[Commentary] [UK] Transgender journey: time for sex reassignment surgery at last

[Stephanie Stevens]

The Guardian, UK


Series: A transgender journey
<http://www.guardian.co.uk/lifeandstyle/series/transgender-journey>

Transgender journey: time for sex reassignment surgery at last

The day of the operation has finally arrived. Juliet Jacques recounts
the final preparations, the surgery itself and the aftermath

Juliet Jacques

guardian.co.uk, Thursday 30 August 2012 04.00 EDT


Six weeks before sex reassignment surgery (SRS), I am obliged to stop
taking my hormones<http://www.guardian.co.uk/lifeandstyle/2011/jan/12/transgender-health-and-wellbeing>.
I suddenly feel very differently about my forthcoming operation. I'd
previously seen transition as a marathon: surgery was like breaking the
tape, but the race was won far earlier. Now I reconsider: perhaps this is
more like a difficult cup final after some hard previous rounds.

The surgery completely dominates my planning and thinking. My temporary job
ended in March, and the knowledge that I'd be incapacitated for at least
two months from mid-July made it difficult to find another. Ineligible
for Employment
and Support Allowance<http://www.direct.gov.uk/en/MoneyTaxAndBenefits/BenefitsTaxCreditsAndOtherSupport/Illorinjured/DG_171894>until
after surgery, I sign on, the whole scenario feeling farcical as both
my case worker and I know that I am unlikely to get a job, but still have
to fulfil the jobseekers'
criteria<http://www.direct.gov.uk/prod_consum_dg/groups/dg_digitalassets/@dg/@en/documents/digitalasset/dg_200090.html>to
get my weekly allowance, haemorrhaging money all the while.

It consumes my conversations as it inches closer. I am constantly asked how
I feel: everyone expects a mixture of excited and nervous, and they are
right. Above all, I'll be glad when it is over. I take a little holiday in
late June, staying with friends in Scotland, and travel back on the first
day of July. Then, for the next fortnight, my concerns over the practical,
physical and psychological effects of SRS intensify by the day.

My psychotherapist, whom I've been seeing all year, tells me that I've
barely touched on the surgery, so I devote my final pre-surgical
appointment to it. After an hour of airing my anxieties, I feel calm and
able to continue.

Final preparations

Five days before checking into hospital, I sign off. Returning from the
Jobcentre, a man with a taste for "shemales" (his word) follows me home,
making me feel far less secure in my house – my sanctuary in a life that
has felt in constant chaos. I break down in tears, crying for 30 years of
feeling like an outsider, 20 years of knowing this to be related to my
gender, 10 years of exploring it, three years of transition and two years
of writing about it, with all their stresses and traumas simultaneously
hurtling to the fore.

For four days, everything makes me weep. At first it's painful, then
cathartic, and finally just annoying – having not cried when I expected to
for years, the sight of every ornament, every poster in my house sets me
off, and I don't know when it'll stop. Eventually, I realise I need to get
out: I visit old friends in Brighton, who indulge me as I discourse about
the run-up to surgery and my feelings about it.

I return a day before admission: having to address the practicalities pulls
me together, as I ensure I have everything I'll want or need during the
seven-day stay. I've never been seriously ill or injured, so I've sought
advice on what to take: I buy slippers and a crossword book. Once I've got
everything on my list, and packed, I feel completely relaxed. I go to bed
content, close my eyes, and then see a car crash outside my bedroom window.
It's so vivid, it takes several moments to realise that the flaming
wreckage is no more than the invention of my hyperactive subconscious, but
once I do, I get a solid night's sleep – my last for some time.

Obsessed with being brave and independent, I'd travelled alone to my
previous surgical
appointments<http://www.guardian.co.uk/lifeandstyle/2012/may/15/transgender-journey-reality-surgery>.
This time, on advice, I've arranged for my friend Tania to take me to
hospital. She arrives around midday: we eat in my favourite cafe and then
get the tube to Hammersmith, well before I have to report to Charing Cross
hospital reception at 4pm. We say little, putting our arms round each
other, but once I've checked in, she gives me some earplugs and a cuddly
tiger ("You'll need a soft toy, trust me"). Then she goes, telling me to
surrender myself to the nurses, and I find my bed in F bay on the Marjorie
Warren ward.

In the ward

There are six beds, with most but not all occupants also undergoing SRS.
Reassuringly, there are two people who had surgery a day before, who can
hold conversations and move unaided. We chat before the nurses take my
weight and blood pressure, measuring me for stockings to fight deep vein
thrombosis as I'll be spending so long in bed. I order dinner and then
sleep, struggling more with the sweltering temperature than anything else.

At 5.30am, I'm woken for an enema: they have to thoroughly clear my bowels
before the procedure<http://www.guardian.co.uk/lifeandstyle/2012/jul/18/transgender-journey-teeth-gritted-fists-clenched-toes-curled>.
It's not pretty but I take it, shower and return to bed. At 7am, James
Bellringer,
the surgeon <http://www.genderxchange.co.uk/>, enters with two consent
forms – one for the hospital, the other for me. He asks if I will allow
"the tissue removed" to be used for medical science. In the hazy
half-light, I agree (to the disappointment, I imagine, of friends who've
asked if they can have it). "I'll see you soon," he says. The anaesthetist
comes soon after and asks several questions before I lie back down.

At 8.20am, I'm escorted upstairs. I take the lift to the 15th floor in my
slippers, white hospital gown and navy stockings. The chattering voices in
my head silence themselves, with just the closing bars of a favourite
song, Laurie
Anderson's O Superman <http://www.youtube.com/watch?v=-VIqA3i2zQw>, soaring
through my mind, and I am ready.

Yuri, who assists the anaesthetist, lays me on a trolley and takes my blood
pressure and temperature. The anaesthetist enters, attaching a
cannula<http://en.wikipedia.org/wiki/Cannula>to my right wrist. She
asks if I have any questions. "This'll definitely
work, right?" Yes, she says, irked. "It's just that I studied 19th-century
medicine<http://www.vam.ac.uk/content/articles/h/health-and-medicine-in-the-19th-century/>,"
I say. "It didn't fill me with confidence."

"It'll be fine", she says, raising a needle. "You may feel a shooting
sensation in your arm …"

I wake in the recovery room, dehydrated, my lips bone-dry. I demand water,
but it's nil by mouth until I return to the ward. I'm slow to come round,
though, and they won't move me until I'm fully awake, however much I ask.
After what seems an age – I've no idea how long – they wheel my bed into
the lift, and then back to F bay.

The women there are glad to see me back: I tell them that it went well,
before finding a wave of "good luck" messages on my phone. I go on Twitter
to say that I'm conscious again; throughout my stay, social media keeps me
sane, providing contact with friends, family and well-wishers at any time,
saving dozens of energy-sapping conversations.

The first night

The nurses set up intravenous morphine, which goes towards compensating for
the hated catheter bag strapped to my thigh. The machine bleeps whenever
morphine is administered, which is not every time I press it, and it does
bizarre things to my sleep: I close my eyes for what feels like several
hours, only to find it's been five minutes, but I get through the night.
Dizzy and nauseous, I try not to be tetchy with the nurses, who do their
best, but I struggle with the shared ward, wanting my own space and getting
annoyed when they open the curtains without asking, feeling guilty about
occupying myself with my headphones although everyone else is perfectly
understanding.

One day after the operation, the morphine is removed. The nurses say it's
to stop me getting addicted: I argue, unsuccessfully, that we can cross
that bridge when we come to it. It's replaced by paracetamol and ibuprofen,
which doesn't always shift a headache, and proves woefully inadequate. With
vaginal packing to keep me open, I'm in severe discomfort: the lights go
out at 10pm, and, laid flat on the hard mattress, with resting on my side
impossible for the foreseeable future, I cannot sleep, the excess light,
sound and heat driving me crazy.

At 3.30am, I ring for the nurse. She comes, and I beg for sleeping pills,
or stronger painkillers. I needed to ask earlier for pills as they have to
be prescribed, and I've had my allotted pain relief, so there's nothing she
can do. I ask when the packing comes out. "Monday", she says, which I
repeat in disbelief: it sounds an eternity. Then she leaves. Trying not to
scream, convinced that no operation could ever be worth this level of pain
and cursing myself for signing up, my outlet is Twitter. I post that this
is the worst night of my life, and that I feel like I may never sleep
again, and a handful of kind responses from insomniac friends and
transatlantic contacts give me a little cheer.

At 6.30am, I fall asleep. I wake an hour later, to find nothing has
changed, and it feels like this night will last forever. A nurse enters to
take my blood pressure and I start crying, having promised myself I
wouldn't, for the loss of independence, privacy and dignity, symbolised by
the hospital staff changing me like a baby. "You surrender those when you
walk in, I'm afraid," she says: harsh as it sounds, the reminder that these
feelings are to be expected provides comfort, and night eventually rolls
into day, clearly demarcated by the nurses turning on the lights, opening
the curtains and offering breakfast.

Manjit, the nurse specialist, comes to check the wound, removing the pad
over it. I look down and start hyperventilating: it's encircled by heavy
bruising, the pad splattered in blood and pus. She insists I tell her
what's wrong: I say it's discombobulating and looks disgusting. Worse,
there's a "phantom limb" sensation, as I think I can feel the old organ
moving in the itchy cloth underwear like it used to, even though I know
it's gone. Psychologically it's unbearable. This will pass, she says; there
are no complications, so all will heal.

The day room

My old university friend Joe
Stretch<http://www.independent.co.uk/arts-entertainment/books/features/talent-issue--the-novelist-joe-stretch-766036.html>(
http://www.independent.co.uk/arts-entertainment/books/features/talent-issue--the-novelist-joe-stretch-766036.html)
is coming down from Manchester to visit. With time passing so slowly, the
prospect of his company keeps me going: I text to say that as he's coming
before dedicated visiting hours, he must meet me in the day room, and that
as I've not slept and am in absolute agony, I won't be at my best. Even
though it hurts to laugh, his reply is perfect:

'Stop moaning! It's probably just a cold!'

At 10am he arrives and I shuffle to the day room, moving like a toddler
who's learned to walk by watching John Wayne films. Gently, he hugs me, and
we sit. I take the sofa as I need to stretch my legs out, and talk him
through everything from leaving my house to the present. I keep stopping,
holding my forehead as the physical and psychological pains engulf me, but
after an hour, I'm done. I pause, then ask: "Anyway, how are things with
you?"

We laugh, but I insist he tells me: other people's lives reintroduce
normality, and discussing our usual subjects becomes really important. To
make myself feel more human, I've put on makeup. We joke about the contrast
between that and my "sexy" catheter.

Feeling less tired and looking better than I'd expected, I change my pads
and empty the catheter myself, passing time by watching Georges Méliès
films<http://archive.org/details/The_Impossible_Voyage>and Paul
Merton's programme on Buster
Keaton<http://www.youtube.com/watch?v=iIkxLneBs2I>on my laptop.
Billie, who's had her operation days earlier, introduces
herself. We click, sharing a love of sport, political theatre and
literature; she looks at my books, and I tell her that the only one I can
handle is a favourite volume of poetry, Jacques Prévert's
Paroles<http://www.scribd.com/doc/43651031/Paroles-by-Prevert>.
She's intrigued, and suddenly, in this rarefied environment, there's an
unanticipated moment of beauty. She sits, takes my hand and reads:

*To Paint the Portrait of a Bird*

First paint a cage
with an open door
then paint
something pretty
something simple
something beautiful
something useful
for the bird …

Before she even finishes this beautiful little
poem<http://thebluelantern.blogspot.co.uk/2011/02/to-paint-portrait-of-bird.html>we're
firm friends, swiftly united in subverting our routine as much as
possible. Just as the nurses are putting everyone to bed, she sneaks in and
disconnects my catheter from the night bag so we can go and watch GB's
Olympic football team play Brazil. The match is uncompetitive, sterile and
meaningless but here, all the aspects of the BBC's football coverage that
usually induce apoplexy, particularly Garth Crooks's endless
banalities<http://www.chrisrand.com/hmhb/look-dad-no-tunes-ep/lock-up-your-mountain-bikes/>,
are strangely soothing, and I go to bed far happier than when I rose,
having requested sleeping pills well in advance.

I sleep deeply for four hours, then wake, fixated upon the question of
inequality. Gradually realising that I'm in no fit state to resolve this
longstanding problem, it takes time to settle back down. I take them again
the following night, and something similar happens: I rise with this
singular sensation of disconnect from my body. At 3.30am I go to the day
room to read. Billie joins me and we watch more football together.

Soon, I weep again, through tiredness and pain. I venture out into the
garden for the first time. Just seeing London life – a tower block, a
single car and pedestrian – makes me realise that soon I'll be out, with
the pain subsiding, and this and the fresh air makes me feel infinitely
better. That night I meet Katya, who'll be having her operation tomorrow,
and I tell her that although she'll be sore, she'll be fine if she asks for
sleeping pills and gets friends to sneak in food, and that the joy at
resolving her gender
dysphoria<http://www.nhs.uk/conditions/Gender-dysphoria/Pages/Introduction.aspx>will
make it all worthwhile, as it has for me.

Departure

As soon as I wake on Monday, I ask the nurse when the packing and the
catheter will be removed. "After breakfast," she replies. Suddenly, I've
never wanted tea, toast and cereal so much. When it comes, I eat
voraciously, impatient for her to return. Eventually, she does: the removal
is traumatic, taking longer than anticipated, and seeing the blood-soaked
gauze makes me hyperventilate again. She cools me by saying I can shower
and wash my hair, and that if I relieve myself efficiently, I'll be
discharged tomorrow. Later, I manage to pee: it goes everywhere, but
that'll fix itself, and the discomfort is outweighed by knowing that I'm a
massive step closer to leaving. My morale is boosted further as I put on my
own clothes.

I start dilating, using lubricating jelly and two five-inch dilators, one
two inches wide, the other three. I have to use the smaller one for five
minutes, then the larger for 20, to keep the neovagina open, three times
daily for now. (In Scotland I met someone who was down to once a month,
three years post-SRS.) This is very dull, and I make it tolerable by listening
to music <http://www.youtube.com/watch?v=EWZHOjfIxqk>. It goes fine, so
there's just one final barrier to my exit: I need to open my bowels. On
Monday night, after I've ducked across the road get takeaway pizza, the
first time I've left the hospital grounds, the nurse gives me laxatives,
and I prepare for the most important dump of my life.

You don't need me to describe this – I couldn't top the toilet scene in
Ulysses <http://www9.georgetown.edu/faculty/jod/ulysses/ulys4.txt> and even
if you've not read it, you know what it's like – but later I triumphantly
tell the nurses that I've done the business, and they say I can go now if I
wish. I call my parents, my housemate Helen and others, deciding not to
leave in a rush.

This proves wise as Manjit, who's not back until morning, must see me
dilate. She's satisfied that I do it properly, and now the only thing
keeping me is the wait for the pharmacy to send my medication. Helen comes
to help me home: I'm overjoyed to see her, and we chat for an hour before
my painkillers and taxi arrive.

When the car pulls up at my house I drag my suitcases inside before
collapsing on to my bed, overwhelmed by the simple pleasure of seeing my
own home.


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http://www.guardian.co.uk/lifeandstyle/2012/aug/30/sex-reassignment-surgery-transgender-journey