ID Check: To the Knife and Back

By Leela Ginelle, PQ Monthly

(Editor’s note: This special edition of ID Check chronicles Leela’s gender reassignment surgery abroad. Parts of it first appeared online, and now, for the first time, all appear together in print.)

 Part I. The Plan

In my mind, it’s as though I’m planning to walk into a curtain of whirring circular saw blades. For the privilege, I’ve had myself examined by doctors and a therapist, procured a new passport, and prepared to spend all of my own money and that which I could solicit from friends.

I’ll board a plane for one hour, another one for twenty two, and a third for one more. That’s the first part that seems impossible and, in my imagination, treacherous. Any one of them could blow up, fall from the sky, or be delayed by weather, human error or a thousand strange mishaps. At any of the airports I could be detained, miss my flight, or encounter some frustrating, Kafka-esque scenario that throws me irreparably off my itinerary, causing me to lose my chance for who knows how long.

The flight is the first gauntlet, which, when it ends, leaves a rest until the surgery itself. The surgery—a procedure I’ve avoided looking into, perhaps out of fear, and perhaps because I’ll be unconscious when it takes place, and, therefore, have very little to do with its success or failure.

The surgery, which requires me to be anesthetized while my genitals are sliced, repurposed and sown into place again, hopefully without incident or complication. The surgery—which will repair a lifetime’s experience of dysphoria about which I’ve only been able to be honest in the past months—as I knew it would finally end.

The flight and the surgery are not the blades that cloud my vision of the next few weeks; they’re what the blades could impede. The flight and the surgery are the answers to a previously unsolvable puzzle and anything that sabotages them, and the life I envision resulting from them, feels like an existential villain.

A four nights’ stay at the clinic follows the procedure. The things I can imagine: exhaustion, medication, visits from my roommate, who’s travelling with me, perhaps some correspondence with loved ones at home. Unimaginable, though, is what I’ll feel—how soon, how much and in what ways I’ll feel it.

I’ll lie with an open wound, halfway around the world from everyone and everything I know, save my roommate, and hope my healing progresses without incident, which I suspect it will, my optimism occurring selectively from some mysterious instinctual source.

From the clinic, I’ll move to a hotel or guest house with my roommate where I’ll rest more, attempt to amuse myself, stay in contact with all the people I miss, begin a lifelong regimen of maintenance around my new body parts, and try to understand what’s taken place. On the appointed day, my roommate and I will fly home, and a few weeks later I’ll return to life as usual, only significantly different, in ways I can’t really foretell.

Those feelings of doom, personified as disembodied weapons, are like pictures with the caption, “I’ll never get what I want.”

When I read my descriptions of them back they sound self-absorbed and neurotic. I see them as symbols I associate with childhood abuse, which arise when I need a solution that depends on the expertise and honesty of others, as opposed to my own perseverance. “Passenger” and “patient,” roles in which my agency is limited and my anger and voice are superfluous, feel uncomfortable.

Discomfort, hidden for a lifetime, however, is what the process is intended to alleviate; shedding the dread I’ve felt surrounding it is one more chance to separate my story today from that of the past, which was full of sorrow and rage. It’s probably romantic to think I’ll find something to replace it during my journey somewhere across the globe. Change happens all the time, though, inside and out.

Part. II. Anticipation

With all my preparations made, and nothing left to obsess about, my mind flies from website to website, from junk food to exercise, only occasionally pausing long enough to observe how spun out I am. In those moments I see my plans, looking like giants, completely out of proportion with anything in my previous experience.

My brain—perhaps conditioned by trauma, perhaps because it’s a brain—often acts like a scout, breaking off to the future to try to keep myself safe. When my mind reaches the upcoming procedure, all it sees is darkness. The only tool I have for this milestone, in which I’ll be given general anesthetics that render me unconscious for its duration, is surrender. Surrender is comforting, not diverting.

It’s very difficult on some level to travel halfway around the world and allow people to cut me, even for this very necessary reason. The darkness my mind reaches is a barrier that, at most times, I’m unable to overcome.

In some moments I’ll think of returning to my home after the trip and feel a bolt, a sudden understanding that at that moment I’ll have the body I want. That’s spontaneous, unconscious future-casting, though. Any more routine worrying, drifting from the current moment forward, crashes instead on the shoals of those hours, lying helpless and incapacitated, my groin under operation.

In frustration, I’ll push past those missing hours, and all the possible dangers they hold, and land in the days of incapacitation they’ll result in—catheters, painkillers, feebleness, and blood, all experienced in a city I don’t know, apart from nearly everyone I love.

Even this period, though, seems relieving, as experiencing it would mean I’d lived and emerged without obvious complications. Surrender, again, is my sole strategy at this time. Resting, following doctor’s orders, and hoping to start life again.

The recovery is wrapped in a mystery: What will this change mean and how will I experience it? I can’t really know, but the little rays of peace and bliss I intuit suggest a kind of effortless, internal congruence foreign to my current existence.

Here at the airport in Taipei, three days after starting this piece and two days before my operation is scheduled, these worries seem ephemeral. The results still feel unknowable, but the chatter I’ve described has receded, leaving a desire to notice things other than potential threats and enemies. Having grown up under perpetual enemy threat, this desire feels unwise, but that’s a thought I imagine will fade, as well.

This journey, since its conception, has seemed parallel to a second one, leading away from old wounds toward a more open, trusting way of viewing the world and my place in it. As I await my final flight, then, and find myself optimistic about nearly everything, I’m almost not surprised. Grief doesn’t last forever, and, in my experience, acceptance and peace, even prior to a surgery, are often its happy outcomes.

hospitalPart III. The Operation

During the battery of tests I was given on the day prior to my operation (EKG, blood draw, chest x-ray), by nurses who spoke almost no English, and could offer no reassurance to my questions when they looked befuddled or concerned, I felt both calm and terrified.

I told myself the tests were perfunctory, as I had already travelled here, and paid for the procedure I’d booked nearly six months ago. Realistically, I thought, nothing could derail the surgery, which grew closer by the hour, to both my excitement and terror.

That night I met the surgeon at his clinic along with two other women from Los Angeles, who were there for the same reason. He seemed calm, confident and kind, like my research had suggested, and I left, counting the hours down.

The day of the surgery, I moved to the inpatient floor. I was ordered to change into a gown, my entire groin area was shaved, and a nurse administered four consecutive enemas, during which I, not being a stoic, moaned and complained to my roommate. Breaks ensued, which felt endless, as I watched the clock; my IV was soon inserted, and, as scheduled, I was wheeled from my room into an elevator, and on to the operating room.

The room was freezing. Those within it talked and joked in Thai as they made preparations. The anesthesiologist, a charming man, told me he’d worked with my surgeon for twenty years, a fact I found reassuring. His drugs, administered by IV, paralyzed my body as he asked me to breathe into a plastic mask.

I came to slowly in a different room, taken by the fear that if I fell asleep again, I’d die. Consequently, I made an effort to stay awake. I announced to the blurry figures around me I was conscious, and they soon wheeled me back to my room.

I arrived thirsty, and with my teeth chattering. My roommate gave me another blanket and some water, and my fears began to recede.

The surgical area was covered with thick adhesive bandages, out of which two tubes, one connecting to a catheter bag and another to a drainage ball, protruded, making the region, ironically, bulkier and more unsightly than before.

After three pleasant, tedious days, the surgeon returned to unpack the wound. With elan he swooped in, assuring me he’d “done this a thousand times.” He peeled the bandages down from my waist, revealing what appeared to be a violet mass of blood-stained gauze surrounding rubber tubes shooting out from my indecipherable new genitals.

In terror, I watched him chop, with great effort, through the tubes, centimeters from my mutilated flesh. In some order I don’t remember, the bandages were fully removed, volumes of gauze were taken from my neovagina, and the tubes were yanked out of me.

With the utmost delicacy, I showered, and getting out, lined my underwear with a pad, as bleeding is common for several weeks following the surgery. Pulling my underwear up onto my new body, I experienced a burst of pure joy and elation, one of many that accompanied the understanding my dream had been accomplished and my predictions and beliefs had been correct.

A few days later, after moving to a hotel, I was taken to the surgeon’s outpatient clinic. After nurses removed my stitches, the surgeon, placing a condom and lube on a thin, solid shaft of unyielding plastic, demonstrated the practice of dilating, inserting the instrument into my new vagina. Shocking, uncomfortable but not painful, nowhere near as bad as the enemas, the event was clinical, and an odd, but necessary way to inaugurate my new orifice.

At home the next morning, I repeated the practice, which prevents the neovagina from closing. During my preparations, I held the mirror they gave me under the surgical site, staring at the different areas, which had been grafted together, and which were in various stages of healing.

I thought of the words I’d been hearing, like labia and perineum, and wondered why I hadn’t known them before. I second guessed everything, feeling gross, and thought of not dilating at all, of ignoring my new genitals until they went away. I gathered my things and went to my bed. Clinically, I inserted the dilator, hoping I was doing it right.

As a thought exercise leading up to my operation, I would google things like “pencil skirt” and stare at smooth groin areas in all of the pictures. A few times I queried “gender reassignment surgery,” and was horrified at the pictures. I like looking at myself in underwear now, perhaps because women in underwear are considered sexy in our culture, while women’s genitals under examination are not.

In my most anxious moments prior to this trip, when everything seemed too dangerous, I would try to calm myself by remembering women from around the world do this every week with this same surgeon, and that I’d heard of no incidents occurring.

If they could do, my reasoning went, I could, as well. And I have.

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Leela Ginelle is a journalist and playwright lining in Portland, OR. You can write her at