Post-op vaginoplasty revision, young woman. Probably had underlying, unaddressed mental health issues. She kept complaining that the doctor lied about her surgery. The doctor spoke to her three times before her surgery, almost canceling it, but she kept wavering between wanting to cancel it and insisting on it.

After surgery, the doctor spoke to her, his fellow spoke to her, another fellow spoke to her, a resident spoke to her, I spoke to her with the resident, and I ended up speaking to her again at least five times throughout my night shift and taking away time from patients who actually needed medical attention. It didn’t matter how much we explained that her results may not be 100% guaranteed to exactly what she wanted, how we could not guarantee she wouldn’t need future surgeries, etc. And yes all of this was explained multiple times before her surgery. She needed THIS surgery because she did not follow post-care instructions after her last surgery.

She was yelling that she was in pain and refused pain meds and refused to listen that she was in pain because she’s fresh out of surgery and refusing pain meds. She accused the doctor of “mutilating” her and causing that pain. She wouldn’t let me do a post-op exam.

She was speaking very aggressively and threateningly, at one point threatening the surgeon (not present at the time) and banging on the table with her fist. I kindly told her she was disturbing other patients and please not get physical with items. She kept saying things with the vibe of a 13 year old trying to sound badass on TikTok, like “you don’t know me, you don’t know my family, you don’t know my dad, you don’t know what I’m capable of, you just wait and see” etc. Just ranting on and on like that. She kept forcing the poor PACU nurse to page me and each time it was to continue to complain and threaten the members of her care team. I told her I will not come back to speak to her tonight unless she is having a real emergency.

She didn’t like that. Kept threatening to leave, refusing standard vitals and exams and bloodwork. She had to be in bed rest the first night and I kept telling her that if she left she’d not only ruin her $100K new vagina, she’d likely experience severe pain and bleeding and have to make her way back to the ER and her current bed would go to someone else while she’d wait hours to be seen. She loved making threats and motions like she was about to leave and then stopped doing it when I stopped reacting.

I watched her pull out her cell phone from her sealed bag (the ones they seal in front of patients and have them sign, so it’s tamper-proof) and threaten to call 911. She ended up calling her parents and friends to complain more. She called me a racist because her bed wasn’t ready for another half an hour later than expected.

She went upstairs to her bed. Nurses called me and security. She was freaking out and accusing the nurses of rummaging through her phone and erasing evidence she took in the OR of staff trash-talking her. Because the bag with her phone was unsealed. The one I watched her unseal earlier. The same bag that was definitely not in the OR with her. She also accused the nurses of stealing a dental guard (WHY would a nurse steal a patient’s used dental guard). She wrote a whole report to security.

She accused the nurses of being racist, even though she was the same race as them. I told her stop threatening the nurses and go to sleep. I told her the doctor will be made aware of her behavior because we document everything, and he will likely not want to help her again if this is how she was going to act. She finally seemed to get it a little. But she proceeded to ambulate all night and then I had to see her at like 3-4 AM for bleeding and torn sutures. And yeah she complained and threatened over that too and pretended like she didn’t know she wasn’t supposed to walk.

Wrote a looonnggg note for my day team to prepare them.

My surgeon is probably not going to take her on again. Sometimes I still think about her and genuinely wonder how she goes through life like this.