Nursing Voices

Thursday, November 09, 2006

Transcending Gender

What is abnormal? This book was published in 1964, and its cover illustrates the many misconceptions people hold about those who live an alternative life style. Susan Palwick over at Rickety Contrivances of Doing Good posed the question, “What kind of education do emergency-medical personnel get about gender and sexual identity? If they don’t get any, how can that be changed?”

I was never given any information about or training on handling patients with sexual orientation/gender issues when I was in nursing school. I went to nursing school many years ago, and my school was located in a town where people were routinely wearing white sheets and burning crosses in a public park that was designated for Blacks only. Believe me, no one in that town, or in my school talked about tolerance. I thought things would be different when I graduated from school and moved to a liberal university town, but in 1983 I nearly lost my job for letting a gay man sit at his partner’s bedside after visiting hours. His partner died of AIDS during my shift, and I was suspended for breaking the rules about non-family visitation. I’m not telling you this story because I want you to think I’m a saint, I’m telling you this to illustrate how misconceptions about people can interfere with the delivery of good patient care.

Like Kim from Emergiblog, I have always asked my patients what their needs are, and how I can help meet those needs. There’s nothing magical about taking care of a transgender patient. All you have to do is treat them like everyone else.


Blogger Kris said...

I had my first transsexual just out of nursing school. He had breasts, but only had started hormones so he still had facial hair and a low voice. He wore his makeup very tastefully, and we were to call him "Debbie". It took some getting used to, but I made sure she got the care she needed.

8:19 PM  
Blogger Susan Palwick said...

Nice post, MJ; thank you! As I've also said to Kim, if all nurses were like you, I never would have asked the question in the first place!

8:52 PM  
Blogger Bohemian Road Nurse... said...

This is a wonderful topic! We're all in the human race.

10:36 PM  
Blogger Gill said...

ah- the universal lady boy has been around since the dawn of time!!

5:07 AM  
Blogger Lea said...


If everyone had compassion, this world would be a better place.

10:07 AM  
Blogger poody said...

LOL I am remembering my first encounter with a gender/pt. I was in nursing school and working as an aide with the LVN who was the charge nurse. Back then as a student I could and would do anything. I went to put a foley catheter in what I thought was a lady but hello she had both genitalia and where the heck does this foley go anyways. I went to report this to my charge nurse who had no idea what the heck I was talking about so we both go down ther and peek and sure enough hermophadite. The meatus was actually almost as if hypospadia, in that it was far down the shaft of the penis which was located where the clitoris usually is. Sheesh!

11:25 AM  
Anonymous marachne said...

Good topic, been following it across blogs. Might have more to say later, but just one bit of info: folks like that describe by poody don't like to be called hermaphrodites but intersex.

And most of them were mutilated as infants when their "ambiguous genitalia" left them in the hands of doctors who decided that it would be too much for them to deal with and performed surgery to give them a specific gender -- and never told them so their feelings of being "off" were never explained.

As to other transgender folks, another few thoughts: 1) There are more and more individuals who are thinking that they don't have to do surgery, so they can provide big surprises for any medical personnel. 2) There are more folks who started hormones in the late teens/early 20's. What kind of health issues are we going to be dealing with after 30+ years of hormones? 3) For those of you with same-sex partners--yeah, there are now enlightened places where they will respect your relationship and allow you the same rights and legally recognized family, but you never know where a disaster can strike: Make each other your medical power of attorney!

2:36 PM  
Blogger Jean-Luc Picard said...

Who'd have thought there were titles like that in 1964?

2:49 PM  
Blogger Cyndy said...

As an aged-care worker, I haven't come across any transgender clients, yet, but in the years to come, this will change, simply because it will have to. Only at that time will the policies be developed to ensure optimal patient care. In the meantime, caring is the best thing we can do. There are also a lot of grey areas in regard to the status and legal rights of the defacto of any gender that are yet to be dealt in a satifactory way. Recently, my Aunt passed away, and her loving partner of 15 years was informed that he had no legal rights in regard to her. Luckily for him, we all love him to death..he provided love and stablility for my Aunt that she had previously never known, so Len's wishes were paramount for us. Unfortunately, this is not always the case, with ex-spouses making decisions that are not always appropriate.
OK, I'll get off my soapbox now. Thanks Mother Jones for providing these excellent forums for discusion ;)

10:52 PM  
Blogger Smalltown RN said...

What a great are right I was never taught in nursing school about trans gender or intersex or gay lesbian relations. I guess we were just expected to treat everyone the same. It was the administrators who had the problem.....mind you I still work with nurses who have difficulties with visiting hours who just can seem to be able to be flexible with the hours. Go figure.

Thanks for a great post!

11:51 PM  
Blogger RX850 said...

I am involved with a non-profit foundation and one of the modules that we are working on now to teach is about tolerance and gender issues to healthcare professionals.

I started out in nursing in the 70's and still find it hard to believe how little has been done. Our non-profit has identified a great need among the aging population to continue to hide trans gender situations or their sexual preferences in order to receive quality care.

I learned long ago to leave any preconceived ideas out of my nursing practice and am happy to now teach some sensitivity to others.

Another great topic MJ. Thanks

10:26 AM  
Anonymous marachne said...

In terms of training, I am involved with one project called "Removing the Barriers" that was designed by the Mautner Project (

That was specifically aimed at myths related to treating lesbians, bisexual, and transgender women who partner with women, and their families. I just went to their site and see they've teamed up with Gay and Lesbian Medical Association (GLMA) and the Human Rights Campaign to create a "simple two sided tool designed to help GLBT people be more open and improve communications with their health care providers" I looked at the tool and it's one side for consumers, one side for providers. There are also a couple of free videos to watch. So there is stuff out there!

12:37 PM  
Blogger Susan Palwick said...

Marachne, thank you for the information!

12:47 PM  
Blogger jbwritergirl said...

Don't ever let beaurocratic protocol change who you are and how you work. The world needs to lighten up and care for everyone no matter what choices they make. If I ever get sick I'll fly you in.

10:08 AM  
Blogger SQT said...

It's nice to know there are medical practitioners like yourself and the others who've posted here who have compassion for people who live "alternative lifestyles."

A big part of why I'm married is just so that I can have a say in my husband's care and well being, and he can look out for me as well. I always feel bad for the loving partners who are cut out of the equation because the law hasn't caught up to reality yet.

2:46 PM  
Blogger Gerbil said...

I used to do workshops on sexual orientation/gender identity for mental health professionals--you'd think that we of all groups would have our act together, but you would be wrong. I got my big ol' degree just this spring, and my program was deliberately ignorant about anything non-heteronormative.

It's disgusting how often my partner or I get subjected to the following line of questioning, even after reporting that we are exclusively lesbian: "Are you pregnant? [no] Any chance you could be pregnant? [no] Are you sure? [yes] How can you be sure? [my partner is incapable of impregnating me] Has he had surgery, or is this a medical condition? [um, my partner has ovaries] Oh."

We even get asked this in front of the other, which would be absolutely awful if it didn't give us the opportunity to cause the provider to blush with "We're still trying to figure out which one of us isn't making enough sperm."

8:56 PM  
Anonymous Anonymous said...

So Poody, how on earth DID you get the foley in LOL :P?

7:53 PM  
Anonymous Anonymous said...

I just recently had my first TS pt in almost 3 years of nursing - it was really interesting how I found out...I walked into a room answering a call light and saw what appeared to be an elderly obese man sitting there with close cropped curly hair so I said, "yes sir, how may I help you?" There was a slight pause and then I was told nicely exactly what "he" needed. As "he" was telling me what "he needed" I went to the top of the bed to turn off the call bell. On turning around I noticed the back of the gown was open exposing an EXCEEDINGLY obvious female rear end covered in undies with "Hanes Her Way" scribed along the waist band! Back in front, I noticed the fatty chest did in fact seem to have small widely set breasts. Come to find out that she was a nurse at an old hospital one of my co-workers worked at when she was not a she! I was kinda tempted to talk to her about it - I was really tempted to pursue hormone use and such when I was growing up - would have been very interesting I'm sure to see a little of what my life may have been like had I chose to become a woman.

11:27 AM  
Blogger Mimi Vogue said...

This comment has been removed by the author.

6:31 PM  
Blogger Mimi Vogue said...

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6:37 PM  

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