Inter/Act

Monica

I can understand why they did it.

My doctors had choices to make and they did what they felt was best. When push came to shove and they were faced with the unknown, executive decision-making fell in their court. That doesn’t make it right nor does it make their point of view clear. So what is that viewpoint? Why is a black-and-white answer for a physician such a gray-scale answer for the patient? I’ll give you a possible explanation: emotions.

While I am not a psychoanalyst, I would argue emotions, by definition, can be irrational.  They are too closely linked to mood, temperament and personality to not have an effect on highly charged, stressful situations. The disconnect between the emotionally-shocked patient and the scientifically rational doctor may be one of the key issues in the doctor vs. patient feud that is all too common in the world of intersexuality.

Admittedly, my position is a curious one.  As an intersex person with 17-beta-hydroxysteroid dehydrogenase deficiency (17β-HSD3-Deficiency) I have undergone numerous surgeries to “normalize” my physical features. How on earth can I sit here and say that I understand the position of my past physicians?

It’s not that I possess an overly forgiving or unemotional personality, nor is it a lack of reflection on my situation and how I’ve been treated. Rather it is the fact that I’m entering my clinical year of veterinary school, and as such have been trained in the medical field…

This clinical training has given me unique insight into what could possibly be going through medical minds as they recommend procedures that end up being detrimental to the patient in the long run.

Some may scoff at the notion that veterinary school is even remotely similar to medical school for humans. Let me assure you it is closer than you could possibly imagine. The patients I will treat (and have treated) are not human, but every patient I see is attached to an owner.

By default the emotional scheme that we deal with is on par with the human medical field. Though the owner is not personally afflicted with the disease, the emotional attachment to their animal can bring the same feelings of grief, shock and emotional trauma experienced by human patients and their loved ones. Medical doctors and veterinarians alike are trained in dealing with grief, sorrow and loss.

We are both trained to:

• give comfort when necessary but also to maintain a professional distance,
• maintain objectivity and to offer the best medical advice we can in the face of emotional trauma and shock, and to 
• present the options to patients and offer advice on the best course of action.

I wouldn’t describe this training as cold and calculating but rather an attempt of science to maintain rational dialogue in the face of irrationality and emotionally-charged situations. That may mean nothing to you so let me elaborate with a scenario from my own life.

I was 14 when I was first diagnosed with an intersex condition. I thought I had enough to deal with just being a living, breathing teenager. Despite the troubles we all face at that stage of life, my world flipped upside-down in a way I could not have predicted.

My diagnosis left me reeling, and my parents were likewise blindsided. Snippets of conversation stand out in my memory, such things as “XY chromosomes are normal for boys”, “your clitoris is enlarged”, “you have no vagina to speak of”, and of course, “you need surgery in order to make things right”.

Those were not very cheery conversations. In time I became sullen and angry at the world, bitter at my doctors, and dissatisfied with results of surgeries gone awry. No doubt many can relate to these feelings and emotions.

Fast-forward twelve years to present day. I’m seven years into an eight-year doctorate of veterinary medicine program, and have a different perspective on those conversations from so long ago. Through the course of my medical training, I’ve had lectures from physicians of every area of veterinary medicine.

From oncology to neurology, internal medicine to trauma victims, I even had training in how to handle the more delicate areas of grief counseling and referring psychological resources for shocked and grief-stricken owners. When our clients are presented with information that is both shocking and foreign we are trained to maintain professionalism and present the facts.

Empathy and understanding is important but we are also tasked with helping clients understand the unknown. As part of that, we are trained that clients will often struggle to absorb information when shocking news is presented to them, and therefore we must be clear as possible, discarding medical jargon and instead using concise words that the laymen would understand.

So what does it all mean in my particular scenario? I would argue that my doctors did their job. I was the patient who was shocked, confused and scared. They played the part of the professional trying to comfort and inform. In my world of gray emotional turmoil, they tried to bring back a balance of black and white rationality, offering solutions that remain the medical standard. What I originally took as blunt indifference, I now see as a valiant effort to inform without overwhelming me.

Please don’t misunderstand me: I do not condone everything that was done to me, nor do I see medical practices of “normalization” as right. I do, however, strive to bridge the gap between doctors and intersex patients. In good conscience, I cannot claim to be the only misunderstood side of the coin, for I have played both parts in this charade.

My doctors did not mean to harm me. They merely did the best they could in an impossible situation. 

Is there room for improvement? Absolutely.

That’s why we’re here now, isn’t it?

Monica, 2-23-12