More Tales From the Good Doctor Files

I’ve seen a fair number of doctors in my day, and I experience a varied range of interactions with them on a regular basis. Very rarely do I encounter a doctor about whom I rave, because, for the most part, my interactions with medical professionals don’t go well. I’ve rarely been treated with outright rudeness, but I have encountered condescension and snobbery and that sort of thing because of who I am, my size, my life.

Which makes me want to start lauding the rare positive encounters I have, as kaninchenzero recently did in “How to Be a Good Doctor.” The doctor I’m writing about today isn’t actually a doctor, she’s a physician assistant, and she performed my annual exam several years ago, but my experience was so positive that I still remember it vividly.

My appointment started, as they always do, with me arriving 10 minutes early and then sitting in the waiting room for 30 minutes. It’s a very busy clinic, the place where I go for reproductive health stuff and primary care, and I’m used to that. They overbook the schedule a lot, and a lot of seemingly simple appointments turn more involved as the patient says “I’m having suicidal thoughts” or “hey, what do you think I should do about this huge bleeding ulceration on my foot” right as the doctor is leaving the room. So, I bring a book and try to stay calm.

Which is hard. The waiting room is often really crowded, which makes it very noisy, and forces me to sit sandwiched between people, which tends to make me anxious. On this particular day, though, I wasn’t bothered as much, because I was still kind of riding the high from a very intense scene the night before. It was one of those rare nights where I went deep into subspace, that place in my head where I can go when I trust the person I am playing with completely and totally, and just turn into a ragdoll. I like that place, and it leaves me feeling good for days when it plays out well.

So, eventually the nurse emerged to bring me through to the back where I could be weighed and measured. The first awesome thing that happened is that the nurse did not calculate my BMI. There’s an ominous little chart next to the scale, so I was fully expecting her to, but no, she just noted my height and weight without comment or judgment. And she brought me to the exam room, where I changed into the woefully inadequate exam gown and girded my loins for battle. (Literally in this case, I guess.)

So, the PA walked in, and she apologized for the fact that I had been kept waiting before we went over the quickie basic questions to make sure that nothing in ladytown was exploding. And then we started getting into that trickier ground about sexual partners, which I answered honestly, noting that I very rarely have penetrative sex but I did engage in sexual activity with more than one person, and she noted it without comment. Not even a freakin’ eyebrow.

And then, she went to listen to my heart and lungs, and she said “what are these marks,” and I realized, oh, that’s right. I was covered in all sorts of marks which must have looked pretty horrific and nasty. I took a deep breath. How do I explain this? I think it’s good that doctors take note of marks which look like abuse, and I want to make it clear that this is not abuse, but that I am not at all upset that she asked about it. It’s pretty reasonable to assume that marks like these are the result of abuse.

“I’m a member of the BDSM community,” I said, finally. “Those are probably marks from the consensual scene I was in last night. I know what they look like, but…really, I’m not being abused. I’m ok.”

“Oh, ok,” she said. There was a bit of a pause.

“I guess that’s pretty rare up here,” she says.

And then, we actually had a conversation. About what BDSM is, what it means to be safe, respectful (which I prefer to the ableist tagline “sane”), and consensual. About how boundaries are negotiated, the steps people take to protect themselves. I touched very briefly upon some ways that you can identify abuse in a BDSM context, where things like burn marks and scars and rope marks don’t always mean what you think they mean.

And she was so respectful. She obviously wanted to learn, to file this information away to help her work with  other patients, but she didn’t make me feel like a laboratory animal, she didn’t make judgments, she just absorbed information and asked clarifying questions and noted down some of the resources I recommended.

It was…refreshing. Other interactions I’ve had with doctors about this have not gone well. And when we were done, she finished the exam, taking the time to be slow and respectful and to actually respond to my statement that pelvic exams are usually excruciatingly painful for me. She took steps to make it less painful, delivering the least painful pelvic exam I’ve ever had. It was uncomfortable. But it didn’t make me writhe on the examination table. And it was fast.

Disabled sexuality is already marginalized, so when you are disabled and you are a member of a community which engages in alternative sexuality, you become even more marginalized. This isn’t just about the need to find a doctor who respects me, it’s about the fact that services are denied to people because of their sexuality, and this problem is even bigger for people with disabilities. When I meet a doctor who is accepting, I feel safe and comfortable. I feel like I can be open. And I feel like we can have a productive relationship with each other.

She didn’t make assumptions. She listened to me. She reflected statements back at me. And when she was finished, and I got dressed, she stopped back in to personally thank me. To thank me for taking the time to educate her. As a patient, I am not used to being thanked. It was a good feeling that she left me with.