The Politics of Aesthetics

When we ask what the conditions of intelligibility are by which the human emerges, by which the human is recognized, by which some subject becomes the subject of human love, we are asking about conditions of intelligibility composed of norms, of practices, that have become presuppositional, without which we cannot think the human at all. Judith Butler (2001). “Doing Justice to Someone: Sex Reassignment and Allegories of Transsexuality”. GLQ: A Journal of Lesbian and Gay Studies 7 (4): 621-36.

Today I wore boxers. It felt transitively gender appropriate and maybe even, essential, since I was heading off to see the plastic surgeon about chest reconstruction. Recall, that this is the only plastic surgeon in British Columbia who does chest surgery for fTm trans folks AND who does breast reconstruction. This guy, I figured, would get my particularities. But still, I needed the performative insurance boxers might provide. After all, I would need to convince the surgeon that doing chest contouring would be, in my case, an genderqueerly appropriate form of post mastectomy/breast cancer “reconstruction surgery“.

Typically, chest, or “top surgery” is regarded by the medical professionals and the health care system in British Columbia as a form of fTm Sex Reassignment Surgery (SRS). The rules regarding SRS are archaic and extraordinarily discriminatory towards transgendered folks. They include proscriptive requirements, such as, for example, that a candidate for SRS “pass” successfully for a member of the “opposite sex” for a minimum period of two years PRIOR to approval for surgery and that this successful “passing” be observed and recorded by “qualified professionals”. It is also the case that candidates for SRS need to be interviewed and approved for surgery by two mental health professionals.

Step Two, if we are to think of Step One, as the deliberate selection of the Calvin Kleins, involved filling out copious forms. Dr. B wanted to know such a lot about me. There were 8 pages of questions about my sexual and gender identity in relation to temporality, as in, “Who were you when you were born?” (identification via biology), and “Who would you like to become?” (identification via surgery). I was asked to use the space inside of an empty circle to demarcate, with a single dividing line, just how much of ME was f or m at those two critical times - past and future - actual and virtual. All my circles were covered with lines going every which way, tartan-esque, and sported a lively mix of f and m. It was appropriately messy.

Complete these sentences: Gender Identity. I think of myself as a _____. Ideally, I would like to think of myself as a _____.

I experimented with playful answers, as in: How did others perceive your gender identity as a child? Answer: Simplistically. How do others perceive your gender identity now? Answer: Generously.

Step Three was the live interview with Dr. B, who was intelligent, informative and kind. Dr. B is a really stunning example of ethical medical sensibilities. He was emphatic about wanting to use respectful language in asking me about “personal aspects” of my life, and encouraged me to correct him if he went astray. Dr. B didn’t read my answers on the forms. That impressed me. He just chatted away and asked lots of questions. Medical protocol requires doctors to establish that patients seeking any form of SRS actually, seriously want surgery based on what is called, in transgender health discourse, the test of Real Life Experience (RLE). And so the performative criterion becomes, Can I establish that I have a stable and longstanding record of making successful choices in the world that are recognizable and public actions which would pass as Otherly gendered?

I knew that many of the queries were quite important to get right, no matter how casual they may have appeared, like, “Would your ideal gender identity include male genitalia?” If I sounded like I love being a woman “just the way I am,” including all my womanly parts, I would fail the necessary performance of some stable elements of gender dysphoria that would make wanting a male chest something other than totally pathological. Fortunately, “bottom surgery” (as we trannies call it) is a pretty risky biz, so I made some kind of blisteringly ironic statement about preferring a dick I could slam in a drawer to one that might whither away and drop off my body. It seemed persuasive. And I meant well. “Have you told your parents?” This was a tough question, on all kinds of levels, not the least of which is, “What’s to tell?”. Once again, humour was my friend. Most of the time, I was able to assert my stubborn attachment to a transitive relation to gender — a moving project with no fixed address. I insisted on standing in the space of gender queer, and of living a life that is about playful complexity, rather than having ever inhabited something as apparently simple as a tick box on a form.

We moved on to Step Four, because I passed Step Three. OMG. Who was born of this moment - this institutionalized accomplishment of intelligibility?

Dr. B told me enthusiastically that he would not require me to be evaluated by a psychiatrist, because it seemed like I “had a really stable and healthy identity in relation to my complex gender”. And so I learned about the various options for my chest reconstruction, which include several variations, from fixing the problems residual to the bilateral mastectomy, to a full chest contouring operation. I have lots to think about. At the end of today, I was fixated on two thoughts:

If I had been talking about using reconstruction to get a 36DD chest, I would not have been required to disclose whether I felt like I had been born, secretly, as Dolly Parton, and now needed surgery to correct a lack of fit between the inside feeling and the outward appearance.

Maybe everyone should have to read Foucault as a right of passage into adulthood, and yearly thereafter. There might even have to be a test.

I am left with enormous respect for a doctor who has learned so very much about how to care under conditions of institutionalization, uncertainty and risk. I am, also, so very proud that I found within myself the courage to insist on speaking truth to power about a kind of complexity of intelligibility for which there are so very many punishments, sanctions and harsh measures.

 

Life stuff…

Since I want to enjoy the sun and my family today, this entry will have just the basics with no frills, no theory, and no clever commentary. So I haven’t updated my blog because for a week now, I have been in hospital. Yeah, I know. It’s f*cking unbelievable. But that’s also just the way it is. I am currently at home for a few hours on a day pass. Like a good inmate. Then, back to the institution. A week ago I ended up at the ER because I had been trying unsuccessfully to cope with intense abdominal pain for about a week. Something sure wasn’t feeling right. And it turns out that is because I am sharing my abdomen with a 10.5 by 8.4 cm mass on my left ovary, and maybe a diverticular attack as a chaser. The higher risk factor that I now carry for ovarian cancer pushed me to the top of the list, more or less, and I have been fast-tracked for surgery on Tuesday, Aug. 6. I know and like the surgeon who will be operating Tuesday. She may elect to take what few bits are left out (both ovaries and fallopian tubes), or I may just lose the mass and one ovary. It all depends what has chosen to take over my body. Many of you have helped to pass this time joyfully and have been incredibly supportive. I love all of you, whether you are one of those folks or not. People in the hospital have been extraordinarily kind. I am terrified and also not alone, so it’s almost bearable. I will have more to say when I get back. That’s a good motto I guess — yeah — more to say when I get back…

 

Up and Over

Today is Friday, and my surgery was Tuesday. That’s how long I have been unable to get to my computer and update the blog. Not bad, really. And I could even say that about the surgery. Not bad, really. It wasn’t.

All the staff at VGH were incredibly kind. I was so very appreciative of their warmth and empathy. Usually I am not one for falling into the outstretched arms of others, but the day of my surgery was all about letting go and believing that other folks really could look after me. And they did. My first challenge was the injection of radioactive material into the breast to enable detection of the lymph nodes closest to the cancer - part of the sentinal node biopsy procedure. I had read about this injection online and frankly, I was really terrified of the pain. So I told the radiologist, and he very calmly and gently described the typical reactions to the shot given without a local anaesthetic. He didn’t rush me, nor did he discount my fear. I am so appreciative of that kind of response. And sure enough, the pain of the agent entering the blood stream, while it wasn’t pleasant, wasn’t awful either. The whole event was a good object lesson.

When they wheeled me into the operating room, I relieved some of my anxiety about waking up after the operation by telling the anaesthetist about my bad experience waking up in agony post-hysterectomy. Yeah. Just three years ago, I gave up another anatomical marker of femininity. Dr. B, the anaesthetist, was very sweet and told me that he would consider it a very significant personal failure on his part if I had to go through that kind of trauma again. He said it like he meant it. Just the words I needed to hear at that precarious moment. And life is so very precarious. It’s just times like surgery that push the very fragile fabric of life up into microscopic view. And fragile can, of course, also include resilience. Sure enough, I did not wake up from my surgery in agony. In fact, I had to look down to make sure anything had been done at all. My surgeon was — what can I say — like any surgeon I have encountered. Not cold exactly, but — what is the right word that I need here — clipped?

Dr. C told me that two lymph nodes were removed in the sentinel node biopsy, which is where they look for lymph nodes that are close to the cancer so that they can examine them to see whether or not cancer cells have moved beyond the immediate site of the DCIS. I really won’t know much about the state of invasiveness of the cancer until I hear about the pathologist’s report, which will be a couple of weeks after the surgery. Dr. C was VERY excited that she saved my tattoo. It is rather extraordinary and I still don’t understand it anatomically, but somehow, she managed to remove my breasts and save most of the skin that covered them, and in so doing, save the tattoo. It wasn’t my goal to save the tattoo at all, but the challenge clearly appealed to Dr. C’s achievement orientation, and that is probably good. Keep the surgeon amused.

My time in the hospital from the end of my operation until discharge was just under 24 hours. During that short time, I was showered with love and flowers and food and incredible kindness by my amazing friends. I can’t express adequately how deeply I am moved by my friends. They created an amazing blanket of love to wrap me up and they all stood with me in that horrifying place of fear and pain and anxiety and they steadfastly kept me close. And of all of those folks in my life, none has been more brave than my amazing and gorgeous partner, Janice. From the nerve-wracking time of the initial diagnostic mammograms through to the mastectomy, Janice’s support has been nothing short of heroic. There is a lot of misuse of the discourse of heroism in cancer narratives, but in this case, it would not be awry. Love, love and more love.