An Exciting New Career in Medicine

A woman takes a hands-on approach to healing

Once on the N-Judah train. Twice on BART. Three times in a stranger's car traveling toward Los Altos, where rows of dead houses are waiting. Fifteen times in the living room of her small flat in the Richmond, with friends and casual acquaintances who have agreed to help. And each time she repeats a mantra she learned from her piano teacher 20 years ago: Practice is the key to success.

Really, it is not unlike any other task requiring manual dexterity. She is studying to get her license. The study is self-directed, but the licenses are 100 percent official and distributed by the health department. Prescription drugs are expensive these days, the Canadian border has been closed, progressive health departments are rapidly moving toward a concept of nurture over narcotics. The medically administered hand job has become a common treatment for a number of nonterminal illnesses:

• Heart arrhythmia

• Asthma

• Tendonitis

• Premature male-pattern baldness

• Back pain

• Nearsightedness

• Farsightedness

• Depression

• Full or partial paralysis

• Hypertension

Surprisingly, the most obvious ailments are never treated in this manner. Men with sexual malfunction, testicular cancer, herpes and urinary-tract infections are forced to go the traditional route. In a new crop of informative medical journals geared sympathetically toward the layperson, hand jobs are referred to as a "through the back door" method. Heal the cock, and the heart/mind/knee/spine will follow.

Pulling earnestly on the fleshy stub of one arthritic Mr. Delfoy, the wheels of the 22-Filmore going round-round-round like a song she remembers from kindergarten, she notices that Mr. Delfoy's fingers are gripping his briefcase with strength and agility. Is he really even arthritic? she wonders as the 22-Filmore comes to a halt in front of a rowdy schoolyard. Mr. Delfoy answered her ad in the paper calling for courteous, professional, middle-aged males to help her study for her exam. She met him at the agreed-upon time at the bus stop at Steiner and Broadway. They exchanged polite introductions, then boarded the bus together. Now that it is a medically accepted practice, no more or less controversial than doctor-prescribed marijuana, one often sees people engaging quietly in the treatment in public places, although some degree of discretion is expected. This time, for example, the patient laid his jacket over his lap before she commenced with the procedure. Mr. Delfoy lets go of the case; she lets go of him and wipes her hand on a napkin. The entire transaction, from initial meeting to completion, has taken less than 10 minutes.

She recognizes, of course, that the system harbors great potential for abuse.

Not long ago she worked as a copywriter for a small PR firm. Her career change was precipitated by a tragic event.

In Los Altos last month, wildfires swept in during a dry spell. Multimillion-dollar homes in the hills burning. Her own sister trapped up there, just 16 and probably painting her toenails or doing homework when she saw the flames approaching. Unlike the other 12 victims, her sister didn't die of smoke inhalation. With the first floor of the house already ablaze, she jumped out the third-floor window just moments before the fire truck arrived. "She would have made it," one fireman said, shaking his head, toeing the ground with a sneaker. He said this at a public barbecue in the park, a charity event for the victims. "We were so close." He pulled a thin slice of pickle off his burger and dropped it on the ground.

Her sister did not break a single bone, but she hit her head on the garden's decorative brick border. The hardy geraniums survived.

Even as her sister was being carried away on a stretcher, the hoses were uncoiled, the mighty house was saved. Inside the house on the second floor were two live cats, one live dog, a school of exotic saltwater fish making their rounds in the giant aquarium. Outside, there was one dead sister. It was so like her to go gracefully--nothing broken, nothing bruised, not even a cut on the skull. But inside her head, where mathematics had beautifully ruled, where equations and logarithms filled the intricate mazes, inside that lovely head the shoe-in for valedictorian, the good daughter, the baby sister, bled and bled and bled.

The licensing exam is in three parts: written, oral and manual. The written is mostly multiple choice with a couple of short-answer questions thrown in to weed out the blatantly stupid.

Oral is the bedside-manner portion of the exam, and it is strictly hands-off. The student sits face-to-face with a test subject who reads from a script. A panel of examiners watches from behind two-way glass. The test subject says things like "I have been experiencing sharp, shooting pains in my right calf" or "My doctor prescribed this treatment for migraines." The examinee then explains to the test subject what she is going to do and how it is going to help him. Every now and then the test subject will throw in a question or comment fraught with emotional land mines. This is where about 20 percent of potential licensees fail the examination. For example, the test subject might say, "I want you to take off your shirt," or "If you fuck me, no one will know." A skilled practitioner of the art will dismiss these comments in a polite but professional manner. A weaker examinee will become angry or flustered or, worse, flirtatious.

During the wake, a man she had never seen before walked up to the casket. This man put his hands on her dead sister's face, and he stood there for a long time and cried. After a while the family members became uncomfortable. She was delegated the task of removing the weeping stranger from the casket. She went up and stood beside him. His hands on her sister's face were very small. He was wearing a wedding ring.

"Excuse me," she said. He looked up. His eyes were red, his short black beard streaked with tears. "We haven't met," she said, feeling ridiculous. "She was my sister."

"Oh," he said. "Your sister took a summer course in astronomy I taught at the university." He glanced around at the crowd of mourners waiting for their turn at the casket. "She didn't mention me, did she?"

For a moment she deliberated. She looked at his small hands, his short beard, the hopefulness in his eyes. "As a matter of fact, she did. She said you were a very good teacher."

"Thank you," the man said, wiping his eyes with the back of his sleeve. Then he went away.

An interesting fact: While the ranks of general-practitioner nurses remain primarily female, the new specialty in manual manipulation attracts mainly males. She learned this on CNN, in a heated debate between a well-known Democratic senator, who supports medicinal hand jobs, and the president of the American Families Action Committee. The latter said, "God will strike America down like Sodom and Gomorrah if this is allowed to continue!" It was later revealed that the president of the AFAC and his entire senior staff had been receiving treatments at a less than reputable clinic in Montgomery, Alabama for going on two years.

Another interesting fact: The test subjects used in the examinations are never, ever average. They are either devastatingly sexy or monstrously ugly, the intention being to detect and discard two unworthy segments of the applicant pool: those of questionable morals and those lacking in compassion. She hopes she will get an ugly test subject. In this world, she is susceptible to two things: captive elephants and good-looking men. She has been known to make self-destructive sacrifices for members of both species. Her last boyfriend, for example, was six-foot-four and worked part-time as a hand model. It was for him that she moved into an Airstream trailer in Pacifica, for him that she cut her hair short and took up vegetarianism.

The last time she saw her sister was at the Albertsons on California Street. They ran into each other at the checkout. Her sister had been busy with high school, she had been busy with her job at the PR firm, they had not seen each other in almost a month. They had always liked each other but had never been very close because there were 15 years between them.

(continued on page 145)Medicine(continued from page 62)

"What are you doing in the city?" she asked.

"Just errands," her sister said, blatantly evading the question. Errands? In the city? So many miles from Los Altos? Her sister's shopping cart was stocked with small, expensive items, as if she were planning a gourmet meal. She placed a couple of rib-eye steaks on the conveyor belt, a small bag of fresh basil, some shiitake mushrooms. "Mom wants you to come over for dinner soon."

"I know. I've been busy."

"Next Saturday?" her sister asked.

"Next Saturday, I promise."

"There's someone I want you to meet."

The thing she remembers most vividly from that encounter is that her sister was wearing a pair of red brocade house slippers. Her sister, who was five-foot-two and had preferred heels since she was 12 years old, was shopping in public in house slippers. And she looked radiant, as if she'd just returned from an exotic vacation or received some very good news.

Three days later her sister was dead. Only after the funeral did it occur to her that the person her sister wanted her to meet might have been the astronomy professor and that the Albertsons on California Street was just a few blocks from the campus where he taught.

Ever since her sister died, she has felt a profound sense of disconnection--from her family, her work, the entire world. A few days after the funeral, she gave her two weeks' notice at the PR firm. "Why?" her boss said. He was wearing a Post-it with a cartoon drawing of a Neanderthal man on his forehead, trying to make her laugh. Everyone in the office was trying to make her laugh.

"I need to find work that is more personally fulfilling," she said. She had rehearsed this line a number of times. Her boss came forward and hugged her.

"Tell me if there's anything I can do," he said. She could feel his steamy breath on her neck. The Post-it bristled against her hair. For years the boss had tried unsuccessfully to hide his crush on her. Later he would be one of the friends whom she called upon to help her prepare for the exam. She practiced on him three times: once on BART, once in his car, once in his light-filled loft in Potrero Hill. That was the time they ended up going to bed together. Afterward he stroked her back and said, "Now that we're together, I can't let you pursue this career path."

"What?"

"I don't feel comfortable about you getting so intimate with other men."

"We're not together," she said. She got up and dressed, found her purse, her cell phone, her keys.

Naked, he followed her around the apartment. "Don't leave," he said. He tried the Post-it trick again. She hasn't seem him since.

She is not the kind of person to make career decisions without thoroughly thinking them through. She did not quit her job at the PR firm without first considering the consequences. These factors drove her decision:

• Manual manipulation is a booming and lucrative industry.

• The hours are flexible.

• She is not and never has been squeamish about bodily fluids.

• The male sexual organ is an organ like any other, in most instances, not something to be feared or reviled. Erections and the male orgasm are mere reflexes, somewhat on par with knee jerks and sneezing.

• She cannot remember the last time she did something even remotely selfless for another human being. She cannot remember the last time she touched another person in a way that felt truly intimate.

The portion of the exam about which she is most nervous is the manual. This is where 57 percent of applicants flunk out. After a failure, one cannot sit for the exam again until 13 months have passed. It is unclear where this time frame originated, but she suspects it is meant to weed out dilettantes. Thirteen months is plenty of time to find a new career path or to begin dating someone who doesn't approve, someone who puts his or her foot down.

She plans to pass the first time. At this point in her life there is no other career path, no potential love waiting in the wings. The boss is not on her radar. All of her exes have swiftly and cruelly moved on. She realizes from past breakups that she is an easy person with whom to sever ties. She is 31. Her last boyfriend married a software executive and is living in a $2 million bungalow in Palo Alto. Recently on the phone the ex said to her, "I am flush with love and cash," and there was no hint of self-deprecation in his voice. The software executive is expecting.

"Expecting what?" she said when the ex told her the news.

"You know," he said, sighing the exasperated sigh that characterized most of their exchanges during the last four years of their relationship. "Expecting."

"But you said you never wanted children," she reminded him. "You said children have nothing to offer. You said they would cause undue wear on your hands. The diapers, remember? The preparation of nutritious meals. The assembling of swing sets."

To which he replied, "You always were so negative."

The week after the funeral she received a call from the astronomy professor. He was weeping into his cell phone. "I have to see you," he said. "I need to talk to someone."

They met at the diner by Lake Merced. It was a cool day. College students were rowing through the fog on the lake. The afternoon special was chicken salad on rye served with a side of hash browns. She had the special, he had coffee, he confessed he had been deeply in love with her sister.

"My sister was only 16," she said. "You're a married man."

His eyes were so small, his hands so small, his beard so short and bristly, she wondered what her beautiful sister could possibly have seen in him.

"Did you know her dream was to map the distance between Earth and the nearest sentient life-forms outside our solar system? Yes, she was 16, but she was working on a mathematical formula that could quite possibly have changed the way humans view our place in the universe."

She looked at her hash browns and shook her head dumbly. "No, I didn't know."

"What I'm saying is, to you she was a 16-year-old girl. To me she was a great scientist in the making."

And a lover, she wanted to add. And you're married. But she didn't say it. It occurred to her that her sister may have tapped into something enormous and inspired, a kind of love she herself had never experienced.

Although a number of schools have opened to serve the vast number of hopefuls flocking to the new profession, formal training is not required to sit for the exam. Nonetheless, she briefly considered enrolling in a local certificate program in order to validate the respectability of her chosen path, but when she looked into it, she discovered the costs would be prohibitive. Three thousand dollars a semester, and that didn't even include the lubricant.

Anyway, what she knows about hand jobs could fill a textbook. She gave her first at 14, to a banker's son named John Zephyr, in the living room of her friend Ramona's house during a party at which no adults were present. Everyone had been drinking Seagram's and Seven, and John Zephyr was passed out on the sofa. Someone sent her to wake him up; it was long past his curfew. She tried slapping his face, pulling his hair, talking loudly into his ear, but he just kept on snoring.

Then she saw that his pants were unzipped, a fact that was not entirely surprising given the haze of marijuana and alcohol that wafted through the house. She opened the fly of his boxers and gently took him in her hands. She had not planned on doing it; it just happened that way. Soon he was awake and proclaiming his undying love. She was surprised by the pleasant stiffness in her hands and the way this boy, who had paid no attention to her before, succumbed entirely to her control.

After that, she was very popular at parties.

When she tells the ex about her new direction, he says, "You always were good at that." He has a way of turning every compliment into a stinging insult, just by his tone of voice.

Sometimes she lies awake late into the night, thinking of her sister. The image is always the same: her sister stepping up on the windowsill, looking back one last time at her bedroom. The woods around her blaze with firelight. In her brilliant mind she calculates the distance from windowsill to ground. She considers the probabilities of her survival. The ground beneath her window is soft, the first floor of her house is burning, it (continued on page 149)Medicine(continued from page 146) takes only a few seconds to die of smoke inhalation. For some reason she does not factor in the brand-new brick border framing the geraniums.

When people ask why a nice copywriter like herself is making such a dramatic career shift, she mentions the good pay, the flexible hours, the geographic mobility. She does not mention that she has always been at ease when giving a hand job. She never admits that she finds it comforting, the feel of her palm against giving flesh, the way she can control a man's face and his emotions with a simple shift in speed or rhythm. She doesn't say that she enjoys the moment of intense tightening just before he lets go and then the quick, hot stream of semen. She never mentions these things because she fears that perhaps she is a little strange to find peace and wholeness in such a simple, primal act.

And she tells no one what goes through her mind while she is working on her practice subjects. Occasionally she tries to concentrate on rhythm and technique, speed and accuracy. More often, though, her mind wanders, and she finds herself thinking about everything except the job at hand:

• Will she see her ex, the software engineer and their new baby on the street? If so, what will she say?

• If, on that day at Albertsons, she had known she was seeing her sister for the last time, what would she have said?

• Did her sister believe in an afterlife? Does she herself believe in an afterlife? If there is an afterlife, will she one day in the distant future be able to locate her sister there?

• How do her parents manage to pass the endless days in that enormous, immaculate house in the Los Altos hills, and does her mother still tend the geraniums?

The day of the exam arrives. She goes to a nondescript building on Polk Street, rides the elevator to the 12th floor and joins 37 other hopefuls for the written exam. She uses a number-two pencil and finishes half an hour early, certain that she has aced it.

The oral exam is more difficult. Her test subject is extremely attractive. She resorts to an old technique she has of slightly crossing her eyes in order to blur her vision. This way she does not have to look at his beautiful green eyes, his perfect face. He reads from his script in a convincing way. When he says, "I'm so ashamed to be here," she says, "There is nothing to be ashamed of. This procedure is a medically sound method of relieving upper-back pain." A few minutes later, following the script, he says, "You fucking whore," to which she replies, "Please refrain from making comments that may interfere with the treatment." As she is leaving the room she can hear murmurs behind the two-way glass. She spends half an hour in the waiting room, flipping through Popular Mechanics.

Finally the administrative assistant calls her name and says, "Please proceed to room 1237 for the manual portion of your exam."

She finds her test subject in a large room containing nothing but two hard-backed chairs. The room is painted white. To her great relief the test subject is a fat man in his mid-50s with a receding hairline, complaining of excruciating leg cramps. She takes a pair of disposable surgical gloves from a box by her chair and gets to work. It takes only three minutes and 27 seconds.

The next day she receives her final results by phone. A sleepy voice of indeterminate sex says, "We are calling to inform you that you have passed all three segments of the Manual Medical Caregiver examination. You were in the top third percentile of your exam group. Congratulations, this is the beginning of an exciting new career in medicine."

A few weeks after she passes the exam, her mother calls and says, "You never came to dinner."

Meaning, of course, that she is a lousy daughter, that she quite possibly caused the fire, that it should have been she who died instead of her younger sister.

Her mother says, "Your father wants to talk to you."

Her father comes on the line. "Who is this?"

"It's me."

"Oh, hello. I heard through the grapevine that you've become one of those whatchamacallits."

"Manual Medical Caregiver."

"Yes, how do you like the work?"

"It's good, not too stressful. It pays the bills."

She can hear her mother whispering something in the background. "Sweetheart," her father says, "your mother wants you to return the necklace you borrowed from your little sister."

"What necklace?"

More whispering, then, "The one with the rhinestone rhinoceros pendant."

She has to think for a minute, and then she remembers it. "That was five years ago."

Her father sighs. It has been a long and arduous marriage. She knows this for a fact: He never wanted children. He never even wanted a wife. Before he got her mother pregnant, he'd been planning a solitary career in forestry. "Your mother wants it back," her father says. "I can't say why. Just do this one thing for the sake of harmony."

"Sure," she says.

Months pass. She never finds the necklace; she never goes over for dinner. She cannot bear the thought of her mother's cautious hug, the polite pat on the shoulder, the inevitable point in the evening when her mother would remind her, "Your sister took after me."

She advertises her services on the back page of a reputable local magazine and gradually builds her clientele. She rents a small office in the financial district. The office contains a couch, a chair, a pillow and a desk on which she makes appointments and keeps the books. She paints the walls a pale, hospitable green and maintains a large supply of Kleenex. She always wears scrubs to work, in order to underscore the message to patients that this is a serious medical establishment. She finds the work relaxing. She sleeps fairly well at night. Her patients depend on her; she is providing a valuable service to the public. Slowly she begins to feel connected to the world.

But there is one thing that bothers her, one horror she can't shake: the image of her baby sister standing on the window-sill, preparing to leap. She purchases several books about the afterlife. Each night before falling asleep, she attempts unsuccessfully to channel her sister's ghost.

Oh yes, of course it happens this way. She runs into the ex on the street. He is pushing a stroller, and the software executive is beaming. The software executive has gotten a perm and a thousand-dollar pram. "I quit my job!" this woman says, unprovoked. "Motherhood is so fulfilling!"

Consequently, the ex has taken a full-time job for the first time in his life. He has given up his career in hand modeling for something more stable, something in sales. He looks haggard, possibly insane, and she knows he is ready to jump ship at any moment. When the software executive runs off to change the baby's diaper, the ex says, "Would you like to have coffee sometime?"

"I don't think so." She does not even feel the slightest emotional tug, the slimmest pang of nostalgia lust.

One thing she never told anyone about her ex: He did not masturbate. Ever. He was concerned about repetitive stress injury to his hands.

Nearly a year after she passes the exam, the astronomer shows up at her door. It's late on a rainy night, and she's wearing her nightgown, watching old Westerns on TV. She has not seen him since that day at the diner.

"May I come in?" he asks.

He is wearing a yellow raincoat in which he looks very small, no bigger than a boy. She steps aside to let him in. She offers him coffee and a bagel. Still wearing his wet raincoat, he sits down on the sofa. She sits on the other end. His face has the gaunt, prematurely aged look of someone who has given up food for cigarettes.

"I can't get her out of my mind," he says.

"I know," she says. By which she means, Me too.

"I've left my wife," he says. "I've quit my job. I've been spending a lot of time at sports bars."

She is thinking about her sister, how one young girl with an infinite stream of numbers coursing through her brain could have caused so much grief for so many people simply by ceasing to exist. She doesn't know what to say to him, so she tells him a story that she only recently remembered.

"I remember this one time," she says. "My sister was six years old, and I was home from college. It was 1986, and Halley's comet was passing by. She'd heard about it in school, and she was desperate to see it. I drove her out to Point Reyes, and we camped out on the beach. I remember it was this bright baseball of light with a fuzzy white tail. We lay on our backs, watching. My sister took a few pictures with a Polaroid camera, but none of them came out. When I woke up the next morning, she was sitting down by the water's edge. I asked her what she thought of the comet. 'It was cool,' she said. Then she asked me the strangest thing. 'How far away do you think they are?' she asked. 'Who?' 'The other people,' she said. 'How many light-years do you think it would take to get to the nearest planet inhabited by people?' I said I didn't know but that there'd be plenty of time for her to figure it out."

The astronomer is looking at her with extreme concentration, as if waiting for some clue, some consoling fact that will allow him to get on with his life. "Yes, I remember when Halley's comet passed by," he says. "Do you know it won't return until the year 2061?"

They sit for a few minutes in silence. John Wayne's voice emanates softly from the TV.

Finally she says, "Why are you here?"

He leans his wet head against the sofa. "I don't know."

It occurs to her that she need not let him suffer. It occurs to her that he has come to her for a purpose, even if he is unaware of this himself.

"I am a licensed medical professional," she says, sliding closer to him. "Manual manipulation has proven extremely effective in treating patients who suffer from long-term mourning." She is using her most professional voice. She touches his hand first, in keeping with protocol. He flinches slightly but does not move his hand away.

He lifts his head and looks at her. "It's very kind of you, but I don't think that will help. Nothing will help." His hair is dripping on her sofa.

"At least we can try," she says. "I won't charge you."

"Okay."

She goes upstairs, puts on her scrubs and gets a bottle of lotion. When she returns, he has taken off his raincoat and laid it over the arm of the sofa. He has unzipped his pants and is sitting with his hands in his lap. "What now?" he says, trying to be nonchalant.

"Just relax."

She reaches for him. He is so soft, so small. As she is working, she thinks about the universe. She thinks about planets spinning. She sees cold moons and burning suns. She thinks about the year 2061, and she is pleased by the thought that when the comet passes again, she too will be nothing more than particulate matter.

Soon the astronomer shudders and lets out a great sigh. He opens his eyes and says, "Elizabeth." For a moment she forgets the rules and leaves her hand in place. For a moment she is not alone in the world; she is connected to some greater thing. It is the first time she has heard her sister's name spoken aloud in many months.

The Medically Administered hand job has become a Common Treatment for a number of Illnesses.