Care of, p.12
Care Of, page 12
What followed was the most uncomfortable and humiliating medical procedure I’ve ever been subjected to. She literally would not touch me. She passed me the lubricated wand and instructed me to put it in myself. She asked me after it was done to sign a consent form, and she admitted I was supposed to have signed before the exam began. She was visibly uncomfortable, curt, and impatient. When it was over she was about to leave. I asked her for a tissue or something to clean myself up, and she took a box of Kleenex off of the counter, tossed it on the exam table at my feet and bolted out of the door. I barely made it back to my truck before the tears came. I sobbed in the parking lot for ten minutes and then called the clinic and asked to speak to the manager. It took days, a three-page email, phone calls and more phone calls, and I finally got a half-assed apology from the someone in charge, and a promise that the technician would be reprimanded. “I don’t want her reprimanded,” I said, “I want your staff to be educated.”
“Do you have any information you can send me?” the manager asked. “Like a one-page sheet, something I can photocopy and just hand out at a staff meeting? We don’t really have any kind of budget for this kind of thing.”
“Sometimes I just want to go get an intravaginal ultrasound,” I tell her. “Sometimes I don’t want to turn me taking care of my own health care into your free learning opportunity,” I tell her.
She pauses, then asks me to email her the information, which I do, and I never hear back from her again.
I told my doctor about the experience, and she promised me she would also call and complain, and she referred me to a gynecologist, who she assured me was trans friendly.
But first I had to get in to see him. I walked into the office. The woman behind the desk smiled at me and asked me if I was lost. No, I said, I have an appointment with the gynecologist at 8:30. She did a double take, looked uncomfortable, and told me someone would call me in a minute. I waited about 45 minutes. I had to pee, and when I went into the washroom, I got screeched at by an old woman for being in the wrong bathroom.
Finally, a young man called me into the gynecologist’s office. He’s not the doctor, he explained, he’s just going to ask me a few questions. Any chronic health conditions? he asked. Have I ever had a major operation? Yes, I said, I had a double radical mastectomy in 2013. Cancer? He asked. No. I said. I’m trans. He dropped his pen, squirmed in his chair, and really looked at me for the first time. That’s okay. He said. I know. I tell him. He looked at the floor, looked at his pen, looked at his papers again. Have you ever had a major operation? he repeated. He was nervous now, and had lost his place in his form.
Something in me snapped. I could almost hear it. I could definitely feel it. It smelled like frustration and it tasted like blood. I realized I’d literally been biting my own tongue.
I’m stopping you here for a minute, I told him. Are you gathering information for the doctor or is this a learning experience for you?
A bit of both, he admitted.
Okay. I said. Here is your learning opportunity for today. I’m done with this. Your homework is to go and educate yourself about the realities of trans people before you conduct yourself like this with another patient. You can take your forms and leave now. I will wait here for the doctor.
Maybe I was too hard on him, I thought, as I waited another 15 minutes for the actual doctor to show up. But it wasn’t just him. It was the ultrasound woman, and the front desk woman. And the old woman in the ladies’ room. It was the dude in the men’s room in Dallas too.
The gynecologist apologized, sort of, for the medical student’s conduct. I told him about the woman at the front desk, and the lady in the bathroom too. We have a men’s room on this floor, he said. It’s just way down the hall and a little hard to find.
But I’m not a man, I told him. And you are supposed to be the trans friendly guy.
I certainly have no problem treating trans people, he said, and I have seen a few of…I’ve seen a couple of trans patients over the years, but predominantly I do pelvic floor reconstructions. My specialty is treating incontinence. He referred me to another colleague of his, and I started all over, waiting another two months, and two long periods to get in to see her.
Great, I thought on my way back to my truck. The woman I scared in the ladies’ room was probably incontinent. Good thing she was on her way out when I scared her and she screamed at me, and not on her way in.
Months later, I am finally scheduled for an endometrial ablation. The last thing I hear, just before the general anesthetic kicks in, is one of the staff repeatedly calling me she. The first thing I hear when I wake up is a nurse, also calling me she.
I use the singular they pronoun. I mumble groggily.
What? she says.
I’m trans.
We will worry about that later. She says. Right now, we have more important things to worry about. How much pain are you in? Scale of one to ten.
Depends if you mean physical or emotional, I think, but bite my tongue again, metaphorically.
About a five, I tell the nurse.
Well, we can help you with that, she says.
It all turned out to be worth it in the end, though. I had the endometrial ablation and it changed my life, it really did.
I know that by now you have probably heard many stories like these, from multiple trans and non-binary people, and that you most likely have several of your own you are right now packing around with you, but these are just a few of mine.
All this to say how glad I am that you became a nurse. I am tearing up as I write these words, thinking of just how different any of this might have been for me had you been in that ultrasound clinic, that doctor’s office, that operating room. What if I had woken up after top surgery, or the ablation, with you standing over me, seeing me for who I really was? Knowing the words I use to describe myself, and using them?
A little thing, some would say. I would not.
The scars on my chest have faded almost totally away, I think my last period arrived late last July, and my old family doctor retired three years ago, but my heart still pounds every time I step into a medical facility of any sort. I often imagine what it must be like for trans people who are not white, or who don’t speak English as a first language, or who are not of the masculine variety—how many “tiny little” times are they disrespected, deadnamed, misgendered, disregarded, or refused, while trying to access health care? How many don’t even go because they already know?
How many microaggressions are there in a macroaggression? I’ve always wondered. How do they include us in the death count if the numbers think we don’t exist?
Doesn’t it all just make your cortisol thrum through your veins just thinking about it? You said in that first email that the measured cortisol levels of trans people were higher than those of soldiers in combat. Maybe you never tracked down the evidence but still, I believe it, because most days it’s hard not to feel like we are thrust into a constant battle, just by being. By insisting to exist.
I’m so glad that you exist. I remain ever grateful to know that you are working as a nurse. I think of the million tiny kindnesses I know that you bestow on all of your patients.
Tonight I will light this candle on my desk to keep you safe. It smells like cedar and juniper. It smells like wood. Every time I touch a flame to the wick, it makes me want to build things with my own hands.
Please keep in touch. I love an email, but I’m also old enough to appreciate a good old phone call, too.
With much respect,
Ivan
SEPTEMBER 20, 2020
Hi, Ivan—
I was very pleasantly surprised to get your email—and I enjoyed it a great deal. I know you’re a writer, of course, but many authors don’t write with the human voice and breath in mind, I feel—where your writing clearly does. Lovely.
I actually have ended up working in a hospital oncology unit. Much cancer treatment these days happens on an out-patient basis, but on our acute-care hospital unit, we have some of the sickest of cancer patients, as well as people getting days-long chemo treatments, and a wide variety of other things. At any one time, one or two may be actively dying, or heading that direction in fairly short order, while others are successfully treated, and move on to the rest of their lives. I wanted to get into nursing for a variety of reasons, but one of them was precisely for this close contact with the deepest mysteries of life: to touch the dying and the dead; to stand face-on to human suffering and admit it into my daily reckonings; to contemplate the human spirit in its extraordinary beauty and appalling self-delusion; and so on. The job has not disappointed in this regard, but I wish I could be clearer to myself what I have really learned from all this. Some friends now seem to view me as the holder of some kind of secret, but I still don’t have a clue what it is.
We do wear VGH-style blue scrubs—our Smurf suits, we call them—have done since the start of the coronavirus, so that we aren’t wearing our own scrubs to and from work, or laundering them at home. But no blue car: I got rid of my tiny carpentry truck a year ago—one of those little Japanese Tonka toys with the steering wheel on the wrong side—and bought an electric bicycle. I wanted an electric vehicle for environmental reasons, and this was the only one I could afford—and outside of my Tonka-truck years, I’ve always commuted by bike ever since moving from Saskatchewan almost 35 years ago. My obligatory trans man’s beard, unfortunately, is gone—another casualty of coronavirus. N-95s don’t work with facial hair, so I shaved it off months ago, and still feel daily regret about it.
As for nursing as a trans person: I was very moved by your stories about living in the liminal world of trans-ness and non-binary-ness. It’s true, I have plenty of stories of my own, including in medical situations. I had to have a mammogram once, and had an experience in the waiting room very like yours about getting the ultrasound, for instance. And of course the bathroom stories—an entire genre of trans-specific stories living (and lived) in plain sight, but utterly invisible to the rest of the literary world. But your particular stories still got to me. And I was very flattered by your appreciation of my work as a nurse: very kind of you to say. Though I am really not sure it’s deserved.
Because the thing that I’m really torn up about, is that I’m not out as trans at work. I interrogate myself about this every day: I was once a deliberately visible and unapologetic lesbian, and from those days I still believe completely in the political necessity of being out, and visible, and vocal. But somehow I find being out as trans much harder than being out as a lesbian. Part of it is the actual “mechanics” of coming out: it’s very easy to talk about “my partner, she…” and simply be done with it in just that many words. But I haven’t figured out how to come out as trans in such casual terms. “Back when I was a girl …” or something similar, doesn’t fit into a sentence that can then just roll on to the rest of the intended story. I don’t want to stop a conversation in this way; I don’t wish to be the focus of the kind of dramatic attention it would draw, either in the moment, or in the ongoing culture of my workplace; I am especially terrified at having my body scrutinized and its detailed gender features parsed out by a bunch of nurses whose eyes are way too attuned to people’s physical signs and signals. Coming out as trans feel very much more intimate than being out as a lesbian: it’s way too close in.
It seems that I am passing completely at work, and it’s convenient to disappear in this way. Sometimes it’s even fun to join in the unthinkingly bi-gendered teasing that straight people take for granted: it means I have a place here, and that maybe some of these folks even like me. But it comes at the price of a bizarre ongoing mummery of heterosexual masculinity—not so much in my manner (my dad was a fairly effeminate guy, and I have decided that I’m fine with that as a model for a legitimate version of masculinity), but in the stories the other nurses assume of me. At various points, for instance, I’ve been directly informed that I must either be a “breast guy” or a “butt guy” (no comment), that if I were kicked in the balls I’d be prostrate with pain, or that I can’t find the box of medium chemo gloves in the storeroom because guys can never find things. All said with humour and usually some implied affection. Though there’s also the truly offensive stereotype that as a “male” nurse, I am lazy because male nurses always are, even after 5 years of a perfectly solid work ethic on my part.
It is a very odd thing to be the object of this strange double sexism: sexism against my ostensible maleness and all that I therefore automatically embody; let alone my co-workers’ complete inability to imagine that perhaps I am not such a “male” at all, and may be something quite else. Even the “female” I once was feels the sting, since all of my female-bodied experience is so utterly erased—periods, breasts, pregnancy and childbirth, living as an ostensible woman in a misogynist world, being the younger sister of two older brothers back in a pre-Second Wave Saskatchewan.
But daily, there is the usual tallying of damage should I come out: some of my workmates would be fine with it, even very positive about it—but my experience since transitioning is that it can also be very surprising who turns out to have a problem with it. Nursing is one of those kinds of work where you have to rely on your co-workers in profound ways; we are extremely close, even while only being colleagues. As a carpenter in a female body, there was the odd guy who was really antagonistic, and I always knew exactly where they were when I leaned over the huge panel saw or stuck my hand into the planer to clear out the woodchips. The dangers as an out trans nurse wouldn’t usually be so obvious and physical, but there is still genuine risk, and I am not anxious to go back to living at that level of vigilance. And there’s the risk, too, of my being outed by a colleague to the wrong patient—which really could go badly.
Yet I feel quite strongly that I would be a better advocate for my trans/NB patients—of whom I’ve had a very few—if I were out in my workplace. Your email was a serious reminder of that. I have come out to a couple of my trans/NB patients, but the point of nursing is that my own identity and stories run a distant second place to the needs and meanings of the patients themselves, and I want very much not to insist on their attention to my history unless I think it’s of some use to them. I don’t know how to say what’s important, while leaving all the space to them, to speak their own lives, and fear, and present suffering.
And silence, as a trans person, is an extremely powerful habit to give up very easily. It may begin as an enforced effect of hounding erasure, but for me, it also became an incredibly rich place to live. So badly unspoken when I was young, I am still fiercely driven to be heard, even to my own detriment, but much of my life still resides in this other place. I still experience trans-ness as almost entirely silent. I mean, I can tell stories of how difficult it is to move as trans through a ludicrously cis world, but while those stories communicate some part of what it is to be trans, I find it very much harder to communicate the positive meanings.
I know that I am not just characterized by a history of suffering and misunderstanding; nor am I only a tightly-strung, highly electric nerve, sensitive to the least drift of molecules on the air, let alone to the ferocious terrors of prejudice and violence. I am also, as trans, something vital and meaningful and earthy: I must be. But I find this much harder to bring to awareness, let alone to speak. On the days when I’m not nursing, I work outdoors, gardening and building things—long hours as alone as possible, protected by earphones and the podcasts I listen to. I am lucky to live in a housing co-op, in Kitsilano, which consists of three old houses side by side, where the backyards are run together and so allow for big gardens, a few chickens, and a space for my tools and a chance to build things. It’s a way to recover from the stresses of work, but it’s also a kind of project to be trans in the light and air, amongst the small birds and the green leaves of the world, and to breathe myself into being through sawdust and capable hands and considered movement. If only there were a way to be trans in this way, too, in the larger, noisy world beyond my backyard.
So your email has occasioned another round of questioning about how to best be a nurse, and what it means—or should mean—as a trans person with sometimes trans patients. I am grateful to be reminded that I could be useful in this way.
I am also envious to hear of you building a cabin up north. I did construction work for a laneway housing company for a while, and still dream of building my own small house. If it weren’t for coronavirus, I’d gladly invite you to come over and work together on something—there’s endless work to do for the co-op, though most of it is less interesting than building a house—just for the sake of getting your hands on some tools and staying in practise before heading north again. It sounds as if you’ve already gotten a fair bit of experience, building concrete molds and so on, but hopefully the carpentry course will set you up for the next stages of your house.
Okay, so I think the two spaces after a period just looks better, no? I can never remember what’s correct any more (about just about anything), but I care deeply about what looks good!
All the best,
Darach
15.
VOLCANO
MARCH 31, 2020
Hi Ivan,
I just wanted to write and say thank you for sharing your stories out with the world.
There’s a certain beauty in reading the words of “Shame: A Love Letter” at the end of Rebent Sinner, as this morning I woke up at 1 a.m. with anxiety in my chest and figured that was as good a time as any to start your book (and finish it apparently too)!
