Confessions of a Park Avenue Plastic Surgeon

by Cap Lesesne

  The table was not moving. Perhaps I’d hallucinated the whole thing.

  “That was very odd,” I said, and looked up at my nurse.

  Behind her, a giant crack ran down the wall.

  According to the nurse, the earthquake had lasted close to two minutes.

  Neither romance nor a social life were even options at this point. I was too locked into my training. I was soaking in everything I could from the great surgeons around me.

  After assisting one of my plastic surgery mentors on a face-lift, he pulled off his gloves and shared with me one of the amusing little secrets of a cosmetic procedure that succeeds too well.

  “The big joke, Cap,” he said, “is that when you do enough of these and you get really good, you start thinking of what we do as ‘anti-Darwinian.’ We’re changing physical appearance, the natural expression of the genes. Make someone look too good, and they start to forget that that’s not what they really look like. Then she marries, has a child – and suddenly the baby emerges and he’s ugly. Big eyes, funny nose, giant ears.”

  He looked almost satisfied to visualize the moment of realization for the new mother.

  “We’re not changing the insides, Cap,” he said.

  I was doing cardiac surgery at the VA Hospital. I’d been up since six that morning, on rounds by seven, had completed three open-heart procedures that day. Now it was six thirty at night and I was walking down the center aisle of the CCU, my white coat covering my blood-spattered scrubs, my stethoscope banging at my side. I was adjusting lines, IVs, and meds for my patients. Five beds down each side, ten direly sick patients total, all hoping (if they were conscious) to get out of that big green room alive; their families in the waiting room or scattered about the city or country praying that their loved ones would get well.

  As in most any cardiac care unit, there was the relentless beep-beep of ventilator bags, the drips going, the IVAX machines, the EKGs measuring everyone’s extremely precarious heart activity. Whenever you’re in a place like that, even if you’ve been around it for a while, there’s always a seed in your brain – sometimes big, sometimes small – but always there:

  Thank God I’m okay. At least that’s not me.

  I moved to check on my next patient, a post-bypass being tended to by a nurse. She had adjusted his IV line. I told her I wanted to put in an A-line (an arterial line, to measure the blood’s oxygen) and she nodded. Then she looked past me, as something over my shoulder caught her attention.

  I turned to see what she was staring at. The TV over the bed of the patient behind me.

  On the TV screen, amid all the steady drip-drip of the IVs, an incredibly dreamy scene played out. At least one patient’s TV was always on in the ward, and it was usually just white noise to me. But now the TV was delivering something miraculous, and what it was showing seemed to be moving almost in slow motion. Onscreen, two people walked gracefully down an aisle, he in a long morning coat, she in the most spectacular wedding dress, a train that must have been ten yards long, all silk and shimmering jewels. They stepped into a carriage. It was right out of a fairy tale.

  Actually, it was a fairy tale.

  The nurse moved to turn up the volume.

  “And here is the new Princess of Wales meeting her subjects for the first time,” the announcer purred in an erudite British accent, as Prince Charles, future king of England, and his new bride, Princess Diana, began to wave at the adoring crowd from their carriage. She radiated beauty.

  Youth, love, future. Here I was, among men and women who would be grateful for a brief, highly medicated, not too painful future.

  I wiped my brow with a sleeve of my blood-covered scrubs, then began to insert an A-line into the radial artery of the sickly man’s hand, to keep tabs on his blood gases.

  New York Practice

  After three thrilling, exhausting, mind-bending years at Stanford, I came East for another residency, this one specializing in plastic surgery, at Cornell and New York Hospital, another world-renowned institution. In North Carolina I’d learned to be a doctor, in California a surgeon. In New York, I would learn to be a plastic surgeon.

  At New York Hospital, I learned an enormous amount – about different types of face-lifts, about rhinoplasties, about dealing with burns. At Sloan-Kettering Cancer Center, one of my last rotations, I did reconstructive surgery on cancer patients. As a surgeon doing that kind of work your mind-set is very different from what it is when you do cosmetic work. You’re not worried at all about scars. Instead, you’re doing things like repairing large defects and covering chest holes. You’re happy if the patient is just able to leave the hospital alive.

  I also learned who some of the good guys in New York medicine were, and who were the bad guys.

  When that two-year plastic surgery residency at Cornell came to a close, I had two professional options: to apprentice with an older plastic surgeon (if I could land such a job), or go out on my own. I decided on the latter.

  I thought I was ready to take on the world, nervy as that was. I was young, unknown, knew almost nothing about how the business worked, had no patients, and was unfamiliar with the rank and file of the Manhattan upper crust, where so many patients would eventually come from.

  Other than that, I was set to go.

  My last day as a resident at New York Hospital, I was nervous but excited about my future. I felt like a runner in the starting blocks. It was a gorgeous, late-spring day in Manhattan. A tall woman in a black Danskin top, red leather skirt, and tights passed me and entered the exam room. My last patient as a resident! Because I knew I would not be operating on her, I told the brand-new resident to “work her up” – take her basic info and do a standard physical exam – after which I would come in and sign off on the proposed surgery.

  Two minutes later, the resident came to fetch me.

  “She wants to see you,” she said.

  I recalled my own virgin exam-room debacle, at Stanford years earlier, when, as the new resident there, the patient had sneered at having “some high school kid” examine him.

  I was all set to make my own protect-the-dignity-of-the-new-resident speech to the tall lady in the leather skirt and the Danskin top. But when I walked into the exam room and smiled at her, something clicked immediately.

  To start, she had awfully large ankles.

  I whispered to the young resident that I would take this one, not to worry, and closed the door, leaving me alone in the room with the patient. I smiled and introduced myself.

  “Dr. Lesesne,” she said in a deep voice, “I wanted to speak to a man.”

  I nodded.

  “I’d like to have breast implants,” she said, then paused.

  I waited a moment to see if more was coming.

  “I want them put on my back,” she said.

  Because I’m Midwestern-slow, it was only now that I was getting that she was a he.

  You’d think all that time I’d put in on transsexual cases at Stanford would have sharpened my eye, and I would have picked up on it when she – he – first passed me on her way to the exam room. Especially with those large ankles.

  “Breast implants on your back,” I repeated.

  “Yes,” he boomed. “So my lover can have something to hold on to when he and I have sex.”

  It took a moment to get the visual, and it might take you a moment, too, so here:

  Man dresses like a woman. His lover is a man. But the lover – a gay man – wants breasts to hold on to while he’s having sex with our man, so he can imagine he’s having sex with a woman.

  Ergo, this patient’s breast implants need to be on his back.

  Check.

  “Got it,” I said.

  Because it was my last day, and he was my last-ever patient as resident, I felt in a puckish mood. I decided to refer him to an attending doctor who had always been a jerk to all of us residents.

  “I don’t do that particular operation,” I told the gay transvestite, “but if you’ll go r
ight now to this doctor” – I scribbled down the irritating surgeon’s name and Fifth Avenue office address, knowing who would be in his waiting room – “he may be able to help.”

  It was mean, I confess. The darker side of medical humor.

  An hour later, the nurse told me that the doctor to whom I’d sent the transvestite was on the phone. As soon as I put my ear to the receiver, he was spewing.

  “Whichoneofyougoddamngeniusessentthisqueentodisruptmy office?!”

  As much as I loved the teamwork and camaraderie of working with other doctors, it was time for me to go solo.

  At least until I had business cards made up.

  It was a bold move, and not the best one. I could have – should have – stayed on a few more years at New York Hospital, getting more experience, handling a variety of cases, establishing my name as a plastic surgeon, and not worrying about paying my bills. Even better, I should have apprenticed with an established surgeon and learned the business from him. I could have met his patients, observed how he interacted with them, and learned medical and practical aspects of running an office.

  I didn’t have patients or patience.

  I was so anxious about succeeding in New York on my own, for weeks I went nearly sleepless. How am I going to make it here? I wondered. I found a Park Avenue office I could share with a group of older doctors, but they were constantly screwing me: They’d tell me I could have the OR for this time slot or that one – then, at the last minute, they’d inform me there’d been a change and that they needed the OR then. It made me look unprofessional to the few patients I did have.

  One Saturday morning at six thirty, the phone rang. (I knew, by the hour, that it had to be another surgeon calling.) It was Dr. Sherrell Aston, one of New York’s most well-respected plastic surgeons, calling to say that Manhattan Eye, Ear & Throat Hospital, where he was an attending surgeon, had an opening for a fellow and would I be interested in joining them?

  A pretty great bolt from the blue. Just the phone call I was looking for. It seemed the proverbial answer to a prayer.

  But independence pulled at me. Before I could say yes to him, I had to think about it. I thanked Dr. Aston for his generous offer and told him I’d call him after the weekend.

  Monday I called to thank him again. And to turn it down.

  Who says you learn from your mistakes?

  Only later did I find out that Dr. Aston was possibly interested in taking me on as a partner, after a few years. He was thirteen years my senior and highly regarded by doctors and patients all over the city. We would have gotten along, I was sure. I knew how to be a team player.

  If I had said yes to him, or joined another plastic surgeon, it might have shaved years off my time line for making it in New York. On the other hand, I wasn’t going to waste time second-guessing my decision. If my persistence and impatience had driven me to this point, at age thirty, then it was inevitable that those traits would cause me to take some wrong turns, too. I’d been trying for so long to get into the wider world, from the moment I’d left my small, leafy Michigan suburb to find excitement in the East, in a different and, to me, more intriguing world.

  Still, the go-it-alone route I was now taking would be the tougher one by far.

  The first step was getting hospital privileges. I got them at two places – Manhattan Eye, Ear & Throat Hospital and Beekman Downtown. I now had ORs to use for my own patients, especially useful if my office partners continued to pull the rug out from under my OR time. My hospital affiliations also meant I would get work by being on their ER call list. If someone came into the ER requiring plastic surgery, I’d be one of the surgeons to get the call. I’d get paid if the patient had insurance; if he or she didn’t, which was half the time, well, then I’d just done surgical pro bono work.

  One of my big problems was that I wasn’t a self-promoter. I didn’t know a good way to announce that I was officially open for business. (Today, lots of plastic surgeons advertise everywhere – New York magazine, Texas Monthly, L.A. Confidential, infomercials, radio.) I was confident I could do good surgery. But how would I find enough patients to operate on? So that I would eventually have enough business to run my own Park Avenue practice?

  I was broke and unknown in New York, a plastic surgeon with barely a practice. I had no clients. I was invisible to everyone.

  I knew that if I worked constantly and stayed the course, it would work out, but this time, seriously, I had bitten off more than I could chew.

  Years later, after I had established myself with many friends and patients, I started to take the occasional three-day weekend. Once every two or three months, I would fly out on Delta Airlines on a Friday evening from JFK to Atatürk Airport, in Istanbul, Turkey, hail a cab to the downtown Swiss Hotel, shower, eat breakfast, and then see consults until eight that evening, go out with friends for dinner overlooking the Bosphorus – the magical strait that cuts through the city, dividing Europe from Asia – maybe go to a coffee club until midnight, get a good night’s sleep, see more patients the next day, then fly back to New York Sunday night.

  On one trip, I decided to throw a cocktail party for my many close Turkish friends. But I had to be careful about whom I invited: I couldn’t include everyone I wanted to because I’d operated on quite a few of them, and they might feel as if to attend the party would be to “out” themselves. But there were enough close friends to choose from, and in many cases I’d gotten to know several generations of families – parents, grandchildren, etc. I hosted it at the Cirgon Palace, by their gorgeous reflecting pool, overlooking the Bosphorus.

  My strong connection to this beautiful and fascinating country had been sparked years before, when two well-to-do, already stunning Turkish women came to me for eyelid lifts. Happy with their results, they recommended me to their friends. The parade of attractive Turkish women through my office was almost laughable: They were routinely dark-haired, green-eyed beauties, gracious, well-mannered, and intelligent. Some could have drowned in the amount of jewels and Chanel they owned. Soon I had a flourishing minipractice just among Turks, women and men both. In the beginning, they came to my Park Avenue office (world travelers and international businesspeople, they frequently passed through New York or even maintained homes here), but I would often go to Turkey for consults. I’d been to Istanbul roughly thirty times and had gotten to know the city quite well. I especially loved the art and architecture. Because of the numerous friendships I’d developed there, I had even read the Koran, so I could understand their nuances. Turkish women, in particular, tend to communicate elliptically. “Oh, Cap,” they would often say to me, “you know what I mean.” It was imperative that I understood what, in fact, they meant.

  The party I threw was about friendship, not plastic surgery, especially considering the covert nature of my business; many of the people there didn’t even know I was a surgeon, much less a plastic surgeon. They knew I was American, a New Yorker, a doctor. A beautiful crowd came. Their money had come from concrete, banking, cars, real estate, steel, textiles, and telecom. There were multimillionaires and high-ranking government officials. I think everyone had a grand time.

  Kemal – the brother of a friend of mine – came over and toasted me on this festive night.

  “A very special evening, my good friend,” he said, and took a sip of champagne. Then his look turned curious. “Every time my wife comes back from New York, she looks better. What do you do again?”

  “I’m a doctor,” I said.

  “What kind of doctor?”

  “A surgeon.”

  “What kind of surgeon?”

  “Plastic surgeon.”

  He nodded, sipped his champagne, then raised his glass in toast once more. “Now you really are my good friend,” he said, smiling underneath his mustache. “Inshallah.”

  “Inshallah,” I said. If God wills it.

  One of my friends, an heiress named Melek, said that the next evening she was going to a party in Gstaad and asked me to join h
er. After a morning of consults, I drove to the airport for a Turkish Airlines flight to Geneva, where a limo met us. We wound our way to a castle in the Swiss Alps, where a party was being hosted by Umberto II, heir to the throne of Italy. Surrounding me were displaced European royalty. Also present was the legendary Brazilian plastic surgeon, Ivo Pitanguy, who was flirting with all the women. Afterward, Melek and I walked the streets of Gstaad. I paused to look at a surprisingly inexpensive watch in the window of a jewelry store. Melek, who had been looking elsewhere and had kept walking, turned to see where I was. She doubled back, and now she herself was taken by something in the jewelry store window – a huge diamond necklace, with emeralds in the center, and matching emerald earrings. She entered the store.

  Fifteen minutes later, she exited, with the necklace, the earrings, and most of the remainder of the window display (though not the cheap watch I’d been eyeing and had decided not to buy).

  Two and a half million dollars in jewels. In nine hundred seconds.

  But that sort of episode would happen much later.

  For now, I was still getting stiffed half the time after I performed surgery in the ER. My notion of a glamorous evening was dining alone at the local French restaurant. And the only journey I cared about was the one that led to my becoming a surgeon, a good one, in New York.

  You Can’t Go Home Again

  What bothered me most the summer of 1986 is that the goal I was shooting for – a private plastic surgery practice in New York City – was not happening. Too expensive. Not enough contacts. Not enough contacts in the right world.

  Fortunately, there was a place I could go that was not too expensive, where I had lots of contacts, and where I had lots of contacts in the right world – in short, I could make my dream of a private practice come true immediately.

  Grosse Pointe, Michigan.

  The fear of practicing in New York had sent me home. But when I left the city, I didn’t look at it as a surrender. I knew I would return.