Once you realize a person is prone to lying, trust is often a self-destructive option.  Until you see this pattern of untruthfulness clearly, the question of trusting or not trusting can be tricky.   I think humans want to trust the people around them, this appears to be a default setting.  We homo sapiens are a communal, if also often communally irrational, species, after all, and community is based on trust.  

When you’re a helpless infant you have no choice but to trust the people taking care of you.  This trust is rewarded if you’re nurtured with care.  Trust can be shattered forever if you learn you’ve been continually pissed on by your caretakers and told to shut up and stop whining about a little rain falling on your head.   Most of us have upbringings that fall somewhere in between.  Knowing when to trust and when not to trust is often only learned by hard experience.   We put our trust in somebody, in their expertise, and sometimes that trust is revealed to have been misguided.  The question: how do we know in advance that we can trust someone?

We tend to trust people, I suppose I generalize from my own habit, who are relaxed, friendly, show a sense of humor, make the proper sympathetic facial expressions, and react reassuringly, when you express concerns.   The obvious problem is that these are all the behaviors of the best conmen and almost all manipulators and compulsive liars.

I’m thinking about this because I had a consultation with a friendly, reassuring, good humored and very likeable urologist back in August.  We left the office very impressed with him.   He assured me that during the tests I was going to have two weeks later I’d be under comfortable “conscious sedation”.  I was relieved to hear that since having devices shoved into your penis is not always comfortable, and is usually done without any palliative measures.  The standard line is that most patients tolerate it.  You wince a bit, maybe groan, at the insertion, and the rest is fairly tolerable.  But I was glad to know I’d be sedated, the better to wince less, and maybe not have to grunt.

When I arrived for the tests, and asked about the conscious sedation, his nurse expressed frustration that he always tells his patients they will receive conscious sedation when his office NEVER gives conscious sedation, does not even have tranquilizers they can give patients.  She said he probably thinks it makes his patients more relaxed.  I didn’t need to convince her that learning, at the moment of your test, that the doctor lied to you is the opposite of relaxing.  I endured a ninety minute ordeal with this gentle, determined nurse, as she tried, unsuccessfully to insert catheters into my urethra to drain my bladder for the test.

The doctor came in, sweaty and smiling, and asked how I was doing.  I told him I was wondering what happened to my conscious sedation.  He had a fit, denying he’d ever said that, essentially calling me a fucking liar.  In that moment I knew I was done with this asshole, and managed to remain the adult in the room.  I quickly calmed the angry baby down and got him back to business. He told me he wouldn’t do   further tests, telling me my urethra was already irritated enough for one day. 

Then he wrote a detailed report, which I got a copy of and which was sent to all of my doctors, not mentioning the unsuccessful catheterization, but stating “patient tolerated procedure well.”  It then gave detailed findings of two tests this motherfucker never did.  He billed Medicare for them, and I got bills and a statement from Medicare confirming the charges and what they paid.  Medicare did not seem concerned about the fraud, it was virtually impossible to report it, even as determined as I was to. 

My next urologist was also affable, smiling, quite chill, with a sense of humor and all the other indicators of a nice guy you could trust.  He was openly horrified by the doctor’s false report I presented to him and suggested I contact HR at the place his unethical colleague worked.  (No doctor is going to suggest a disciplinary complaint to the state licensing board).  He did no tests, described a non-invasive surgery that should correct my urinary problem, I postponed the procedure once to have a fuller discussion of it.  He gave me a detailed theory for why this procedure was better than the standard alternative, which I’d had years earlier, to great life changing effect.  I had the procedure Thursday and left the hospital with a catheter and piss bag on my leg, as is common after this kind of surgery.

There was a complication when I removed the catheter the next day as instructed.  I was unable to urinate at all.  After 4 hours with a full bladder, and the constant urge to urinate,  I wound up in the ER where I was “fast tracked” and it only took another 3 hours to have the painful urgency to piss out 600 ml of urine relieved by a new catheter.  

I was sore, irritated and in need of advice afterwards and called the number the urologist had smilingly touted as a 24/7 doctor on call, no worries.  I left increasingly agitated messages.  Five messages and five hours later, at 2:45 a.m., I got a call from a bot, instructing me to go to an ER and have the ER doctor contact their on-call doctor.

I called again when I woke up and got a fairly quick call back from the surgeon himself.  He sounded indignant to have been defamed the way I’d spoken of him in my increasingly agitated messages.  He told me I had a poor recollection of our detailed conversations prior to the surgery.  I was in a pissing contest with a skunk, only my piss was dribbling slowly into a leg bag.  I asked him why he hadn’t done any pre-surgical tests before doing what seems, at the moment, and in light of what he told me after an unnecessary surgery.  He was able to see with the scope that, contrary to his prior test-free opinion, there was no scarring from the previous procedure and that I’d likely need the original procedure repeated soon in any case.  ) He told me he had the notes of recent tests from my previous urologist, the tissue of lies he had attached to my file in the hospital.  He made numerous other excuses and told me how busy he was doing Saturday surgeries at another hospital.  I sensed there was not a trace of his winning smile on his face as he defended himself and his perfect recollection.

So, quite naturally, as an irritating drip of urine intermittently leaks through the painfully re-inserted catheter into the leg bag, I am musing about trust, when to trust, who to trust, if you can ever trust someone who is employed by a demanding bottom-line driven psychopath, which is what every corporation is.  After all, this guy is the director of his clinic, part of a chain across the US, the largest corporate provider of high quality, infallible, humane, patient-centered urologic care.   You can read all about it on their fucking website.

Or just listen to their compassionate on-call doctor, who phones you personally at 2:48 a.m., a mere five hours after your first of five distress calls.