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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Previous entry -- My Million Baht Body
Following entry -- Home Sweet Home in Romania

My Million Baht Body -- or -- The Exclamation Point (Part 14)

So what did I have done in Phuket, and how much did it cost?

Until now I have written only in general terms, so let me  get specific for anyone who may be considering surgery through the Phuket International Aesthetic Center (PIAC) at the Phuket International Hospital (PIH).  (Note:  Dr. Sanguan Kunaporn has his own site in addition to the PIAC site at phuket-plasticsurgery.com.)

Gender confirmation surgery (GCS) with Dr. Sanguan Kunaporn cost $11,000 USD.  I prepaid this fee directly to Dr. Sanguan's account both for OD and for myself.  There is an additional $2000 charge if an extra skin graft is required.  As it turned out, one of us did require the extra graft -- I won't disclose whether it was was me or OD -- this graft being taken from the top of the leg.  We paid the extra cost by credit card on the spot.

Breast augmentation (BA) with Dr. Sanguan was $4000 USD done in conjunction with GCS.  Both OD and I had been uncertain about BA before going to Phuket and made the decision only after we were in the hospital.  We paid for this also by credit card.  Of all the surgeries we underwent, it is BA that provides the nearest thing to instant gratification.  Prior to BA, I was not quite a 36B/38B.  After 250ml implants, I am a full C cup.

Then we come to facial feminization surgery (FFS).  OD, lucky girl, had no need for FFS of any kind, but yours truly knew she could benefit from some degree of FFS.  The question from the beginning was, how much?  The FFS surgeon at PIAC is Dr. Rushapol Sdawat, to whom I sent a series of photos some six months before surgery and from whom I received a number of recommendations.  After meeting me in person in Phuket and after looking at photos of my sisters, Dr. Rushapol modified his recommendations, in particular dropping his earlier recommendation for a chin implant.  The guiding principle was that I needed to come through FFS with it still being evident that my sisters and I are from the same family of Scotch-Irish heritage.  This is the final list of procedures that we agreed upon along with prices in Thai Baht --

• Forehead lift -- 215,000
• Lower face and neck lift -- 200,000
• Lower blepharoplasty -- 28,000
• Reduction rhinoplasty -- 150,000

Thus the total fee to Dr. Rushapol was 593,000 Thai Baht,  approximately $19,900 USD.  I was not the first person to learn on this journey that FFS is generally more expensive than GCS.  I had transferred more than this in advance to the PIAC account used by Dr. Rushapol, and PIAC was very professional about refunding the overpayment.  (Note that payments to Drs. Sanguan and Rushapol go to separate accounts.)

FFS was the greatest gamble in all the surgeries I underwent in that one does not truly see the results until two, three, or more months after surgery.  As I write, my face is still swollen, a work in progress to be evaluated come summer.  All I can say at present is that I see good movement in the right direction since the days immediately after my surgeries.  

I can also say that I felt myself in good hands with Dr. Rushapol, who was both professional and gentle at all times.  I will never forget how he stood by my bed in the intensive care unit and personally fed me my first post-surgery meal the way a mother would feed a child, mouthful by mouthful.  Bandaged and without sight, I could not feed myself.  Although Dr. Rushapol could have called for a nurse, he took the time to do this himself, speaking soothing words about the results of the surgery that he could see but that I could not.

I will write separately about the care and service at PIAC.  In fact, I will have quite a bit to say, most of it positive but with a view to giving others advance information based on our personal experiences.  I will also give some hindsight consideration to the question of whether I should have undertaken quite so much surgery in such a short period.

First Post-FFS Day with Makeup

At the moment, however, I am remembering my last day at the PIAC office when we went over the final financial accounting.  Kat, one of PIAC's coordinators for international patients, took me through the paperwork line by line.  When she got to the last page, she paused.  She looked up and said, a bit in awe, "You spent over a million Thai Baht!"  

For those who prefer USD, I spent in the vicinity of $35,000-37,000 USD for all surgical procedures.  As to total trip cost, add $3160 USD each for round-trip business class tickets from Bucharest to Phuket and $1925 USD for our two days at the Aspasia resort before our surgeries and another twelve days after our release from PIH.

I am now recovering slowly at home in Bucharest.  I had intended to return to work tomorrow, but instead, I was felled by a virus that must have found its way into my system during our nearly 24 hours of flights from Thailand back to Romania.  Two days ago I was running a temperature as high as 103F (39.4C), and only today do I feel I have rounded a bend as the fever has dropped and remained below 100F.  My return to work will be delayed a few days more.  I am beginning to learn what others have learned before me, that recovery from this amount of major surgery will require time and patience.  

No longer feverish, I think back on Kat in the PIAC office and look at myself in the mirror.  I like what I see even with much of my face still swollen.  I am now the proud possessor of a Million Baht Body.

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Previous entry -- Vodka without Beer?
Following entry -- My Own General Contractor

We Interrupt this Program -- or -- The Exclamation Point (Part 12)

I wrote the previous web journal entry on Thursday, January 29; today is Friday, February 8.  Twelve days have passed.  The good news is that OD and I were released from the hospital yesterday and are now back at the Aspasia Resort where we stayed before reporting to the Phuket International Hospital for our surgeries.

I raised two questions in my previous post, so let me answer both of them.  The first concerned "a matter of depth."  The answer is five inches.  Sometimes I'm just under five and sometimes a tad over, but more or less, five inches is the number.  I will have more to write about dilation at a later time.

"I also will learn the answer tomorrow as to how painful facial feminization surgery (FFS) really is."  That was the second question I raised.  The fact that twelve days have elapsed since that post implies the answer.  It was the most difficult surgery with the most unforeseen consequences.  For most of the past two weeks I have been unable to see clearly due to the bandaging that kept my glasses too far away from my nose.  I was simply unable to write anything other than short notes on Facebook and in e-mails.  Beyond my blurred vision, my head frequently was pounding too much for me to stare at this netbook screen for more than a few minutes.  

The other unexpected consequence was a dropped left foot.  I awoke from the long surgery to find I had no feeling in my lower left leg and foot and was not able to lift the foot from the ankle.  Fortunately, both motion and feeling are returning.  I'd say that I have reached about the 40% point as of now.

It will take me weeks to recount the events of the past twelve days.  I scarcely know how to begin.  Since I need to begin somewhere, I will reprint below some of the notes that were posted to Facebook or sent in e-mails over this period.  I will even preserve the typographical errors.  Relating our feelings and what we learned about ourselves will take longer.  Please forgive the unexpected but entirely necessary interruption.

February 1, 2013 -- Facebook Posting

Hi eeveryone. I can't really write today, but I wanted you all to know that I am on the healing path. After FFS, I was kept overnight in the ICU in some degree of pain. OD was beside herself with worry, not knowing what had happened with me. Yesterday was much better as I was brought back to our room. I could only barely see out of one eye, however. Today I am also beginning to be able to open my left eye also for short periods, but writing her or anywhere is with great difficulty. OD, lucky girld, is now completely disconnected from everything and is taking a nice long shower all by herself. I hope to be there also in antoher one or two days.

February 1, 2013 -- Facebook Posting

Continued rapid improvement and healing today. I can keep both eyes open, watch films and documentaries, and even read a little bit. I'm afraid the blog, however, will have to wait. OD had her packing removed and is an entirely free woman of the ward. Tomorrow I will have my nose straightening, the last word for me in Phuket. That will be about a 4-hour procedure. I'm told the worst part of having one's nose worked on is the claustrophibic feeling of having to breath entirely through one's mouth for several days. So far the pain of everything has been less than I feared, but as PW has written, I don't think I will want to see the inside of a hospital again for some time to come :).

February 3, 2013 -- Facebook Posting

Just want everyone to know that I'm improving but not really able to read or write today. My eyes are still very swolen, making seeing very difficult. Right not, I'm typing pretty much in the blind. Forgive me, therefore, if I am not responding to notes and letters. I just can't read them quite yet. My facial surgeon says the swelling should be down tomorrow and that he will remove tubes and some of the bandages then. I'm in little pain. The worst so far, of all things, has been my left foot. I've lost all feeling in the top of the foot and am unable to lift it. The doctors, of course, say it's because I've been lying flat for so long. They say I should have feeling backin 1-3 weeks. I'm walking the hallway carefully, lifting my left foot carefully and holding onto the railing. As to how I look, does anyone know of Halloween party tonight? I would easily win first prize.

February 4, 2013 -- Facebook Posting

OD has just gone for her last surgery (BA). I am hoping the tubes and "grenades" will be removed from my head today, after which I will be able to sleep and place my glasses close enough to my eyes to actually be able to see. (Right now everything is blurry because the lenses of my glasses are so far away from my eyes.) Biggest concern is still that I am not able to feel the top of my left foot or raise my left foot from the ankle. Dr. Kunaporn says this is likely a pinching of the perineal nerve (?) and that feeling and motion will come back. The BUT is that it may take several weeks. Meanwhile I limp as well as I can.

Sorry if I've been sounding down. GCS and FFS are possible in quick succession, but it takes a great toll on the body. Fortunately, I am falling back on my good physical condition from decades of being a daily bicycle commuter. If I were not in good physical condition to begin with, this would be all that much harder. A week from now, I see OD and myself sitting on our balcony, looking out on the view, and having these post-surgical memories as just that, memories.

Good news is that we are both dilating and getting expected depth. I am at 5" to start and up to dilator No. 4. Not that this easy, mind you, but it is possible.

February 4, 2013 -- Facebook Posting

Much better news to report. First, OD is back from her BA and is resting comfortably. That's the last surgical procedure either of us goes for.

For me personally, better yet is that all my bandages and "grenades" have been removed. I had thought I looked like a Mack truck had run over me two days ago. I now realize I have just reached that exalted status of beauty today. Two days ago it must have been as though ten trucks had rolled over my face. I am all shades of black and blue and yellow and orange, and my eyes in particular look as though they are staring out from two purple abysses. But now I can place my glasses at the right distance from my eyes and can actually see normally. As scary as my face looks at the moment, I think I can see enough to understand how it will heal. My forehead has been contoured nicely, the hair line having moved forward noticeably. The eyes have been opened and evened as well. I imagine it will be 2-3 months before everything settles.

I also just had my first shower in days. You can imagine what it was like to wash all the congealed blood out of my hair. It might have been better to ask our marines to give me a buzz cut and start over, but after an hour and lots of help from one of the nurses, I don't look quite as terrifying as I might otherwise.

Not much change yet on my left foot, but they are taking it seriously. I had one physical therapy session in my room this morning and will have another in the PT department this afternoon.

Best of all, I might now start catching up on something approaching normal sleep. 

February 5, 2013 -- Facebook Posting

Just a quick update to say that the big toe on my left foot now has some motion. Now I need that motion to spread to the rest of the foot. I had two PT sessions today.

Biggest complaint of the day was last night's sleepless night. Between constipation first followed by an enema at midnight, I think you will get the picture. It's only 7:30pm now, but I'm going to bed in hopes of a few more hours sleep than yesterday.

February 6, 2013 -- Facebook Posting

Continued slow progress with my left foot today. After one PT session in the morning and another in the afternoon, I am able just barely to lift the foot from my ankle under my own power.

Only setback has been my face. The surgeon decided to rebandage much of it because he did not see the swelling as going down as quickly or as much as he would like. So once again, my glasses are perched at the end of my nose, making things like reading and writing difficult. Even navigating while walking is not easy. Yes, my vision without proper optical correction is that bad.

The plan is for us to be released to our hotel tomorrow. For me there will be daily taxi trips back to the hospital for PT, and both OD and I will have multiple check-ups with our surgeons.

February 7, 2013 -- Letter to my Sister

Hi I.,

Good news is that OD and I will be released back to our hotel today.  I don't know how much of FB you have been able to follow, but I did try to put something up there everyday.  Writing in the blog was pretty much impossible, as my face was so bandaged that I couldn't place my glasses close enough to my eyes to see in anything other than a blur.  Even the FB postings were difficult to write.  As I think you can see here, that is beginning to improve :).

I should have known better based on all my years helping with XXX's sister and aunts, but I have now proven independently for myself that there is no such thing as an easy surgery or an easy stay in the hospital.  This has been hard, very hard.  One evening I was reduced to tears, almost at the end of my physical and emotional stamina.  

Thankfully, the rational side of my mind turned out to have been correct in its pre-op assessment that I was strong, in good physical condition, and ready to take almost anything.  I did take it all, but it was the equivalent of surviving the most horrible of imaginable car wrecks, the type where you wonder how it was possible for the driver to walk away.  Doing both SRS and FFS together was overload, like inviting two independent trucking companies to drive their 18-wheelers over my body as many times as they would like, each driver paying little heed to the other.  Total time in surgeries for me was on the order of not quite 24 hours.  Just imagine -- as I should have tried to imagine -- how the body will react to being under general anesthesia for a full day.  It is good news that I have had only one bad side effect, namely a dropped left foot.  They say I should regain full use within a few weeks, but for now I will need to walk with great care.  

Please give my love to G, P, and everyone.  I am on the recuperation path now.  Despite the pain and complications, know that I am happy.

Love,

Robyn

February 7, 2013 -- Facebook Posting

Release day!  This photo was taken just as OD and I were released from PIH. What the staff lacked in English, they made up for with smiles. OD is ready for the beach, but I think one look at me will explain why I haven't been able to write or do much of anything at all. Today, however, we both felt wonderful.

The other news of the day is that OD and I got to our hotel in the early evening and unpacked our suitcases for the first time since coming to Thailand. My foot continues its slow return. For the coming week I will be returning to the hospital each morning for physical therapy. It's a good thing I was in as good shape as I was to begin with. Even so, I can tell it will be weeks, months, or a half year before I am back to that level. In addition to physical therapy, I plan to walk as much as I can to get the muscles working. The rest of the time I hope we will be sitting on the balcony and enjoying the water view. With my vision no longer obstructed by quite so many bandages, I may even get back to writing the web journal.

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A Matter of Depth -- or -- The Exclamation Point (Part 11)

At times in my life I have thought of myself as a deep thinker, but these days all questions of depth apply not to my brain or my thoughts.  Rather, they belong to a completely different and much newer part of my anatomy.  In short, how deep will my vagina be?

Yes, dear readers, it is time for a clinical discussion.  Those who prefer to think deeply about other matters may wish to skip this post, but for many of us, vaginal depth is a question of deep importance.  So let's get to it.

In the standard penile inversion method of vaginoplasty, vaginal depth corresponds directly to the amount of penile material available for inversion.  The stories are legion of MtF transsexuals who wake after surgery to find that their vaginas are of less than desirable depth.  Many surgeons have, therefore, developed their own variations on penile inversion to provide a depth closer to that of women whose vaginas have been with them since birth.

The method developed by Dr. Sanguan makes use of scrotal tissue as a graft to increase vaginal depth.  From his pre-operative examination, Dr. Sanguan predicts I will have a depth in the 5-6 inch range.  He will only know for certain tomorrow, however, when he stretches and inserts the penile and scrotal tissue to create the vaginal lining.  It will likely be the first question I ask when I wake up after surgery.  "How deep am I?"

For those who have been on hormonal replacement therapy (HRT) for an extended period, the amount of penile and scrotal tissue available is sometimes reduced through atrophy.  In those cases, Dr. Sanguan makes use of an additional skin graft from a donor site, that site agreed upon in advance between doctor and patient in the interval between the first and second stages of gender confirmation surgery (GCS).  Dr. Sanguan, OD, and I have all had that discussion, leaving its implementation in the hands of Dr. Sanguan if necessary.  Anyone interested in the full details of Dr. Sanguan's method can find them at http://phuket-plasticsurgery.com/P-PS-grs-procedure.html.

So does anyone of my age, transitioning as I am later in life, really care about vaginal depth?  Given that I feel myself as fifty-something going on twenty-something, I believe the answer is self evident.  Insofar as medical science will allow, I want to be the woman I should have been born as in the first place.

Having delved deeply for a moment, I now resurface to report that OD is resting comfortably as we watch a French comedy dubbed into Russian.  She is bound to the bed for the next three days or until the grafts have taken.  I have walked the hallways as much as possible today in expectation of the same bed rest that awaits me starting tomorrow.  

The most difficult part of recovery is beginning.  My own surgery tomorrow will be the longest yet, as Dr. Rushapol will begin the facial feminization procedures we agreed on after lengthy discussion, photo sessions, and measurements today and yesterday.  I also will learn the answer tomorrow as to how painful facial feminization surgery (FFS) really is.  In months of advance research, I could not get a clear answer.  Some who have been through FFS say it is far more painful than GCS.  Others comment that there was virtually no pain at all.  Still others say that FFS is painful only insofar as it involves soft connective tissue.  More simply, "If it moves, it will hurt."  Fortunately, we are not talking about much in the way of connective tissue, so I am hoping for the lower end of the pain spectrum.  This is also what Dr. Rushapol predicts.

That is where we are on this, our seventh day at the Phuket International Hospital.  OD is drifting in and out of sleep as we watch our French comedy.  Last night I dreamed of being at her wedding.  I have slept beautifully almost every night since we checked into our little room.  Who knows the depth of the dreams that will visit us this night?

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Collapse of the USSR -- or -- The Exclamation Point (Part 10)

So what do two women of transgender experience share with each other when they are between their various surgical procedures and have already closely examined each other's anatomical changes? Why, the collapse of the Soviet Union, of course!  What else would you expect from OD and me, veterans of Soviet history that we are?  Over two days we have watched the eight part documentary film, Крушение СССР (Collapse of the USSR).  OD has introduced me to a number of Soviet-era films that I had never seen or had seen and forgotten.  Intermixed with Collapse we have watched Афоня (Afonya), Безыменная звезда (Star Without a Name), and Не может быть (Impossible).  I was surprised to find that OD had never seen the classic film Покаяние (Repentence) from Gorbachev's years of perestroika.  We've watched a good Russian-dubbed version of PS -- I Love You, and I have Питер-FM (Peter-FM) waiting in the wings.

Collapse of the USSR

We are both in excellent moods today.  OD's post-operation fever is gone, and we have both had our vaginal packings replaced.  We've been walking up and down the hallway as much as the nurses will allow us.  The binding around my breasts has been removed, and I am able to stand and admire my C cup figure.

I met my craniofacial surgeon Dr. Rushapol Sdawat today.    I showed him photos of my sisters and said that my one requirement was that we still look like sisters when he finishes.  We agreed that "less is more" and that most of what he will do will be around my eyes.  As it is, I have always had one eye that is more closed, appearing more "drooped" than the other.  He will do most of his magic in parallel with the second stage of Dr. Sanguan's GCS on Thursday.

We also met our neighbors, a young Russian couple from Moscow who had come to Phuket for their honeymoon.  On the second day here, the young bride had the misfortune of being hit by a truck.  She has been in the hospital for ten days now with broken ribs and lacerations while her husband goes out and forages for familiar Russian foods and ointments.  We only met our young neighbors today when one of the nurses came and asked if we could be interpreters for the doctor.  Our young friends speak no English, and I can only imagine how terrifying it must have been for them to come here for a honeymoon that ended up being spent in the hospital.  Fortunately, the young bride is now recovered enough to travel, and they will return to Moscow in two days.

I sat talking with our young Russian friend for an hour or so at one point while her husband was taking care of insurance matters.  We talked about this, that, and everything, in particular about how much care her husband had been taking of her.  She asked me to show off my new breasts.  At one point she asked if I had seen any of the ladyboys in Phuket.  She said she had been surprised to see a group of them on her first evening here.  She wasn't so much shocked as she was curious.  She asked, "What must it be like for them?"  Knowing that my young friend was sitting in some degree of pain with broken ribs, I thought this not the best time to begin an educational lecture, let alone enlighten her about yours truly.  I just smiled and commented that it was wonderful to see how accepting the Thai people are of differences.  My young friend nodded in agreement.  Shortly thereafter her husband returned.  We all hugged and said our goodbyes.

It is now 10pm.  OD goes for her second stage GCS tomorrow.  Meanwhile, it is time to choose another Russian language movie to close out the evening.  Although we have both seen it more times than either of us can remember, perhaps Ирония судьбы (The Irony of Fate) would be the right choice.

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