I had an embarrassing encounter with a patient, similar to those "Want To Get Away?" commercials for an airline. I approached my next patient in preop. She seemed like a nice lady. Pretty blond hair, makeup, eyebrows plucked just so. "Hello Ms. Jones, I'm Dr. Z. I'll be your anesthesiologist today." "Nice to meet you," she replied in a sweet voice.
I looked through her chart. Her H+P from her surgeon's office was an incomprehensible chicken scratch. Luckily most of the form was a checklist for the review of symptoms, which were all marked negative. After asking some rote questions, I told her I was going to start the IV. "My you have nice big veins. The IV nurse would love you." "Yes," she replied, "I have never had any problems with IV's before, though they're not very lady-like." I swear I could stick a central line catheter into her peripheral veins.
Then we were ready to go. I gave her some Versed and wheeled her into the operating room. I hooked her up to the usual anesthesia monitors. Then I started my induction. Just as she began falling asleep, she whispered, "I'm a man." "What was that?" I wasn't sure what I had just heard. At the last second, right before she lost consciousness, she said in a loud voice, "I'M A MAN!" Then he was asleep.
The circulating nurse and I looked at each other in amazement. My face felt all flushed. We lifted up his gown, and sure enough--he was a man. The patient never corrected me in preop when I kept calling him "Ms." The surgeon walked in and laughed. "I see you've had your 'Crying Game' moment with the patient." He explained that the patient was in the process of having a sex change. He changed himself as much as he could but did not have enough money to undergo the final "transformation."
Lesson learned. Just like one should never assume the person standing next to the patient is a relative, one should never assume the sex of the patient by the face alone. Next time I'll be sure to ask, besides the usual questions about age and weight, "Are you a man or a woman?"