Sunday, March 31, 2013

Back in the Saddle

I am back in the saddle in Bucharest.  Thailand is a still fresh but increasingly distant memory.  Dilation, ever easier but still maddeningly time consuming, has become as much a part of my life as breathing and eating.  I have been back to work for five weeks, to my own surprise not missing a day since getting over my post-Thailand fever.

There is much to do.  There were letters and reports to write in the wake of the anti-LGBT protest at the Peasant Museum.  Then came the season of annual employee evaluation reports (EERs), so dear to the hearts of Foreign Service Officers (FSOs).  (Unlike performance appraisals in private industry, EERs are the only documents used by a blind panel in Washington to make promotion decisions each summer, and, hence, they achieve a cosmic importance in the life of an FSO.)  Pride Month is just over two months away, and planning has begun in earnest.  In both work and personal life, I am back in the saddle.

I am also back in the saddle in a literal sense.  Dr. Kunaporn stipulated three months as the time frame before I should be riding a bicycle again.  I took that time frame seriously, sort of.  Although Dr. Sanguan is the expert on gender confirmation surgery (GCS) and recovery from said surgery, I posit that I know a bit more about riding a bicycle than he does.  Throughout my life, I have had to field warnings and expressions of dire concern from friends and colleagues who cannot fathom the reality of my life in which the bicycle is my main form of transportation.  Thus I took Dr. Kunaporn's instruction as a guideline only, as sincerely expressed as the warnings of friends who do not understand that I have ridden my bicycle in traffic for as many years as they have driven their cars.  I would make my own decision on when to return to the bicycle, listening and looking to my own body for instruction.

I first tried to ride my Rivendell Atlantis a month ago, shortly after returning from Thailand.  This was an indoor ride on rollers, and I lasted for only 30 seconds, if that.  The message from my new anatomy was very clear.  "Don't even think of it," my soft parts yelled.

I tried again indoors three weeks ago.  Based on the experience of my earlier attempt, I covered my Brooks leather B-17S Ladies Standard saddle with two layers of foam rubber and a layer of bubble wrap.  I road indoors on the rollers for some twenty minutes, only to regret my determination afterward.  My soft parts had tolerated the ride but had become inflamed and swollen from the pressure of being pressed against the saddle.  A second attempt the next day after lowering and adjusting the angle of the saddle did not give a much better result.  I abandoned further attempts and turned instead to research.

In the days following, I learned that I was not the only woman to experience bicycle discomfort.  As much as I love my bicycle, the industry has catered primarily to men, not thinking much if at all about female proportions and differences in anatomy.  Before long, I came to Terry Bicycles, The Original Women's Bicycling Company (  I ordered a Butterfly Cromoly Gel saddle and waited anxiously for it to arrive.  Unlike my Brooks, the Terry saddle has a long open slit in the center of the saddle designed to relieve pressure on a woman's soft parts, in particular her labia, urethra, and clitoris.

The Terry saddle arrived in less than a week.  I mounted it and tried a twenty minute ride that Friday evening. I then rested and mounted the bike for another twenty minutes.  Even after careful inspection the next morning with a mirror, I saw no reddening, no swelling, nothing indicating that I should stop riding.

Bicycle Protest, April 23
With Alexandra at the Bicycle Protest
It was then Saturday morning, time to try my first ride on the road since before Thailand.  I had no big plans, just a short ride to find out if I could ride at all.  Then my friend Alexandra called.  "Robyn, there's a bicycle protest today.  Can you come?"  A couple of hours later, I found myself among more bicyclists than I had known existed in Bucharest.  There were at least a thousand, perhaps two, who had gathered for a sanctioned protest of Bucharest city government plans to expand the system of bicycle lanes on sidewalks.  These were clearly my type of people, bicyclists who know that their place is on the road with traffic.  We road together slowly for more than an hour, stopping in front of the city government to blow our whistles, sound our horns, and yell as loudly as we could.  This slow group ride was the best possible test of my new Terry saddle, as it forced me to stay forward and in the drops so as to keep my hands near the break levers.  If there was any ride that would cause my soft parts to scream, this was it.  They stayed silent the entire time, and a close inspection by mirror that evening showed they had slept through the entire experience.

Riding the Rollers
No, I was not ready to hop on the bicycle and resume daily commuting that Monday.  My legs, heart, and lungs had paid a price for my being largely sedentary for three months.  Instead, I road the rollers each evening, coaxing myself back slowly.

The Bucharest weather cooperated in keeping me indoors.  A surprise spring storm dropped six inches of snow on the city on Tuesday.  While others grimaced at the sudden return to winter conditions, I smiled to see the snow.  The Embassy opened two hours late.  I stayed indoors with my coffee, admiring and loving the view of the continuing snowfall.  I had missed most of winter by going to Thailand, but winter had saved itself to give me one last display.  I could not resist the urge to go outside and play in it, even attempting a snow man that ended up more like a snow pomegranate.  It was wonderfully beautiful, and a tear fell, the first of many in the months to come, as I thought that this will be the last snow that I see in Romania.

My Snow Pomegranate
The snow melted, I headed out on the road this Easter Sunday, riding in the direction of the Embassy and back.  The time has come.  Tomorrow I will resume my normal life, riding by bicycle to and from work as I have most of my life.

I am back in the saddle in Bucharest on this last day of March, making every minute of every day count, holding on but preparing for the changes that I know this spring will bring.

Sunday, March 17, 2013

Home Sweet Home in Romania -- or -- The Exclamation Point (Conclusion)

Time lost meaning for us in Thailand.  In the fog of surgery, anesthesia, morphine drips, and surgery again, OD and I quickly forgot about days of the week and even how long it had been since we left Romania.  When our release day came on February 7, it took us by surprise.  Only once back at the Aspasia Resort did time again begin to take on meaning.  There was the necessity of dilating three times per day along with the need and desire to be up in time to walk, donut cushions in hand, to the Aspasia's outdoor restaurant for the morning breakfast.  Still, when the time came to depart Thailand on February 19, we were almost as surprised as we had been on the day of our hospital release.  It was time to go home, to begin the process of returning to work and normal life.

Final Dinner in Phuket
Phuket to Bangkok and then Bangkok to Amsterdam.  Business class may have been a luxury on the way to Thailand, but it was our salvation on the return, the thought of an economy seat almost as painful as the thought of sitting on a bench without our donut cushions.  Our route took us directly over Samarkand, bringing with it good memories of my last visit there with my son in the winter of 2009-10.

Amsterdam to Bucharest, OD and I were beginning to go through the emotions of parting.  How could it be that we were about to go our separate ways after supporting each other through one of the most significant life events any human can experience?  Through customs at Otopeni Airport just after midnight, a group of our friends stood waiting with hugs and flowers.  From there it was off to the airport hotel for OD, who had one short flight remaining the next day to take her home to Moldova.  For me it was a twenty minute ride to my home in downtown Bucharest, where friends.had made my bed with clean sheets and seen to it that I had enough cooked food for my first days back.

I was not up until after noon on the 20th as the reality of the calendar returned.  February is LGBT History Month in Romania, and the LGBT rights organization ACCEPT had scheduled a film showing that evening in the auditorium of the Peasant Museum, just a ten minute walk from my home.  I decided to go, as I knew I would find many friends there.  Since the film was to be shown with U.S. Embassy sponsorship, I knew I would find Embassy friends there as well.  

What I didn't know was that a group of anti-LGBT activists planned to disrupt the event.  Just before the film was to begin, some 50-60 protesters filed into the auditorium, outnumbering the film-goers.  Within minutes of the film's start, they had blocked the projector's light path and had unfurled Romanian flags and banners as they began singing the national anthem and other patriotic songs interspersed with homophobic epithets.  They shouted "Shame!" and "You are not Romanians!"  The police were called but declined to intervene in the auditorium.  The film-goers eventually abandoned the hall, leaving it in the hands of the protesters.  Fortunately, the protest was limited to words, not blows, and we all left without harm.  

Video of the Peasant Museum Protest

The fog of Thailand dispersed entirely as the reality of life in Romania returned.  As welcoming as this country has been to me, there is a dark side in the form of people and groups who oppose LGBT rights and are willing to be vocal about it.  Late last year, a young LGBT activist was hospitalized after he and other volunteers were attacked by hooded men following an LGBT event at a local university.

If there is a silver lining to the night at the Peasant Museum, it is that the protesters may have won the battle but appear to have lost the war.  Most press accounts came out against the protesters.  I'm proud to say that the U.S. Embassy responded strongly with a public statement and an op-ed in support of LGBT rights and decrying the Peasant Museum protest.

My Welcome Home Evening with Friends
The next morning I woke to the uneasy feeling that I may have caught cold.  By Friday I knew I had a fever.  Embassy friends had organized a welcome home party for me that evening, and I almost didn't go, warning the hostesses that I might infect everyone.  Feverish, I went by taxi and stayed one hour, bathed in the love of friends who had come that night with flowers and hugs.  By the time I got home, my fever was 103F (39.4C).  I collapsed on the couch.  Only several hours later did I have enough strength to undress and drag myself to bed.  I was in far worse misery than I had been at any time in Thailand, apparently the victim of something that had found its way to me on the flights home from Phuket.

My Bucharest friends rallied to me on Saturday and nursed me back over the next several days.  All hope of returning to work on Monday was gone, but surprise of surprises, the fever finally broke without any follow-on cold or flu symptoms.  I returned to work for the first time on Wednesday, February 27.

My recovery from my various surgeries continues rapidly forward.  I'm constantly tired from the necessity of being up before 5am to do my morning dilation.  I have no lunch hour as I now use that hour for dilation in a room set aside for me at the Embassy.  By the time I've done my evening dilation and had dinner, it's nearing 10pm.  The good news of dilation is that I have already said goodbye to Lyolik, Johnny Angel, and Dimchik (Nos. 1-3).  I begin now with Good Neighbor Sam (No. 4) and move up from there.  (See Vodka Without Beer.)

Exercise is a problem.  It will be some time before I can return to bicycle commuting, and I now depend on friends for rides to and from work.  Since there is no workout room where I live, my only exercise is stair walking.  When I get home in the evening, I put on my exercise outfit and climb the stairs of my five-storey building fifteen times.  I've tried riding my bicycle indoors on rollers just to see if I can, but even with additional padding over my leather saddle, my soft parts let me know they are not yet ready.  I have hopes for a split saddle that I've ordered from Terry Bicycles that will leave my clitoris and urethra free from saddle pressure.

Weight is also a problem.  With little exercise since mid-January, I've gone from 62 to 65kg.  I've made some dietary adjustments that I hope to maintain even after returning to my daily bicycle regimen, but at this point my hope is only to stop the weight gain, not reverse it.  I miss my bicycle and the independence and weight control that it gives me.

Other than for weight gain and obligatory dilation, life is returning to normal with its cycle of work and friends.  I look in the mirror both marveling and in wonder.  "Could I ever have looked different from the way I do today?"  I know the answer is yes, but the emotional answer is no.

Home sweet home.  I am home in Romania, in the circle of friends who have seen me through the greatest transformation of my life.  The exclamation point now stands proudly at the end of a long sentence that has been my life so far.  To all who helped me put it there, you have my deepest thanks and more.  May the luck of the Irish be with you on this St. Patrick's Day and every day of your lives.

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Follow these links for more of The Exclamation Point:
Previous entry -- My Own General Contractor

Sunday, March 10, 2013

My Own General Contractor -- or -- The Exclamation Point (Part 15)

Extreme discomfort.  Not really pain, but I am not well.  I can't see.  My eyes are swollen shut, and I sense that my face is heavily bandaged.  My back aches.  Some device seems to be compressing my legs at regular intervals, perhaps to keep the blood circulating?  My throat is as dry as sand, but I moan a rasping question, "What time is it?"  Someone answers that it's 11pm.  I remember being wheeled to the operating room at noon.  The same voice tells me that I will be kept in the intensive care unit (ICU) for the night.  I moan for water and am given a small drink through a straw.  I then moaned one phrase over and over again:  "OD.  Tell OD I'm here."  No one replied.  Perhaps the ICU staff thought I was delirious? 

This is my report card for the Phuket International Aesthetic Center (PIAC), the Phuket International Hospital (PIH), their surgeons, and their staff.  The title of this post gives the hint of what the grade will be.  At PIAC, you are your own general contractor.  During my long night in the ICU after 9-10 hours of surgery made up of 2nd stage gender confirmation surgery (GCS) followed by 1st phase facial feminization surgery (FFS), I had ample time to ponder whether I was qualified to be the general contractor behind my own surgical fate.

What do I mean when I say that at PIAC you are your own general contractor?  Quite simply, you, the patient, are the one in charge of your treatment.  You are in the driver's seat, the one who makes the decisions of what surgical procedures to undergo, the one who decides how much discomfort can be endured.   It is a very American trait to want to be in control of the buying process in any major purchase, but in the case of major surgery, should I be the one in charge, the general contractor who makes the major decisions?  I'm not sure.

I think back to a year ago when I first corresponded with PIAC.  One aspect of the correspondence that immediately appealed to me was that Dr. Sanguan Kunaporn, the surgeon for gender confirmation surgery (GCS), corresponded with me directly before turning me over to his administrative office.  I noted early on that I was considering some degree of facial feminization surgery (FFS) in parallel with GCS, to which Dr. Kunaporn replied, "Yes, if the FFS is not really very extensive and you have approx. 1 month time in Phuket, I have no objection."  He then put me in touch with the Dr. Rushapol Sdawat, the craniofacial surgeon who performs FFS at PIAC.  In the following weeks based on photos that I provided, we decided on several facial procedures that would be beneficial.  After that, it was a matter of waiting.

A driver and one of PIAC's international coordinators met us at the airport in Phuket on January 20 and took us to our hotel, the Aspasia Resort in Kata Beach.  Two days later we reported to PIH.  OD was admitted that day, and I was admitted the next.  The admission procedures were straightforward and efficient.  After admission, we were taken to the PIAC office, where one of the English-language coordinators welcomed us before sending us on our way with a technician who took us first for an X-ray and then to our room.  Up to that point, our PIAC experience rated an A grade.

Our first qualms started when we were in our room.  The nurses and assistants, every one of whom we came to love, spoke only the most limited English.  Even ordering OD's first meal was not easy.  With time we came to joke over thrice daily ordeal of ordering meals.  "Hot green tea" and "guava juice," both of them listed in the menu, caused consternation, as though they were ordering exotic beverages from Mars.  With time we would point at OD and say over and over again "hot green tea."  Then we would point at me and say "guava juice with ice."  These became mantras.  By the time we left the hospital, we had concluded that OD should begin teaching the staff English, as her very limited English was generally better than that of much of the nursing and support staff.

If we had trouble ordering meals, just try to imagine the difficulty we had with medical issues.  I will never forget the night when I had a splitting headache that would not let me sleep.  I pressed the call button more than once, and the assistant on duty came immediately each time but seemed unable to understand that I wanted something for a headache.  In exasperation, I finally got up and walked to the nursing station.  There was an empty chair.  I sat in it, put my head on the desk, pointed at my head, and repeated again and again, "Headache."  Finally one of the senior nurses heard and understood.  I got my Tylenol.  

Thus my overall grade for the nursing and support staff is B-.  That's made up of a C- for English ability and an A for caring once they could be made to understand.

Dr. Sanguan Kunaporn
What about the surgeons?  Both Drs. Sanguan and Rushapol get an A- or A in my book for technical expertise.  In transgender circles, Dr. Sanguan is the better known of the two.  He is professional and caring, no doubt about it, but he is also busy.  We first met him in person on the night of OD's admission, and we did not see him again until the next night, the eve of OD's first-stage GCS.  Our direct contact with him was at all times limited to what was necessary:  the operating room, brief post-op checkups, dilation instruction, and suture removal.  That said, he was always ready to answer our questions.  We just had to remember to have them ready to ask during those brief windows of direct contact.  He gets an A for bedside manner and a B for availability.

With Dr. Rushapol Sdawat, Two Weeks after FFS
I knew less about Dr. Rushapol before going to Phuket, but by the time we left, I felt I knew him better than Dr. Sanguan.  First there were the pre-surgery photo sessions and discussions of what procedures to do, what procedures to leave out.  I've already noted in my previous post that Dr. Rushapol fed me personally, spoonful by spoonful, in the ICU on the morning after the first phase of my facial surgery.  I saw more of him in the days and weeks following surgery than I did Dr. Sanguan.  I will never forget his caring, gentle, and soothing voice.  He gets and A for technique, an A+ for bedside manner, and an A- for availability.

Although I did not know it before we arrived in Phuket, I was indeed my own general contractor at PIAC.  I had naively expected that Drs. Sanguan and Rushapol had discussed between themselves the extent of my surgeries and what was reasonable.  In retrospect, I imagine that if such a conversation took place, it was of short duration.  There was no one at PIAC to serve the function of patient advocate.  I say that even though I came to love the young women who work there as international coordinators.  It's not the same thing.  There is no one to sit with the patient and review the overall treatment plan, expected results, and recovery timeline.

I had ample time while bandaged and with limited sight to recall  that what I was encountering in Thailand was not necessarily that different from what I would have encountered in the US.  I thought back to an earlier time in my life when my sister-in-law landed in the ICU at a hospital in Maryland.  She was there for months.  It did not take many weeks for us to realize that there was no one "in charge."  Many different specialists came and went, but no one seemed to have the high ground with the overall view of my sister-in-law's treatment.  My ex-spouse rose to the challenge.  She became the greatest and best patient advocate I have ever known, cracking the whip over nurses and doctors alike.  She became an expert on the hospital structure and organization and learned how to work through it to get the best possible treatment for her sister.  She became the general contractor who organized the work of doctors and staff.  THAT is what is missing at PIAC.

As we came to grips with this fact, OD and I did the best we could to be advocates for each other.  I would not recommend that anyone go by themselves for GCS or FFS anywhere in the world.  OD and I had each other, commiserating in discomfort, keeping up each other's spirits, and laughing when we could.

Should I as general contractor have ordered such extensive surgery in such a short period of time?  In retrospect, I would say the answer is NO.  Three major surgeries, twenty-four hours of general anesthesia, and days of morphine are a heavy load for the human body to bear.  If I had known six months ago what I know today, the rational side of my brain might well have decided that GCS and FFS should be done separately with perhaps a year in-between.

When we were released from PIH, OD and I returned to the Aspasia Resort.  My face was black and blue, still with bandages in many places.  I attracted stares from everyone and quickly came just to nod my head yes when people would ask if I had been in a motorcycle accident.  I had lost all feeling and motion in my left foot during the long 2nd stage GCS and 1st phase FFS surgery, a classic case of drop foot likely caused by a pinched nerve from being in a gynecological position for so long.  

Working Out at the Aspasia
Despite this, within days I was doing light workouts on the elliptical machine in the resort's workout room.  In the evenings I would walk down to Kata Beach and walk from one end to the other and back.  As general contractor, I had decided that my recovery should be as active as my condition and energy level would allow.  I might have been capable of only a third of the physical activity I had been used to prior to surgery, but a third is not zero.  With each day I could feel myself get stronger.  The memories of my night in the ICU began to fade.

One Day Before Returning to Bucharest
Now back in Bucharest some six weeks after my 1st stage GCS, I am well on the path to full recovery.  All the scars and bruises on my face have disappeared, and the swellings are diminishing.  Dilation goes well three times per day, and I can now sit in most any chair without using a donut cushion.  In fact, I briefly road my bicycle on rollers today for the first time since before surgery.  Perhaps in another 1-2 months I will be able to ride it for longer intervals and return to the road?

So from the perspective of today, I am glad that I said YES to all the surgeries six months ago.  Even if this general contractor should have paused before ordering so much surgery, today she is glad she did it all.  It is over and done, and I can move on with my life.

It is premature for me to give a final grade to PIAC and my GCS/FFS experience, but as of today, I would say the overall grade is a healthy B+.  (Kata Beach gets an A+ as a wonderful location for initial recovery.)  To anyone else thinking of PIAC for GCS and FFS, I would just say do your research and evaluate your own physical condition and what you can endure in a short period.  If you are comfortable being your own general contractor, PIAC could be the right choice for you.

Final Sunset from Kata Beach

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Follow these links for more of The Exclamation Point:
Previous entry -- My Million Baht Body
Following entry -- Home Sweet Home in Romania