celesteh – Page 8 – Les said, the better II

New Passport Due Soon

I have just returned home from the US Embassy in London. In three weeks, a new passport with correct information will arrive by post. Huzzah!

Always be Prepared

This is a culmination of a much longer process. In May, I changed my name via statutory declaration. Then I contacted my phone companies to get them to change their records. I brought a copy of the form to my GP’s surgery. Most Brits change their name via deed poll, as it’s cheaper and easier, so the receptionist had never seen a statutory declaration before and was reluctant to accept it, but eventually did so. Then I went to my bank, who I hate with the fire of 999 suns, and they refused to let me change my name on my account at all, unless I could also provide photo ID in the new name. And finally, I went to my university, who updated my student records and ID card and printed out a letter affirming that I am a student there.
Then, I had to wait for phone bills to arrive in my name and to call BT more than once. And finally, appointment letters from the hospital where I had top surgery provided the final documents. So I then had three types of paperwork with my new name on it.
Shortly after I began compiling paperwork to change my name, the US State Department changed their rules about gender markers on passports. The letter I was planning on asking my surgeon for would no longer count. However, a letter from my GP would suffice. I asked him to write one saying I had completed transition, as then I could get a full term passport instead of a two year one. And, indeed, under the terms of the new regulations, I have completed transition. I find this to be entirely reasonable, as nobody would mistake me for a woman if they saw me or talked to me and the state of the parts of me covered by clothes are nobody’s business but those in who’s company I choose to disrobe.
My GP wrote the letter and charged me £25 for it. When the surgery’s receptionist asked me to pay, I was initially surprised, but then went to a bank and got some cash. GP practices are privately owned and the money they get from the NHS doesn’t cover things like letters to foreign governments. If this had been a problem for me, I think I could have gotten the Charing X psychiatrists to write a letter for me. That would also be acceptable to the embassy, but it’s over a month until I even see them again.
Armed with all of this paperwork, I made an appointment to go to the embassy, as you can’t just turn up. I began to fill out the application forms. They wanted to know if I had ever been married and what was the date of that and what was the date of my divorce. The divorce date, I remember. The date of the marriage? Not so much. I went back reading through old blog posts, seeing if I could figure it out. The ceremony was on day, but a paperwork snafu meant we got the license on the following monday . . . finally, I made a guess. And then I remembered the Defence of Marriage Act.
Every country in the world considers me to be legally divorced, except for my home country, where they hold that I was never married at all. When I was in Holland, I had to get a certificate to say I wasn’t currently married, so I have US Government-issued documentation that says I’m divorced, but they don’t actually back that statement. The state of California, however, also considers me to be divorced, as do five other states. It’s a strange sort of feeling, the one of non-recognition. The marriage may not have felt real, but the divorce certainly did. All those documents and lawyers fees and bitter acrimony never actually happened according to the great country of my birth. Obama said something about overturning that law, the one that says that years of my life weren’t real, but he didn’t actually mean it.

Today

The embassy makes people queue outside, on the pavement. Fortunately, the weather was sunny. I waited for a while with non-US citizens and then got into the correct queue. I knew one of the security guards from when I played in the gay band. She came over to chat and then came back to let me skip ahead of the queue. I appreciated the gesture and it made me a lot less nervous, actually. ID checks and pat downs make me nervous, for obvious reasons. She was cool. I did feel a bit guilty about queue-jumping though. I hadn’t brought my phone, although I could have and they would have held it for me. They took my USB stick and my Boris Bike fob.
The architecture of the US embassy is somewhat reminiscent of the Lincoln Center in New York. It’s sort of brutalist concrete, but with a lot of decorative corrugation. Inside the waiting room, there are gold-coloured metal columns. I wish I’d got a picture of it, but, of course, cameras are not allowed. I also wish I’d gotten a picture of the sign that sad to beware of terrorist bombs. “If you suspect something, call 999.” it said in small print at the bottom. I sat in one of the several rows of chairs and waited to be called.
Over the course of the last week or so, I’ve had an email correspondence with an embassy worker who was not very informed about new State Department rules. She seemed to think a surgery letter was still required. She asked for a “background statement,” something left undefined. When I asked for more information, I was instructed to ask for a particular staff member when I got there. So when I was called to the window, I asked to speak with the staff member with whom I had been having emails. She was a posh woman, apparently the manager. She told me to go to a window in a private chamber – a room with a door, however the walls don’t go up all the way to the ceiling, creating an illusion of privacy where none exists.
She started to ask about my medical history. Had I fully transitioned surgically? It seemed as if she was trying to be delicate while enquiring about the state of my genitals. In fact, the State Department has no right to any information beyond the letter written by my GP. What operations I have or have not had are none of their business. I explained that under the new rules, the letter from my GP should suffice. She said that the letter was only good for a two year passport.
The hassle of a two year passport isn’t just that I would need to return to the embassy every 18 months. The UK will not issue me a visa that extends longer than my passport, so my plans to get a two year work visa after graduating would become much more of a bother. Also, I would have to produce a new GP letter every time and appear in person with it. Otherwise, I would revert back to my initial state.
I argued that this is not what the new rules said and I was certainly not going to disclose information to which she had no right. I had the distinct impression that she just wanted me to declare that I’d had surgery, not actually provide documentation of it. I refused to budge, but the strength of my principles was somewhat undermined by the fact that one of the documents I brought to demonstrate that I’d changed my name specifically mentioned “mastectomy for transgender.” She called me up later to say that document would do nicely, but they were going to have to write to the States for guidance on the new rules. I hope they are provided with ample clarification. Indeed, plastic surgeons are not even on the list of doctors allowed to provide documentation.
The first time I spoke with her, she noted that she had seen a lot of this sort of thing before, and I certainly wouldn’t be the last. Perhaps she was trying to appear professional, but it was more of a knowingness, like she was an anthropologist and I was an exotic subject of study, about which she might one day write a book. So despite, apparently, being entirely successful in my mission to change my name and gender on my passport, I was still fairly wound up when I left. I rode a Boris Bike home, pedalling away my annoyance. Mostly.

Genitals, Dysphoria and Dating

My experience with the sonogram tech was somewhat troubling, but the sting of it quickly fades. To avoid repeating it, when I’m next in a situation where such a thing might happen, I’m going to start off by saying, “In case the paperwork you got isn’t clear, just so you know, I’m a man. I’m transsexual and I’m having this done because I haven’t had all my surgeries yet.” I think this is probably going to work out alright because it doesn’t place blame anywhere except on vaguely unclear paperwork and starting with that means that it should prevent confusion before I’m confronted with it. The hearer might not entirely agree with my self-assessment, but will at least be polite (and if s/he’s not, I’ve got recourse). Also, I should be spared the growing realisation that something is amiss.
I want to clarify something from my last post, in which I said that a portion of my bits is not functional. While the inside bits are not so great, the rest is awesome. I don’t want to inadvertently start a rumour. Indeed, I’m proud of my junk, in that ridiculous way that men sometimes are. Which is not to say that I don’t still experience dysphoria, alas.
I fear the sort of interaction around disrobing that I had with the sonogram tech, but fortunately, it almost never happens. When I’ve met women socially and had occasion to be pantless in their presence, this has never lead to confusion on their part. Indeed, one time after such an encounter, I said something about having been a Girl Guide (aka Girl Scout) and the woman was completely confused. “What are you talking about?” She had forgotten about my history.
People who have an overwhelming sense of me as a man; as I look, act and smell like a man; do not seem to look at my bits and then change their minds about that. However, I know that it’s all non-standard and I feel insecure about it. I feel like I don’t pass naked, even if, usually, I do. And I think this has less to do, really, with the other person than it does with my own discomfort. So when I disrobe in the presence of others, I’m not just revealing something that might cause them to re-evaluate my gender, I’m exposing something that is complicated for myself.
So, in order to be pantless in the company of another, I have to make a large leap of trust. I have to trust that they will be respectful and that it’s a safe space for me to reveal something about which I have mixed feelings: that makes me happy and uncomfortable at the same time. I need to have faith in her, in myself, and take a plunge. This is profoundly at odds with how casual sex is supposed to work.
So if I sleep with somebody that I hardly know, I’ve already invested a rather large amount of trust in her. This actually requires very little on her part. Since I already will have ascertained that she’s not transphobic, she just needs to be forewarned and interested in continuing the encounter. But, because of dysphoria, it requires quite a lot more on my part. And if I trust her, and it turns out ok, which is usually the case, then it seems like this person who I have trusted must have been worthy of that trust. Ergo she is trustworthy. And I’ve invested way too much emotion into her way too fast.
I think anybody that will sleep with me is awesome. I mean, this has often been the case. But not always. And, again, not so casual. So I try to form a relationship with whoever I’ve just slept with, whether or not this is actually, really a good idea. Because she’s awesome.
This has got to stop.

I think that top surgery will actually help with this, despite being a different site of former dysphoria. I used to keep a shirt or vest (aka undershirt) on all the time, except when showering. I do mean all the time. I remember the first time I changed my shirt in front of my last girlfriend, because it was such a big deal for me, but not for her, of course. This is part of the reason I’m taking photos of my chest as it heals. I’m not just vain (although I certainly am that) but I want to get used to the idea of it being a neutral part of my body, infused with no more baggage than my adam’s apple.
I think the most obvious answer, though, is to try a different model of dating. In the old days, people would go out a lot before they had sex. That way, they actually know if a person is really trustworthy before they have to trust them. This seems like a good model. It’s not much employed by the queer community. I actually don’t know typical heterosexual dating patterns, but I think people still tend to have sex somewhat early on. So I don’t know if I could do this and be on okcupid, for example. (Although with it’s CV-like profiles and dating as interview process, it feels so much like applying for a job anyway that I’m not sure I’m overly into it.) I don’t want to wait for marriage or anything, I just want to actually know the other person first and know that putting a lot of trust in them is actually an appropriate thing to do.
The longer term solution is to reduce the level of dysphoria I have around my bits. I have an appointment in September to go speak with a shrink about bottom surgery. They rescheduled this appointment; it was originally supposed to be for two days after I see my plastic surgeon again and can quit wearing a post-surgical binder. It feels a wee bit rushed, but it’s on their schedule. They asked me about this in May, when I was still waiting to meet the surgeon to do my top surgery. The faster I get this over with, the sooner it’s done.

Commenting

Cis people are allowed to comment on this one, but anything that either references bravery or the myth of the suffering transsexual will be deleted.

This post talks about genitals

I got a letter in the mail telling me to turf out this morning for a “transvaginal ultrasound” at the Royal London Hospital. People who have been on testosterone for more than two years have a slightly increased risk of uterine cancer. The NHS has a strong emphasis on preventative medicine, because it saves money in the long run. So I get all kinds of tests that I wouldn’t get in the States, where no bureaucracy has heard of anything but the next quarter.
I walked over. This is the same hospital I went to A&E at, not long ago. It’s in old brick buildings and has a crumbling, Victorian look about it. It’s definitely an urban hospital, swarmed with people form the tapestry of urban life. The woman at reception didn’t seem to notice my accent, but she must hear as many foreign accents daily as native ones.
The clinic I was looking for turns out to be directly above the A&E, on the next floor. I went to the window at the nurses station and signed in. They directed me to a waiting room. Much to my immense relief, it was co-ed. There were as many unhappy looking men as unhappy looking women. I took a seat on a blue chair and pulled out the book that I had brought. Nobody else was reading. The white, windowless room had no magazines.
Rather quickly, my name was called. I was instructed to go pee and then meet the woman in a back room down a dark hallway. She lead me back to a darkish room. The lighting was indirect and the walls didn’t go up all the way to the ceiling. She instructed me to remove my shorts and pants and then sit on a table. She did not leave the room for this, but just told me to put on a gown first. So I did as instructed.
She told me that my GP had referred me for this “because of the drugs [I’m] on.” I started to say I wasn’t taking post-surgical drugs anymore, but then I realised she meant testosterone. It’s funny how I don’t think of it as a drug, but rather something linked to a state of being. It’s not that I’m on drugs, it’s that I’m transitioning. I’m on T, which is, somehow, not a drug.
She asked questions about menstrual cycles, something that’s long since been chained up and abandoned like an unwanted bike. Then she got a wand thing and said it wouldn’t hurt, but it wouldn’t be pleasant.
These bits, I don’t speak of them. I avoid thinking of them. I’m unsure what to call it. But unlike Buck Angel, it’s also non-functional. Testosterone has caused tissue to atrophy, so even it was not mentally troublesome – which it is, it’s physically painful. The cure for this is topical oestrogen cream, which is alarming and for something I don’t want anyway. The other option surgical removal.
So I told her it might hurt and she said that it would be fine. Very old ladies have some of the same physical issues and they’re unhurt. She prodded with the wand and we chatted, as she looked at the screen. I should have taken paracetamol ahead of time. It’s the kind of hurt of getting your teeth scraped by the dentist. Uncomfortable and annoying, but not overwhelming.
She was on the lookout for thickening of the uterine lining. She asked who was going to interpret the results, because it didn’t look thickened, but it looked different than what she had seen before. I said my GP would probably forward it to somebody who was an expert. As it went on, I said something about a hysto and she wondered about osteoporosis risks associated with that. I said T would protect me. “We” women are at risk for that, “but I guess men aren’t.” she said.
She with her invasive, prodding wand, stuck into a site of all sorts of discomfort; a psychic wound; an unwanted opening. Chatting about “we” women. I did not say, “I’m a man,” flying futilely in the face of what must seem like overwhelming evidence. I did not say anything about it at all. I talked about how sex hormones work in men. “Men like me,” I did not say.
She finished and left me alone to get dressed. I thanked her on the way out. I did not do or say anything to challenge the notion that I’m an unusual woman; I just left. Thinking: I will be a subject of medical curiosity and tests and prodding for the rest of my life. It will never be all right. The surgeries I can get will never be perfect. I will never pass when my genitals are examined. When I most need sensitivity, it will never be forthcoming.
I walked out, past the entrance of the A&E, with the feeling of not passing. Outside, there was a man with a broken neck, smoking cigarette. I made eye contact with him and then thought it was rude to stare at the screws holding his head in place, so I looked down. “Nice DMs” he said. I was sure he could tell, sure he was feminising me, complimenting my body in some unwanted way. “What’s a DM?” I asked. He smiled and pointed at my shoes, mistaking them for Doc Martens. “Oh!” I said as the lightbulb went off. It was all blokey and male bonding and fine. I smiled back, “thanks!” I said.
I cannot get a hysto soon enough.

Note

I don’t want cis commenters on this. If you don’t know what cis means, it probably means you.

Week 3

Life

Well, the nurse last week was very cautiously approving of my gig plans, but everybody I know who has actually had top surgery was against it. Meh, what do they know? I made plans to have a first practice with Jet on Saturday. To prepare, I was taking longer and longer walks, with my recently returned dog, to build up my strength, but not playing bass. I was tapering off painkillers. Life was good.
When I actually pulled out my bass, my dexterity was really low in my left hand and my playing kind of sucked. I got gradually better as the practice went on, but it was pretty short because I got tired really fast. Jet, who is lovely btw, went on to her next appointment. Then the pain started.
Oh my gods it hurt. The next day, I thought I might have torn something. I had no more of my more powerful painkiller left. I called NHS Direct to find out if it’s ok to take parecetamol and ibuprofen at the same time. “I just had a mastectomy.” I explained. “A vasectomy?” the woman asked. Um, not exactly. Anyway, mixing them is fine.
By Tuesday, the pain had receded enough that I thought I might manage being social in public, so despite not being able to use my left arm for things like wasing up, I got on a bus with Paula and headed to Vauxhall for Bar Wotever. I turned up earlyish, got a seat in the back and didn’t budge for the evening. Dr. Jane came by. She noted that I’d written that she rushed up to me after my dressings appointment two weeks ago. “You were walking like this,” she imitated an old man shuffle, eirily reminiscent of my grandfather and then described how pale I was. I guess it must have looked pretty alarming. Anyway, the night out was fun. I got pretty tired by the end, but it was ok and I was fine in the morning.
Which was good because I walked over to my GP’s office to learn the results of having my hormone levels tested. Shockingly, they were fine! I’m very pleased as I’ve been feeling fine. In the past, feeling fine has correlated with my levels being too high, followed by my dosage being cut to a level where I don’t feel fine. 2.5 years on Sustanon and I finally know how much to take how often.
Meanwhile, coincidentally, my godmother signed up for facebook. It alerted me, as they seem to have a copy of my addressbook. About a year ago, I had sent her a coming out letter and had heard nothing back. So, I sent her a friend requst and she accepted and then sent me an email. We had an exchange and she asked why my status messages were about being too tired to walk my dog properly. I explained I’d had an operation without further specification. She didn’t ask what my op was, but instead what name I prefer to go by. My heart was greatly warmed.

Third Outpatient Appointment

Yesterday, I headed down to Tooting for my last appointment with the dressings clinic. I walked from my flat to Tower Hill at near normal speed! Just being able to walk quickly again is such a relief. I had the same nurse as last time. I described to her my bass playing woes and showed her my non-painful range of movement. She said there must be scar tissue and that I need to keep moving to keep from stiffening up entirely. She suggested shoulder roles and gently raising my arm as far as it wants to go. I need to work back to being able to reach things. I’m going to procede with caution.
I also asked about getting signed off for medical leave, as I haven’t done any studies for about 3 weeks now. She said the hospital would automatically give me one week and if I want more, I need to talk to my GP. One week?! Good lord. The ideal Briton must heal very quickly indeed.
She looked at my wounds. My right nipple continues to heal as it should. The left nipple has become appropriately dry and therefore no longer needs bandages. The necrotic bits on it will turn to scabs and should come off on their own. She advised against picking at them, something I don’t need to be told twice. Or even once, really. I’m to moisturise both nipples twice a day. This will help the puffy, ruffly bits to flatten out and thus hide my scars.
Because neither side needs dressings anymore, I am not scheduled to return to the dressings clinic. I will see my surgeon again in about 3 weeks. It’s possible to ask her to do the documentation for medical leave, but I’m going to try my GP first because that will take less time and because my surgeon, like all surgeons, thinks people recover from this after 2 weeks. If I can only get a note for 2 weeks, that’s better than none, but since I’ve been useless for 3, that would be better.
I look forward to being able to bicycle again and play bass and take long walks with my dog, holding the leash normally instead of looping it through my belt. And also to write some new music. Being medicalised gets old fast. It’s worth it, but I’d like to go back to normal.

Second Outpatient Appointment

My Week

After my overly-exhausting walk to my GP’s office last week, I took a few days off from wandering around. Even going across the courtyard to my neighbour’s house was leaving me pale for several minutes afterwards. But then, over the weekend, I was feeling better and asked my neighbour if she would go for a walk with me, along the bus route. I asked her to tell me if I started looking pale.
We walked about a kilometre, sat for a long time on a park bench and walked back. It was fine. I was feeling happy to be ok again. I went to the grocery store the next day, with Paula’s help to carry stuff and then hung out the rest of the evening, felling completely normal. A lot of friends were coming around to see me. I wasn’t going out at all, but had enough company to stave off loneliness. Things were pretty good.
On Tuesday, I picked up a novel before bed, intending to read a couple of pages. At 3:30, I realised I had read the whole thing and was up later than I meant to be. I’ve been going to bed around 1, so it wasn’t that much later.
I woke up the next morning feeling like crap and in pain. I could barely stagger around my flat. I took a bunch of pain pills and when they didn’t perk me up adequately, I called the Hospital to delay my appointment. I suddenly felt very fragile. They said I would be mostly recovered by 2 weeks and it was just shy of that and I couldn’t even manage to stay up slightly late.
My friend Jet had asked if I could play some improv bass for her theatre piece on the 25th. Aside from not really being up on generic improv, I suddenly became worried that maybe I wouldn’t physically be able to do it. I started asking around and most guys are saying it’s not actually a good idea, but one shared a story about having a major recording session about 3 weeks after. Meh, I really want to do the gig!
Meanwhile, I was changing my dressings everyday and taking photos of my chest while the bandages were off. My right side is still looking perfect. It has hardly any bruising at all and the wound healed completely within a few days. The adhesive from the bandages began to irritate my skin, but, aside from that, there were no problems.
My left side is probably more typical. It’s bruised and swollen. The haematoma has gradually decreased, but not vanished entirely. The dark band of necrosis on my nipple seemed to be decreasing in size, but the whole lower half of my nipple was oozy and gross and seemed to be slowly dissolving. It was sticking to my bandages. I tried not to pay too much attention to it.

Thursday

So when Thursday came around, I asked the TFL for a route with minimal walking. It sent me on a short walk to a long bus ride east to catch the DLR to Bank. Climbing the stairs to the DLR platform was surprisingly tiring. But the route was ok and had a lot of escalators. When I got to Tooting Broadway, I walked to the hospital rather than riding another bus.
Thursdays, the Dressings Clinic is not in some back corner of the hospital, but mysteriously moves to a ground floor clinic in the same wing as where I had my operation. I saw a different nurse than last time and asked a lot of questions.
People have been urging me to try Arnica, which is a flower that is rumoured to help with bruising. I had been concerned about drug interactions or possible allergies, but then I learned that Austrians make schnapps out of it. Anything that’s made into schnapps has got to be relatively harmless. Still, I asked the nurse and she said that there were no studies that indicated that it had any effect at all. She did say it was harmless, so I bought some gel on the way home.
She said that the rash I was getting from the bandages is probably not an allergy, but from the irritation of pulling off an outer layer of skin every day. She suggested that from now on, I should peel off the bandages while in the shower, as the water would weaken the adhesive and thus spare my skin.
Because my right side has closed all the open wounds, I don’t need to wear a bandage on it at all anymore, but should massage in moisturiser around the edges. She was demonstrating this and I felt a bit of pain where she was poking me, which is actually good, because it means my numb spots on that side are nearly all gone, except for my actual nipple, alas. My skin is really itchy, but this is apparently a sign of it re-awakening to sensation. Also, I’ve been feeling a lot of weird sort of stabbing sensations, like somebody is poking me with something kind of sharp. This feeling is nerves reconnecting and waking up. So despite it’s being somewhat annoying, it’s a good sign. And, I mean, some folks would pay good money to feel like they were being sharply poked repeatedly in the nipples.
My left side is still way more numb than my right side, but in the last couple of days, the sensate portions have dramatically increased. And it’s got the stabby thing going on a lot more than the right, so it’s continuing to heal. Ironically, that nipple is often itchy and has more feeling than the more perfect looking one.
The nurse said that the generally gooey yuck of the left did not mean that it was dying, just that it needed to dry out. She confirmed that the necrotic band had really reduced in size. In order to dry out my left side, she switched the sort of bandages to put on it. Now, I start with an iodine-soaked piece of gauze, which i press into the folds of my wound, as much as I can. Then, I put a regular sheet of gauze over that. And then a non-waterproof adhesive on top. Theoretically, the new bandaging is breathable and the iodine should encourage dryness. It was much less yucky when I changed it this morning, but alas, I pressed in the new sheet perhaps too gingerly.
She gave me all the stuff I’m going to need to bandage myself for the next week, including a disposable pair of scissors. The dressings clinics gets sterile pairs of steel and plastic scissors, uses them once, and then incinerates them. I was flabbergasted last week when I saw the nurse throwing them into a sharps bin. She said they used to autoclave them, but not anymore. I really find it hard to believe that many germs could survive a trip through an autoclave. If it’s good enough for tattooing equipment, which actually touches blood, it’s got to be good enough for scissors that only touch sterile dressings. If this is cheaper, it’s certainly a false economy. Nothing that wasteful can seriously be a good idea.
I talked about how fragile I felt after staying up too late and asked about playing the gig in a little more than a week. She was cautiously encouraging but stopped well short of saying it would be fine. What she said was that the consequences of doing too much would make me feel over-tired and bad, but it does not actually impair the healing of my wounds. So the risk I would be taking by playing the gig was not any further harm than exhaustion. I’m not going to mess up my operation.
She said I should work up to it. I intend to do this by getting gradually more exercise leading up to the gig and also by practicing every day and making sure I have the stamina to play bass for the duration required of me. I’m not going to move any gear and I’m going to play while seated, so there’s very little actual, physical stress. The only concern is exhaustion, which, while uncomfortable and definitely something I want to avoid, has no long-term consequences.
I feel cautiously optimistic. Anyway, taking walks and getting better at bass playing will both be good for me.

Outpatient Appointment

I woke up yesterday morning feeling relatively feisty, so I put all my clothes and stuff into bags, ready to go home to my own flat. Jara helped me carry the heavier bag. It was all good, but by the time I walked down the stairs, across the courtyard and up the stairs to my own flat, I was too tired to do anything. I didn’t leave my flat in the cleanest possible state, and fixing this is very slow going.
In the mid-afternoon, Dr Jane came around in her awesome little sports car to collect me for my first outpatient appointment. I was very grateful for the lift and the company. Given that it was a trek for me to cross my estate, I wasn’t quite ready for the tube and it’s much more pleasant to go with a friend than alone in a cab.
There was a lot of traffic in central london and the outpatient plastic dressings clinic is in a strange back corner of the hospital. I arrived 20 minutes after my appointment time and then probably walked for at least another 10 minutes, around the perimeter of the hospital, until I finally found a dark hallway that seemed to be right. The plastics dressings clinic, where I was headed, was next to Bereavement Services. It’s good that the hospital provides this service. It seemed to be a small, windowless room with 3 or 4 chairs around a low table. Kind of a depressing setup, but I guess that doesn’t actually matter.
I apologised for being late, but they were running behind anyway and so I waited for a bit and then went in to a very warm, windowless room. There was a fan blowing, but the nurse turned it off when it kept blowing the paper off the examining table I was trying to recline on. The walls were lined with little plastic bins that contained different kinds of bandages and things like that.
I took off my shirt and chest binder and the nurse started to peel off my bandages. She did the right side first, first taking off the plaster covering were the drain had been. She said it was dry and didn’t need to be rebandaged. Then she took off the plaster over my nipple. It had a bit of blood on it, but was fairly clean. I looked down at my chest.
I had been warned that it would look weird at first, but man, it is weird. The process the surgeon used was to cut out my nipple, but keep it attached to the blood supply and nerves, and then remove the moob around it. So this left a hole, so she stretched the skin from the outside of the moob towards the middle. To visualise this, think of cutting a circular hole in a sheet. Then you want to close the hole, so you bunch all the fabric from the perimeter of it together and then put a button or something in the middle of that. That’s kind of what my chest looks like.
There’s an expanse of pale skin, that gets kind of wrinkly and ruffly, which surrounds my pink nipple, poking out from the middle. All the stitching and scabs, etc are only surrounding the nipple. The nurse said it looked perfect. Ok!
The she took off the bandages on the left. These were much more dirty and I averted my eyes for the rest of the process because I didn’t want to feel faint. She also, very happily, removed an electrode that was still stuck to my back, that I couldn’t reach. “You haven’t taken a bath for a week?” she asked. Um, no. I started thinking about who it would be least awkward to ask to come over to rub my back with washcloth.
She was concerned about the swelling, so she asked another nurse to come have a look. The other nurse was busy, so we had a longish wait where we made awkward small talk. She put a paper towel sort of thing over my chest, probably because I was obviously freaked out by the scabbiness. I took it off after a bit to get a better look. Meanwhile, I had kept my binder on nearly continuously since my op and the sensation of having it off was also kind of strange. It’s purpose is to reduce swelling, and while it was off, I could feel swelling tugging at my stitches. The nurse told me not to worry about it.
The other nurse finally came in and looked at a lump I have on my left side between my armpit and nipple. It’s somewhat larger than a golfball. She said it was a hematoma, which means a bunch of blood and other goo trapped under my skin. “We could aspirate it with a needle,” she said and then laughed at the look on my face, “but that would increase the risk of infection, so we’ll just see if it goes away on it’s own.” I m deeply in favour of that plan over the popping-like-a-water-balloon plan. She said the (now extensive) bruising was also normal and not to be worried about it.
Then she got out a mirror and showed me my left nipple. “Do see you the shadowed part underneath?” On the bottom of my nipple, below the pokey bit, about 10-20% of my nipple has darkened. She explained that this indicates a blood shortage. The shadowed bit will probably die. It will dry out and then she and the nurses have a way of getting it off. And then, I guess, somebody will tattoo the pale skin around it and the world will be none the wiser.
They told me I could take showers again! Huzzah. I should moisturise the ruffly bits of my chest afterwards and when I change the bandages, which I should do everyday. They gave me some moisturiser to use and meant to give me a week’s worth of bandages, but accidentally only gave me enough for one side. I’m allowed to keep taking the same pain meds, despite the prescription ending. She told me to look out for signs of infection, which I have not absolutely committed to memory, because of my propensity to worry. If it doesn’t seem wrong, it’s not wrong. If does seem wrong, I should just call them. I’m to come back in a week.
I walked around to meet Dr. Jane by the café in front of the hospital. Jane came rushing over to meet me. Later she explained that I was shuffling like an old man and looking very pale. She suggested we sit for a bit and have a bite. “How are you doing?” she asked. “Part of my left nipple is dying, but it’s not a part I was really using.” I said.
We sat nicely for a bit and then went back to mine and hung out for a bit more. I took my last antibiotic, thank gods.
This morning, I had to go get my T levels tested at my GP office, which is a bit further than a kilometre away. I asked the guy drawing my blood if having an operation and the massive stew of drugs I’ve been on since my last T injection would skew the results. He didn’t think so, but wasn’t sure. I guess if it says the levels are too high, I can push for a re-test, since this new 0.8ml / 18 days is the best I’ve ever felt on T and I am not entirely keen to decrease.
On the walk back, I had to stop and sit about after every third of the trip. I was back to my old man shuffle, but trying to stand up as straight as possible. I’m so used to slouching that it’s very awkward looking when I try to stand up straight. But since I’m wrapped in a piece of elastic and recovering from surgery, I’m all awkward anyway, so might as well get used to it now.
When I got back, I was shattered and slept for a couple of hours. I probably should have taken a cab home or waited longer in the waiting room before walking back. Still, stronger ever day.

Home From Hospital

The doctors had said I was going to be out “mid-morning,” so when it got to be afternoon, I asked the nurse what was going on. She explained that there’s only one pharmacist working in the hospital on Sundays. The ward didn’t have my antibiotic on hand. They only kept supplies of one I’m allergic to.
She came around again later to remove my de-pressurised drain. The right one had been gently coaxed from my side by a different nurse. But this one she took out all in one quick motion. It was quite a bit more uncomfortable than the right side, but everything on the left has been more uncomfortable. I remarked on the speed at which she removed it and she claimed there was less pain overall if it was done quickly. She also, finally, removed the IV line, which had been painfully poking me for the last few days. I couldn’t move my arm much without the needle n it restabbing me. It was such a relief to come out.
She came back again with a bag full of pill boxes and a letter. The pill boxes were all my prescriptions for pain killers and everything I had been taking while in hospital. They even included boxes of paracetamol (aka: Tylenol or acetaminophen).
The letter explained what procedures had been done and who had done them. There were also appointment letters for two outpatient followup appointments.
I asked the nurse if I should watch out for anything. She said I was going to be back so soon for a followup, that I really didn’t need to worry about anything. But if there was discolouration, then that would be something to lookout for.
I had texted Paula that I was being freed and I knew she was on her way, so I got dressed and walked over towards the nurse’s station to stand around. I was thinking of going outside and sitting there, but wanted to tell them where I would be, so they could direct Paula. However, by the time I got to the nurse’s station, I was feeling more tired, so they pulled me up a chair and then suggested I could go to the day room. So I went down the hall there, where two other patients were half passed out, watching Wimbledon. I have to confess that I don’t understand the popularity of tennis. Or golf. After sitting there for several minutes, I realised that what I really wanted was a nap, but I thought they might have made up or given away my bed, so I stayed where I was while Paula and Jara navigated the weekend engineering work on the tube system.
We went downstairs to the cafe and I had a bite and then got a cab from Tooting back to Wapping. The bouncing of the cab was extremely uncomfortable, but as there was nothing to be done for it, I didn’t complain. We got back and I very slowly climbed the two flights of stairs to Paula’s flat. It was a relief to be out of hospital and finally able to walk around a do things. However, things like pitchers of water turned out to be unexpectedly heavy. As I was getting ready for bed, I put a glass down on an unstable surface and made a grab for it with my left arm to catch it before it fell. Something in armpit pulled uncomfortably. I went to bed.
In the morning I woke up and stumbled towards the bathroom. I looked down at my left hip and saw some bruising. Funny I didn’t notice that when I was still in hospital. I splashed some water on my face and then realised it hadn’t been there when I was in hospital. I took off my binder to look at it, and it was a line of purple bruising from up in my armpit where the drain had been, all the way down to my hip.
I got the letter the hospital had given me and called the number on it and got the main hospital switchboard. I asked to speak to my surgeon and they put me through to her fax machine. Paula suggested that I call NHS direct, which is an advice nurse service run for the whole of the UK. The friendly nurse on that line suggested that I draw a line around the bruise and if it got worse, I should see a practice nurse or ring the hospital. Paula obligingly drew a line around it.
After a few hours, I asked if it was worse and she wasn’t sure. Some parts might have been darker, but there didn’t seem to be anything new. I took a nap. At dinner, I asked again if it was worse. Paula gasped, so I rung the hospital and asked to be connected with the ward in which I had spent the most time. The person who answered the phone told me I should go to a walk-in clinic, or if that was closed, I should go to an A&E (Accident and Emergency, aka the ER).
I hadn’t eaten in several hours, so I picked at my dinner for several minutes, trying not to panic and then we called a cab to go up to the Royal London Hospital, which is very close by. The receptionist there said the wait might be four hours long. The waiting room was packed and there was a chair shortage. I sat on the floor for a bit. They called me after only an hour wait.
The triage nurse phoned their plastic surgery department and asked what to do. The doctor advised that they give me a blood test to make sure I wasn’t haemorrhaging. When I had been in hospital, they had been giving me shots of blood thinner every night and I mentioned this to the nurse. He nodded and led me to a cubicle. Another nurse came to take my blood. He had to get something and while he was up, I saw a drunk man start hurling abuse at the triage nurse until security threw him out. Then another man started screaming at the guy who was to draw my blood, telling him to open a locked door. The nurse asked what was going on. The screaming man’s nephew had just died and he was distraught. Somebody else came along to talk to him, but the nurse was shaken to have been screamed at and needed a few moments to calm down. I suddenly realised why so many TV shows are set in hospitals.
He finally came to draw my blood and then went away for a while. He came back several minutes later and said the blood test had gone wrong because my blood had been mishandled and he needed more. I decided not to complain because there was already enough drama going on without my contributing. Fortunately, the second time was adequate.
After several more minutes a doctor came around and asked me a few more questions and said my haemoglobin numbers were good. He told me to call the plastic surgery department in Tooting in the morning and said the amount of bruising I had was not exceptional for an operation.
I started putting on my shirt and he threw open the curtain before I had gotten the first button fastened. I was momentarily exposed and ashamed and then I remembered that it doesn’t matter anymore. My bare chest is not a site of privacy.
We got back at maybe 12:30 AM. I took painkillers and went to bed. When I woke up this morning, the purple bruises were the same as last night, but I now have yellow bruises spread over a lot of the left side of my chest and into my upper arm. I called St George’s in Tooting and explained to the plastic surgery department what had happened. The man on the phone sent me to somebody’s voicemail. I left a message but haven’t had a call back. My outpatient appointment is tomorrow, so if it can wait, I would much rather let it wait. The cab ride is long and expensive.
As it has from the start, my left side hurts more than my right and the drain site hurts the same as when it had a drain in it. It I extend my arm too straight, I feel a pulling around where the drain was inside. I wish I had made more expansive gestures with my left while I still had the drain embedded, but the IV line poking me discouraged this quite a lot. Alas, for my having been a wimp.
In all the story so far, nobody ever asked me for ID, nor for money. The receptionist at the A&E just wanted my name and address, but didn’t ask for any verification. The registration took less than 5 minutes. When they told me I could go, both times, I just walked out the door. This sort of non-capitalist efficiency used to be shocking to me, but I managed to get used to it very quickly. If your country doesn’t have a system like this, it could.

Top Surgery Part 3

When I got out to the ward, I felt good enough to start blogging and high enough from opiates to think it was a good idea – and to make loud declarations about my genitals when offered a bottle to pee into. This is probably part of why they wanted me to stay in bed rather than try to walk.
My surgeon came by, and was concerned about my left drain. She thought it might need to be flushed out in the morning, which would be a second operation under full anesthetic. She asked that I get no food after midnight.
Paula stayed with me a while and then visitng hours were over. It was a dramatic night. One old man kept wanting to know where his wife was. A young guy woke up screaming and ripped out his IV line. Then morning came. My left side still seemed swollen to me, but when the surgeon came by, she said it was ok. I felt very relieved.
she told me to try walking around some and to move more like i would at home. She also told me that they’d been forced to take out my ear piercing and it had been lost. It was a ring through my upper cartilage, which was alright, but it did get in the way a bit when i wanted to wear headphones for more than an hour. Apparently, it’s a very big deal when a piece of jewlry gets lost. I’m not overly bothered by this, but the principle is important, she said.
I would need to spend another day in hospital to have my drains observed.
The drugs given to me by the anesthesiologist were all wearing off and i began to feel ill. Paula came to visit and coaxed me into eating a bit. In a sharp contrast to my other nurses, the one i had then was not sympathetic. Paula eventually interceeded and i got a shot of something that was supposed to make me feel better. It took the edge off, but didn’t really help. Around midnight, i rung my buzzer to tell the night nurse that I thought I was going to be sick, but I ended up demonstrating the verb rather than saying it. I didn’t keep anything i had swallowed that day.
A doctor came around to talk to me. I told him I had tossed my cookies. He looked bemused. I said, “is that something you can say in Britain?” He said he got my meaning and then he poked at my stomach and prescribed some drugs for constipation, as apparently the food I ate just had nowhere to go. The nurse came around later with two gigantic syringes. I was alarmed, but she noted the IV thing is still in my arm. So the contents of the two huge syrninges went into there. Then she gave me pills and a sweet liquid. She told me to drink a lot of water with the liquid. I actually felt thirsty, which was a change.
In the morning, I felt dizzy and weak and could barely sit up. But as my stomach settled and I ate things, I gradually felt more alive.
A doctor came by to examine my wounds and said that my right drain should be removed. A nurse came around later and depressurised the drain container, which apparently has some suction on it. Then she used a bunch of pointy tools to pull the hose out of my chest. It was kind of uncomfortable, but didn’t hurt overly and afterwards, it was a nice relief.
Because the left drain was still in, they would keep me for another night. But the ward was getting ready to close for the weekend, so they got a push chair to move me upstairs. I was greatful not to have to walk as I still felt kind of dizzy.
The ward that they moved me to seemed to be full of people suffering from weekend-related accidents. Directly opposite me was a very unhappy man with his arm in a sling, being gaurded by two bobbies. The cops were on the phone, trying to figure out who had arrested him. Other people had broken arms, dog bites, etc. When Paula came to visit, she said it seemed more peaceful than the previous ward, but she missed the arrested guy angrily explaining about how he was the victim and was intending to sue the police.
“Are you alright?” Paula wanted to know, “Jara says you haven’t been on facebook for hours!”
As of this very morning, they say they’re going to let me out. A doctor has come to tell me my prescriptions and my remaining drain has been depressurised. I feel good enough that I think I could go straight home, but am relieved that I don’t have to.
I’ve gotten top quality care here and at no charge. The NHS is fabulous. Socialised healthcare is awesome.

Top Surgery Part 2

Somebody was moving my shoulders. “I’m sorry, I think I fell asleep.” I said and opened my eyes. I was in the recovery room and still quite groggy. I was shivering or started to shiver and then got a warm air blower and put the pipe of it under my blanket. It seemed to work instantly.
it seemed like a flurry of activity around me, but it’s also possible that i slept between spread out things. Also i had a blood pressure cuff that did measurements every 5 minutes. I can’t remember many details, but the nurses were very good.
The room haf 9 gurney bays and there was one nurse for every 3 gurneys plus 1 or 2 extras to spell them on breaks or help for 2 person jobs. My nurse was named Helen. When she got her tea break a nurse named Joan filled in. They were both brilliant. Capable and caring. They were lovely.
Not long after I became alert, my left drain started filling quickly, such that it was nearly half a litre of blood. They asked what to do and were told to sit me more upright. That worked.
they gave me morphine in a drip, but not enough to make me loopy. Then they gave me some water. Then tea! Such lovely tea. It soothed my sore throat, and was one of the most satisfying cups of tea ever. Then a sandwich. Then a pain pill.
I looked down at my bandaged chest and was filled with a profound sense of relief. I was fine. I made it. It worked! It was amazing. Somethingthat for years I was afraid to even want and it was done and I was ok.
However, because of the drain issue, They thought they might need to send me back to the theatre, so I was in the recovery room for a long time, so I chatted w Helen and had more tea. Eventually, a surgeon that I didn’t recognise said it would be fine and i got sent to a ward.
A gurney pusher and two nurses, one of them a student at Kings College, came to move me. They asked an elevator full of people to clear out for me. “Sorry,” i said to a woman who got off. “You must be very important,” she joked. “Everywhere I go, the paparazi!” I said. The gurney didn’t take up the whole elevator, so the nurses were telling people to squeeze in. “Come on, get in there. Ok, now climb on top!” “He’s a bit too young for me” the woman said.
We got to the ward and Paula was there.

Top surgery part 1

I woke up before 5 this morning, took what i knew would be my last shower for a while, gave myself a T shot, packed my bags and got on the tube. My appointment letter was for 7 but I arrived almost 20 minutes early and waited for the surgical admissions lounge to open. That was the same place I had gone for my previous appointment, at which they had collected vital signs and data. A sign by the door said they open at 7, but it closer to 10 minutes after that.
The head nurse gave a speech about the admissions process. He then called us by name one at a time and asked us if we wanted to give them a phone number for a visitor. I gave them Paula’s number and later they called her and told her what ward i was in.
at the same time, other nurses were calling people one at a time and taking temperature, blood pressure, weight and allergy information. Shortly after I talked to the nurse, I got called by the anesthesiologist who explained a bit about the drugs she would give me to kill pain, knock me out, keep me from feeling ill, etc. She (or the nurse before, i can’t remember now) game me two red id badges- one for each arm. They’re red to indicate that i have allergies. Which are to two different antiobiotics. She told me they do my op around 10.
i went to wait again and then the surgeon called me in. She drew on my chest in permanent marker. “You’re quite wonky, aren’t you?” She said. Apparently my spine is curved which she said was the reason my moobs were very assymetric. I felt guilty about my bad posture and tried to blame playing sousaphone in school, but she said it was likely genetic. I told her that a piercer had said i had weird nipples and she sympathised with the piercer! The lack of social skills made me more confident in her surgical skills.
She explained how the op would work: they cut away tissue around my nipples, while keeping the nerves and blood vessels attached to them. Then the would sew that to what was left. She explained that an insufficient blood suplly could cause a nipple to fall off, but told me should build a very comvincing new one and tattoo on an areola and it would like fine, so i shouldn’t worry. Sensataion in my nipples will be decreased. Then, she went through a consent form and asked me to sign it.
i went back out to the lounge and checked my email and then started to read a book. They called me up again and said it was time to get changed. I was extremely nervous. I took off all of my clothes and put on a hospital gown, a bathrobe, anti-bloodclot socks and foam slippers. The the nurse took me downstairs to another nurse who double checked everything. Yet another nurse took me to the anesthesiologist’s room. In it was a gurney, which i lied down on. They put electrodes on me and a needle into my hand. There was a large numbers of ampoukes laid out.
The doctor chatted about her honeymoon in california as the she gave me a shot of pain killer and the nurse gave me an oxygen mask. Then the doctore hooked up a huge vial of milky white stuff she said would know me out. She warned me it would sting.
“so this is the last ting i’m going to remember.” I said and then verified that it does sting. I thought about how it was very odd to have an experience knowing it was going to be erased. I could already be past the point of where i would forget, but right now it was all real and i felt very present. I don’t know what I felt after that.