July 2009


An integral part of the Trinidad GRS journey is Carol Cometto’s Morning After House — it’s officially a place to recover for a couple of days after surgery until you leave Trinidad, but in reality it’s a key part of mental and physical wellbeing and establishing and maintaining a culture around this amazing experience.

I’m writing separate blog entries about the people I met at the MAH, but suffice to say that their presence — made possible by the guest house — was absolutely crucial for our positive feelings about GRS in Trinidad.

Trinidad Sign

Trinidad Sign

Nestled just below the Trinidad sign, the MAH is a big, sprawling house with approximately 3 apartments with perhaps 6 bedrooms and a variety of common rooms, and it’s in these common spaces that the guests tell stories about how they got here, what surgery was like, what pains they’re having, and what their situation is like back home. You can imagine that such a gathering is nothing like your average group of hotel guests out on the highway Motel 6, and that’s obviously because they’re not here simply to get a night’s rest, but rather because they’re all on a really big journey that takes similar paths through their individual lives to bring them to this point.

Carol
The guest house runs on high octane goodwill provided by Carol Cometto, an italian dynamo who has decorated the house to reflect her sensibilities. She zips around town in a little blue jeep with a New York Yankees spare tire cover on the back with a gusto that’s palpable, waving to her lifelong neighbors, gesturing a variety of gestures to passersby, and generally racing around town to get her business done. When she’s at the MAH, she’s watering plants, checking on guests, orienting new guests, saying farewell to departing guests, showing off her yard-sale acquisitions that make her decor jump to life. She’s your friend and hostess, and she makes you feel at home.

When we arrived, Mary Jo and I stayed downstairs for 1 or 2 days, then moved upstairs, and this is one of the logistical issues Carol spends her time figuring out — how to keep families and friends together while also shifting people around while the patient is in the hospital for 4 days, then minimizing the fatigue when someone returns from the hospital. I suppose some could see this juggling as a hassle, but we found it to be a pleasant experience that put us into a community of other travelers with similar issues.

I have read accounts of GRS in Trinidad that argue one should save money and avoid the MAH as much as possible, but I feel strongly that this would be a short-sighted approach to your Trinidad visit. Sure, you might save a few hundred dollars, but you would lose incredible benefits of getting to see others pursuing the same course as you. Instead of staying in a hotel on the highway before surgery and moving back to that hotel after your 2 free days at the Morning After House, I think you should spend your entire trip to Trinidad at the MAH.

When you arrive, for example, you’re dipping your toes into a stream of other visitors, from those who arrived yesterday and are awaiting surgery to those who have returned from surgery and are preparing to leave. You’ve got a chance to learn from others, to allay your fears, and then, when you return from the hospital, to be a resource for others who have just arrived. The MAH is also a place for spouses and friends to channel their energy and give voice to their fears and expectations.

bricksSymbolic of this stream, this journey, is a very cool idea Carol encourages — while you’re sitting around recovering, you paint a brick taken from the old Trinidad city streets — these bricks are quite thick and have raised “TRINIDAD” lettering on the top. When you’ve painted your brick with a message, a simple color, a collage, or whatever, Carol shellacs it and places it into a wall-walkway, where everyone who follows in your footsteps can see the previous steps taken. I loved looking at the bricks and wished Carol had implemented the idea sooner. Sure, she’s got a map with pins in it and a book of thoughts and a photo album, but this brick walkway is a tangible trace of the steps taken in the Morning After House.

Upon reflection, it seems to me that the Morning After House isn’t so much a guest house; it’s an engine of knowledge exchange. We might think of the MAH in light of the Japanese concept of ba, or “place” or “sphere” in japanese. Ba is essentially a shared space that serves as a foundation for knowledge creation, one that is often defined by a network of interactions. the concept of ba unifies the physical spaces, virtual spaces, and mental spaces involved in knowledge creation.

JoyceCarol

The knowledge created and shared at Morning After House? Nothing less than the experience and the culture around GRS. So if, for some reason, you can’t stay at MAH, I think you ought to go by and hang out as much as possible — because the MAH has ba in spades.

Visited Dr. Reynolds today for a new aviation medical, armed with a sheaf of papers from surgeons and psychologists saying I was a reasonable transsexual (as reasonable as can be expected, I guess). I passed the office tests easily: the color blindness, the vision (near and far) test, moving my limbs easily, the urine test, the hearing test, and the full disclosure of all conditions, doctor visits, and hospitalizations over the course of my life.

The nurses were quite chatty and helpful, while the doc seemed a bit gruff. He said at one point that maybe I’d get my medical and I could learn to fly, to which I responded I have over 700 hours, my multi- and single-engine private pilot’s license with an instrument rating and complex aircraft endorsements. Furthermore, my last flight was a few weeks ago, just about the time Dr. Salazar opined that my current medical had been handled completely improperly.

“Oh,” he said. “Well, maybe things will go well in Oklahoma City, then.”

It was nothing, and my paperwork now goes to the regional medical examiner, who will determine if I’m mentally OK to fly. I understand how the FAA works, but I find the whole “Gender Dysphoria is disqualifying until documents are submitted” argument feels as if a certain group of people is being picked on unreasonably.

I believe I’ve finally fixed my pilot’s license (name change, gender change, new multi-engine rating), but I recently learned a key assumption at the FAA Medical Branch regarding Gender Identity Disorder. After months of going around and around with their Oklahoma office and arguing that I already have a valid medical certificate by virtue of an exam last summer with Dr. F, I learned that GID is a disqualifying condition until certain paperwork has been filed with their office and thus, no individual medical examiner may issue a medical certificate on her own, based on the results of the exam in her office. Here’s the eye-opening email thread that finally put me and Dr. Salazar (Oklahoma City) on the same page:

First Clarification

Ms. Bailey - to make sure I have my facts correct since the last email sometime in April 2009. You reported you had an FAA physical August 7, 2008 by Dr. KF in Bedford Falls prior to him being dedesignated. To date we have not received a copy of that physical exam, i.e., the actual 8500-8. This has created the problem that even though you now have produced a second-class medical certificate, the agency has no formal verification of its existence except for the piece of paper in your possession. The last official examination/certificate on file for you was a second-class certificate issued July 12, 2006; at this time that
certificate is not valid for any class.

Even though you have a second-class medical in your possession, we now have to consider the fact you are undergoing sex reassignment surgery. In my opinion, Dr. F erred in issuing you that certificate in August of 2008. He had previously issued you a certificate in 2006 as a male ("oldname"), but issued you a new medical certificate in 2008 as a female (Joyce Bailey). He should not have done that - he needed to have deferred issuance to the agency.

Gender dysphoria, gender identity disorder, sex reassignment surgery and gender variant issues in general, are initially disqualifying conditions until all treatment records, including neuropsychological (NP) assessments are received, and the agency is satisfied that no adverse issues exist. To date we have received no treatment records; therefore, the agency cannot render an opinion on your qualification to hold a medical certificate. As I previously explained, this matter is further complicated by the fact we have no official record of a current physical exam on file for you, and you now have a certificate in your possession that was issued in error. Because we have no official record, it makes it difficult if not impossible to reexamine your qualifications to hold that certificate.

My recommendation at this time is to wipe the slate clean and this matter be started over again. I would request you go to an AME and make an application (either before the surgery, if you have time, or after you have recovered), explain the gender change and have the AME defer the issuance. The agency will then request you provide detailed treatment records, operative reports, and the NP evaluations. Once everything has been reviewed and the agency is satisfied successful recovery has been made, a proper certificate can be issued. By doing things this way no one can challenge the validity of that certificate.

At this time you have in your possession a medical certificate issued in error, with no supporting physical examination on record. Therefore, I am concerned that this presents a serious problem, and the agency will not issue you a replacement medical certificate at this time. I would strongly recommend you do not use the certificate in your possession to fly as pilot-in-command as this could represent a violation of 14 CFR Part 61.53.

My first reply
A bit unnerved by that last part, the suggestion that I may have been violating the FAR’s, I wrote the following for clarification (being a bit snarky, I admit):

I still have my previously issued medical certificate, which is still good through august 31. Are you saying this one is also tainted because a doctor did not turn in his form?

It sounds as if you're advising me to abandon my second class medical as well as one year of my third class medical, even though I had a stellar exam last August. Are pilots usually held responsible for AME actions beyond their control?

I will seek a new AME and get a new medical exam after i'm back from surgery in 2 weeks, then. I do think it all stinks, as I've asked the FAA and my AME about ny condition from the very beginning, and I find out only now that all that effort at full disclosure was for nought.

And here is Dr. Salazar’s definitive answer:

Ms. Bailey - We have 3 physicals on file for you: July 2, 2002, July 14, 2004, and July 12, 2006. The July 12, 2006 examination expired for ALL classes on July 31, 2008.

I cannot be any clearer in that Dr. F issued the August 2008 certificate in error and since he did not forward the application the agency could not have know. It was not until April 2009 that the agency found out about your intent for gender reassignment surgery and the fact there was a 2008 examination that had not been transmitted. At that time we had no record of a valid medical certificate. Today I receive confirmation from you in the form of a copy of that certificate. That changes the entire picture and it is my responsibility to inform the certificate holder of any problems with any certificate they hold.

Dr. F's issuance was "less than stellar" since you were not qualified at the time he gave you the certificate. I have discussed this matter with an agency attorney who concurs on questioning the validity of the 2008 certificate because no 8500-8 is on file and also because the AME knew you had a disqualifying condition and still issued the certificate.

However, the key issue is that you have a disqualifying condition; therefore, any certificate in your possession is called into question until the matter is reviewed by the Aerospace Medical Certification Division and a determination is made of your eligibility for medical certification. While I understand your concern about "walking away" from a medical certificate, but you must understand that certificate has major problems and could legally be viewed as an invalid certificate. Dr. F has created this problem and I am simply trying to undo his errors.

Uncle
Since I had just earned my multi-engine rating and was on my way to Trinidad for GRS, I figured it was a good time to cry uncle and ground myself, seeking a new medical exam when I returned, and thus I wrote the following to Dr. Salazar after my surgery:

Dear Dr. Salazar,

On your advice, I have scheduled a new medical exam with Dr. R in Bedford Falls on July 28th, and we will try to fix this whole mess that Dr. F's inappropriately-documented medical exam last summer has caused. I will bring every scrap of medical and psychological paperwork I have so that Dr. R can make sure we submit a whole file of proper documentation required by your office.

Having just completed GRS in Trinidad, Colorado, last week, I'm obviously self-grounded, and I intend to remain so until Dr. R and I have satisfied your office.

Thank you for your frank and authoritative help. I apologize if I've sounded frustrated over the past few months; I was just perplexed about Dr. F's medical certificate from last summer and the steps I needed to take to rectify this situation so I can continue flying.

He returned with his own “uncle,” vowing to expedite my paperwork:

Ms. Bailey - as long as Dr. R defers certificate issuance to Oklahoma City under the special issuance process, your case will be handled appropriately. Although Oklahoma City will handle the issuing, if Dr. R notifies my office when the case is transmitted and deferred, I will have my staff work to expedite the processing. I cannot give you a specific timeframe, but if we monitor the progress it will move quicker.

While I’m relieved to finally have a clear plan, several things frustrate me. First is the FAA’s assumption that gender issues of all sorts are automatically disqualifying and put the onus of proving mental and physical health upon the trans* person. Hell, Dr. Salazar’s language puts ALL gender variance into this category, so I assume even weekend drag queens could have their pilot certificates called into question:

Gender dysphoria, gender identity disorder, sex reassignment surgery and gender variant issues in general, are initially disqualifying conditions until all treatment records, including neuropsychological (NP) assessments are received

My second frustration comes from my trust in my medical examiner last year — he told me quite authoritatively that the medications I was using (estradiol, progesterone, and spironolactone) were authorized drugs and that I was thus free to fly. As far as I knew, I had disclosed everything to the FAA, honestly and openly, and I only now find out that I have been skirting the edge of the law. It’s frustrating to follow all the regulations and to disclose everything and then discover that one key person didn’t follow their rules, thus putting my good name and my pilot certificate in jeopardy.

I’m sure my new medical exam will go swimmingly next week. I will be sure to remind the doctor that he cannot issue the certificate, but that we need to submit surgeons’ and physicians’ and psychologists’ letters to Oklahoma City so that they may issue the medical certificate.

You may recall my difficulties in changing the M to an F with the FAA (here, here, here, and here), but I am happy to report that I finally buckled and complied and have now been issued an airman’s certificate that has my new name and new sex written on it.

One of the problems with the FAA regarding gender marker changes is that their policy is inconsistent and incoherent, which is kind of unusual for an organization that defines everything. Where I got on the wrong path (and perhaps it was unavoidable) is that the FAA website makes it sound as if gender marker changes are easy, but that the actual FAA regional officers don’t use the website, but rather a field manual called FAA Order 8900.1. You see, on the very first page of the FAA website that deals with pilots, the requirements are pretty plain and make it seem as if all you need is a letter from a psychologist:

Gender change

To obtain a new airman certificate that reflects a gender change, it is necessary that you appear at an FAA Flight Standards District Office (FSDO) for positive identification. One or both of the following documents must be presented to an FAA Inspector:

1. A court order issued by a court of the United States or it's territories stating that the applicant has changed his/her gender, and/or
2. A statement from a physician or clinical psychologist treating the applicant that contains:
* Identification of the applicant by name and address, and
* Verification that the applicant is undergoing treatment that has altered or will alter the gender

However, this information is incorrect, as the field inspectors use an internal document, as I was told at my local field office. This document, they said, requires a surgeon’s letter. However, a visit to the FAA and a search for “8900.1″ reveals that there’s a whole website devoted to Flight Standards Information, http://fsims.faa.gov/, and if one searches that site for gender, one finds the current version dealing with exchange of valid pilot certificates, and at 5.317, part D, “Changes to personal data,” we find

D. Change of Gender. For a change of gender on an airman certificate, the original copies of two documents must be provided to the certifying ASI. After examining and verifying these documents, the ASI photocopies the documents and attaches the photocopies to Form 8710-1. In block I, under “Other”, the ASI notes gender change reissue. The file is then forwarded to AFS-760 for processing. The required documents are:
1) A court order, issued by a court of the United States or its territories, stating that the individual has changed his/her gender to ___, or a court order stating that the individual’s gender is ___; or
2) A physician’s statement clearly indicating that the individual is physically the gender noted on the court order.

I do not know where my office gets the “surgeon’s letter required,” but suffice to say that was what I had to do to change the gender marker.

But the point of this blog entry is to highlight inconsistencies, so I wrote the FAA webmaster about the wrong information on their website, and here’s the letter I received in return:

Your are correct:

Our web page at http://www.faa.gov/licenses_certificates/airmen_certification/name_change/ does not specify a physical gender change while FSIMS Volume 5, Chapter 2, Section 5, para. 5-317 does.

We are researching his discrepancy. You may contact the Flight Standards Web Manager, Joel Wilcox, for the status of this research: 202-493-4876.

It’s small, but at least it’s a recognition that there is an inconsistency. What’s frustrating is that this labyrinth of information isn’t easy for the transgender pilot to navigate. A system of information that was user-oriented, one that anticipated that there’s a transgender pilot who wants to change information, would try to answer, unambiguously, that person’s question. Instead, the web gives us false hope, the official regulations (FAR’s) mention nothing about gender, and order 8900.1, which pilots don’t even know exists, is the “ultimate” guide — but even this order seems to have been revised with multiple versions floating around out there.

An awfully odd day, this, one that marks a big transition from being a medicalized patient to becoming a fairly normal person. Today was the day to remove all my packing and my catheter, so I slept a bit fitfully, eager to finally get rid of the catheter, which has been causing me some trouble in sleeping.

I woke early and took a wonderful shower — wonderful, that is, until about 4 ft of my packing fell out, plop on the shower floor as if I had given birth to a tiny mummy. I knew from my instructions that a little packing falling out was no big deal and that all I needed to do was cut it off. However, being naked in the shower room at 6:15 did not lend itself to much of a search beyond poking my hands into the nearby cabinet, a search that was fruitless. I called out to Mary Jo, who, dozing, asked what I needed. Scissors for my packing, I yelled across the expanse of the upstairs apartment. She ran around, looking in every drawer upstairs to no avail, then rummaged around downstairs, eventually returning with a kitchen knife, a utility knife, and some wire pliers, the best she could do. “Who doesn’t keep scissors?” she kept complaining. The utility knife wouldn’t catch across the fibers of the roughly half-inch ribbon, and it was a bit freaky seeing Mary Jo holding a razorsharp knife so close to me. She hit paydirt with the wire pliers, which snipped the packing neatly. “You get to clean up the shower,” she grumbled. “This is the grossest thing I’ve done in a long time.”

We left early for my 11:00 meeting with Phyllis, the nurse in charge of “vagina boot camp,” as I have come to see it. Mary Jo and I went to a coffee and knickknack shop for 30 minutes and then went to our appointment, which took place at Dr. Bowers’ office. Phyllis is a middle-aged, no-nonsense nurse who will tell it like it is — with compassion but without pity. Mary Jo decided to skip the fireworks since she had already had an exciting morning, so Phyllis and I began by tidying things up. First, she pulled out my catheter, a procedure that only burned for a couple of seconds, subsiding within 5 minutes. Next, she pulled out the rest of my packing — they use 9 yards, so that meant that I had a good 7.66 yards left — and her methodical pulling and folding the packing resembled those magicians pulling scarves out of their sleeves. More and more and more emerged, seemingly from nowhere. With a final tug (which I felt deep inside me), the rest of the packing was removed. It was quite a relief, and I realized just why I had had trouble getting comfortable the past couple of days — between the catheter tube and attached bag and the 9 yards of packing, my entire core was tight and stiff.

The next step was to take a mirror and get a really good look at what I had paid for — Phyllis deftly oriented me to these new parts like a park ranger showing hikers how to navigate around a state park. I felt as if I should have been taking notes in case there was a quiz afterwards.

Next, Phyllis gave me the set of 3 polyurethane dilators that come with GRS and to show me how to use them. They come in a handsome roll-up carrying case, too. After showing me the set, Phyllis said we’d begin with the blue one (looking at the orange one just about made my eyes pop out of my head). I won’t go into detail, but suffice to say that it was quite surreal to have this grandmotherly nurse objectively and dispassionately talking to me while illustrating the proper technique of “applying” Mr. Blue into an orifice I didn’t have until just a couple of days ago. I felt incredibly vulnerable.

Next, Phyllis asked me to do the same while she watched and coached. Again, all I can say is that it surreal, being coached in the proper use of an object into a new body part, one that’s still healing with stitches and swelling. She kept urging me, not unlike a drill-sergeant, to relax my legs, something I would have been happy to do if I hadn’t just then been experiencing the business end of a blue plunger into me. “Relax those legs, soldier!” “Ma’am, yes Ma’am.” Eventually, I managed to achieve the proper dot (there is a series of dots so you can know when to stop before breaking through into what they technically call your innards) and was allowed to de-plunge myself; however, she explained, “your normal sessions will involve sitting there for a full 15 minutes before you stop.” Oh, Joy.

I cleaned up and Mary Jo came in and I got a full indoctrination into proper care of vaginas (mine, in particular), a second phase of boot camp that included manuals, pictures, and lectures. My head was buzzing with all this new information, so I’m glad I got some reading materials.

The rest of the day was pitifully simple by comparison — some television, some pizza with Mary Rae and her family, and puttering around the Morning After House. The only interesting moment came at the end of the day, when I set about doing my own dilation — outside of the bootcamp and Phyllis’ coaching voice. It was a lot harder on my own, and I wasn’t sure why. I was set to give up and declare myself a failure, but I somehow managed to complete the mission after much defeatist swearing. Note to all others seeking GRS — this part isn’t in your promotional materials, but be sure to take it into account when tallying up your psychic energy and enthusiasm for the procedure.

On July 13th, after being discharged from the hospital, Mary Jo loaded me in the car, and took me to Carol Cometto’s Morning After House, where we had stayed prior to going to the hospital. I spent much of the day sitting around and trying to avoid pain. I reclined on the upstairs couch and watched the Sotomayor hearings, but did precious little else. In the evening, a rainstorm moved over Trinidad, especially over Fisher peak, and we all watched from the porch. After the storm passed, Fisher peak was bathed in sunlight amidst a deep and thoughtful sky. The air smelled new and clean.

On Tuesday, July 14th (Surgery +5), I woke to a sunnycrisp view of the mountains, felt the cool air pouring through windows, and listened to Trinidad going to work on the streets below. This being Bastille Day, I decided I’d get out and walk a bit. Mary Jo, who had been staying very active while I was in the hospital by riding Carol’s bike and hiking, declared she was hiking up to the Trinidad sign, which is up to the west of the Morning After House, and not really very far. I sat in my easy chair, looking at the peak through my window, waiting to see her figure far above. When she finally appeared, I gingerly walked downstairs and stood on the porch waving to her while Danny took photos of her tiny figure below those enormous letters.

After lunch, we were thumbing through satellite channels on the TV and managed to catch Harold and Maude on AMC from the beginning. Although we had both seen it, we realized that it had been years since we watched it together. With its balance of comedy and raw emotion, fueled by Cat Stevens’ emotional songs, I alternately cried freely or laughed out loud. It seemed the perfect movie for this day, especially for me and Mary Jo, determined to live our lives according to our own desires instead of following other peoples’ norms.

Mary Rae, who was one day behind me, arrived at the Morning After House, and we sat out on the porch watching the sky and the ever-present Fisher Peak in front of us. I was getting really tired of the catheter and the packing, which made it increasingly difficult to find a comfortable position. That’s just the nature of this phase of things, but it leads to grumpiness and impatience.

This hospital stay is a lot like any other hospital stay. Days run together and there’s really not much to tell or to reflect upon. Thus, I’ll dispatch the rest of the hospital stay in the following essay.

July 10th. Surgery +1 — I had a pretty crappy day, but did get to eat solid food finally. Confined to bed, there wasn’t much to do except to feel the discomfort at not being able to roll over, to listen to the leg-squeezers keeping clots from forming in my legs, and to await the nurse visits for to check my J-Drain, empty my catheter, and take my vital signs. Operative concept today: hard to find comfort. I did enjoy getting to talk with my roommate, Justine, from the East Coast, a woman who was 2 days ahead of me and who was able to let me know what to expect along the way.

July 11th. Surgery +2 — Finally allowed out of bed, with IV and leg-squeezers removed. I took 3 walks, shuffling around the wing with my catheter bag handsomely carried in one hand. Resumed reading James Joyce’s Ulysses to Mary Jo, something we had begun doing upon arriving in Trinidad. I have read this novel 20 times, but have never read it aloud, and am enjoying it immensely.

July 12th. Surgery +3 – Justine was released in the morning, and I was moved over to my friend Mary Rae’s room. I walked 5 times, and Mary Rae timed my best circuit around the ward at a blistering 2:35, a time I was not able to break. They came to take out my “J-Drain, a tube with a suction bulb that helps drain the surgical area of blood, and this sucker hurt like a hot poker when it came out — to her credit the nurse told me as much, even going so far as to explain that “this hose is only the outer portion, but the inner one is much larger and it has to come out through this hole.” Odd to say, but it was the sharpest pain of the visit to Trinidad.

I took a shower, which was pretty sobering, getting to look at the whole new me in one panoramic vision, but it also felt wonderful. Mary Rae and I had a visitor, CC from a few hours away — CC brought flowers to Mary Rae and a yellow rose to me with a card saying, “It’s a Girl,” which is oddly appropriate and hilarious at the same time when you think of it. CC left after a couple of hours, and Mary Jo and I continued to read Ulysses aloud. It was a full and exhausting day, and even though Mary Rae and I watched a ballgame together (Cards v Cubs), I only managed to open my eyes when there was a roar of the crowd on television. I got a very long, good night of rest for the first time in several days.

July 13th. Surgery +4 (Monday): Unless you’ve got problems, you leave the hospital on this day. You’ve been active, had a bowel movement (if you’re lucky — ahh, the simple pleasures of life), and there’s nothing more the hospital can do for you. This happy condition was how I found myself as I packed and, with Mary Jo’s help, left the hospital around noon, next destination the Morning After House, where we had started a few days earlier, and where Mary Jo had stayed while I was in the hospital.

Trinidad clearly has a great asset in its midst in the Bowers-Hospital connection — While the hospital is clearly not just a “Tranny Hospital,” and serves the community in a number of important ways, it’s equally clear from speaking to the nurses and their assistants that they see the transgender population as a special learning and caring opportunity, one that’s impossible for nurses and nursing students in larger cities like Denver or Albuquerque. These professionals “get it,” and should be properly seen as a major part of why Trinidad is such a good place to come for GRS.

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