Notes On Surgery

The Toast’s previous coverage of trans* issues can be found here.

Author’s note: My husband has read, corrected, commented on, and supported this piece. I can’t write his story, only my experiences.

My husband and I didn’t have a honeymoon. The closest we got was a trip to the southwest, ten months after our wedding, to a rented condo and a private hospital where he would have his second round of female-to-male surgery: hysterectomy, oophorectomy, vaginectomy, metoidioplasty, and primary urethral lengthening. The upshot is that at the end of this he would be rid of reproductive organs and naturally-produced hormones, and, we hoped, be able to pee standing up.

***

I met Mark in grad school. We first met, briefly, before he started transitioning, but by the time he started the program he was living as a man. Before the semester began he and I and two other students went to see a movie at the second-run theater, and then out for pie. He told us he was trans, but thanks to a slightly shell-shocked administrator, we already knew. I had, I think, the reaction that most well-meaning people have, assuring him (and myself) that it didn’t matter, then being conspicuously, exaggeratedly careful with my pronouns. Sometimes I would stare, trying to see the girl in him. At first I could, but as time went on testosterone redrew the lines of his body, adding muscle, reshaping his face, changing his voice.

His physical transition gave me a lot more respect for testosterone, whose powers I had always dismissed as some boys-will-be-boys excuse for bad behavior. Being with him has made my thoughts about gender more complicated, but in some ways my relationship with gender roles easier. I like to sew, knit, bake, watch Colin Firth dive into the pond at Pemberley. He likes playing rough sports, boxing and hockey, woodworking in the basement, swinging kettlebells while watching football, grilling steaks with a beer in his hand. I always felt uncomfortable fitting into these gender roles, but with him it was easier. I knew he had spent plenty of time, more than I ever had, thinking about gender. I didn’t have to assure him that just because my only trophies are for sportsmanship means I think that’s how women should be. He knows. I can knit without guilt.

Two days before surgery, we flew down. We got in late and had to deal with a rental car agent who tried to up-sell us, charged more than the website promised, and relentlessly inquired what we were doing there. We’re here for my husband’s hysterectomy, oophorectomy, vaginectomy, metoidioplasty, and primary urethral lengthening, I wanted to say, but didn’t. We finally got out of the airport and to the condo. I went out for the first of many shopping runs, but in the dark could only find a Whole Foods. I looked for Gatorade because the next day he would be on a clear liquid diet. Whole Foods did not carry Gatorade. I got something with jackfruit in it. I hoped it had electrolytes. I went to sleep violently wishing we weren’t there.

The next day we had preparatory appointments, but there was still too much time for us both to sit and worry. I struggled, and still struggle, not to think about the money we were spending. We were incredibly fortunate not to have to take out loans. I had inherited some money from my grandparents and, though we had originally talked about using it to pay down student loans, or as a down payment on a house, it was going towards this. I don’t like the way thinking about the money makes me feel. I love my husband, and I want the best for him. I want him to be happy, and healthy, and safe. This surgery was important for all of those things. I have to actively push against becoming bitter, because sometimes it is so satisfying to feel self-righteous. But that’s not how it really is. This is what marriage is. This is what love is. This is what tying our future lives together is.

That evening he started something blandly called “bowel prep.” It wasn’t as bad as he thought it would be.

***

My older brother had come out to us as gay about six years earlier and married his long-time boyfriend not long after Mark and I started dating. In addition, my mother had a couple of MTF transgender coworkers. So the concept wasn’t entirely alien to my family, and they never said an unsupportive word about him or our relationship. I could tell, though, that my mother worried about this making my life harder. I feel bad for worrying her like that.

Mark’s home state reissued his birth certificate with his proper gender on it, which made our marriage in my southern home state easy. We did tell the officiating priest, but he assured us it didn’t matter. So we got the candles, the incense, the thees and thous in a beautiful ornate church, all with no deception. It was easier, and more official, than my brother’s unlicensed ceremony.

***

The morning of the surgery we got to the hospital at 5 am, neither of us having slept much. We drove there in the dark, in silence. I wanted to hold his hand, to touch him, squeeze him. For the first time I was worried. I trusted his doctors and knew the surgery wasn’t life-threatening, but things can go wrong. He has MS and I worried there would be complications. Thanks to his boxing days we knew his nose bled easily and the air was so dry there I worried about it starting during surgery. I made sure the doctors knew about all of this. They were unconcerned.

He has two surgeons, both men in their fifties. We met one of them in a consultation a few months earlier, a small, fast-talking man who favored loud shirts and louder ties. He brushed off any worries about complications, assuring us he never had any trouble. The other doctor was larger and always spoke ponderously, bemusedly. His arms were covered in scratches, and I joked to Mark that it looked like he had wrestled a coyote.

I sat in the waiting room watching local news while Mark went to get prepped. After about a half hour they called me back. The prep room was a big open area with hospital beds encircled by curtains. The rectangle of ceiling over his bed was painted with blue skies and fluffy clouds, though later he’d tell me he didn’t notice. He was gowned with an IV in, and he was pale and quiet. I put my hand on an unencumbered part of his arm. His anesthesiologist came to get a urine sample for, oddly, a pregnancy test. It was impossible, since he spent the day before taking laxatives and hadn’t been allowed anything to drink since midnight. The fast-talking surgeon told me not to worry, then they wheeled him away.

I went to the waiting room and plugged in my laptop. My work was wonderfully accommodating, letting me take three weeks to be with him as a mix of remote working and sick time. They didn’t pry into what the surgery was for, just believed me when I said I needed to be there. Our insurance didn’t cover it, but a recent court case means it should be tax deductible, so that’s something.

At some point the first surgeon came out and told me his part went perfectly. It would be a few more hours, so he suggested I get some lunch. A few blocks away I found a bar and got a tuna melt. The man next to me was having a shot of whiskey; I considered doing the same but decided against it and went back to the hospital. The second surgeon came out, but just for a bathroom break. He (ponderously) described how my husband had “gristly” tissue. He kept saying gristly and making sawing motions with his hands. He promised to show me a picture later. I thought, that’s not necessary, really. It was a few more hours before they told me they were moving him to recovery and I could wait in his room.

I hadn’t spent much time in hospitals, but enough to know the room was nice. It was private, with a bathroom, a small round table, two wooden chairs and something like an armchair. It was some time before he was finally wheeled in. The nurse told me they were delayed in recovery because he was vomiting. That didn’t surprise me — he told me he had the same reaction after his double mastectomy about four years earlier. His eyes were open but he wasn’t quite conscious. I stood next to him while they arrange his IV and monitors. I stroked his arm and forehead. I told him what the surgeons told me — that everything went perfectly, and he had nothing to worry about.

He drifted in and out of sleep. When he was awake he whispered water and I went to stand next to him, holding the straw to his mouth. He couldn’t lift his arms, so after each sip he turned his head aside to slowly swallow, then back for another. He wasn’t awake long enough to do anything other than take a few sips of water and, later, the broth or jello that I spoon fed him.

Nurses came in and out. At first I was hesitant to say anything, trying to hear what they were saying, making notes on what they did, and when. As time went on I got bolder, asking questions and pointing out things I was worried about. There wasn’t much I could do for him but I tried, rubbing his head and feet, holding his hand, going to the nurse’s station when he needed something.

***

Deep down I don’t understand what it is to be transgender. I can sympathize but can’t empathize. I have the average amount of (on a good day) discomfort with and (on a bad day) hatred of my body, but I know this doesn’t matter. My inability to put myself in his shoes has no meaning for the reality of his, or anyone else’s, identity and experience. I believe him. I trust him. I love him. I don’t have to completely understand.

I’ve learned that “transgender” is a ridiculously large catch-all. When we started dating, I tried to avoid uncomfortable conversations by doing my own research. But the more I read the more I realized that my initial idea was too simplistic. What it means to be transgender varies dramatically from person to person. I couldn’t learn what I needed to know without talking to him. Strangely, we didn’t start that conversation until after we first made out.

***

I hadn’t planned on spending the night at the hospital. I thought they only allowed it in special cases. But when it started getting late a nurse showed me how the chair folded out and brought me sheets and a blanket. I didn’t have anything with me, so I took off my bra and exchanged my jeans for the oversized pajama bottoms I had brought for him.

There’s no good sleep in a hospital, even a fancy non-emergency one with a private room. The first time an alarm went off on his heart monitor I shot up. By the fourth time I just groaned and wanted to shake the nurse and demand to know why they couldn’t adjust the settings since he clearly had a slow resting heart rate. Same for the first time the IV machine beeped urgently. I ran to the nurses’s station to get help, only to learn it meant a tube was slightly twisted, or the bag needed to be changed. Periodically the pressure bandages on his legs and feet loudly tightened or loosened. He woke up several times, calling my name in the dark. I went to him, holding his cup of water and guiding the straw into his mouth.

***

The next day he was more alert and could do small things like lift his arms. He still spent most his time sleeping. I had worried about him being bored but he was never awake long enough for it to be an issue. Both surgeons stopped by (the taller one repeated gristly but, luckily, forgot to bring the picture) and there were frequent nurse rounds.

The second night was harder than the first, even though I knew better what to expect. At some point he woke me up and I went to him. He was on the verge of tears, desperately whispering that he had been calling and calling me and I hadn’t woken up. I stroked his forehead and helped him drink. When he was done I started to go back to my cot, but he was agitated. What if I need you again? You won’t wake up, he said, dismayed. I pulled one of the wooden chairs flush against his bed and curled up in it as best I could, within arms reach, so he could wake me anytime.

Sometime late that night or early the next morning he turned his head and hoarsely whispered that he would rather die than spend another night in the hospital. He’s stoic about pain — he never pressed the button for additional medicine or complained when he was moved or examined, and once we left the hospital he never took any of the prescribed narcotics, only a few Tylenol. But being there was draining him. He was pale and weak and couldn’t stand any more time trapped in that bed, with a needle in his arm, a tube across his nose constantly blowing cold oxygen, his legs constrained by circulating bandages. I promised him he wouldn’t, that we would leave that day.

After his plea the night before I wanted more than anything to get him out of the hospital. He felt well enough to eat a little solid food in the morning and to walk, with help, to the bathroom. A nurse handed me a thick sheaf of post-op instructions and the number for the doctor’s answering service. They showed me how to empty his urine bag and gave us a pillow to make the car ride more bearable. I pulled the car around while they wheeled him out. I drove as quickly as I safely could, torn between wanting to get him home as soon as possible and making the ride smooth and painless, not to mention avoiding the terrifying possibility of a car wreck with him so breakable. He asked how much longer it would be and I lied, saying we were almost there.

It was maybe fifty feet from the car to the door of our condo but he barely made it, leaning on me, tethered to the urine bag I held. While he napped I went to the store to get more supplies and prescriptions filled, then pulled out a spiral notebook and made a daily schedule: antibiotics morning and evening, probiotics at noon, anti-swelling medication three times a day, one cream daily to bruises but not incisions, another twice a day to incisions but not bruises. Pain medication was as needed, so I made a column to keep track of when he took it. Because he was worried about infection, I recorded his temperature three times a day. I kept notes on when and how much he ate, how much pain he was in, how frequently we emptied the urine bag.

He had two follow-up appointments back at the doctor’s office, and other than that we mostly spent our days inside the condo. At first he napped frequently but as time went on he started keeping a regular schedule. Soon he could walk around the condo unassisted, though I continued to empty the urine bag for him. I stood outside the shower while he rinsed off the first time, holding the bag in one hand and ready to steady him with the other. He downloaded all the Harry Potter books to his Kindle and as he finished each one we rented the movie and watched it together. We played a lot of Crazy Eights. One day we drove a half hour to a donut shop that had a segment on the local news. I worked, mostly while he slept. We talked about the job that was waiting for him to start after a long period of uncertainty and counted down the days until we could go home.

At first his wounds were tough to look at, his genitals a swollen mass of purple and blue bruises, dried and clotted blood clinging to the sutures, tubes jutting obscenely out of him, refusing to let open holes heal. But things I thought would be hard turned out to be nothing — changing his dressings, carefully cleaning the incision sites, helping him in the bathroom. They’re just things and you do them.

One day he told me that the hardest thing for him was knowing that if something happened now, if I was attacked, he couldn’t protect me. The slow process of recovering his strength gnawed at him. He hated the tube that poked out of his penis, and the other one that ran directly from his bladder out an incision below his belly button and into the urine bag. The bag always had to be below his bladder since it relied on gravity to drain. One night he nearly screamed in frustration as he tried to get settled into bed. I taped the tube to the bedside table, struggling to find some better way to place the bag. But there was no way to keep everything functioning properly and relieve his discomfort. Another night we went for a slow walk around the complex. A woman smoking on her balcony stopped us to ask about the urine bag. Her husband had one, she said, and asked how it was attached. I’m all for medical solidarity, but asking strangers about tubes coming out of their penises seems a little forward.

After the first follow-up appointment he got the tube out of his penis. I anticipated a sophisticated procedure, but it turns out it’s the nurse saying one, two, three, and pulling. That left one tube, coming out of his bladder, now capped, with the hated urine bag gone. That night he got to pee standing up for the first time. It worked. A few days later they removed that tube, and we flew home.

***

There’s no such thing as gender reassignment surgery, despite what various government and news agencies seem to think. There’s a menu of therapies, medications, and surgeries, and people pick what combination works for their body, their health, their mental and emotional needs and, not least, their finances. The government as a whole doesn’t have a good grasp on what it means to be transgender, and definitions and regulations vary wildly from office to office and day to day. What it really takes to get a passport issued is anyone’s guess. Even in the time we’ve been together these things have improved, thanks to hard-working activists, but there’s still a lot of work to do both in writing new regulations and clarifying existing ones.

There’s not a line — before here he was female, after he is male. I think he’s still deciding on how to think about the person he was before transitioning. Every once in a while I see a picture of him before he cut his hair and changed his name and how he dressed, before he was the man I married. It’s an odd feeling. It’s him but not him. I don’t dwell on it.

I don’t dwell on my own sexuality either. I’m straight. I wasn’t attracted to him when he started transitioning, when there was still a feminine curve to his cheeks and hips. If you had asked me then if we would ever date I would have said no. It took two years of being friends before I realized I liked him (liked liked him). One day he asked me out and I thought well, why not? And then we fell in love, fast. We were almost immediately talking about our future, marriage, kids. His being transgender faded to the background. It sounds unbelievable but I still sometimes forget. He has to remind me that people he met in the past might not know who he is now. I don’t know, or care, what loving him means for my placement on the Kinsey scale, or whatever spectrum is the going standard. If I lost him I would undoubtedly date cis-men. I love him, and I love being his wife. Figuring out what that labels me as seems like a waste of time.

***

I’m pregnant now with our first child. When our relationship first got serious I imagined a host of complicated measures to make sure we would both by biologically involved, but in the end we went with something much simpler. I don’t know, but I think it’s a boy. Chances are he’ll be cis-gender, but if he isn’t I have a pretty good idea about how we’ll talk about it, and I know I’ll be able to truthfully tell him I don’t give a fuck, as long as he’s happy and healthy and gets his full share of love. We haven’t discussed how exactly we’ll talk to our children about their father being transgender, but I’m sure it will be a process, a series of conversations starting when they’re small. Frankly, I can’t imagine they’ll care, or see it as a big deal. Kids know family, and they know love, and they don’t have any problem understanding intuitively that people and families are different and it doesn’t matter.

We’re talking now about what will hopefully be the final two surgeries, which will give him testicular implants. Compared to what we did last year these are minor surgeries, almost outpatient procedures. I might not even go with him, since we’ll have a small child by then.

This is not the way I anticipated my life going, but I’m hardly alone in that. What difference does it make if we’re in the hospital for metoidioplasty instead of, say, cancer, or why exactly our child was conceived at a fertility clinic, like so many other children? Things happen. I got married with my eyes open, a privilege a lot of people don’t have. I wish we didn’t have to deal with these things. But I’d still take him, hospital stays, medical bills, questionable legal status and all, over anyone else, any day. I married a good man. I hope my children are as lucky.