ROLE REVERSAL

   I told you about the story of patient who came with testicular torsion , and was dressed up like a female . This made me think for a different diagnosis, as I thought that 'he ' was 'she'. He was dressed up as female due to 'nessecity '  and not as choice . The story that I am going to tell is of different kind.
   I saw this white male 75 years old . He was admitted to hospital with pneumonia. When I saw him he was in his room , with his wife and was in hospital gown . After taking the history and and talking to him and his wife , I felt that he was aspirating . Aspiration means food or liquid instead of going in to stomach ,it goes to lungs . This can happen after stroke or as some people get older . This is due to poor coordination of swallowing muscles.So I ordered the swallowing function test . This is done by the radiology and speech therapy team . It confirmed my suspicion . He was grossly aspirating and the speech therapist felt that he should not be allowed to eat , but should get a feeding tube . This tube is inserted in the stomach , and then patient is fed with a liquid like Ensure or Boost etc . I spoke to them and they agreed for it , only me telling them that this could be temporary . The plan was to do the stomach feeding tube  and then repeat the swallowing test in next 2-3 months .The he had the feeding tube inserted . His pneumonia was getting better . One day I was quite busy and could not see him in the morning . So I went to see him in the evening . He was not in the room . So when I asked the nurse as to where abouts of him , she said that he and his wife were walking around in the hallway . I went to see him and when I saw him I was surprised . He was walking with his wife , but he was wearing female night gown . i was not too sure as to why he was wearing the female gown . I asked his wife latter on . The answer was perplexing . He wanted to be a female at age 72 or 73 . and had told this to his doctor . He had also told this to his wife and it seemed like she had no objection . He was also prescribed female hormones to reduce facial hairs and develop breasts.
  I did see him in my office . He did come in femenine clothes . He still had aspiration , though it was little better . He did not want to continue the feeding tube , so we compromised . He was allowed some 'forms ' or 'consistenct ' food with reduced risk and he was also fed via the stomach tube .  He was diong this as his choice.