Out of the hospital

I was just discharged from the hospital on post op day 8. I ended up needing to have a couple of units of blood cells transfused because of heavy bleeding for the first few days but it slowed down to a trickle now. I’m exhausted. 

This was the most painful and draining experience of my life. The pain is unbelievable. My pelvis was completely torn apart and reconstructed. I never truly appreciated how involved your pelvis is in every little movement you make. That combined with the pain of top surgery, where I had large implants placed under my pectoral muscles makes doing much more than laying on my back incredibly painful. 

My hospital course was like this:

Day 1: surgery. I was wheeled back to the OR after having an IV started, was given some sedatives, and then was given propofol (the white stuff that makes you unconscious), my arm got tingly, and then I was instantly awake but super groggy in the post surgery recovery area being told way too much info about what to do while in the hospital. I didn’t remember a bit of it. I remember being given my PCA (patient controlled analgesia) which is a button you push when you have pain and it gives you a dose of IV opioid pain medication, pushing that a bunch, and waking up seemingly dozens of times in pain, pushing the button, and going back to sleep until the next day. 

Post op day 1: bedrest (meaning cannot sit or stand up at all), pain, clear liquid diet, pain. Bleeding. A LOT of bleeding. had to get dressings removed, bleeding area packed and clotting material placed, bleeding slowed down. 

Post op day 2: bedrest, pain, full liquid diet, pain, feeling greasy, gross, stuck, crampy. Bleeding less, but still there. Heart rate high, labs show anemia requiring transfusion of a couple units of red blood cells. (Thanks donors!), Feeling a bit better after blood transfusion)

Post op day 3: bedrest, pain, full liquid diet, heart rate better, still crampy and feeling gross and dirty. Anemia improved and stable. 

Post op day 4: dilator taken out and replaced with packing, bedrest, soft diet, got some horrible scrambled eggs that tasted like heaven, pain, feeling very gross, PCA switched to oral pain meds.  

Post op day 5: off bedrest! Got to get up and take a lukewarm shower with assistance. Sitting and standing is incredibly painful. Still have urinary catheter in place. 

Post op day 6: catheter removed. Wow, that hurt, packing replaced, got up and walked a mile around the nurses station and got a certificate for it ūüôā pain improved a little. Still crampy but better with walking.

Post op day 7: dilating starts. More on that later. Wow, it’s difficult and surprisingly emotional. I initially really wanted to be discharged this day but the surgeon wanted me to stay for the day and dilate in the hospital. I’m glad he made me do that. 

Post op day 8: today! I got discharged. I had some mild opening of some of the sutures so i was instructed to take a couple days off dilating which is welcome since I’ll be traveling home by plane tomorrow. After being discharged, the walk to and from the pharmacy to the apartment where we are staying (which is 1 block away) was excruciating. It was much better once i got back and took some pain meds, but wow. Flying home tomorrow is going to be rough! 

Post op day 1

I’m sore all over, itchy, and super restless. But! it’s done and there were no major complications other than a pretty heavy amount of bleeding. I’m on a good amount of pain meds and that takes the edge off.  I’m on bedrest for 5 days :/ that’s the worst part. I can’t get up out of bed until at least Wednesday and I’m on a clear liquid diet only right now. Because of the pain meds, my intestines are going really slow and I’m super crampy and when I try to push, it hurts even more. It’s such a brutal combination of irritating symptoms!

I’m so relieved that it’s over though. I still haven’t been able to really see what I look like down there yet, but I’m sure it’ll be better at least! 

I can’t wait for all this swelling to go away!

Ugh. That’s all my complaining for now. 

ūüôā

T-minus 8 days to surgery!

I can hardly believe it’s actually here. Interestingly, this last week has gone by much slower than the previous several months it seems. The anxiety is finally settling in and I’m running through all of the different complications that I’ve seen as a doctor that could possibly happen to me. It seems unreal. I’m trying to just focus on the fact that two or three months from now I will be completely done with all of this, well healed, and moving on with residency. I wish I could just fast forward to that moment.

I had to discontinue taking hormones a couple of weeks ago to lower my risk for blood clots. I’m feeling pretty crabby and I had a hot flash today. ūü§ē 

I find myself feeling quite conflicted. There’s a chance that residence or medical students could be in the operating room when I have my surgery. They likely won’t be doing any of the critical parts of the procedure in anyway. Even so, I feel myself wanting to ask my surgeon not to have any students or residence in on my procedure in anyway. Intellectually I know that that’s unlikely to be reasonable or beneficial. I know that when people are demanding and overbearing for me, The anxiety that causes me as a physician causes me to be more rushed and I think it causes me to provide lower quality care. And I know it’s very hypocritical. I have benefited so much from people who have allowed me to “practice” on them as a resident, and before that as a medical student.  Nevertheless, I still feel this elitism, that I should have “premium” care for some reason even though I know that is unreasonable.

I know people say that doctors tend to make the worst patients. I’m going to try hard not to live up to that stereotype. I’m going to obey my nurses and doctors orders as much as I possibly can. I want so badly for this to go smoothly. I desperately need something to go as planned because I’ve had so many issues with other parts of my life lately. I’m hoping that this process of being on short-term disability for surgery will be a sort of “reset” for me. I’m hoping that I come back recharged and ready to finish off the back half of my residency with passion and energy.

I’ll try to remember to write some updates over the next couple weeks so that I can remember this process and that I can vent and let off steam.

“Officially” disowned

As I have said before, I am currently scheduled for gender confirming top and bottom surgery this December. It’s been a big up and down experience getting it scheduled and approved and paid for. ¬†I’ve spent so much time and money pushing forward for it. ¬†It’s good to know I’m on the schedule officially but really, I just want to fast forward to 2 or 4 months after when the recovery isn’t as intense anymore. ¬†It’ll be nice ūüôā I can’t wait.

Anyway, In the process of all this, I told my mom about it. She was really curious about the procedure and the results and asked pretty surprising and good questions. ¬†She’s come a long way in her openness, honestly. I thought all was good. Soon after I told her that, a few weeks ago, she felt like my dad was making progress toward being more accepting of me and so she told him that I was having surgery. ¬†He didn’t take it well…

He immediately told my mom to never speak to him about me again and he made her take all the pictures of me down in the house, even baby pictures. ¬†My mom told him that she wouldn’t let him stop her from supporting me and that if she needed to come see me, she wouldn’t let him interfere. She agreed with the rest though. ¬†She took down all my pictures. She called me crying, telling me about it, and almost asking me for permission to comply with his demands. ¬†She said “I thought you might actually be ok with it since all the pictures on our walls are pictures of you before you were you.” ¬†That’s true in a lot of ways. Nevertheless, the situation really sucks. ¬†There is one picture in particular that I loved. ¬†When I was 3 years old, we had our one and only real big family vacation that I can remember. ¬†We went to San Diego, CA and went to Disneyland and the beach. We didn’t have any other real vacations other than camping because we really couldn’t afford it. ¬†This one was only possible because my uncle was in the Navy and got us cheap tickets to disneyland and let us stay in their apartment. ¬†I don’t remember much but I do remember the beach. ¬†That day, my mom snagged a picture of my dad holding my hand, staring out on the water. ¬†I was a tiny kid and I remember loving him so much at the time. ¬†I looked up to him. I felt safe with him. ¬†She had to take that picture down too…

I’ve had huge ups and downs since then. ¬†I find myself so envious of people with functional, supportive families. I’m surrounded by them at work and it’s hard to curb my jealousy. ¬†I also find myself feeling resentment toward my mom for many reasons. Partly because I am jealous of other peoples’ relationships with their moms after they have had authentic, real relationships their whole lives and mine is really just starting. ¬†Partly because I resent that she’s not fighting my dad more, but I can’t really hold that against her given her circumstances.

Other times, I find this whole thing so absurd that it is almost funny. ¬†Think about it. ¬†I was already a doctor for over two years when my dad disowned me for having a corrective surgery… ¬†A surgery, who’s results he will never, ever see or be effected by. A surgery that matters only to me, my partner, and my doctor. ¬†It’s simply crazy. ¬†I don’t get it. ¬†I don’t understand why that was the tipping point for him. ¬†It’s almost comical. ¬†My mom later said (when she was at the grocery store, so it was safe to speak to me) that she was worried and wanted to make sure that I “really really want this” because “it’s just so final.” ¬†That in itself is comical for obvious reasons as well, lol. Yes, I’m sterile now, and will be 1 million percent irreversibly sterile after. Other than that, I’m not sure what she means. ¬†I feel like my transition is quite irreversible at this point and I would never want to do that anyway. I crossed the point of no return a long time ago. ¬†I guess that’s harder to grasp for some people. ¬†I kinda got frustrated when she told me those things though and went off on how it’s nobody’s business anyway and I only told her because she would want to know why I’m on medical leave from work and would probably be angry if I went under for surgery without telling her. ¬†I felt bad afterwards but I needed to say it.

Blegh. ¬†In other news, K’s mother is in the hospital after having a pretty large, but relatively benign tumor removed from her brainstem. ¬†She’s having a somewhat complicated recovery, so that’s pretty stressful as well.

I’m staying afloat though.

There’s a common saying in medicine that’s partially derived from a famous book, but is perpetuated on days and times when things are hard. ¬†“They can ALWAYS hurt you more… but they can’t stop the clock.” ¬†Meaning, times can be hard, and they can be extremely hard, and then they can keep piling on and hitting you when you’re down, but there will be a better time. ¬†There always is, and you just have to survive through it. ¬†That’s my mantra this year. ¬†It’s been a hell of one.

 

Here’s a cute picture of my dog ūüôā

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Wanting to write again

I went on a hiatus from writing on here for a while. ¬†I had a day where all of a sudden I had a ton of visits and I was worried that someone I knew had discovered my account, which was likely since I made a video lecture for my residency program on trans healthcare and they use a wordpress and I think someone tried to link me as an author and found my wordpress account. ¬†Since then I’ve decided not to care that much and have recently felt like writing again as an outlet.

Since I last wrote, a few things have changed. I’m living with K again. Things are going really well between us. ¬†Work is super busy and I’m on the hardest, busiest, most disorganized, and hectic rotation of residency, I’m burnt out but there’s only 2 weeks left. ¬†There’s light at the end of the tunnel.

For my transition, I’m¬†still always working to try to align my appearance with who I am. ¬†I try hard to present myself in a way that leads to me being misgendered less and I wish I could dress and act simply how I feel rather than having to consider that. I know, I don’t have to, but I still do because being misgendered hurts.

I got a dog! ūüôā His name is Ace and he’s a half weiner dog and halft something else. He’s a rescue dog we got from an adoption agency. Here’s a pic of me and him when I first brought him home:

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Finally, I’ve gotten everything set up for me to have gender confirming top and bottom surgery In December! I’m nervous and excited. ¬†Mostly I just want it to be over with.

For now though, I need to go to bed because I’m going to be at the hospital for 30 hours starting at 5:30am tomorrow ūüė¶

Sometimes I think about quitting this job and working at a medical spa…. ¬†But then I remember the good parts.

ūüôā

Haylee

 

The other side of the medical bill

Being trans has been my first significant life experience with being on the other side of healthcare, that is, the receiving end. ¬†It has been a heck of an experience to say the least. ¬†It’s pretty humbling at times to be the patient instead of the doctor. ¬†I have to say that this whole experience has solidified my opinions about our healthcare system in the U.S. ¬†I have had a difficult time wrestling with it. ¬†It is insanely convoluted and I am quite frustrated with the concept and navigation of an insurance company. ¬†Organizing mental health appointments, HRT appointments, letters, surgeon referrals, and prescriptions are frustrating enough without having to deal with getting things paid for through various third party organizations. ¬†It’s madness!

I had an experience with my insurance company that brought me to tears later last year. ¬†I had my name legally changed in March, 2015. ¬†After that, I had my name updated with my job, bank, social security, and insurance among dozens of other things. ¬†I waited to have my name and gender updated with my healthcare provider until it was official with my insurance, just like I was supposed to. ¬†Everything seemed peachy at first. ¬†Then, about 3 months later I got a letter from my provider saying that my health insurance company has rescinded their payment for services I received long prior to my name change because the name no longer matches the name on file. I immediately called the insurance company and was told they didn’t understand why that error happened but they would fix it and I wouldn’t have to worry about it. ¬†I went ahead and called my provider’s organization and let them know that I had remedied the problem and my insurance company would send them their money soon. ¬†This happened 6 more times. ¬†Each time, I called. Each time, I was assured the problem was fixed. ¬†The problem was that it was never fixed. My provider kept getting payments rescinded, and they never gave any of them back. ¬†Eventually, I got a bill for $1300 worth of appointment fees (around 5 or 6 visits) that I didn’t have and a warning saying that I had 60 days to pay in full or my account would go into collections. ¬†I called again to my insurance company, crying, begging for help, and they finally got someone higher than the supervisors I kept speaking to when I asked to “escalate” my complaints. ¬†I ended up getting a call a couple weeks later when I was told there would be a board meeting where my case would be discussed and things would likely be fixed. ¬†They finally were. ¬†That was a 4-5 month painful struggle that I hope they fix for any future person going through what I did.

My current frustration is much more humiliating and highlights the convolution and brokenness of our health insurance system in the U.S. ¬†Back in November of 2015, my state announced that it would now be prohibited for a private insurance company to exclude healthcare from any one based on gender identity and specifically pointed out that it would include gender confirmation surgery (GCS). ¬†This was awesome for my state! ¬†I thought it would be awesome for me as well! ¬†I have insurance through a private company that my employer provides, so I thought I would be covered. ¬†At that point, I had already been battling with HR for about 5 months trying to get them to remove an exclusion in my insurance coverage that excluded coverage for GCS. ¬†I thought I didn’t have to worry about it anymore and the state prohibition would have won the battle for me! ¬†I was wrong. ¬†As it turns out, this private health insurance company simply manages the payments and claims for my hospital which does the insurance for us. ¬†it’s called a “self-insured plan” and, as I have been informed, it does not have to comply to state statutes. ¬†Therefore, they can discriminate based on however they want. ¬†So, here I am, 3 months later, still pushing and trying to get my hospital to remove this exclusion from my health insurance plan. ¬†That means I am having to have conversations and emails every week or so about my very private, very embarrassing healthcare needs with human resource directors and hospital administrators. ¬†I have been doing this for the last 8 months. ¬†It is painfully old. ¬†The most recent news I have gotten is that the hospital has “completed their research with the benefits broker and legal” and that they “expect direction from senior leadership within the next 2 weeks.”

It seems comical almost. ¬†The idea that administrators at my work place are researching and arguing about whether or not to cover my healthcare that the state has accepted and agreed is non-elective and medically necessary is laughably humiliating. ¬†Especially when you consider that if I were in residency at a program a few blocks away, it would have been a non-issue. ¬†Or if they just gave me the money to purchase absolutely any other private plan in the state, for that matter. ¬†It’s baffling and frustrating. ¬†I am at the point where I am willing to wait a few more months to get an answer and if it’s a “no” I am going to start looking for options for switching residencies. ¬†Any of the other programs in town wouldn’t have this issue and I have gotten excellent training and nothing but good reviews, so I’m hopeful that I would be able to find a spot somewhere quickly if I called connections. ¬†I have 3 years and 5 months left in residency. ¬†I’m not going to put off this procedure that long. ¬†I’m to the point where I need it. ¬†I’ve jumped through all the hoops my surgeon requires me to jump through, I just need my insurance to agree to cover it and I can schedule it (hopefully for this Fall). ¬†If I am rejected by my hospital, I will be terribly disappointed in them and I think I will have to move on.

For now, I hope I don’t have to cross that bridge. ¬†Hopefully I will get good news in a couple weeks and I can move forward to whatever is the next hoop I have to jump through in this transition.

Oh, and in the meantime, I’m working in the Emergency Department this month, doing research on ammonia testing and IV sedatives, just recorded a lecture on trans health that my hospital will likely publish soon, am working on developing a transgender clinic in addition to agreeing to be the referral resource for HIV positive transgender patients seeking HRT within my hospital, working on a grand rounds presentation on transgender healthcare, and studying for 2 yearly in-training exams which are essentially mock board exams that are multiple choice, in addition to an oral board-style exam that I have to do every year as well. ¬†So, dealing with all this personal healthcare stuff is no biggie really…

In reality, yes, I know I still have it better than the overwhelming majority of trans people in the world as far as access and resources go but still, it is disheartening to see how much work we have to do as a country to make things better for healthcare access for us and everyone else while we’re at it.

Sigh.

Changed relationships

I have two friends who have been like brothers to me. ¬†I have known both of them since middle school. ¬†We have all had ups and downs in our friendship but we had always been very close. They were some of the first people I came out to. ¬†One of them is married and I was the best “person” in the ceremony. ¬†We have been through a lot together and it at first seemed like we were going to get through my transition together as well. ¬†There were talks about both of them coming to visit me at some point and whenever we spoke, things felt warm. ¬†It wasn’t as close as we used to be, but we were all trying to figure out how to interact comfortably whenever we talked.

Something has happened over the last couple months though. ¬†It feels like whatever relationship I had with either of them has been withered away by time, work, and distance. ¬†One of them specifically communicated that he didn’t feel like he knew me anymore early after coming out to him. ¬†It feels like neither of them feel comfortable with me anymore. ¬†It feels cold and impersonal. ¬†Our relationship has changed into an acquaintance dynamic rather than a “basically siblings” one.

I don’t know if I can rekindle it again from far away and while I’m this busy :/ I don’t want to surrender these relationships to residency and transition, but I don’t know how to fight it while I’m this busy and far away. ¬†Bleh. ¬†Why can’t life be easier?

Almost through

Today was Christmas. ¬†I went in to work my shift in the Emergency department. ¬†It was supposed to be a long one, but I’m on a rotation where I just do resuscitations and orthopedic procedures around the department. ¬†I’m kind of¬†an extra set of hands who just floats around. ¬†Because I’m “extra,” ¬†my program director, who happened to be working today sent me home early. ¬†It was nice. He certainly was expecting me to be going home to friends and/or family, I imagine. ¬†I used the time to do some laundry. ¬†Later on in the evening I went for “Jewish Christmas” with another co-worker. ¬†I never heard from my mom until the day was technically over, around midnight. ¬†I got a Facebook message saying she missed me. ¬†That’s it.

I wish there was some way for her to understand what my life is like. ¬†I wish there was some way for me to understand what her life is like too. ¬†Maybe it would be easier to feel ok about our relationship. ¬†I am very disappointed in my parents. ¬†They were supposed to love me unconditionally and what we have now doesn’t feel like love. ¬†It feels fake and awkward.

When I have a young patient die, like I did this week, I often selfishly think about my own situation. ¬†One of the things that scares me most is that if I were to die before my parents, I can’t imagine they would bury me as myself. ¬†I think¬†they would erase me. ¬†I think they would bury me with my old name. ¬†They would bury me dressed like someone I’m not and they would tell stories about me with no regard to who I truly am. ¬†It terrifies me.

I don’t mean to be so down all the time. ¬†I’m spread quite thin and I’m hoping for strength. ¬†It helps to unload regularly. ¬†I’m hoping for someone or something to step into my life that will recharge me occasionally. I’m trying to have patience waiting.

 

Why my Christmas Eve sucked.

Today I was cutting into the pleural (chest) cavity of someone who in minutes would be pronounced dead far ahead of their time.  While doing so, I had a brief mental pause.  I was doing something absolutely critical.  If this person had any chance of surviving, it was going to be by me and about 12 other people feverishly supporting their heart and lungs to supply oxygen to their brain long enough to figure out how to fix them.  The thing that gave me pause mentally was that my chief resident, the person who was running this trauma misgendered me to everyone around.

I didn’t correct him. ¬†It didn’t affect me. ¬†It was insignificant given what was going on in front of all of us. ¬†I re-focused on the task at hand. Get the blood and/or air out of their chest cavity and do it fast without stabbing yourself. ¬†That was my goal.

Afterward we all debriefed. ¬†That’s when we gather and perform a too-soon futile exercise to make what just happened seem somewhat normal, I guess. ¬†It never helps. Nobody ever has anything to say. ¬†Those of us who refuse to become cold are too impacted¬†to say anything and those who are cold are unaffected. ¬† I felt horrible about this person’s death. ¬†It was a bad situation. ¬†It was hard¬†to see, as it always is when it is so up close and personal.

I¬†felt overwhelmed by thoughts at times this afternoon related¬†to¬†this¬†situation. ¬†I see death at least weekly, if not daily some months. ¬†This one was too soon for this person. ¬†They were very young, it is christmas, and their family was distraught. ¬†I was torn¬†and saddened about it. ¬†I hurt for them. ¬†I had a flurry of overwhelming thoughts and emotions. ¬†Further, I was conflicted and frustrated that in the midst of dealing with the emotions that come from seeing something like that yet again, I also had to deal with the humiliation of being misgendered. This chief resident has been notoriously horrible at pronouns for me and I have had talks with him about it and pleaded with him to try harder. ¬†It felt like being kicked in the shin while trying to give a speech and having to pretend like it didn’t happen

I felt like a petulant kid for even thinking about how *I* was hurt during this whole thing. ¬†I guess most of all I wanted someone to vent to about it. I then got angry that I can’t talk to my mom. ¬†That my dad is such a jerk and prevents us from developing a relationship. ¬†That I am entirely supporting myself here and that everyone around is talking about how wonderful the holidays are because of family and love and friendship.

Screw the holidays.

I guess I’m just going to vent to you all. ¬†Sorry :/