Getting an EMR certification: Two weeks of emotional roller coaster

The past two weeks have been hectic. I should include the two previous weeks too, when I had to work twice as much as usual while pre-studying for my paramedic course, so I wouldn’t have to worry about money during the course. But it was just busy, not especially emotionally charged. That’s why I wanna focus on the two weeks during which I was doing the actual course.

[…]

The past two weeks have been hectic. I should include the two previous weeks too, when I had to work twice as much as usual while pre-studying for my paramedic course, so I wouldn’t have to worry about money during the course. But it was just busy, not especially emotionally charged. That’s why I wanna focus on the two weeks during which I was doing the actual course.

And it was a hell of a ride!

_20171126_162729

Both wonderful and horrible things happened. It’s also when I realised how fragile being transgender is in a social context, and how your confidence can be shattered by one unexpected event at the worst possible time.

Actually, the first week was pretty uneventful. It was more like the first climbing slope of a roller coaster. You reach the top very slowly but you can’t see what’s over the edge of the slope.

I had contacted the instructor early on to tell him that I was transgender and that I used a different name than my legal one. When we arrived on the first morning and he distributed the prop bags (tools we were about to use during the course), he handed mine with my chosen name written on it. I thought it was a nice touch and built up my confidence. Then, we had to introduce ourselves, but in a particular format. We were to first introduce to 2 other persons, who subsequently had to introduce us to the rest of the group. So I told my two follow classmates that I was transgender, and the guy who introduced me to the group used “she/her” pronouns right away and that was it. Except for the only person who didn’t get it and misgendered me quite a few time before I took him apart to make things straight, I didn’t have to complain about anything. It’s quite important to note, because that’s what was coming around to bite me at the end of the course.

So, the first week was quite uneventful. The most difficult things for me was to catch up every night with the study we had to do for the next day, because we received our books quite late and I couldn’t get ahead quickly enough while working twice as much as usual. Which was a problem later because I couldn’t stay after the class to practice the skills. And unlike the youngest persons in the group, I really can’t afford to skip sleep time, or I don’t function anymore, and I needed my brain fresh everyday if I wanted to remember the huge amount of stuff we were learning in a very small amount of time.

So here we are at the second week. Things start to be complicated.

Monday: the top of the slope. That the highest point in the track. You can contemplate everything from there. You have a wide view of the bottom and you may see the end of the track, but it’s kind of blurry. You’re just expecting the first descent, but also worried about how steep it is, because you still can’t see it yet.

Tuesday: It’s steep. Very steep. I crashed that day. I had a total mental breakdown. Everyday, after we had the lesson of the day, we were applying the new knowledge in role-playing-type scenarios. Everything we couldn’t do for real, we were stating them out loud, and the instructor, or the patient, was giving out the result. And I messed up big time. Like, I did everything wrong. I couldn’t asked the right question and I only took wrong decisions. I felt like I was so out of it, I went home completely depressed. And I couldn’t just decompress. I had to cram again for the next day. Maybe that’s what saved me somehow, because I didn’t have brain time to spiral into this depression. I had to stay on track. And I came back the next day, deciding to take it slowly but do all the required steps in order. Speed would come later with practice.

Wednesday and Thursday: Going with the flow. Turns after turns, loops, rolls, you just readjust your arse on your seat knowing something else is coming next. In a martial arts flick, it’s when the hero gets back on their feet and start again from the basic, and prepares for the incoming battle. It’s a reborn. And that’s what happened: I went back to the basics, reaffirmed my knowledge of the protocol and carefully asked the right questions to get to the right conclusion and provide the best treatment, while absorbing the constant flow of knowledge dumped on us. So I was prepared for the grand finale, the battle of the chosen.

Friday: And I lost! The villain cheated, as all villains do to undermine the hero. More seriously, the examiner who came that day, rounded up everyone to explain how it was going to happen and… outed me, in front of everyone. For some people, it’s probably not a big deal, or maybe it happens so often that they are used to it. For me, it was the first time. And it came after two weeks of being around people who were too busy with their own learning to actually give a fuck about whether I was transgender. So, for my whole session, she kept misgendering me and every time I needed a result, I had to insist several times because she was too busy looking at her phone. I was completely disoriented and made critical mistakes. So she failed me.

I can back home in shambles. It was a disaster. I had spent so much money and effort into this, and for what result? I couldn’t think straight. I had a choice: either to retake the next day, risking to fail again and definitively, or spend more time in practice and retake at the next course exam. For the past two weeks, even in my sleep, all I could think about was scenarios and protocols, but that day, when I came home, and all night, I was thinking about how I could get my money back. I talked with one of my classmate, who tried to encourage me to go right away, saying I knew the stuff and I could do it. But my confidence was utterly shattered. Still I went early to bed, and though I did not sleep well, I decided to pop up at the exam, and to decide then whether to retake it again.

Saturday: An emotional victory. When I arrived in the morning, there was a new examiner. He was obviously way more professional and I felt more confident in my abilities. I also came mentally prepared to be misgendered, and I actually didn’t tell him I was a woman, I just gave him my legal name right away, which cut the need for explanation and let him use male pronouns. Only my friend let him know at the end of the exam (mainly because I had to play the patient once and my follow classmates kept referring me as a woman, which must have surprised him somehow). I still did a few mistakes, but not critical ones, and I was a bit too slow, because I wanted to make sure I wasn’t cutting any corner.

When the examiner called me in to give me the result, and showed me the green paper, all my body suddenly relaxed and I almost cried in front of him. I had been gradually stressed for two weeks, at a point where I completely burst, and then I found myself in a spot where I didn’t have anything more to do.

But I learnt a lot more than a skill. I learnt that the stress of being transgender in a social undertaking exacerbates any other stress that you may currently be subjected to. It is something that I have to be careful of, and I need to be able to identify it before it becomes a problem (I shall write an article about that later). And I also learnt that I can totally pass as a woman (1). Which amazed me, to be honest.

 

(1) I didn’t expand on that because it’s already a long article, and it was not the main point, so I’m doing this side note to talk about it but it’s totally not necessary to read it to understand the article.

So, as I said, no one but the instructor and two classmates was told that I was transgender. I basically spent two weeks assuming that everybody knew but played along, not giving a fuck (although I had to tell one guy especially, whom I heard talking about me to another person later on). Therefore it came as a surprise, on Friday, after the examiner asked for my *legal name* in front of everyone, that a classmate asked me if I was going by my middle name (my legal name may sound a bit like a female name for English-speaking people, so she wasn’t surprised). When I told her later that I was upset about being outed in front of everyone, she didn’t understand. She genuinely thought I was a cis-woman, and that was a huge comfort at the end of a horrific day.

So I am really wondering if people knew I was transgender, and who actually knew. Also, I had to use the women’s washroom, and it was quite stressful, because I didn’t know, if I ran into someone else (not someone taking the course), would they complain about it and rat me out. I was always timing my exit depending on people coming in or going out. I ran into an employee only once (I didn’t hear her coming), but she didn’t say anything. We just smiled at each other while I was stepping out of my cabin.

I can say that these two weeks have been weird on several accounts. Now it feels like a dream. I just woke up in the real life, but I still want this to have happened, I can’t believe it was all just a dream. And it wasn’t, because I have my certificate that proves it.

Would I live as a foreigner for the rest of my life?

I had to ask that question to myself at least once in my life. And by “as a foreigner”, what I mean is “in the eye of the people of the country you live in”. It can take many shapes. In some country, intolerance toward a specific group makes it difficult to live there, even if you’re born there and speak the language natively. Descendants of Algerians people in France often mention that they feel like foreigners, even though Algeria was a French region for decades and countless Algerians moved to France around the independence. And I’m sure the same thing happens to many people in a lot of countries.

[…]

I am gonna talk about transition again, yay! Bear with me for a moment.

I had to ask that question to myself at least once in my life. And by “as a foreigner”, what I mean is “in the eye of the people of the country you live in”. It can take many shapes. In some country, intolerance toward a specific group makes it difficult to live there, even if you’re born there and speak the language natively. Descendants of Algerians people in France often mention that they feel like foreigners, even though Algeria was a French region for decades and countless Algerians moved to France around the independence. And I’m sure the same thing happens to many people in a lot of countries.

In some other country, it’s the lack of foreign people until recently that makes it difficult to live there as a citizen. Meaning that it doesn’t matter how long you stay there, people will always see you as a curiosity. That’s the case in Korea, where I lived. Wherever you go, people will always assume you’re new and you can’t speak Korean. I have friends who have been living there for over 20 years, and Koreans are still spooked when they hear them speak Korean fluently. I was always receiving comments like “Ho you really speak Korean well”, and sometimes they even dared saying it in English, like if ordering a beer was the only thing I could say in Korean.

I am not criticizing that, I completely understand the reasons. If you where from a country that was considered insignificant by most of the world for a long time, that would be normal to not understand why people would be suddenly interested in living there (even though you became the 11th economic power in the world and provide half the world population with pocket phones). But the point I want to make is: would it be alright for you to live in a country, if it means you would be considered a foreigner probably for the rest of your life? There is no right answer; it’s totally acceptable for many people and for countless reasons. The people born from Algerian parents that I mentioned at the beginning consider themselves French (and they are), and see no reason why they would live somewhere else (and many say that when they visit their families in Algeria, people say they’re too French. They’re loosing on both sides). There are a lots of perks living in Korea, that can overshadow the small inconvenient of being seen as a foreigner. Or you can be married in said country and it’s simpler to live there than moving your family away.

Personally, I live in Canada, more precisely in Vancouver (BC), and since I arrived, I never felt that I couldn’t belong. People just don’t give a crap if you’re a foreigner. I get asked occasionally where I’m from, because I have a strong accent, but there are so many people from various origins that it just doesn’t make sense to ask it to every one all the time. And I like that way better than the other solution. And that’s how I could answer another question that’s so weirdly similar.

One of my biggest fear when I started transition was: will I pass? (See, I told you it was about transition) Most trans know it. It’s one of the biggest concern when deciding to transition, since it’s strongly related to discrimination. In the latest poll, it ranks second, before “what’s my actual sexual orientation?” and after “Am I gonna get killed for being trans?” (1). And I say the questions are similar because, to me, when people look at me weirdly, it feels like I am a foreigner. Some trans person don’t care. They know people look at them, but they don’t give a crap, and for other people, especially when you don’t like the attention, this self-consciousness is very crippling. I never wear obviously feminine clothes or heavy make-up for that reason (also because I don’t want to spend half an hour more to prepare in the morning).

So, when I realized I could correlate both questions, it became easy to answer. Since I didn’t want to live as a foreigner in Korea, which is one of the reasons I didn’t try to stay longer, I realized that yes, I need to pass as a woman. I can probably bear to be seen as transgender for some time, but at some point, I want people to see me as who I am and not at “who I’m trying to be”, if that makes any sense (it does to me and that’s what matters), and I’m ready to go to very long lengths (depending on my resources) because there is no way that I am going back.

 

(1) Poll realized with a non-representative sample of 1 pseudo-randomly self-selected transgender woman trying to be funny.

How to change how things are done (GRS)

How to change how things are done, which can be also resumed as fighting inertia, is quite a general topic, but we’re going to focus on gender transition treatment, and more particularly surgery for transgender women (i.e. gender reassignment surgery a.k.a. vaginoplasty). So here I am, talking about transition after saying in my first post that I wouldn’t do it so often.

[…]

How to change how things are done, which can be also resumed as fighting inertia, is quite a general topic, but we’re going to focus on gender transition treatment, and more particularly surgery for transgender women (i.e. gender reassignment surgery a.k.a. vaginoplasty). So here I am, talking about transition after saying in my first post that I wouldn’t do it so often. But this one will be rather long, and I don’t want to be banned from twitter for spamming. So here we go.

A few weeks ago, I stumbled upon this article in Wired that talks about a “new” vaginoplasty technique that is better than the current one. It says a bit what it does, who does it and… that’s it. The problem, I find, is that it cruelly lacks sources, because, let’s see:

  1. They say it’s Dr Ting who performs it, and he is director of surgery at Mount Sinai (NYC). Ok, this one is easy, here is Dr Jess Ting, although they only say he does hand surgery and plastic and reconstruction surgery. Well, reconstruction surgery matches with vaginoplasty, so I guess we nailed that one. But is he the only one in the USA?
  2. a paper describing the work of some doctors in India who were building vaginas a bit differently.” So apparently, there is somewhere a paper that describes a technique used in India (only?) that’s better than what is generally used now. Nice, can you tell us more about the paper? Not the paper itself, I’m sure it’s under strict copyright, but the authors, the publication? A DOI maybe? Well, no, apparently, it’s not interesting enough to have more information for people who might be interested in such topic, like, other transgender women.
  3. They were performing surgeries on women with a rare disorder that causes the organ to develop abnormally or not at all.” This one is just lazy. Seriously, not even the name of the disease?

So in the end, we literally can’t find actual useful information about this without putting extra effort. This article smells purely like a hidden advertisement for the Mount Sinai so they don’t get competition. They don’t even talk about it on their website, like it’s a Research and Development project and they don’t want anyone else to do what they do. This is obviously not in the interest of transgender women who want to access what’s best for them without having to travel thousands of kilometers away or pay more than they should (which is zero or close to that figure in many countries). It’s always better to find a solution in your local area, or at least in your country, especially when your country has a relevant health care system that will cover it.

Enough said about this badly sourced article, now how do we get to have this kind of procedure?

First, we need to know what we’re talking about. This is why yours truly went above and beyond to find that information. So I started by contacting the Mount Sinai hospital about this matter and never got an answer. So either they’re too busy to answer a transgender woman they claim they want to help, or they just didn’t want to answer. Either way, they weren’t helpful at all, so I moved on to my second step: finding about the procedure.

The good thing, despite the lack of information in the article, is that they felt compelled to give out a minimum of technical information so they actually look like they know what they’re talking about. “They found a way to do that with tissue from the peritoneum, which is basically a bag of loose tissue that encircles the inside of your abdomen and holds your guts in place.” The fact that they actually name the organ they use (the peritoneum) helped a lot, because, after research, I managed to find more information about the procedure (which is called “Davydov’s colpopoeisis”). I won’t explain it in much detail, but if you’re curious, The Beverly Hills Center for Laparoscopic Urogynecology explains it very well, with pictures. And you learn about the condition of the women born without a functional vagina (Mayer-Rokitansky-Kuster-Hauser, MRKH), since that’s what the surgery was designed for in the first place. That also means that the Mount Sinai isn’t the only place to get that surgery.

If you want more detailed information about the procedure, there is an article (Ward et al., 1998(1)) for that. And you read right. It has been written in 1998, so obviously, this technique has been around for some time, and not only in India (I didn’t find the Indian article, though, which makes me wonder how this woman found it in the first place and not the article from Ward et al.).

Then, they are talking about the outcomes of the surgery: “while the new procedure is showing superior results so far, it will be important to monitor to see how it holds up long term“. They’re right, we need to know how the surgery holds up in the long run. Or do we? It turns out, there is already an article detailing that (Zhou et al., 2010(2)). And it’s neither in the USA or in India. Now it’s in China. Looks like this procedure is done all over the place after all. And don’t get me wrong. We definitely need more study, especially regarding transgender women. But the article is seriously misleading, and honestly the procedure is exactly the same for trans and cis women since it only involves body organs that are shared in both male and female bodies. And they can start from there.

Now the big question: how do we get to have more surgeons performing this surgery for transgender women. As I said in introduction, changing things is about fighting inertia, and the strongest inertia is, the more energy we need. In this case we need an insane amount of energy, first to be heard, then to be listened to, and that’s where we need to do something together. I can go only as far as people are listening to me, and I don’t have a big notoriety or charisma that helps the subject to be brought forward. I tried to talk to my doctor, but she said it wasn’t her place to tell surgeons what they have to do, which is sound. I told the PHSA (health care system in Canada) in my local branch, in Vancouver; the person I have in contact said it was very interesting, and basically told me that they are currently training surgeons to provide surgery services in British Colombia, so we don’t have to go to Québec, but I don’t know what they are trained on.

Now I’m on a stand still. I really don’t know what to do since I have almost no useful contact in that regard. My only is that the information I salvaged gets to be shared the most widely possible.

So, please share, and talk about it to your practitioner, your health care representative, your pharmacist, your Shoppers clerk (who’s also your pharmacist), your mom, your dog, anyone who listen to you. Maybe together, we can do something about it.

 

(1) Current Obstetrics & Gynaecology (1998) 8, 224~226© 1998 Harcourt Brace & Co. Ltd

(2) Fertility and Sterility Vol. 94, No. 6, November 2010  Copyright© 2010 American Society for Reproductive Medicine, Published by Elsevier Inc.