One of the first issues VNSNY nurse Soraya G. faced with her patient, Roberta*, didn’t involve medical care, but it was still vitally important. Roberta had just come home following gender affirmation surgery (GAS), in which her sexual organs were transformed from a man’s to those of a woman. But her mother, who was caring for Roberta during her recovery, continued to call her daughter by her former male name.
Soraya stepped in politely but firmly. “I pulled Roberta’s mother aside and tried to explain in a nice way that it would be good if she addressed her child as she wished to be addressed,” she said. “Traveling from one gender to another is a big change, and patients going through it really need to have their feelings supported.”
Over the next several weeks, Soraya monitored Roberta’s overall recovery, coaching her through the vaginal dilation process (which needs to be done several times a day following male-to-female surgery, to prevent closure of the newly fashioned vagina) and keeping Roberta’s surgeon and the rest of her medical team at Mount Sinai–Beth Israel Hospital in Lower Manhattan updated on her progress. She also continued to provide emotional support. “Roberta told me she didn’t realize that there were professionals like me, who understand transgender surgery and come to people’s homes to take care of them.”
Home care workers often look for common ground with their patients so they can build relationships that go beyond physical care. Joyce H. is another nurse who has received GAS training from VNSNY. She and her home care patient, Martha*, had both grown up in the Caribbean. Both knew the culture’s deep stigma around gender nonconformity—and Martha knew it first hand, growing up as a boy who “always felt different.”
A conversation quickly revealed what they had in common. “I said, ‘Where are you from?’ and when she told me, I said, ‘How did you cope?’ Because we both knew what it was like to grow up in the Caribbean, I understood how hard it must have been for her,” says Joyce, who provided skilled nursing care to Martha following GAS. “She felt relaxed, that I was someone she could relate to. In addition to providing physical care, I also provided the emotional support that I give to all my patients.”
Since the spring of 2016, VNSNY has trained more than 100 clinicians in caring for GAS patients; most are nurses like Soraya and Joyce, but the team includes a growing number of rehabilitation therapists. The training program covers a cultural sensitivity component and a clinical component, in which the clinicians learn how to support the patient’s surgical recovery.
“The clinical aspect of the training is obviously very important,” says Shannon Whittington, the Interdisciplinary Care Team Manager with VNSNY Home Care who directs the program. “But we also really stress the cultural side. This population is accustomed to being discriminated against by health care workers. When our clinicians ask patients what their preferred pronoun is, for example—some people prefer ‘he’ or ‘she,’ while others may prefer to be called ‘they’—the patient understands right away that our caregivers know what they’re doing.”
Since the program began, VNSNY’s GAS team has provided post-surgical care for close to 100 patients. Home care typically last three to eight weeks. Each patient receives several home nursing visits per week at the start of care, with the schedule then tapering off as recovery progresses. While about 70 percent have been referred by the surgeons at Mount Sinai–Beth Israel, VNSNY also cares for GAS patients from NYU Langone Medical Center and the Rumer clinic in Philadelphia.
“Our collaboration with VNSNY has been fantastic from the get-go,” says Zil Goldstein, Program Director for the Center for Transgender Medicine and Surgery at Mount Sinai. “Implementing this special training around the GAS process has been a smooth operation, and we’ve had some great outcomes right from the start—patients being very happy, and feeling they’re really being taken care of after they go home. Post-operative care is a critically important part of the GAS clinical process, and there’s a huge emotional element involved as well. For our patients, having someone available who has been trained in this area to come in regularly and make sure they’re okay is incredibly reassuring.”
* The patients’ names have been changed for privacy.