Hospital stay provides unexpected Gender Validation
Lets face it, you are the most vulnerable when you are naked. Everything is exposed for all to see. Clothing has the opportunity to hide your insecurities as well as your past; and many other things. Nakedness exposes those bodily features you don’t want people to see until you have had time to do some more “work” on them. It could be a fat roll, a birth mark, weird looking belly button, or many other things. It also exposes any scars you have; which can tell you a lot about that person. It may even tell you how easy or hard their experiences in life have been. Every scar always has a story, but it may not always be obvious to understand. Lets face it, if you are in a situation where you are naked, it can be embarrassing whether you like it or not.
Your comfort level may also be outside of your control. When you have certain injuries, like a pelvis injury and you are getting treated in the hospital; you don’t have much choice in the matter.
These situations get even more complicated if you happen to be transgender. Any interaction with the medical community has the opportunity to put that person on edge. Anxiety can build simply based on the potential experience you may or may not have coupled with the encounter. How will I be treated? How much do they know? Will there be any problems because of my status? How knowledgeable are they about my condition?
Lets face it, medical care is gender/sex based. Care is provided based on assumptions based on the sex you have registered with your insurance company. If you’re female, you are assumed to have a uterus, vagina, cervix, ovaries, breasts, etc. If you’re male, you’re assumed to have a penis, testicles, prostate, etc. And if you are transgender, there's a good chance you may have a mix of these things, and they can also change over time. While some are transitional, others may be more permanent.
In a nutshell, we (transgender people) break the current health system’s practices and questions. Some of these are good, while others problematic. Reminders for pap smears (not typically applicable to transgender females) and yearly breast exams are good things. But missing prostrate exams can lead to issues.
The worst part, is the anxiety that can come from the assumptions that stem from the questions. This is not something most people have to worry about on a trip to the hospital and I wish I could just worry about the issue that brought me there in the first place. But, I am special and have to worry about these issues and lots of other things as well (like the knowledge level of the doctor’s treating you).
The good news is, that most medical people will try to treat you with dignity regardless of the parts and pieces you have, but I feel that is not always the case. We all hear the horror stories of mistreatment, and I can’t say that I have been totally immune to it. I do, however, find that the variations in handling and respect can be based on the how much that person knows about you. E.g., if presenting female, at first the voice, or other oddities don’t seem to be enough to contradict an initial impression. However, if I expose my history, or they do a more thorough detailed reading of my medical history, it can invoke a handling change in some people. That’s when the possibility of miss-gendering and incorrect pronouns can really begin to fly. So, some of that anxiety comes from waiting for the exposure to occur and then seeing who is going to change their behaviors.
And it can start right off the bat. A typical visit to a new doctor will include the filling out of some forms. One of the standard questions for female patients is when was your last menstrual cycle? I’m truthful and usually fill in - never. But, that then solicits additional questions when seen by the on-boarding nurse; which then leads to questions about why I don’t have a uterus. When was your hysterectomy? That would be never too…(Or maybe I should tell them @ November of 66, since I was born in June of 67 — wonder if they would get/understand that? hummmm?) You have no choice to tell them a piece of your history to explain why you are missing these organs. All of these questions, 90% of the time, are not applicable and have little relevance to why you are there to see them in the first place, but part of just general health questions. Luckily, this is usually a first time visit thing and typically they don’t ask again on subsequent visits. For these later encounters, it becomes who looked at your record before treating you.
This is known and something I deal with all the time. On subsequent visits, I try never to tell or remind them (I find this easier…), by default. However, if it becomes relevant…then I may remind them of it.
So, you can imagine how when something major happens, and you’re being passed from one new medical team to another…it can put you a bit on edge.
The Pelvic Fracture
My most recent medical experience that brought me to the hospital this time around was a pelvic fracture, caused by a bike accident. In the process of getting treated for this, I got to deal with many different medical teams along the way; and each were an adventure into the worries that I mentioned earlier in the discussion.
My first encounter was with the ambulance staff that picked me up. They asked all the relevant information and their handling was perfect. They handed me off to Hospital #1, and their handling was also perfect. Since we had stopped to pick up my ID’s along the way (which all match) this was the info radioed in for each of the teams. I didn’t stay very long at the first hospital, just long enough to get x-rays to confirm/figure out I had broken my pelvis, so I was then handed off to a helicopter transport team to take me to the trauma ward of Hospital #2. Again, the helicopter staff handled everything perfectly. It amazes me how validating it can be to hear information about you being relayed in these transfers. This is Christine, a 54 year old female…..she this, and she that, etc., etc..
All this would come to an abrupt halt the following day, after surgery when one of the nurses slips out a “he” without correction in reference to something simple. It’s obvious she suspects something or has read my medical history, because I had still not said a thing. I raise this later with someone who comes in to ask me questions and we end up having a very nice conversation. She informs me that she is aware of my history, but that they don’t see to many pelvic fractures in the first place, and had never seen one on a transgender patient, let alone one who had been through GCS. She politely asked how long it had been since I had had the surgery and I voiced to her some concerns about the current injury and relations to it.
I find out, via this conversation, that the Hospital is a teaching hospital, and offer to her that since my situation is so unique, I would be happy to answer any questions they would possibly have. She’s very excited and tells me that she would like to take advantage of that…and we set a time for 11 AM the next day to meet her and about 6 students. (It was a great discussion with the students, but that is not the primary point of this story. Educating the world about the life we live and what we go through medically does though.)
Having a pelvic fracture does not leave any room for humility. But neither does being transgender or a woman in general. If you are shy about anyone ever looking at your private areas…well you better get over that real quick. A vast number of nurses, doctors, and other staff are going to get to see everything for 40 million different reasons over the course of your life…and this particular medical incident was no different.
Back to the point
It would have been so demoralizing to me during this incident if I had still been pre-op. In these situations, that little item would have been a complete game changer in regards to how I was being treated. If the visual doesn’t match the presentation (and who looks great in a hospital gown to begin with), has a tendency to increases the amount of miss-gendering that would have been occurring.
Even though over time it became pretty obvious that some of the people were aware of my medical history…there were only some minor issues with 2 out of the maybe 30 staff who worked on me. Most of the time, it was incredibly validating…to know that nothing was out of place or I had nothing left behind to still be ashamed of from at least a visual perspective. Sponge baths, going on a bed pan, changing sheets and dressings, etc. left everything exposed. There’s just no getting around these things, particularly with a pelvic injury. Everyone is viewing your private areas, seeing you naked, and the beauty of it, is that it's not really creating any issues…
I didn’t think of moments like this as a reason for why I wanted to have my GCS Surgery (there were some aesthetic concerns), but it sure became relevant now. I wrote about definitely being embarrassed by having the wrong parts, but I wasn’t really thinking about others seeing them while I was naked for a medical incident. (God, that would have been a horrible thought!) This incident was really my first major post GCS medical encounter. I had some minor incidents (on arms and legs) and other issues that went through the awkward question phases, but most of those didn’t require exposing anything and ultimately went a little smoother.
More issues coming to light
As part of the treatment, I now have a Caesarean like scar for where they operated on me to put in the plate to hold my pelvis back together. This has a bandage on it that required changing and periodic inspection to see how it is healing. During one of these inspections, it became clear that I had also injured my lady parts and required inspection by their in-house OB/GYN. Since the entire area was painful, I was not really distinguishing the reason where each of the pains were stemming from or were caused by. Also, since they had attempted to temporarily catheterize me during surgery, which I think they may have messed it up a bit, having urination pains didn’t seem out of the ballpark. It was also leaking, so when I asked to have it removed, they obliged. They started to use of an external catheter instead (which wasn’t terribly effective) since any movement only made things worse. I was hoping that once the catheter was removed the painful urination would at least dissipate, but it ended up developing into a urinary tract infection.
Even though the clitoral area was also sore, it was noticed that along with the swelling labia, one side was turning black and blue. Hematoma’s were surfacing, so it was becoming obvious that my whole genital area had taken a hit in the fall as well. I was not happy learning about all these new developments after all the work I had done down there. A recent revision surgery (6 months prior) had included redoing things to make the labia look nicer, so now I was left wondering if I had done any permanent damage. (I would like to avoid revision surgery number 3…) Even though I was not happy that I obviously did some damage, again the entire experience was completely validating. Without a more specialized person available, daily discussions with an OB/GYN as a substitute specialist became part of the daily routine. So, I started sharing with them many of my more specific concerns. The only question at the time was how much detail to go into and whether it was going to cause any issues. Did I do enough damage that something needs to be repaired now? Is there anything in particular I need to be concerned about?
(These incidents are some of the reasons why I do as much medical research into my needs as much as possible. Simply because it becomes relevant to know these things and fill in for the lack of general knowledge in the medical community as a whole in regards to these things when in a time of need, such as this.)
After a nice discussion with the OB/GYN (she was impressed with my knowledge of the area), I had mentioned my next concern was in regards to the dilations I have been skipping the last couple of days. I did have my friends drop off the dilation “tools”, but I wasn’t sure if I could even move around enough to do it in my current state. Any hip movement at the time was extremely painful. (Legs lying down flat and closed are not a good position for dilation.) She agreed to help/assist me arrange my legs and get into position. We started off with the small (purple) to see how “she” feels with me doing most of the work. We later move up to blue and when we pull it back out, it is a bloody mess. I jokingly mention to her that yes, even trans women have to deal with blood coming from the vagina from time to time and here is proof positive of that. She gives out a small laugh. While not normal, it also doesn’t seem completely out of the ordinary either. There’s usually an explanation, yes I have injured myself down there before and then there were the surgeries themselves. (I think I have definitely made up for all of those lost periods I missed out on.) Bleeding in that area happens so often that it has simply become something you simply deal with and move on as necessary. This particular bleeding issue is likely from a tare that occurred during the fall and dilation just irritated it. She prescribes a cream to help with the bleeding and some spray to help with the swelling labia. I’m assured that swelling in that area is normal with a pelvic injury, however it doesn’t make me feel any better about it. (I will have to wait to see what they look like when they go back to normal.)
I couldn’t help but wonder if a constructed labia behaves the same way as a genetically made labia? So, more questions are swaying around my head as I worry more about my unique health concerns. Is it worth pointing that out to any of the doctors? I decide it’s likely something to bring up to my GCS surgeon (the expert) since I have a follow up coming up anyway. On my second visit with the OB/GYN I setup a joint call with my GCS’s emergency on call person. They are unsure about any specific concerns, but suggest having a follow up after I am more mobile. I’m thinking that he may not be happy if I just ruined all of their prior work. I know I’m not particularly happy with their current look, but I’m trying to be patient with the healing process.
I realize that it may not be the biggest thing to be concerned about. There are plenty of other areas that are also swelling…and maybe I should be more concerned with those areas. So, I begin to question about what I should care about more — vaginal area or the pelvic bone healing, pins, and other important things; like being able to walk again?
Moving along in transition, I have gotten to the point where as the years go by living as a woman, I am forgetting about the prior life I had as a man. Its so much more natural now, and now that I have corrected my life, I don’t necessarily want to dwell on what I went through to get to my truth. Medical people miss-gendering give me those little reminders of my past and that my path to bodily womanhood was different. At the same time, people treating me as the woman I am are also extremely validating, even if I have to worry about if they are treating me adequately due to my uniqueness.
Later, as I was released to a rehab facility, similar interaction stories were repeated over and over again. Again, those who treated me for the woman I am far outweighed the couple of people who were jerks. Only at this facility, there was one nurse who seemed to go particularly out of her way to misgender me. Luckily, I didn’t have to interact with her much…but her record for every interaction was 100%, even after I mentioned it to her. (Some people just refuse to change or do it out of spite…Yes, these people exist.)
I ignored her and made it through the encounters fine. It did not detract from meeting some very nice people and having some very detailed discussions with some of them. I even shared a couple of let your hair down moments and described some of the shittiest things that trans women have to deal with. I think this helped with her understanding, as she was very empathetic and understood completely.
After release from rehab, I was sent home with visiting nurses and physical therapists coming initially very frequently. Early on, I had met with one of the visiting nurses two times with no gendering issues at all. On the third visit, she asked about how a follow up had gone with my surgeon. I felt I had no choice to expose to her about my transgender status, to relay to her part of the conversation I had with the surgeon that left me questioning about whether he knew or not based on one of the explanations he gave back to me. Within 5 minutes of that exposure, she started to referring to me with male pronouns 6 times in the course of just minutes. I was stunned, even though I had seen the same reaction in others prior. After all the prior interactions during the last two visits, it left me feeling extremely disappointed with her. It reminded me that with some people, that is just the way it is….and it’s almost impossible to get them to change. And this is why I don’t tell if I don’t have too. Luckily, she was replaced with another nurse right after, with whom I have had no problems with at all.
In summary
It all makes me dream of that idealistic day when I can go perfectly stealth. Or, when it has been such a long time since my GCS, that it gets buried so deep in my medical history, that any medical person would have to do some serious digging to find it. A time when it truly no longer matters. (You may understand why I am not super supportive of something on my permanent record showing it. (AMAB, birth sex, etc.) I think it has the potential to create more problems than what it is intended to resolve. I particularly think it’s better not to expose it give the current system support, general state of medical knowledge in regards to it, and the general public's understanding.)
I got a small glimpse of that perfect life with this medical experience (which was very validating), coupled with some reminders that it hasn’t been long enough yet. And that I need to learn to shut my mouth some time….(should have not told anything to my visiting nurse…it wasn’t really necessary.)
To summarize, the score for this experience has been a 95/5 split. 95% of the medical people I encountered treated me as the woman I am. 5% still had issues with doing that for some reason. That’s a much better percentage than with experiences I have had in the past… I think part of that was based on where I am in regards to transition (IDs matching, post op, general presentation, etc.) more than the state of political correctness or other issues.
