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“It’s really terrible.”

“Does it hurt when I do this?”

“No, not so much.”

“How about this?”

“A little, but not so bad.”

“How about this?”

Todd howled with pain, tears welling in his eyes.

“OK, son, why don’t you get dressed and come into my office. I’d like to talk to you.”

Dr. Williams washed his hands in the sink and exited, closing the door behind him. Todd put his clothes on and poked his head out the door.

“Nurse, should I go into the doctor’s office now or wait until he comes back?”

“No, Todd,” said the pretty nurse, “you can go right in now.”

Dr. Williams was seated behind a burnished mahogany desk, writing something with a Mont Blanc pen. On the wall, there was a large painting by LeRoy Neiman of a macrophage ingesting salmonella bacteria.

“Todd, have a seat,” he said, signing the document with a flourish and placing it on a stack of other documents.

“Todd, how do you occupy your time? What sorts of things do you do?”

“Well, I don’t do too much of anything, really … mainly reading and watching TV and stuff.”

“Do you do anything athletic, participate in any kind of sports?”

“Not really.”

“Is there anything you do with your hands, anything that you do over and over again that you think might be contributing to this pain?”

“Not really.”

“Todd, I want you to think very carefully. Is there anything — I don’t care how trivial or silly you might think it is — that you do with your hands or wrists repeatedly every day?”

“Well … there is … I’m kind of ashamed … I …”

Todd made a loose fist and gestured up and down.

“Masturbation, Todd?”

“Yes, Dr. Williams.”

“That’s what I thought, Todd. Todd, there’s absolutely nothing wrong with masturbation in and of itself. It’s perfectly normal behavior. About how often do you masturbate?”

“A lot.”

“What’s a lot?”

“Well, it’s hard to count — maybe thirty or forty times a day. I do it all day. I ejaculate and then I just keep stroking until I get an erection and then I stroke until I ejaculate and then I start all over again.”

“All day without stopping?”

“Well, I break for meals, but if it’s a food I can eat with one hand …”

“Todd, do you have a girlfriend?”

“No, Dr. Williams. It’s really been tough finding someone I can really talk to. I’ll meet a girl who’s really into chemical weapons but she won’t know anything about Norse mythology and then I’ll meet a girl who’s really up on the mythology — she’ll know everything about Odin and the Valkyries and Rodmar and Thor and Valhalla — but then she’ll think that mustard gas is something you get from eating too many hot dogs.”

Dr. Williams smiled.

“Todd, have you ever heard of something called carpal tunnel syndrome?”

“No, Dr. Williams.”

“Carpal tunnel syndrome is a repetitive motion injury. It’s also called a cumulative trauma disorder. I’ll be giving you some literature about this so you don’t have to remember all the jargon. In carpal tunnel syndrome, a fast repetitive motion, over time, damages the nerves and tendons in the hands and wrists. Come over here and let me show you on this model. The tendons over here, which pass through this narrow channel of wrist bones — the carpal tunnel — swell and press on this nerve here, which is called the median nerve. That’s what’s causing your pain and numbness. This disorder is found most frequently in people who work in meat-packing plants and poultry slaughterhouses — employees in chicken-processing plants, for instance, must make difficult cuts 60 or even 90 times a minute. And more and more, we’re finding carpal tunnel syndrome in word processors — people who are hitting keys tens of thousands of times an hour. Given the frequency and duration of your masturbation, you’re making the same forceful strokes 180 times a minute. That’s 10,800 forceful strokes an hour …”

He tapped the multiplication out on his calculator.

“… and that’s 86,400 forceful strokes a day, given an eight-hour day of masturbating, which may be conservative in your case, Todd.”

“Is there anything they can do about it? I mean, pills or an operation?”

“I’m going to schedule an appointment for you with my friend Herb Horowitz. He’s one of the best musculoskeletal men in the business. And if, having examined you, he agrees, I’d like to schedule you for surgery.”

“Surgery?” Todd said, looking frightened.

“With surgery we can take some of that pressure off the nerve — remember the median nerve I showed you? — and that can relieve the numbness and pain that you’re experiencing. But that’s not going to solve the problem entirely. We’ve got to eliminate or at least drastically cut down the forceful repetitive strokes you’re making.”

Todd looked glum.

“I don’t think that’s going to be easy, Dr. Williams.”

“Look, Todd — first of all, I’d like to get you into a group. Y’know, you’re not the only one going through this.”

Dr. Williams handed Todd a glossy brochure entitled “The Auto-Erotic Repetitive Motion Disorder Association of America.” It had a photo of a bunch of nerdy guys sitting around with various sorts of bandages and slings and splints on their hands, wrists, and arms.

“Dr. Williams, what if the therapy doesn’t work and I can’t stop? What then? What’s the worst-case scenario?”

“We’ll have to have you fixed.”

“Fixed?” Todd said, his voice cracking.

“Relax, Todd. You said it yourself — it’s a worst-case scenario. Now let’s take this one step at a time. I want you to see Herb Horowitz next week and let’s see what our next move is, OK?”

“OK, Dr. Williams. Thanks.”

Todd walked out of Dr. Williams’s office with the brochure under his arm.

William Carlos Williams, respected physician and distinguished poet, turned to the computer keyboard at the side of his desk and began to type, trying to compose a few lines — perhaps even a stanza — before his next patient arrived.

“That was great, Mr. Leyner! Really great!” Joe Casale said, tucking a flipper under his pillow and nestling into a fetal curl. “What book is that from?”

“That’s from a book called Lives of the Poets,” I said, showing Joe the cover before I turned off the lamp on his night table.

“Mr. Leyner, do you think I could borrow it sometime?”

“I’ll tell you what, babe — tomorrow I have to be at a store downtown to sign some books. I’ll pick you up a copy of your own.”

(The book I was scheduled to sign — which had just been published by Rizzoli — was a $75 oversized volume of nude photographs of myself taken by a spy satellite in geostationary orbit over New Jersey. Annie Leibowitz, famed Rolling Stone photo-journalist, upon learning that the satellite was capable of providing high-resolution images down to the brand name on a golf ball, contacted the Department of Defense and suggested that they collaborate with her on a book of photographs of me lolling about the headquarter’s rooftop patio, au naturel, basted with oil, and flexing.)

Joe started getting out of bed. “Mr. Leyner, let me give you some money.”

“Forget about it, babe. It’s on me. It’ll be a token of appreciation for the job you’re doing here at headquarters. Don’t think I haven’t noticed. You’re up every morning at five A.M. walking Carmella, helping Trezz train the bodyguards, making sure Baby Lago has everything she needs for the commissary. You’re taking care of business … and I’m proud of you.”

“Thanks, Mr. Leyner.”