Extreme Medicine

As the theme music and taped intro ended, Healthy Harry pursed his lips toward his microphone and spoke in his deep, good-bedside-manner voice: "Today, we will perform the first ever on-air surgery at Remedy Radio, health resource of the hoi polloi and all thinking medical consumers. Don't know what the hoi polloi is? That's you and me, brothers and sisters; that's me and you, sisters and brothers. Today we have a two-hour surgery special. Yes, folks, The Lew(d) Howard Learn to Golf Show is canceled today in the interest of this experiment."

Harry barely pronounced that "d" he added to Lew; only those in the know were certain they heard it.

"Actually, so you golfing fans don't bury me in outraged messages, the truth is that Lew(d) is canceled because he's on vacation. I presume he's golfing.

"Now, what do I mean when I say that we are going to perform surgery on the radio? I mean that most of us are going to listen while one of us, a certain... Lester, in Crazy Creek, Wyoming... is that location correct, Lester?"

"Yes, sir."

"Does that name have a story?"

"Crazy man tried to pan for U-ranium here. He was one state too far north, U-tah's got the U-ranium, and he was using the wrong tools. Pan. Crazy."

"Interesting. Well, today, Lester is going to perform a cyst removal on his cousin, Will. Are you both ready, gentlemen?"

A higher pitched voice said, "Yes, sir."

"Good. Before we proceed, let's hear from our sponsor, The Lovecraft Family Fitness Company, Fighting Fat and Forever Young."

Harry switched to the ad and felt anger flash. This habit of commercial-precipitated rage was not healthy, but ads made him think of money. Since the deregulation of medicine, he'd been busting butt to become the king of medical radio, premier purveyor of information and entertainment, and his ex-wife was taking a queen's slice of his income. Da fa' did she ever do for him that she should get such a share of his pie?

Healthy Harry was heard in six land-locked western states, six of the least populous states, granted, but he was in negotiations with a conglomerate of California country music stations. His show was a first, his concept was brilliant, and people were taking notice.

Unfortunately, the day to day on-air time grew tedious, and his mind wandered. To Charles, his assistant and call-screener, Harry said, "I can't stop thinking pissed off thoughts."

"Take your own mental health advice, my man."

"I'm better on the physical side than the mental."

"No you're not; you're squeamish!"

"That's mental."

Harry thought Charles was danged critical for a guy whose job was to be the lowly sidekick.

After the ad, Harry said, "We get letters every week from listeners anxious to perform home surgery or to rent one of the rolling surgery containers that have sprung up. Personally, I think retrofitting shipping containers as surgical theaters is a brilliant business plan and a fine example of recycling."

Charles made the 'I've got a good caller' sign, rolling his hand in a horizontal circle. They sat facing each other in the darkened studio. Harry was a romantic about the early days of radio and about darkness and red lights.

Harry said, "We get more mail about surgery than anything except prescribing drugs. Everyone wants to know about drugs." Charles laughed into his mic. Harry said, "Surgery is much more popular than exercise, for example." Charles laughed again. "Of course, exercise and diet have always been deregulated, but surgical deregulation is new. Personally, I think divorce should be deregulated, too, but that is a different story.

"For the benefit of all of us, I'd like to hear why you listeners want to do surgery, apart from the financial savings. Surgery involves blood, pain, and the pressure to do something quickly and perfectly the first time. Sounds messy, anxiety-producing and dangerous. Tell me, dear listeners, what is the attraction?"

Charles switched on a line and Harry said, "Who is this, please?"

"Sylvester. I want to do surgery because of the challenge. Did you watch the old medical TV programs? There was urgency, both in the dramatic series and the reality shows. We don't have much chance to do anything with that kind of pressure and consequence in the contemporary world."

"The reality shows are off TV because of lawsuits. Juries were sympathetic with people whose relatives died on the table, no matter what the deceased signed. But tell me more about your attraction to surgery."

"I mean, I want to do a simple operation to begin with."

"Obviously you wouldn't want to start with heart surgery."

"Like maybe an ingrown toenail…"

"An ingrown toenail is not so simple…

"Or something that when you see it done it looks easy: a cut, a tuck, an insertion, whatever. Why should you pay a professional? I mean, if you can…"

"Don't forget that absolute cleanliness is crucial," said Harry. "Can you guarantee that? Otherwise you get infections, sepsis. And there are unforeseen..."

"It's empowering, like the ads say, to be able to make these decisions. The intensity, the pressure, I think I can handle it. Sort of like what a professional athlete experiences."

"...compare surgery to athletics, first time I've heard that, but another person's health is..."

"...scalpel cut here, a few stitches, it doesn't seem so awesome. Or setting a simple fracture. We have all this info on the web now. It would be better if more of us had some skill. Even in terms of first aid. How do you tell if the victim is in shock? How do you stabilize someone for transport?"

"That is a generous point of view, taking care of others."

On Sylvester's line, a woman's voice broke in, "He wants to work on me. How do I know it's safe? Why should I trust him? Tell me that."

"The treatment you choose is up to you, as the patient."

"But he really wants to do it."

"He shouldn't pressure you. Get the best possible information about the procedure he is proposing and make your own decision."

Charles broke in, the designated devil's advocate: "Or perhaps you could demand that he pay you, if he's going to practice on you, if he wants to use you as his first experiment. What is it you are proposing to have done?"

"Breast implants. The man prefers a double D..."

Harry made the cut sign across his neck and Charles cut the call off after just enough salacious talk to amuse the listeners. Harry said, "That is not an appropriate procedure for a first surgery. But we are not here to protect people from themselves. Deregulation demands that we take responsibility for protecting ourselves. Now it's time for another break, folks, this one for Sheery's Sure-fire Shingles Solution."

It was a low-rent ad, and Charles read it, beginning, "I said Shingles, folks, not singles. This is not a solution to your dating problems, although dealing with that herpes infection on your lower back might help..."

When he finished the ad, Harry gulped his coffee before he realized it was cold and held the cup up for the studio gofer to get more. He felt he should be pleased with his income and grateful to the listeners who were cheerfully entertained by embarrassing conditions, gory accidents, and miracle cures. The art in talk radio was to find subject matter with an emotional charge, then draw it out and amplify it. It was human nature for the listeners to feel that emotion or its opposite. It was cathartic. On that score, radio surgery was a brilliant idea. Surgery was rife with fear, horror, and great expectations.

Charles spoke on-air: "Harry, it is absolutely true that we are not here to protect people from themselves. Before medical deregulation, special interests like the AMA pretended to protect us from ourselves, but they had their own nefarious plans for us."

"That's simplistic," Harry said, "and perhaps the AMA has been demonized enough." This was a game Harry and Charles played for the benefit of the listeners on the two sides of the debate. "We experimented with a highly regulated medical structure, and now we are experimenting with a deregulated structure. That's politics, and it's human nature. I think most of our listeners agree."

In this case, Harry did not give those listeners a chance to comment. He knew that the irate and the impassioned would send messages they hoped he would read on the air. Their riled up feelings and the effort it took to comment would increase their commitment to his show. Harry believed that, in order to build an on-air empire, he had to collect and use the energy of his listeners. He needed to ramp them up. He needed to be a bright, energized spot in their day. His audience wanted a sense of community, but also disgust, horror, surprise, suspense, voyeurism, and happy endings, and he intended to provide all those experiences.

Harry said, "Let's move on to today's main event. As Sylvester said, you wouldn't want to start your surgery career with heart surgery. In fact, you wouldn't want to start with ingrown toenail surgery, which involves removing part of the side of the nail and destroying the nail bed beneath. The toenail is cut off to create a new, straight nail edge. The cells underneath will try to re-grow a nail, so they must be destroyed. If there is hypertrophied tissue on the side of the toe, that must be cut away. There are many opportunities for mistakes and complications."

Charles had his mic turned off and was laughing. Medical descriptions disgusted Harry. How did the man get into this weird business, anyway? Even people who insisted that Harry went too far, even people who claimed he gave them nightmares, listened for just such descriptions. If Remedy Radio depended only on listeners who suffered from the conditions Harry discussed and hypochondriacs who feared they had everything, the program would have just a few handfuls of listeners.

Harry said, "Let us return to Lester. Lester, would you measure that cyst, please?"

"Three inches, three inches across."

"My, that's a big one!" said Charles, and he winked at Harry.

"An' almost a inch high."

"Time to be rid of it," said Harry. "It says in my MD's Out-Patient Surgical Reference that epidermoid cysts, cysts in the skin, often arise from a ruptured pilosebaceous follicle associated with acne..."

"I never had no acne!" said the high voice.

"... obstruction of a sebaceous gland in the follicle results in a channel opening to the surface, producing a dome-shaped lesion. Lester, are you certain a cyst is what Will has?"

"Yes sir. I ast a nurse I know."

"And how is business for her these days?"

"Fine. She's good with the drugs. She can tell you what to take."

"I see. And have you taken anything today?" Charles chuckled in the background.

"No, sir. This is important. My mind is clear."

"My Reference goes on, 'These cysts contain keratin and lipid, and the rancid odor often present is caused by an inflammatory response which produces a purulent material.' Lester, thoroughly clean the area before you begin, and avoid contact with the contents of the cyst.

"I understand the word purulent. Sir."

Lester sounded hostile. Harry was taken aback. He said, "Yes. OK, then. A splatter shield should be used to protect the physician from spraying of cyst contents."

"Charles went over all that with me. He checked that I have the right tools and materials."

"No harm in double checking, is there? Measure twice, cut once, as the saying goes. Next, we come to the description of the procedure. The skin overlying the cyst and the tissue to the sides and under it are anesthetized with 2 percent lidocaine with epinephrine.' Did you look up the possible side effects of lidocaine?"

"Yes sir. Convulsions and an allergic reaction. Actually, we already tested it on Will to make sure he could handle it, didn't we, buddy? I gave him a little shot of the stuff yesterday. Won't mention where."

"We did," said the higher voice.

"Well, that's unconventional. It's not according to the procedure we recommend..."

"That's medical freedom for you. Sir."

"You have a point, Lester, you have a point. So. Now, let us go through the actual surgery. You will use a number 11 blade to make an incision in the center of the cyst. Insert a small-tipped hemostat into the cut and gently open the cyst. Don't pry it, be gentle. Compress the edges of the cyst with your fingers to squeeze the contents through the opening. Or the hemostat can be removed and both thumbs used to express the cyst contents. The hemostat can be reinserted, if needed, to pull out the sebaceous material. There should be minimal bleeding at this point and throughout the operation, because a cyst is a discrete body. Following complete expression, reinsert the hemostat into the cyst cavity, grasp the capsule at the base of the wound, and lift. Remove the sac through the opening. It may be necessary to snip the bottom loose."

Charles said, "That's disgusting," and mimed vomiting. Harry looked away and said, "This step is necessary to prevent regrowth. When you have done the best you can, apply antibiotic ointment to the wound and tape gauze over it. The patient should hold direct pressure (using gauze) to the site for an hour following the procedure. Most small incisions do not require suturing. Lester, is this clear?"

"Yes, sir."

"Do you feel confident about proceeding to work on Will?"

"Yes I do, sir."

"Will, are you willing?" Charles laughed into his mic again.

"I'm fine with it," said the higher voice.

"You sound a little tight, a little wired. Are you sure?"

"I always sound like this. I'm fine."

Another thought crossed Harry's mind because of the high voice, and he asked, "And are you old enough to give consent?"

"Same age as Lester, thirty-three."

Will's apparent fear was not Harry's problem. Better that people should do this with his help and information rather than by themselves. Then again, Harry supposed that was what doctors had always believed, and the medicated public had pretty well slapped them down.

After another commercial break, this one for Ooby's Doobys, Harry said, "OK, here we go, everyone. Lester, disinfect the site and your hands, put on your latex gloves, and I will guide you through the local anaesthetic. You practiced giving a shot on an orange, right?"

"Yeah, and I practiced on Will. Remember."

"OK,then... take the number 11 blade and make that small incision."

"Eh. It's taking more effort to cut through the skin than I expected."

Will said, "I don't need to hear that."

"I got it now. I'm beginning to remove the contents of the cyst."

There was silence, and Charles said, "Now, Lester is on the spot. Can he do the job of a medical professional with online information, a little practice, and our help? Is he calm enough and precise enough?"

The silence continued. Harry said, "Guys?" Silence on radio was never good.

Lester said, "There's a whitish lump in here. It looks like chicken fat. I have it with the hemostat but it does not seem to want to pull out."

Charles mimed vomiting again. Harry said, "You may have to clip the bottom with the scissors."

"Wow, this is much bigger than I thought. Have to open this hole a little more."

"If you make too big a hole you'll have to stitch it. Charles checked to make sure you have the tools for that."

"The tools for that," repeated Lester. "What's inside here is much bigger... The surface is all lumpy and weird."

"How is Will holding up?"

"Oh, he's fine."

"Try to get the inner sack out, too."

"I hear you, man."

Into the next silence, Harry said, "Lester must be concentrating."

"I have blood here," Lester said, "More than I should have."

"Put pressure on the wound."

"Shit I must 'a hit a artery. Blood gushing..."

"Apply pressure, hard, and take Will to emergency or call 911! Whichever will get you help faster."

"...don't think I can reach in there again... blood everywhere..."

"Wrap that leg up tight, have Will keep pressure on it, and take Will to emergency! They will stop the bleeding and complete the procedure."

"But I want to do it myself."

"You have done an excellent job. You just ran into an unforeseen complication. It happens to medical professionals all the time." Harry was trying to stay calm. How much blood was Will losing?

"I'll have to pay for it."

"The most important thing is to get Will to help. You are in Crazy Creek, Wyoming and the nearest emergency is..."

"Damned if I am. I'm in upstate Pennsylvania, near Olean, New York."

"But you told us..."

"Course I did. I know you jokers like backward sounding places. I wanted to do the first radio surgery."

Lester had them there. Harry liked the odd places people claimed to be from, and it usually made no difference if they lied.

Harry said, "Call 911, Lester."

"I'm holding this pressure. You call. My zip code is 16923, my address is 73 Halcott Hill Road."

"You'll get help fastest if you call 911 from there. Get Will to hold the pressure."

"There's no Will. I'm working on myself."

"But you said..." Harry heard himself sounding stupid as he spoke. Lester was really screwing him up.

"...blood everywhere if I let the pressure up, no pants on..."

Charles circled his index finger by his temple and mouthed "cuckoo."

"Will was going to be here but his truck broke down and he needed to work on it. If I'd told you, you'd have got someone else. I wanted to be first. I was going to tell you at the end."

Charles said, "I've rung 911 and they are on their way. Hang tight, Lester. Folks, we have a series of firsts here today: the first radio surgery and the first radio self-surgery. Maybe we should call it sui-surgery, like suicide. Harry himself is a first, so he should empathize with you, Lester."

Lester said, "I want to drive myself. I'll just tie something around this thing and go..."

Harry said, "Don't be foolish. Loosing blood like that, you could faint."

"I'm trying to perform surgery here, Harry, under difficult circumstances. Let me do it my way."

"This has gone beyond surgery to emergency. We're trying to help, but if you..."

"You can't abandon me; that would be malpractice. You have to let me talk. What if I faint, like you said? I could die. Ask your listeners. Ask what they think. They'll be sympathetic with me."

Harry said, "Abandon you! I said we were trying to help you!" Harry turned off the mic and said to Charles, "What is this? Some kind of hostile takeover?"

Charles spoke on mic, "The board is all lit up."

Harry said, "While we wait for the ambulance we called for Lester, let's hear what listeners say. Here is Gary."

"He's a lying MF, but clever and he deserves help. He should put a tourniquet on that leg."

"A tourniquet is destructive to tissue if not removed quickly, but it is good for the short term. Lester, can you put on a tourniquet?"

"I'm in my car now, bringing you the blow-by-blow by phone. In case I faint."

Harry said, "That is not wise. Wait there for help."

Lester didn't answer. Harry made an I-don't-know gesture at Charles, palms turned up, and said, "Emma from Saskatoon, Canada has an opinion. She's following us on the web site."

"That guy is a plant. No one is really dumb enough to perform surgery on himself by himself. What if he fainted?"

"I ain't gonna faint."

Harry said, "Good, you're still with us."

Charles said, "Lester, how come you sometimes sound like a redneck and sometimes like an educated guy?"

"I'm a' educated redneck, sucker. It's not uncommon."

A moment passed and Harry said, "Lester hung up on us, folks..."

• • •

The next day, Harry began his program by saying, "We had a real cliff-hanger yesterday on Remedy Radio. We attempted the first ever on-air surgery; a guy named Lester said he was going to excise a cyst from his cousin, Will. The surgery got into trouble, the patient bled too much. Then it came out that there was no Will, and Lester was operating on himself. Now we know that Lester is really a character called Lehigh Ransom, aka Lee Ransom. He was not even in the state where he said he was. He started to bleed, we called 911 for him, and he hung up on us before help got to him. Pretty nuts, I'd say. Now, what do you suppose happened to that misguided guy?"

Harry allowed a few listener comments: Ransom was just exercising his right to treat himself however he wanted; Ransom was abusing the new system and endangering its success; Ransom was such a nice, polite boy and we should pray he was alright.

"It took Charles, who is quite a sleuth, hours of research to find the man, this Lee Ransom, even though we knew he was near Olean, New York. Ransom was found in his car and taken to emergency by the 911 crew we called. Once there, he was so excited and irrational that the medical professionals were forced to sedate him. He was detained in order to complete his treatment and because he did surgery on himself, something which has long been recognized as a manifestation of mental illness."

Charles said, "Listeners may be surprised to hear that orchiectomy is the most common type of self-surgery: the removal of one or both testicles."

"Fortunately for him and his progeny, he did not do that," said Harry. "All he tried to remove was a cyst." Harry and Charles laughed, and Harry reflected that Lester had been such a pain in the butt that he, Harry, deserved to get some mileage out if the jerk.

Harry said, "Disturbed people sometimes do even more serious self-surgeries than that. If you are interested in some extreme cases, check out our web site.

"We have an email here asking if we feel responsible for what happened yesterday. First, I'd like to point out that, although the show took a surprising turn, the end result was as we hoped: Lester, or rather Lee, or perhaps Will, is rid of his sebaceous cyst. An event like yesterday's is unlikely, but always possible."

After the show, Harry slumped over his desk. Charles said, "Hard couple of days."

"What does a man have to do to get a little peace in his life?"

"Not what you do, pal," said Charles. "You don't want peace, you want fame."

"I want fame and fortune so I can buy peace. What was with that guy, anyway?"

"Hostile takeover, like you said. Guy was determined to be the star of the show."

"Well, he wasn't. Just some lying bastard who stabbed himself in the leg and had to spend a day under psychological observation."

"He was the exciting part of the show. It was damned hard to fill the rest of the time," Charles said.

"Not so hard," Harry said, defensively. "Listeners talked about their theories of Lester. It was OK." He shook his head. "Running this show is like trying to herd cats. And when I began, I thought my listeners were your careful, health freak types!"

Charles laughed and said, "Let's go have a drink, buddy."

• • •

Six months later, Harry began Remedy Radio by saying, "Today we have a real treat, a special guest who is a rising star in the night sky of medicine. What shall I call you, sir? Shall I call you Lester?"

The man laughed comfortably. "You already revealed my real name, Lee Ransom."

"And this is your second visit to Remedy Radio. Since your first visit, you have become the leader of the Extreme Medicine movement."

"Not the leader. We're not organized like that, hierarchically. I'm the spokesperson and … I'm the theorist of Extreme Medicine."

"Tell us what happened after you did that first surgery on yourself, broadcast right here on this program."

"I was briefly incarcerated, accused of insanity. I became a test case for the extent of the new medical freedoms. Because I exhibited no signs of derangement, a judge ruled that an unconventional medical decision could not by itself be considered an indication of madness, of wanting to do harm to myself. My case set an important precedent."

"There was great press coverage of your situation."

"I became a sort of folk hero. When I got out of psychological observation, many people wanted to talk to me about one surgery or another they proposed to do, and sometimes even about other unusual medical situations."

Harry was thinking, Those people are supposed to want to talk to me. To ME. But he said, "Give us some examples."

"This may shock your listeners, but there are people who want surgeries, from the orchiectomy you mentioned on that earlier show, to plastic surgery, to amputations, and cannot convince a doctor to do what they want for them."

"How does that happen?"

"Sometimes they intuit that some part of their body is diseased in a way the professionals are unable to diagnose. Or perhaps a medical intuitive tells them that they have a very early stage cancer and it should be treated in a certain way, or maybe they want this or that surgery for psychological reasons. Someone wants their ears to look like Dr. Spock on Star Trek, for instance. We've always recognized psychological reasons for plastic surgery. Often these people are employing a very broad definition of what constitutes good health."

"So you've uncovered the existence of that market, and I'm sure someone will arise to serve it."

"Yes. Anyway, that original group of people grew and morphed into the Extreme Medicine movement we have now."

"It is growing fast."

Lee laughed. "It has spread to all fifty states, Harry."

"In its present form, it seems to combine medicine and entertainment."

"You exploit the possibilities of that combination on this very show. We at Extreme Medicine look to you as our inspiration. We grasped the true potential of something you fathered."

"Ah." Harry felt belittled rather than complimented.

"On the day I did the surgery, a woman called into your show and said she felt uncomfortable about her husband's desire to do breast enlargement on her. She felt pressured. Perhaps that is a situation where people should be protected. After all, we protect people from assault and robbery. If you are doing surgery on yourself, there is no question that you want it. Clarity of intent and commitment are benefits of self-surgery. It takes real commitment, because you are definitely going to cause yourself some pain."

Harry said, "You could have bled to death. The consequences could have been grave. Aren't you afraid you will get someone killed?"

"No."

"Ah." How could you answer that?

Harry said, "By the way, may I see your scar?" Then, "That is quite large. You definitely needed stitches."

"Harry, whether my surgery was successful depends on your criteria. I removed the cyst and, more important, I broadened the treatment choices available to everyone. I combined medicine and entertainment in a new way. By my criteria, my surgery was successful. It is partly that freedom of criteria that defines Extreme Medicine."

"Well, you are a rising star with a unique view. We hope you'll be a frequent guest on this show."

"Extreme Medicine is the wave of the future. I intend to spread the word. I'd be happy to be a regular guest here."

After the show, Harry said, "Did you hear him invite himself to be a regular guest? Who does he think he is? Now I'll get messages demanding I have him on regularly."

Charles said, "He's just like you, Harry, only more."

"How so?"

"Skillful with words, inventive, ambitious, willing to do what it takes."

"I feel like he's trying to execute a coup."

"I can see that," said Charles.

"I try to be helpful. He's going to get someone killed."

"Medicine has always killed people."

"You don't have to play devil's advocate anymore," Harry said. "We're off the air. Speaking of which, you were damned quiet while Lee, Lester, whoever he is, was on."

"What could I say?" Charles asked. "Besides, I have an ingrown toenail I'm thinking of cutting up myself. I might join his group."

"No," said Harry.

"Yes," said Charles.


Due to the need to make a living and a serious addiction to back country skiing, this writer lives in a state of vagabondage between NYC, Salt Lake City, Pine Hill, NY, and Torrey, UT. Linda Peer has skied in Kashmir, and published work or has work upcoming in Bartleby-Snopes, Writers' Bloc, Foundling Review, Used Gravitrons, the2ndhand, and Rose and Thorn.