M to F; Surgery
If you are wondering how to undertake male to female gender reassignment surgery (GRS) then this may just help you along the way; take this as a temporal guide as to how I went from not having a clue about surgery to being a week or so post-op. This second part covers the surgery itself. You can find the first installment here: M to F; Prep.
Please keep in mind that for this segment, surgery, this is all based on my experience; my surgery, my surgeon and my stay at Masada Private Hospital in Melbourne, Australia. Wherever you go, whether if be a clinic in Bangkok, or seeing Dr. Marci Bowers in California, your experience will be different, you will respond differently, your surgeon and hospital’s approach to everything will be subtly, or not so subtly, different. This is not meant as a definitive rule book on surgery, more as guidelines, the lines that exist in a paint by numbers colouring book that you fill in yourself.
First, just a statement; you are about to do the most selfish thing in your life. At every step you must do what makes you happy, what you are comfortable with. Do not, under any circumstances be swayed by peer pressure…this is all about you and no one else.
T - 1 Day
Things are getting real at this point. Two items for today, the first being the last set of blood tests before the surgery, this time a full blood exam (FBE) along with blood matching in case of needing a blood transfusion the next day. And the second is the, frankly, yucky, bowel prep.
You aren’t likely to be, pooing in slang parlance, or having a bowel movement if you are in the profession, for a week or so, so the need for a very clean bowel is paramount. It commences at 6 PM with four tablets and an enema drink, all followed by water every hour and then a final enema drink at 9 PM. This will take you to maybe midnight, perhaps sometime after. And yes you will have a very clean bowel.
You are now ready for the big reveal.
T - 0 Day
On admission they will run through all your details, question your travel history for infectious diseases, and start getting you ready for surgery. This will consist of a natty surgical gown (your new fashion item du jour) and surgical stockings. The latter are to reduce the chances of deep vein thrombosis; you will be lying down for a week, and after abdominal surgery this is a very real risk. Finally if you have any jewellry that can’t be removed, it will be taped down to avoid any spark risks.
Shortly before the scheduled surgery time you will be escorted to theatre where they will re-run through all your details to make sure you are who you supposed to be and you know what is coming.
Once on the operating table you will be wired for all your vitals, a cannula will be put in a vein, the anesthetic will be administered…
…4 something hours later you will be moved to recovery.
You may or may not remember much of recovery (I didn’t), they will make sure you are coming out of the surgery OK, and the effects of the anesthetic are under control (mine weren’t).
Next stop your new home for a week; the ward. At this point you will have a dressing around your groin, an IV in your arm, a drain for the wound, a catheter and cuffs around your calves that fill with air and squeeze your legs. (The technical term for these cuffs is intermittent pneumatic compression devices.)
Your new routine will now start to overlay your life. Observations (obs) every two hours; blood pressure, heart rate, oxygenation and temperature. They will also start to administer broad spectrum antibiotics and painkillers.
Only things you now need to do are basically stay lying flat and drink as much water as you can; hydration is very, very important.
T + 1 Day
Dazed and confused may be an apt term for the day. The obs will continue, they will start to bring food, they will fill your water jug whenever you ask, the antibiotics and painkillers will keep coming, and they will ask your pain score (a scale of 1 to 10 how much pain are you in). Your surgeon will likely pop in and see how you are doing. Expect to see them everyday till your discharge.
Today is where you discover that movement in bed is hard, and you will be using parts of your body that you didn’t know you would ever need; to do things that you took for granted, like eat or drink. This is also the point where any work you did on fitness and strength will pay off in spades; being able to move yourself around by dint of your elbows is a god send.
Finally if you struggle to sleep on your back and need to be on your side, make sure you have a pillow between your legs to reduce pressure on the wound.
That is pretty much it for the day.
T + 2 Day
Personal pet tips - firstly be as polite as possible to the nurses, please and thank yous go along way. Secondly start to take an interest in your obs and your medication. Blithely not paying attention to how your condition is progressing isn’t too grand an idea.
Depending on how much you knew your vital signs before surgery, it is likely you will see a marked difference in them. Heart rate will be accelerated and your blood pressure could be scarily low (92/48 was my lowest). Your blood pressure will drop due to blood loss in surgery, lack of water (see previous point about hydration) and your extended period of being prone. What you don’t want changing is your temperature, an elevated temp will be a sign of an infection and that is bad news.
Everything else is rinse and repeat the previous day, now with added post-op blood tests. That is all you can really do.
T + 3 Day
Big day, you will likely be asked to stand. Just 30 secs, so no big deal. More like you’ve just been presented with a moonshot and all you have is a bit of string and tape. No really, 30 seconds will seem like a lifetime.
To get off the bed will require new found gymnastics skills; you can’t roll your legs off the bed and sit up normally as that will put pressure on the wound, you will need to effect a rolling motion with you legs and hips, and push off with your hands to get standing. Don’t worry the nurses (three for me, but then I am 6' tall and weigh 200 lbs) will be there to catch and put you gently back into bed if needed.
If you collapse on the first attempt then don’t be disheartened as that is quite normal. You’ve been through major surgery and not moved for two days; what do you expect?
Lastly you will possibly be started on blood thinners. DVT is still a threat at this point and you need all the help you can get.
T + 4 Day
More standing is the order of the day; twice will be the aim, this time for a bit longer, say a minute or two. The nurses will be there for you, just like the first time. You may be asked to do some on the spot marching and perhaps a few steps around the room.
For all of the standing and the steps don’t over do it. If you feel dizzy sit down. This is not a race or competition. The only thing you will be beating is yourself.
The obs, food and drinking routine will now be settled in. You may even start to be able to tell the time by what drugs you are being given and the shift changes of the nurses.
T + 5 Day
More standing is the order of the day; three will be the aim. If you are moving well enough, perhaps a crack at cleaning your teeth in front of a mirror as opposed to in bed.
Hopefully everything else is just ticking over; blood pressure in a good place, heart rate stabilised, cannula still there. But don’t be overly alarmed if things are bouncing around and nurses are having pokes and prods with needles and things; they are just doing their job.
T + 6 Day
All going well then this is the big, big reveal; dressing removal day. You will perhaps be given a tablet or two that acts as a muscle relaxant. It is much easier to peel the sticky bandages off and remove the sutures that have held the dressing in place if your muscles are relaxed. The surgeon will have a good look at their handiwork, hopefully their response is positive.
And now sleep.
Once you awake it will be time for some more standing and walking and perhaps you will have the luxury of a shower; if you move enough and walk enough, then all of your remaining accouterments (catheter and IV) can be decamped into the shower room and finally normality (whatever and wherever you can find it) will start to return. A salt bath will also be on the agenda (as a nurse said to me, salt helps everything). Part of your regime going forward will be at least two salt baths a day.
Oh. And other things will start to return to normality, like bowel movements. You may be given drugs to assist this process along, but once it does then you will need to make sure the mould that is being used to support the size and shape of your new vagina is removed and you follow it up with a salt bath. You may also need to re-learn how to wipe; not smart to go back to front now.
Post salt bath, time to get that mould back in; and also the first time for some exploratory wandering to see where things are…you will need to do this to help get the mould home (honestly!!). Don’t worry if you can’t get the mould in easily or first time. Remember this is a new part of your anatomy, you will get there. And yes the nurse can help, but if they do the heavy lifting who is that helping?
T + 7 Day
Catheter out and IV off; you are free. The IV cannula will stay in just in case they need to get you back on a drop again (frankly with the effort it takes to put a cannula in i’m surprised we aren’t surgically fitted with them Matrix like).
The warning I was given for the catheter being taken out was “it will be a weird feeling.” That is all i can say. It is a weird feeling. Next weird feeling is peeing sitting down. There will also be the final addition to your drug regime; this will help you pee. Due to swelling it may be hard to actually go, and this will address that.
The rest of the day will be starting to get back to normal. With the added pleasure of salt baths after most toilet visits.
T +8 Day
If, and only if, everything is good; bloods good, blood pressure good, temp good, you’ve shown you can bath yourself and change your mould yourself, you can stand, you can walk, then you can go home.
The cannula will be removed, there will be a final run through of your paperwork, your drug regime over the next week or two and another run through of your hygiene steps.
Now you can go.
The Rest of your life just opened up ahead of you (I felt like Sarah Connor at the end of Terminator 2).