29 March 2007

Sex change surgery: do it yourself

April Ashley, something of a pioneer

There is an amazing ward in Dr Grumble’s hospital where the patients enter as men and go out as women. It’s not actually quite like that because the men enter disguised as women. Living as a woman is a prerequisite for male to female gender reassignment surgery. Dr Grumble sees quite a few of these patients. The surgery has been going on for such a long time that some of these patients are now elderly and the elderly often have the need to see Dr Grumble. Very occasionally he sees them shortly after their surgery.

Last week Dr Grumble was called to see a patient in the gender reassignment ward. ‘Gender reassignment’ always seems a strange term to Dr Grumble. ‘Sex change operation’ is probably what the tabloids call it but these days we are too prudish to use the word ‘sex’. So the patients have ‘gender reassignment surgery’. It sounds a bit as if Patricia Hewitt has deemed that you are of the wrong gender and it has been decided by the NHS to assign you to another one. But it’s not like that. Dr Grumble is no expert on gender reassignment but the concept does interest him. It’s not a prurient interest. It’s more an amazement that people have this problem and that any man might want to be turned into a female. If you are a male and comfortable with your role, the thought of being reassigned does rather makes the blood turn cold. Another thing that impresses Dr Grumble is the technical skills of the surgeons who achieve such good results. So Dr Grumble was interested when he had to see a patient on the sex change ward.

He was greeted on the ward by a tall young blonde doctor. She offered to present the patient to Dr Grumble. This is unusual these days. As the juniors’ hours have been slashed there’s less time available to them in the daylight hours to interact with senior staff who tend to be less nocturnal in their working habits. It’s nice not to have to wade through notes and just be quickly brought up to speed.

The story went something like this. A couple of days ago the patient had had his gender reassignment surgery. It’s easy to think of these patients as men and Dr Grumble made a mental note to be sure that he referred to him as ‘she’ and not ‘he’. It is an easy mistake to make but not one that would be well received by the patient. The ‘lady’ in question had coughed up some blood post operatively and ‘she’ had also passed some blood per rectum.

Dr Grumble went to see the young ‘lady’. He took a careful, though not full, history. There was no need. He had heard most of it from the helpful junior doctor. He then began his examination. He was stunned. The patient had well formed normal breasts. It is unprofessional to describe them as stunning but, given that this patient was a man not long before, Dr Grumble is happy to admit that he was, well, stunned.

Now, if you remember, there was a problem with bleeding from the tail end. This meant that to do the job properly Dr Grumble needed to examine the more private areas and he can only say that following the examination the surgeon concerned with the operation had shot up in Dr Grumble’s estimation. The results were truly remarkable. Without genetic testing Dr Grumble can honestly say that he could not have told this ‘lady’ from, well, a lady.

Having completed his examination Dr Grumble went to talk to the patient’s mother who was understandably concerned about the setback. It’s never a bad idea to build up your colleagues and Dr Grumble expressed his amazement at what surgeons can do nowadays and what remarkable results had been achieved. The mother seemed herself to be somewhat unimpressed. People just expect these things these days. Men into women – no problem. They just expect it - and on the NHS. But Dr Grumble still felt it was quite quite amazing. Then, over the mother’s shoulder, Dr Grumble caught sight of the attractive young blonde doctor. She was gesticulating. She was quite wildly gesticulating. There appeared to be some urgency about the gesticulation. Dr Grumble made an excuse to the mother and went over to the other end of the ward.

And then the bombshell. The patient had not had a sex change operation at all but something much more minor. No harm done. But Dr Grumble came very close to being embarrassed. Sometimes it's better to do it all yourself.


z said...

Great post - always heartening to feel that there are medics who are doing it right.

Just taking care of the pronouns makes a big difference.

(I am a female to male transsexual as well as a Doctor, not that I would ever tell you if I met you in real life. But The Internet is anonymous.. hopefully.

Dr Grumble said...

Who better to comment than z? Thank you.

Unknown said...

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