ROLE REVERSAL

  I have seen many surprises in my medical life , but certain things one expects from certain age groups . I would not expect hardcore drug addiction in older patient ,At the same time I would not suspect cancer in younger patient . But things are not always that clear cut . The two short stories that I am going to tell , belong to such category .
     I was working in ER many years ago . It was late at night . We used to have 2 residents working in the ER , but after 1am or so if the ER was not busy , then one resident would go home .On that day I was suppose to stay till  morning .At about I was told that there was a lady who had come with 'lower abdominal ( belly ) pain '. So I went to see her .Normally at such odd time two types of patients come in , those who are so bad that they can't wait till AM ,or those who have no time otherwise to come to ER at other time .
    When I entered the room , I saw this young lady . From her dress I would have suspected that she was a prostitute .Her make up , her flashy dress was indicative of that . The first thought that came to my mind was that if she had lower abdominal pain , the she had gynaecological problem , called PID, pelvic inflammatory disease . In our ER we had separate Gyn ,resident. But I had to make sure that there was no medical cause of her belly pain . So I started asking questions . So where does it hurt,? I asked 'Down bellow '. 'Down bellow , where ' I asked . The answer was shocking . He said , 'Down bellow in my balls " I did not understand , So (s)he pulled pants down . She was not 'she ' but she was 'he'. He was pretending to be a female , so as to get 'clients '. He also was taking hormones , estrogen to get enlargement of the breasts  He did not do any sex change as he was not transvestite . When I examined him he had testicular torsion , twisted testicle , which can cause severe pain and needs quick surgery . Needles to say I called urologist and he was taken to the surgery .and did well.My other story in next blog .