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Dr. Irwin Goldstein

Boston University School of Medicine

This is not the only proof of the injuries. There also is the arteriography with circles and arrows showing the injuries. And the report from the radiologist saying that my circulatory system is healthy up to the point at which it was traumatized. And Doppler ultrasound. And a sonogram. And other tests that would need a lot of explaining for most to understand. Instead of all that, on this page I'm offering one example of what it took to get them.

Finding Doctor Right

It took a long time for me to learn enough to understand what kind of physician was needed to explain the details in the diagnostic imaging and where such a physician might be found. It is unfortunate that I did not discover Dr. Tsuang sooner. He was right in my hometown and had the correct expertise and was known by my primary care physician. He is the one to whom my primary care physician should have sent me the first time I presented these injuries to him, but, as it turns out, the last thing my primary care physician was going to allow was for someone to help me. At that time I did know doctors do that when other doctors injure patients.

After a few years he finally did send me to see Dr. Tsuang. When I returned from out of town with confirmation of injuries consistent with the assault that I had been describing from the beginning (links to another site), my primary care physician became apologetic and sent me to see Tsuang. Tsuang confirmed the injuries and was proving to be a great help, but then my primary care physician flipflopped and told him not to help me anymore - a longer story than I'm going to relate on this page, about the lengths doctors go to in order to persuade themselves of a vision of of the truth they need to believe for their own purposes. The end result was my needing to find someone beyond the reach of my primary care physician because he was dedicated to protecting a colleague from the consequences of having assaulted me when I was tied down and helpless in the hospital.

The physician I found was in Boston. I was able to find him because he has a national reputation. For months my experience with him was the same as with Dr. Culley Carson (delays and avoidance), but eventually I persuaded his secretary to work on this. Word came back that he'd be willing to talk to my lawyer. I didn't have one, but I got one to call him up. Dr. Goldstein told the lawyer that he would look at the x-rays but it would cost $500 per hour. I sent him the x-rays and the check. The check never cleared.

Time wore on. I kept on top of it. Eventually I figured out that his office had no record of me or my x-rays or the check. I've been at this long enough to know when someone is going to ignore me forever. But his secretary hasn't and because of that the door didn't feel quite as tightly shut as other doors have felt. For instance, when I called and said that I wanted to make an appointment, she let me. So I made one and hurred up there before minds changed. Two weeks after the planes that flew into the World Trade Center took off from there, I landed at Logan Airport in Boston carrying yet another copy of my x-rays.

Some neighbors who heard where I was going responded as though I was a fearless daredevil to fly into that airport at that time. My thought was that it probably was the safest airport in the world at that moment. Where would people be more on alert to preventing terrorists from doing something again?

I arrived with yet another copy of my x-rays. It was a long wait in the waiting room. Finally a man came and took me to his office. He had presented himself as though he might be the physician I came to see, but he wasn't. He was a psychologist who said that his job was to do an overall psych screening to see what issues I was bringing to the appointment. I didn’t ask for this and didn't believe it was relevant to the analysis of an x-ray, but I wasn’t given a choice. I’d traveled a long way and I wasn’t going to have the surgeon "run late" and not have time to see me just because I didn’t jump through these hoops.

I hoped that having to undergo this evaluation before seeing the surgeon might make it so that for once the surgeon himself did not feel it necessary to play psychologist and waste time trying to do that himself, which too often comprises the entirety of my appointments with doctors about these issues. But no such luck.

When I was admitted to the surgeon's office he had students with him and asked if that was O.K. I told him that I was getting used to it.

His office was busy. Frequently people either telephoned or stepped in the door and interrupted. You might think that would not be a good thing. But when you are making as many notes as possible, it provides time to be more thorough with that. Sometimes I interrupted him myself to ask him to repeat or spell something while I jotted it down.

He said to the students,

SURGEON: "All right. Joel had a horrible, God damn, reaction to a hernia operation, of all things."

JOEL: "Actually, it was [lawyers deleted phrase]. An angry surgeon beat the hell out of me."

SURGEON: "O.K. The relationship of hernia to impotence has not been linked, but. . . "

JOEL: "It's not linked here either. These injuries have nothing to do with the operation."

SURGEON: "Well, hang on. O.K. Let's start at the beginning. Finish this sentence for me. 'I am here today because. . . ' And go slow. I'm going to write down what you say."

How many letters? How many emails? How many phone calls had there been? He even has talked to "my lawyer." And still he frames it as a medical procedure mishap. Doctors not only do not believe patients, they don't even hear them. Other than one who, miraculously, had been given an accurate referral, and one other who was too busy to, I have yet to speak with a single doctor who did not do this same thing.

Slowly, as I watched him write it, I said that I was here for an analysis of an angiogram of my pudendal arteries.

SURGEON: "That can't be why you are here."

Did I mention that doctors don't believe me? He then asked dozens of questions (really, it was dozens) that included, "Who is going to verify that you had this attack?" and "Can you recall any incidents or injuries, bicycle riding or horse back riding or motorcycling or anything that could have hurt the penis in a sporting event?" and "At the Mayo Clinic were they able to make a relationship or a connection between the physical problem and the hernia operation?"

JOEL: "I don't ask anyone to do that. It's not appropriate for a doctor to try to do that. You can't do that. It's not possible. You can't be judge and jury. All you can do is see if there are injuries."

Perhaps hearing the mounting frustration in my voice, eventually he moved on to what doctors usually move on to.

SURGEON: "Since that hernia operation, have you had any other surgeries?"

This is how it works. If you've been injured once, then you probably are crazy. But if you have been injured twice, then you definitely are crazy because in medicine they believe that is not possible. Getting examined requires never having had any other complication. Some people outside of medicine might think that even crazy people deserve diagnosis. But inside medicine, they don't. The only way to keep this from being a wasted trip and another closed door is to have had a wonderful experience every other encounter in medicine I've ever had. So that is how I was going to have to describe the shoulder decompression I had gotten after the assault.

In fact, the shoulder decompression had created a complication, brachial plexus stretch, something of which I had never heard. It resulted in reduced function in my hand, a reduced ability to bend fingers and such. Fortunately it resolved itself in about six months. Full function returned on its own.

However, I told Dr. Goldstein that my shoulder had been a problem since I was an adolescent, and now, as a result of the surgery, for the first time in my adult life, my shoulder was no problem at all. That both was true and apparently what he needed to hear.

SURGEON: "Why are you coming here for analysis of x-rays that were done in Cincinnati?"

I explained it to him the best I could. He said,

SURGEON: "Oh, I see. Referrals follow you. Without a referral you’re virginal, so you don’t have that pre-bias situation. That’s what you’re saying?"

Exactly.

SURGEON: "Wow. I can’t even imagine any of this happening. I can’t imagine any of this story happening. It’s so weird. God love you, Joel. O.K. I'm not going to do another ultrasound because apparently you've had several."

JOEL: "Two."

SURGEON: "I’ll do a physical examination on you. But I’m not going to do any cystos or DICCs or anything. I’m just going to review this arteriogram from Cincinnati."

At last he is going to do what he originally had said he was going to do. All I had to do was fly here and spend the night in a hotel and jump through the hoops that I'm finally learning to negotiate. If ever again I'm intentionally injured by a surgeon, I'll know how to get diagnosed before it is too late.

In the beginning I wouldn't even have been able to relate this dialogue because I didn't now what they were talking about when they said things like "arteriogram" or "cyctos" or "DICCs." And they are willing to spell and/or define terms only a limited number of times during one appointment. Later during this appointment there was some wonderful educating of a student by naming and explaining arteries on my x-rays, but I simply didn't know enough to make notes fast enough to keep up with them, and he wouldn't repeat it slowly enough for me to follow.

SURGEON: The link though, to the hernia operation, is difficult to make.

I have found no other way to communicate this. I have told him enough times during this appointment already that there is no link. I rose and hurled my full weight at his desk, leapt back and did it again, five or six times, causing great crashing sounds and shaking the room as I brought the entire weight of my body down on my hand on his desk. Fortunately, the desk did not break.

JOEL: "Like this. I got the hell beat out of me like this. This is not part of an operation. This is an angry surgeon who got mad and pounded on me like this."

He took it calmly. He's quite charming, actually. We went to another room where he looked at the x-rays. He rifled through them quickly finding nothing, until he focused on some staples.

SURGEON: "What do you have clipped? What do you have clips in there for?"

I explained, as I had to previous doctors who had seemed concerned about them, that the staples were from an earlier hernia repair that had been perfect, but he wasn't buying it. Eventually I became suspicious too. This led to my spending time afterward making sure that the doctor who had assaulted me hadn't maliciously used staples.

I went to Dr. Bossert, the surgeon who had done my first inguinal hernia repair. He says that he installed all of them. He is a surgeon who was not malicious and who has been helpful and friendly when I have gone back to him for information like this. Thank God for him.

Finally, we returned to looking at the vascular injuries. The common penile artery was completely blocked.

FEMALE STUDENT: "But the operation was on the left side."

SURGEON: "And it’s the right side that’s blocked?"

JOEL: "Because he was on the left pounding toward the right." Or at least that is what it felt like. The first blows knocked my head to my right. What parts of my body were tied down? What was the fulcrum?

SURGEON: "Pounding on the right side. O.K."

I wish doctors would stop trying to be detectives and just do what they are qualified to do. He didn't finish looking at the x-rays. Some of them were never lifted to the viewer. Once he found that blocked artery, he concluded that that was the problem and looked no further. Dr. Tsuang had been so much more thorough, but now that my primary care physician has told him not to, he no longer will help.

He had me pull down my pants and lie down and he began poking around.

SURGEON: What I’m saying to you is that right in this area . . . this is the Alcock's canal right here. So the common penile artery is injured right in here. So you understand physically what happened.

JOEL: O.K.

SURGEON: O.K. If he’s banging on you here. . . Here’s the common penile artery in Alcock’s canal at the origin. It enters the (he said a word that sounded like "crus") right about here. At the inside part of it. Now what’s really curious is the pummeling that you took is right in this area. And you have a blockage in the urethra which is the exact same site. They’re both next to each other.

JOEL: Mm hm.

SURGEON: So something happened to you in where my finger is that caused you damage to the urinary system and damage to the arteries.

This surgeon thinks I might be a candidate for revascularization. I would be more confident in his assessment if he had looked at the rest of the x-rays and found some of the additional damage that Tsuang found. He wants me to come back for a DICC to investigate this further.

When I got a copy of his notes about this visit, they covered our discussions and my history, but said nothing about the injuries he found. Fortunately, I had the x-ray on which he drew circles and arrows to show me. He created better records than perhaps any other doctor I saw, but still, he was not going to provide a written record of anything bad occuring in medicine. Patient safety is a lost cause if doctors are the only source of the record.