to, you know, toward the end of the case, even though the person's still asleep, you turn the music off, you change the tone of conversation. Because-it's a libel issue-people can wake up and say, "I remember you were talking about my b.r.e.a.s.t.s, you were talking about this or that." They can sue. And some of the jokes do get pretty raunchy. Depending on the surgeons. It gets kind of ugly.

I'm not into those jokes so much but, you know, what do you say? I mean, realistically, what do you say? It's the last true bastion of an old-boy network. It's a bunch of old white boys and they are in charge. Seriously in charge. If somebody's above you, they're above you. There's no room to say anything about them. There's nothing you can do. Because your next position is determined solely on what the people said about you at your last place. So you rock the boat and you're gonna get kicked out.

Different people have different problems with the system. You know? I think women surgeons have problems because it's a typically male-dominated field. And they catch h.e.l.l from the nurses because the nurses are typically women. There's a lot of kind of weird social dynamics. And I'm a black man and I have some dynamics being a minority surgeon in a predominantly white field. Things come up. It's not like I'm about to quit over it. But s.h.i.t comes up.

There's a good amount of s.h.i.t you get from patients-things as silly as you walk into a room to see a patient and they hand you the menu telling you what they've checked off for a meal. It's like, "No, I'm the surgeon. I'm coming to look at your wound." Or, you know, the people that you see and they ask you if you're a male nurse. But the fact that you could be a doctor-it's beyond their understanding.

And when it comes out, you know, that I'm the guy who's going to open them up, there are some patients who say they don't want a black doctor. That's their right. And I'll help them find another doctor. [Laughs] 'Cause I certainly don't want to operate on them. I mean, you know, you have a responsibility to the patient to not abandon them. But I also feel like I have a certain responsibility to myself. I owe the patient a certain respect and the patient owes me a certain respect.

But, by and large, there's not a lot of that overt kind of stuff. The thing that happens most often is you walk into a room to interview a patient and they ask you where you went to school. As if you need to pa.s.s a test for them, beyond all the tests you pa.s.sed everywhere else. It's a little subtle, you know? But it's racist. I mean, they don't ask the white surgeons that. [Laughs] So what I usually tell them is something like Grenada. Just to get their response.

With the doctors and the staff here, a lot of the racism is very subtle. There's not a lot of blatant things at all. However, it comes up. Usually it's some very off-color joke, or someone just stepping a little beyond what's considered politically correct. s.h.i.t happens. I had a nurse make some comment about me being like a gorilla. And I just thought, you could have picked any other animal but you picked a gorilla. So, my answer to that is a nice letter to your supervisor. Usually things like that are addressed pretty quickly.

I'm a very practical person. I think you have to be practical to make the decisions as a doctor-and as just a human being in society. You have to prioritize. These things are important now, these things are important but can wait. And for me, what's important right now is medicine, you know? I'm still the same person who left Kansas City back sixteen years ago. I've grown from the things I've seen. I think it's enhanced my personality, not changed it. The core of that personality is still the same. That's not the case for everybody. Some people get so tarnished and jaded from what they've experienced, they're no longer compa.s.sionate. The process has beaten out of them that initial light that drove them to medicine. Because you need to want to help people. If you no longer want to help people, you'll find yourself becoming a very unhappy health care provider.

So, you know, I've stayed-basically, I'm independent. I speak my mind. I'm honest. And I think patients by and large appreciate honesty, especially from their physicians. If someone comes and says, "My back hurts." And I say, "Well, Mr. Johnson, you're forty pounds overweight, you smoke, you have a sedentary lifestyle-why don't you lose some weight, stop smoking and do some exercise." People appreciate that kind of honesty, if you phrase it in the right way.

But honesty is difficult in the hierarchy of the old-boy network of surgical training. Basically, you can't be honest, really honest, and build your career. You have to just have a sense of humor to deal with some of the c.r.a.p. Because honesty, well, you know-for example, one of the chief residents here committed suicide. This kid had gone through medical school, seven years of surgical training-and his last year he kills himself. And we're on rounds-I'm rounding with the chairman of the department, a lot of attendings, and they say, "I heard that the chief resident killed himself last night." Then they said, kind of joking, to me: "Dane, I hope we aren't that hard on you that you'd go and kill yourself." I said, "Don't you worry. I'll go postal before I kill myself. I'll take you with me." And you know, there was like-silence. n.o.body laughed. n.o.body said anything.

That's the kind of honesty people don't appreciate. You know? They're happy to tell their jokes about a guy who killed himself, but turn it around, and they don't feel so good. I gave them the real sense of the kind of person I am-I'm not going to commit suicide, I'm going to take you out if it gets that bad. [Laughs] Don't worry! You'll be the first to know if I'm feeling that bad.

I knew that resident. He was a great guy. I'm sure he had been struggling with those suicidal feelings for years. And I guess things became too overwhelming-he'd almost reached his goal and he was probably still unhappy, and that reality was probably overwhelming to him. I think a lot of times those feelings of dissatisfaction are worse when you arrive than when you're trying to arrive.

Suicide has never been a thought I've had. I've definitely thought about taking a few people out, but that's just usually interpersonal issues. You can deal with those things. In general, I'm very happy with my career. I don't regret it for a second. Not at all. In fact, I think there's nothing else that would have worked for me. I mean the thought of being trapped behind a desk pushing paper, or glued to some computer screen, I couldn't survive that way. Here, I'm doing all this fascinating stuff-getting into people's lives, their bodies, helping them. It's physical and it's mental. Even with the racial stuff, it's not all bad news. There are numerous times where patients have told me, "I'm so glad to see a black doctor." It makes them feel more comfortable. Which, you know, that's a wonderful feeling for me, too.

Ultimately, it all comes back to the patients. You meet people at a level and at a time that is so disturbing and tumultuous. It's just a unique and special opportunity. If someone comes to you, they've been walking and functioning well and now they can't use their legs, they've been through a terrible event, an accident, they're in terrible distress-if you can somehow help them get through that-then you've played a special role in their life. You feel needed. And that's good. And that's all there is to it. The rest is just c.r.a.p.

Youth, beauty-these things have been

held up as ideals since the beginning

of time.

PLASTIC SURGEON.

Todd Wider.

I first got interested in plastic surgery when I was eight years old. My father's best friend, who happened to be a plastic surgeon, had done some time in Vietnam, operating on injured soldiers. And we were at his house in Connecticut one night for dinner, and I sort of wandered off, you know, as eight-year-olds will do. And I stumbled upon this book of photos of preand post-op patients that he had operated on during Vietnam. And I was amazed by this. I sat there for an hour just poring over all these photos.

I thought it was so cool. I mean, these people had been seriously injured. They'd had body parts blown off or were severely scarred or suffered major, damaging wounds. And to think that someone could change the way those people looked-restoring them to what was considered normal, or as close as you could get to normal-that was so intriguing to me.

So since then, since I was eight, I wanted to do this. That was the plan. I went to college and medical school saying, "I want to be a plastic surgeon." [Laughs] Which was unusual. But that's what I did.

Today I have a practice in New York City. I do about sixty-five to seventy percent cosmetic surgery and about thirty, maybe even forty percent reconstructive surgery. The reconstructions are essentially, well, you can move almost anything around. The body is essentially like a large jigsaw puzzle. As long as the blood supply can be maintained and reestablished, you can reconstruct almost any part of the body by moving any type of tissue-composite or not-from one section to another. In the case of a jaw injury, maybe from a terrible car accident, for example, you can take the bone in the leg-the fibula-carve it into the shape of a jaw, plate it so that it looks like a jaw, then take it away and use it to reconstruct the missing area. Teeth can be implanted into the bone later on. In the case of a woman who's had a mastectomy due to breast cancer, a flap of muscle tissue, with the overlying fat and skin, can be taken from the belly, shaped and carved and sculpted to look like a breast, and then rotated under the abdominal wall, into the place where the missing breast once was. Other flaps of skin can be transferred to simulate the nipple and aureola. And the color-we do a little tattoo to increase the color-the brown or pink pigment of the aureola. It's gotten to the point where at times it's almost hard to tell that they ever had anything reconstructed.

The other branch I deal with is cosmetic surgery. Aesthetic surgery. I do a lot of nose jobs-rhinoplasties, as they're called in the trade. I do a lot of face-lifts. I do a lot of eyelid work-taking away extra skin and bags around the eyes. That's very common these days. Liposuction is also very popular right now. We are a fat-obsessed culture. We hate fat. I mean, at the gym, people today work out not to feel healthier, but to look better. Ninety-nine percent of the people working out right now aren't doing it because they like to exercise- it's because their a.s.s is too fat or they've got hip rolls that they don't like, or they've got love handles that they don't like, or their husband made fun of them or their wife made fun of them or their boyfriend made fun of them or whatever.

Men, in particular, have been coming for what's called submental lipectomy. Which is removing the fat from below the chin. I've done a lot of men-anywhere from late twenties to late forties. A lot of the stereotypes, I think, are just wrong. Men are as narcissistic as women in many respects. But, in the past, it wasn't particularly acceptable for a man to have plastic surgery. Now, I think it's become more and more acceptable. So they do it. And many of the men that you see in the media-anchormen, or movie stars-have had a fair amount of plastic surgery, actually. It may not be obvious, but they've had it in one way or another.

So that's my practice. A blend, you know? Almost every day, I do both cosmetic and reconstructive work. It's interesting for me. It allows me to see two different worlds at the same time. In the one case, you're restoring what is normal, and in the other case you're enhancing what is normal. They're really very different, but both have the same sort of ground rules-a concept of aesthetics, basically.

I mean, if you have no idea of aesthetics or sculpture or art, I don't think, frankly, that you're going to be a very good plastic surgeon. When I was an undergraduate at Princeton, my major was art and art history. I actually wrote my thesis on aesthetics, on the image of feminine beauty in Florence during the late quattrocento. And I took Botticelli's Primavera as sort of a start-off point. Then I went backwards to Plato, and sort of synthesized an argument about neoPlatonic ideals of beauty and how they've changed over the years. That was my thesis-basically a philosophical treatise on beauty.

Why is one thing considered beautiful and another is considered ugly? It's a fascinating thing to think about, really. Why is Rebecca Romijn beautiful and not Roseanne? And why would another culture see Rebecca Romijn as not beautiful at all? I mean, the Renaissance- Reubens' women were enormous. They were extremely voluptuous, large, very heavy women. Today those women would be on the treadmill all day long-puffing away, and short of breath, you know? And yet, the Reubens women, in the paintings, they're beautiful. Despite changes in tastes, there's something innate about enduring, cla.s.sic beauty. But it's very sort of indescribable. You can't really put your finger on it. It's about symmetry. It's about parts in relation to the whole. It's about color and light, line and form. And-I mean-all that stuff goes into my head when I'm operating on someone.

In the vein of cosmetic surgery there are so many different things that one can do to one's self, so to speak. There are so many different interesting sort of scenarios. And what I like about my job is that every day is really quite different than the one before. One day, I'll have a seventy-five-year-old widow come in who hasn't been on a date in ten years, and she wants a face-lift. I'll do a face-lift on her and she'll look like she's fifty. Another day, a woman in her twenties might come in who wants to be a model or something, and she's very influenced by what she sees in magazines, television, movies, and whatnot. And she wants to have her b.r.e.a.s.t.s made bigger. She wants to have a D-cup breast when she was born with an A-cup.

Now, you might ask, should this be the way it is? I mean, is this the right thing to be happening? This older woman, for instance- should she really be getting a face-lift? Why can't she just deal with the way she looks? I mean, she's aging. Why not age gracefully, right? Why not just accept the fact that you're seventy-five and you're a widow? And why won't the younger woman just accept her breast size? I mean, this is absurd. You know, it's an aberration of the human body. It's some sort of b.a.s.t.a.r.dization of what is, you know, holy-the human figure in its original state. Well, you would have a point, I think, making that argument.

But, on the other hand, youth, beauty-these things have been held up as ideals since the beginning of time. Youth has forever been worshiped as a virtue to aspire toward. It's a.s.sociated with s.e.xuality, with virility, with potency. All these things have to do with youth. In Florence, in the late 1400s, the ideal of beauty was the thirteen-yearold girl. So it's nothing new. Aging is basically a drag for the human being. We are all conscious organisms. We're aware we're going to die. But I don't think most people want that to happen in their near future. So trying to reclaim the youthful ideal is a goal for many people.

And this seventy-five-year-old woman who got the face-lift-her life completely changed. She started dating. She met a man. She looked like she was fifty. She told the guy [laughs] she was fifty-five. All the power to her! I mean, she's happy. Why not, you know? And in the case of the younger woman whose b.r.e.a.s.t.s were enlarged, well, larger b.r.e.a.s.t.s have, again, been worshiped in our society and many societies for all of history as a sign of femininity and s.e.xual potency. I mean, that's just a reality. The breast has been worshiped in art and literature, et cetera, et cetera. Poets have written treatises on the breast. You know? It's just impossible to deny that this woman was giving herself something very powerful.

Ideals of beauty are being beamed into people's heads constantly. On the Internet. On television. In the movies. In the magazines. Everywhere we go. You come across a newspaper or a magazine stand and there's four thousand images of women with large b.r.e.a.s.t.s staring you in the face. It's enough to make a woman with small b.r.e.a.s.t.s feel inadequate-this woman might look in the mirror at night and think maybe, "I wish I looked different. If only I could change this maybe I would feel better. Maybe my relationship would be better. Maybe I would be more fulfilled as a person." And it's unfair to fully deny or discount those concerns.

Personally, I do have a bit of a sort of, I guess, ethical problem with the thing. I mean, I do. I question what I do on a day-to-day basis. I'm not totally comfortable with it, frankly. Which is one of the reasons why I like doing the reconstructive operations. And I do a lot of charity work. I've partic.i.p.ated in international surgical relief missions, where a team goes to third world countries without access to plastic surgery, and does free work on kids with cleft lips or very bad burns or skin anomalies. I also volunteer for victim services in New York-operating on individuals who have suffered from child abuse or domestic violence. So helping those people is incredibly edifying. For me, performing these operations acts as sort of a moral reprieve in a strange sense.

Not that I think that it is amoral to do cosmetic surgery. But I do think you need to sort of question the morality of it-the ethics of the whole thing. If you're going to be a healthy plastic surgeon, you've got to keep that in your head somewhere. Because there are many times when patients come in that are not appropriate candidates- who can easily be taken advantage of-people that are desperate, insecure, not stable. These people should not and cannot be operated on.

I would say maybe ten to fifteen percent of my prospective cosmetic patients get turned away. Maybe twenty percent. Reconstructive patients, people who come in and say, "I've had my breast removed because of cancer"-I'm not going to turn them away. But some of the cosmetic candidates are just not realistic with their expectations. They delude themselves into thinking that plastic surgery will solve their career problems or fix their relationships or their s.e.x lives. I can't tell you how many women come in with their boyfriends pressuring them to have their b.r.e.a.s.t.s done. I'll help these people in any way I can, but I'm just not going to operate on them. I've sent individuals to psychiatrists in the past. I've sent them to nutritionists. I've sent them to weight-loss programs. You know, I've done a variety of other things, "alternative treatments," quote-unquote, to plastic surgery.

I had a woman recently come in, and she's about sixty-eight years old. She said to me she wants to have a face-lift because she wants to work. And she was sure that if I did a face-lift on her she would get a job. Her goals were not realistic. Her aspirations were not realistic. Maybe she's unemployed because she's incompetent. Maybe she can't remember stuff. I mean, there are other reasons why she might not be working other than what her face looks like.

And also, frankly, I thought she looked very good for sixty-eight. She looked to me like she was fifty-five. I really didn't think she needed a face-lift, to tell you the truth. So for that reason alone I wouldn't have operated on her. But the more important reason was that her goals and desires were not realistic. Her aspirations were not grounded in reality. They were grounded in fantasyland. She was not a good candidate for plastic surgery. And I had to send her off. I'm sure she wound up having someone else do it, but I just didn't feel it was the right thing to do.

If I do choose to work with someone, I try to guide them in terms of my aesthetic as to what I think would look good on their body. I'll also partic.i.p.ate with their aesthetic and consider what they think would look good. But I try to steer how they view themselves in an appropriate sort of educational way so that they can make a proper choice as to how big, for example, their b.r.e.a.s.t.s will be. You can go from an A-cup to a B-cup. Or you can go from an A-cup to a triple D-cup as well. You can do either. But one is aesthetic and one is not, basically. [Laughs] You know?

I think b.r.e.a.s.t.s should look as natural as possible. You want them to droop a little bit. You want them to hang a little. You want them to be soft. You don't want them to, you know, come out of the chest like two rocket torpedoes. That's not a natural-looking breast. I think the ideal plastic surgery almost has the effect of purposeful misdirection. When you look at the person, you shouldn't really be able to tell exactly what they've had done. They just look younger. Or their b.r.e.a.s.t.s are slightly larger. Or their nose looks a little bit smaller and a little bit more shapely and a little bit more refined. Or their lips look a little bit larger. But none of it should jump out of the page at you.

This philosophy is, unfortunately, not something that all plastic surgeons adhere to. Many doctors, especially in past years, have made aesthetic judgments that I consider to be very questionable, frankly. I mean, take the "seventies nose job," for instance. In the seventies, so many doctors were performing this generic nose job operation on all their patients. They gave them this tiny pig snout of a nose that happened to be popular at the time. Everyone got the same nose. And that's crazy. Every nose doesn't belong on every person's face. There's not one ideal nose for every single person in our society. It's absurd.

But the fact is that plastic surgery has become incredibly popular and common in the United States. I think that has to do with a lot of things-not all of them, by any means, being the need for plastic surgery. I mean, it has to do with the heightening information age that we're in. And it also has to do with the increased amount of disposable income that a lot of people in the United States have now, thanks to the stock market. Plastic surgeons do very well when the stock market goes up and don't do so well when the stock market goes down. So I think it's important to take note of these trends and patterns and to be able to step back and examine them-to question them a little bit more seriously than maybe we have been. You know, to really look inside of ourselves and ask the question, "How important, really, is the way we look, you know?" I mean, how important is that?

Because, in the bigger picture, as a society-I think that maybe we could take some of this incredible amount of energy we expend focusing on the way we look and perhaps use it for something a little deeper-something that might be considered more positive and productive? You know, it's hard to say. But that would be my advice to our society. To possibly maybe step back a second, take a deep breath, and look within ourselves maybe a little bit more and try to find more of a moral grounding, frankly.

Not that this hasn't been an incredibly rewarding field for me personally. There are moments that I've had with patients that are just awe-inspiring. I've done breast reconstructions and the result will be so good that it will match the other side exactly. And the woman will thank me in tears that I've, you know, changed their life or restored her back to normal. That's an incredibly powerful thing to do for someone. Even helping someone cosmetically-enhancing their self-image can feel great if I can tell it means something to them and will positively impact their life.

It's not only playing G.o.d-it's like playing Michelangelo. You know? You really are doing that in a certain way. You're sculpting the human body-live flesh-that breathes and is warm and can talk to you. It's a wild thing. It's a piece of clay that's alive. It's an amazingly powerful field. And it's a real sort of privilege to do it. It has a tremendous and very sort of weighty responsibility that cannot be denied, I think. But it's also a privilege. And it's one I enjoy.

Antidepressants help.

PHARMACEUTICAL COMPANY SALES REPRESENTATIVE.

David Newcomb.

I'm a pharmaceutical sales representative for Eli Lilly and Company. Which means, in essence, I try to influence doctors' prescribing habits. The emphasis there is on the word "influence." It's indirect sales, as opposed to, you know, selling cars or shoes or whatever. Because a doctor doesn't buy any drugs. He's not the end user, he's only the middle man. He or she basically prescribes medication-as influenced by people like myself-for patients. The patients are the end users. But I don't really deal with them.

What I do is visit practices and try to influence the physicians' prescribing habits versus other products they might use. So I talk about Eli Lilly's product versus Pfizer's product, versus SmithKline Beecham, versus, you know, all our various compet.i.tors' products- and I try to explain how our medication has better features and advantages over theirs. That's the whole idea-I'm trying to give a doctor reasons to prescribe my medication over someone else's. And to do that, I might show comparison studies of the efficacy of various drugs on the market. Or I might show a head-to-head study of sideeffect differentiation. Or I might give the pract.i.tioner free samples. Which they love. [Laughs]

I've been doing this for the last six years. Right now, Eli Lilly has the world's leading antidepressant with Prozac. Thirty-five million patients are on it. It's my number one product. I mean, I have a whole portfolio of drugs that I deal with, but Prozac accounts for a good sixty percent of my sales. Because in my territory-how it works is, you're given a territory-a geographical area. And it's set up by dollars, so that every sales rep has a territory and each territory generates the almost exact same number of dollars. My territory is the Upper East Side of Manhattan, basically from about 45th Street to 96th, between Central Park and the East River. It's the smallest territory in the country. Some of my peers are responsible for five states to get equivalent sales to what I have in basically two and a quarter miles. Eli Lilly does about twenty million dollars in business in my territory-and Prozac counts for twelve million of that.

Prozac has basically revolutionized depression. No question about it. Because it's so easy for a doctor to prescribe. In the past, before Prozac, doctors would always worry about a patient taking too much of the old antidepressants-because if they took like a month's worth of pills, they wound up in the hospital for trying to commit suicide. Nowadays, a patient has to take a whole year's worth of medication to wind up in the hospital. Basically a person can overdose on aspirin easier than they can overdose on antidepressants. It's extremely safe liability-wise. Which is one of the big difficulties that a clinician has to worry about-liability insurance.

I know a lot of people say that America-as a society-we're overprescribing these drugs. They say it's wrong for people to just take a pill to try to help themselves out of depression. Well, let's put it this way-depression is chemically oriented. Not just something that can be worked through through therapy. You need both the therapy and medication to really help these patients. And that is proven through literature, through-I can't even tell you-about fifty, sixty different studies. Depression is chemically oriented. It just is.

Why are we so depressed? In my opinion, one word-stress. The stress of our society is causing a lot of people to become more and more depressed. I mean, I sit next to patients all day long sometimes. Because a lot of what I do is sit in a waiting room until I see the doctor. I'm in my suit with my notebooks, my literature, and my sample bag, and all these patients turn to me and say, "Ooh, what's that? Are you a sales rep?" Immediately patients start talking to you and opening up.

I had a woman yesterday who was telling me, you know, "The doctor told me to do this. Do you think it's okay?" She's more open talking to me about it than she was talking to the doctor about it, because she was afraid to insult the doctor. What does that tell us about stress in our society? We go to doctors-we pay them hundreds and hundreds of dollars for fifteen minutes sometimes. And you know what? We still don't believe them. But yet we don't want to insult them, either. So we don't do what they tell us, but yet we pay them anyway.

What is this society coming to? I don't know. But the antidepressants help. You look at the studies, most of the people on antidepressants are getting a life back that they haven't had before. So this helps them. Which is great.

But that doesn't make my job any easier. Because there are nine pharmaceutical companies out there now with antidepressant drugs that are similar to Prozac. Nine companies! And we're not talking about a lot of statistical significance between these drugs-they're all very similar. They all have the exact same cycle of efficacy. They have very similar profiles. The differences are that they're chemically structured differently and they have different side effects. Some might cause more diarrhea than others. Some might cause more nausea.

So basically, it's a head-to-head compet.i.tion between nine pharmaceutical companies to get the doctor to prescribe their antidepressant. All the companies are really pushing-and they're seeing that they need more and more sales reps to remind the doctors about us and keep us prevalent in their minds. If you look at the number of representatives out there, it went from like forty thousand to almost sixty thousand within like the last four years. As a result, I'm competing more and more to try to get these doctors' time.

And the thing about a doctor's time is-well, at least in my territory, Manhattan-most doctors don't want to meet with us. I mean, pharmaceutical representatives are some pract.i.tioners' idea of getting knowledge, keeping up-to-date with literature, but more often than not, I'm a doctor's idea of [laughs] I don't know how to phrase this- a lot of clinicianers see me as a wall between what's making them money. Because think about it-a doctor doesn't make money unless they see a patient. If a doctor spends five minutes with a representative and they have eight reps walking in that door that day, that's one or two patients they didn't get a chance to see. It hurts their bottom line.

So I have to be creative. I have to do what it takes to get through to the doctors. Just to get in there, to get through the door. You know? You do what it takes. You do a lot. [Laughs] I mean, let's just say sometimes you go to the nth degree to get your name and face in front of them to show that you really don't want to take too much of their time-just a minute or two-but you have something to offer.

Sometimes you have to create time in the doctor's life outside of their office structure. Whether it be dinner. Whether it be lunch. Whether it be showing up at the hospital where they might be doing rounds. Sometimes you might be using personal friends, using connections to get to them. To get them out to dinner. To get them to know you as a person before they can accept you. It's not easy. And you can't fight, you can't ever be too aggressive. You just have to try to show that you have resources and you have reasons-that there's benefits to seeing you.

One of those benefits is the samples that I can give. Samples really do help me a lot. Because they help doctors start patients off. And they save the patient some money, which the patient appreciates and so the doctor appreciates. And they're convenient, you know, especially if you think of yourself being sick and you go to see your doctor at seven-thirty, eight o'clock at night, you don't want to go from there to a pharmacy to get some medication. It would be nice if you could get your medication and go home in the cab. Make it a lot easier for you. And then the other things is-and this is I think a big deal in my particular territory where there are so many antidepressants being used-samples are discreet.

I'll get a call from a doctor and they've got a model. Or there's somebody in politics. There's somebody who's too famous to have their name put on any insurance form for taking an antidepressant. So what happens? They want them to have samples. They want them to be given the product without anybody knowing that they're having the product. That happens at least once a month. I don't always give them the samples. I mean, I have to prioritize my-I'm only given so many resources. Resources for myself are samples and my budget. And I have to allocate them to grow my business. So if some doctor calls me up who I don't know because they primarily do psychotherapy and they don't write a lot of prescriptions, I'm not gonna give them samples, no matter who they're for. Because I need to save my samples for my best clients.

I have about a hundred and sixty doctors that I see roughly every month. Those are my best clients. There's another four hundred doctors in my territory that I don't call on because they don't write enough prescriptions. But even so-even with my best clients- the amount of time I spend with each one ranges wildly. [Laughs] And I can't stress that enough. It could be from saying h.e.l.lo, walking in the office, to getting kicked out-forty seconds long. Or up to an hour and a half. It really depends. It depends on personality. It depends on the comfortability of the clinicianer with pharmaceutical representatives to begin with.

Plus, the fact that we're Prozac and everyone knows the name- it's a double-edged sword. Because some patients ask their doctor for the product because they know the name of it. Which is obviously great. But then the other side of that is that there are some patients that come in and say, "I don't want Prozac. I heard it kills people." [Laughs] Because maybe they heard that on some TV show or read it in a tabloid or whatever. It depends on the ignorance-it depends on the education of the patient. Some of the stuff people think about drugs is just absurd. I mean, thirty-five million people are on Prozac. Thirty-five million. It definitely doesn't kill people. You know? It treats depression.

Of course, there are side effects. I mean, one of the things we talk about with doctors is s.e.xual side effects. Because with all antidepressants it's probably one out of two. So you're looking at a fifty percent rate of s.e.xual side effects. However, even if I do a quick survey of all my friends-if I interviewed ten of my friends and acquaintances that I know are on antidepressants, probably eight out of ten of them would stay on them, even if they knew that one hundred percent of the time they were going to have s.e.xual side effects-because it's better to have that than to have the depression. Because ninety percent of the time when you have depression, you don't want to have s.e.x anyway. Because you feel awful. You feel like you're not worth anything. You're fatigued. You can't concentrate. You know? So that's the message there. And I think usually doctors appreciate that, and their patients do too.

There are great things about this job. A doctor tells you he had a great experience with your drug. That thanks to your drug-it saved a person's life. That really makes you feel good. And, just generally, I'm an individual who loves to have people contact. I'm an extrovert. Very much, you know, open and I like being able to talk a lot-and talk about lots of things. This is a good job for that. It's stimulating. I'm never bored. [Laughs] And then, of course, one thing you've got to remember about the pharmaceutical industry is that it's profitable. Right now, it's very profitable. So while it's sometimes frustrating-and I definitely don't want to be a sales rep for the rest of my life-it's been a great experience for me. I mean, this is my first job out of college and I've made good money and I've learned an incredible amount about business and about physicians and pharmaceuticals-and I wouldn't be at all unhappy if I ended up working my way up in management in this industry.

At the same time, it's like every job has its advantages and disadvantages. You go through cycles. We have performance appraisals once a year, and we're expected-they want about a twenty percent increase in sales every year. Roughly. Meaning the doctors in my territory have to write twenty percent more prescriptions for Eli Lilly drugs this year than they did last year. That's the target. It's not easy. The target's not always met. I've been here six years and I've done above average. Which I'm proud of. But some months are better than others. And sometimes you can drive yourself, you know, into a depression [laughs] because you're just-you're stressed about trying to reach the numbers, trying to get the numbers higher. Because, basically, sometimes you just can't get through the door. And you struggle with that.

You get rejected a lot. You get a lot of animosity toward you. The doctors are rude or just-you know, very straightforward and bottom line. I had a doctor say to me once basically, "Buy me a laptop computer and then I'll write your prescriptions." [Laughs] He was dead serious. I had another one say, "Buy me a fax machine." The same thing. And that's-I don't know-I was just like, whatever. See ya! I don't go there.

It's frustrating. It upsets you. You don't understand it. It's so tough getting through to these doctors, really tough. There's so much rejection. You try to figure it out and you can't. In the end, you just have to realize you're not going to win everything. I mean, there's no way around it. You have to be able to shrug it off and not feel, you know, that this is something personal against you. You have to throw it off the shoulder-let it go. Or it's going to eat you alive. No two ways about it. I think that's probably the number-one thing that causes representatives to leave the job. They just can't handle it after a while. Fortunately, I can. I don't know why. It's just something about my personality. This fits with me.

I allow myself to be somewhat braindamaged

as a form of empathy.

PSYCHIATRIC REHABILITATION THERAPIST.