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.

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.


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.

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.

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