Before I was wheeled to the OR, I asked my GCS surgeon if he could make it sparkly. Worried sparkles could cause lead to infection, I then asked if he could make it magical. This is the journey of my magical vagina.
Author’s Note: I am more than four months post-op, but the emotional volcano that erupted in my home during my recovery delayed the publishing of this story. However, I would be remiss to write about my transition without ever detailing what I referred to as Ultimate Taco Tuesday.
The Consults
My process started with two consults with two different surgeons over the span of about two years. The first had been a few years ago with a surgeon my insurance carrier forced me to see at the time. She had never performed the surgery before, but she intended on beginning to offer the surgery soon with the help of another doctor whose name she could not disclose. On the heels of that disastrous consult where she could not answer or adequately address my questions and concerns, I won an appeal to my insurance company that allowed me to have a consult with the famous Marci Bowers. Coming out of that meeting, I was confident Marci was the surgeon for me. However, her wait list was approaching three years, and even though I was local to her, I could still expect to sit 1 1/2 years on a cancellation list. Then, all that went out the window when I got my new job and my insurance carrier changed. Enter Kaiser.
I grew up in the San Francisco Bay Area, and Kaiser was always the bottom of the barrel choice for healthcare. My pediatricians were never memorable; care was questionable. Kaiser has worked hard to reverse its reputation and is trying to be a leader in transgender healthcare. So when I was effectively forced into Kaiser with my benefits plan, I was extremely apprehensive and biased. On Day 1 of my coverage in October 2018, I put Kaiser to the immediate test, and to my welcoming surprise, they met my all of my requests. By March 2019, I was sitting in the clinic of my would-be surgeon at my third and final consult. My options for GCS surgeons were limited in the Kaiser pool, but community members and friends strongly recommended my surgeon, and he did wonders to put me at ease. At the end of that afternoon, I had a surgery date just seven months away.
Following the appointment, I more or less maintained my weight to avoid going over prescribed a BMI number that would have delayed my surgery. As time got closer, I started on my FMLA paperwork and my disability claims. Logistically, I was on top of everything. Emotionally, I struggled to find support [6 mo. pre-op; 3 weeks pre-op].
In the meantime, I diligently worked with a laser technician and an electrologist, to remove the necessary hair. My high tolerance for pain helped me through this part. I actually laughed at my laser technician when she would warn me about potentially sensitive passes. In six sessions, I think she really only got me to flinch once. My electrologist did a lot to put my mind at ease in the final weeks making sure I was clear enough not to have my surgery date moved, and at my final pre-op appointment, my surgeon agreed that my hair removal was sufficient.
The Final Pre-Op Appointment
As I have said before: Every transition is different. This one is mine. Doctors like to find standardized, cookie cutter approaches to solve problems. However, because every body is different, every medical transition must be handled individually. Additionally, not enough studies have been done to really say that there is one right way to approach any of these procedures. However, at my doctor’s clinic, they have a policy that transgender women should stop estrogen 30 days prior to surgery in order to reduce the possibility of deep vein thrombosis (DVT) and pulmonary embolisms (PE). While I totally understand that throwing a blood clot would be extraordinarily bad—even potentially fatal—I was extremely concerned that a one-month stoppage would crash out my estrogen levels to near zero, which could lead to post-menopausal physical changes and increase my chances for depression. Crazy me believed such increased stress would be problematic going to major surgery.
To address the concerns, I set my final pre-op appointment 34 days prior to surgery to talk about it. I mentioned that other hospitals’ policies varied, recommending ceasing estrogen anywhere from 0 to 2 weeks prior to GCS, and that those plans seemed more reasonable. Thankfully, my surgeon heard me, and we agreed to a 2-week stoppage. Because I use injections that take one week to clear my system, that meant my last shot could not be any later than 3 weeks prior to surgery. I was a good girl, but I ensured my last injection was exactly 21 days before the date. My overall risk for a clot was approximately 3% based on my surgeon’s estimated guess. On a side note, I was able to take progesterone right up to the end, as it was not considered a clot risk. Cool.
The hardest part of that visit was not actually the estrogen cessation discussion. Surprisingly, the most difficult moment came when I was presented a seemingly simple form. I was required to sign off on a notice that the procedure would result in sterilization. That consent, of course, was academic in nature. By its very nature, going through this surgery would leave me without a natural way to reproduce. But still, I could not help but pause… and pause… and pause. My dysphoria centers around childbirth, and while I wish I had a female reproductive system, any thought that I cannot have any more children affects me greatly. When I started HRT, I had these same feelings. I researched sperm banking, but it was prohibitively expensive. I knew that if I stayed on estrogen more than six months, I was effectively resigning myself to killing off any chance of having more children that shared my genetics. That decision was heart-wrenching, but my transition was more important. I could not stay depressed just to hold out hope that I might be able to have another child someday. With this consent form, those emotions came flooding back, and my friend who was in the room with me could immediately see it in my face and in my body language. I signed the form, of course, but it was with a heavy heart. Where is the form that allows me to take part in the experimental uterine transplants that are starting human trials?
The Days Leading Up to Surgery
When I received my surgery date in March, I was ecstatic, but I was also very concerned. In the following 7 months, I wrote a couple of entries expressing concern that my wife would not be capable of supporting me during the surgery she said she would see me through. I enlisted the help of my best friend and reached out multiple times to others in the attempt to expand my emotional support circle. I was largely successful reaching out to others, but as expected, I never felt that my wife was fully on board. In the weeks and days leading up to the big day, she found more and more ways to get out of the house, presumably taking as much self-care time as possible so that she would be ready for my recovery period. She made it all about her, and none of it about me.
I was incredibly concerned about preparations, including setting up my care calendar, house cleaning, and the purchasing of items I would need during recovery. I was clearly getting stressed, and she did not understand why until I detailed some of my concerns. In addition to home preparation, I was also scrambling at work to get everything prepared for my leave and ensure my disability paperwork was squared away. In fact, on the day prior to surgery, I had to rush to the Employment Development Department before they closed to make sure they had my name properly changed in their system so that I could properly file my disability claim. I had enough stress in my life. I did not need additional stress of things not getting done at home, but that did not happen. From my perspective, everything seemed non-urgent to her, even though she was stressing internally. In the last week, she did manage to set up my care calendar, but only after I had mentioned it as a concern.
Otherwise, she did not seem especially upset or happy for me. Her emotions were internalized, and I read that as her being uninterested in my situation or my feelings. Granted, I may have misread those emotions, but the non-communication issues which cripple our relationship were in full effect. I just felt like I was already alone. She did not check in with me as I suffered effects from my estrogen stoppage. She did not make any extraordinary effort to houseclean to clear walking obstructions, even though I had been trying to do some that myself. There was no party or symbolic cake. There was no celebration of my last day at work or build-up of excitement going into surgery. Sure, there were a few taco memes sent between friends to mark Ultimate Taco Tuesday, but I generated most of that excitement with minimal input from my wife.
And then the “fun” began. Two days prior, it was time to clean my bowels out by intentionally inducing diarrhea. How does one do that? By drinking four liters of the worst lemon-ish Kool-Aid-like concoction imaginable eight ounces at a time every 15 minutes. Four liters. Four! For the metrically challenged, that is approximately the size a large bottle of bleach or an industrial size bottle of Elmer’s glue. Eight ounces? That’s about half of a disposable bottle of water. But this medicinal water is thick, which can induce a gag reflex. The addition of the lemon flavor packet is still debatable. Really, I’m not sure if it helped or hurt. What I do know is that it took approximately four laborious hours to drink the whole bottle. About an hour or two into the experience, the frequent bathroom trips began as expected and would continue for hours. This process is considered to be so debilitating, I could have started my disability claim on this day. This is the kind of thing I should have support around, yes?
Where was my wife? She was out with her boyfriend having one last self-care day when I finally needed real help. She left me home to deal with the bowel prep and watch the kids. To my kids’ credit, they encouraged me as much as they could with each glass I struggled through. They felt my pain as I started making frequent trips to the bathroom about when I reached the midway point. There was a mini-celebration when, after four hours, I finally drank down the final drops. But my children were not the one that should have shouldered that burden. My wife just did not understand, and when I complained that she was not there, she accused me of not being able to parent the children by myself—which was a totally unfair assessment of the situation. I did successfully feed the children, evacuate my bowels, and survive the process, but it was more of a struggle than it needed to be.
From that point forward, I was restricted to a liquid diet. Thankfully, the family ate mac & cheese the first night, which was no big loss to me, but on the second night, my wife made tacos, which is probably the yummiest, most fragrant dinner that gets prepared in our house. While she claims the choice was not intentional, the fact that she did not even consider how that decision would make me feel was totally inconsiderate. Not 12 hours before I was to report to the hospital, I had to sit in a living room sipping chicken broth while my family pigged out on savory, spicy awesomeness. In a word, that dinner was evil, whether it was planned or not. She would later apologize, but this type of thing seems to happen a lot. Either there is no forethought in her decision making, or there are very intentional thoughts to hurt me that she will not admit. I suffer either way.
Preparing the Children
Going into surgery, I was stressed about a lot of things: my emotional support, my ability to function during recovery, how all the disability claims would work together, finishing up as much work as possible so that my leave would not cause a major problem, what would happen with my Girl Scouts troop while I was out, whether or not I would have visitors at the hospital, and more. There were many moving parts and loose ends ends to tie. However, the area in which I was most secure was most secure and least stressed was my children.
The frequent readers of this blog know how important my children are to me. Motherhood is a central core of my being, and through my transition, I have constantly been open and upfront with my kids about my journey since I went full-time. When I had FFS two years ago, I explained what was happening and what to expect. With GCS, it was no different. I had frank discussions with them about what was being done to me and why. I checked in with them on a fairly regular basis to make sure any questions they had were answered. I even had a short discussion with them about dilation so that they would know why I was going to disappear to the bedroom frequently after I came home from the hospital.
They were so prepared by the time came, the only concern they had was that I would be in the hospital for Halloween, which meant I could not trick-or-treat with them. Thankfully, on the Saturday prior, I was able to attend a Halloween party with them, so at least they got to see me in costume one time this year, even if it was not on Halloween proper.
I continue to be thankful that I have such understanding children. My transition has not been easy on them, but they know Mom loves them, and they do not treat me any other way. For the record, other than a brief phase where my son wore a dress to bed several years ago, he and his sister seem to be squarely falling into the stereotypical gender roles reinforced by their peers. My transition has not queered them, and my identity has not “rubbed off on them,” just in case you needed proof that transgender identities are not contagious.
Honesty and openness are so important in all relationships, and that extends to the parent-child relationship. I lead by my mother’s example. Children are capable of grasping big concepts when the proper age-appropriate language is used. I was able to explain my transition at a basic level when they were 5 & 3. I was able to explain my surgeries at slightly older ages. Through love and understanding, they support me, even when they may not fully understand. I encourage them to ask questions when they have them, and I am prepared to answer truthfully. This type of open communication model does not exist between my wife and I, and maybe that is why I felt more supported by my children in their limited capacities than I did from my wife throughout this process. How sad is that?
But enough about my magical children and my non-magical home life. In Part 2, I get my magical vagina and share the story of my hospital stay.
A Dreamer's Transition: Transgender, married, parent, coping... 