Gender Respect in Death and Dying
Two years ago my teenage daughter did a report on women in history who disguised themselves as another gender. I loved the topic and followed the studies along with her and found myself really cheering the trans individuals on. I wanted them to be brave and clever and “win” against societal norms. And then we came across the story of a well respected and loved man who was born with female genitalia who became old, was sent to a nursing home and there was “discovered.” He was dressed in female clothing, was addressed as "she" and called by his female birth name until he died.
Now, this was around 1920. But, I’m not so sure anything much different would happen today. If a female brought into a nursing facility was there discovered to have male genitalia, would she be given a female roommate or male? I keep reminding folks that separating by gender these days is nearly irrelevant… Girls like boys like boys like bi like trans like girls and unless you are talking about sex or pregnancy, gender don’t mean a thang.
As a Private Duty nurse I once sat overnight with a woman who was born female who had a double mastectomy due to cancer 50 years earlier. (The woman was 104 years old) She was in an active phase of dying and was actually physically active. Even though she was dying simply of old age, her body was still very strong. She used no walker, no hearing aid, and only used pull-ups at night “just in case.” Around 2 am her breathing started to become restricted and because she was still so strong she sat bolt upright at the end of her bed and started pulling at her nightgown. I asked her if she would like some water or a back rub, or if I could sing her a song. No answer. In fact, she was not really “in this world,” if you will. She pulled off her nightgown so she was just in her pull-ups and then wanted her nightgown back on. Then she wanted socks on, and socks off and nightgown on and nightgown off. Each time her nightgown came off she impulsively threw her arms over her chest to cover where her breasts once were. She was not panicking… Just obsessive. I checked with the RN who said she had no meds that could be given and so I just sat with her. I made sure she did not hurt herself and was there if she needed any assistance, but the most I could do was simply breathe and witness. I did this with and for her consciously with intentions of offering vicarious comfort. As I witnessed this human dying, I awakened to the fact that I had occupied this same out-of-mind, and body-in-turmoil when I was in heavy labor with my first child. This also looked very similar to every pet that I had sat with while they were dying. I took comfort in reminding myself of the body's natural process and when she calmed down and returned to bed, likely, quite light headed, I reminded her of this very natural process as well. I told her she was doing everything just right.
This woman had no breasts not even nipples. Her hair was short and sparse, she wore no jewelry and her face was very 104 years old. If someone had walked in to that room having not looked at her chart the first thing they would note is the frantic movements and the fact that the person appeared to be struggling to breathe and was unable to relax. It would not be until the patient moved over to the night stand and pulled a cap off from a very worn tube of bright red lipstick to apply it with the perfection of 90 years experience and without glancing in a mirror, that one might then say, “Oh, she’s a woman.”
Last week at a conference I was attending, a homeless individual walked in and sat down, looking old and… homeless. I walked up to them and said, “Can I help you with anything?” They replied, “Can I stay here for a bit? And, yes, I’d love some tea. And as many cookies as you can offer me.” I asked their name and the reply was, “Pete. But I’m transitioning to a woman and I’d like to be called Sonja.” I looked at Sonja’s clothes and noted the brown, grey and black colors and also the eye-stinging stench of urine. She said, “Would you like to see something?” Suddenly one skinny leg flew up into the air and with a yank of the pant leg she revealed a flesh-toned fishnet stocking-- and a smile.
Two hours later we were eating burritos and Sonja was wearing clean Depends with extras in her bag, clean pink socks, had washed her hands and face and was wearing pink and blue sunset spandex leggings with a hot pink tee shirt. Of course warm practical layers went over these, as I reminded her that showing too much leg this time of the year is not appropriate-- She’ll attract the wrong kind of crowd. She agreed.
I don’t know how Sonja will be treated at the homeless shelter with her new clothes. But I remembered how many times the 104 year old woman with the double mastectomy threw her arms over her lack of breasts each time she pulled her off her nightgown and I imagined how many times Sonja might have wished she could apply red lipstick whenever she wanted. You should get that in your life. You should get to wear whatever the hell you want to even if you’re elderly, schizophrenic and homeless, or if you’re 4 years old and come from a great family.
Even in death, gender matters. For better or worse I don’t know, but it matters. Though our bodily systems cease just the same regardless of gender, skin color, or language differences, and we can even act rather animalistic, because we are human, gender matters. Many times if something has impacted your life so hugely, your strongest desires and your habitual responses remain until life exits your body. Even through dying, even in death, the you that lived here and the individual you intentionally were should be respected by all care takers in your most vulnerable moments- straight through to your stone carving.
Your responsibility is to do advance planning and/or have your awesome next-of-kin able to speak for you so you are respected in the manner you deserve.
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