27. R.I.C.E

The day has come and gone. I have had my face feminization surgery, and am in recovery.

In the seven days since that surgery, life has been… slow; long; indistinct… the days are not that different from one another, the hours somehow seem both endless and fleeting. I have been tired… and yet, restless.

But that is recovery. Soon, I will have hundreds of stiches and staples removed, and will be given a blessing to head out into the world (even if in small doses) to regain a feeling of my own humanity. I will start having energy again, taking back the vigor I have been donating to the various cushions and beddings I’ve been sinking deeper and deeper into while watching various streaming services in an attempt to chip away at the days.

I’ve seen plenty of accounts of recovery from other people who have undergone similar surgeries before me. Plenty of photos of the same bruised eyes and swollen jowls, plenty of timelines, “day 1… day 2… day 3…”

But what I have not seen is an accounting of the moments leading up to the surgery, and the day or so afterwards.

Resolve

The day prior to surgery, I kept finding reminders: I was reminded that this would be my last meal before I couldn’t eat solid food for some time; I was reminded that I may soon not be able to breathe properly from a swollen or blood-filled nose; I was reminded that I would soon be in “memorable” pain; that I would soon be swollen beyond recognition; that I would soon have my bodily autonomy chemically stripped away, only to then (albeit not while consciously present) have my actual physical self peeled and ground away… that soon a face I had spent my entire life looking at through the mirror would be gone forever.

Forever.

But I kept finding other reminders, too. Why am I here, now, steeling myself for all of this? What if I were to not do this, to keep my old face, to avoid the blood and swell and pain and choking bandages? Looking in the mirror at the face that was about to be gone didn’t bring me regret, but rather provided me with resolve. This is what I want, and it is what I need. For all the fear and anticipation I was feeling in those moments before having my last bite of food, or laying my head flat on my pillow for the last time for what could be weeks, I would soon not be responsible for any of the hardest work (I have hired professionals for that), but instead skip directly to recovery, with no fear of what may be… but just hope for what will be.

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The morning of the surgery was early, with a scheduled arrival at 5:30AM. Preparation was unremarkable: check-ins, gown-adornment, a random assortment of boring and standard vitals-tests. Having an IV placed was a bit uncomfortable, as they opted for my hand (ouch) instead of my forearm (which I am more familiar with). Eventually the surgeon came in and chatted through the plan one last time, followed shortly thereafter by the anesthesiologist. The whole time, I was able to be pleasant and friendly, make some jokes, stay positive… despite knowing that it was only a measure of minutes before things would get very serious very quickly.

Soon a nurse anesthetist came in to do some final checks and offer some final insight into what to expect. He would administer some drug to help me calm down (and, according to him, make it hard for me to remember things). Said drug was administered, and I was rolled out of the prep room and down the hallway (it was this moment — despite my not-yet knowing it — that marked the start of a very lonely phase).

We passed by the nurse station, through some double doors, down some non-descript hallways…avoided one area where there was construction happening (an opportunity for me to joke about having surgical wounds getting filled with gypsum), and eventually made our way to a very well-equipped operating room. It was cold, I thought, not that it mattered: I soon wouldn’t “be there” for it, and if the surgical team (or the insides of my body) found the cold more comfortable, so be it: that was the audience the thermostat cared about.

The various nurse assistants were very personable and friendly, each introducing themselves by role (possibly also by name, although with my penchant for remembering names it almost doesn’t matter if they did or didn’t). The surgeon was there already, scrubbed in, masked up, wearing various blood-catching shields (I assume this is what all of the clear plastic is for). They had me shimmy myself from the rolling bed to the surgical table, then scoot up… scoot down… split the difference… fit my head into some half-donut shaped pillow (I want one), all while the others in the room scurried around collecting tools, supplies, machines, and any number of other things all just outside my peripheral vision.

The doctor called everyone’s attention, reading from some pages, “today we are doing a tracheal shave, orbital recontouring, sliding genioplasty…” and the variety of other procedures that they should all be in alignment regarding. “That sounds about right to me,” I say, wondering if they are going to miss my uninvited geniality.

“Okay, we are going to administer the sedative now,” the anesthetist says to me. This is it, this is where my job ends (for now), and a clear line demarks the “then” from some future “now.”

“Is this the part where I get to count backwards from some number?”

“Sure.”

“Cool! What Number should I start with?”

“… how about twenty?”

I count quickly. I might as well go out with a bang, some last humorous display of resolve, something to leave the team with before all they have to keep them entertained is whatever fun music they choose to listen to for the next many hours, whatever stories they tell each other during the tedious parts of their work, whatever interesting secrets they find lurking between the outside world and my (literal) inner self. Maybe I can get to some low number that will somehow impress them, maybe it will make for a fun story, if not for me, then for the anesthetist, who certainly doesn’t have very many of these stories to tell already. I’m pretty articulate, I’m pretty quick when I need to be. Why not, it will be fun!

“Twenty”

…

Isolation

When I sleep — without disturbance, without stress, without the pains of morning hunger or the pressure of a morning bladder… without the calls from pets or people who pine for my nighttime attention, without the heat or cold of a bed and room not quite just so — I sleep. On the best of nights, it is as if I am cradled in the swaddle of some lost infancy, a blanket tucked tightly around me, holding firm to my cheeks and temples, lifting my neck just enough to feel as if my head no longer need bear even itself, much less the thoughts or worries of the waking world.

…

“Okay, you can wake up now.”

I hear the voice, but choose to hold on just a moment longer. I am in such serenity. They ask me to perform a series of small tasks — move my hands, squeeze something, perhaps — and declare that I’m not dead and they did a very good job: high-fives all around (or something, I don’t know: I was choosing to keep resting my eyes).

I start taking inventory. Don’t move, just feel; can I breathe through my nose? I can, and so clearly! Does my forehead hurt? My jaw; my nose? Not the least bit, but rather I feel coddled all around… likely in part due to the bandage-made helmet I’m likely wearing, much like those I’ve seen online before. What about my mouth? I know there are major incisions inside my mouth below my teeth, between my gums and cheeks. No pain, but I do notice what must be a stitch, soft and gummy, accessible as it sneaks between my first and second bicuspid. That will be fun to poke at incessantly for the next week.

I am offered a mirror, and take it, having a quick look at my face. As predicted, I look like the 1933 Invisible Man, although even now I can see a smoother brow and more upturned nose. Everything else is hidden beneath bandages, but that’s fine.

I feel so lucky: I could be beyond consoling, a heap of misery and pain… buried below not just layers of physical agony, but also the likely psychological trauma of dealing with so suddenly inhabiting a new face like Kovacs in Altered Carbon.

I am rolled down some hallways, eyes open now, towards my recovery room. I am still alone, but I know they will have texted my partner to come join me for my recovery. She should be here soon. It is dark outside… she must have been waiting quite a while: The clock on the wall suggests it’s after 5pm. I must have been in surgery for nearly ten hours. I notice my bed: it is a self-modulating bed that constantly adjusts the softness/firmness of each small section (perhaps half-a-foot-square increments) to help avoid bedsores. I am provided with calf-compression “stockings” (they are more like blood-pressure cuffs) that periodically inflate and deflate in turn over the course of 30 seconds or so. They are nice. I remember this technology from when my child was born, although I was not the one wearing them or sitting in the fancy robot bed then. I am tired, despite having slept all the previous night and again all that day (“sleep”). My partner arrives; I am glad, but I don’t say much: I am too tired and too wrapped-up. But I am happy; I am safe.

I am so glad for how this has gone; I am so lucky for feeling so comfortable.

…that was the last time I felt physically better than I did before the surgery.

It didn’t take long, and soon I found I needed to swallow. I knew that the tracheal shave may lead to some minor discomfort, but also knew that the intubation tube may lead to a great deal more discomfort than the shave itself. I begin to gulp down the modicum of saliva (or whatever) that has slowly accumulated in my mouth, and am hit with what felt like broomstick to the neck.

I have had plenty of sore throats. My share of colds, my share of post-concert voices, even having mononucleosis in such a way as to have spent an entire vacation scouring the various bodegas of a small Costa Rican town looking for throat lozenges. That pain always felt higher, experientially at the top of my throat, perhaps where my nasal passages drain down into my esophagus.

This pain was different: much deeper. I felt like I was being strangled, being throttled by some invisible hand. There was no outside pressure, no noose tightening around the skin of my neck, but it was as if the rope had osmosed through my skin and was tightening around the tissues beneath.

I couldn’t do it: I couldn’t swallow.

I later learned that I also couldn’t burp. Not even the big, comical, “I drank too much soda too fast” burps of a playground or elementary-school cafeteria, but just the little “I moved my body and a bit of gas needs to shift around” re-equilibrium burps that I hadn’t really ever noticed before. But now that they were unavailable to me, I noticed their loss profoundly.

When whichever drugs I had been on that were keeping the pain at bay began to subside, I was asked to take a prescribed opiate (very small, like the size of a Nerd candy). That was off the table. They offered to crush it into a powder to emulsify in water to help me drink it. I complied, lurching with pain at each gulp (it took two, each approximately 10-15 ml). Satisfied, they left, leaving only my partner to witness me begin retching after my body refused to allow gaseous displacement for the new liquid in my stomach. Strangely, dry-heaving — as terrible as it is, and despite my contemporaneous fears of “I hope I don’t spasm my scalp or neck or mouth wounds into separating” — was less terrible than swallowing. And apparently — according to my body, which made the choice to opt for this rather drastic solution — less terrible than burping.

I was exhausted. By the middle of the night, I hadn’t eaten in more than a day; I was in constant pain — everywhere, but especially my neck — I was tired and groggy and dizzy… I was aware, but because of my physical state, the drugs in my blood, the bandages wrapped around my face, I felt isolated within myself. The outgoing, pesty, sociable person I normally am was still there, but each thought of gratitude, each idea for a pun, each rumination I would normally excogitate with whatever unlucky bystander happened to be within earshot, couldn’t muster enough import to meet the requisite investment to overcome the many high, high barriers built up between me and the world around me.

I was alone, in a prison built of my own self: not so much a trap, but more a shroud, a mist, a gulf or a distance that had risen up. Not unlike the helmet of bandages or the bedding of blankets that had helped me feel so tightly swaddled, this wrap left me immobilized — albeit mentally — and unreachable.

Convalescence

I was well-supported by the staff at the hospital and have been very well supported by my partner and advocate. A series of morphine injections (effective for my headaches, not as effective for my throat), lots of 10-minute naps, approximately 2500ml of saline drip (this estimate based on the amount of urine I expelled during a day of drinking not more than 30ml of water), and about 36 hours of waiting allowed my body the space it needed to slowly climb out of that hole. I wasn’t healed, but I was healthy enough to be discharged to continue my recovery from the hotel room.

I have been able to take various medications by mouth now, and dutifully did so, all under the careful supervision and gently-guiding hand of my (at this point also extremely exhausted) partner. I have occasionally been struggling with my nose becoming so clogged (mostly with old blood, but probably regular stuff as well, and I am disallowed from nose-blowing for several weeks) that I have had to tediously rinse and rinse and rinse with saline spray — this has been the most challenging aspect, as losing the ability to breathe through my nose while also having my jaw (incidentally) held shut by Ace bandages makes it profoundly difficult to breathe at all. My partner has been taking me on walks (highly romantic constitutionals up and down the hallway of the hotel floor), and has been reliably replacing ice packs and bandaging every few hours, including through each night. She has also been helping me find palatable food to eat drink… as much as is possible.

But eating is hard. I suspect that the opiates have reduced my appetite, and if not, the inability to chew anything or feel my lower lips and teeth has made eating a regular amount of food inaccessible to me. I lost 11 pounds in 5 days, which for someone who is starting at around 150 lbs a rather big deal.

Each day has gotten easier, though. I’ve been eating more, sleeping better, taking fewer painkillers, and moving around more. I’ve taken a few baths, although I have only rinsed my hair once (mostly out for fear of disturbing the 200-some-odd staples holding my face on right now). Soon, I’ll be having [some of the] stitches and staples removed, and will be cleared to go out into the world a bit each day. Maybe I’ll even be able to eat food again.

Endurance

More than anything, this has felt like a test of endurance. Each day has a finish line a bit further off than the last, but each day I’ve been getting there… eventually. I know someday the struggle that I’ve been enduring this past week will be only episodic memories, where I can tell of the events as they happened but won’t quite be able to remember exactly how it felt to experience them in the moment. That will be nice.

But before I let it go, it’s important that I mention something that came to mind during that first night after surgery.

I knew that this experience was temporary; I would be able to swallow; I would be able to burp; to sleep; to breathe; to stand again, talk again, engage with the people around me; to be freed from the dark shroud of isolation that had fallen over my body. But I also knew that for some people… they would not. I imagined feeling as I did, that night, but without the promise of recovery. Perhaps because of disease. Perhaps because of age. I imagined my family, my friends, my homes, my memories, and everything I would be going back to, and how some people would know that they never would: perhaps those were all long-gone (in the case of old-age), perhaps they were just forever out of reach (in the case of disease or progressive enfeeblement). I imagined feeling how I did, but knowing that I would never feel any better: that my worst day was my best remaining day.

I had philosophically understood how some people seek euthanasia or an assisted suicide. I believed there was a certain sense to it, but it was hard for me to really understand how that would be something someone could want. But, living through that night, in those moments, fallen away from the world around me, I understood. If I had no hope, I could see it. And I could see myself peacefully embracing it.

Someday, perhaps, I’ll be there. Hopefully, many years from now when I am very old and the world has changed around me; when I am relegated to staring out windows, yelling at clouds, and only being able to engage with my long-gone world through my own stories, spoken aloud or left to gather dust in my mind. I am not anywhere near that time now; so distant, in fact, that I couldn’t even fathom what that would be like. But I can see it, feel it — have lived through it — now in a way that I hadn’t before.

I am glad to have had a world standing beside me, populated by nurses, a partner, a delightful set of self-inflating calf-compressor stockings, and half-a-dozen text message group-chats populated by friends, family members, and co-workers who at once sought to comfort and torment me, each offering what support they could (while probably also looking the reliefer of news of a good outcomes, themselves). My world has been waiting for me, and I am looking forward to coming back to it soon.