healthcare – Les said, the better II

Adventures in American Healthcare

A few days before I left England, my ear began to itch, in the spot where I used to have a cartilage piercing. I didn’t worry about it, but scratched at it, absentmindedly, thinking I really should do something about it but then forgetting. Then I got on a 10 hour flight, followed immediately by a 16 hour train ride. I got to my dad’s house and felt exhuasted and my ear was irrated to heck. I caught a glimpse of it in the mirror and my entire ear was red enough that I could step in for Rudolph and save Christmas, in case a holiday movie suddemly formed around me.
My dad took me to see a doctor at an “urgent care clinic.” This is American for a walk-in clinic. First, a nurse took my contact details and then told me to wait in the lobby. The primary feature of this was a large flatscreen TV showing adverts for prescription drugs. “Feeling stressed? Ask your doctor about Damitol. Damitol can help with burts of impotent rage. Do not take Damitol if you are already taking Fukitol. Side effects of Damitol may include becoming red faced, excessive sputtering and fatigue. Damitol works best when combined with diet and exercise. . . .” Blah blah blah. They had a 5 or 10 minute advert for a diabetes drug. Then they had a minute or two of random health-related information, then another advert. It was all branded as CNN Health.
“This is weird.” I said to my dad.
“I think it’s just general information about insulin . . . oh. That is weird.”
A nurse took me back, weighed me, took my blood pressure, pulse and temperature and asked about allergies. All interactions with healthcare providers in the US start with weight, blood pressure, etc. I explained about my ear, which was significantly less red by then. She took notes and left.
A moment later, the doctor came in and I repeated my story. He looked at my ear for 5 seconds and prescribed sulfa antibiotics. “They’re cheap,” he explained. I asked something about my ear and he said it was probably a staph infection and they tend to respond to sulpha.
“Staph?!” I thought.
“Unless it’s MRSA,” he continued.
I quit listening to his list of dire diseases. I asked about side effects and he started talking about posssible allergic reactions. “In the worst case your mouth and tongue will swell up and . . .”
“I just wanted to know if it was ok to drink or not.” I interrupted.
“If you drink, it will make the allergic reaction hit more quickly . . .”
I stopped listening again. Then I went out to the front to pay. Actually, my dad paid. It was over $100. Then we went to a pharmacy, where the drugs were only $14. They really were quite cheap.
The pharmacist explained that they might upset my stomach, etc. i had forgotten that in the States, you get this information from pharmacists and not doctors. Probably because we were in Washington state, she didn’t mention that I should stay out of the sun.
So I started taking antibiotics, wondering if my British GP would have prescribed them. he certainly would have poked my ear several times first. I also started putting hot compresses on it. It hurt if anything touched it, so no wearing headphones or hats or sleeping on that side.
Last night, on the 8th day, it was bright red again. And still hurting and warm to the touch this morning, so I resolved to go to a clinic. I called the one closest to my house. They weren’t answering, so I called another which was taking a holiday and then another and another. Every clinic seems to be closed today, except for one 3 miles away, which said it was open, but the recptionist was busy. I cycled over. It was closed.
Finally, I tried the Berkeley Free Clinic and was startled when a person answered. I described my woes. “You need to be seen,” he said, but they couldn’t see me before Monday. “Do you have money or insurance?” The person asked. Money, yes. Insurance, no. He suggested that I go to Highland Hospital. “They have an urgent care clinic. Go to the emergency room and they’ll direct you.”
I faffed around for a bit and finally got on a bus. Highland is an emergency-only hospital with a reputation for highly organised, professional helpful staff in the midst of the complete chaos.
I asked for the urgent care clinic and was told it had closed down. They said they just do it all in emergency now. The intake person said it was fine that I wasn’t having an emergency and took my ID and told me to sit.
I got called up to a triage desk and a nurse took my temperature pulse and blood pressure and asked about allergies and past illnesses. “When was your last tetnus shot?” Then she asked what the problem was and gave me a red wristband to indicate that I have allergies. She told me to wait in a different room.
I got called back to a different desk where I was asked for ID again, address, emergency contact information, mother’s maiden name, social security number, whether I had a job and a GP and many other questions. “Did you come by car or bus?” Then, she told me to wait again.
A nurse called me and walked me over to a bunch of cublicles. “Wait here for a moment.” He said and then vanished. A while later, a woman introduced herself as a doctor and I repeated my entire tale of woe. She looked in my ears and then prodded my ill one a bit. She said it was a minor infection and would probably go away on its own, but decided to prescribe me new antibiotics. She told me to keep sitting there and a nurse would come.
The nurse had the prescription forms. “You have to take these every 6 hours, which is a pain in the ass.” She looked at my warm, but no longer red ear and wondered why I had been given a prescription at all. She lead me to wait for a financial advisor. While waiting, I heard an announcement calling the trauma team to assemble, saying a type 2 trauma would be arriving in 8 minutes.
The financial person asked if I had a job and for ID. I said I worked in England. “So you’re not a resident of California?” Well, I kind of am, I’m just studying abroad. I gave her my expired drivers lisence. It has the wrong name on it. This did not help clarify matters. She said I would need to provide pay stubs to prove my income. I said they were in England. She sent me to wait to talk to her supervisor.
I looked at the information provided to me while I waited. “Cellulitis usually clears up on its own.” No mention of staph or mrsa. The financial person called me back.
“You’re not a resident here.” We began again. I finally gave up. She asked what had happened during my visit. “Oh, that won’t cost much anyway.”
“How much will it be?”
They don’t tally it up for a couple of weeks. In my experience, a trip to an emergency room is at least $400, so I really hope this will be billed as if their clinic still existed.
I took the prescription to Walgreens pharmacy, despite knowing that they have a 1000% markup on some drugs, including ones I got from them in the past. 7 days of the new antibiotic cost $60, but if I spend $20 to enroll on their discount program, I could get it for $30. Obviously, they have a large markup on antibiotics also. Charming. I enrolled in the program. The form I got explained that it was not health insurance. No kidding.

Post Script

The bill from Highland came out to $283, which is a lot less than I’d anticipated.

The Bottom Surgeon (aka The Dick Doctor)

The doctor’s surgery was about a block from Regent’s Park. He’s in private practice and the office was incredibly posh. The waiting room had what looked like 18th century prints, in four colours and several nice sofas. I felt under dressed compared to the furnishings.

The sign in form asked for my credit card details and insurance information. I told the receptionist I was on the NHS and she told me to fill out the other parts of it. I overheard the patients before and after me saying the same thing, so maybe Friday is NHS day.

I went up to the doctor’s office, which was smaller and had two oil paintings hanging behind the desk of what looked like impressionistic Parisian street scenes. Rather clichéd art, alas, but hardly the focus of why I was there.

The doctor was a big man and spoke in a relaxed manner. He asked me my height and weight, my allergy information and what musical instruments I play. Have I had any previous surgeries? I told him about the benign tumour I had many years ago and he examined the scars on my wrist. “This is important for this kind of surgery” he explained and then asked if I was right or left handed. “So you want to get a phalloplasty.” I said I wanted a meta and asked if I was in the right place. He explained that he calls them all phallos.

I didn’t take notes and I wish I had, so some of this is not in the same order as it actually happened. My impression that a meta is only one operation was in error. It’s actually three operations, depending on what happens. He said that 2/3rd of people who get it are unhappy later. Skinny people do have the best results, as it sticks out more. He told me about how they move everything they can away from it, to increase the sticking out. Natural dick growth happens over the first four years people are on T. I’ve only been on it for 3 years. The people who have the biggest dicks starting out will have the biggest dicks at the end.

In the first op, they do a hysto, if the patient is having one, add the waterpipe, move stuff around and build a scrotum. They start out giving the patient two catheters, one through his belly to his bladder and one in his new dick. They take out the one in the dick after a week, because it’s irritating, and leave the other one for three weeks, to give the waterpipe a chance to heal before sending wee down it.
There’s a 30% chance of developing a leak, either at the tip, which can split or at the base. If there’s a leak, they give it a while for the patient to otherwise heal and then try to fix the leak. I’ve heard elsewhere that this is difficult and doesn’t always work the first time.
Then finally, they add in silicon prosthetic bullocks. He opened his desk drawer and pulled out a bag of ovular, squishy balls. He showed me one about the same size as the end of my thumb, above the top knuckle. He said it would be that large and then pulled out another, clear ball and said it would be made of the material in the second ball. The first one seemed small, but it’s not like I have a lot of experience with how big they normally are. He said they had to use small ones or it would dwarf the meta-dick.

I gave the material a squeeze. Again, not much basis for comparison, but it seemed kind of firm. If I sat down hard on something, I might bounce a bit. He emphasised how durable the material was, “You can pierce it with a needle or stab it with a knife, and it will be fine,” listing several things I hope never happen to me. He took another, much squishier one from his drawer. “I used to use these. They’re nice and squishy, but I kept having to replace them when they sprang leaks.” I said I appreciated durability.

If I got a hysto at the same time, it would be two days in hospital, assuming that was done lacroscopically. However, the lacroscopic surgeon he works with isn’t in London, but a hospital out in the country. I wondered if it was similarly posh to his offices, but didn’t ask. That hospital is just off the main line from Paddington, which does not sound like it would be a fun commute while one has a catheter protruding from one’s abdomen.

Then, back to work shortly afterwards. All the wounds are in the same area, so that apparently makes things simpler. He talked some about complications, but I’ve got them all jumbled in my head now. Apparently, smokers have the worst ones. So he’s quit operating on smokers. Fortunately, I do not smoke.

He also said that skinny people have the best results, since it sticks out the most and many (but not all) skinny people can wee through their fly. The rest cannot. Which is probably related to the unhappiness factor. This truly makes a very small dick, which is not considered usable for ‘normal’ sex. However, it is my understanding that it’s a dick that has normal spontaneous erections and, provided, one sleeps with yoga practitioners, it’s possible to manage to stick it places.

He was generally fairly negative about the meta, so I asked about the normal phallo.

That used to be 4 operations, but they’ve got it don to 3, he said proudly, contracting his earlier statements about how given the complication rate, one shouldn’t get to caught up on the number of operations.

They take skin from the patient’s arm or belly and use it make a shape like a sausage roll, attach it to the existing blood supply and hook up nerves. He showed me some photos of post-surgical penises, that he had on his blackberry. They were on the large side, but they looked just like any other dick. (Again, not much experience, although one does see them a bit in pron.) The first was an arm one and the second was a belly one.
Of course, if you use the belly, you don’t get any erotic sensation, he explained. “So the belly is out,” I said. “Everyone says that!” he said.
He drew some pen marks on my arm, one of which intersected my tattoo. They would take one of two sets of veins and arteries leading to my hand and two sections of skin, leaving only a narrow strip. They would shape the donor skin “like a sausage roll” and sew it on, connecting up my existing blood supply and connecting nerves. They take some of the nerves from my existing dick and connect those up also, so most people get a mixture of erotic sensation and normal sensation. The existing dick can be stuck sort of under the new one, left out on it’s own or taken off completely, but that’s an extra thing and makes everything somewhat more complicated.
My tattoo would end up part of the waterpipe and not be visible. They replace the arm skin with skin from the patient’s bum. “So it comes with a free bum tuck” he said. “I’m 9 stone, I don’t need a bum tuck.” He said if there was not enough skin on my bum, they could peel the surface off of my thigh and do a thinner layer of skin. Other surgeons do it that way routinely and it can also have a good result. He showed me a photo of a skin-grafted arm.
“Oh, I forgot about the head!” and explained how they built that, but I was thinking of half-peeled thighs and feeling alarmingly like crying, so I don’t recall what he said.
He looked at my left arm and tested the blood flow to see if it would be good enough for me to sacrifice half of it. He said it would be fine. They had one patient, about ten years ago, who’s hand died, but that guy was a heavy smoker and that probably wouldn’t happen to me. Most blood flow problems happen to smokers. Some of them lose their entire penis. He’s stopped operating on smokers because of the complications.
He took out a BMI chart and looked up my BMI and said it was a bit low. The layer of fat under the patient’s arm skin was what provides girth for their penis. He told me I should try to put on a stone or two. “Not, muscle; fat.” Once they made the penis, it would be “diet-proof” but eating more fat wouldn’t make it get any bigger either.
He asked if I had a partner and when I said no, he asked if I was looking. They don’t do the final stage until the patient has a partner or is looking. He took two devices out of his desk drawer. They were like those fat, ergonomic ball point pens, but half again as long as those normally are. One device just had one of those things and the other had two. He pointed at the single one and said they would use that for me, as I’m thin. Also attached to the devices were small squishy pumps and a bulb, maybe 10% bigger than a kiwi fruit.
The phallic portion would go in the phallus, the pump in a bullock and and the bulb somewhere in my abdomen where I wouldn’t feel it. He squeezed the pump a few times. Water comes from the bulb and goes in to the phallic part to make it stiff. When one is tired of being stuff, they squeeze another part of their bullock to release the seal and squeeze the water back into the bulb.
A dick that reliably gets hard and stays hard as long as you want isn’t all bad, really. He said the infection rate for adding these devices was 10%. I said this sounded high. He explained this was an achievement compared to the previous rate. The infection can take up to a month to become apparent. After that, one’s body forms a protective shell around the devices and starves the bugs of food. they give antibiotics for a few days after the operation and then wait to see if an infection develops.
The devices are fairly complex and fail at 1-2% a year. This is why they don’t do that part until the patient has a partner or is looking, he said.
I asked how long I’d be unable to work and he said it would be a month before I could use my left arm again. I don’t know if that means actually a month or is like the “two weeks” my last surgeon told me.
He told me to go think about it. They don’t want to force people to have operations. Patients need to be sure of what they want. I asked if I called back tomorrow and said I was certain, how long it would be until I would have the operation. “3 to 6 months” he said.
I could have a willy in 3-6 months.
I thanked him for his time and said I would call him after I’d thought about stuff and then went looking for fatty foods, feeling completely freaked out.
. . .
It took me many weeks after the last operation to regain my mental focus, so if I got an operation in the next 3 -6 months, the chances of me actually graduating are quite low. I’ve already made some sacrifices for this stupid PhD. In for a penny, in for a pound. It would be really stupid to bullocks it up (so to speak) in the home stretch.
If I do not graduate, my plans to stay on in the country are not going to work out very well (unless I could get married, but I suspect a bandaged wiener may impact my ability to find somebody to marry). So I would have to have the operation and then bugger off right afterwards. Given that I’m entitled to NHS coverage on the basis of being a student, taking this and then leaving without even graduating seems more than a little morally suspect. Assuming that I could get all the operations finished before my visa ran out, which seems unlikely.
If I’m trying to get a job right after graduation, which seems wise, it might be problematic to take sick leave right away. My next likely break where I could lay about recuperating is the summer of 2012. Of course, by then, with the cuts, my NHS funding could evaporate. And the massive cuts in university-level arts education may mean that I can’t find a job and I have to leave anyway. So a planned delay may well mean starting over in another country or it could very easily mean never. I strongly suspect it means never.
I am literally sacrificing my right nut for my PhD.
And my left one.
The next time I’m in a pub’s bog, in a cubicle with no latch on the door, hoping nobody notices that I’m sitting down to wee, I’ll be sure to think how fucking awesome my PhD is.
. . .
I feel completely freaked out. Indeed, even if my PhD weren’t at stake, and I was certain exactly what I wanted to do, I’m not ready for another round of surgery. My chest still hurts and last week a blob of pus came from what I had thought were healed scars. I need 6-8 months for my chest to settle down before I can call it healed. I know some men do move this quickly, but arm, bum, chest and bits is a lot of things to be healing all at once and my uneducated guess is that this probably increases the chances of complications. An infected dick would be disconcerting, but a numb dick would be a personal tragedy.
Whatever I do, it’s a few months of pain and then I’ll have the results of it for the rest of my life. I think that provides a useful perspective. I should take time to think, but really, I know what I’m going to do and it’s terrifying. However, step one is to wait.

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.

Pre-operative Consult

Three weeks ago, I had an appointment to meet my surgeon. It was at St. George’s Hospital in Tooting. The hospital seems to be a new construction or has recently been renovated. The landscaping had not yet been planted, and I passed some heavy equipment outside. Inside was nice, but had confusing hallways, like all hospitals must. I found my clinic quickly. There was a guy I knew in the waiting room, waiting to see the same surgeon. He had gone online and found some pictures of the surgeon’s work and talked to a happy recipient of the same surgery, so he was very positive about her. After a longish wait and a nice chat with my friend, I was ushered into her office. She examined me, told me what sort of operation I’m to have and talked about recovery times.
She asked me to take off my shirt and produced a small tape measure, which she used to measure the distance between my neck and my nipples. One of my moobs has always been more droopy than he other, something exacerbated as testosterone has slightly (not entirely, alas) deflated them. “You’re quite asymmetric” she said, which suddenly called to mind the time I got my left nipple pierced. The piercer had gotten it crooked and had blamed it on my having “weird nipples.” It’s a good thing I already wanted to get rid of the moobs!
Anyway, what will happen is that the surgeon will cut off my nips, remove extra moob from around where the nips were, then re-attach the nips and sew it all back up. This method leaves minimal scars. I forgot to ask if I would have any feeling in any temporarily amputated parts, but it seems unlikely. Alas for that, but it seems like a worthwhile trade off and it’s possible that feeling may slowly return over time. When I had a tumor cut out of my finger, years ago, the top of my finger was numb for a couple of years, but is now normal.  
The surgeon explained that given my existing asymmetry, I should expect to have some later and cautioned me that if I got out a tape measure, I might be disturbed. (Buck Angel, who has a perfect chest had greater asymmetry than I, but he went to a Hollywood doctor and paid a small fortune. As I’m getting this for free and don’t plan a career in porn, I’m pretty ok with this.) So I will be keeping my odd nipples and my lopsided chest. Whatever. At least I’ll be able to cavort around topless and even do wild and crazy things like wear T-shirts.  
Any surgery carries an infection risk, which she didn’t seem overly concerned about. And there’s some chance my nipples would fall off, which, thankfully, is very rare. She blocked out 2 hours of operating room time, but it should be quicker than that. I’ll have to stay overnight in hospital. So the risks are acceptably low and I’m happy this is coming, but it is more serious and invasive than I had realised.  
I can expect to feel really shit for a week. Because Xena pulls on her lead, I probably can’t walk her during this time. Then, I can’t lift anything or do any exercise for 6 weeks. So no gigs for me, unless I get a roadie. I’ll also need to wear a post-surgical binder. She explained that the NHS did not currently fund the one she thought was best, although she’s been pushing for it, so I should try to buy my own. She cautioned me that it will be kind of pricey. How much? I asked. Around £50. She explained that if I couldn’t afford it, they could provide something else and I shouldn’t worry about it. So I’ll be that much out of pocket, plus the £7 copay on whatever pain killers. My first new T-shirt is going to say “God Bless the NHS.” 
The surgeon asked me if I had anymore questions and I asked why she goes by Ms. rather than Dr. She told me that she, like all surgeons, was qualified as a doctor. But then she had done several extra years of training to qualify as a surgeon. It’s customary for surgeons to go by Mr or Ms to signify their greater level of training. She also said it had historical roots from the old days when surgeons/barbers had entirely different training than doctors, who just did bloodletting and prescribed drugs. It’s kind of weird that her profession is descended from shaving beards. I did not bring up Sweeney Todd, but I thought of him.  
After answering all of my questions and whatnot, I was sent off to have “before” pictures taken. The NHS documents everything, she explained. I got somewhat lost on the way, but a helpful woman noticed me looking lost and offered directions. On the way to the multimedia department, I passed several classrooms and a student examination in progress. St. George’s is also a medical school.
The multimedia department had a proper photo studio with lighting and backdrops. I had to sign a consent form which asked if my pictures could also be used for teaching. I said they could. The photographer explained my face would not be in the pictures. I told him that I had recognised somebody’s before pictures from his tattoos. The photographer looked surprised by that idea and I suspect may bring it up at a future meeting. For the pictures, I had to face different directions. It felt like I would imagine how getting a mugshot feels.  
And that was it. I went home. About 2 weeks later, I got voicemail scheduling my pre-op appointment, which will be 15 June. The operation will probably be two weeks after that, I think. I don’t know. It’s hard to plan things when I don’t know dates, but I’m pretty happy.

I write letters

Dear Honorable Senator,

I am writing to encourage you to protect meaningful health care reform by protecting the public option and women’s access to reproductive health services. In order to be meaningful, the public option must be available to everyone, even if their employers offer health insurance. I would chose government-run health care and would like the right to do so no matter what my employment situation.

I’m alarmed about the abortion amendment tacked on to the house version of the bill. I hope that the senate is able to protect women’s rights to access abortion.

Thank you for your leadership on health issues.

Sincerely,
C Hutchins

Write your congress person

The public option is a compromise, and not a very good one. But access to health care is a moral issue and we have to do whatever we can to make sure that everybody has access. We can pass a compromise now and fix the rest of it later.
Howard Dean has a list of how everybody in congress has indicated they’re going to vote on health reform. The number of people who “don’t know” if they support a public option is high enough to swing it either way.
Feinstein is on the list of “don’t know”s, so I used her web form to send her a letter.

Dear Honorable Senator Feinstein,

I would like to encourage you to support a public option for health care reform. Any bill which does not include this option is not real reform. I voted for Obama partly because of his promises on this issue.

I vote absentee in California, but I’m studying overseas in England. The NHS is a fantastic system and we would be doing well to recreate it in the states. A public option is a compromise and not the best one. Failure to support even that is not just a political failure, it’s a moral failure. I’m sure that I don’t need to remind you of the alarmingly high number of uninsured children in California. They are counting on you to support a real reform, with at least a public option.

Thank you for your time,

C. Hutchins

It’s probably also worthwhile to write congress people who support it and thank them.