Trashy and cheap

Trashy and cheap. The two words flashed through my mind as Joanna, a lanky woman with over-teased platinum-blond hair, enough eye shadow to paint a house, and skin-tight jeans ambled her way into my exam room. Her huge breasts, heaving through a tight, low-cut top screamed, "Boob job" like a Vegas neon sign. Her voice, smoky and low, rasped with a tone some men find sexy. It hollered "heavy smoker" and "lung cancer risk" to me. She was only the third patient I'd acquired since opening my new practice, so I mentally spanked myself with my stethoscope for harboring such unflattering thoughts toward a patient. Joanna deserved a compassionate and tolerant doctor, not one who was judgmental. I stuck out my hand and introduced myself. She extended a boxy hand sporting two-inch red nails.

After inquiring about her occupation, family history, and allergies, I rattled off my usual "new patient" questions: "Have you had any surgeries before?"

"Yes," she mumbled in her gravelly voice. "I had my sex organs removed."

"Oh, a hysterectomy,"I responded.

"Um, not exactly." She avoided eye contact.

"Your ovaries?" I offered.


"Fallopian tubes or vagina?"

"No, not them either," she said,  now squirming in her chair.

Okay, she had me stumped. What other female sex organs were there?

She must have read my perplexed expression because she mumbled, "I had a sex change operation. My previous name was Joe."

Lesson number one in Bedside Manner 101 class: Never reveal to a patient she's totally shocked you. Stay calm and act non-chalant--like every female patient you doctor used to be a man.

"I see," I responded without missing a beat. "So when and where was your surgery?"

"Zurich, in 1988."

I scribbled frantically in her chart, trying not to show she'd rattled my cage. My mind went blank.

The sex change operation did explain her narrow hips, low voice, boxy hands, and need for breast augmentation surgery!

But now came the real dilemma. Do I offer her a Pap smear? The woman had no real female organs so it wasn't necessary, but isn't enduring a Pap smear one of the "rites of passage" that usher a girl into womanhood? If I didn't offer her the test, would she feel slighted? Deprived? Unaccepted? Worse yet, discriminated against? Would some snarky lawyer take up her cause and sue me for discrimination against transsexuals because I hadn't treated her like other women?

On the other hand, if I did offer to do a Pap smear, would she laugh in my face and snap, "Why would you do a Pap smear when I don't have any real female organs?" I'd look like a fool. Like someone who had failed Human Anatomy.

In the end, I decided to be honest and explain why I didn't feel a Pap smear or Mammogram were necessary. She agreed with me and thankfully, no blood-thirsty lawyer came prowling.