Guest editor Joyce Hislop, AD, RN, is a freelance writer in Breinigsville, Pa.
Anxiously, I answered the firm knock on my father's kitchen door.
At 1 p.m., the nursing agency had called to say they were scrambling to replace the previously scheduled evening aide for my father. A retired nurse myself, I understand schedule frustrations. My dad needed assistance for the day and evening shifts 7 days a week. Of his five adult children, my youngest brother and I lived locally and did what we could, but we each had work obligations. Our dad had agreed to hire an agency to provide home health aides during day and evening hours; our brother covered any late night needs, and our sister JoAnne drove from upstate New York for the weekends.
Standing in the doorway, a tall, stunning woman with a wide smile put her hand toward me in a friendly greeting, at the same time offering an apology. I'll call her Sandra.
"Hi, I'm Sandra, from the agency. So sorry to be late- I didn't anticipate all the traffic lights along the highway and I managed to hit them all!"
The agency had sent us yet another new aide. Sandra was in her 30's, and she looked like a runway model, draped in a gracefully flowing skirt in muted colors of turquoise. The color suited her grey eyes and shoulder-length dark hair. I had to admire her presentation.
Our introductions made, Sandra followed me toward my dad, who was watching and listening from his red leather chair in the middle of the large kitchen. Sandra confidently stretched out her hand to him and smiled broadly, repeating her name in case he had not heard clearly.
"I love your kitchen," she said, and he beamed. In better days he had liked to cook and appreciated any notice of how the kitchen reflected that interest.
"Perfect," I thought, listening to the two chat for a minute about the baker's rack filled with his favorite cook books and shiny pots. The slight Southern drawl in the aide's voice was both charming and soothing.
I showed Sandra where to put her purse and pointed out the phone and emergency contact list. My main concern was that she use good body mechanics to get him up from sitting or lying down: He was a tall man and weak after several months of dialysis. I asked Sandra if she'd mind demonstrating how she'd help him up from his chair.
"Why, sure!" she replied, and squared herself in front of him. In just a couple seconds he was on his feet, looking somewhat surprised at the power behind the position change.
"As long as I'm up, I might as well go in there," he said, and motioned toward the bathroom. Sandra's steps matched his as they slowly moved the short distance. Allowing him privacy in the handicapped bathroom, she stood by the closed door and waited for his call. I gathered my jacket and bag, telling Sandra that our sister was coming in for the weekend and she'd arrive tonight in plenty of time for the shift change. I could see that Sandra and her charge were comfortable with one another and it would be okay if I left.
About 9 the next morning I got my sister's update on Sandra's shift.
"So, Joyce," she began, exaggerating a laid back and casual tone.
Oh-oh. Her tone was leading up to something.
"Is everything okay?" I was afraid to ask.
JoAnne assured me that our dad was fine. She went on to tell me she'd arrived at the house about 9 p.m. Dad was having his usual evening issues with restlessness, alternating between the kitchen and his hospital bed in the living room. Sandra had just settled him back to the bed; it seemed they'd both had a relatively uneventful evening. JoAnne went into the living room to say hello and goodnight to Dad and then came back to the kitchen. Getting a snack, she offered Sandra the same. A cup of coffee and conversation led to the discovery they had mutual friends, and during a second companionable cup Sandra shared a personal confidence: 'Sandra' was really Samuel; her biological gender was male. Through her elementary and high school years she'd rejected the gender assignment she'd been given at birth and had never felt comfortable having to live as a man.
This revelation was astonishing to me. The quality of care Sandra provided had been excellent, and Dad had even suggested that Sandra become one of his regular aides. However, my father, at age 78, might have seen it as a deception. If he'd known Sandra was born male, I believe he wouldn't have understood her choice to live, behave, and dress as a woman.
This encounter happened nearly 20 years ago. It was a different time, before terms like gender dysphoria and transgender were common. With a society more open to different expressions of gender identity,1 I wonder how this situation would play out in today's world.
How would you have handled this situation?
1. Pitts L. Human dignity gets an important boost. The Morning Call. July 3, 2015.