Confessions of a GP

by Benjamin Daniels

For those of you who are interested, the operation is called ‘male to female gender reassignment surgery’. There are various techniques but the most popular appears to be cutting off the testicles and inverting the penis. The penile and scrotal skin are combined and used to line the wall of the new vagina and to make the labia. The surgeon makes a clitoris using the part of the penis with the nerve and blood supply still intact. According to the surgeon’s website, this enables some patients to orgasm. I haven’t yet asked Kirsty about this but I’m sure she would happily tell me all about it given half a chance.

  Despite the extrovert exterior, there was a real sadness about Kirsty. The sacrifices that she had made to change her gender were extraordinary. She gave up her marriage and children (only one of whom still talks to her). She lost her job and many of her friends and the pain she describes of the surgery and recovery period is unimaginable. Kirsty now lives slightly on the fringes of society. She is stared at in the street and struggles to find acceptance at every corner. It seems amazing to me that she would have put herself through this much to make the change.

  Kirsty, however, has absolutely no regrets. She told me that five years earlier she felt that her only choices were to have the operation or commit suicide. In the nicest possible way, Kirsty is a bit of a drama queen but I genuinely think she means this and the doctors at the practice who knew her as a man agree that she was pretty close to ending her life back then.

  Empathy is defined as an ‘identification with and understanding of another’s situation, feelings and motives’. I like Kirsty but I can’t really empathise with her, as I just find it so hard to imagine what it would be like to be so unhappy with the gender I was born with. Kirsty is quite astute and I think that she has spotted this in me. As she left, she said, ‘It’s fucking hard being me, you know. You should try being a trannie for a day.’

  I did once lose a bet at medical school and had to spend an evening out dressed as Smurfette. I’m not sure it really corresponds to empathising with the emotional and physical turmoil experienced by a transsexual; however, being painted completely blue and wearing a dress and blonde pigtails, it did take me a hell of a long time to get served at the bar.

  ‘It’s my boobs, Doc’

  Stacy was in her late thirties but the years of smoking and sunbeds made her look much older. She stormed in and sat down with the look of someone who wasn’t going to leave until she got what she wanted. ‘It’s my boobs, Doc.’ I must have had a slightly puzzled look on my face, so in order to enlighten me she lifted her top to reveal her large and extremely distorted breasts. They looked like two oval-shaped melons surrounded by a layer of puckered skin and had two nipples drooping off the ends. They were pointing at awkward angles and looked completely disconnected from the rest of her body.

  ‘Something needs to be done,’ she demanded. ‘I ’ad ’em done ten years ago but they need redoing.’

  It turned out that the original surgeon was happy to ‘redo’ them and his letter from 1998 did clearly state that her breasts would need repeat surgery after ten years. The problem was that he was charging 10K for the redo and, according to Kerry she didn’t have that sort of money. ‘I need ’em done on the NHS, don’t I?’

  My sympathy for Stacy was limited. Yes, she did have hideously deformed bosoms but the local breast surgeons were rather busy removing cancers. I didn’t really feel that she should qualify for NHS treatment. I began to try to explain that I wouldn’t be referring her today when Stacy began rummaging through her bag, eventually emerging triumphantly with a copy of a women’s magazine. She opened it up to a double-spread headlined: ‘My Fake Boobs Burst and Nearly Killed Me’. I read on to see that, like Stacy, this woman had had a breast augmentation in the 1990s, but ten years later her implants ruptured and left her in intensive care with blood poisoning.

  The prospect of Stacy being poisoned by her exploding fake breasts might have entertained a lesser doctor than me, but then Stacy pointed out the part of the article showing that the poisoned implant lady was taking her GP to court for not referring her earlier. I could see in Stacy’s eyes that nothing would give her more pleasure than suing my arse for every penny she could. Defeated and broken, I made an apologetic referral to the surgeons as Stacy looked on smugly.

  Two weeks later Stacy stormed back in with the letter from the surgeons stating that she didn’t qualify for the operation because of ‘PCT funding guidelines’. It was the perfect scenario for me. I didn’t really want NHS money spent on Stacy’s new boob job but could now blame some faceless managers for it not being done. I was off the hook and happily faked sympathetic noises as Stacy complained about how unfair the world was. A month later Stacy found the money to get her breasts redone privately.

  Mr Hogden

  I was spending a few weeks working in a very pleasant rural practice. It was nice to have a break from the poverty-fuelled social problems of the inner cities. I had dug out a few ties that I had long since stopped wearing and also rediscovered my best posh accent that I had last used for my medical school interview in 1996. Surrounding the surgery was a collection of very pleasant villages with big houses and twee thatched cottages. It was foxhunting and green welly territory. During a sweltering few weeks in July, it was a pleasure to be cruising around the countryside doing my home visits rather than stuck in city traffic jams cursing the lack of air conditioning in my car.

  Driving down a small country lane, I came across a row of small run-down bungalows. They looked a little out of place in contrast to the rest of the local housing. They were the area’s small quota of council housing that the rest of the village tried to ignore.

  The patient I was visiting was called Mr Hogden. He lived quietly with his sister in one of the less well-kept bungalows. He was only in his early forties but hadn’t left his bungalow for nine years. The medical notes seemed to suggest that this was due to a history of agoraphobia, but more obvious on meeting him was that there would be no way Mr Hogden would have fitted through the door. He was fucking enormous.

  Mr Hogden resided in the smallest room of the bungalow. It was about the size of a double bed and was taken up entirely by Mr Hogden himself sprawled out on the floor. He had long since broken his bed and now spent his time on a very old, filthy looking mattress on the floor. Each of his limbs was made up of several huge rolls of fat with a hand or foot poking out at the end. His head emerged out of a humungous mass of lard that was his torso.

  The sight of Mr Hogden sprawled out on the floor was a bit of a surprise but it was the smell that I really struggled with. The bungalow was like an oven in this hot July sunshine and there was only a tiny window in the room that barely let in any air or light. Flies were buzzing around in their hundreds and as my eyes slowly adjusted to the dimly lit room, it became apparent where they were coming from. Unfortunately for Mr Hogden, the flies had found that the warm sweaty crevices between his rolls of fat were a perfect place to lay their eggs. Emerging from his legs and body was a legion of maggots. The sight of the maggots and the horrendous smell were almost too much for me and despite priding myself on a strong stomach I had to do my utmost not to vomit.

  ‘You’ve got to help me, Doctor,’ Mr Hogden pleaded with me as he watched me take in the horror of his predicament. Despite the terrible state in which he was living, this was the first time that Mr Hogden had called out a doctor in the last ten years. He had managed to get to the toilet and back up until now and he simply spent the rest of his time lying on his mattress watching a tiny television that was mounted on the wall of his bedroom. His sister brought him his meals and Mr Hogden had quietly grown enormous without bothering a soul. Until now that was. This was yet another of those moments where I felt completely useless and, like all good cowards, I fled. To be fair, what was I going to do? I could have crouched down and picked the maggots out of Mr Hogden’s groin creases but I would have vomited. The flies would have fed off the regurgitated contents of my stomach, only adding to his problems.

&
nbsp; I called the district nurses. I felt bad. I did. Really. No, I did. I warned them what to expect and when I bumped into them a few days later, they were amazingly stoical about the whole clean-up operation. They put me to shame. I went back to see Mr Hogden the next week. The maggots were gone but he was still lying on the floor of his squalid little room. We had a chat and talked about how we were going to sort things out. His expectations were low. All he really wanted was to be able to spend his days sitting in the lounge on a sofa and watching the television like a normal person. He was too heavy for the current sofa – hence the filthy mattress on his bedroom floor.

  I was feeling guilty about my near-vomiting experience during our first meeting so decided to make it my mission to get him a new sofa. I phoned round endlessly and eventually social services agreed to supply a specially reinforced sofa for the bungalow. I had absolved myself. A few weeks after the sofa arrived I received a phone call from a hysterical Mr Hogden. ‘Please, Doctor, come round, please.’ Worried that the maggots were back, I avoided lunch and headed over. Mr Hogden was sitting on his brand-new sofa and had been there since it had arrived. Unfortunately, the effect of now sitting upright meant that his huge weight was now all being placed onto one pressure point on his bottom. He had not moved from his sofa since it had arrived and had developed unpleasant pressure sores on his bottom. The material of the sofa had gradually begun to stick to the infected sores and Mr Hogden was phoning me to tell me that he was now completely stuck to the sofa and couldn’t move at all.

  I couldn’t quite comprehend what he was telling me over the phone, but as I arrived I saw that he was quite right. The material of the sofa and the sores on his bottom had become one. It was impossible to see where Mr Hogden ended and the sofa began. It was not a pretty sight and he had the same pleading look in his eyes that I had witnessed during the maggot incident. He was in a great deal of pain and I was feeling helpless again. I couldn’t believe that he had let his sores get so bad without calling anyone. He really needed to go into hospital but this was easier said than done. The first job was to cut him out of the sofa, which required a fair bit of teamwork, a set of garden shears and a very strong stomach. The next task was the more difficult job of physically getting Mr Hogden to hospital. I had ordered a specially reinforced ambulance with a strengthened trolley but, unfortunately, despite best efforts, Mr Hogden just couldn’t be fitted through the door. Four paramedics, a nurse, a medical student (I had to bring him along to show him that general practice wasn’t boring), several of Mr Hogden’s neighbours and I all tried to find different angles or ideas to get him out of the bungalow. In the end the fire brigade had to be called to cut out a wider door. They were reluctant and made Mr Hogden sign a disclaimer promising that he wouldn’t try to sue them for damaging his bungalow. Eventually, we got Mr Hogden to hospital. The next day my placement ended and I’ve no idea what happened to him. I hope he’s lost some weight and perhaps gained some quality of life.

  Small talk

  Drew was a very good-looking guy. He was in his early twenties with big muscles, perfectly chiselled features, blonde hair, blue eyes and a probably fake but nonetheless healthy-looking tan.

  ‘I’ve got a painful testicle, Doctor. Wondered if you’d have a look at it.’

  I was the only male doctor to have worked at this practice for over a year and my first few days were spent seeing a queue of relieved men worried about their genitalia. Some had been worried about their ‘bits’ for months but had been too embarrassed to expose themselves to one of the female doctors.

  So there I was, gently rolling Drew’s testes between my fingers, looking for lumps. It can be a slightly uncomfortable situation for the patient in every sense of the word, so I decided to try to make a bit of small talk to put him at ease.

  ‘So Drew, what do you do for a living?’

  ‘I’m a film actor.’

  ‘I thought you looked familiar. Have you been in anything I might have seen?’

  ‘That depends, Dr Daniels, I only really do gay porn.’

  ‘Ah, probably not then, no. You…erm…must have one of those familiar-looking faces I guess. Definitely wouldn’t have seen you in a film. Nothing against porn or anything, except the degradation of women and all that…well, not many women in your films, I should imagine…’

  There was now only one person in the room who was uncomfortable and it wasn’t Drew. I really should remember to limit my small talk topics to the weather and city centre parking problems.’

  Notes

  It is always drummed into us how important it is for us to keep clear, coherent and detailed medical notes. These are apparently real extracts from medical notes. They have been doing the rounds as an e-mail.

  She has no rigours or shaking chills, but her husband states she was very hot in bed last night.

  Patient has chest pain if she lies on her left side for over a year.

  On the second day the knee was better, and on the third day it disappeared.

  The patient is tearful and crying constantly. She also appears to be depressed.

  The patient has been depressed since she began seeing me in 1993.

  Discharge status: alive but without my permission.

  Healthy-appearing decrepit 69-year-old male, mentally alert but forgetful.

  The patient refused autopsy.

  The patient has no previous history of suicides.

  Patient has left white blood cells at another hospital.

  Patient’s medical history has been remarkably insignificant with only a 40-pound weight gain in the past three days.

  Patient had waffles for breakfast and anorexia for lunch.

  She is numb from her toes down.

  While in ER, she was examined, X-rated and sent home.

  The skin was moist and dry.

  Occasional, constant infrequent headaches.

  Patient was alert and unresponsive.

  Rectal examination revealed a normal-sized thyroid. (Thyroid gland is in the neck!)

  She stated that she had been constipated for most of her life, until she got a divorce.

  I saw your patient today, who is still under our car for physical therapy.

  Both breasts are equal and reactive to light and accommodation.

  Examination of genitalia reveals that he is circus-sized.

  The lab test indicated abnormal lover function.

  The patient was to have a bowel resection. However, he took a job as a stockbroker instead.

  Skin: somewhat pale but present.

  The pelvic examination will be done later on the floor.

  Patient was seen in consultation by Dr Blank, who felt we should sit on the abdomen and I agree.

  Large brown stool ambulating in the hall.

  Patient has two teenage children, but no other abnormalities.

  The patient experienced sudden onset of severe shortness of breath at home while having sex, which gradually deteriorated in the emergency room.

  By the time he was admitted, his rapid heart had stopped, and he was feeling better.

  Patient was released to out patient department without dressing.

  She slipped on the ice and apparently her legs went in separate directions in early December.

  The baby was delivered, the cord clamped and cut, and handed to the paediatrician, who breathed and cried immediately.

  When she fainted, her eyes rolled around the room.

  Lists

  Please don’t bring a list of problems when you see your GP. I understand that you might not get to the surgery very often. Perhaps you have to sweat blood to get an appointment. Maybe you had to plead with your boss for the morning off and then beg our receptionist to squeeze you in. In fact, it is probably so difficult for you to get an appointment with your doctor, you’ve saved up all your niggling health queries that have been building up for the last few months and thought it would be better to get them all sorted out in one visit. Please don’t!

  We have te
n minutes per appointment. That isn’t very long, but we GPs pride ourselves in dealing with even quite complex problems during that short period of time. We have to get you in from the waiting room, say hello, listen to your concerns, take a history, examine you, discuss options, formulate a plan, write up your notes and complete any necessary prescriptions or referrals…all in just ten minutes! It’s amazing that we ever run to time. However, if you have saved up four problems to sort out, then that leaves just 2.5 minutes per problem. That isn’t very long and we’ll either spend 40 minutes with you and annoy the rest of the morning’s patients by running very late, or we’ll only half-heartedly deal with each problem and probably miss something important. This is clearly bad for your health and our indemnity insurance premiums.

  If you do have a list of several problems, please warn us from the start and tell us what they all are. I’ve frequently had patients tell me that they are here to talk about their athlete’s foot and then after a leisurely ten minutes casually mention their chest pains, dizzy spells and depression on the way out of the door. If you have got several problems you want addressing, try booking a double appointment or decide what problem needs to be dealt with that day and book in another time for the others. Moan over. Ta.

  Ten minutes

  I see the ten-minute appointment as the patient’s time to use as they so wish. Most patients will fulfil the time in the conventional way with a discussion of a health problem that we then try to collectively resolve. However, any GP will tell you that not all consultations run like this. For example, one of my patients uses the time to tell me about the damp problem in her spare room and another about the affair that she is having with her boss that nobody else knows about. I have one patient who comes into my room, sits down and strokes a toy rabbit in complete silence. Initially, I desperately tried to engage her in conversation, but I have long since given up and now I get on with some paperwork, catch up with my e-mails and check the cricket score online. When her ten minutes are up, she gets up and leaves. She doesn’t even need prompting, a perfect patient!