Eli Reynolds has a strand of beads about a meter long. It’s a colorful menagerie of glass and plastic and porcelain. Some are etched and oblong; some are covered in little red flowers or purple stripes. Every bead that Reynolds strings represents a moment in time: a doctor’s appointment, an MRI, a diagnosis, a biopsy. And in between each bead is a delicate freshwater pearl, one of which is added every time Reynolds is misgendered by the medical community since being diagnosed with cancer.

Reynolds, who identifies as nonbinary (and uses the pronouns “they” and “them”), was diagnosed with stage 2B breast cancer in early August of 2016. Reynolds had started taking testosterone earlier that year, and after years of tamping down their chest with a binder, had scheduled a consultation for top surgery (to remove breast tissue to masculinize the chest). After the appointment, they went home and took a long look at their chest in the mirror, the way you would tuck your hair up before deciding on a drastic cut. They pushed in their breasts to see what the result would look like. That’s when they discovered a lump in their armpit. “It’s really ironic,” Reynolds says. “I was so ready to have a flat chest, and then along came this thing.... It felt as though a lot of choices were taken away from me.”

Suddenly, the surgery had to wait. “My experience of breast cancer robbed me of every meaningful aspect of my transition,” Reynolds says. “Now I had to have months of chemotherapy.”

When a cisgender woman is diagnosed with breast cancer, the options for course of action are scary, but fairly clear. Lumpectomy or mastectomy, chemo and/or radiation, reconstruction. But for Reynolds, the question was: Why reconstruct what already feels out of place? So they had a choice. They could have the lymph nodes removed and then go to a doctor for top surgery, or get it done all at once, which would mean that their chest wouldn’t look quite like what they had imagined for themselves in those wishful-thinking mirror sessions — it would be more scarred, more sunken. “But I told them when they went in there to just take everything out. I couldn’t wait anymore. And at least now it’s better than it was,” Reynolds says.