SophiaBee
Jun 6, 2010, 10:54 PM
From Bilerico Project: http://www.bilerico.com/2010/06/sex_reassignment_surgery_when_things_go_wrong.php# more
Sometimes, things go wrong with the surgery.
It has many names and many acronyms, SRS, GRS, GCS-Sex Reassignment Surgery. Whatever you call it, it is an irrevocable commitment and irreversible step should you choose to take it.
Male to female (MtF) transpeople talk about it a lot. You know: Are you, or aren't you? Is she pre-op, or post-op? Who did yours? Whom are you going to have do yours? We talk about it a lot, except...when things go wrong. Then--we don't say much at all. In fact, we won't talk about it publicly, but it happens. We cover it up as if we should be ashamed. We feel damaged.
Something odd ensues, much like forty or fifty years ago. Back then, people spoke in hushed tones, if at all about the family member, colleague, or friend who had certain illnesses-the "C word"-only whispered. Many times this lack of openness about such matters led directly to preventable consequences--even deaths.
We need to talk about healthcare for the transgender individual and I want to talk--openly about my experience--about what can happen when things go wrong with SRS....
The Endemic Problems In Transsexual Healthcare
My story--and my surgeon's-- illuminate important problems endemic to healthcare for the transgender and specifically, the transsexual person.
•Lack of access- Discrimination by doctors and hospitals and inability to get insurance or pay outright makes it difficult, if not impossible, for many transgender people to access care - primary or specialized.
•Lack of knowledge- Documentation of protocols for care of patients undergoing transition is severely limited. Additionally, techniques for remedial care of complications are not well developed; instead, procedures designed for amelioration of fistulae in natal females are used.
•Lack of training- There exist no specialized courses of study or teaching hospitals for SRS surgeons.
•Lack of experience- While some surgeons learn techniques from other doctors already performing SRS, there are no residencies for those wishing to become SRS surgeons.
•Lack of inter-disciplinary collaboration- Ignorance, discrimination and arrogance on the part of specialists often block those needing specialized post-SRS care.
In 2008 both the American Medical Association and the American Psychological Association issued white papers - policy statements calling for equal and fair access to healthcare for the transgender community. Both organizations recognized lack of access to health care as a growing crisis among transgender people.
Significantly, however, while both bodies asked the insurance industry to remove discriminatory blocks for transpeople, neither the APA nor the AMA asked for better training and documentation of skills. Neither organization called for unilateral coverage of transition related care and procedures. The APA resolution reads thus (emphasis mine):
THEREFORE, BE IT FURTHER RESOLVED THAT APA recognizes the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments;
And the AMA:
RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient's physician.)
Ok, pretty strong statements, right? Look again and in particular, consider the italics. The APA resolution makes one BIG assumption-that you will be able to be "appropriately evaluated" , this requires you to have found and be able to pay for a psychologist, assuming of course, that you want to be evaluated. The AMA resolution assumes much the same thing; that you have a physician and that he or she is willing to make such recommendations, if, in fact, they are so qualified...
There is no curriculum, no specialization, no residency, and no board certification for SRS surgeons. No medical texts detail the procedures. Most SRS surgeons have followed in the footsteps of pioneers.
In my doctor's case, the pioneer was legendary Colorado surgeon, Stanley Biber M.D. whose compassion for a social worker led him to develop the most celebrated sex reassignment practice in the States. The surgeon who did my SRS learned from him and took over his practice when he retired. Soon, she began refining his technique and developing and teaching her own. Today, she routinely performs SRS as many as two hundred times a year...
My Surgeon Doesn't Know How to Fix It
Then, seemingly, neither does anyone else. My SRS surgeon attempted to fix the two-inch tear in my colon while I was still there, the repair failed in less than twelve hours. Next, a colon-rectal surgeon was found in the nearest large city and brought in to look at me. He aborted his attempt to repair the defect and instead, performed a full colostomy.
I flew home to Michigan with a bag attached to my abdomen and thick pads between my legs to soak up the blood.
A local colon-rectal surgeon, persuaded to see me by my primary care physician, was upbeat. Each time I went into surgery with him he would encourage me, saying "this time we'll get it". Coming out of surgery, my spouse Cindy would hear from him how well it went and that he was "optimistic this time" the closure would take and a new defect would not open up.
Another surgeon who has had some success with other fistula patients seemed promising, but eight months later, under the pressure of a barium test, that repair too, failed.
I have had stitch-overs, mucosal flap advancements, and pelvic floor muscle mobilization; each new approach diminishes what viable tissue I have for another attempt. I have tried to go into every surgery with a realistic outlook; multiple failures however, become difficult to bear.
Still, I am one of the fortunate ones with this complication; I stand a chance, albeit small, for an eventually favorable outcome. Many transwoman are not able to find a colon-rectal surgeon who is willing to work on a transperson, much less "someone else's problem", nor do all of us have the means.
Even if you are fortunate enough to locate a doctor--and in my case, privileged to have insurance and financial means to cover remedial procedures, then there is still only a slim chance for alleviation of this humiliating and debilitating condition. One surgeon, out of frustration no doubt, finally washed his hands of me saying, "well, you did this to yourself".
Losing the Patient
I am not writing this to slam the physician who did my SRS. Far from it, she is a dear friend. We have shared much together, laughing, and holding each other; the two of us have grappled for footing. We have cried together, and yes, yelled at each other. She is an icon in the transgender community and heroine to many transsexuals. She is also perhaps the most accomplished of the few surgeons doing primary SRS in the United States.
However, even a surgeon as accomplished as mine cannot overcome obstacles that she has no training for and little experience resolving. There are unseen and unsaid barriers that come into play when someone with complications from SRS must seek treatment aside from their original surgeon.
As I mentioned before, most surgeons just do not want to deal with what they may perceive to be another doctor's mistakes, if they are willing to look at you at all. A person would be hard pressed to get a doctor to admit that they are closed-minded, yet there are many doctors who simply will not work on-or treat a transsexual.
My surgeon has told me, and has repeated often, that she would see me through this. I believe she has tried, but somewhere in the mix of discrimination, ego, and fear, the patient has been lost.
:( ...
Sometimes, things go wrong with the surgery.
It has many names and many acronyms, SRS, GRS, GCS-Sex Reassignment Surgery. Whatever you call it, it is an irrevocable commitment and irreversible step should you choose to take it.
Male to female (MtF) transpeople talk about it a lot. You know: Are you, or aren't you? Is she pre-op, or post-op? Who did yours? Whom are you going to have do yours? We talk about it a lot, except...when things go wrong. Then--we don't say much at all. In fact, we won't talk about it publicly, but it happens. We cover it up as if we should be ashamed. We feel damaged.
Something odd ensues, much like forty or fifty years ago. Back then, people spoke in hushed tones, if at all about the family member, colleague, or friend who had certain illnesses-the "C word"-only whispered. Many times this lack of openness about such matters led directly to preventable consequences--even deaths.
We need to talk about healthcare for the transgender individual and I want to talk--openly about my experience--about what can happen when things go wrong with SRS....
The Endemic Problems In Transsexual Healthcare
My story--and my surgeon's-- illuminate important problems endemic to healthcare for the transgender and specifically, the transsexual person.
•Lack of access- Discrimination by doctors and hospitals and inability to get insurance or pay outright makes it difficult, if not impossible, for many transgender people to access care - primary or specialized.
•Lack of knowledge- Documentation of protocols for care of patients undergoing transition is severely limited. Additionally, techniques for remedial care of complications are not well developed; instead, procedures designed for amelioration of fistulae in natal females are used.
•Lack of training- There exist no specialized courses of study or teaching hospitals for SRS surgeons.
•Lack of experience- While some surgeons learn techniques from other doctors already performing SRS, there are no residencies for those wishing to become SRS surgeons.
•Lack of inter-disciplinary collaboration- Ignorance, discrimination and arrogance on the part of specialists often block those needing specialized post-SRS care.
In 2008 both the American Medical Association and the American Psychological Association issued white papers - policy statements calling for equal and fair access to healthcare for the transgender community. Both organizations recognized lack of access to health care as a growing crisis among transgender people.
Significantly, however, while both bodies asked the insurance industry to remove discriminatory blocks for transpeople, neither the APA nor the AMA asked for better training and documentation of skills. Neither organization called for unilateral coverage of transition related care and procedures. The APA resolution reads thus (emphasis mine):
THEREFORE, BE IT FURTHER RESOLVED THAT APA recognizes the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments;
And the AMA:
RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient's physician.)
Ok, pretty strong statements, right? Look again and in particular, consider the italics. The APA resolution makes one BIG assumption-that you will be able to be "appropriately evaluated" , this requires you to have found and be able to pay for a psychologist, assuming of course, that you want to be evaluated. The AMA resolution assumes much the same thing; that you have a physician and that he or she is willing to make such recommendations, if, in fact, they are so qualified...
There is no curriculum, no specialization, no residency, and no board certification for SRS surgeons. No medical texts detail the procedures. Most SRS surgeons have followed in the footsteps of pioneers.
In my doctor's case, the pioneer was legendary Colorado surgeon, Stanley Biber M.D. whose compassion for a social worker led him to develop the most celebrated sex reassignment practice in the States. The surgeon who did my SRS learned from him and took over his practice when he retired. Soon, she began refining his technique and developing and teaching her own. Today, she routinely performs SRS as many as two hundred times a year...
My Surgeon Doesn't Know How to Fix It
Then, seemingly, neither does anyone else. My SRS surgeon attempted to fix the two-inch tear in my colon while I was still there, the repair failed in less than twelve hours. Next, a colon-rectal surgeon was found in the nearest large city and brought in to look at me. He aborted his attempt to repair the defect and instead, performed a full colostomy.
I flew home to Michigan with a bag attached to my abdomen and thick pads between my legs to soak up the blood.
A local colon-rectal surgeon, persuaded to see me by my primary care physician, was upbeat. Each time I went into surgery with him he would encourage me, saying "this time we'll get it". Coming out of surgery, my spouse Cindy would hear from him how well it went and that he was "optimistic this time" the closure would take and a new defect would not open up.
Another surgeon who has had some success with other fistula patients seemed promising, but eight months later, under the pressure of a barium test, that repair too, failed.
I have had stitch-overs, mucosal flap advancements, and pelvic floor muscle mobilization; each new approach diminishes what viable tissue I have for another attempt. I have tried to go into every surgery with a realistic outlook; multiple failures however, become difficult to bear.
Still, I am one of the fortunate ones with this complication; I stand a chance, albeit small, for an eventually favorable outcome. Many transwoman are not able to find a colon-rectal surgeon who is willing to work on a transperson, much less "someone else's problem", nor do all of us have the means.
Even if you are fortunate enough to locate a doctor--and in my case, privileged to have insurance and financial means to cover remedial procedures, then there is still only a slim chance for alleviation of this humiliating and debilitating condition. One surgeon, out of frustration no doubt, finally washed his hands of me saying, "well, you did this to yourself".
Losing the Patient
I am not writing this to slam the physician who did my SRS. Far from it, she is a dear friend. We have shared much together, laughing, and holding each other; the two of us have grappled for footing. We have cried together, and yes, yelled at each other. She is an icon in the transgender community and heroine to many transsexuals. She is also perhaps the most accomplished of the few surgeons doing primary SRS in the United States.
However, even a surgeon as accomplished as mine cannot overcome obstacles that she has no training for and little experience resolving. There are unseen and unsaid barriers that come into play when someone with complications from SRS must seek treatment aside from their original surgeon.
As I mentioned before, most surgeons just do not want to deal with what they may perceive to be another doctor's mistakes, if they are willing to look at you at all. A person would be hard pressed to get a doctor to admit that they are closed-minded, yet there are many doctors who simply will not work on-or treat a transsexual.
My surgeon has told me, and has repeated often, that she would see me through this. I believe she has tried, but somewhere in the mix of discrimination, ego, and fear, the patient has been lost.
:( ...