Let's Get 'Physical'

When Harper's magazine sent James McManus to Las Vegas six years ago to cover the World Series of Poker, he cashed his advance into chips and entered the tournament. That assignment became the basis for his last book, Positively Fifth Street, which earned raves for its first-hand reporting.

With his latest book, Physical, McManus turns that passion for average-joe experiential journalism toward our health-care system. He checks into the Mayo Clinic and undergoes every battery of test imaginable, frequently stopping to muse about nurses who incite erections at inopportune moments, the politics of lying to your doctor, the libidinous effects of marijuana and the inelegance of the prostate exam. We spoke to McManus about the difficulties and indignities of first-world medical care.

Your book, though not specifically about sex, ends up being quite a bit about the sexual awkwardness created by our health care system. It occurs to me that health issues and sex issues are similar in that they're both things people feel they need to whisper about.
I think that's true, although I think it's becoming less so. You've got people like Katie Couric and David Letterman. Bill Clinton's talking to Larry King as he's about to get his chest ripped open with saws. That boundary is coming down. Although I think people still don't talk about their sex lives too openly.

You write that, statistically speaking, people in marriages and long-term relationships are healthier than single people.
Richer, healthier, longer-lived. The actuaries really are clear about it.

Do you think routine health care is more awkward and more psychologically fraught for men than it is for women?
Yes. Just look at how the culture clothes us. When you go out to a fancy event, men are covered up from Adam's apple to toe, and women have these very revealing party dresses on. I think the male power structure demands that men be more fully clothed than women, so when we have to take our clothes off and interact bodily with someone else in a clinical setting, it is more embarrassing for men than it is for women.

For example, you write about your prostate exam at the Mayo Clinic, and how afterward, against your instincts, you and the doctor have to sit there and talk as though nothing that threatens your manhood just happened.
Right. We have to pretend this stuff doesn't make us feel weird because he's a "medical professional." And he's sitting there wearing your shit stain on his finger and his Prada suit. It's a strange situation. I'm not complaining about it. I had a glorious experience at the Mayo. But it is an awkward experience. You've got these young, hot babes stripping you down and stressing you, shaving your chest hairs and whatnot. My primary care physician is female, and it's very different getting a prostate exam from her than from a male doctor, one simple reason being that male doctors have bigger fingers.

It seems we're all expected to be more comfortable with the medicalization of sex than we're culturally ready to be. Things like erectile dysfunction ads, penile implants -- for men, is this empowering or just emasculating?
I don't think it's empowering. It feels slightly emasculating. I also just think it's funny. As a writing teacher, I'm always getting questions from students like, "Can I write about this if it's going to embarrass my stepbrother or my mother or whoever?" And I say, yeah, you have to go there. You're sort of signing up for that embarrassment when you write. When they're measuring your blubber content, you don't want to report that to the world. You don't even want to have the nurse standing there while she's doing it.

So why did you decide to do the book?
I wrote Positively Fifth Street as nonfiction and that did better commercially than my fiction, so Louis Lapham suggested I go to the Mayo Clinic and write about that. About a year after that, Esquire wanted a piece about stem-cell research and they liked some pieces I had written for other magazines, so they hired me not as a medical expert, but as a person who would be looking at it as an average joe.

Average joes today are expected to be much more medically savvy than in the past. There's so much available information.
In the book, I try to write a calculus for how much pain and pleasure I want in my life, because so many of the things that give me pleasure like food and booze shorten my life. Since we have so much information about this stuff and so much access to health care, our brains are constantly balancing. I don't think my grandfather sat around looking at a peanut butter sandwich. He just ate it. We probably will live longer because we have the information, but we've become obsessed with keeping score about what's doing us harm and doing us good. Sexually, it's the same way. "When's the last time you had an HIV test?" has become part of the sexual ritual.

In this sense, do we lose something on the road to good health?
Sure. It's not terribly romantic to be talking about the last time you had an HIV test, who your former partners were. But that's now clinically crucial to know.

You write about how we're expected to make all these medical choices, and often the pragmatic choice and instinctual choice conflict. For instance, you never got a vasectomy even though, at a certain stage in your life, that would have been practical. Was it because there was something traumatic about the idea of rendering yourself infertile?
For me, there was. I still haven't had one, and I should have one. My wife has been bearing the contraceptive load for us and I think that's unfair. But as I write about it in the book, there is something -- traumatic is a bit too strong. It just gives me pause. Potency is so delicate for men that anything that fucks with it is enough to give you pause.

The hard truth at the core of this is that your physical health tremendously impacts your sexual desire, your sexual ability and your sexual desirability. People find others more or less attractive depending on what kind of physical shape they're in. You may not want to impregnate somebody, but the reason we have sex drives is to propagate the species, and if we we're not fit to do it, we would not be able to do it.

Is that why youth is so attractive?
I think that's why men are attracted to younger women. Although youth in general are more and more powerful in our culture these days, and youthfulness and power is a potent combination.

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