I referenced in my post about my post-op appointment with Dr. Safir that I would be returning home earlier than a person normally would having just had a lower surgery procedure. I was able to arrange this because I found a urologist locally that could and would treat me. She also referenced me not being her first transsexual patient who had lower surgery during a previous appointment. I have been satisfied with her care, even though I have had issues with nurses in her office. I have separated this post into two sections because what shouldn’t have been an ordeal getting post-operative care at home became one.
The hospital system that my local urologist works in uses an outside scheduling service to manage appointments with all practices within the hospital system. To set up care for this surgery, my local urologist instructed me to use a messaging system that the scheduling service uses to schedule post-op appointments once I returned home. She thought this would be easier than calling and trying to schedule that way.
I started using this messaging system the day after my surgery. I had a feeling that getting appointments scheduled could become an issue. It became clear within days that my feeling was right. By the time I left San Fransisco on October 11th, I still did not have a post-op appointment with my local urologist. Around October 15th, I received a phone call from a scheduler informing me that I had an appointment with my doctor on November 21st. This was laughable, as I still had a catheter in. I told them that would not work and I needed to be seen much sooner.
I went back to the messaging system and informed the nurse on the other end again about my procedure, my catheterization and that an appointment in November would not work. At this point I had begun my voiding trial, which thankfully went very well. I also reached out to my primary care physician (PCP) to assist me because I was worried about an impending UTI going into the weekend. I was totally frustrated and anxious, neither of which is good for healing.
To make matters worse, I was then misgendered in the last message I received from this scheduler. While I understand this was most likely an honest mistake, it was icing on the cake. I addressed that and wrote back a lengthy response, telling the scheduler that Dr. Safir’s office had sent the requested medical records on October 12th and asking why getting even one appointment was so difficult. I never heard anything back. In the interim I had been scheduled for an appointment on October 31st, the day before I returned back to work. It meant four total weeks with a catheter, but honestly, I gave up with the scheduler because I wasn’t experiencing any problems and was exhausted by the whole situation.
On October 25th, I had a phone call with Dr. Safir to follow up on my progress. It was the shortest phone call I have ever had with him, but there wasn’t much to say other than that I was voiding well and that I was continuing to heal. I did let him know what was going on back home, but of course there was nothing he could do about it.
All of that leads us up to the appointment.
I decided before my appointment that I was not going to bring any of this up, as I wanted to get good care and didn’t want to make anything awkward or tense. I had resolved at this point to change practices because of this situation even though I was satisfied with my doctor.
I was called back and while my attending nurse was very kind, I don’t think she understood the nature of my procedure either. I asked if my urologist wanted me to do a flow test because she had last time. The nurse thought about it and agreed that it couldn’t hurt. So I did and then she checked to see how urine I had left in my bladder via ultrasound. Everything was fine and she left.
My urologist came in and we talked about my surgery, my results so far, my questions, and then came time for her to look. Here are the important parts from the visual exam:
- She was impressed with Dr. Safir’s work. I asked how much longer the incisions would take to heal and she said 2-4 weeks.
- I had been having feelings that week about my penis length. It was looking kind of retracted because of healing and the tissue wasn’t relaxed. She said that he had given me another centimeter in length, I just couldn’t see it due to my mons and not having had mons work done. This helped alleviate my negative feelings.
- She was very impressed with the results from my flow test.
As she was getting ready to take the catheter out, she brought up the whole appointment fiasco. I told her I was relieved she had brought it up because I didn’t know how to address it without potentially making things awkward or tense when one of the people involved was going to pull a tube from my body. She chuckled. After the catheter pull we talked about the situatiuon.
She apologized sincerely and informed me that the first she heard of me contacting the practice was October 21st. I told her that I had been trying to get scheduled since the day after surgery. She admitted that this was a total lapse in care and blamed the scheduling system (which does have a notorious reputation for being awful). I told her that because of all of this, even though I was happy with her care, I was considering finding another doctor due to the situation. The bottom line is, if I had a complication or infection I would have been out in the wind and that was not OK. She agreed.
My urologist handed me her card and told me to email her work email from now on to schedule anything with her or setup any other care. I told her I wanted to write up a formal complaint, complete with all the messages between me and the scheduling nurse. She told me I should. We also discussed the pieced together network of specialized surgeons that makes up trans health care and what that means for big hospital networks trying to treat trans patients. In a nutshell, something has to give with that or health care that is trying to cater to trans people will end up being just as gate kept, if not more so, and as a result ineffective. I intend on writing a separate post about this at some point.
If you made it this far, you understand why it took me so long to write this. I felt that sharing this experience was important. It is important to be your own advocate. It is important to communicate with all of your health care providers. It is important to educate yourself on how to navigate these systems. It is important to have a support network.
I told my urologist that not all trans men would have been able to handle this appropriately or adequately, and that even though I had, it still put me under a lot of needless stress. She agreed and encouraged me to continue to advocate, not only for myself, but that by doing so in this system, I might be able to advocate for others.