Dividing lines…

‘As every divided kingdom falls, so every mind divided between many studies confounds and saps itself.’
Leonardo da Vinci

I’ve spent quite a lot of this weekend squeezing a man’s cock. Repeatedly holding it and squeezing it, adding lube as needed. It eventually descended into what could be described as a threesome when a tall, dark stranger arrived and joined in, taking over the squeezing and pulling until the job was done.

Except that this really needs to be reworded.

I wasn’t firmly gripping a slick lubed up cock for fun; I was at work and holding a patient’s penis in order to treat him as his doctor. And the tall man who helped out wasn’t a hot stranger but rather my urology colleague whose specialist assistance was needed. My patient had developed a paraphimosis – an uncomfortable situation where an uncircumcised foreskin gets trapped behind the head of the penis and swells up, further trapping it and eventually restricting the blood flow to the area. It’s pretty serious and painful so needs to be fixed as soon as possible. And the cure? Squeeze until the swelling has gone down enough for the foreskin to be pulled back. So that’s what I did. Or more accurately, what I tried to do before calling for more specialist help…

It was while I was standing there, squeezing this stranger’s penis, that I began thinking about quite how narrow the dividing line between what is sexual and what isn’t can be, and how blurring that line can be complicated and potentially dangerous.

Because a lot of what I do to my patients could be considered sexual contact – I perform breast and scrotal examinations, diligently ‘fondling’ each part to ensure there aren’t any hidden lumps or masses; I frequently perform rectal examinations, ‘slipping’ a gloved lubed finger in to check for bleeding or constipation, or deeper to ‘massage’ the prostate, and these are just a few examples.

I’ve used air quotes around the descriptive words here to again emphasise the fine difference between what I do for medical reasons with robust consent and usually a chaperone, and what is sexual contact. Of course I don’t fondle boobs, I examine breasts and so on… But it’s close; they’re described as intimate examinations and procedures for a reason.

The difference is that professional distance. As the burly urologist was tugging on his foreskin, my patient joked that he’d rather I was still doing it, and I wished he hadn’t. It was an awkward joke to relieve his discomfort in an awkward situation, but it reminded me of the possible sexual connection with what we were doing at a time when I really didn’t want to hear it. Yes, sexual health and freedom is important and frequently inadequately addressed in hospital, but it would perhaps be better to discuss it at a time when I don’t have my hand around his penis. I am in a position of power and could use that to my advantage, as all of the terrifying and frankly disgusting accounts of doctors abusing their position of trust can attest, so I must remain sexually neutral. I must be a blank wall; I must be disconnected at all times.

Keeping this distance isn’t difficult but it is a conscious decision. My sexual and  professional lives are two very separate entities. It’s why I was taught not to practice examinations on lovers when I was at med school so that there was never any subconscious memory of seamlessly moving from medical professional to fucktoy. It’s why sexy nurse/doctor role play is a hard limit. It’s why dating patients or, for me, even entertaining an opinion on their hotness is both impossible and unprofessional. If I think a patient is hot, am I really completely concentrating on his breath sounds when I lean in and hold my stethoscope against his chest or am I just thinking about his chest? No thoughts, certainly no comments and definitely no touching. I am Dr Livvy and I am cold. It’s better for everyone that way.

Except sometimes crossing that line is unavoidable. It’s not that I’m expecting to meet a patient who is impossible to resist but because it’s not uncommon for someone from my non-professional life to need professional assistance. I usually just deflect the problem unless I’m certain I can help. My mother is endlessly frustrated that my answer to her medical questions is always ‘oh dear, you should see your GP about that.’ Professionally, it’s not worth my career to give bad advice and personally, I sometimes just don’t want to be your doctor because it becomes complicated.

As an example, a few years ago my sister had a breast lump. She was young enough that the chances of it being cancer were ridiculously low but still, it’s a breast lump. They’re scary! When I talked to her about it, I chose to be her sister, holding her hand and telling her that it was nothing and she’d be OK. I didn’t offer to examine her breast to feel the lump myself and I didn’t bombard her with differential diagnoses and statistics. I was grateful to have the knowledge to help if she’d asked but she never did. She needed her sister, not another doctor.

And there was another time when I got even closer to my self-determined professional/personal boundary. Do you remember Exhibit A tweeting earlier this year about getting a hair caught in his penis? (See – I’ve never referred to his beautiful cock as a penis before. I have sex with his cock. For this, I thought of it as a penis.) There’s a link to his tweets with this photo. When he’d asked me for help, I immediately offered all the advice I could, which essentially boiled down to ‘oh dear, you should see your GP about that!’ But when the GP couldn’t help, what should I do? We talked quite a bit about my concerns before doing anything – namely that looking at his cock as a doctor might be weird. And it might be weird afterwards. Luckily, it worked out fine – the hair came out so easily that I’m not sure what the nurse before had been doing and I hadn’t needed to medically scrutinise his penis to such an extent that I forgot that it was also the same cock that had driven me to such wild extremes of pleasure before and since. And even more importantly, I have never thought of this moment again when I’ve been examining other penises in a professional context. Phew…

But what happens when you can’t split what is professional from what is personal? When it’s not possible to keep each part separate, such as when you’re a carer for someone you love?

This somewhat rambling thought process was triggered when I read Ella Risbridger’s post on being a carer and a girlfriend that she shared again today. She is a carer for her boyfriend who has cancer and wrote about how just difficult it is being a carer, both financially and emotionally because of the additional pressures on relationships.

Does the relationship change from a romantic and passionate one to something more familial when you care for someone you love? When undertaking personal care such as washing and dressing, can you look at their body in the same way? And does it matter? Is the relationship stronger for this difference or irreconcilably changed?

I am so impressed by those who do take on this role because, for me, being a carer is not a long term option. Oh God, if someone I loved needed assistance, I would do anything and everything in a heartbeat, but I would be looking and hoping for longer term support alongside, as I suspect most people would. It’s a semantic and pedantic difference but although I would do anything needed to care for them, I could not be their carer. It is a job; a professional responsibility. I was worried that looking at my boyfriend’s cock once with non-sexual eyes would change our relationship; I’m not going to wipe his arse for years if I can avoid it, even if admitting that makes me sound cold and professional again.

This is why the destruction of the social care system upsets me more than the systemic annihilation of the NHS and why the increased reliance of family/partner carers is one of the worst and under recognised ills of our society. Sadly, there is no impetus to change because caring is fucking expensive – Ella describes unpaid carers as a ‘second, invisible NHS,’ saving £132bn by taking on the job themselves, and it’s not right.

I understand that it is impossible not to take over care when someone you love needs help, but it does make me sad that there is no choice and so little support. Asking for help to care for a loved one can be seen as abandoning them and it can become difficult to see how anyone else could do the work, as these quoted sections from Ella’s post demonstrates:

‘It’s hard to pin down exactly when the normal love and care of a relationship becomes officially “caring”. Isn’t it normal to look after your partner, your parent, your child? Wouldn’t anyone?’

‘“People offer to help…but realistically, they just can’t. They can’t come to my house at 7am and help dress or shower him, or hug him as he cries, or lie in bed and stroke his back to try to distract him from the shooting pains.”’

My answer to these worries is that other people can help but the lines between carer and lover, professional and personal, become too blurred to see how. To use the examples above, professional carers are supposed to come to the house early to help dress and shower someone, so that their partner is emotionally and physically strong enough to be there for them as their lover, hugging them when they cry and stroking their back. These needs don’t have to be provided by the same person, and I’d argue that they shouldn’t.

When I’m asked how I would fix the NHS, I have a number of different answers but the one that carries most emotional weight is the urgent need to improve the social care system. I don’t want any more of my patients to be waiting so long in hospital for care that their family have to step in. I don’t want to have to explain that it’s OK to want to stay as just a wife/husband/partner/child and not want to risk their loved one becoming a burden, that it’s OK to ask for help. I just wish that help was more readily available for them.

Social care is a mess; it is back-breaking work that is underpaid, understaffed and unappealing, not to mention under-appreciated. Instead, we are reliant on the loving care of partners and family members, which neither acceptable or sustainable but as with everything else wrong with the health and social care system, I don’t know how to fix it except with more money.

I do, however, know that sometimes professional and personal separation is necessary and wanting to maintain this does not make you a failure. To go back to the beginning, my patient needed me to be a professional when I was squeezing and manipulating his penis, and my sister needed me to be her sister when she was scared, personal and not professional. Trying to do and be everything while blurring these lines is risky and I cannot express enough how much I admire those who do manage this and make it work, and how much I regret that I can’t help more…

Following some feedback, I have made some changes and wanted to add this postscript. In writing this post, I had hoped to highlight how limitations of the social care system were not only failing patients who needed the care but also those who were having to fill the gap. I wanted to throw light on an aspect of this issue that may not have been considered widely before, and I apologise if this message got lost.

28 thoughts on “Dividing lines…

  1. What a huge post, so many things I can’t really comment on, except to whoelheartedly support your points.

    The only time I’ve been examined by a male doctor for a breast exam, there was a female nurse in the room too – should you be squeezing penises all alone without another person there, for your own protection and the patient’s?

    1. That’s a very good point – I always offer to find a chaperone but most patients don’t want one so I don’t insist. If I’m concerned about it becoming at all compromised or awkward then I don’t give them an option and just bring a nurse. I might start doing that with everyone though to be safe. It’s actually quite a good example of residual sexism in the profession – men don’t examine women alone but the same doesn’t yet apply to women examining men. Xxx

  2. Thank you for writing this. As someone who declared that day-to-day I wanted professionals doing my care (even with the all stress that brings, as my twitter followers well know!), trying to explain why I haven’t just let my family take over is often tricky. I do end up with personal care from family, and within 12 hours of my first meeting with my (sadly now late) partner he had to help too. It was something he knew coming into the relationship, yet our idyllic wished for view of living together included my professional care for the day-to-day.
    See also the paramedics who pick me up – I might joke about them on twitter, but I have to keep that distance when they are here. I can’t let that side of me come into my friendships or beyond. I’ve felt awkward when carers have hugged me recently, they’d argue they are here for my emotional well being as well as my physical needs, but remembering their comforting scent does make the rest of the tasks that bit more difficult.
    I know it from the patient side and I am grateful for professionals who have thought these things through. (Unlike the paramedics informing me of places I could go in this city for being strapped to a table if I paid, without having to endure A&E and x-rays… not awfully helpful as I lay there fearing a broken neck!!)
    Anyway, I digress… thank you.

  3. This post is simply brilliant and very enlightening.
    I have always felt incredibly uncomfortable during any medical examinations and it was interesting to see how detached the doctor in question actually feels.
    I’ve cried during exams and have I repeatedly cancelled an operation I am due to have (for over a year now) because of how I feel. My GP says I have a phobia about it. It just causes me so much stress.

  4. I have such respect for people who are in the medical field and can keep their personal feelings separate from their profession. Especially when a loved one is undergoing care. I’m so ridiculous, I’d be scrutinizing every single thing my loved one’s caregivers did and ultimately cause a problem. I know this because I’m not in the medical field and I already do this. :/

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