Unfinished Business

Occasionally a patient or family member will call the ER to say that they are on their way in to see us.  Similarly, radio traffic alerts us to the dispatch of ambulances in the surrounding communities.  I refer to potential patients not yet within our walls as “lurkers”.  Thus, when asked if I am busy, I might respond, “3 here, 2 lurking.”  The lurking patient has already entered into my problem-solving calculus, and perhaps not in the manner you might expect:  lurkers count double.1

Why, you might ask, should this be the case?  Is not a bird in the hand worth two in the bush?  Quite the opposite, as far as I am concerned.  There are many words that might be used to describe what I do at work:  diagnostician, comforter, risk manager, explainer, and so forth.  In order for me to be an Emergency Physician, however, something else must be in the mix.  I am someone who finishes shit.  I meet people, enter into their dilemma and, to whatever extent possible, solve the problem.  At the very least, I figure out how it is going to be solved.  Quickly.  Perhaps you have a physician who knows you like a neighbor and who will walk with you through decades of sickness and health.  That’s not me.  I’m the one who checks out at 7:30.  I do as much as I can as well as I can, then I go home.  I am a specialist of the first hour, sifting through the problems of the day and always trying to be maximally prepared and available for the next bad thing that happens.  You need me to have such an outlook–the next disaster might befall you, and you will want my full attention at that time.

A lurker is a person I cannot yet help, a problem I can not yet solve.  If the lurker would kindly arrive, then we might make some progress together.  A job begun really is half done, as far as I am concerned.2  Until then, I have unfinished business.

I dislike unfinished business.  I paid off my 30 year mortgage in 12.  Don’t ask me to pledge x number of dollars for every mile you walk.  Tell me rather how much you want and how I can complete the transaction online right now.  No, I’m not interested in a wine-of-the-month club, and hell yeah–I belong to Amazon Prime.

By now you’ve guessed the segue, and if it sounds familiar, I think it is because I have riffed on it before:  transition is seemingly endless.  Whether it is actually endless, I cannot say.  I have met plenty of people that speak of completing transition in such and such a year, but the very fact that I have met them usually owes to their presence in transgender support groups.  Maybe they are Bodhisattvas, remaining among the transitioning to help us along our way.  Following that analogy, though, I wonder if transition, like enlightenment, is more something that you habitually do than a place you arrive.3  Use it or lose it.

But oh, how I hope it is a destination!  I even know what it would look like:  a state of happiness and coherence.  In this respect my goals are not much different than those of anybody else.  It doesn’t really matter how one gets there, so long as one gets there.  If the journey  itself is the reward, however, then I could end up nearly anywhere.  One can get in decent shape even by running after nothing, but in line with my introduction, I have always proceeded under the assumption that the point of a race is to break the tape at the end.

There you have it–a perfect recipe for my restlessness and a plausible explanation for why I intermittently flip out.  For me, there is not a reliable degree of joy in the journey, only the sense of not having arrived.  A friend of mine bears a tattoo stating, in oriental script, “Not all who wander are lost,”4 but I secretly suspect a healthy percentage actually are.  I certainly am.  This is hard…really hard, and I don’t know if I’ll ever, as the Scots say, “Get on wi’ ae.”

I believe people who say they have completed transition.  They own their stories, just as I own mine.  The sense I have gotten from speaking to several who have said so and from reading the blogs of others though is that they are referring very specifically to gender confirmation surgery (GCS), i.e. when they had their fun bits rearranged.  This is certainly understandable, since society in general thinks is what transition means.  Apparently, at least for some,  this really can be the end of the road.  The tricky part is that we are all on different roads and I don’t think we can infer too much from the experience of others.  The end of my road, you recall, is primarily defined by a mental state–happiness and coherence.  There doesn’t seem to be any guarantee that these things follow surgical transition.  The people I know post-GCS appear to fill a broad spectrum between happy and miserable.  Having major surgery because someone else said it helped them is flawed process.5

I experience transition as a mental phenomenon.  It is in my mind that I envision happiness/coherence and in my mind that I suffer its absence.  When you ask me how I feel, I think I can safely assume that you refer to my mental state, not my genitals.6  I publish my story largely to help me “think things through”–now there is a metaphor–hoping along the way to help the next transgender person do the same.  When I blew an emotional circuit breaker last month, I called my psychiatrist, not my endocrinologist.  It is in my mind where my demons lurk7, and it is there that I go to fight them.

I was raised this way, taught that my mind would “take me far.”  In some sense, it has, and yet I recognize that my religious upbringing thoroughly stigmatized “the flesh” as corrupt.  I often wish that I had recognized myself as transgender when I was younger, but I don’t see how that would have been possible.  I didn’t have the tools.  Speaking to another issue, but with great eloquence, my sister once remarked, “We were raised without bodies.”  She has since found hers back but I am still looking.

I have moved on, but I still tend to forget that the mind/body dichotomy is a metaphor.  It is often a useful metaphor, but metaphors have their limits.  We ought not to eat the menu.   Humans do not think, octopus-style, with their arms, but the brain is nevertheless thoroughly embodied.  When I deal with depression, I experience physical pain in my upper abdomen strong enough to wake me from sleep.  In my summary of a year on estrogen, I recounted what I was hoping it would do to my mind, and how surprised I was by how quickly it was messing with my body and that the things it was doing to my body were affecting my mind.  Well, duh…I need to stop being shocked by the obvious.  The term transgender would be meaningless if I had no body.

I have a body.  It’s that tall thing that glares at me from the other side of the mirror, every damned time I look.  It knows that I don’t like it and I can tell that the feeling is mutual.  Lately, just to piss me off further, it has been getting older.  Perhaps someday we will call a truce, but for now, we scowl at each other like old enemies, each demanding that the other surrender.

Unfinished business.



There are no happy endings.
Endings are the saddest part, 
So just give me a happy middle
And a very happy start.

Shel Silverstein, Every Thing on It


  1. Mathematically rendered Total Patients = Ones Here + (2 x Lurkers), or TP = H + 2L
  2. Professionally anyway.  In my home life, this principle must compete with a another nearly as powerful, i.e. that a problem ignored long enough will wander off eventually.  Patients are different in that they rarely wander off, and when they do, we are obligated to chase them.
  3. Not all Buddhists think this way, but a) I am not a Buddhist, b) I don’t find any version of eternal bliss credible, and c) Odds are, I made you look up Bodhisattva.  We learn, then we die.
  4. I like to ask her, “Why does it say ‘Kung Pao shrimp’ on your shoulder?”
  5. Bonus rant:  People don’t believe scientific studies anymore, for the most part.  They believe their cousin’s friend’s sister who is married to an EMT.   Fortunately, there are plenty of folks who will sell you products endorsed by your cousin’s friend’s sister.  I digress.
  6. Although we have all met folks who are exceptions to this rule.
  7. And must therefore be counted twice

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