#also i have a migraine so the funny number going up has helped me retain the will to live while my head hurts (hyperbole)

[daffythefox]

yes! and then now that they've said that there's this expectation that I'll start opening up more to them or that I'll start acting in a different way. like girl this is it this is the show-- are you not entertained? and now all the eyes are on you, and no matter what you do, you're fucked.

"you don't have to perform around me" sweetheart i have to perform in front of myself

[phalloplastytime]

Phalloplasty Consultation with Dr. Chen & Dr. Watt

Here is what I remember from my experience going through my consultation with Dr. Chen from GU Recon (his private practice) and Dr. Watt from the Buncke clinic in San Francisco, CA, USA. My apologies for the length, I wanted this to feel kind of immersive for those of us still in the waiting process because stuff like this helped me. Also - small content warning I do use a couple anatomical terms.

For those of you unfamiliar, Dr. Chen is a urologist and Dr. Watt is a microsurgeon.

My partner and I traveled down to San Francisco to stay for two nights. We flew in on Thursday evening and flew out on Saturday evening, not wanting to be gone for too long and rack up even more expense on the hotel bill. If I had planned ahead several months ago, I would have tried to stay at the Quest House during this time but I didn’t realize a short stay was potentially possible. 

We are fortunate to be able to use the public transit system offered in SF, which is pretty good in my opinion. They have buses, trolleys (cable cars?), and an underground/train system. We utilized this to make our way over to Castro street, where the medical office building and also the hospital are located. 

Without any plans for the day we went ahead and headed over about 3 hours early because I had seen that there was a dog park right nearby. We sat and watched local dogs come and play and have a break in the middle of the day and we ended up meeting an older gentleman whose dog wouldn’t leave us alone asking for pets. It was pretty great, and nicely calming as I was pretty nervous before the consultation. We then got some food at the local cafe on the corner. It was actually pretty good. 

We realized we still had time to kill so we decided to hike up the hill to the Buena Vista park where we looked out over the city and rested for a bit. There’s a path that has some disturbingly friendly squirrels on it.

About 30 minutes before my appointment headed over. Inside the medical office building, Dr. Chen’s suite is right across the hall from the Buncke clinic. I wasn’t sure where to go to check in, so we walked all the way down to the entrance of GU Recon and saw the door was open. Inside the waiting room was fairly spacious with comfy seating and plenty of random coffee table books to peruse. There was nobody else there at the time. At the receptionist window was a sign indicating to check in over at the Buncke clinic, so we quickly hopped across the hall. 

The Buncke clinic waiting room was much smaller and was actually quite crowded for a Friday afternoon. I checked in and they asked for my ID and insurance card (even though I had sent in pictures), and they didn’t ask for any kind of copay or payment. I suspect I will receive a bill at some point for the specialist copay from my insurance which is $30. Hopefully.

They instructed us to head back over to Dr. Chen’s office to wait, so we went back over and started looking through a photography book. At this point I was still about 25 minutes early to the appointment so I was ready to wait however long it would take. 

About 5 minutes later, Dr. Chen himself appeared behind the reception area with pizza and Starbucks in hand, apparently not expecting anyone to be in the waiting room. He noticed us right away and began apologizing for the wait. He explained the schedule didn’t indicate whether or not we were having a phone consultation, so he just assumed it was going to be over the phone based on my address. 

This whole interaction solidified every good thing I had heard about Dr. Chen, and I immediately felt so… normal. That’s the best way I can describe what I felt. I felt like I had known Dr. Chen for years and that he was.. reachable. Human. 

He told us it would be a few minutes, and sure enough a few minutes later Dr. Chen and Dr. Watt appeared at the door and we made introductions. My partner came with me because I wanted her to hear what the doctors had to say and I wanted another pair of ears listening, and also because I wanted the doctors to see that I had support. 

We went down a narrow hallway and went into Dr. Chen’s office, which hosted another comfy couch which he had us sit on while he and Dr. Watt sat across on office chairs. They each had some papers (my medical information). The room was somewhat dimly lit, but calming and comfortable. 

The consult started with Dr. Chen confirming my reason for the visit (seeking phalloplasty), and he asked me how important it was to me to stand to pee. I explained that my personal goals were 1 - Sensation, 2 - Stand to pee, 3 - Aesthetics, and 4 - Sexual function. Which, again, are personal goals and it is completely valid to have other priorities with lower surgery. This is my own journey. 

We then went over my medical history, which is fairly short, but Dr. Chen was thorough and asked me about my minor eczema, asthma, and migraines. Dr. Watt was quietly taking notes and listening during this time. Next, they asked about any trauma to either arm and I basically explained how my right arm is essentially immediately disqualified from being a donor arm. In my specific case, I broke my right arm when I was 18 months old and had to have a surgical repair. This repair didn’t heal correctly and now my arm when extended is quite crooked. 

This has put some strain on my ulnar nerve and gives me hypersensitivity in my palm.  Further, I had a different surgery on my forearm which involved an incision and left me with a scar right in the middle of the graft area. This could compromise the blood supply, so we pretty much immediately dismissed my right arm as an option. To top it off, it is my dominant arm for most activities. I kind of would have preferred to keep my left arm nice and clear of any scars, but I think having 1.75 properly functioning arms is preferable to only 1 functioning arm in case my right side nerves ever gave out. 

Next, Dr. Chen went on to explain his portion of the surgery - he starts with the vaginectomy and then relocates the end of the urethra to the natal phallus using labia minora tissue. He then mobilizes this and relocates it to the other side of the pubic bone to come out to the site of where the neophallus will be placed. At some point during this discussion, Dr. Chen explained the complication rate and he was both realistic and optimistic about it. He said the vast majority of complications that happen are fixable. Further, the most common complications often heal on their own. I can’t remember the exact numbers, but he said of the patients that do have fistulas, only around 20% of them end up needing a surgical fix. Strictures don’t show up right away, and usually occur within the first year. 

While Dr. Chen does the work down below, Dr. Watt explained his team mobilizes the RFF and prepares it for the new location, using the tube-in-tube method to create the urethra and phallus. Dr. Chen places a foley catheter through the neophallus and into the relocated urethra to line everything up, and he sutures everything together once the microsurgeons connect the blood supply and nerves. Dr. Chen then places the suprapubic catheter and the RFF site is covered with the split-thickness graft from the leg.  If requested, Dr. Watt would place integra on the RFF donor site before the split thickness graft (not staged like other teams).

They then explained what recovery typically looks like - 5 nights in the hospital, including 4 days of strict bed rest and then up and walking on day 5.  If you’re able to walk well enough, you get to leave to recover elsewhere. They then check up every week for four weeks before sending you home. During your 1 week post-op visit, Dr. Chen removes the foley catheter from the neourethra complex. You start your peeing trials just before the 3 week checkup, and if you’re able to empty enough of your bladder the SP catheter can be removed. If you have significant fistula(s), an additional week for healing may be allotted and the SP catheter retained for that time. 

Dr. Watt then did an exam of my arm, performing the Allen’s test to see if my hand receives enough blood if the artery they harvest for the RFF is removed. The test seemed really quick, but I guess with how fast my hand refilled with blood he was very confident I was a candidate for RFF. He indicated that no further testing of my forearm blood supply was needed. 

He examined the hair on my forearm, which turned out to be really funny because while he was looking at it he guessed that I had undergone electrolysis up to about 6 inches down my forearm. I laughed a little and explained nope, I just haven’t grown hair there in my ~5 years on testosterone. He gently pinched/grabbed the skin to see the thickness and said they’ll likely delay my glansplasty, and when he looked at the underside of my arm where the urethra graft would be taken he said I was basically hairless there and that any electrolysis at this point would just to be to remove hair from what will be the outside of my phallus, which is optional and he said I can always shave or use something like Nair. 

I then had a chance to quickly look over my questions to try to find any that hadn’t been answered. They were pretty thorough so the most I asked about was about Integra because I was most curious about it. Dr. Chen then explained that he needed to do a quick visual exam of the genital/mons region and we walked across the hall to an exam room.

He apologized for the discomfort and had me just quickly drop my shorts while standing. All in all I think it took about 5 seconds of exposure. When we got back into the other room he reported to Dr. Watt something along the lines of “minor prominence” of the mons. I checked my questions one more time and asked if they had any testicular implants that I could feel, but Dr. Chen explained that he had a patient waiting that was somewhat urgent and he promised that he would show me next time. He was very polite about it and I understood, and all in all I think the consultation took about 30 minutes. 

We said our nice to meet yous and goodbyes and Dr. Chen showed us out the shortcut out of the clinic and boom it was over. Despite the quick ending, I still didn’t feel rushed out of there and felt like they really took the time to make sure I understood the surgery and that my possible concerns were heard. 

All in all I left feeling really good, which for me was everything. I was actually excited about the future. Also, they said they would be forwarding my information to the phalloplasty team about our consultation, and that they should be reaching out to schedule with me. What ended up happening was I emailed Logan with a follow-up question and after we emailed back a forth a couple times, Logan asked me if I wanted to set my date. So now I am officially on the books for Left RFF Phalloplasty and words cannot describe how much joy/relief/excitement I feel about it. 

Like, I still can’t believe I get to do this and I don’t know when reality will set in. But for the first time in months, I am hopeful and optimistic about the future. 

Edit: I forgot to mention that Dr. Chen also will perform a scrotoplasty during his part of the procedure.

[theverytinybird]

There Was a Time for Fear.

I have had a lot of loss in my life.

It started when I was young. Someone touched me and they shouldn’t have. I was too young to know it was wrong, but old enough to know it didn’t feel right. I was scared. I told family about it, and some friends dropped away. It seems people are allowed to hurt you as long as you’re the less desirable of the two.

This happened a few times, and I learned an invaluable lesson: trust your gut.

I was popular, but not popular enough. I made lots of friends, lots of meaningful friendships, but then somehow they never stuck. I knew all of the “popular kids,” but each one of them felt they needed to be friends with me in private. If I was friends with all of them in private, then why couldn’t we be friends in public? It seems that people aren’t ashamed of something until someone important sees it.

This happened many, many times, and I learned an invaluable lesson: don’t give away trust easily, because you can’t know who deserves it.

My mother said I couldn’t have this friend, or that friend, and I was banished from speaking to them. I was afraid of her, so I ignored someone I cared about, and walked high up on the bleachers while they yelled my name and I pointedly looked away. It never occurred to me to talk to them at school and lie to my mother about it.

A friend lied to their mother on the phone. They’re a bad influence and I can never speak to them again. A friend sits on the futon for most of the time they’re at my house, sleeping over. They’re lazy and I can never speak to them again. Friendships gone like flies.

I moved around, but not because I had to. I didn’t feel right where I was. I left friend groups, returned to them. Left them again. Returned again. They were less excited about me returning each time I came back. They stopped caring if I left, assuming I’d come back. 

This happened a number of times, and I learned an invaluable lesson: if you ask people to care too much, they’ll grow fatigued. But only about you.

I liked a boy, but so did a friend. I knew her in middle school, all the way through high school, and we were close until our mid-twenties when we were living in a dorm and we both liked the same boy. She told me she didn’t. Multiple times. He and I met in the first place because she told me he harassed her, and I didn’t hide my opinion about disliking him. He approached me about it when I was alone in the cafeteria one morning. He was charming. He smiled at me and told me that I would definitely come to like him.

I did.

When her and my friendship ended the first time, it was because she got tired of hearing me tell her that holding hands together inside his pocket was inappropriate. She got tired of me saying she shouldn’t caress his neck during the entire movie. When our friendship ended the first time, I found that I wasn’t surprised. 

She took other friends of mine with her. No, not her friends. Friends of mine, who she made friends with through me--those are the ones she took. I got her back, but they stayed away. She still claims she didn’t sabotage my connections with them, but I find it more than coincidental that they suddenly stop caring about me at the same time that she wanted my boyfriend.

This boy, who we both liked, was not kind. Loving him hurt, and so did his touches. I cried a lot. I was alienated. I was scared. I was alone. The ones close to me were forced to be close to me only when out of sight. Like the popular kids who only played with me in private. Only, this time, it wasn’t because they were embarrassed of me--it’s because they were scared of him.

I retained only a few of those friends from the dorm. I built those friendships from the ground up, with help from no one who knew me before I arrived there. 

Fleeing him, she took me in. Despite liking him, and despite our problems, her concern for me was more important than the fighting. I loved that about her. I lose her a second time, but that comes later. It’s more permanent than the first time.

I had multiple groups of friends. My friends from childhood, which because of me, all merged into one single group, connected by the friend who liked the boy who used to hurt me. The second group was my online friends. They weren’t very connected, but they were very important.

Three of them stood out. One, a blunt boy who was very unlucky. Another was a bubbly, seemingly genuine person. The third was a deep, smog-like person, who would soak in through my skin and into my heart for many years. All three are gone, but they go at different times.

The boy disappears after he becomes frightened of the friends I try to connect him with. I lie for him. This lie still stands with some people. I regret it sometimes, but only because there are people who believe I’m cruel in a way that I don’t find attractive. He understood me. We cared a lot about each other. He is probably dead somewhere.

The second is forcibly kicked from my life, and takes the girl who liked the boy who hurt me with them. This is one of many times I remove them. I am a weak, pathetic person who has a lot of love in their heart, and despite my loss--and perhaps because of it, I fear raining that pain down on someone else. 

I move into a big house with the second person. We rent out rooms to strangers who become friends. Everything seems fine.

My mother was unkind often. I find a new mother who will love me. And she does. She loves me dearly. She teaches me what motherly love should feel like. She teaches me what it feels like to know that someone exists who believes I am capable of anything, that I have the potential for everything, and--when she dies, I am cold and empty, because no one will ever believe in me like she did.

My mother was unkind often, so when she, too, dies, I find myself in a confusing state. I drive to my father’s and I walk in the house, only to be told that her body is still on the floor, waiting to be picked up. I look at her. I touch her. We watch a movie in the other room while we wait. Days pass. A friend reaches out to me-- someone I was friends with in the dorms, who was afraid of my boyfriend at the time, and who was friends with me only in private--like the popular kids had been. They move in with me, directly into my bedroom. It helps us both: I need help, and she was fleeing someone who was hurting her, too.

I attend the funeral. I’m driving back to my father’s house and I pull over to catch some Pokemon. I catch three. A head ache sets in. It stays. I wake up in the middle of the night and throw up. I go to the hospital. I lie in bed with a migraine for a week.

The second online friend enters my room to complain about their mother. It hasn’t been two weeks since my mother died. I tell them they’re being inconsiderate. They shrink in on themselves and run away. I see them again that week in the kitchen. They have to go because they’re making up some hours at work on one of their days off. When I ask why, they tell me it’s because they left early to come home and be with me when my mother died. Except, I was with my family. So they’re making up hours that they took off because of me, and I wasn’t even there--the implication is that they did this for me. I recognize it for the guilt trip it is, the guilt trip I hear in their voice. I call it out. I don’t hear much from them for the next month.

When I tell them I don’t want to be friends anymore, they want to go for a walk and begin with saying they don’t even know what my problem is, they haven’t done anything wrong. When I tell them that my mother had died and I saw them maybe twice in the following month, they say they wanted to give me space. I said that I’m essentially giving them space, too.

There was more to the conversation, but that’s the part that matters.

They drive over to the house of the friend who used to like my boyfriend. That’s when I lose her the final time. She has been told I had been abusing the friend who was never there for me, and she just didn’t want to be associated with that. She doesn’t tell me this until months later when I’m diagnosed with a personality disorder and I’m excited to tell her about it so we can look back at my life and point out all the times hindsight bias shows us I had a disorder. 

She says she doesn’t want to be friends, and she won’t change her mind, but we can still be people who sometimes message each other to see how they’re doing. I tell her I don’t care for relationships like that. I also tell her that I haven’t trusted her the same since she stopped being friends with me the first time, so she could chat up my boyfriend, and I also tell her other issues I have and then I block her on Facebook because she said she didn’t want to talk about it, and I’m tired of people leaving.

I somehow stay friends with the inconsiderate person who isn’t there for me when my mother dies. They tell me that after I blocked her (the girl who liked my boyfriend) on Facebook, she complained that that was “so like [me]” which is funny, because I never told her anything that bothered me, and she hadn’t been a real friend in years, so how does she know enough about who I am to know what’s like me?

The third person, the smog, leaves when I refuse to let them stay.

We were friends for nearly fourteen years. We liked each other for all of them. We are very close. She cuts people out of her life. Burns bridges. Through all of it, I am unscathed. We love each other in ways that only lead characters in indie movies do. We talk about how ‘love’ is a bad word for what we have, because it oversimplifies something complex. Only we understand us.

I still believe that.

I still love her.

I will always love her.

I loved her even when I blocked her on every social media I could think of, after sending her a text, telling her, in different words, that she brought this ending upon herself.

We had a lot of issues in the past couple years. We started dating, too, and it went downhill. She hurt me, too, but not in the same ways the boyfriend used to hurt me. I once cried on a couch with no blanket, in a freezing house, with two pugs at my feet, trembling in fear because of something she had done. Just barely a month after my mother had died.

But this is what finally did it.

It all came down to two text messages.

The first text was from me, telling her about how someone had been abusive to me just following Christmas dinner. In short, I went home early, sobbing, and shaking.

The second, was her sending the words “how horrible.”

This message was unaccompanied for two hours, until she added “were you close?”

That’s how my internet friends were gone, in addition to my growing up friends. At this point, I had the dorm friend that I was still dating, and I had the friends I lived with.

I lost them both at the same time.

I moved someone in with us. I drove from one coast of the U.S., alone, and then back, with a passenger and their things. This person was the catalyst. I was working two jobs. I was taking care of the finances of three people, not including myself. It was difficult. The person that I moved, however, sexually assaulted one of my roommates.

I moved them across the country because they were very ill, and my state has great health insurance. I was worried about them. I brought them here, knowing they would have no resources or income, so even though they sexually assaulted this person, I told them I would pay for their rent and utilities at wherever they went next. I told them I’d help find them people who they could relate with, and who they felt comfortable and safe with. I said that I was moving out, and that I wouldn’t be living with any of them.

I told this to everyone I had been paying for, including my girlfriend. 

The three people I’d been paying for all got together, and they shared everything I had ever said about any of them, as well as some things I hadn’t said. They told me they never wanted to talk to me again. I was a horrible person. It was posted all over their social media that I was a bad person who abandoned them. They were posting Gofundme pages for money, saying I had left them homeless, when in reality, I was moving out with the person who had been sexually assaulted, and I had agreed to pay for each of their rents.

The person who was the catalyst happened to be black. The people we had chosen to live with us were progressive liberals and feminists, as we were left-wing queer people. The catalyst was livid at me, so when they called me a racist in a house full of White Feminists, I lost that final friend group as well.

Over a month ago, I decided that enough was enough, and that if someone was detracting from my life, they don’t need to be in it.

I blocked the person who ignored me after my mother had died (who had cost me a friend group as well) from my social media. They had called me, wanting to chat because they were driving and bored and we did this often. I wasn’t feeling well, so after they talked for quite some time and they asked me how I was, I said I didn’t want to talk about me. They moved on easily, and I was relieved.

Then they backtracked. They wanted to know if it was forever. Or if it was just them that I wouldn’t talk about me to. I realized they would never stop being exhausting. That everything would always be about them. My roommate, the one who had been sexually assaulted, had cut this person out of their life, too. This person had been afraid that I would bad mouth them to my roommate, because they were hoping to become friends again, and didn’t want me to ruin their chances.

It always bothered me that this person assumed I would be hurting their chances with my roommate, when in reality, my roommate was the one hurting that person’s chances of staying in my life. With enough encouragement, I felt like cutting that person out of my life was the right thing to do, and when I accepted that the friendship was bad, I let it go.

Now, I have three friends: one online who lives in Hawaii and cherishes me, my roommate who was sexually assaulted and has an incredible mind, and a third from when I was living in the dorms--who also had only been friends with me in private, like the popular kids had.

I have had a lot of loss in my life.

But I’m not afraid anymore.