Another in a long line of PCIntern reminiscences:
You know at one time I was actually thinking of writing a book, but since nobody reads books anymore, I decided not to waste my time. The last thing I want to see before I leave this Earth is my name as an author on remainder shelves in pop-up bookstores.
When I established my practice in 1980, I moved into a very large building in Center City, Philadelphia, which primarily had dentists. In fact, in the 15 floors of this building were about 120 dentists of all specialties as well as those in general practice , and if it seems like a large number, you must know that many of the doctors were sublets, postdoctoral students who were permitted to practice a day or two a week, and semi-retired dentists, who showed up when one of their patients gave them a call. It was a whole different era in healthcare, believe me… you younger people would not believe what was going on and not going on in those days.
Since I inhabited that building for over 40 years, I came to know nearly everybody both docs and long-time staff in one way or another and I will tell you that this is why nothing which happens in the corridors of power with respect to influence, sex, money, blackmail, surprises me… for one instant. To begin with, there were a number of self-described “aristocratic” very well known dental practices which catered to the elite of what we call the Delaware Valley: Philadelphia and the five surrounding counties, which included the Main Line. In addition, people used to come from all over the East Coast to have their reconstructive work done in some of these offices because a few of these dentists were internationally famous within the field, such as Cary Grant who took the train biweekly from Manhattan.
Now the word “famous“ is of course relative, but I will tell you frankly that these people thought they were elite and very very special, very narcissistic. One fellow actually compared himself to Pasteur. They commanded enormous amounts of power within the profession and God forbid you ever get on any of their nerves personally or professionally because you would hear about it immediately and they held grudges forever.
Now in the metropolitan areas there is or was an established standard of care which essentially required us as general dentists to refer to specialists for root canal therapy, for orthodontics, and for any reasonably complex oral surgery, other than routine extractions of teeth. The pathways of referrals were often ironclad, and it piqued my interest as a young practitioner that if say a certain periodontist referred to patient to me for restorative work, I was only “allowed“ to refer this patient to a certain endodontist if they required root canal therapy. So okay, I followed the rules with one raised eyebrow.
So one day, I run into an endodontist with whom I dealt very infrequently and he was wearing a plain white Arrow shirt and he asked me if I had seen so-and-so this Periodontist, who was one of these fellows who stipulated referral to this particular doc to whom I was speaking. . I replied no, and when I looked at his shirt pocket I could see that there was a check folded in half and I could read the doctor’s last name, this Periodontist about whom he had asked, and an amount and understand, this was 1984 or so, and amount was for a little over $13,000. I realized that that moment that this was the fee splitting payoff which is illegal in medicine and dentistry at least in Pennsylvania. Suddenly, things started to make sense with respect to referral patterns. .
The second thing which was fascinating, was that when I opened my office, a dentist came to visit me, whom I did not know, introduced himself to welcome me to the building, all very nice, and he started asking me some questions about school and where I was from and the like, and then he asked me if I was married or not, and I said no, but I at that time had a long-term girlfriend with whom I was essentially living. And the conversation went on from there and ended very genteely and politely, and that was it. Or so I thought.
So as I’m getting to know people in the building, I realize that many of them, male and female, are leading second lives of a personal nature. I would say that perhaps 40% of the dentist in the building who were long-term people there were gay or lesbian and not out of the closet. Virtually all of them had families living in the suburbs, but believe me when I tell you, I was able to observe behaviors and companionships among many which would be atypical of a standard issue heterosexual American family. I realize that this gentleman who came to see me to say hello was in fact sent to see if I was a member of their club which was very extensive and self-protective which of course they had to be in those days. Interestingly, as an aside, as time went by, several of these individuals came out to their families, divorced, and led lives in retirement away from Philadelphia and the vast number I never heard from or about again.
Of course, I didn’t care what people did in their spare time and I became one of the grand old men of the building as time went by and one of the few people who knew the history of the goings on within. It was like a giant dysfunctional family, and the vast number of us got along famously because we were all in the “club”. I never once said a word to anyone about anyone’s business outside because in the first place, I had been entrusted with a certain amount of confidential knowledge and secondly, I did not want to open Pandora’s box and be a lightning rod for the sequelae.
Now to the point of this post: of course I like telling stories as I am a natural raconteur, but that it it’s important, no, critical, to understand that in every situation, no matter how innocuous and benign it might be, such as “a whole bunch o’ dentists” there exists a complex network of financial and sexual politics that can at any moment easily destroy an individual or a group of people. When I read the emails coming out of Epstein‘s life, I think to myself that the incredible complexity of managing all of these people who were truly powerful, truly famous, truly manipulative, and vindictive, was remarkable almost beyond comprehension. It is clearly the pinnacle of the narratives which portray megalomania, sexual insanity, and the worst of human behaviors. The fact that it is encompassing so many individuals from so many different spheres is a testimony to how flawed we are as a species, and we better get our act together soon.
And I didn’t even start getting into the stories about professional and personal blackmail…. Too many of the victims whom I knew are still with us today.
Tough world in which we live.
= new reply since forum marked as read
Nice analogy and observation. 
