Note to self

Alex tells me I need to bring a pillow. “You’ll want something you can hold on to.” He explains how to insert the pillow in between the flat straps of the car seatbelt, so I can cradle it as we go over the bumps, curves, and potholes in the road. He also says he hired an Infinity Chair for his recovery and recommends I look into it. I can see from the website that it’s a chair that supports all parts of the body; it makes you feel weightless. An engulfing levitation in beige, the Infinity Chair seems to be part cushion, part coffin. From a side view, it resembles a giant egg in which to be coddled while

PRE-OP 1/4
  • Take things down from high / hard-to-reach places.
  • Clean your fridge and do an archaeological dig in your freezer to make way for what you will actually need.
  • If you like it, go to the gym every spare minute you can manage (for recovery, but also to enjoy the body’s capacities before it has to take an extended break).
  • Food shopping—especially dry goods and other heavy things to buy in advance.
  • Lots of home cooking. Freeze some for later.

waiting to heal. But it doesn’t appear to be for hire in the United Kingdom. Later that night, I read Rosemary Mayer’s short story about a world in which chairs are nearly extinct—no chairs for nobody. In that world, the narrator fantasizes about a utopia in which numerous kinds of chairs would be easily available: “chairs with firm, supportive backs and arms for those who need or want that sort of chair; wooden chairs and metal chairs, depending upon preference; stuffed upholstered chairs; cushions for chairs and footrests for those who need or like to raise their feet. Different wood and different colors would be available; different ornamentation or the total lack of it. And finally, chairs of different weight, so that those with less strength or a bad back need never feel intimidated by the place a chair is in as opposed to where they would like it to be.”

Emmie and I have started watching YouTube videos about postsurgical recovery in preparation for next month. I notice that online, all the boys are young and beautiful. They know how to light their small bedrooms, tilt their delicate, bruised bodies up to the camera, and rig the sound up on their phone

PRE-OP 2/4
  • Do all the laundry, especially bedsheets, towels. Will go through lots, and fresh sheets make you feel less glum about spending more time in bed.
  • Is there enough toothpaste, toilet roll, soap in accessible (low and reachable) places?
  • Electric toothbrush? (Especially if someone needs to do this for you.)
  • Baggy clothes for recovery, especially hoodies with zips or things you do up the front.
  • Protein powder (good before the gym but is good food supplement post-op too).

to make their T’ed-up voices crystal clear. There are some videos I watch by grayer men, my age or older. They shoot often with light directly behind them, against domestic backdrops of kitchens, or living room shelves stacked with DVD boxes and books, and the camera casually propped up from a low angle with a smeary lens. With various levels of expertise in life and in technology, this chorus of anonymous voices guides me through their pre- and post- surgery rituals, massage oils, vitamin supplements, and silicone strip recommendations.

I have a recurring dream that one of my post- op nipples falls off while I’m standing talking with some friends at a party. Each time we’re on a large fake-fur rug. We’re all drinking and having a nice time, and then, suddenly, I realize my nipple has gone missing. I try to find a polite gap in the conversation, to wait for a friend to finish telling their story, so I can casually say, “Sorry, but I think I dropped something?” I dip down to my knees, looking for it as one would a dropped contact lens. My friends, keen to support me, eager to be good allies, also start looking. There are so many knees

PRE-OP 3/4
  • Borrow/buy extra pillows.
  • Millions of noncaffeinated tea bags, all weird types. If nothing else, the ritual of making tea will pass the time.
  • Back scratcher. So wish I’d gotten this. Also get some kind of sponge on a stick.
  • Get something nice that has nothing to do with surgery. A treat or new clothes to look forward to.
  • If you find human touch or holding uncommon with people (or those who will be your primary carers), practice being picked up and moved by the friends who will help you, so you’re not negotiating touch in a moment of urgent need.

and feet and hands, and everyone is wearing scummy trainers on the hairy rug. It’s a bit dark. I never find the nipple. I imagine it tangled up in the knots of the thick wool pile, encrusted with the chunks of mud dropped from the treads of someone’s thick-soled worker’s boots. Before I wake up, I say to my friends who are all crouched down on the rug with me, waving my hand with feigned breeziness, “Sorry. Don’t worry. It’s totally fine.”

I haven’t been able to find any record of the first top surgery. Initial online searches produce an unending cascade of first-person anecdotes (of which I guess this is also one), but rarely a reflection on the procedure beyond each author’s own encounter. In the library, I glean little more information from older medical history books that mention early FTM surgeries, the language of which is often delivered in a pathologizing nag, or, more specifically, the scrutinizing of psychological aberrations in relation to otherwise “perfectly healthy” bodies.

In its removal of the breast and the adaptation

PRE-OP 4/4
  • Drugs?
  • If you don’t have a bedside table, find something sturdy so you can reach everything as you need it. You’ll maybe need a tray for the bed too.
  • Pay all the bills, or find a way of managing this in advance, so you don’t have to deal with it during recovery.
  • Distribute a spare set of keys to one or more friends, so you’re not having to answer the door.

of breast tissue along the pectoral curve of the chest, the top surgery procedure draws directly from the techniques of mastectomy and breast reconstruction/ augmentation. I fear that the comparison of trans surgeries with the experiences of women undergoing breast cancer surgery is an uncomfortable and rather brutal flattening of crucial differences. Nonetheless, the surgical parity is there: the removal, reconstruction, and adaptation of elements of the chest area.

As prevention against the advancement of breast cancer, mastectomy began prior to the invention of anaesthetic. Novelist and playwright Fanny Burney wrote to her sister, Esther, in 1812, describing the memory of her own procedure, blow by blow and in sharp focus: “I felt the instrument—describing a curve—cutting against the grain.” Burney’s twelve-page letter, kept in the British Library and available online, is exhaustive in its detail and is interrupted only by a short empathic sidebar from Burney’s husband, who notes to Esther that reading the contents of her letter “almost killed me… I don’t flatter myself I could have got through it.” Burney lived an- other twenty-nine years after her successful surgery.

Augmentation emerged as an operation to replace or reconstruct the breasts of postmastectomy

  • Organize who will help you leave the hospital and get home. Hospital might not discharge you otherwise.
  • If friends want to visit early on in your recovery, give them an estimate of how long you think you can engage with visits when they first arrive, so you leave enough time for rest. Do not try to host.
  • This is an important one, especially if you don’t like relying on other people in your daily life: You can make an ongoing to-do list that is either in the flat or circulated with friends online, so that everyone can see it, and they can just select things they want to / can do and tick them off your list, so you don’t have to keep asking for things one by one.

patients and later gained popularity as an elective surgery. Elective, cosmetic, and aesthetic surgery: the history of such procedures has long been associated with histories of war, race, criminality, and sexual deviancy. It is about reintegrating bodies and correcting deformity—making them legible within the wider social context. It is no surprise, then, that medical historian Sander L. Gilman associates the cultural switch in American desire for the small breasts of the “sportswoman” to the new diagnosis of hypomastia, or the underdevelopment of the breast. Gilman adds, “during the 1930s and 1940s the ‘primitive’ racialized breast came to be seen as the erotic breast.”

The first recorded FTM surgery I could find was a combination of the much more complex procedure of phalloplasty accompanied by top surgery. This operation took place in 1945—though I presume that top surgery as a single procedure predates this operation. Certainly, by the 1970s, it was common. I return to the internet to look at cached archives of surgeon’s websites as far back as I can find

This list might be made up of the following:
  • Trash / recycling take out
  • Laundry
  • Changing your sheets / pillowcases
  • Buying toilet paper
  • Vacuuming
  • Help in and out of the shower
  • Prescription pickups, helping you keep track, writing it down for you

them. On Dr. Michael Brownstein’s old homepage from 1999, I watch a large, mesmeric GIF of an ethereal blue-skinned body dissolving from Amazonian full-breasted bust to superhero pectoral sculpture and back again. The early web aesthetics of these pages seem directly inspired by the aspirational graininess of the star-strewn Netscape icon, come only a few years after the Dancing Baby GIF (aka sk_baby. max), and precede James Cameron’s Avatar by a de- cade. Brownstein was an early pioneer of the procedure, had Lou Sullivan as one of his patients, and averaged two hundred top surgeries per year.

Around the time Brownstein’s GIF first made its way onto the internet—and before I had boobs— my father was taking me on trips to the National Galleries of Scotland, the large Parthenon-like building at the bottom of the Mound in Edinburgh. One of the paintings there, rendered in the style of high Italian Renaissance just before it tipped into the gloopy bodily exuberance of Mannerism, was Giovanni Busi Cariani’s Portrait of a Young Woman as Saint Agatha from 1516–17. My dad and I would stand in front of it, agape at the image of this impersonation of a martyr. The painting depicts a young

  • Company for doctor’s appointments and take notes
  • Food you like that people will make / bring round for your freezer / buy / eat with you
  • Leave money in the hall or kitchen in case people need it for corner shop runs.
  • Get movie recommendations from friends that you can watch alone or together.

woman tilting a clear glass dish up to the viewer. The plate contains a pair of severed breasts delicately resting, nipples upward, like two helpings of blushing panna cotta. The chest area of the woman is obscured by her arm, whose tilting wrist protectively covers the breasts as if keeping them shaded from sun. The story goes that Agatha turned down the overtures of a Roman governor in favor of her vow of chastity. For her refusal, she was punished. The most infamous of her tortures was the removal of her breasts. Like her severed parts, Agatha’s life has been carved up into interpretations of her worst sufferings (imprisonment, whipping, stretching, rape, breast removal, not to mention the fact that Mount Etna was erupting around that time too—so immolation was posthumously added to the list as a proximate agony). Her biography thus services multiple and sometimes disparate communities: survivors of sexual assault, firefighters, bakers, bell founders, women with breast cancer, and wet nurses. When I returned to this painting recently, for the first time I noticed the side-eye of the sitter. Her single-arched eyebrow beholds a viewer lesser-than. A different shade.

  • Ask for pre-meds. My general anaesthetic was quite painful until I passed out. I should have asked for something.
  • Doctor refused to prescribe me Vicodin or Percocet for recovery. 😦 Probably for the best but I was hoping…
  • Taking paracetamol as a secondary drug really helped, as it extended the effects of morphine and ibuprofen.
  • Homeopathic stuff did absolutely nothing for me (was taking arnica and bromelain).
  • Wish I’d organized a THC and CBD vape in time. CBD oil tastes terrible but felt great. Trial your CBD beforehand to make sure you don’t have adverse reactions like anxiety.
  • Probiotics and multivitamins suit some people. Check with the doctor.

My doctor comes in to say “Hi” before we go into the operating room. He brings a Sharpie and adds some incision guidelines on my skin. In a tone of absentmindedness, he asks if he can write a note-to-self on my chest, to which I agree. He scribbles something. His writing is too high for me to see upside down, so I ask Alexis and Emmie what it says. “It says ‘NIPPLES.’” Below the text are two arrows pointing to blank spaces on my chest, and not in exactly equidistant areas. I ask the doctor if his note is in case he forgets them, and he laughs. “No, I just want to remember that you want them flat.” I have little memory of the rest. I cry a bit because I imagine myself dying at the center of a melodrama of my own making, but I also cry because the anaesthetic burns as it floods my veins. I remember Charlotte’s story of trying to think of somewhere nice, so I try to think of swimming in Greece, but the anesthesiologist keeps on talking about his own disastrous holiday that had a connecting flight delayed in Newcastle, which becomes the focus of my last thoughts before surgery.

  • Make friends aware of any food allergies and intolerances, especially if they’re bringing food or cooking for you.
  • No car trips unless you can help it. Seatbelts and potholes will unzip you. If needed, bring a pillow so you have something to hold on to.
  • Check your meds for any bad interactions. Sometimes grapefruit juice can be a problem with certain drugs. If you’re too foggy, ask a friend to check.

The morphine was amazing, but I also knew my daytime nurse in particular was a dream: attentive, sympathetic, and with cheery chat. But the night nurse wants an easy shift. She is attempting to foreclose potential wants and needs by treating me briskly and negatively, so I won’t want to ask her for things. No, you can’t have any more morphine; no, you can’t have that until the next shift; no, your cannula has to stay in until the next nurse can come and take it out in an hour or so because to be honest I just don’t have the time.

One of the other patients starts throwing up because of a bad reaction to his morphine, so the nurse rushes back to me with an antinausea pill as if his vomiting might be contagious. “You need to take it.” “I’m fine,” I say. She insists. I explain that when I woke up from surgery, I ate porridge, an apple, some toast, scrambled eggs, Diet Pepsi, apple juice, orange juice, coffee, two biscuits, fizzy water, an energy bar, and some pineapple slices. I ordered my à la carte while high, ate it all, and haven’t seen any of it since. I resist the nurse a bit in a bid to per- form a thin sliver of negative autonomy, then realize it is easier to swallow. Then she flushes my syringes into my hand hard and fast, the vein ballooning

  • Plastic straws. Basically illegal now but can still be found.
  • Fresh fruit and veg you will actually eat. Be honest, not optimistic.
  • Protein powders.

under my skin. “That’ll hurt a little bit,” she says and then leaves the room.

The doctor never told me my new nipples would be stapled on. I would have feared less for them falling off had I known, though the appointment to have the staples removed without anaesthetic sends Emmie, who has taken a seat in the corner of the room that is closest to the door, ashen-faced. The drugs have long worn off, and I am alarmed at how alive my chest feels. The vessels are dilated, throbbing and radiating heat. My chest spurts a bit as the staples come out. Before I leave, the hospital gives me an upgrade of the bloodied Tubigrip binder I woke up in seven days ago. This new one has a soft Velcro outer and matte flat inner, in a sandy color that reminds me of the nicotine-stained Atari computers I used when I was younger. The doctor calls this new neoprene binder “a bit more lux,” though it soon feels like I’ve been rolled up in rug made out of recycled teddy bears. After a few minutes, I feel beads of sweat lubricate the thin space between my swollen skin and the rubber binder. Nonetheless, with my chest no longer zealously overwrapped with packing tape and staples, and feeling a surge of adrenaline, I insist on taking an unscheduled three-hour detour walk in the direction of the Airbnb, along a coastal route called Daddyhole. It ends in town, and we stop off for happy hour margaritas. I slur my words and stagger home, so I can swap the hospital flaps

  • Cafés
  • Trips to the park, even if the weather is bad. The basic elements will feel amazing after days of bed.
  • Taking you shopping, but make sure you have a get-out plan if your energy drops or pain comes on.
  • Watching films at home, especially with those with whom it doesn’t matter if you fall asleep and they can just let themselves out or do sleepovers.

for something more breathable: a thin white binder I bought from Come As You Are, an unbearably worthy worker-owned cooperative sex shop that provides this item under the webpage category “Gender Gear.” Filled with uncommon gratitude and tequila, I leave a generous review on the website, hoping that potential buyers will be able to forgo my experience of sweaty carpet rolling and smell of damp rubber. Later on, I wash and keep all three binders, rolled up like sacred scrolls, in my grandmother’s oversized jewelry box.

I open my laptop, turn off my out-of-office reply, and start responding to a stacked inbox with apologies: Sorry it took me a while to get back to you after surgery, sorry I’m on painkillers so I’m a bit foggy, sorry I’ve come off painkillers so my attention is diffuse. Friends and colleagues whom I’ve either forgotten to tell, or with whom I’ve been too distant to initiate a longer, more complicated version about gender, etc., begin to answer their replies with “Sorry to hear about the surgery,” “Sorry to hear you’re sick,” “Sorry, what’s wrong?” I smile when someone texts “taps aff!”

I work through a backlog of Google Docs while massaging my scars, interrupted every now and then by an unnerving popping sound. Initially I think it’s

  • Longform
  • Casefile
  • Burn It All Down
  • Edge of Sports
  • Reply All
  • Serial
  • Heavyweight
  • Ear Hustle
  • Where Should We Begin
  • Crimetown
  • ESPN 30 for 30
  • The Dropout

the joints in my fingers, but then I realize it’s undissolved stitches below the skin, snapping under the pressure of my fingers like bubble wrap. One day, part of the scar goes black. A self-indulgent diagnosis of gangrene, trench foot, and sepsis seems the most likely—all the things my dad warned me about when I was fourteen years old and trying to get a consent form for a body piercing. Turns out it’s just a blood bruise buried beneath the scar. In a glib sense, the reality of the healing is banal.

  • Ariana Grande. It was all my brain could handle. Don’t judge me.


A version of this text appears in Oreet Ashery: How We Die Is How We Live Only More So, Mousse, 2019.




















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