Death by provincialism

I went to Grand Rounds today* at our nearby non-major-world-religion-affiliated hospital, where the speaker gave a talk on transgender medicine. Interesting stuff, especially the historical bits in the beginning.

It was a mixed crowd. At least one residency program rotates their docs-in-training through this hospital, so there were lots and lots of young faces. Neat! Have I mentioned how much I miss teaching and just being around residents? I do. Anyway, I spotted a few of the local docs, some young, some old. Some very old. Some docs when they retire, they hang up the stethoscope for good; some docs keep coming back to grand rounds because, well, I guess they love medicine and they like to keep up with new things. I can appreciate that.

One old guy must have been pushing ninety — tiny, hunched over, but with a briskness to his step. After the talk, he left the conference room with some of the other retirees, and said to one, “They never taught us about THAT in medical school.”

I felt like telling him, “I graduated in ’90, and they never told US about that, either!”

Add transgender to the list of Things Not Even Deserving One Hour of Lecture Time, along with nutrition and . . . well, sex. Did we get any talks at all on sex? I remember one of my female friends asking a lecturer about dyspareunia, eliciting titters from some of the students and sidelong glances at her blushing boyfriend. But that wasn’t even a lecture on sex; I think it was a lecture on genital anatomy. And NO, that does NOT count as a lecture on sex.

Sometimes I think we’re still a very provincial, puritanical nation, even in our institutions.

One lecturer even saw fit to warn us of the dangers of provincialism. Here’s the story he told the class:

This was some years ago, when most gay men outside of San Francisco remained closeted. A fellow from one of the suburbs an hour away used to come into town on the weekends, do his thing, then on Sunday evening return home, where he worked the usual Monday-through-Friday nine-to-five job. One Monday evening he developed severe abdominal pain and drove himself down to the local hospital’s ER.

The man’s abdomen was tender but not yet rigid. Who knows what the ER doc was contemplating — perhaps a general surgery consultation to evaluate the patient for appendicitis. That, at least, would have made some sense. But the patient made the mistake of telling the doctor the truth. “We were fisting,” he said.

After explaining to the doctor what this meant, the doctor decided his patient was delusional and gave him a fat shot of thorazine, which knocked the patient out. They kept him on thorazine for the next day or two . . . however long it took for the supervising physician to note that his patient had gone into septic shock. By the time anyone realized what had happened to the man, it was too late.

I took this story to heart as a cautionary tale. A doctor’s ignorance could be deadly to his patients.

Which is why, of course, I try to keep informed on all of the newest paraphilias 🙂

D.
*The idea being to shmooze the local docs . . . but they were all far more interested in the speaker than in me, a new face in the room. Oh, well. I’ll try again in a couple of weeks.

5 Comments

  1. noxcat says:

    Re: provincialism.

    Yes, we are still very provincial. And it’ll get worse if Palin makes it to President. 🙁

  2. Interesting. What aspects of medicine?

  3. Walnut says:

    Mostly, she was talking about how far you could go with hormone therapy (both for MTF and FTM) without resorting to surgery. Very little on gender reassignment surgery . . . although she was not subtle in condemning phalloplasty (apparently, it’s a really crappy operation). She showed one MTF who had had $80,000 worth of surgery to shave down a brow ridge, feminize a jaw line, refine the nose, and lower the hairline. Excellent results, but $80,000!!

    She also talked about how there’s a big transgender community here in Sonoma County, but most folks go to SF for care because they all have stories of being dissed (or worse) by the medical community here.

    They’re having a 1.5 day seminar in October. Inexpensive as such things go ($150 for docs, approx.) I’d be tempted, except it really has no relevance to my practice. I just think it’s a fascinating topic.

    One very interesting thing she touched on was the use of Lupron to prevent puberty in children who feel wrong about their gender. The idea is, let them grow up a bit, and at some point let them decide to either mature “normally” or use meds to push puberty in the other direction. Obviously, the parents would have to be on board for this. Even if they are, I can imagine CERTAIN PEOPLE (sarahpalin sarahpalin sarahpalin) getting their panties in a wad over what other families do with their kids.

    One good (sad, but good) joke she told about the risks of hormonal therapy for MTF: “the risk that you’ll now earn seventy-seven cents on the dollar.”

  4. $80K!? Yowch! As for phalloplasty, it’s probably one of those things that’s a lot easier to take off than put back on…

    Perhaps unsurprisingly, Seattle’s got a large trans community too, and the medical community is more sympathetic than not – IIRC, even the local VA hospital is pretty good on trans issues.

    A friend of ours was recently relaying to us the first moment when she really felt like she’d successfully transitioned: her first OB exam went without a hitch…

  5. Walnut says:

    I guess, surgically, innies must be easier than outies 🙂