Day 12 post-op

•July 5, 2009 • Leave a Comment

19:00

I have felt very fatigued since arriving home; most of the previous days have been spent much as they were in the hotel: sitting or sleeping, and making the effort to move for only bathroom breaks and food. Before, with room service to clean and provide for me and thus most activity taking place at waist level with minimum effort, my incapabillity did not seem so obvious; I now find that returning to my lifestyle has presented several unanticipated difficulties.

My reach is limited to a 45º angle at best; the majority of dishes and pantry shelves require a tall stool to access. My mother has arranged a selection of cups and bowls on a countertop, which I anticipate on rotating through for another week at least. My bedroom being on the second floor, I have also found descending the staircase rather painful.

The tissue above and beside the areolae feels very bruised and slightly swollen, although the areolae themselves appear to be healing well. The left one is of some concern to me as nothing of the scabbing has shown the slightest sign of falling off, leading to an increasingly blackened and hardened appearance. However, the edges of the incision are pink and holding securely, so tissue death does not appear to be an issue. There has been a little bleeding around the nipple itself and the bottom edge of the incision on the right for the past few days, although it ceases quickly.

The tape covering the breast incision is becoming slightly saturated, and although its removal is recommended around two weeks, I am hesitant to do so as the incision itself is rather sensitive and I worry about the possibility of it opening during a high reach or quick arm movement, in particular given that tomorrow I return to work for the first time in a field that is quite physically demanding. While for the past few days I have hardly been able to stand to not wear the binder for the feeling of tension, exposure and tenderness, just today I find that it is becoming more tolerable to go without it.

Nonetheless, the overall healing process seems to be progressing with little obstacle. A natural stomach-sleeper, I have as of yet been unable to accommodate such a position as I am very aware of my skin stretching and of the weight on both the grafts and the bruised tissue, which causes a lot of discomfort. Sleeping on my side is both comfortable and painless, however; so it has become my position of choice.

The site this morning. Very little aesthetic change so far. The smudges here and there are tape residue from the nipple gauze, and there is some faint indentation from the binder.

From a different angle; not the best photo as my hands occupy half of it, but there can be observed some swelling above the areola in the upper left. The drain holes are beginning to close.

Advertisements

Day 9 post-op

•July 2, 2009 • 3 Comments

8:00pm

At last, we arrive home from California.

The removal of the sutures was less painful than I had expected ; while I was aware of a slight sensation of pulling, the fact that the areolae are completely numb continues to surpass my conscious thought.

There has been a level of pain following their removal, mostly localized around the edge of the chest incision, which seems to be a target for irritation from clothing, the binder and general arm movements. While not unbearable, on occasion it has become a cripplingly sharp, yet quickly subsiding, stab at the attempt of rapid movement or the act of pulling; difficult this past night as maneuvering into a bunk on the train involved a small level of bodily lifting. There is also a bruise-like sensation throughout the general chest area, in particular directly between the incisions in the middle of the sternum where the skin is rather taught.

Today was my first shower in 9 days, which was a great relief. Showers are to be taken facing away from the water for the next few weeks, while as the incisions can become wet they cannot be hit with a direct stream. I encountered slight panic as I happened a glance downwards sometime during its duration and found the grafts covered with shampoo suds despite my efforts to shield them from any foreign substances; — this being their first contact with air for more than a 30-second period — but they appear to be fine and, in retrospect, soap was likely the best of a number of possible things with which they may have had contact. As I removed the gauze for the first time prior to showering, a moment of Dr. Brownstein’s session wherein he recounted the occurrence of someone pulling off their newly grafted nipple haunted the recesses of my consciousness, but they are secure and a slight wetting of the gauze allowed its removal with ease.

It was also to be observed that the somewhat revolting, bumpy and blackened skin is not severely bruised areolae, as I had originally assumed, but in fact merely a gigantic scab covering the entirety of the area. A small flap seems to have peeled away during the shower, revealing a very pink and healthy nipple beneath.

These pictures are graphic.

My chest prior to surgery.

The site prior to the removal of the sutures, one week post-op. The lighting is rather sickly as the hotel bathroom fixtures left something to be desired. The tape will remain on the incisions for another week. The small red dots are where the drains were sewn in, although the faint scar lines directly below them are from an infantile surgical procedure.

One week post-op, from the side. Definitely obvious that I spent the past week in bed in comparison with the pre-op photo.

Prior to showering today, after removing the nipple gauze. Most of the purple marker had worn off over the past few nights.

The left nipple today, a little squashed.

The right nipple today. This is rather nasty; but I was loath to peel away any of the scabbing for fear of bleeding or infection.

Day 7 post-op

•June 30, 2009 • Leave a Comment

09:20

Today Dr. Brownstein removes my sutures. It will be a great relief to be rid of the gauze and surgical binder, as its tendency to slip down has become an increasing annoyance in these past days.

I am now nearly fully mobile and able to raise my arms above my head; a small yet significant feat, considering some days past the farthest they could reach was horizontal with my shoulders. There is still a measure of pain down the side of my chest, from the underarm to the bottom of my ribs; particularly when the binder has slipped, as both the incision and the graft become partially exposed and are almost too sensitive to touch. A good deal of feeling has returned to the exterior of the areolar graft site, although directly along its incision is still devoid of sensation.

With the minimal bandaging I have, somewhat guiltily, found it quite easy to pull at the front to allow peeking. The nipples are hidden behind gauze and tape covers the incision lines, but I can clearly see the obvious flatness. Despite this and the fleeting glance on Friday, I am slightly nervous to see the end result this afternoon.

Top surgery, part 3

•June 27, 2009 • 2 Comments

6:00pm, day 4 post-op.

Yesterday morning I had my first post-operative appointment with Dr. Brownstein. I had been hesitant about the removal of the drains and had considered requesting that they remain until Monday, as at the event of their last cleaning there was a significant amount of fluid yet.

While in the waiting room during surgery, my mother had made friends with the mother of another young transman — incidentally whose surgery was scheduled immediately following my own. The similarity was discovered after Dr. Brownstein came to give them both updates while her son was being prepped, shortly after my release to recovery. This was a fortunate occurrence indeed; as we realized after meeting that not only are we exceedingly alike in history, perception and surgical experience, but also that they are in possession of a car and are vaguely familiar with the bay area. It so happened that his post-op appointments were scheduled directly after mine, lending the opportunity for us to carpool to Dr. Brownstein’s office for this first.

“Oh, you’re awake,” he said, somewhat amusedly, at the sight of me.

I was taken in first and instructed to lie back on the exam table. After some minor struggle unwrapping the binder, the at least inch-wide padding was removed from the right side. As he began clipping the sutures around the drains, he prepared me for the imminent yet minor pain to follow as he would detach the tubes. The right side having been the most localized pain throughout the past days, I was not entirely prepared at the moment in which he decided to pull it; although it was not altogether too painful, and ceased nearly immediately. The left side was barely felt at all; though the acutely unique sensation of a tube being pulled through a small hole cannot possibly be analogized or explained.

Following the removal of the drains, he also cut off the thick pads of gauze surrounding the areolar grafts. I don’t recall noticing any sensation at all during this; although, as we both discovered later, it may have been due to the fact that the surgical site is almost completely numb to the touch; which I had both failed to notice and anticipate.

“Do you want to see?” he asked, brandishing a small mirror in my vicinity.

Unsure of what potential horrors I would encounter from a head-on view, I waved away the mirror and glanced downwards across my torso: the thin, pink outline of the incision wound its way in a flattened semicircle just below my armpits, to meet at the center of the sternum. The areolae were half their original size, flattened and symmetrically grafted; although they were extremely bruised and for this hardly recognizable. The tissue was slightly dented where the nipple gauze had been squashed against it, though it will recover in some days. Most obviously, the area was entirely flat. I could see a few fading purple marks where the incision was made; the rest of them lost on tissue no longer in existence.

“Holy shit,” I said.

Small, flat rectangular gauze pads were taped over my nipples, and two larger pads to cover the chest before reapplication of the binder. Sans drains, I was surprised to find that there was no longer almost any pain at all, even raising my arms horizontally to put on my shirt. Standing was easier as well; as the original bandaging had rendered a straight posture quite impossible, forcing me to lurch around in the appearance of classic teenage grumpiness, despite my mood being rather elated these past days. Without the extra padding, however, the binder does tend to slip down; a slight yet manageable annoyance. On occasion, there occurs the feeling of muscle tremors mostly localized around the grafts. With any luck, this may signify the slow return of sensation to the area.

Though the view was short and foreshadowed, I am confident that I will be happy with the results. The sutures will be removed come Tuesday, and Wednesday morning we board the train home. Having left a full week ago on the previous Saturday, the restlessness of hotels, restaurants and taxicabs has begun to set in; unfortunate given that we have six more days until departure.

In the meantime, I have found that the binder makes a very suitable place to tuck one’s napkin.

Top surgery, part 2

•June 24, 2009 • Leave a Comment

3:40pm, one day post-op

Not being allowed to eat anything prior to surgery, I woke up and remained hungry the entire morning as we prepared to leave. I took my last shower for the next week, as the bandages are not supposed to get wet at all.

The hospital owns the hotel we’re staying in, and for their patients’ convenience a shuttle between the two hospital campuses and the hotel is provided; however, the first shuttle departed at 6:15, so we had to arrange for a personal shuttle arriving at 5:30 to allow us to reach the hospital by 6.

Once there, we were greeted by a friendly man named Billy who charged my debit card for the anesthesia, had us sign various paperwork and led us into a small pre-op patient room where I could change into the hospital gown; which I was pleased to find closed entirely at the back and hung below my knees — nothing like the short, open-backed white gown worn during my brief stay at the psychiatric hospital. Also provided were rubber-bottomed socks and skin-tight elastic nylons which went up to mid-thigh to assist with blood circulation during the procedure.

It was not long before a nurse arrived to take my vitals, attach the ID band to my wrist and talk us through any concerns. Dr. Brownstein came in shortly afterwards to mark my chest with his famous purplish-blue marker. An IV was attached to my arm — not as bad as I had anticipated, though not altogether as easy as I may have hoped either. After a short waiting period, we were wheeled into the elevator and then to a public waiting room, where the anesthesiologist went down the beds one by one. The reality began to sink in at about this time, and as I was the last in the line, I had plenty of time to begin freaking out. Several tears were shed between the two of us; and after about 5 minutes, the anesthesiologist reached my bedside, where he asked if I was ready.

By this time it had been roughly an hour. Mom was allowed to accompany me until the door leading into the OR, but no farther. Upon our arrival I vaguely recall being transferred onto the surgical table, but I cannot be completely sure. I do recall noticing the world seeming to take several seconds to register after my eyes moved.

“Woah,” I said. “Is that the anesthesia working already?”

“Yep,” someone answered.

“Oh,” I said; and, promptly afterwards, conked out.

~~~~~~~~~~~~~~~~~~~~~~~~~

I had anticipated having some notion of, “so when are we starting?” after waking up; although immediately upon waking I could remember having a number of dreams, and was aware that some time had passed. I couldn’t feel a thing; nor could I keep my eyes open in the slightest. I recall being wheeled back into the pre-op room, where Mom was waiting.

“Sup,” she said.

“Sup, yo,” said I, and fell asleep.

I was feeling unnaturally groggy and kept fading in and out as the effects of the anesthesia waned; when I had regained no consciousness around 3:00pm, nearly five hours later, we began to worry slightly. Most patients seem to leave around 4 or 5 hours following the procedure, however, so we waited. A generous dose of morphine as well as antibiotics were injected through my IV.

I went to the bathroom several times with Kate, my nurse’s, help; completely draining all energy once returning to the bed. It was determined during this time that my nurse call button was broken; which was discovered after I had repeatedly pressed it to no avail upon feeling nauseous. By 6:00, I was feeling even more tired than I had ever been, and found it physically impossible to hold my eyes open for more than 5-second time periods. This was beginning to be a problem as the daytime ward closed at 8, and if anything I was showing decreasing signs of ever waking up.

After talking to several nurses, on their recommendation I was brought ice chips and a few Saltine crackers; which, though their taste was tolerable, were exceedingly difficult to eat on a dry mouth. I managed to ingest two full crackers and half the cup of ice chips, yet still with no possible chance of regaining coherency. Concern turning into slight panic, I began to feel truly doubtful that I would ever wake up at all; particularly as I had not yet actually fallen asleep; simply, I could not open my eyes. Reluctantly, particularly given the extra $425 fee for overnight stay, it was determined that the cab ride home would likely kill me in such a state and arrangements were made for my boarding overnight; it would seem that I am among the 1% population with such adverse effects from the anesthesia that would require such a hold.

I was wheeled to a lower floor, situated in a small private room and switched to another bed. My nurse, Fabio, a small but very friendly Latino man, took it upon himself to make the room as comfortable as possible, ensure that his call button was functioning properly, and even locating a plush reclining armchair for my mother to stay the night in beside my bed. With the IV feeding me saline at a constant rate, the night was restless as I had to go to the bathroom every hour or, later, every half-hour. This required unhooking the IV, removing the finger-clipping heart monitor and several other medically attached devices; after the second time, a portable toilet chair was set beside the bed so that I could simply roll over to it and take the IV with me.

Dr. Brownstein had another surgery scheduled this morning shortly after 6:00, and he arrived to take a look at the site around the same time. He assured us that my vitals were stable throughout the entire procedure and that there were no complications whatsoever. He was unconcerned at my yet persisting inability to wake up; some people, apparently, simply do not take well to the sedatives. He did however insist that I get up, walk around and above all, eat; being Wednesday morning I had eaten nothing since 8pm on Monday. I managed to ingest a small container of jell-o and a few more ice chips, and my mother and I took a short jaunt around the hospital corridor. Feeling slightly more functioning, I was able to dress myself and even remove the elastic stockings. I was loaded onto a wheelchair and taken down to the lobby to await the shuttle.

The shuttle back to the hotel was a bumpy and uneven ride, and though I had not yet felt any nausea, when we stopped I felt sure that I would throw up. Our hotel room had been changed overnight, as we had found the original room a bit too small and had been annoyed with its various idiosyncrasies, including being as far as physically possible from the elevator. Our new room is closer, much larger, and includes amenities such as a a desk and two small armchairs. I did my shot after we got back and was surprised that I could hardly feel the needle going in; no doubt to the morphine not yet having worn off.

By mid-afternoon, I am now quite high-functioning and have been able to eat two bowls of cereal, half a yoghurt and half a container of Cupnoodles. Dr. Brownstein wrote me a prescription for Vicodin, although I have not had to take even one yet. There is definitely an all-around pressure surrounding the incision site, particularly as the binder is wound very tight around the dressings; but there is really not much pain at all short of if I attempt to raise my arms or sit up completely straight. The only real pain that I can pinpoint is the drains at the place where they are stitched into my skin. They require flushing every 6 hours, and though at first they were almost entirely filled with blood, I can tell that the emissions are becoming more fluid.

drains

Top surgery, part 1

•June 24, 2009 • Leave a Comment

We arrived in San Francisco a little after 4:00 Sunday afternoon, over an hour before our scheduled arrival time — astonishing, given the fact that we left the Denver terminal over two hours behind schedule. This would in part be due to the fact that throughout the night, it would seem the engineer was very nearly exceeding the 80mph speed limit across the Nevada plains; causing myself and, I imagine, several others to fear for their lives in the middle of the night as we awoke to the sensation of flying off the rails every time we changed tracks.

The ride overall was uneventful, and though I had expected to encounter boredom sometime after 15 minutes on the train, we were surprised to find that doing nothing for two days was quite peaceful; to the exclusion of the train breaking down for several minutes somewhere in nowhere Nevada. This did not altogether soothe ones’ thoughts during the previously mentioned midnight cruise. As we passed alongside a river for a number of miles, a large collection of rafters could be seen waving; and, farther up the river, exclusively mooning. It seems there would be a rural custom of which I am not aware.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

After a cab ride to Dr. Brownstein’s office — and a call to his receptionist Kathy after standing lost on the street corner for several minutes — we managed to find the door. The office is nothing like doctors’ offices around Denver. It’s small, tucked into a side street, and very un-office-like. The walls aren’t all white plaster; instead covered with dauchsund pictures and vaguely abstract art. The exam room is next to his desk — seated in front of an intimidatingly enormous, overstuffed yellow chair remeniscient of something out of Charlie and the Chocolate Factory — separated by a simple wood-and-paper room divider no doubt obtained from Chinatown or similar Asian design shops.

Kathy and another receptionist walked me through the procedure, answered questions and set up the post-op appointments. Then we met Dr. Brownstein, who went over anything that the girls missed and talked about the drains and dressing I would be wearing afterwards.

We took a cab back to the hotel, ate a light dinner and waited for the 4:30 alarm the next morning.

Day 600 (1 Year, 8 Months)

•June 12, 2009 • 1 Comment

“Oh, hey Jason – ohh, my god!” Visiting my father for a weekend, his office manager greets me in the morning as I wander to the kitchen of his half-house, half-office. Her hands fly to her mouth. “You look so different.”

I try to think when she has seen me last; and I think it must be a year at least. “Yeah, uh,” I chuckle as her eyes travel the length of my body, “it changes a lot.”

“You have a beard!” she exclaims. “Okay, just let me adjust.” She turns away and looks back several times, clearly baffled. Born and raised rural, southern yet astonishingly open-minded, she’s never seen anything like this. Having met me shortly before beginning testosterone, she’s never known me female, but she’s never seen me this male either.

I only notice change when I choose to look for it, but I find that I am almost always surprised when other people do.

“Those arms…” my brother mutters, shaking his head. “Home grown, my ass.”


I have come to the point where I will admit to people that I am nervous.

I realize that all of my defining traits have become exceedingly exacerbated in the weeks prior to surgery — in particular, always possessing a slight lack of control over the ability to sit still, though surprisingly less apparent after testosterone, I cannot seem to stop moving in some way or another. I am beginning to obsess on what must be done before we leave, the small details of our arrival, appointments and instructions in California, and what to expect following surgery; particularly given the physical debility and limitations in regard to my very physical day job. Stress-influenced weight loss, to be observed beginning in early April, continues as the panic mounts despite my efforts to maintain a healthy diet in the relative chaos before any such major event. I hope for the pounds lost during the past months to return following the surgery; as, certainly, a relief and calmness will settle after so much anticipation.

I admit that many mixed feelings have occurred in these past days, particularly as the countdown comes to two weeks and now, a mere week and day until our departure. While I cannot possibly imagine the experience of simply not having to think about my chest, it is the aftermath of the event of amputating a part of my body itself that concerns me. While breasts are, after all, something that enters my mind quite frequently during the dull moments of the day, it is some strange form of comfort that there is a manipulable pair in my immediate vicinity to entertain me, existing entirely separate of my male identity; yet not belonging to another being, merely existing independently. The curiosity presents itself that I may miss them; despite that they no longer represent anything feminine from the alterations of testosterone.

Still. I have attempted to prepare myself for the ghastly post-surgical appearance, contrary to the perfectly sculpted masculinity that my mind may wish to imagine. I am aware that the scarring will be horrific to my perception; as are, sadly, all transsexual surgical procedures to me; though I am also aware of the intricacies of what I am capable of accepting — this or this I could live with. This, I could not. While the latter is by all means not among the “unfavorable results” presented at Dr. Brownstein’s session last year, for reasons I cannot explain or even differentiate entirely, it is simply — perhaps shamefully — not an outcome I would accept easily.

I struggle with the selfishness of judging so critically a procedure of which the result cannot possibly be guaranteed, predicted or even expected. But I cannot help feeling a panicked desire for perfection as I move through my last days of physical purity, existing as of yet in an exceedingly healthy, unmarred 19-year-old body, free of the surgical alterations by which it will be defined for the rest of my life. I cannot help the sense of entitlement that I should receive an outcome which is not only tolerable but pleasing in this event of elective plastic surgery — there is no cancer; there has been no disfiguring accident, genetically mutating disease to require the need for aesthetic surgical procedures. I proceed entirely of my own pursuit and desire, and I cannot help but worry that the surgery to which I have pinned my freedom from my body may in fact imprison me in revulsion of its result, and that there will be nothing to blame for my ruin but myself.

Fuck yes, I am nervous.