This Doesn't Change: Conflicting Advice

It almost goes without saying that a gender "transition" involves changes as great in number and degree as most people are likely to ever experience.  Still, there are some things that don't change.  Sometimes, thankfully, they are the things we hope not to change.  As an example, some people who were in my life before my "transition" are still in it. 


On the other hand, there are some things that don't change from the day a trans person first talks about his or her identity with someone through the days, months and years following surgery.  Here is an example:  We continue to find conflicting and even contradictory advice and mandates about the care we have to give ourselves.


Marci and Nurse Phyllis recommend that we dilate three times a day for the first three months after our surgeries, twice a day during the following three months, and once a day after that.  According to them, receptive intercourse can substitute for one dilation.  


I would tend to trust what they say, simply because they have more experience with transgender patients than almost any other health-care professionals.  And my gynecologist hasn't advised me to do any differently.  However, I've seen a few sources--purportedly written by post-op trans women and/or their health care providers--that say once a week should be sufficient.  I saw a couple of articles that recommended even less frequent dilation, or that say each trans woman will find out what frequency is right for her.


Does other medical advice vary so widely?

You Can't Get An Education From Anyone You Don't Trust Or Who Doesn't Trust You

I am thinking again about yesterday. Perhaps that's not a productive thing to do, but I'm prone to that sometimes.

Anyway...I find myself reflecting on what I've been learning during these past few months. So much of it comes down to trust. And now I realize that the trust I'm learning is not only toward those who can actually give me the care and education I need. It's also a trust in myself.

When you don't feel whole, complete or simply right-- whatever that means to you-- how can you trust yourself? What can you trust if your body is lying to you and in order to survive, you have to tell-- or worse, perpetuate-- lies of one sort and another? And how can you hope to get an education of any sort if even your name is not your own?

James Baldwin once wrote that a child cannot learn from a teacher who despises him. That's more or less right. But I think that it would be more accurate to say that no one can get an education from anyone he or she does not trust, and who does not trust him or her. All you learn is a sort of defensive deception: You lie, dodge or commit whatever other subterfuge is necessary in order not to be harmed. And, of course, if someone is telling you the complete truth about something, it cannot be anything but a falsehood in such circumstances.

You go to a doctor because you think you've cracked your ankle in a fall. If the doctor, or his or her screener, asks if you've felt depressed, you say "no" because you want your ankle fixed, not to raise suspicions that you harmed yourself on purpose.

Something like that happened to me. And to practitioners I've previously used, I've said that I had sexual fantasies about women, and even talked about wanting to marry one or another, just so that I wouldn't get locked up somewhere that couldn't offer me what I needed, much less wanted.

How many times do we get through a situation, a day or a period of our lives by saying what someone else wants, or seems to want, to hear? Or worse yet, what we wish were true?

When I saw Mom back in August, I said that my years at Rutgers, where I was an undergraduate, were the worst of my life. She asked what I would have done differently: Would I have gone to another school? Studied different things? Or delayed going to school?

I might have done all of those things, I said, but I probably still would have been miserable. She cringed when I said that last word. "Oh, you were!," she said. "I haven't seen very many people who were more unhappy than you were in those days."

I explained that I was, by any definition of the term, deeply depressed. I felt as if I had nothing in common with anybody at the college. In part, it had to do with the fact that when I was young, I tended not to make friends among my peers. What friends I had were, for the most part, women older than I was.

Also, I felt more hostility toward who and what I am than I ever felt in high school, or before that. For many years afterward, I accepted the standard explanation: that I was noticing it more. And, being the sort of person I am--one who just wants to live her life--I trusted other people's opinions before I trusted my own experience.

The thing is, the higher you go in education, the more you encounter that mentality. If you experience something, it doesn't count for as much as what some "expert" says about it. I have come to realize that such an "expert" is more than likely to be self-appointed and gains his or her authority because so many people are, for whatever reasons, too cowed or indifferent to challenge it.

But there was another dimension to the conditions that made me so unhappy: I was in a residential college. So I was living with other students, whom I saw every day. They included various jocks or jock-groupies and frat guys. Living among them meant that I had to keep my acts and my defenses up at all times. I played the drinking games with the guys and feigned more interest in "banging" women than I actually had. Worse, I not only went along with the "fag" jokes, I made a few myself.

And, because I engaged in such mendacity, I came to despise everything about the college, college generally, the people in it and what I had to do to keep myself there. Today, of course, none of that surprises me--or, for that matter, the people who've heard this from me--because I had, by that time, learned to so thoroughly despise myself.

I fell into such an awful state because I could not articulate what was happening to me. I tried to fit into the labels: I was "straight;" I was "gay;" I was "bi" (whatever those terms mean! ); I was a guy with a "feminine side." And, of course, I kept that side as far from view as I could.

The result was that I never did anything more than half-heartedly. I was present only physically in my classes and in other college functions; when I reached out to others (Yes, I got very lonely sometimes!) I could only do so from behind a wall. And even in that relative safety, I was still in a mask and costume, whether or not it was Halloween.

So I could never ask the sort of questions I wanted to ask, or do anything that would allow me to get the sort of education that stays with a person: that which teaches a person by expanding his or her self-definition. This means helping that person to learn how to do what he or she is capable of doing, and to expand that person's range of what is capable.

Maybe this is the reason why, in spite of all the time I've spent in a classroom as a student and teacher, I have never quite trusted Education (with a capital "E"). Even when I enjoy teaching (which, these days, is most of the time) and otherwise helping students, and when I enjoy an exchange with a colleague (a more frequent occurrence these days), I still sometimes feel as if I cannot trust it. Perhaps I am still carrying a lot of residual damage.

I am interested in helping people gain an education, whatever that means for them. And most people go to school for that, and we are--at least in theory--charged with that role. But I often feel that my own education bears only an incidental relationship to the time I've spent in school.

In brief, I felt a little sad after leaving Dr. Jennifer's office yesterday for the same reason that I shed tears upon leaving Marci, Nurse Phyllis, Robin and all of those other people I met in Trinidad: From them, I was finally getting an education--a real education.

Now I'm wondering whether it's the only education I've ever had.

Another Graduation

Today I had what will be my last appointment with Dr. Jennifer, at least for a while.

She confirmed what I've suspected: Psedomona is gone! Okay, say it again: Pseudomona is gone! Just rolls right off the tongue, doesn't it?

Yes, that minor-but-pesky infection I had is history. And, she said, all of my major healing is complete. But she did advise me to finish my current round of antibiotics and to wait another week before getting back on my bike or getting that other kind of exercise. You know which kind I mean.

Of course this is great news for me. But I shed a few tears, too. For one thing, I was actually enjoying those visits with Dr. Jennifer. All health-care professionals should have her warmth and empathy as well as her skills. That, of course, is what I also say about Marci Bowers.

My tears today were, I feel, like the ones people shed at graduations. They are tears of joy, yes. But they also express a feeling of relief, of having arrived safely and well at some destination.

In some way, this really feels like a graduation, in much the same way having finished my session with Nurse Phyllis or seeing Marci the day after my surgery: I had "made it" through something through which each of them had guided and nurtured me.

That I learned about my body from each of them almost goes without saying. However, I now realize that my new-found education has come about because I had to trust each of them with my body as well as my spirit in ways that, earlier in my life, I simply couldn't have with anyone --partially because I never had to.

With each of them, I had to allow myself and them a level of intimacy that, for most of my life, I didn't know how to permit anyone else, much less myself.

You might say that I was experiencing, viscerally, what I had experienced vicariously when I saw The Vagina Monologues: a shared experience of having one.

As I understand it, that is supposed to be a reason for graduations: The new graduates reflect upon the common experiences of those who are graduating with, and who have graduated before, them.

So what does this "graduation" mean? For now, at least, I can, in some way, function independently as a woman. Maybe it was the logical "next step" for me. I've gotten to the point where, when people address me as "Ma'am," "Miss," or "Lady," I do not append it, even in my own mind. Although having lived as a male will always be a part of me, I no longer see it as a qualifying condition.

I have graduated again; I came home on a spectacularly beautiful fall day.

Nurse Phyllis

Imagine that the magician has a woman on the table and, instead of sawing her in half, he pulls endless silk scarves out of some orifice of her body.

That's about what I experienced today. Not that it was a bad thing: It means that I am one step closer to living as an independent woman. And the person who provided the expereince could not have done it any better.

Today I had an appointment at Doctor Bowers' office with "Nurse Phyllis." She has the broad face and shoulders of some earth goddess, and the warmth and light of the sun coursing through her eyes. If you are ever going to have your insides pulled out, she's the person whom you want to do it.

What I described in that last sentence isn't as terrible as it sounds. You see, today she removed my catheter tube, which means that I'm free to pee and make a mess of a bathroom all on my own. Actually, I was a good girl in the bathroom today: I really didn't have to clean anything up after myself.

You'll never know what a privilege it is to pee without having a tube and bag attached to you, and having to empty that bag (or having to wait for someone empty it for you, as you do when you're in a hospital bed) until you have one of those tubes pulled out of you. And you'll also never realize how nice it is to sit down without having to angle your crotch or to sit on one of those inflatable donuts until you have a few yards of packing material pulled out of you, and that area feels more or less normal, if not the same as it was before it was packed. Of course, the fact that it's not the same is the whole point of the operation.

Anyway, Nurse Phyllis made the process painless. You relax, not only because she tells you to, but because she knows that, deep down, that's what you really want.

Then, she taught me what "graduates" of "The Trinidad Experience" refer to as "Vagina Boot Camp" or "Vagina 101." That mini-course included, as you might imagine, dialation as well as other care and feeding of my new organ. In other words, she teaches people like me to treat our vaginas in ways that lots of natural-born women never do. She recommends wearing cotton panties and not wearing materials that don't breathe. Now I'm really happy that I stopped wearing those stretchy shorts for cycling this year.

I'm so glad I had that session with Nurse Phyllis. She has such empathy for anyone who's put her feet in those stirrups and lay prone with her legs spread apart. That's one time you want to absolutely trust whoever is standing over you. And I knew, from the moment that I met her, that I could.

That's really what's made this whole experience of getting my GRS/SRS surgery so comfortable, at least relatively speaking: I could trust everyone who stood over me as I was vulnerable. That, of course, starts with Dr. Bowers: She is the very embodiment of that quality, and she finds people to work with her whose most essential quality is just that.

That need to trust is, from what I can see so far, one of the things that makes a woman's in getting health care different from a man's. I never had to be so vulnerable, so in the hands of those providing the care, as I have been during this experience. That is not to say that I've had to be passive; in fact, when you have to make yourself prone, that's exactly when you need to take charge of yourself. And that means, at least in part, finding the ones whom you can trust when you are lying down and, for the time being, helpless.

Now I am confident that I have gained at least one more of the skills I will need for the rest of my life. Thank you, Nurse Phyllis.