Facial Surgery, Round 2

In mid-2017, I met with my surgeon at Kaiser, Dr. Andrew Kleinberger, as arranged by the Multi-Specialty Transitions Clinic.  We worked out what I needed for my facial appearance in the way of surgical changes.  A CT scan of my head was arranged to gather data the doctor would need in guiding his work.  

The doctor broke down the needed work, totaling some 14 hours of surgery, to be done in two parts.  The first stage, involving bone and cartilage work from forehead to jaw was about 8 hours worth, and the second portion, adjusting soft tissues to match the new bone structure and making some changes to alter the throat cartilage was estimated at about 6 hours of surgery time.  The two surgeries would be at least a year apart to allow adequate recovery and healing of the bone before shifting the soft tissue.

The first surgery was done in late August of 2018, and is documented here.

https://michellepaquette.blogspot.com/2018/08/my-recent-surgery.html

The second stage surgery was performed on March 9, 2020.

We arrived at Kaiser Oakland at 6 AM for checkin and preop stuff.  I was quickly tagged and after a few minutes was back in the pre-op area to be weighed, measured, plumbed and wired for surgery.  I was in the usual little hospital bed, the Gown of Embarassment donned and ready in just a few minutes.  They had that lovely warm air blanked already running and hot, which felt very good indeed.

Because of the time I would be on the OR table, special pads were placed on my rear and shins, something new to me.  The usual EKG wires were placed, and an IV run into my left hand.  Blood pressure was through the roof initially, so I spent a little time in breath meditation to bring this under control.

Laurie was brought back to help me relax a bit, and we chatted about nothing in particular, she trying mostly to reassure me all would be well.

Dr Kathy Brandstetter came by about 7:30, along with a newer doctor on the team, to place guide marks for surgery on my neck and face.  Both had excellent bedside manners, quite reassuring.   They explained that Dr. Kleinberger was a little late and I would see him in surgery.

My anesthesiologist came by, and we discussed what would be done, the broad sequence of events, IV + oxygen + gas, intubation once I was well sedated, and that the tube would be removed post-op, likely before I would be able to remember.  We discussed nausea control and whether or not the anti-nausea patch would be a good idea.  Oh, I got the patch, unlike the first round, and it worked very well!

At 8 AM I was rolled away, saying good bye to Laurie until I was done.  I had the easy job and would be asleep.  Laurie got to sit in the waiting area watching the status board for color changes next to my tracking number.

I was rolled into OR6, still wide awake.  “Good morning, Dr. Kleinberger!”  Three surgeons (one in training), anesthesiologist, scrub nurse, assisting nurses, all circulating around me!  I was shifted onto the surgery table, positioned, armrests attached and my arms lightly fastened down.   My head was on a foam doughnut and chux pad, giving me a great view of the upside-down anesthesiologist and some huge adjustable surgery lights.

The recorder started, all present checked in.  “Michelle, do you you understand what we are about to do?”  “Yes, sir.  Rhytidectomy and chondrolaryngioplasty.”  Basically, a lower facelift and trach shave, as we had discussed a few years ago.  The other stations gave their reports.

“We are ready to begin.”  The anesthesiologist placed the mask and started the oxygen feed.  The doctor mentioned that he would not intubate until after the chondrolaryngioplasty.  (They need to use probes to verify that the incision on the cartilage would not impact the attachment point of the vocal folds.)  Position would be shifted 180 degrees after the chondrolaryngioplasty.  

The smell of the gas suddenly changed.  The room gently spun and faded from view.

I woke in the recovery area about 4 PM.  I felt more than a little spacey, and was thoroughly bandaged up.

I was told that the surgery had gone well, and I would be shifted upstairs for an overnight stay shortly.  I gathered that a Foley catheter had been placed for the hours of surgery, and had been removed about half an hour before.   Laurie was able to join me in post-op, although I don’t remember too much.

At some point we were rolled upstairs to the 11th floor.  I was placed in my room, met the staff, told I would be on a liquid diet, and was asked to watch a couple of videos on fall safety and the hospital stay.

After a few hours they had me out of the bed, and with the aid of a walker made a lap of the floor.  I managed to demonstrate bladder function to their satisfaction, so I was not catheterized (Yay!), and drank my juice and water.

Laurie would be sleeping in my room with me,k a great comfort.  I drifted off after being given two Tylenol for pain control.  I woke just about midnight as the night nurse came in to start an antibiotic IV going.  Pain was ramping up, and I was given 5 mg oxycodone.  This got me to sleep more easily, although the BP checks at 2AM and 5AM woke me again.  

About 7:30 two other doctors on the ‘head and neck’ surgery team came by on their rounds and changed the dressings, showing me how to tend to this.   The dietician came by for my breakfast order... cream of rice or cream of wheat... Decisions, decisions...

The discharge orders were in by 8:30 and a Percocet prescription was ordered for me.  Laurie went down to pick this up.  By 10:30 I was getting dressed, and Laurie went to get the car while I waited for the nurse to take out the IV line and the escort to roll me out of the building in the usual transport chair.

It all went smoothly, and I was home by 11:30.  Oh, breakfast never showed, but Laurie and I had some steel cut oats once home.

The first two days I used a Percocet every 6 hours just to ensure I was comfortable.  The third morning  I switched to one 325 mg Tylenol and stayed with that a few days, just taking a Percocet at bedtime.  

I’ve adjusted my bed to raise the head a foot and have been using a few pillows to support myself.  The elevated position lowers pressure at the surgery site and promotes drainage.  Everything is healing nicely, and the stitches come out Monday, a week after surgery.

I’m back to eating solid food, and the soreness in the jawline and throat congestion from probes and intubation is almost gone.

I’m just waiting for a little bruising and swelling to fade away.

I think I’ll be happy with the result.

#TransLoveStories: Michelle and Laurie's Story

Michelle’s Story

Our current culture likes to tuck people into little boxes for matchmaking, and my little box was pretty unlikely to match.  I'm in my 60s, a woman, identifying as femme, attracted to femme, a demisexual sapphic queer person, with a transgender history.  Sapphic, old, femme, and trans is pretty much an undatable combination.  Only 9% of lesbians would even consider dating a trans person, and 0% over 60.  Femme is generally shunned except by other femmes. I was resigned to living alone as the cost of my transition.

I did have online friends, folks I could message privately and chat with through online forums.  I spent some time moderating a few forums, and that meant interacting online with other moderators to solve problems and keep things running smoothly.  I found myself interacting with another of these moderators frequently, and my chats with Laurie often drifted from the task at hand to more friendly banter.

Now, Laurie liked driving and road trips, and had described long trips across the country that she had taken.  I had never done such a trip since I was a child, beyond a few trips up and down the West Coast.  We bantered about her coming to my area, and how I would get a new room ready for her in the place I had just bought.  It would need to be suitably equipped, with the proper eyebolt and restraints, I joked.  She went along with the joking, adding touches about needing to hunt me down.  

It turned out that she was serious about wanting to visit, but didn’t have my address yet.  I provided that, and finished getting my guest bedroom ready for company.  

Laurie drove overnight to get here, several hundred miles, and I was very happy when she made it here safely.  Perhaps a bit too happy, for when I saw her in the building lobby, according to her I launched myself through the air and knocked the wind out of her with that first hug!

We spent several days together, sharing meals, talking, and walking through the neighborhood.  I felt close to her, connected in some ways by common experiences in our lives, from childhood through the losses we had as part of coming out.  At the dinner table, a few times Laurie would step behind me and rub my shoulders, helping ease the muscle tension that I often had.  After a few times, this developed a bit of a tingle in me, a sense of something waking!  I think she had managed to establish an emotional or romantic connection to me, even if unintentional.

Oh, I responded, tilting my head back, eyes closed and lips pursed.  Nothing.  As she rubbed my shoulders another time, I reached back and stroked her legs.  Nada. Zip.  

I didn’t know if she was uninterested, not getting the message, or perhaps something else.  I was a bit frustrated, as Laurie had managed to make that connection that my demisexual nature needed and, well, urges were awakening.  Her visit was coming to a close, and i resolved to do something.

We took her bags down to her truck and loaded them.  We talked for a few minutes, and she gave me a hug in farewell.  I took her face in my hands, and kissed her on the lips, not a peck but something lingering.  That startled her.  We talked for a few more minutes, where I tried to explain that I had some feelings for her.  Time to go, we hugged again, and once again I kissed her.

As she drove away I teared up a bit, but on her long drive she frequently paused and messaged me.  Apparently I had given her something to think about on the long drive home, and she rather liked the idea.

Laurie was back in a few weeks, in my home and in my life, and we have been together far more than apart ever since, sharing road trips, cruises, meeting new friends together, and loving life and each other.

We recently became engaged, exchanging rings on a cruise to Hawaii, and are enjoying life with one another.  We just celebrated our two year ‘Smoochiversary’, two years since that first kiss by her truck.

Laurie’s Story

I'm Laurie and I vouch for this story. I was there. It's true. And I am thankful Michelle came into my life when she did. What she did not mention is that, I believe she was instrumental in my being here today. 

You see, I was just beginning to emerge from a deep depression. By my reckoning, I had 2 -3 weeks left to live. Antidepressants had just begun to work and had allowed me to make this visit. I had not yet given up my plan to end my life in a tranquil forest grove once spring had sprung. Surrounded by emerging new spring growth and quiet sounds of life all around me I intended to end my life with a shotgun shell so I could once again be at peace with myself. 

Michele changed all of that and gave me a reason to live. I once again had a purpose in life and someone to live it with. I love her and she loves me. Life is good (ok better) again. Thanks to finding a love I was not looking for. 

Thank you, Michelle. I love you. 💘💝💝💞

#TransLoveStories

Education Time! “They” vs “he or she” vs “He/she/they” vs...

Gender neutral language is not about “not offending folks because everyone ie so easily offended these days.”  It is about recognizing that our world is much more complex than we have considered, and including those who were excluded.

The old “he or she” constructs we use at least admitted that “he” really didn’t cover all the bases once our culture granted women some equality, but it still assumes a binary gender model, something we know is incorrect.  Gender is a bimodal distribution, with peaks near the cultural standard male and female genders, but plenty of space in between and outside.

There is an easy fix, fortunately.  In 1275 the word “they” was first used as a singular indeterminate pronoun, and by the 14th century the genderless term was in common use.  It wasn’t until 1745, in “A New Grammar”, that the use of “he” to refer to a person of any gender was introduced, with some heavy rationalization about it being related to the genderless original sense of the word “man” in Germanic languages.   While considered grammatically correct, the genderless “he” may also be considered a violation of gender agreement.

The construct “he or she” is a clumsy attempt to recognize that “he” and “man” really are not considered genderless, and to try and de-weaponize the use of “he” in to exclude other genders.  The “Persons” case in Canada tried to deny seating female Senators around the reinterpretation of “he” as a gendered pronoun, as did the Massachusetts Medical Society’s refusal to admit female doctors, for example.

Now we have an even more diverse set of recognized genders, with California IDs and birth certificates following the lead of other states and permitting gender-neutral birth certificates and IDs, to cover any of a vast range of genders.

Similarly, we have the singular “they”, a pronoun on the shelf and ready for use since 1275!

Writers should use the singular “they” in two main cases:
(a) when referring to a generic person whose gender is unknown or irrelevant to the context and 
(b) when referring to a specific, known person who uses “they” as their pronoun.
 - APA Style Guide

It is not necessary or desirable to use inadequate constructs such as “he or she”, nor the very clumsy “he/she/they”, as “they” is already appropriate for an unspecified, unknown or irrelevant gender.  “He/she/they” is also annoying in that it privileges persons identifying with the normative binary genders by having their genders specially called out, in addition to the “they” used for unspecified gender.

Navigating the Social Minefield

We are the summation of all our life experience, including that which results from the sex assigned at birth.

I personally reject the idea that the sex assigned at birth determines all of my identity, drawing a hard boundary around the gender role and presentation I am permitted, and forcing me to remain in one little box of gender identity.

I am aware of the potentialities of biology and biochemistry, and understand the path this body has taken from conception onward, resulting in a person who has transcended the boundaries that this culture draws around gender identity, presentation, and role.  My awareness demands that I reject the ideologies that declare assigned sex at birth to be all, or even the primary determinant as to which cultural boundaries I must remain within.

I recognize that there are those whose ideology demands that they deny the validity of my experience, and who demand that I remain within the bounds set by assigned sex at birth.

I also recognize that there are those who accept part of my path and my experience, but for whom my origin and experience are insufficiently pure, ideologically unacceptable in summation, to be worthy of their chosen labels.

These various interacting ideologies and prejudgements make social interactions a bit of a minefield. Living in a culture that insists on a gender binary, and only accepts a narrow set of paths through life can lead to someone like me being rejected or viewed as undesirable by some others.  While I personally do push hard for acceptance and recognition that people like me are human and valid, I don’t do this to deliberately others cause discomfort in others. I wouldn’t be comfortable pushing into a crowd that rejects my right to exist as myself.

I would, for example, no more demand entry to a “womyn-born-womyn” event than I would try to attend a Klu Klux Klan rally, for similar reasons.  I’d be encountering people whose ideology denies the validity of my existence, and who would not be swayed by my presence.

I do have to be mindful that not all such groups label themselves clearly, and am careful to reach out to organizers in advance to make sure my attendance won’t cause difficulties.  I’ve run into situations where a group might tolerate me, but other individuals there are uncomfortable with my presence.  I generally will drop such groups, rather than have my presence cause issues.

This is an area that lies outside the experience of the typical white upper-middle-class cisgender woman, but is a part of my life.  I am somewhat social and extroverted, and can’t really live my life closeted to avoid causing discomfort to others.

Transgender Day of Remembrance 2019: Speech at Todos Santos Plaza with Rainbow Community Center

Welcome!  I am Michelle Paquette, and my pronouns are she/her/hers.   I am a person who transcends cultural gender boundaries, that is, I am a transgender person. In my case, as in many others, when I was born the regions of the brain that mediate perception of my body didn’t match the sex assigned to my body.  To put it simply, my body didn’t fit my gender identity.  We try to reconcile this as best we can, adjusting our gender presentation, roles, perhaps even through medical care.

This mismatch occurs slightly less often than natural redheads do, a normal if infrequent expression of biological diversity.  Transgender people are normal, if not common, but are also the target of pervasive and persistent violence for simply existing.

"Transgender Day of Remembrance seeks to highlight the losses we face due to anti-transgender bigotry and violence.“, said founder Gwendolyn Ann Smith,  who started this day in 1999 as a vigil to honor the memory of Rita Hester, killed in 1998, and all those killed through violence.  She continued “...it is vitally important that those we lose are remembered, and that we continue to fight for justice."

Transgender people are a living study in intersectionality.  All transgender people can be the target of transmisia,  Transmisia is prejudice plus power, systemized discrimination or antagonism directed against transgender/nonbinary/genderqueer/agender persons.  Historically, 17 percent of all reported violent hate crimes against LGBTQ people are directed against those who identified themselves as transgender.

Now, add into this systemic misogyny, entrenched prejudices against women within this culture, doubly impacting all transgender persons with a femme presentation. About two-thirds of all reported violent hate crimes against transgender people are aimed at transgender women and femmes.

Next, add into this systemic racism, embedded in all social institutions, structures, and social relations within our society, which triply impacts transgender women and femmes of color.  Historically, over 80 percent of murdered transgender women are persons of color.

Transgender Americans experience poverty at double the rate of the general population, and transgender people of color experience even higher rates.  We have an unemployment rate three times the general population, and transgender people of color are unemployed at a rate of four times the general population.   Poverty and unemployment or underemployment impact transgender people’s housing and medical care, and so stability and quality of life. Those without access to stable housing and employment and left out on the streets are most vulnerable to violence.

We have seen the federal government act to permit discrimination against transgender persons everywhere from adoption services, through medical care, and even emergency shelter.  We have seen our government argue in the courts that gender identity discrimination is not a sex related discrimination, and that discrimination against transgender people is perfectly legal.

We have seen the government ban military service for transgender persons, who have served honorably, as I have.  We saw the government try to legally define gender to be irrevocably the sex assigned at birth.

We have seen propaganda campaigns that try to demonize transgender people, as part of a broad campaign to make simply living our lives more difficult.  We have seen a new campaign launched, built on curated misinformation and aimed at transgender children and student athletes.

Allies, no, accomplices, consider what author Imogen Binnie suggested a few years ago on Twitter: ask what the article or conversation would have trans people do. And “if the answer is something like ‘not be trans,’ please consider that most trans people have tried that and it didn’t work.” And if you are having a conversation in public or private that at its core is debating whether a person should exist, please re-consider the value of that conversation.

These campaigns impact transgender youth disproportionately.

   

“Every day they have to hear these terrible things. They are less than a person, they can’t count, they can’t use the bathroom of their choice, they can get fired just for being who they are,” said Alexis Chavez of the Trevor Project.  The Project’s research has shown some disturbing results: More than half of transgender youths have seriously considered suicide; 78% reported being the subject of discrimination because of their identity.

Since January 1 in the United States, 22 transgender or gender non-conforming people were fatally shot or killed by other violent means. We say at least because too often these stories go unreported -- or misreported. 

Worldwide, in the one year period ending October first, at least three hundred sixty-eight (368) transgender persons died in violence.  Thirty of these were in the United States, including deaths from violence under suspicious circumstances, and five more driven to suicide that we know of.

We have been meeting like this for twenty years.  In that time, 3,317 trans and non-binary people have been recorded as dead through violence around the world.   Transgender women of color bear the brunt of this terrible burden. 

The visibility of transgender people can not be denied. We live in your neighborhoods.  We are doctors and lawyers, ministers and judges, sex workers and artists.  We are the same as everyone else.

We are here, and we will not be erased.    We will not be erased.

WE WILL NOT BE ERASED.

Call to Worship: Sacrifice and Refueling

Welcome!  I am Michelle Paquette, and  my pronouns are she/her/hers.

I want to tell you a story from my youth, a tale of sacrifice and support.  To understand this tale, I need to disclose a few things about myself.  I was born in 1953, and reached my teenage years in the late 1960s here in the Bay Area. I am also a person who transcends cultural gender boundaries, that is, I am a transgender person. In my case, as in many others, when I was born the regions of the brain that mediate perception of my body didn’t match the sex assigned to my body.  That is, my body didn’t fit my gender identity.

This mismatch occurs about as often as natural redheads do, a normal if infrequent expression of biological diversity.  

When I reached my teens, the changes that started to happen in my body were seen as incorrect by the brain’s perceptual network, triggering a strong and persistent sense that something was wrong.  The medical folks call this gender dysphoria.  Normally, if something was wrong or really bothering me I would have talked to my Mom or our parish priest for guidance, but observation and experience told me that this would be a really bad idea.   I had to sacrifice any expression of my authentic self, and hide beside a false front to avoid conflict at home.

Instead, I experimented.  I found that growing my hair out helped.  If I could dress in a more feminine style, that helped a bit.  I was discovering that shifting my gender presentation could be a coping mechanism, but it really wasn’t enough.  I couldn’t talk to anyone.

I did read the paper, though.  Eventually I read that something radical was happening over in San Francisco.  For an extra dime, the bus would take me over to the city.

I put on my flared jeans, my platform shoes (oh, yay 1960s!), and packed a rather BoHo top in my bag.  When I got to the TransBay Terminal, I ducked into a restroom, changed my shirt for the top, brushed my hair out, and took off into the city, just another 14 year old hippie chick.  I would repeat this trip many times in the next few years.

I found my way to the Tenderloin, and discovered others like me.  There were groups that gathered at Glide Memorial, and over on Van Ness at the “Center for Special Problems”.  Older women gave me the “Dutch Auntie” treatment, showing me where it was safe to go, where I could rest or eat, and how to avoid being arrested.  

The other teens were amazing.  I made friends, actual friends!  Some were living on their own, or in ‘group homes’ with a half dozen living together in a Tenderloin hotel room.  We talked, sharing and caring for one another.  We listened to one another.  We helped and protected one another.  

As the group dynamics shifted, we shifted our preferred hangout over to the Golden Gate Park panhandle and the growing community of nonconformists in the Haight-Ashbury neighborhood.  There, nobody seemed to care about our nature.   We could fold and stuff copies of a local paper for food or a place to crash.  Amazing music was everywhere.  And best of all, I got to just be myself, with others like me. These were the best days of my youth.

That gave me the strength to get through all the days I had to stay hidden, so my existence wouldn’t upset everyone around me at home and school.

I don’t have to hide any more.  The days of sacrificing my own existence to avoid upsets are behind me.  I am part of a community where we can support and spiritually refuel one another.  

Let’s look at how we do this today, as we worship together.

Call to Worship for November 3 “That Which Has Been Our Delight”

“That Which Has Been Our Delight”

Last week, while driving through White Pass in Washington, I was struck by the beautiful fall colors in the trees, brought on by a few nights of freezing temperatures.  The trees were marking the season, the end of burgeoning growth, a time of slowing in nature in preparation for the long sleep of winter.

This is also a time of year when we humans may pause, gathering in and perhaps celebrating the harvest, and as we pause, remembering the changes in our lives over the past year.  These changes may include those with us only in memory, and we can share those memories and celebrate their lives in ritual.

Many cultures have independently found ways to mark the changes that come into their lives and have their own unique ways of honoring the dead. 

Here in California, with our strong cultural ties to Mexico and it’s culture, we are somewhat familiar with Día de los Muertos.  The celebration emphasizes celebrating the lives of the deceased, complete with food, parades, dances and parties. Celebrants believe that on this day, the spirits of the dead return to take part in the celebrations alongside the living.

Samhain ( “s’ouen”)

My own family background includes a substantial Irish component, with my mother’s roots in clan Cusack, from County Meath, Ireland.  There, Samhain (“s’ouen”) has been celebrated for many centuries.

It is said that at this time of year the link between this world and the other is at its thinnest, and the dead may return to this world using doors of the sidhe (“shee”) so they could warm themselves amongst the living.

Feasts are held in honor of the dead, with a place set for ancestors who may visit from the other world. After the large supper, the untouched plate of food is placed outside to be left for the sidhe (“shee”).

"i Morti" in Italy

In Sicily, children hunt for treats left by loving relatives no longer around. In northern Italy people leave their homes empty in case the dead want to visit. All over the country, Italians set an empty place at the table for people who no longer sit there.

Obon Festival

A traditional Buddhist festival in Japan celebrated a few months ago, Obon commemorates lost ancestors, whose spirits are believed to return then to visit relatives.

Traditionally, lanterns are hung in front of houses to guide the ancestors' spirits, dances are performed, graves are visited and cleaned, and food offerings are made.  At the end of Obon, floating lanterns are put into rivers, lakes and seas in order to guide the spirits back into their world. The customs followed vary strongly from region to region.

Chuseok (chu-see-ok)

Chuseok (chu-see-ok) is one of Korea's largest national holidays,  celebrated a few weeks ago, and traditionally marking the fall harvest. Marked with dancing, games and food, Chuseok is also a time for Koreans to honor their ancestors, and during the three-day festival, the living give thanks to the dead for their part in providing bountiful crops.

I note these special days and rituals not to somehow conflate or colonize them, but simply to recognize that the need to remember those no longer with us, and celebrate their lives is a human thing, larger than any single faith or culture.

Today we, as a Unitarian Universalist congregation, continue our own tradition, keeping in mind the many other traditions of our world, as we celebrate That Which Has Been Our Delight and worship together.