You are currently browsing all posts tagged with 'surgery'.
Displaying 1 - 5 of 14 entries.

Happy anniversary

  • Posted on July 18, 2015 at 7:07 pm

My partner went to bed at about 3am this morning. She did’t wake me, because my phone was switched off and her messages from Germany only popped up this morning. Before leaving this week, she had left me a beautiful pair of earrings and a card, with a keyring inscribed ‘you are loved’, tucked secretly in the back of a drawer.

Rather than write a long and philosophical blog this week, I just want to celebrate my first anniversary, of perhaps the most significant day in my life so far.

This day last year I woke to no breakfast, only the promise of an enema. Oh; and surgery. I waited longer than expected, and for a while sat writing my thoughts in my notebook. I never copied them out, but here they are:

This is a bit unexpected. I awoke so peaceful and calm. It is not that the coming hours are matter-of-fact. But there is something of a watershed here. A grand leaving behind of a whole side of life, about which, yes, there is some relief, but mostly just that it’s true. It’s a strange thing to see and touch part of yourself that has been important and know that soon it will be gone. Mainly, though, I’m full of wonder that how I shall soon be is a fulfilment of my deepest self-image. Are you familiar with Rupert Sheldrake’s concept of morphic resonance? That there is an energetic space that our bodies fill? Without claiming this as ‘fact’, I have an intuitive empathy with this, and a strong feeling that this is how I shall feel – a better, truer fit with my energetic self. Will that innate sense of body, experienced in meditation, come finally to rest in me? Over coming weeks I shall get to know a new reality, but already I know it will be right.

I was right, and now, one year to the day I am in an unexpected place. The surgery was as perfect as could be, my healing was quick and unproblematic, the high heat of summer turned to autumn and I finally let go a number of final strands of my past. These were mental ones; ones that helped me in decluttering my flat this year. They were cutting loose my grief, even cutting free my acceptance of loneliness. I started going out to do things that would reattach me to a progressive world; I started to look for the future me.

And it was in a ‘Future You’ workshop series that I quite unexpectedly met my partner. Of all the things that happened this last year, this is the one that has changed life the most. No-one has been so accepting of all my realities, and that in itself is tremendously grounding. To be loved, and to love, I find the most validating experiences anyone can have.

A number of trans women have commented (or advised) that the few years after surgery are ones of ongoing self-realisation. Certainly, they are unencumbered by other people’s decisions, clinical treatment, uncertainty about the next appointment and a constant sense of waiting, kicking your heels. And I think I must agree. Had I not wanted the treatment, then it would not have been a watershed, but once you are committed to seeing it through, it feels like nothing else matters. I no longer had the obsession this day last year, so the time since has been one of free self-development.

Speaking only for myself, I do not feel in a trans space any more. I know I still need to explain sometimes to people why I may seem a bit different, but I don’t feel ‘trans’ or queer in myself. I wouldn’t mind if I did, but I just don’t. The body I enjoy now looks OK, it feels OK, and better than that, sharing it with my partner has never been other than completely natural and complete. Even writing my blog on trans matters can feel like an old story. I write still, to encourage, and to observe even this.

If this is your journey, and you are still travelling, it may seem long; just trust that you will get there, and that it’s good. If you know someone who is trans, and going through the hormone and /or surgery route, try to celebrate with them that this is the most authenticating experience they will ever have. If you are trans but not inclined to have every or any clinical intervention, then be happy and fulfilled. It’s just that I did need it, and it for me it’s the best thing I could ever have done.

Journey planning

  • Posted on September 27, 2014 at 3:04 pm

On Tuesday this week, I had an appointment, to return to the hospital I left two months ago and review things. You know, those things. There is often a need to make minor adjustments, because as things heal and any swelling goes down, not everything may be quite as good as it can be – even peeing slightly sideways can be worth correcting – and sometimes a bit of cosmetic improvement is needed. I’ve been happy enough, from my mirror-and-feeling-around point of view, but there is always a chance that something might come up in the conversation to suggest a…

Disclosure and choice

  • Posted on August 30, 2014 at 4:34 pm

This blog is long, but here are the headings: Return to work; Being the anomaly in the workplace; Confidentiality and the Gender Recognition Act; Social media; Disclosure; Advice.

Many happy returns!

I had fondly dreamed of a triumphant, joy-filled, regathering with my colleagues, dropping my handbag on my desk and announcing ‘I’m back!’ I mean, is that not how it goes? Not to applause, but at least welcomed back with a sense of belonging?

Well, no. Return has in fact been a very stressful and hurtful time for me. So I thought it may be helpful for you to know a few useful things when it’s your turn to negotiate this – from either side, employer or trans emloyee.

Important

I wish to make it abundantly clear that here, on my blog, I make a point never to name anyone, nor to speak against anyone or any organisation personally, but only to observe as factually as possible, the experience of transition in its many aspects. I do not even identify my place of work on Facebook, where I exchange life with friends. But I do feel there are important principles about being a trans person, and that we must be free to speak about them, share them, improve things for the next generation. This does not make me disloyal or uncommitted in any way, nor do I ever make personal attacks on anyone, even if I were to feel I have a grievance. Even I may have genuinely misunderstood. But I nevertheless feel vulnerable because I know there is next to nothing to protect me, and you should know that too. Our voice is valid, but we are vulnerable.

Being the anomaly

I was reminded (by a trans friend) that we are an anomaly at work, and that therefore we are treated differently. We create an issue simply by having had gender dysphoria, simply for being transsexual. Nobody really knows what to do, what to expect, and they certainly are not going to take our word as the living expert on ourselves, for anything.

If you are trans, you are different, so expect to be treated as if you have a little-understood disability, perhaps like a disfigurement. Yes, HR will go out of its way to protect you from adverse treatment by colleagues. But you in turn must express gratitude for this accommodation. You are the anomaly; don’t assume that the rights you have to equal treatment are simply about human respect. No, any protection or accommodation you are afforded is because your employer will want to protect themselves. And of course they do, quite rightly. But I sort of think I am not just a possession of the organisation, but also a person, and that normal respect applies. That you have a clinical diagnosis of gender dysphoria usually has no bearing on your ability to do your job, and adds no additional special or concessionary management requirements.

Accommodation of your needs at work? You mean acceptance as a real person with equality of treatment? Someone said to me recently that rule number one for the trans person is never to express gratitude, never to apologise for what you are.

In the early stages of transition, awareness helps ensure that there is protection from harassment. After that it is simply not relevant. At the point of surgery, I maintain, it is nobody’s business other than yours and a single point of reference in HR.

At the same time you will quite possibly experience sexism at work. So that means, for the trans person, normal sexism as a woman (or man) plus cis-sexism (i.e. the compartmentalising or othering of trans people as not quite included in the normal world, neither one thing nor another). Expect it; I hope you may be lucky.

Some while ago, and for several months, on top of the normal sexism, I had a female colleague whose questioning, in open plan office, in front of colleagues and manager, was quite intrusive, very personal, and at times disconcerting. I, as you know since you read me here, decided to take it head on, simply to demonstrate that I am just another person, capable of stating my case, clarifying that gender dysphoria is a medical condition, not a behavioural trait, and that in every other respect I am just another woman. I did not silence it, though perhaps I should. I did not complain, though perhaps I should. I do not want special treatment, and I am not a natural complainer, except in cases of real unfairness. Argue my case? Oh yes; but not to create waves or to play games.

As a trans person, you do not need ‘accommodation’. You need fairness and equality. As an employer or HR person, you are not accommodating the trans person. If having a trans person on your staff is an awkward thing, the problem is the people in your organisation, not the fellow human being who is inconveniently not quite like you. Do not see fairness and equality as a special effort you must make, for a person who is ‘difficult’ simply for being misgendered at birth.

Like me, you should indeed be thankful for correct treatment during early transition, and yes, always be thankful for correctness. But gratitude for being treated fairly and equally? Think about this a moment, if you yourself do not have a ‘difference’ of any kind.

  • Is your gay or lesbian colleague expected to be grateful for being accommodated in the workplace, for being non-heterosexual?

Point made, I hope.

Confidentiality and privacy: Gender Recognition Act

The first point to understand in the UK is that you have few rights at all until:

  • you have lived at least two years in your identified gender
  • sworn a declaration
  • legally changed your name and title
  • supplied documentation proving your medical diagnosis from two qualified professionals
  • supplied detailed (intimate) proof of surgery and/or hormone treatment – or jolly good reasons why you have not
  • provided documentation in the form of passport, driving licence, bank statements, utility bills, employment documents, wage slips, letters etc., that consistently show your deed poll title over the entire period
  • submitted all the above with a fat fee to a panel of experts to express their opinion as to whether you are the gender you identify

    and finally:

  • received from the panel, a Gender Recognition Certificate!

It does, however, apply, if your employer knows that you have applied for a GRC. Therefore you must put this intention in writing. Mine was, if I remember right, merely verbal, but we did discuss it and the patronising nature of the process.

Until this point, protection of your personal data, details and status under the Gender Recognition Act need not always apply. After this, records relating to gender change must be sealed. All disclosure then legally becomes entirely your own. But, let’s also be clear, anyone disclosing your gender history who claims they honestly did not know that you had, or had applied for, a Gender Recognition Certificate at the time (I mean, the more you flash it around the more you are telling everybody? Right?) may claim they are not culpable (Gender Recognition Act, Section 22 on data).

If they do know, then clearly disclosing surgical descriptors (i.e. GRS) is disclosing part of your protected gender history.

  • Dear HR: please be aware that ‘need to know’ in the case of sickness absence, can be covered by ‘gynaecological surgery’ (accurate and sufficient for all purposes) and that once you state ‘gender reassignment surgery’ you are disclosing the person’s previously assigned gender, and this does contravene the GRA.

See also GIRES on the Gender recognition Act, Section 22.

But you exposed yourself!

I have two levels of expectation about disclosure. Among friends, and here on my blog where everything is explained and contextualised, I am open about gender dysphoria (which I no longer have). At work, in public spaces, in my everyday life, it is nobody’s business but my own. Of course this causes ambiguity, but I do only need to be asked if it’s OK to reveal and discuss my gender! This is called respect.

The same probably applies to very many, probably most, trans people, especially those who have fully transitioned, put it in their past, but wish to remain supportive of others. Few go ‘deep stealth’ (totally invisibly trans), and I am an example of those who are open to talk about it, but for whom it has little to do with everyday life.

If you find me on Facebook, and if you friend me and if I say yes, you will see that I belong to a number of transgender groups, some with closed membership. What a giveaway! I have been open on Facebook to my friends throughout my transition. This is probably true of most trans people.

I write a personal blog every week, to relate this whole journey. What a giveaway! Yes, but if you are reading ‘Observations of gender dysphoria and beyond’ then you are in a context, a serious one that looks not just at me, but the issues surrounding transition. Maybe you have a blog too.

Let me then make it abundantly clear that this does not mean anyone can use it to do anything other than observe that I was born with gender dysphoria. It is not an excuse to disclose anything not essentially and legally necessary to people, as if it were relevant to a situation where it is not.

But of course, with so much social media, everyone is much more personally exposed than ever before, and some employers use it more in order to find evidence against than evidence for. I would bet more people have fished in my blog for comment, or my Facebook pages, than my endorsements and skills on LinkedIn, for example. I’m just saying, be aware.

Disclosure and the law

The question is, just because you are detectably transsexual on social media, does this mean that the Gender Recognition Act protections are done away with? Not quite, but it is there to ensure that information exchanged in the workplace (for example) is strictly on a need to know basis. I shall quote here from the UK Equality and Human Rights website:

Gender Recognition Act 2004

The Gender Recognition Act (GRA) gives legal recognition to transsexual people in their acquired gender.

If an application to the Gender Recognition Panel is successful, the transsexual person’s gender becomes for all purposes the acquired gender and they will receive a full gender recognition certificate (GRC). The GRC allows for the creation of a modified birth certificate reflecting the holder’s new gender.

In specified circumstances the GRA prohibits disclosure of the fact that someone has applied for a GRC or disclosure of someone’s gender prior to the acquisition of the GRC. Such disclosure constitutes a criminal offence liable to a fine.

The privacy provisions apply in most circumstances where the information is received by someone acting in an official capacity. The exceptions are very narrowly drawn, so it should generally be assumed that if you are a employer, manager or colleague; or if you are working in any capacity for an official body or service provider, the law will apply.

Unlawful disclosure applies not only to direct word of mouth communication but also to uncontrolled access to paper or computer files. A transsexual person may consent to you disclosing the information if they decide that it is in their interests to do so. However, such consent must be explicit. It may not be assumed.

As a general rule it is best to agree what to do with information when an employee or service user informs you that they have applied for or obtained a Gender Recognition Certificate. This may often necessitate physically destroying records that reveal inappropriate information, or sealing them for use in specified exceptional cases.

Advice for transitioning at work

I wish I had read all this before, but there are some definite points for attention, if you are heading this way:

  • Be crystal clear, in writing, about your preferences regarding who can know what, and at every stage. What you are prepared to disclose when you are obvious (coming out, early days, or with an existing employer) is not the same as being at the point of surgery or beyond.
  • Give this information to the most senior person in charge of personnel records, explaining helpfully.
  • Let your HR contact know each stage you are at, because this alters things: intention to transition, engagement with clinical services, diagnosis, intention for surgery, application for a GRC – everything.
  • Ensure that any documents that may reach other than your HR contact do not disclose anything unnecessary for the purpose. For example, my hospital sicknote simply stated ‘Surgery’ as the reason, whereas my GP’s fit note clearly stated ‘Gender Reassignment Surgery’. (I was told this had subsequently been seen other than by HR.)
  • No-one wants to be paranoid, but like me you could end up feeling quite distressed if anything goes wrong. Therefore keep records, and if necessary record communications.
  • Be very factual. Grievances are not about stories, they are about actions. They are not personal either, they are administrative, for which people hold responsibility.
  • Assert, don’t argue. You may well hit a wall. Speak to it, don’t hit it. I hate bureaucratic justification and it raises my hackles every time. But it doesn’t help. If you have done the above, and if you have a grievance, state it clearly and back it up. Even if you do not wish to make an official complaint about it.

I wrote this piece because I could not see the relevance of the nature of my surgery to my return to work under a new line manager. My surgery was disclosed, and I observed that no woman in the organisation would wish the nature of her gynaecological surgery to be disclosed to a male manager, unless that detail was directly and specifically relevant to her ability to resume her work (i.e. cover the employer’s liability).

The complicating factor here is that post-surgical maintenance for gender surgery needs initially to be done three times a day. This requires privacy and washing facilities, and if not available at your place of work, you will need to negotiate working from home, at least to cover a mid-day half hour. Now this does not take a lot of imagination as to exactly what you are doing, so how do you request a degree of working from home for a short period (so you don’t need to stay off sick longer than absolutely necessary)? For me it is perfectly sufficient for any manager to know that you have had surgery, need a recovery period, and can return to work making allowances (lifting, maintenance etc.) for confidential reasons.

Am I right? Please tell me if I am not, especially if you are in HR, and I can correct this blog and this advice.

Back to the post-operative maintenance: by telling anyone else in the organisation that your surgery is gender-related, immediately tells your manager (what, a man?!) that you wish to work from home in order to dilate your vagina!

This is why extra sensitivity is required by HR when deciding just how relevant it is to tell another member of staff that the nature of your surgery was to do with your genitals. I don’t care how understanding or empathic the man in my office is, or how discreet he may subsequently be. It is none of his business; it is intimate and personal to me, and most of all, it has no bearing on my work situation whatsoever.

Please, so that you do not suffer the same distress, explain this to your HR contact well in advance, otherwise these unnecessary accidents will happen.

 

Phew! Finally … If you are in UK HR, and anything I have said is inaccurate in its interpretation, find me on Facebook and tell me so that I can correct it. If you have useful things to add, please also find me and tell me. We all need to know these things and ensure better handling than I feel I experienced.

So, what’s it like, then …?!

  • Posted on July 28, 2014 at 4:37 pm

This has been the most significant, final and irreversible week of direct action in my life so far. I gave some explanation of the process before, to enlighten the curious and worried, and I am not into giving ‘too much information’. Anyone who wants to research the surgical techniques can do as I did, and see how it’s really done, in graphic detail. There will be no new-born LOL cats on this blog! Nevertheless, I will have left people around me in various states of discomfort, curiosity, squeamishness and wild imagining.

I am proud of my surgeon’s reconstruction. It is authentic, functional, meticulous, and best of all, it is mine! Even during this early stage, it feels completely natural, looks amazing, and in every sense fulfils my long-held self-image. It is as if my brain were already pre-mapped onto this reconfiguration. Not one nerve surprises.

But what does it really feel like to, well, you know …?

What, wake up without your bits? OK. I’ll tell you, because if it matters to you, it really matters. If you’re just nosey, at least you’ll know it will never be you.

The last wee

It may be your horror, or your greatest dream, dear reader. But yes, there is always that last wee. If you’re trans, you’ll be sitting down anyway, and thinking perhaps of all those worrying times when it touched (yuk) the inside of the porcelain in some foreign loo! You will wash it for the last time, because trans people at this stage are meticulous in maintaining the best condition for their tissues. And like me, you will feel some relief, but most of all a complete disinterest in the idea of any loss whatsoever. In fact you probably won’t even be thinking ‘last time’.

But what about the last … you know?!

Believe me, you won’t remember it. It won’t have functioned for a long time, not like that. That’s why the anti-trans ‘bathroom scare’ of predatory ‘men in dresses’ is such a ludicrous proposition! You may well have had pleasure; I did. but in a new way, and all you are hoping is that ‘that’ bunch of nerves will still be functioning afterwards, repositioned correctly.

Could you have changed your mind at the last minute?

As I left the hospital, I was chatting with the discharge nurse, joking as to whether anyone had ever arrived at the hospital and run away again? ‘Oh yes! We once had someone jump off the anaesthetist’s trolley!’ Thank goodness …

For all my harping on about the gender clinic and appalling waiting times, and about the unsupported two year ‘real life experience’, it is absolutely vital that you come to this point with utter certainty that there is no alternative. This is no ‘nice to have’, no optional extra. This is no wasted NHS money on a lifestyle preference. No, this is a cure for which there is no alternative. If it isn’t that to you, stay away as long a you can. The problem as I see it, is that the so-called real life experience is nothing of the sort. If it was a prosthetic limb, you’d get physiotherapy. If it was mental health you’d receive therapy on adjusting to normal life. If it was loss of sight, you would have support and aids, groups and workers around you. This is because for all other conditions, they are considered as past events to adjust to. Gender transition is seen as a future event you are working towards, a diagnosis yet to be made. This is inadequate for helping people adjust to a gender presentation they have never been socialised into while growing up. To overcome this, as much needs to be undone as to be done.

So yes, you can stop at any point, though after signing the consent, they don’t lift the mask to ask ‘are you really sure?’

What does it feel like when you wake up?

Like any other procedure. You haven’t a clue where you are, what time of day it is, or what your last memory was. I have a very vague sense of a face and a reassuring female voice saying that it was over, or something. All I can remember was that I was breathing, and having to think about breathing! Then, much later, I realised I was back in my room, and it was late afternoon. Why had it taken so long (I went in at 11 am)? I asked the next day, and found that it had been very straightforward and over in two hours! I just took ages to come out of the anaethesia.

But yes, I did have time to come round and reflect what it was I was waking from. This was the brief period when I just knew that the decision had been final. Had I any shadow of doubt, this is when I would have screamed …

But I didn’t.

For a couple of days you don’t see much, and actually feel very little. The procedure is not actually a painful one, despite being quite invasive. The most uncomfortable part is usually the drains – tubes to relieve any fluid build-up – because they’re sutured into place and pull the tender skin of your lower tummy. So the greatest psychological rearrangement is simply knowing that you have been reconstructed as expected. There’s plenty of time to let it sink in.

And when you look down …?

I’d like to write separately about this, because there is some profound realisation about sex and self here, so watch out for the next thrilling episode …

If you are reading this from any perspective where male bits matter to you, you will not understand. You will see it as an awful dismembering loss. This is OK. If, on the other hand, you are reading from a perspective of horror at your own body being not right, it may seem a dream come true to find the bits magically disappeared. This also is OK. But as I have written before, this is reconstructive surgery, not amputation, and this is vital to understanding why people like me go this far. For me, there was something always missing, not just something present.

The first time I looked down, of course, I couldn’t see anything. The bandaging is actually pretty minimal, and you have three tubes, and someone shaved you while you were asleep! Apart from that, you are left with knowing that the job has been done. And you just get used to the fact that rather a lot of people are going to be looking freely at your vulva in the next week. And they will be seeing a lot more than you for a few more days! Dignity? Hey, a small price to pay, because this feels good. Very good indeed.

I did say to the nurses one day, as they examined me, ‘this must seem very strange to you?’ They just said, ‘no; you’re just like us.’

Doesn’t it feel odd though?

Of course it might seem that way, but it doesn’t. People having this surgery will react very individually. For some it is right, but nonetheless difficult. For others it will have them whooping as soon as they can draw breath. I think my first words in deep mists of anaesthesia were ‘thank you’.

To be honest it has been a very normal thing for me. No surprises, no disappointments, a better than expected outcome, a textbook result, minimal bruising and swelling etc. I have been one of the lucky ones, so far with no difficulties. These may yet come. But I will always remember three events:

  • the first mirror experience down there: how neat, how tidy, how right, how me
  • the first full length mirror experience back at home: how perfect, how right, how complete
  • the first think-in-the-bath: my goodness, how lovely.

Perhaps oddly, I have not one backward glance in my mind or memory, because this, now, is how I feel I should always have been. And that really is the odd bit, that I cannot any longer even imagine having a penis. Its significance has completely disappeared, in a way that I had not expected to such a degree. And to have a vagina? It just feels normal, not particularly new.

This, fundamentally, is the final proof of the diagnosis and treatment, that it is so overwhelmingly ordinary once you have been put right. No-one else could possibly feel like this over something that strikes so intimately and deeply into one’s sense of self and identity, with such finality.

Summary: what it is really like

This, for me, has been at once more profound and more ordinary than I had imagined. Yes, it is an amazing privilege to have received such professional and expert treatment. Yes, it marks both the end of a long physical, mental and social journey, and the beginning of a new fully-released sense of self. Yes, there is a substantial period of aftercare, during which in a sense I shape my own vagina. Yes, there is a certain getting used to the differences. But more than anything, I just feel terribly ordinary now, ready for whatever comes next. Complete.

I have written openly and extensively for two and half years, and will add some bits and pieces. If anything seems worth adding for those of you going through this, or watching others, I shall add more. I think it’s important to be direct and honest, because no-one should get through to this point without being very fully aware of what it is about. I do know that for many non-trans people this is unfathomable. And that for some trans people, knowing all this above, there will be an awareness and a comfort that they don’t need to change this much. Please, be yourself and be proud of it. But for many, this will be a scary part that lies ahead, both a dream and a nightmare. Don’t be afraid. Keep asking all the questions of yourself and you will know. If it’s right for you, you can come through, and then leave it all behind.

Remember, this is the most personal and honest place anyone has to face in life, and it is only about you. Never join the club, never be a follower, never wish you were ‘more trans’ so you could make your mind up to do this. Never be afraid to change your mind at any stage, but please, for your own sake, never let anything else ‘buy you off’ making the right decision for yourself. In the end we do not owe our lives to anyone else, and no-one owes theirs to us. And this is not a rehearsal.

Finally, for most trans people, there are family and partners for whom all this is just too much. You can’t help them understand anything that they can’t face. You can only be you, and maybe one day they will be able to peep through the cracks of their own fears just enough to realise you’re still there. Yes, you.

Hold this day

  • Posted on July 27, 2014 at 4:09 pm

This poem, also from my collection Realisations, predicts the feeling of completing surgery, even before I began living full-time in my authentic gender. Would it be like this? I didn’t read it for a very long time, I actually thought it a bit presumptuous. I read it two days after coming home from hospital. I cried. I would not rewrite a single word.

Hold this day, this birth day
write it in your diary, send me cards.

Never has a vaginal passage
delivered such a child as this –

she is an inversion of another
a restoration, a renaissance.

And this is her day, emerging
without cries, or protest, or recoil

but claiming birth-right almost
in defiance of everything umbilical –

with pain, blood, trauma and delivery
come to claim her world, her way.

Waking, ethereal, calm, complete
from mists of anaesthesia, almost in

disbelief at her prior parent, pregnant
with this progeny lain so long –

a gestation – no, an indigestion,
an indignity of containment.

I grasp this day, this birth day
red date in every diary, calendar

every future memory, mark and
milestone – and slip into life.

 

2012 © Andie Davidson