Top surgery consultation #2

Content warning:  discussion of self-injury.

On Monday, I traveled to consult with Dr. Rumer, and the appointment went well.  In stark contrast, I had a terrible consultation with a local surgeon, at a cancer center, yesterday.  She mainly works with breast cancer patients, and the mail / paperwork I received in advance reflected this.  (The center could easily draft up non-cancer related documents for trans-clients!)

I was there for a total of an hour and 45 minutes – lots of waiting!  When I got there, I filled out paperwork about my breast cancer diagnosis.  I just put N/A for a lot of it.  Here’s a sampling of questions I was prompted to answer:

– What do you know about your diagnosis?
– Previous breast history?- Some cancers are more prevalent in persons of different racial and ethnic backgrounds.  The following information will help us to better understand your potential risk in developing certain types of cancers and to understand your prognosis.  [Followed by questions about ethnicity.]
– What percentage of waking hours do you spend up and about?
– more than 50%
– less thank 50% – I am confined to a bed or chair
– I am completely disabled, totally confined to a bed or chair

On the phone, when I scheduled the appointment, the woman was sensitive to the reason I was coming in, and to the fact I hadn’t legally changed my name yet.  Regardless, that didn’t translate over to the present day, and I was called by my birth name and even, “Mrs. [last name].”  I don’t think I’ve ever before been called “Mrs. [last name].”

I finally was brought up to the breast cancer suite and my vitals were taken.  I waited in an exam room and a nurse came in and went over some of the questions with me.  She left for a while and came back, saying, “let’s fill out this paperwork.”  This one WAS relevant to why I was there.  I asked her, “Why was I filling out papers for breast cancer patients?”  She replied, “Oh, well, they just gave you the wrong one down stairs.”  No big deal… ???

She left and a doctor with an intern student came in.  The doctor asked if it was OK if the student was present, and introduced her.  She then asked, “Are you so-and-so?”  I said no I’m not.  She said, “oops, sorry, wrong room.”  I sat there waiting a while longer and finally the surgeon came in with TWO student interns.  At no point did she ask for my consent for them to be present.  They introduced themselves and we got started.  She started by putting words in my mouth – “So you’ve felt this way since you were a teenager.  That’s when you started feeling different…”  I just let her roll with that.  She asked about mental health, suicidal thoughts, and even self-injury.  I’m not sure why.  She asked very little about gender identity.  I answered her questions honestly, including that I’ve had vague suicidal thoughts, and I used to use self-injury as a coping mechanism.

She then said they were going to leave the room and prompted me to put the robe on.  They were gone a very long time.  They all came back, rubbing hand sanitizer into their hands.  I had a flash fear thought – are all these people going to be touching me?!!!  Fortunately only the surgeon touched me, but the presence of all these people was enough for me to check out for this part of the appointment.  A few things that registered:

– She commented on my tattoo, asking if that was magic marker – it looked like marker.  ???
– She talked a lot while I was sitting there half exposed.  She described the procedure she would do, and manipulated my breast in her hand to demonstrate it.  I looked down briefly, and seeing her grabbing my breast was totally surreal.  She was talking at my chest, and not to my face.  I was poked and prodded a lot more than seemed necessary.
– She actually said to me, “This scar, is this from cutting?”  I could not believe I was being asked this.  I was in shock.
– I was aware of interns in the background, watching this whole thing.  They were fuzzy.
– I said to her, “I’m just in the consultation phase, and I have some questions for you.”  This changed the dynamic and she wrapped up the part where I was sitting there, vulnerable.

When this part was finally over, they left and I got dressed.  I waited a very long time again.  When they came back, I went through my list of questions.  She has a year and a half of experience working with trans-patients (really?!!), and does chest masculinizing surgeries a couple times per month.  She requires patients to be off T one week before and one week after surgery.  50% of patients will immediately retain nipple sensation, and 80% will eventually over time regain sensation.  She could not show me any examples of her work that would be related to my surgery type.  She could not tell me how much it would cost, not even a ballpark estimate.

Before leaving, I gave her feedback.  I told her how I had been misgendered by the staff.  She conceded that they needed to work on that.  I also, in front of the students, said, “As someone who is transgender, I have gender dysphoria around my naked body.  These may not be the best types of appointments to have students present.  It felt like I had an audience, and I didn’t feel comfortable being partially exposed.”  She responded, “Thank you for that feedback.”  I understand she might not have control over when she has interns with her, but she could CERTAINLY ask for consent, or ask that the interns not be present for the naked part.  I wanted to give her more personal feedback, such as, “It’s not appropriate to comment on my body,” but in the end I didn’t go there.  I just couldn’t right then.

This surgeon and the staff could benefit from some trans-related training, particularly to the sensitivities trans-people may feel about their naked bodies, specifically chests.  Make it short and sweet!