A Screenplay

 

TESTOSTERONE & ITS DISCONTENTS

BY 

Obadiah Youngblood

DATE APRIL 21, 2025

COLD OPENING

FADE IN:

INT. EARLY MORNING

Sounds of vigorous sex, a woman, ABIGAIL CHANDLER, coming to climax in a dark room. She rises from the bed, naked but only dimly seen, walks to the window and pulls her hair up to a bun, and draws a curtain, admitting more light, but still she is only dimly seen as she looks out at the falling snow. There is someone in the bed moving, but not identifiable.

                                                      ABIGAIL:

It’s never going to stop snowing.

 

                                                        CUT TO:

Another room on campus, a naked coed, KAYLEIGH WENTWORTH, arising from bed, in the dark, goes to window and pulls aside the curtain, so you can see she is naked, but her partner in the bed is unidentifiable except for under the pillow, a glimpse of red hair.  KAYLEIGH looks out at the snow.

KAYLEIGH:

It’s never going to ever stop snowing.

 

EXT, DAY:  CAMPUS,  NEW HAMPSHIRE,

February, and it is snowing, and the sky is darkening, students hurrying to get to class, glimpses of banners hanging from lamp light poles flit past: Diversity, Equity, but these are not prominent, just in the background. You might not even notice them.  Camera follows an erect old man, OBADIAH YOUNGBLOOD, hatless, wearing just a wool scarf and a tweed jacket, as he strides along.  A graduate student, a staffer, JARED, in a puffy Patagonia jacket, wool watch hat, trying to keep up with him. Jared is tall, very good looking. But of the coeds who pass them,  one or two  look at OBADIAH, not Jared, and it’s not clear why. None of the passing boys seem to notice either one of them.

 

OBADIAH  takes the stairs to a classroom building two steps at time, JARED scrambling after,  and they enter the building.

 

                                                                               

 

 

 

CUT TO:

INT, DAY: CORRIDOR, CLASSROOM BUILDING

 

OBADIAH YOUNGBLOOD, 73 (rake thin, doesn’t look a day over 65, the kind of man who skis all winter and hikes the White Mountains all summer, incongruously formal in his tweed jacket, vest, striped rep tie, wool slacks) unwrapping his scarf, heading purposefully down a corridor, JARED  struggling to keep up,  passing students, dressed as students do now, as if they had just rolled out of bed from a slumber party, occasional faculty on his way toward his classroom.

              OBADIAH

You didn’t have to do this, you know, walk me to the classroom.  I know how to get to the classroom. I can find the classroom. I checked that out last Fall.

                 JARED

          Well, the president thought it might be nice. The campus looks different in the winter.

               OBADIAH

          That’s what they say about old people, when they get lost driving home at night. Everything looks different at night.

 

                   JARED

          Well, it does. In the dark.

 

                   OBADIAH

          But it’s day and we got actual lights here.

 

 

 

CREDITS/MONTAGE OF COLLEGE SCENES COMING BACK ULTIMATELY TO THE CORRIDOR

 

 

                                                CUT TO:

INT DAY 

As they approach the classroom, a crowd of sixty students is standing in front of the door to the classroom. They are not exactly milling; some of them are standing more actively, looking around, talking intently, nobody laughing. OBADIAH stops to see why this group is there, and works his way past them, as they now all gaze after him with interest, and he shoulders his way into the classroom, followed closely by JARED, and they stop at the rear of the classroom and gaze around. The snow outside is getting intense now, and wind shakes the windows as storm develops. There is even thunder (with apologies to Aaron Sorkin). Just a single deep throb now, but toward the end, during the flashback, the thunder will increase.

 

                                                CUT TO:

Inside the classroom.

The room is packed, every seat taken, students standing along the walls, some seated on the floor in front of the room under the blackboard/ projection screen. The contrast between their sweatpants, Ugg boots and OBADIAH'S  prim tweediness of which they visibly disapprove is apparent.

 

                   OBADIAH (to JARED)

          How many did you sign up for this class?

                  

                  

 JARED

          Twenty-five.

 

                   OBADIAH:

          Exactly. I interviewed seventy and I approved twenty-five. Now we got, what?

 

                   JARED

          (Looking around) Hundred and fifty, and if those in the hallway come in, maybe two hundred.

OBADIAH

Yeah.

JARED

So either there's a mix up, or you are about to get a very warm welcome.

OBADIAH 

This is New England. Warm welcomes consist of tar and feathers. That smell of tar does not smell like victory.

                  

Obadiah walks down to the front of the classroom, noting a few signs held by students "TRANS RIGHTS ARE HUMAN RIGHTS," and "HATE HAS NO PLACE HERE"  and "LGBTQ +: LOVE IS LOVE," reaching the front of the room, he looks around. The faces in the crowd range from hostile to curious to apprehensive. Nobody looks particularly happy, except perhaps a pair of very athletic coeds wearing gray T shirts and leggings.

 

 

 

                   OBADIAH

My name is Obadiah Youngblood. I think there may be some mistake here. I was supposed to have a class here at nine.  What class did you people think was going to meet here today?

 

                   STUDENT 1 (A co-ed)

The transgender bashing thing.

 

                   OBADIAH:

Excuse me?

 

                   STUDENT 2 (Another co-ed)

Where you try to say there’s only two sexes and no such thing as gender fluidity and transgenders are freaks and don’t belong here.

 

                   OBADIAH

No, that class is down the hall at the Young Republicans Club. Professor Ann Coulter. This is a course in the department of Biology, division of Anatomy and Physiology, for which I interviewed seventy students last fall, and selected twenty-five-- as the prerequisite for this course is ‘approval by instructor.’

 

 [As he speaks, ABIGAIL CHANDLER, president of the university, slips in at the back of the room]

 

 

                   STUDENT 3 (male)

And that is part of the problem.

 

                   OBADIAH

And what is the rest of the problem?

 

                   STUDENT 3 LUCAS PHILBRICK

[LUCAS is a good looking boy with long red hair.]

You screened your class for sycophants who would agree with you about gender fluidity, or, in your case, the lack of it. You don’t get to come to this campus and preach to the choir and just spew out hate from the pulpit.

 

 

 

  OBADIAH

Well, you seem to know all about me and we’ve only just met.  Well, actually we haven't, exactly, met. I told you my name. But I didn't hear yours. 

                              LUCAS (a bit uncomfortably)

Lucas.

OBADIAH

Lucas? Is that like Madonna or Sting? Just one name? No, wait, I get it. I'm so out of it. Nobody has two names any more. I'm a dinosaur, I admit it. I come from that Jurassic era when we had two names: Tyrannosaurs Rex, that sort of thing. We should all feel safe, especially if we are taking a side in an argument. I get it. So, Mr. Lucas...Have you ever heard me say anything specifically about gender fluidity?

LUCAS

Actually, professor, Tryrannosaurs Rex did not live in the Jurassic period. He lived in the Cretaceous period. 

OBADIAH (smiling, joining the general eruption of laughter around the room. His shoulders relax as he enjoys the joke on himself.)

Well, that's what I get for getting my information on dinosaurs from Stephen Spielberg. [Switching tone, now gravely]  We have to be careful about where we get our information. I, for example do have thoughts about gender, but they are not drawn, whole cloth from Judith Butler and "Gender Trouble."

LUCAS [betraying a faint smile, liking OBADIAH a little, despite himself]

You told my girlfriend you were screening people for this class because you didn’t want it to become a venue for speeches about gender fluidity and transgender rights.

 

                   OBADIAH 

I don’t recall saying anything of the kind. Is your girlfriend here now?

 

 

                   LUCAS

No, you rejected her.

 

                   OBADIAH

I don’t recall that conversation. I may not have selected her. But I’m not sure that’s the same as rejecting her. I interviewed about seventy students, and the faces blur, especially at my age. You know how it is: young people all look alike. [Nobody laughs. OBADIAH is a little crestfallen, his joke unappreciated.] I accepted, or more accurately, designated,  students who struck me as being curious, open to new ideas and intellectually flexible. 

STUDENT 2

Didn't you write a paper which said testosterone is what makes men dominant?

OBADIAH

No, actually, that is not what that paper said. It said testosterone therapy tends to make men feel more focused, and aggressive, and energized.

STUDENT 2

So, women, who have less testosterone, are less focused and aggressive, and will be dominated by men? That's a scary thought.

OBADIAH

Well, if that thought scares you, then this morning is not entirely wasted. 

STUDENT 2

You want to scare me? Oh, you are going to be very popular.

 

 

OBADIAH

One thing I can assure you  is whether or not I am popular, whether anyone likes me or agrees with me, does not even make my list of top one hundred concerns. 

STUDENT 2

So, with you it's all about intimidation.

OBADIAH

Safe spaces are antithetical to open minds and open inquiry.  If the earth is not the center of the universe, then maybe Man is not the center of God's creation. Think where that thought might lead! We should all drink hemlock!

LUCAS

That's just buttoned down, tweed jacket and vest elitism. 

OBADIAH

So I've violated the  dress code? Oh, well, then surely there's no point in your engaging in discussion with me.

Reactions among the crowd are disparate: some clearly do not like OBADIAH, prima facie, but others are disturbed by the attack on how he looks and dresses.  Others, particularly among the boys, visibly admire how he does not back down. Individual faces reveal a range of opinions, some hostile, some responsive. Two coeds, very athletic women's varsity softball players, are grinning, enjoying the back and forth. One, KAYLEIGH WENTWORTH, wears a gray T shirt with the words, "My Soft Balls Are Bigger than Your Hard Balls" with two crossed bats, and the other, SOPHIE DEARBORN, red hair, wears a T shirt which says, "Soft Balls for Hard Women." They wear black leggings over strong legs.  It's not exactly apparent where they align in the fray, at this point, but they are grinning broadly.

 

 

 

                   LUCAS

You want to say there are only two sexes and transgender athletes should not be allowed on college teams because then you’d have fake women who are really men trampling over real women athletes. And transgenders are psychopaths and transgender clinics ought to be shut down and should not be allowed to use the bathrooms on campus.

 

 

 

 

                   OBADIAH

So, that is what you are expecting me to say? That may even be what you are afraid of hearing me say. But you haven’t heard me say that, have you?

 

                   LUCAS

I know where this all leads.

 

                   OBADIAH

And where does all this lead?

 

                   LUCAS

To the testosterone myth.

 

                    OBADIAH

I’m sorry. I’m not familiar with that.

 

                  LUCAS

Well, that doesn't surprise me.  But, as Sheree Bekker and Stephen Mumford have shown, testosterone giving an advantage is a myth. It’s a book called, “Open Play.”

 

There is a smattering of applause around the room, some giggles. A few girls look up at LUCAS admiringly. Some scattered “right on” and “true that” comments from among the hostile faces.

 

                   OBADIAH (smiling, calmly, friendly)

The women's world record for the 800 meters run is one minute fifty-three seconds, last I checked.  To make a men’s college track team anywhere in this country you’d have to run better than that, by a full second. As a matter of fact, you have three male athletes on campus, currently, who beat that time. Probably a thousand high school boys run faster than that in the US alone, and twice that number across Europe and Africa, across borders, across cultures, run faster than the fastest woman ever recorded. Males simply  run faster. So, if superior male performance really is just a matter of nurture, not nature, as Bekker and Mumford say, you’d have to explain that.

[In the audience, around the room, there is clear hostility to this, among the females especially. A few scattered, "Oh, there it is" comments]

 

                   STUDENT 2

But Katrina Karzis and Jordan-Young have shown that testosterone does not correlate with athletic performance. 

Through these exchanges, reactions of some of the students, who are impressed at OBADIAH's command of the literature. You can see some using their elbows to sit up in their chairs, smiling, intrigued.

                   OBADIAH

I guess you're referring to "Testosterone: An Unauthorized Biography." Those authors, I believe, were talking about the track star Caster Semenya. I happen to have a slide about her, if you'll indulge me.

 

 

 

 

 

 

 

[OBADIAH FLICKS ON A SLIDE OF SEMENYA]

 

 

 It's hard to draw any conclusions about Semenya from what little you can get from the popular press, or even on the internet. She is entitled, after all, to some level of privacy regarding her medical condition. Until, of course, she decides to compete as a female.  Right now, Professor GoogIe says she has 5 alpha reductase deficiency. I  happen to have a slide about five alpha reductase deficiency.

 

 

 

 [OBADIAH clicks up a slide]. 

So these gentlemen have 5 alpha reductase deficiency. When they  were born and as babies, they looked to be girls. No scrotums.

                 

                   LUCAS

You still haven't answered why you wanted to exclude students from your class.  We don’t do that here. We allow students to select their classes. But this looks like you were excluding people who might show you up.

 

 

 

                   OBADIAH [a trace of a smile]

Well, that’s a fair point. I can see how it might look that way–that I was culling out everyone but the members of the choir I wanted to preach to.  I don’t object to protests, understand. But I do think you ought to hear the thing you disagree with first.

 

                   STUDENT 2

We’re not going to allow you to select your own audience to present your own gospel against gays and transgenders. Not here on this campus.

STUDENT 1

No gender shaming! You transphobic twit!

KAYLEIGH (turning in her seat to address STUDENT 1)

Let him at least answer, Dweeb! 

SOPHIE

Chrissake.

 

 OBADIAH

Okay, then.

 

OBADIAH wraps his scarf around his neck and starts up the aisle toward the door at the back of the room. There are startled looks all around the room.

 

 

                   STUDENT 2

Where are you going?

                   OBADIAH

Home.

 

                   LUCAS

So that’s it? You just chicken out?

 

                   OBADIAH

Have it your way. I’m out of here.

 

                   STUDENT 4

You must not really believe in what you are saying, if you would just walk out, not even stay to defend it.

 

                   OBADIAH

[Pausing in his ascent of the stairs toward the exit, turning to face the student.]

And what, exactly do you think I believe? What do you think I’m abandoning?

 

 

                   STUDENT 4

Well, about transgenders and God given sex and gender.

 

 

 

                   OBADIAH

[Looking around the room, which has swollen with even more students as those in the hallway have moved inside.]

 

God given gender? No, God has nothing to do with it.  [Pausing, looking around to see if that has sunk in anywhere in this crowd.]            

You know, actually. I’m retired. Unlike most of your faculty here, I do not need a job. So, yes, I can just walk out and leave you to pontificate on these issues, which so inflame you, on your own. You don’t need me for that.

[The audience seems a bit stunned. He turns to go, takes another couple of steps toward the door, but then stops,  turns around as if he has not really explained himself and needs to]

 I thought it might be nice to try to create a course about sexual differentiation, gender identity and its social implications, for whatever good that might do. You notice I didn’t say “teach a course.”  That’s because I don’t think it’s possible for me to teach you anything. You already know it all, or at least you think you do.

OBADIAH looks around the room at all the young faces, and remembers what it was like to be that young. He starts walking back down to the front of the classroom as he tells his story, and he will reach the front before the flashback begins.

But, when I was not much older than you–actually just a few years older, I was part of a group of medical students doing an elective in Santo Domingo. We got wind of a curious thing up in the mountain villages. In some of these villages--all the kids were given names which were gender neutral, the Spanish equivalent of "Pat" or "Chris." And we went up there, and the villagers explained that was because a lot of the kids had something they called "Guevedoces," which meant "penis at twelve." In these villages they did not assign gender until puberty, because until then, they just could not be sure.  So we got on the phone to our medical school, and this endocrine fellow named Juliane Imperato told us to collect bloods on the villagers, and on these Guevedoces kids, and thus was five alpha reductase deficiency was discovered. Later the disorder got a little press when the novel "Middlesex" was published.

So, when I got back to the medical school, Julianne is waiting for me and she tells me to go evaluate a patient on the  Metabolic Research CUT TO:

 

FLASHBACK. INT DAY

OBADIAH as a 24 year old medical student at the Metabolic Research Ward at The New York Hospital. He is standing in front of JULIANNE IMPERATO, a whippet of a woman in a white lab coat. Through the windows, rain is not exactly pounding, but it's coming down in sheets. As we get toward the end of the scene with Ariadne, thunder will sound, and a flash of lightning, appropriate pathetic fallacy.

 

JULIANNE  

There's a patient I want you to see. Ariadne Lanzo. 

OBADIAH

What's the story?

JULIANNE

She's seventeen. Never had period. She's 46 XY.  She needs an exam, but you know what she's got.

OBADIAH

T-fem?

JULIANNE

Looks like it. But she needs an exam.

                                 CUT TO: 

OBADIAH in an exam room with ARIADNE, and a NURSE. They have just finished a pelvic exam, and the stirrups are still up but ADRIANE, in her exam gown, has sat up, swung around and is facing OBADIAH. The NURSE is collecting the speculum and light attachment and remains for the discussion. As ARIADNE gets the news, the NURSE will touch her shoulder, consolingly. Through a window it can be seen to be raining in sheets, soft, distant rumble of thunder.

ARIADNE

What I really want to know is: Can I have a baby?

OBADIAH

You want to have a baby?

ARIADNE

With all my heart. But my boyfriend and me, we've been trying for a year.

OBADIAH

Well, the thing is, I can't feel a uterus.

ARIADNE (panicking)

You mean, there is no womb?

OBADIAH

Well, we might want a gynecologist to confirm this. But I cannot feel one. And I don't see a cervix.

 

 

ARIADNE (bursts into tears)

Then I am not a woman! And Victor thought all along the problem was him. He thought he was not a man, because we could not get pregnant. And it was me, all along. I am not a woman.

OBADIAH

You are very much a woman. 

ARIADNE (sobbing)

No womb. No woman.

OBADIAH

In a way, you are the most female of anyone on the planet.

ARIADNE (still weeping)

But you say I can never have a baby!

 

                                            CUT TO:

Back to the classroom. OBADIAH looks out over the students, who have been listening in more or less rapt attention. One may even be tearing up. The thunder from the flashback at New York Hospital is now felt, heard in the New Hampshire classroom, tying the two places together. But it is snow seen through the window, not rain.

OBADIAH

So,  this lovely, 17 year old woman who was desperate to have kids some day, but never would be able to have kids.  Here, this is her.

 

 

 

 

 

 

OBADIAH clicks his final slide

 

 

 

This is that woman. Her chromosomes are male--46 XY--so she's chromosomally male, but she cannot respond to male hormones--her receptors just don't work. Is she not a woman? If you prick her does she not bleed? But she'll never bleed a menstrual period.  We all think of things in life which are fixed and immutable. Things which are either/or.  And from the time you are a child, nothing is quite so black and white as male/ female.  Except, that really isn't true. I mean the Kudbadi fish, and clownfish, for Chrissake. They switch sexes all the time. Talk about gender fluidity! Nobody's got a thing on these creatures.  And, so now, all these years later,  I thought, well, I don’t know this current generation very well, but maybe some of them might be as fascinated by this as I was then, and still am.

[Reaction of some students is visibly more sympathetic now] 

But, no. Now, it’s all about causes and banners--and that girl on the ward, whose life plans just exploded, is just not important any more. Heaven forbid we think about the human beings involved. 

[OBADIAH sprints up the stairs and exits the room, leaving the audience in stunned silence, looking at each other trying to make sense of what they've just heard. The varsity softball girls look at each other and then after him mouthing, "Wow."]

 

                  

                                                                                                     CUT TO:

 

 

INT. DAY. OFFICE OF THE PRESIDENT OF THE UNIVERSITY, THE NEXT DAY

 

ABIGAIL CHANDLER, 50 something, athletic, with a face which looks chronically amused, a woman in her prime and she knows it, sits on a love seat in her office in a Fair Aisle cardigan, wool skirt, boiled wool clogs and crosses her legs like she means it, in the direction of OBADIAH, who sits across from her in a wooden university chair with the seal of the university burned into the back. Light is the bright winter light of a cloudless New Hampshire winter's day, reflecting off the snow into the office, giving it a glow.

 

                   OBADIAH

You set me up.

 

                   

ABIGAIL

Well, maybe a little.

 

                   OBADIAH

We agreed on twenty five.

 

                   ABIGAIL

We agreed. Apparently, they did not agree.

 

                   OBADIAH

You set me up.

 

                   ABIGAIL

You’ve really got to stop saying that.

 

                   OBADIAH

Well, it was a stupid idea to begin with.

 

                   ABIGAIL

No, it was a splendid idea.

 

                  

 OBADIAH

Okay, it was a stupid splendid idea which did not work out.

 

                  ABIGAIL

I’m not ready to apply the past tense. In fact, I just this morning had two students in my office saying they hoped you'd teach this class.

OBADIAH

The softball players?

ABIGAIL

How did you know?

OBADIAH

I noticed their T shirts.

ABIGAIL

They're a little young for you. And you never were much into jocks.

OBADIAH

They did fill those shirts out nicely. But no, it was what was printed on them. Have you ever seen women's varsity softball? Wonderful athletes.

ABIGAIL

Coming from you, high praise, considering.

OBADIAH

I could never have hit their pitching.

 

 

ABIGAIL

Now we are getting to false modesty, considering your record. Or I should say records.

OBADIAH

No, really. But this thing, this course: That death wish reasserting itself.

 

                    ABIGAIL

Oh, back to the death wish thing again.

 

                   OBADIAH

Madam President, of all the things a university president can do in this time and place, stirring the pot of gender identity has got to be the closest thing to brewing up nitroglycerin in the garage.

 

                   ABIGAIL

Oh, we've reached the "Madam President" stage? Jared told me he thought you could fill a lecture hall of a hundred and fifty, no problem.

 

                   OBADIAH

Jared?

 

                   ABIGAIL

Your native guide yesterday morning.

 

                   OBADIAH

Yeah, nice kid. What’s this? His first job after graduation?

 

                  ABIGAIL 

Something like that. [Drops her voice an octave, smiles] I like having him around.

 

                   OBADIAH

Now you really are playing with fire.

 

                   ABIGAIL

Being president of a university is possibly the worst job in America right now. It ought to come with some perks.

                   OBADIAH

And you are the best perk any red blooded male can imagine.

                  ABIGAIL

Well, thank you, politically incorrect as that may be. I might be a perk for a  heterosexual man. Here at the university, we do not presume sexual preference.

OBADIAH

Evidently.

 

 

ABIGAIL

So, how’d you like to entertain a hundred and fifty eager young minds twice a week?

 

                   OBADIAH

Seriously? No.

 

                   DIANA

But you were pretty excited about the thought of  twenty five young minds.

 

                   OBADIAH

That was before I met the actual young minds.

 

                   ABIGAIL

Oh, come now. Was it really all that traumatic?

 

                   OBADIAH

You know what was really traumatic? Walking past those “Diversity, Equity, Inclusion” banners.

 

                   ABIGAIL

What? Do we still have those up?

 

                   OBADIAH

Sure do. All over the campus.

 

                  ABIGAIL

I hardly see them anymore. Just background noise. So, you’re not a fan of diversity?

 

                   OBADIAH

I’m happy to look out at a classroom which looks like a Colors of Benetton ad, but I don’t think of diversity as a merit in an individual.

 

                   ABIGAIL

Well, we select individuals to be part of our group.

 

                   OBADIAH

Thus spake meritocracy.

 

                   ABIGAIL

Or, possibly, thus spake mediocrity.  We are the fourth whitest state in the union. Ninety percent white.  Diversity doesn’t come easy here. And what do our kids do when they go out into the rest of the country if their whole education has never included a single Black voice?

 

                   OBADIAH

You know, I talk to a New Hampshire Black on the phone, I can never tell he’s Black, unless it’s FACETIME. Do you know what that guy who interviewed me for this gig asked me?

 

                 ABIGAIL

I told you that was just a formality.

 

                   OBADIAH

And I believe you, now that I talked to him. He certainly would never hire me. He's on what? The university DEI committee or task force or star chamber?

He asked me what I was going to do to support Diversity, Equity and Inconclusiveness in the classroom and I said I was teaching biology and that had nothing to do with any of that. So I told him I did not intend to try to do anything to support or undermine such irrelevancy.

 

                 ABIGAIL

And yet, somehow, you got the job.

 

                   OBADIAH

Somehow, I think you may have had something to do with that.

 

                  ABIGAIL

I think you may just be right about that. I might like having you around.

                               OBADIAH (laughing)

Oh, you have always been insatiable. 

      ABIGAIL

I am old enough, finally, to not take things too seriously.

    OBADIAH

Exactly. And especially at university.

  ABIGAIL

Why especially here?

  OBADIAH

Oh, you know the old line: academic politics are so vicious precisely because there's so little at stake.

ABIGAIL

Oh, that one has become so very worn. And it might have amused, when an impotent man from the Harvard faculty could crow that now he was Secretary of State, he could look back down on his cloistered colleagues, and laugh at their insignificance, compared with his own. I mean, what is Cambridge compared to Washington, and the world? But what we've got here and now is no longer so small and self contained.

OBADIAH

Come now, Abigail. This is hardly Kent State.

ABIGAIL

True that. And that is hardly my ambition.

OBADIAH

And to what do you aspire? For yourself? For this college?

ABIGAIL

I'm in the process of figuring that out.

OBADIAH

But whatever it turns out to be, it goes beyond this campus, this monastery?

ABIGAIL

(For the first time, she is not smiling, at least not the way she was before)

There are some ideas, some truths, which have pandemic potential. Jefferson, Franklin, Madison did not arise from sterile  soil. They were reading Thomas Paine, Locke, Montesquieu. 

OBADIAH

And you really think those kids I saw yesterday, who would build barricades so they can fight for the use of the correct pronouns,  whose battlelines form outside gendered bathrooms, who would expel from their dorms anyone who thinks there are just two sexes and two genders, are broaching world changing ideas?

ABIGAIL

Universities are a witches' brew. Sure, there are kids who fasten on trivial things. But when you have the powers that be trying to suspend Habeas to deal with a fantasy invasion, when perception becomes reality and perception is MAGA weird, anyone lighting a candle in that darkness may become pivotal.

OBADIAH (Seeing her now for the first time)

My God, Abigail. 

 

ABIGAIL

What?

OBADIAH

Do you really think closing down campuses, street riots, marches on Washington stopped the war in Vietnam?

ABIGAIL

They all coalesced. They hastened it.

OBADIAH

The Tet offensive hastened it.  Body bags coming home draped in flags hastened it. TV cameras showing we had lost the war in the field made the difference. Walter Cronkite hastened. A million women in pink knit hats with ears did nothing. Group hugs do nothing. Power is defeated by power.

ABIGAIL

So what were you doing in that classroom, yesterday?

OBADIAH

I was trying to explain myself.

ABIGAIL

To whom?

OBADIAH stares at her, flummoxed.

Still trying to figure that out.

 

 

 

                  

Taking Death For A Test Drive

 

Just now got home from work, for the last time.

I carried a cardboard box filled with things which belonged to Cathy, my secretary/office manager out to her car in the parking lot and she said, "I thought I was going to be sad. But, somehow, I'm not." She looked at me for a moment and said, "I won't miss that mob back there, not for a second." 

The corporation we had worked for over the prior 11 years had gone bankrupt, and the new company which acquired us almost immediately alienated us, but most of all, that mob was clearly incompetent, and Cathy and I had looked at each other as one might look at an airplane pilot reeking of alcohol, who staggers toward the cockpit. 

"Uh-oh," this cannot end well, we said. 

When I resigned from our clinic 90 days ago, I did so only after I checked with her.  I would not have resigned if she wanted to stay on. But she told me she was turning 70 in April and she planned to retire, so that gave me my free pass.

Medical School Class 

Today, she went to talk to the administrator, who had suggested that even after I left the clinic, they "might have something" for her, i.e., a job in another doctor's office but when she stepped in the office, the administrator handed her severance package all prepared for her. She was a little shocked, but not really. She can get unemployment and some other benefits, so she is not exactly bereft. 

Cathy is the person you would dream up if you wanted the perfect health care worker: No patient's request was ever dismissed, delayed or ignored. She would hound me, advocating for even the most uncooperative, desultory patient, making sure prescriptions, lab request forms, letters to employers got done.  Every day was filled with patients at the end of the day who Cathy felt needed "squeeze in" appointments. Patients always had grievances about the medical system, billing, prescriptions not filled correctly, but nobody ever had a complaint about Cathy.  Every patient, doctor, co worker who ever dealt with her loved her and told me so.

Housestaff: Residents and Interns and Faculty

When I arrived home, I thought, well maybe I should be sad. And I did feel that empty feeling I felt after exam week in college, when I had studied constantly, completed long to do lists for each course and then walked out of the door of the last exam and realized I now had absolutely nothing to do. The idea of free, unscheduled time was hard to fathom.

And now, tomorrow I will wake up and not have to leap out of bed and get my day going in order to get to work. 

I have been told by my Merrill Lynch gurus that there is no reason, financially, for me to work. They claim I can live to be 100 and not hurt for money. They may even be correct.

When I resigned my job, I knew that there was not another endocrinologist from York, Maine to Portsmouth, New Hampshire all the way up to Hampton. I could open an office anywhere along the Seacoast and have a busy practice within a month.  

But, after 27 years of signing leases, responding to the various crises of running a small business, Xerox machines breaking down, staffing problems, hikes in malpractice insurance, I was thrilled to leave all that behind and get a W-2 form and become an employee.

The problem with being an employee though, is you need a willing boss who wants to hire and maintain you--and the only bosses hiring doctors in Seacoast New Hampshire to the upper reaches of the Merrimack Valley are big corporations, and they are not hiring, at least not now. Recession is coming. Mass General/Partners is laying people off.

So, I am, somewhat unexpectedly, retired.

When I stepped into my house and put down my briefcase, I realized this journey had been 52 years. I started my career, with my freshly minted MD in 1973, age 26. And now it is over. Over that time, I had never been out of work. There had been a month off between jobs, or that slow period when I first hung up my shingle and started private solo practice in Washington, D.C., coming from a medical school in New York City and with no network of friends and colleagues acquired in medical school. 

Who Was That Guy? After a Night on Call

But I had never stopped being a doctor. I never started a company, never shifted over to hospital administration.

I did get one offer from the CEO of a hospital in Washington, who told me, "Nobody is going to be able to survive just seeing patients in the office for much longer. Come work with us at the hospital."

I hung up the phone and looked out the window of my office, and the faces of faculty members from years before, at Cornell, flashed before my eyes. Give up medicine! It was like leaving the priesthood. Worse than that. I developed acute angina, my left wrist tingling and spasming--what I took to be coronary artery spasm, which took a moment to resolve.

Over the years, we'd heard of some doctor or another who had "gone Hollywood," i.e., who had given up treating patients and gone to work for a drug company or who had left medicine altogether to start a software company, some spin off of medical practice, developing an electronic medical record or something like that, parlaying an MD into an MBS related career and we always smirked a little. Gave up medicine. Chased after the almighty dollar. How embarrassing.

But now, younger doctors who have enormous student loans, earn back that investment and build up a nest egg and get out of medicine as soon as they can. They shift jobs every two years, looking for salary increases. And they leave medicine. Women, especially, leave medicine, for motherhood, or for jobs which are less demanding in time and energy.

And, truth be told, in some ways, I've mentally checked out of medical practice over the past few years, in some ways. I've been practicing in an underserved area, where patients have little education, a load of financial and personal problems, are non compliant--they don't go for their tests, don't take their medications, don't keep their follow up appointments and don't go to the consultants I've recommended. And so, not having changed what they are doing, they do not achieve improved results for their diabetes or high cholesterol or thyroid disease.

And the things they say! I've learned from my patients that vaccines are a vast government conspiracy, that vitamins cure cancer and that lowering cholesterol causes more problems than its worth.

But, I've never, not even for a moment, been anything other than grateful to have had the chance to become a doctor, to have been trained at the New York Hospital, where we all believed we were in the best medical center in the world, and were very lucky to be a part of it.  The Marines had nothing on us for group pride, and a sense of purpose.

One of the professors at Cornell was named Aaron Feder. He made rounds in the early morning at the hospital and again after seeing patients all day in his office, he'd come back to do his evening rounds.  I heard he was found dead in a hospital stairwell at age 63. He never took an elevator. Everyone smiled when they heard how he had died. "That's Aaron Feder," they said. "Died with his boots on. Died as he lived. That's how a real doctor dies."

A Dressing Down

 It’s not just at restaurants that the dress code has become more relaxed; it’s pretty much everywhere. People don’t dress up for the theater, the opera, work or travel. Sometimes airports look more like giant sleepover parties than transportation hubs. And it’s been that way for some time.

This lack of formality, or interest in occasion wear, has prompted some complaining, especially among those in the baby boomer generation who see it as an erosion of public standards. I think that the right way to look at it, however, is as an expression of a much larger and more significant social and cultural shift. One that has been taking place over decades and essentially says that we all have a right to dress as we want. It’s a shift that reflects the prioritization of the individual over the institution.

--Vanessa Friedman, The New York Times

One way to know you are getting really old is when you start looking at the younger generation and you  find yourself shaking your head and saying, "What twits!"

Waitresses, who are otherwise polite and engaging but festooned with nose piercings, so at first glance they look like something really nasty is dripping out of their nostrils. Nurses whose arms uncovered by their short sleeved scrubs, covered with tatoos. 

People at airports looking like they are planning for a sleep over with their adolescent daughters.

What's Wrong With A Little Formality?

Men at expensive, fancy restaurants, where the waiters dress in tuxedos, but as customers they look like they are Mark Zuckerberg wannabes, with just a knit shirt, a hoodie or, at best, a collared shirt but no jacket or tie. Used to be if you tried to get into a fancy restaurant without a jacket, the restaurant provided you with one.

Which is not to say, dressing down is always a bad thing. In 1975, a woman invited me to see Baryshnikov at Lincoln Center, and never having seen a ballet, but knowing it was Lincoln Center, I wore a summer suit and a tie.

She wore nearly nothing: sheer white, form fitting slacks  and a diaphanous robin's egg blue shirt. No jewelry beyond simple earrings. She was 22 years old and the forty something women, who were dressed in evening dresses, jewelry and some with tiaras, looked at her with frank envy: She had a 22 year old body, and she outshone everyone in the place except for the ballet dancers, and she could have passed for one of those on a bus man's holiday. 

I felt uncool and ungainly, and I realized I had seen her boyfriend wearing a simple Brooks Brothers shirt and slacks when I had seen them together. They were cool and avant garde in their simplicity.

I was out of it.

But today, I find myself still cleaving to jacket and tie. I'll never be cool, that's a given. But it's me.

Learning from the English National Health Service

 

One of my fantasies about how I might send my post retirement days, once I can no longer work in the clinic seeing patients, is a job working for someone, maybe the Department of Health and Human Services (if it were run by someone other than RFKJR) or some foundation, doing a survey of how other countries do healthcare, because, Heaven Knows, the United States healthcare system could use some help.

Canadian discoverers of insulin

Whenever I get off the boat in some European (especially Scandinavian) country, I head right to the nearest clinic to look around at what they are doing. My wife is off looking at some cathedral, and I'm spooking around a clinic, until the security guys throw me out. I do look suspicious.

One of the first things you notice entering any clinic in Europe is there is no secretary sitting behind a computer ready to grab your insurance card, or throw you out. There is usually just a nurse, ready to take you back to an examining room.

I spent 2 months in England when I was a fourth year medical student on an elective in cardiology at The Royal Brompton Hospital for chest diseases, seeing how they did cardiology in England. The hospital itself looked pretty modest, red brick, six bed wards, but fifty years ago they were doing cardiac catheterization through the brachial artery in the arm, and it wasn't until just 10 years ago we started using that technique in any widespread matter here in the USA where we have the world's best medical care, or so we are told. Using a smaller artery is safer, as you don't put the entire lower extremity (foot, leg) at risk and there is an arcade anatomy in the hand which allows for greater safety.

On weekends, one of the local doctors who made rounds at the Brompton invited me and a couple of other American students out to a smaller hospital in Uxbridge, where we were dumbfounded about how medicine was practiced.

The most dreaded admission for an American intern in those days was the "GI bleeder." This was before the advent of proton pump inhibitors reduced the incidence of gastric and peptic ulcers to near nothing, but in those days the GI bleeder was very common. If you were the intern, you spent all night running up and down to the blood bank getting units of packed red blood cells and after you had transfused the patient with 15 units, if the patient was still bleeding, you called the surgeons to haul him off and cut out part of his stomach or duodenum. 

In England, they transfused 2 units and put the patient to bed and then they came around on rounds the next morning to see if he was still alive. 

We Americans were pretty horrified.

But, the thing is, the patients usually were still alive. They bled down to a certain level, and their blood pressures dropped and they stopped bleeding. 

At least that's the way I remember it.

The other thing I remember is talking with patients who were admitted to hospital and asking when they expected to see their own private physicians make rounds on them. The patients were stupefied. "Why would Dr. Jones see me in hospital?" they asked. In America, you expected your own doctor to see you in hospital, to get you past the worst experience of your life, in person. Not in England. In England, the patient was taken care of in hospital by the hospital doctors and once they were home, the general practitioner got a full report.

Forty years later, that is what we do in America--hospitalists now care for patients in the hospital, just the way they did forty years ago in England. The hospitalists are there 24/7 and take way better care of patients than a GP trying to see patients in his office and then, after office hours, driving some distance to try to figure out what was going on with the patient who got admitted to the hospital, issuing orders over the phone for a patient he had not seen since the day before, if at all.

Sometimes, I think what we are doing in American medicine now is catching up to where England was 40 years ago.

England is where the CAT scan and MRI originated, after all. That much disparaged "socialized medical system" has been responsible for as much or more innovation than our much ballyhooed free enterprise, for profit American system.

Canadians discovered insulin. The English did all the big innovations in diagnostic imaging.

But America, we have always heard, is the pinnacle of medicine. At least, we are the pinnacle of bragging about our medicine.

So, my fantasy is to be sent over to England, Scandinavia, Germany, France and to be allowed to spook around those clinics and hospitals, to make rounds with the doctors, to hear the complaints from the nurses and the patients and the doctors--and surely those systems are well known to be underfunded and beset with problems, but we can also learn from them, I suspect because they have learned to innovate owing to cost constraints and they made decisions not based on considerations of profit, but because they have been looking for greater efficiencies in a cold eyed way.

Even if I were part of a team sent by who knows who, what are the chances anything we discovered about better practices would ever stand a fighting chance of changing things back her in the US of A, where we think nobody has anything to teach us?

But dreaming costs me nothing. 

We can always dream

What Should College Be?

 Reading the New York Times in New Hampshire is always something of a magic carpet ride. But this piece on how careerism is ruining the college experience threw the Phantom for a loop.

The author, a young woman, now in law school, described her disappointment to learn that college was not about good times and bull sessions, but about competition and hard work.

"When I pictured myself in college, I envisioned potluck picnics and late nights listening to Taylor Swift, overanalyzing class crushes. Maybe even joining a Quidditch team.

I never daydreamed about hiding in the library bathroom crying because I had just been rejected by an undergraduate law journal."

Sophia Macy

A few years ago Sophia Macy, the 18 year old daughter of movie stars, was caught up in a cheating scandal, when her mother was found to have paid to have her SAT scores altered and she remarked that she never studied for her SAT's or, for that matter, much at all, and what she really thought going to USC was about was going to football games and sorority parties. That of course reinforced the idea of fecklessness.

Isabella Glassman

Now we have this twenty something, Isabella Glassman, complaining about competitiveness in college.

Everyone wants to work for Goldman, Saks or McKinsey or go to Yale Law, Glassman laments.

Quel dommage!

315,126 applicants vied for 2,700 positions at Goldman Saks in 2023!

Undergraduates at the University of Pennsylvania cut each other's throats trying to get into the Wharton School of Business. 

People study long hours and stress out about failing.

Of course, what undergraduates are now competing for is not so much places in medical schools--as medicine is no longer a ticket to avoid the military or even to the upper class, but simply a sort of trade school, where, if you are interested in money, you have to compete for places among the radiologists, opthalmologists, anesthesiologists or dermatologists (the ROAD to happiness.) Or surgeons.  Outside the ROAD, most doctors are making salaries just below or just barely into 6 figures. 

No, undergraduates have become too sophisticated to want to be doctors or engineers--they know the big dollars are in finance, venture capital and all that jazz.  So let the games begin!

Of course, in the 1960's, when Ivy League schools began admitting students of modest financial means, a sizable proportion of these strivers wanted to go to medical school, or to become engineers. The only people more miserable at college than premeds were the engineers, the wags said.

These students took difficult courses and competed to be higher up on the grading curve with a bunch of equally determined and motivated kids.  

Nobody thought about potlucks, football games or Quidditch teams, well nobody who came to college to get ahead thought about any of that. 

Of course, there were still those who majored in French literature or Medieval History, who did not seem to worry much about launching into a job, much less a career after college. They somehow thought life would take care of them as it always had.

But then the Vietnam War blew up, and just about every male on campus suddenly got interested in what lay beyond graduation day, because getting drafted was more likely than not, and every biology, chemistry and physics major suddenly discovered that medical school looked like a very good idea. Medical School was an automatic deferment between 1967 and 1974, and law school could sometimes be finessed into the judge advocate general corps, which was not a bad way to become a veteran without getting shot at.

After the draft ended, maybe things got back to hedonism and fecklessness on campus, but if Ms. Glassman is any guide, kids paying big tuitions may have decided a return on investment is in order, and Goldman Saks looks good.

But, if you are female, not worried about the draft, come from money, you can drift through college, party hard, and if you are still unmarried at graduation, go off to the Sorbonne or the London School of Economics and maybe picnic in Hyde Park, and drift along and maybe get a job in publishing or an art gallery or something toney, and why should college be hard work, or stressful or challenging?

College once upon a time was not about fun but about survival, competing and moving on to the next stage.

Pre meds, engineers and even some pre law students are now "careerists," and much gnashing of teeth happens over the loss of liberal education, the demise of departments of English, art history, Egyptology, philosophy, sociology, history and classics. 

When F. Scott Fitzgerald went off to Princeton, there were no SAT exams and the idea of meritocracy was that your father had gone to Princeton or your family was exceedingly rich.

Now it is all about grubby competition.

After all, if college is not a safe space, where does a girl find a safe space?

Real Life

As Thomas Hobbes noted, if you read Hobbes in college, life can be a drag:  "No arts; no letters; no society; and which is worst of all, continual fear, and danger of violent death; and the life of man, solitary, poor, nasty, brutish, and short."