While not all trans people are interested in transition surgery (one physician recently estimated to The Washington Post that just 25-30% of trans people have transition surgery of any kind), those who do choose surgery see it as a momentous step toward matching their bodies with the way they feel. Few people are as familiar with the procedure as the nurses who treat the patients undergoing it, which is why we spoke with Donna, a 42-year-old RN who for 10 years has worked in a San Francisco Bay Area hospital's perianesthesia area (that's where patients going into or coming out of anesthesia receive care). "I'm the last person they see before an operation and the last person they see before they go home," she tells us — and she reports that recipients of sex reassignment are some of the happiest patients she sees. Read on for her perspective.
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What are the general steps of prepping a patient for surgery?
"We do the initial intake, we get the list of medicines they're on, we find out their medical history, their surgical history, and we delve in if there's certain things that don’t sound right. With a young healthy person, it can go as fast as 20 minutes and it’s easy to do over the phone. A person with a complicated medical history, they have to come in and see us. They may have tests that are ordered that we need to do. "And we have this entire surgical infection deterrent. We have a whole protocol in place where they do washes the night before and the morning of and we give them antimicrobial mouthwash to swish around. We just don’t want that bacteria in the OR. We want to decrease any risk of surgical site infection. So we go over that with them. There's a lot of education that goes on even before they enter the hospital, so that they're prepared."
Tell me about the steps specific to sex-reassignment surgery.
"When the patients come in to see us, they have been totally evaluated emotionally, psychologically, physically, where they go through intense evaluation to make sure that this is what they really want. They’ve seen their surgeon multiple times. They are given hormone therapy to start the gender reassignment even before they have surgery — estrogen or testosterone. "And they are actually some of the happiest people we deal with. They come in pretty upbeat because they're finally getting something they’ve wanted, for a lot of these people, their whole life, because they’ve had gender dysphoria from as far back as they can remember... They [knew] something [was] not right as far back as they can remember."
"We do the initial intake, we get the list of medicines they're on, we find out their medical history, their surgical history, and we delve in if there's certain things that don’t sound right. With a young healthy person, it can go as fast as 20 minutes and it’s easy to do over the phone. A person with a complicated medical history, they have to come in and see us. They may have tests that are ordered that we need to do. "And we have this entire surgical infection deterrent. We have a whole protocol in place where they do washes the night before and the morning of and we give them antimicrobial mouthwash to swish around. We just don’t want that bacteria in the OR. We want to decrease any risk of surgical site infection. So we go over that with them. There's a lot of education that goes on even before they enter the hospital, so that they're prepared."
Tell me about the steps specific to sex-reassignment surgery.
"When the patients come in to see us, they have been totally evaluated emotionally, psychologically, physically, where they go through intense evaluation to make sure that this is what they really want. They’ve seen their surgeon multiple times. They are given hormone therapy to start the gender reassignment even before they have surgery — estrogen or testosterone. "And they are actually some of the happiest people we deal with. They come in pretty upbeat because they're finally getting something they’ve wanted, for a lot of these people, their whole life, because they’ve had gender dysphoria from as far back as they can remember... They [knew] something [was] not right as far back as they can remember."
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They come in pretty upbeat because they're finally getting something they’ve wanted...their whole life.
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Have you ever worked with someone who changed their mind about wanting the surgery?
"By the time they get to us, no. By the time that patient is scheduled for surgery and they show up on our doorstep, they are well-prepared and so ready to have the surgery. So ready. The younger people, a lot of times their parents will be there to support them. I think the nicest thing is that when the person is young, 20s, maybe even a little younger, what we've seen is that there's family involvement and family acceptance. The older patients — I've seen it in 40- and 50-year-olds who finally do it — they have a support system, but it's usually not family. It's usually friends, from what I can see." Do you tend to see more male-to-female or female-to-male surgeries?
"I'd say it's about even. I can't say I've seen one more than the other."
"By the time they get to us, no. By the time that patient is scheduled for surgery and they show up on our doorstep, they are well-prepared and so ready to have the surgery. So ready. The younger people, a lot of times their parents will be there to support them. I think the nicest thing is that when the person is young, 20s, maybe even a little younger, what we've seen is that there's family involvement and family acceptance. The older patients — I've seen it in 40- and 50-year-olds who finally do it — they have a support system, but it's usually not family. It's usually friends, from what I can see." Do you tend to see more male-to-female or female-to-male surgeries?
"I'd say it's about even. I can't say I've seen one more than the other."
What is the recovery process like?
"They're in the hospital. They stay in the hospital several days and then they get released, but it is a hospital stay."
"They're in the hospital. They stay in the hospital several days and then they get released, but it is a hospital stay."
Have you encountered misconceptions about trans patients?
"Medical people don’t have very many misconceptions. Medical people get it. Medical people understand it, but what I hear from the public that is non-medical is they don’t get it... People...quote the Bible to me, and the first thing I say to them is 'Really? You do realize that these people don’t have choices.' 'No, it's a choice,' they say, and I say 'Oh, really? Do you think they'd really put themselves through this? So you know the Bible talks about treating your slaves well. Does that mean I should have slaves?' There's a lot about the Bible that is cultural, and it's a culture of the time that it was written and has nothing to do with what is happening... I say 'Well, does God make mistakes? No. God made this person; this is not a mistake — God doesn’t make mistakes.' "If somebody brings it up, I'll discuss it. The fact that I have a gay son brings it up a little bit more than somebody who has straight children... Where I work, [sexuality and gender identity] are not even an issue. It's not 'Oh, this is Dr. So-So and she's a lesbian." It would be like saying 'Hi, my name is Donna and I'm straight.'"
"Medical people don’t have very many misconceptions. Medical people get it. Medical people understand it, but what I hear from the public that is non-medical is they don’t get it... People...quote the Bible to me, and the first thing I say to them is 'Really? You do realize that these people don’t have choices.' 'No, it's a choice,' they say, and I say 'Oh, really? Do you think they'd really put themselves through this? So you know the Bible talks about treating your slaves well. Does that mean I should have slaves?' There's a lot about the Bible that is cultural, and it's a culture of the time that it was written and has nothing to do with what is happening... I say 'Well, does God make mistakes? No. God made this person; this is not a mistake — God doesn’t make mistakes.' "If somebody brings it up, I'll discuss it. The fact that I have a gay son brings it up a little bit more than somebody who has straight children... Where I work, [sexuality and gender identity] are not even an issue. It's not 'Oh, this is Dr. So-So and she's a lesbian." It would be like saying 'Hi, my name is Donna and I'm straight.'"
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Well, does God make mistakes? No. God made this person; this is not a mistake.
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What else sets gender reassignment surgery apart from other surgeries?
"The surgeons who do it are really pretty incredible. They totally believe in what they're doing. They have invested a lot of time in the patient, making sure the patient is ready for this surgery — there's a whole psychological/emotional component to it that the surgeon is involved in. It's not to say that the general surgeon who comes in and does a hernia repair isn't as invested in it, but there's very little emotional component to a hernia repair versus a whole gender reassignment. "Patients [who] come in for gender reassignment are so excited, even if they're nervous about it or afraid about it; they are so ready for the surgery...their whole mind is so different [from that of] somebody coming in for a gallbladder surgery. A lot...of those people have already assumed their new name, but...they may not have legally changed it yet. They may want to wait. So, legally, their chart may say Joe Smith, but they want to be called Josephine. "So the first thing that we nurses ask them is 'How would you like us to address you?' And so we make sure that the OR nurse knows and the anesthesiologist knows and the recovery room nurse knows and the floor nurses know how to address the patient. We go out of our way to try very hard to use he and she correctly. And there's slips, and, you know, a lot of times they’ll make a joke out of it. But when we're really trying, it's...noticed. So we really do."
"The surgeons who do it are really pretty incredible. They totally believe in what they're doing. They have invested a lot of time in the patient, making sure the patient is ready for this surgery — there's a whole psychological/emotional component to it that the surgeon is involved in. It's not to say that the general surgeon who comes in and does a hernia repair isn't as invested in it, but there's very little emotional component to a hernia repair versus a whole gender reassignment. "Patients [who] come in for gender reassignment are so excited, even if they're nervous about it or afraid about it; they are so ready for the surgery...their whole mind is so different [from that of] somebody coming in for a gallbladder surgery. A lot...of those people have already assumed their new name, but...they may not have legally changed it yet. They may want to wait. So, legally, their chart may say Joe Smith, but they want to be called Josephine. "So the first thing that we nurses ask them is 'How would you like us to address you?' And so we make sure that the OR nurse knows and the anesthesiologist knows and the recovery room nurse knows and the floor nurses know how to address the patient. We go out of our way to try very hard to use he and she correctly. And there's slips, and, you know, a lot of times they’ll make a joke out of it. But when we're really trying, it's...noticed. So we really do."