Fairness and Other Myths

Published / by rmaddy / 1 Comment on Fairness and Other Myths

I ran cross country with heart.  I never dogged a workout, and I pushed to the end every meet, not infrequently staggering or passing out as soon as I crossed the finish line.  One muddy race, I lost a shoe a half mile from the end and still eked out second place.  

Second place was my wheelhouse.  I never won a major competition.  Most days, I wasn’t even the best on my team.  Nevertheless, I scored well for my team every single race, and we made it to States during my high school senior year.  I was far more proud of that than of the academic record for which I was much better known.  I worked hard at my sport, and though I barely cracked the top 50 in my state, I think that I managed to be the best runner that I could be.

In my midfifties now, I know that I will probably never race again. Part of is is purely physical—the pounding of pavement extracts a price, and I ran for decades. I find it harder to run at all, let alone push myself for the speed that I once enjoyed. Beyond that, however, I am restrained by the realization that should I run competitively, the next price I paid might be far worse than the aches and pains.

America celebrated Pride 2022 by writing, copying and pasting bills to degrade and demonize transgender people. 35 states proposed anti-trans legislation in the first half of the year. Having failed for the most part a few years back to codify where trans folk can use the bathroom, Republicans are doubling down, finding in anti-trans issues more gasoline to pour on the fires of the culture war.

Their favorite flavor this year is the prohibition of transgender participation in athletics. The gambit is not new, but this year they have found willing accomplices in athletic associations, well-amplified pundits and even among LGBT notables. The formula, “I am (insert queer identity) here, and I don’t think transgender women should…” flows directly and profusely to op-ed pages and online news outlets.

Nobody medically transitions to win a medal, and nobody emerges through medical transition unchanged. And, despite assertions to the contrary, no spate of domination of athletics at any level by transgender women can be demonstrated. One person’s good performance does not a pattern make. Sometimes a good athlete transitions and continues to be a good athlete. Most of the time, I suspect, they do not. When they do, I would think it something to celebrate.

I personally began the process in relatively good shape, knocking out 8 minute mile splits for an hour or more at a time on the treadmill. Within 6 months, those splits had lengthened to about 11 minutes. Would I be exactly as good a runner in my new demographic as in my old? I don’t know, but I’m pretty sure it doesn’t really matter, or at least that it shouldn’t.

“It’s about fairness”, goes the swindle. Incumbent in this notion is the idea that one person can deserve to win an event more than someone else, piled on top of the idea—so strenuously denied—that whether one wins or loses really does matter more than how one plays the game. Anyone who has ever waited for the gun on the starting line of a 10k knows that almost everyone participating will not win, but, I still dare to hope, that it is worth running anyway.

On Bravery

Published / by rmaddy / 2 Comments on On Bravery

It’s happening again.

I first encountered the phenomenon during the early days of transition–basically once people were starting to notice and process the changes that they were seeing in my appearance.  I refer to the ascription of emotions to those going through an unusual process.  The two most commonly mentioned in that case were happiness, as in “I’m glad you’re happy”, or “As long as as you’re happy,” and bravery–“You are so brave!”  That I felt neither in those moments often seemed not to register.

“Happiness” missed the cut in the face of Covid19, but once again I hear with some frequency how brave I am, how brave my co-workers are.  I cannot speak for them, but I know that I did not feel brave in transition, and I do not feel brave now.  

Truth be told, I live with anxiety, and it was not improved either by gender transition or the current pandemic.  Those who experience it know that it can be managed more or less effectively, but it tends to persist lifelong, sharing more commonality in that sense with chronic conditions–heart disease, hypertension, diabetes–than the acute but transitory distress of a broken arm.  I do give myself some credit for doing relatively well under the circumstances–continuing to work and thrive in a broad sense, maintain a disciplined connection to the resources necessary to do so, and becoming, on balance, more adept at managing the day-to-day stress.  If I linger to write my autobiography, I fancy that the subtitle will read something like “My Life as a Well-Coiled Spring”.

I suspect that the attribution of bravery, at least in my case, owes to a lack of familiarity on the part of the observer.  Most people have no idea what it is like to experience an identity not conferred upon them by society or biology or both, and understandably feel a bit flummoxed by seeing someone act decisively in the face of such experience–just as I might wonder at the oft-cast image of a soldier in a movie grabbing a nothing more lethal than a flag and charging headlong at an entrenched, well-armed opponent.  Inspirational, yes, but not just a tiny bit crazy.  Lest any other person, particularly my transgender brothers and sisters bristle at such a word, let me propose that “audacity” is a probably a more apt description, and remind that I am speaking merely of my own odyssey.  So too the plight of the present-day healthcare worker, watching the merciless eruption of a deadly epidemic, wondering not whether but when, as the news is framed, “needs will surpass resources.”  Why would the general public know what that is going to look like when from the inside I barely grasp it myself?

At any rate, suddenly I am brave again.  I find myself in a situation over which I have little control, no genuinely good choices, and ample reason to expect a miserable outcome.  I do my job knowing that it is my job to do.  I desperately need my family, but fear becoming the vector that silently, invisibly, brings the pestilence home.  Aragorn’s “Not this day” speech at the Black Gate bubbles up from somewhere in my subconscious, bringing with it both a flood of both tears and welcome inspiration, but so too does the image of the soldier at Dunkirk dropping his weapons and walking into the waves.  I know which figure I more closely resemble.  

“Superheroes”, a New York Times editorial called us today, although to be fair, the author made largely the same point that I am.  I wonder–is it audacity to set my feet against an onslaught requiring more people, more protection, more resources that I have on hand, or just plain crazy?  Will my training, experience and well-honed sense of moral duty be sufficient to hold back the relentless tide of anxiety and despair?  The only way to know is to pass through, and I don’t want to.  Would that we could linger forever in these last moments when normality is still at least a vivid, recent memory.

No, I am not brave, but perhaps it is not mine to say.  One could posit that bravery is a word which must be externally applied–an observed quality as opposed to an experienced internal state.  Countless are the times I have heard a parent or a healthcare worker tell a frightened child how brave they are while getting their blood drawn, getting a vaccine or some other immediately unpleasant intervention.  Has that not always felt like the right thing to say?

Maybe we celebrate phantom bravery because it is comforting, or simply more comfortable to do so.  It is hard enough to see one person in distress; harder still for that distress to spread like contagion to those around.  Let there instead be bravery, and heroines, and hope, for so long as there is, the story still seems worth telling.

One Small Step

Published / by rmaddy / 3 Comments on One Small Step

I like to think that I was watching as Neil Armstrong let go of the ladder and settled into the lunar regolith.  A toddler at the time, I certainly don’t remember it in any non-reconstructed sense, but increasingly I suspect that we never remember anything without prompting, reshaping and varying degrees of embellishment.  I do recall, four short years later, Apollo 16 standing tall on the launchpad crawler, with Apollo 17 taking shape in a nearby hangar.  With most of my life before first grade 1 long ago faded into an inscrutable fog, vivid recollection of Apollo as an ongoing narrative of my childhood is nothing short of remarkable.

This week marks 50 years since Armstrong’s footprint was first on the moon, and more than 46 since Gene Cernan’s was last.  Untouched by the familiar earthly processes of erosion, they remain there, in stark contrast to our collective memories of them, unblemished to this day.  Strewn about the six Apollo landing craft, a gold olive branch, a half dozen flags, a couple of golf balls, and three dune buggies.2

Of course we did not, as Apollo 8 and 13 astronaut Jim Lovell opined, “just decide to go.”  We were chased there, sprinting breathlessly and headlong, by our political nemesis, the USSR, in a rabid quest for “nuclear superiority”, whatever the hell that means.  If we go back, I am sure that it will be for reasons equally stupid.

Still, count me as one who, having said goodbye to gods and heroes, imagines Collins, Aldrin and Armstrong, listening to the scratchy countdown from their quasi-suicidal perch atop 35 stories of high explosives, as rare exemplars of self-sacrificial courage.

Not all Americans celebrated the landing five decades ago.  I concede that spending $25 billion to send a few dudes 239,000 miles away for a night of  primitive camping3 was a bit over the top, pun intended.  Numerous contemporary critics argued that the money could be used to the greater good on the ground.  Quite so, but what are the chances that it actually would be better spent, then as now?  

In July of 1969, the blood of 400+innocents at the hands of the astronauts’ fellow soldiers was barely dry in My Lai, and within a year, National Guardsmen turned their rifles on a crowd of unarmed students at Kent State who found that sort of thing objectionable.  The Apollo mission, though clearly undertaken in a national spasm of military fervor, was arguably the most peaceful event in the then brief, sanguine history of rocketry.  If it constituted yet another way of reminding our enemies of a gun pointed permanently in their direction, at least on this occasion the trigger was not pulled.  Only three men–astronauts Grissom, White and Chaffee–died as a direct result of the Apollo program.4

I took advantage of a break in the clouds to look at the full moon last night.  50 years ago, citizens of Earth looked up to a waxing crescent with a previously unfathomable sense of proximity.  Aldrin and Armstrong stood in their gaze, their boots half sunk in the ashy “soil” of Mare Tranquillitatis–the Sea of Tranquility5–one short stepping stone closer to the stars.  I hope to live long enough to see humanity step even farther, despite knowing that there may only be a couple more stairs possible before we bump into the hard ceiling imposed by Einstein’s Theory of Relativity, and that my personal timeline begins and ends on the ground below.  

Armstrong waxed hyperbolic.  The nearest star lies 25,000,000,000,000 miles distant.  Apollo’s “giant leap for mankind” traversed less than 1/100,000,000th of that span.  It was decisive only in the same sense that scuffing the ground with one’s boot heel might eventually lead to a new Grand Canyon.  A small step–one step at least–was taken that day, perhaps not so much forward from ladder to surface, but rather momentarily back from the vile, insatiable adult propensity to throw rocks, toward the more sublime, child-like impulse to climb them.

What I Am Learning about Privilege

Published / by rmaddy / 7 Comments on What I Am Learning about Privilege

History flows—oozes perhaps—like lava to the sea, burning all that stands in its path.  That we are among the things in that path is something we generally prefer to forget, only to be shaken by moments that awaken us to the approaching fire.  Accidents, deaths,  national tragedies—each arouse us momentarily to the droning, one way1 march of time.  These moments anchor us in history.  “Where were you when…”

As I sat down to write this evening, news of the Parisian fire awoke me once again from my oblivious slumber.  For decades to come, every child of France will ask, “Where were you when Notre Dame burned?”  A mere Francophile, and not at all religious, I cried at the destruction of the ancient cathedral.

Already we hear the promises.  Notre Dame will be rebuilt, and so it will be.  Ashes do not smolder forever.  When they cool, they will be swept away.   France is awake.  With tears in her eyes, she prepares to work.

Events that turn our eyes to the flames do not relieve us of our daily obligations.   Paralyzed by our grief, we must nevertheless go on.  With  barely a moment to catch our breath, we find ways to take the first few steps.

  • We take control of the story.  Our loved ones are not gone; they watch over us.
  • We tell ourselves that this is for the best.  True, the car is totaled, but the next one will be so much nicer.  
  • We rescue something from the carnage.  We carve a coffee table out of the 100 year old oak uprooted like a sapling by a passing storm.  Better yet, we plant a new tree.  In time might it not also prove to be magnificent?

And yet.  And yet.

We cope and we remember,  We hurt and we continue.  We grow and we change.  We do whatever we can to forget, once again, the relentless approaching inferno. There is no shame in this.  We do these things because it is in us to do so.  “Whatever gets you to sleep at night” is as valid a moral compass as any other as I can imagine, so long as what that is prevents no one else from peaceful rest.

There is no UNDO button on history.   In whatever moment we find ourselves awake, we do well to look momentarily into the fire.  Tomorrow we must pick up our tools and get busy.  And when we complete all we intend, we will rest once again, telling ourselves that it is even better than before, as if to say, of all possible critiques, Notre Dame was nice, but maybe just a little too old.

I remember the room—the half-painted walls and the stacks of books; my therapist’s glasses and the my butt sank into cushions of the old plaid sofa.  Exactly what words were used and in what sequence is far less clear.  We were talking about the price I had recently paid for beginning transition.  I lost most of my friends, and family support was anything but at that time.  

She asked me about why I had lost my friends, and I said something like, ”I broke the man code.”  She directed me to think about what that was and why that mattered, and we spoke of the concept of privilege, an idea which at most I had seen darting across my peripheral vision.  Now I was tasked to look straight at it.  As nearly as I can recall, I said this:

“Whatever I do with my gender dysphoria, that  (i.e. male privilege) has to go.”  

I was, in that moment, startled awake.  Like many erstwhile sleepers, a light flickered on, I bolted upright in bed, and I uttered some gibberish that I didn’t remotely understand.  I had no bearings, but out of this confusion, a new waypoint emerged—one from which I would navigate in the future.

Fast forward 10 years.  

I have completed those aspects of gender transition which most deeply involve medical intervention .  Many of you now do reflexively what I asked of you five years ago—to refer to me by a new name and honor the validity of my gender identity by using coherent pronouns.  For my part, I have begun to understand and that there are nearly four billion living examples of what it means to be a woman, and that I am one of them.  I do my best to remember that being misgendered at this point says far more about the speaker than it does about me.  I take measures to see that such invalidations continue to diminish and I keep appropriate emotional distance from those who cannot or will not make those adjustments.  Transition is a path rather than a destination, but today the path is better lit.

For the past several years, I have had the annual pleasure of helping to teach first year medical students about transgender experience independent of and connected to medical systems.  First year medical students consume information with ferocious intensity.  By the time I meet them in the spring, they separate fuel from fluff with mechanical efficiency.2   This being the case, I look forward most of all to the question and answer period.  This year, the most fantastic inquiry went something like this:

“Having lived most of your life as a well-educated, well-compensated white male, and having gone through such a transition, what have you learned about privilege?”

In the moment, I related the story of the counseling session which lit the spark, to which the student immediately parried, “Do you think you’ve accomplished that?”  My answer was, “No, of course not.”   The remainder of this post concerns what I actually have learned.

I know next to nothing about privilege.

I write at some length in a sincere attempt to consider the question posed to me.  In so doing, I will certainly say things that sound rather stupid and embarrassing ten years from now.  This, I think, is about what one might expect from someone who forfeited only a small fraction of the privilege afforded to me.  I deliberately write under the title “What I Am Learning about Privilege”, because I recognize that I still don’t understand the topic well, and that understanding it better only offers the possibility, not a guarantee, that I will find ways to be less a part of the problem.  Those who wish to learn about privilege from a qualified source should look elsewhere3  I would suggest White Fragilty:  Why It Is So Hard for White People to Talk About Racism, by Robin DiAngelo, The New Jim Crow:  Mass Incarceration in the Age of Colorblindness, by Michelle Alexander,  Whipping Girl:  A Transsexual Woman on Sexism and the Scapegoating of Femininty, by Julia Serano or So You Want to Talk About Race, by Ijeola Oluo.  These are difficult reads for many of us.  Go on, be brave.

I write despite these limitations for several reasons. First, I  remain committed to sharing aspects of what it is like (for me) to be a transgender person, and what is involved in transitioning specifically.   I serve the reader poorly if I leave unchallenged the dominant cultural understanding that transition is a matter of the surgeries one has and/or the medicines one takes.  Second, I know that my readership is limited, and that the vast majority of people who take the time to read do so because they know me in some fashion.  I doubt that the undeniable gall of me writing half-wittedly about this will drown out the voices of those who know of which they speak.  Third, I do some small penance in these pages for the my historical blindness to the plight of others.  In writing these 50 lines on the chalkboard, may I become a little less so.  Finally, I wish to encourage.  If someone as oblivious as I was can start to see privilege, I’m pretty sure that anyone can.

Privilege is a fact, not an attitude.  

Like many beneficiaries of privilege, I originally saw privilege as a character flaw–a way of thinking–and believed that was something that I could unlearn to whatever extent I exhibited it.  Conversations about privilege so often derail because privileged participants feel affronted and respond by defending their honor rather than by trying to understand.  Had I not already been in therapy for an extended period of time and had I not observed that people reacted to me much differently as a transperson than as one they encountered as male, I would have tried to shut down my therapist’s question.  Hell, I probably still did.  I don’t honestly remember feeling insulted, but my initial response reflects that I saw “eliminating privilege” as a bullet point to add to my to-do list.

Privilege is a fact of social structure.  Those belonging to privileged classes—white, male, Christian4, educated, middle or upper class, heterosexual, financially comfortable or wealthy, two-parented, etc. experience easier access to the tools of prosperity—finances, education, employment, power and so on.  It matters not a bit that I never consciously took advantage of anyone else.  Advantage accrued to me, silently, persistently, unsolicited and unnoticed because society, law, culture and the economy were fashioned for centuries by self-interested people who were demographically similar to me, using such power as they had to protect their turf. 

Perhaps you are a positive person, hard-working and always willing to lend a hand to those in need.  Kudos, my friend.  Personally, I’m rather lazy and self-centered.  You are a better human than I am.  You still prosper through privilege which you did not earn.

Seeing privilege is uncomfortable for those who have it.

I worked hard, I assure myself, to get where I am, but even those aspects of my personality that enabled me to work so hard are essentially happy accidents of genetics and social context.  I emphatically am not a self made woman.  I was given an easier path to walk and I did so without falling on my ass—nothing more.  There are uncounted millions who worked harder than I did languishing in poverty, crushing daily stress, and powerlessness.  The price of my easier path to success is the treacherousness of theirs.  

I can not “get rid of privilege” in my life.

I dislike, now that I recognize it, the skewing of society that prevents others who work as hard or harder than I did from succeeding.  Disliking the inequities of society does not negate them or the fact that I still benefit from them.  Disliking inequity does not necessarily mean that I am willing to give up a single thing to diminish it.

Transition merely enabled me to experience directly what goes missing when moving from a privileged (male) to a marginalized (transgender female) gender status.  Parenthetically, when I hear the refrain that people are claiming to be transgender because it is trendy, I worry that my head might explode.  Sure, it is a moment when transgender identity is somewhat novel and newsworthy, but being transgender affords no advantage whatsoever in terms of access to the levers of power and thriving.  

Having lost one sliver of privilege going foreword does not erase the privilege I accrued prior to coming out.  In fact, I continue to possess certain social traits that were rewarded in my male upbringing which were not similarly rewarded in those socialized as female.  I never learned, for example, to be deferential to men or to be act graciously in accepting an assignment that I perceive to be a waste of my talent.  Privilege is a fact, and the facts don’t change until the societal structures that create it are dismantled.

Privilege cannot be addressed, let alone eliminated, until or unless the structures which create it are dismantled.

Sometimes my next bullet point comes to me as I am trying to mop up the last one.  File this under things I did not know that I knew a couple of hours ago, but it turns out that I did.

Privileged people have difficulty seeing privilege because of perspective bias.

I practice medicine in the era of information.  Patient surveys reveal that physicians and patients, when asked the same question—“How long did the physician spend in the room with you?”—give widely different answers, and that the answers often have relatively little to do with the actual amount of time spent.  Perspective matters.

It seems to be a common human trait to overestimate the extent to which we “made it on our own” and to underestimate the extent to which others did so.  Anecdotal evidence fertilizes such perceptions nicely.  How many of you believed that racism had diminished to the point of political irrelevance when Barack Obama was elected President?  I certainly did, because my perspective—a white person voting for a black person—caused me to assume that 300 million other Americans felt more or less the same.  The privilege I experienced as a white person made it easier for me to ignore the fact that employment/housing discrimination, mass incarceration and historically unaddressed racist social structures did not disappear in 2008.  No–I felt good about myself for being so “colorblind”.  This did nothing to mitigate that I could, the next morning, number my black and brown friends without using my toes, and that I had no possible way to actually understand the struggle of being black in America.

This is the trap that prevents reasonable discussions about privilege.  Those who have privilege feel that mention of it diminishes them.  Not so.  Privilege elevates them at the expense of others.  What is felt is not insult, but guilt.  Privilege guilt needs to be faced, not dismissed.

Privilege is nearly impossible to see from the inside

I am a recreational astrophotographer.  I take pictures of the sky because if I do the work, I can count on the sky to be stunningly beautiful.   A few years ago, I posted a picture I took of the Andromeda Galaxy, some 3 million light-years distant from our sun.  Much to my surprise, several people asked if this was a picture of the Milky Way.  I spent years getting to know the sky and hours setting up and acquiring the photo.  Coming from this background, I could not conceive of taking a high-level external photo of the entire Milky Way because I am inside of it.  When next I take a picture of the Milky Way, my telescope will stand idly by, because I do not need to zoom in, but rather to try, as much as possible, to lean back in order to catch a glimpse of the big picture.  

Otherwise put, recall the old saw about the forest and the trees.

I have a friend—truly a friend—to whom I recently confided my angst about the difficulties I might have finding another job if my current one disappeared.  Meaning no ill will whatsoever—in fact intending the opposite—he told me that he understood how I felt.  I told him that he could not possibly understand because our circumstances were substantially different.  I botched the conversation, honestly, but my objection was valid. He felt aggrieved because he personally would have hired me.  Still, he could not possibly know how it feels to be a member of a class which faces employment discrimination and wrongful firing sanctioned by law in the majority of the United States.  He did not see the extent of the privilege that smoothes his path–virtually identical to mine pre-transition–because he never once stepped off of it.  Privilege is obvious only to those who do not have it.

This is the transition I will never finish.

I spent forty years mostly oblivious to the ways in which the structures of society continually enhanced my chances of success.  I spent the next ten, starting on my therapist’s sofa, merely beginning to grasp what is obvious to those who have to contend with structural bias on a daily basis.  If I live another forty, I will still never fully unlearn the patterns stamped into my thoughts or be able to give back the advantages that I received.

It is not enough for me to wish for a better society.  I need to work toward one.  I will probably never be in a position to rebuild social structures, but my shovel too has dug this hole, and at the very least, I must lay it down.

History flows like lava to the sea.  All will burn in the end.  If, for the moment, I find myself on high ground, it is largely because I was born there.  If I stay here, I will still burn eventually.  All around me echo the screams of those scrambling through harsh terrain, pursued by the same fire.  The ground must be leveled so that they will not be tripped up.   I am nothing but a hindrance to this effort untilI get off the higher ground so that it may be used to begin the arduous process of filling in the pits and potholes.  And when the path is leveled, all will follow it.  Then we will run together, run like hell toward the sea, reaching down to help those who stumble and spurring each other on until finally our legs fail us.

Land of the Free, Home of the Obtuse

Published / by rmaddy / Leave a Comment

I began my transition from a position of ignorance.  I was largely disconnected from the transgender community, had not read much from the increasingly rich corpus of trans memoirs and academic writings, and most of all, didn’t know where the hell I was going.  In the past decade I addressed and erased these deficiencies, and I report to you today, among other things, that all has worked out, more or less.1

We all start from a position of ignorance.  Human beings are blank checks of possibility.  We do not know, perhaps, the total balance against which we can draw, but it falls to us to continually fill in the recipients and amounts until the damn things (inevitably, I’m afraid) start bouncing.  Ignorance as a starting place, is not a problem.

Ignorance as a way of life, however…

I infer from the fact that, having read this far, you accept certain propositions.  First, you know that despite the fact that making sweeping assumptions about who people are on the basis of visible/audible characteristics that you perceive often works, it only works up to a point, rather than every time you do it. Since you make such assumptions with minimal conscious effort every day in regards to dozens of people, your assumptions will occasionally  be wrong, requiring you to adjust them on the basis of information subsequently acquired.  Second, you realize that you know almost nothing of the thought life of the people you think you know, and that pretty much everything you actually do know owes to what they say and/or what they do.

Easy-peasy so far, right?  The rest of this post depends on you synthesizing a conclusion out of what you have already accepted.  That conclusion is this:  that your perceptions of the gender of other people is reflexive, shallow, peripheral and effortless, while their perceptions of their own gender is experiential, deep, central and crucial.  Otherwise put, our half-assed, knee-jerk judgments about the gender of others are less accurate than, and trumped by, the gender that they experience internally.  

Yes, we are going to talk about pronouns and names again, but first I need to tell you a story.

In the spring of 2017, my wife, son and I took a brief vacation to West Texas.  The destination satisfied the annual need to escape the hopelessness of lingering winter in Minnesota, and offered further opportunity for some sorely-needed political catharsis.  Specifically, I wanted to take in the beauty of our nation’s natural southern border before some asshole tried to cover it over with concrete and barbed wire.  The trip was glorious, made even more so by the chance to spend a couple of days with a long-lost friend from high school, who parenthetically had, like me, changed her first name since we last met.

As a transgender person, I know that being misnamed is at least distracting, and often painful.  I also knew that if I let my thoughts run on auto-pilot, I would almost certainly misname her.  Auto-pilot, therefore, was not an acceptable option.  50 miles away from her home, on approach, I started to say her name over and over:  “Hello, Marlys.  Hey Marlys!  Yo…Marlys.”  I did this both silently and audibly.  Of course, I had already accepted her new name when she re-introduced herself to me months earlier.  It was, after all, her name, and she had no reason to be mistaken about it.

I think the strategy worked.  The reason I think that is because, throughout our renewed friendship, I always identify her in my thoughts by her new name.  Somewhere back in the brambles of my psyche, I know that she once had another, but unless I write a piece like this, I tend to forget what it was.  She is Marlys.  She told me so herself.  Good enough for me.

I once believed that hoping to be named and/or pronouned correctly by friends, family and strangers was too big of an ask.  I adopted a strategy of never correcting my patients and their visitors.  I concluded—after years of frustration—that it was far too difficult for older people, or those who had known me longer to make adjustments and resolved to just try to take their persistent misgenderings in stride.  I remembered that I too had made misnamed and misgendered others on occasion, mentally downplaying the conscious efforts I subsequently made to rewrite my memories—in the manner exemplified in the Marlys snippet—about those I had so offended.  I could not expect people to make such an effort on behalf of transgender people in general, let alone me specifically.

Then I went to France.

When out and about at home, whether socially or at work, I generally expect to be misgendered 10-15 times per day.  Most of the time, those who misgendered me tend to do so continuously, whether or not I correct them, or if they hear the correct name and pronouns from my work associates.  In France I was misgendered once over the period of two weeks.  The woman who did so apologized, looking somewhat chagrined in the process,  and did not repeat the mistake going forward.

How did France get right what my homeland so consistently gets wrong?  The possibilities:

  1.  I heard wrong.  Maybe I was too distracted by the sights and sounds to notice what usually feels, emotionally, like being whacked with a stick.  The thing is, they spoke English to us most of the time, and when they spoke French, phrases were always punctuated, without guidance from me, with the polite “Madame’s”.
  2. Their language makes gendering easier.  After all, French, like all Latin-derived languages, is structually gendered to a far greater degree than English.  Every object is a him or a her, not an it and every adjective and verb associated with the object follows suit.  “This table—she is beautiful.”  “This wine—he is sour.” In French, even the word this would have to be either masculine or feminine, and the adjectives change spelling, sometimes dramatically.  Perhaps the language does ingrain a sense of importance toward the task of properly labeling, but this in itself would tend to point out that they consistently labeled me as female.  Incidentally, the Brits, Kiwis, Aussies, and Argentinians with whom we broke bread over the two week interval also did so, despite the fact that only the Argentinians would have a linguistic cue to do so.
  3. They culturally accept transgender identity as valid in a way that Americans simply do not.  I’m not going to lie.  I’m betting all of my chips on this one.  

Despite my frustration that misgendering is a fact of my day to day life, and that transgender people are transparently being used as pawns in the raging culture war, I do see some occasional signs of progress.  For example, I have abandoned my previous conclusions that older people cannot get gender right.2. Though still more the exception than the rule, I get correctly gendered by people of all ages and essentially 100% of the time by those employed in customer service.3. Many of you have already updated your thinking.

Nevertheless, I still have ample occasion to cringe when, even as strangers increasingly address me as feminine, some of my closest associates and family—sometimes in the same conversation—continue to refer to me as he, him, etc, almost as if it were their job to correct the person who got it right.  I don’t necessarily assume that this is an intentional thought, but the confusion on the part of the person who just met me is instantly apparent.

I’m tired of making allowances for intention.  Maybe you didn’t intend to call me “him.”  The larger, more salient fact, is that intention has nothing to do with how you speak to me or about me—intention implies both effort and ownership—and that fact in and of itself hurts like hell, especially years down the road with no apparent end in sight.  And, if you really do just accidentantally slip up in a moment of distraction, apologize, for fuck’s sake, and start acting like the problem is yours, not mine.  It is.

Perhaps you find yourself thinking, “It is hard to remember what so-and-so, wants to be called now.”  And so it is.  This is because you are quitting after the word “hard”, ignoring the words “want” and “now”, and what they imply—that you still think you know who I really am, whereas I am deluded on that point.  Read that last sentence again, and understand that I, and most trans folk, hear the message loud and clear.

I wish I could tell you what it feels like.  The closest I can get is another story:

Imagine you meet a childhood friend and have a lovely conversation, reminiscing about old times.  As they leave, they call you the name of another of your old playmates, and it dawns on you that they genuinely thought that’s who you were.  Your companion remembers a moment of shared experience, but the fact that they have forgotten who you are in the story leaves you feeling a little empty.

Multiply by 70 and repeat 10x daily.  Or, better yet, recognize the limits of your ability to make casual inferences about who people are, and listen instead to what they tell you.

The Audacity of Poop

Published / by rmaddy / 3 Comments on The Audacity of Poop

“We should be guided by what works.”  –Barack Obama, The Audacity of Hope

It’s flu season again–our annual lesson in biological humility.  A tiny capsule of protein and RNA, 1/20,000,000th our size manages to break through our admirable system of defenses and actually turn them against us, killing a half million people worldwide every year, and leaving more than a billion of us utterly miserable and worthless for 7-10 days.  Medically, our best hope to treat the disease is not to get it at all, a strategy which requires a new vaccine every year, some of which work better than others.  All of this is compounded by the fact that the majority of the population has somehow convinced itself that the flu is no big deal, certainly not worth taking 15 minutes out of one’s schedule and enduring 1 second of mild pain, to prevent.  It’s the perfect recipe for a pandemic, and nearly every year it rises to the occasion.

Today I take a break from transgender education and advocacy to talk about another deadly infection which continues to adapt its defenses, rendering  the treatments which, until 15 years ago, worked in the vast majority of cases, substantially less effective.  This disease, caused by a bacterium named Clostridium difficile–or “C diff” for short–now infects 500,000 Americans per year, causing approximately 30,000 deaths.  In the waning days of November 2017, I very nearly was one of them.  This is the story of a deadly disease which already lies quiet in your intestines and challenges the way we think about bacteria in general.  And, it’s a story where the best hope of cure lies not in medicine, but in shit.

I recently posted regarding my experience with FFS–facial feminization surgery.  I was about 5 days post op at that point, and still really swollen, but optimistic about a rapid recovery.  It turned out to be anything but rapid.  I developed infections in my cheeks which required multiple courses of antibiotics and surgical revision.  Before the dust settled, I had been on antibiotics for nearly 8 weeks.

Four days after taking my last dose of cipro1, the diarrhea started.  C diff most commonly strikes after antibiotic use, when the normal bacteria of the intestines are disrupted.  I was ready for the possibility of C diff.  I had a full bottle of metronidazole–an antibiotic used to suppress C diff2–at the ready.  I started taking it immediately, and the diarrhea lessened as long as I took it.  No tests were done, but I was pretty sure I had it.  I finished my course of metronidazole on Thanksgiving day.

Three days later, my symptoms were back with a vengeance.  This time, the diarrhea came with intensely burning rectal cramps and high fever.  I was at work at the time, and ended up becoming my own next patient in the ER.  Holding off as long as I could stand it, I ended up just flopping onto the cot in Room 4 an hour before my shift ended.  My temperature was 105, my white blood cell count was 4x normal and it took three liters of IV saline to get my blood pressure back above 90.  I had sepsis and there was some concern that my colon had perforated.  This time a stool specimen was collected, and I was started on another antibiotic–vancomycin.  I felt better after IV fluids, but I was admitted to the hospital for a couple of days.  The test result confirmed that I had C diff.

Vancomycin seemed to resolve the symptoms better.  I ended up taking it for ten days–long enough to get some R and R in Hawaii.  I felt like a limp dishrag, but it is better to be sick in paradise than sick at home.  While there, I saw a T-shirt that I liked, but unfortunately not in my size:  Salt Water Cures Everything.  Unfortunately this proved not to be the case.  Two days after returning home and taking the last of the vancomycin, the diarrhea returned.

I restarted vancomycin again, and this time got permission from my insurance to go on a new medicine tailor made to treat C diff–fidaxomicin.  I was on the good stuff this time–$100 per pill of pure healing.  I still have half a bottle of it in my purse.  I was sick again within five days and switched back to vancomycin, which at least suppressed the symptoms a little better.  I resigned myself to the fact that antibiotics were not getting rid of the infection, and there was only one treatment left to try.

About six years previously, I had given a medical lecture for our hospital staff on emerging infections.  I covered the latest on Ebola and resistant Staph infections (aka MRSA), but mentioned that an old infection, C diff, was making a resurgence and seemed to be suddenly less susceptible to antibiotics.  The change seemed to happen abruptly in 2003-4.  The disease had literally evolved in front of our eyes.3  I mentioned a new therapy–stool transplantation from a healthy donor–to the audience, who mostly, like me, laughed it off at the time.

Now I found myself desperate enough to try it.  The problem was that it was now Christmas Day and nothing much was likely to happen until after the holidays.  My doctor said she would refer me to a gastroenterologist at Mayo Rochester.  It would probably take about 3-4 weeks to get an appointment.  They did have a stool transplant–aka Fecal Microbiota Transplantation–program.  If I were accepted as a patient I should be able to get the procedure done within another 2-3 weeks.  She would be happy to supply with more vancomycin in the meantime.  Quick math suggested that I was looking at early February, and meanwhile I was still sick, never able to do any better than suppress the symptoms somewhat.  Hope delayed is hope denied.  I wondered what I should do.  More to the point, I wondered what would Angus MacGuyver would do.

I gathered supplies and read up on potential complications.  Most hospital based FMT programs require you to supply your own donor, and subject that person to a lot of testing to prevent exposure to other infections.  My donor and I have shared a bathroom for nearly 30 years, and I was not concerned in the least about catching anything from her.  Hospital programs also typically use a colonoscope to deliver a mixture of stool and water carefully prepared and homogenized in their microbiology lab.  I don’t have a colonoscope or a microbiology lab.  I decided to settle for an enema bag and some kitchen tools4.  There is a surprisingly robust DIY community of fecal transplanters online.  I read all that I could from them and from the medical literature about FMT.

One day before the main event, I stopped eating.  I laid out everything in the bathroom and even rehearsed the sequence, practicing shifting from position to position in a manner which would allow my mixture to follow gravity back through the length of my colon.  I drank magnesium citrate to empty out what was left in my gut and waited for shit to happen.  Once it did, the procedure was done in an hour including clean up.  I held the mixture internally for 5 hours.  That night, everything exploded back out.  For good measure, we repeated the transplant the next morning.  This time, nothing came back.  For days.  I have not had a single episode of diarrhea since, nor have I taken a single tablet of vancomycin.

For decades, doctors have prescribed antibiotics for increasingly flimsy reasons to satisfy a patient population that has largely come to expect them.  In so doing, we have created a host of emerging diseases which are resistant to treatment.  The hope has been that even better antibiotics would come along to treat the tougher diseases.  That hope is starting to wear a little thin.  In this particular case, antibiotics gave me C diff, or more precisely, they killed off the normal bacteria that usually keep C diff in check.  I took more antibiotics to kill the C diff, but they could not eradicate the infection.  What finally cured me was not better drugs, but better bacteria, specifically those of my healthy spouse.

C diff may be unique in its ability to be cured by bacteria.  I suspect that it is not.  Regardless, in the long run, we will need to be more prudent, both as physicians and as patients.  Doctors should take the time to explain why antibiotics do not help in viral illnesses (including bronchitis, sinusitis and other upper respiratory infections).  Patients should become savvy consumers, not pushing for medication where time and rest will suffice.  We hope that diseases will become less resistant to antibiotics if we use them less frequently.  Unfortunately, that is only one possible outcome.  The other may be the emergence of a deadly post-antibiotic era, where antibiotic treatment is no longer works at all.


Published / by rmaddy / 5 Comments on FFS

Image credit David Tenant, Hamlet, 2009


The arc of a ball through the air can be described mathematically.  For each fraction of a second, the ball approaches you at a certain rate, drops slightly due to gravity and perhaps curves in one direction or another due to spin.  In a second, the ball moves so far.  In a half second, less.  It is possible to consider smaller and smaller increments of time.  In fact, if you consider an instant, an infinitesimally small increment of time, you may still describe the position and motion in that moment.  To do so requires a branch of mathematics known as calculus.  Odds are, you don’t understand calculus.  Nevertheless, through practice and experience you catch the ball.  Your brain gets calculus even when you don’t.

Something parallel happens regarding gender.  The senses give input to the brain which turns this information subconsciously into complex ratios and estimates of probability.  Men tend to be taller than women, but height alone does not distinguish between them.  Similarly, women tend to speak in a higher pitch, but there is sufficient overlap that pitch alone does not reliably allow for gender recognition.  At any given moment, nearly instantaneously, we measure thousands of parameters in order to classify our human companions with regards to gender.  Most of the time, we are unaware that we are doing it.  In fact, if we try to consciously measure and process data in order to make a gender determination, we suddenly get very, very bad at it.  Our brains are really good at making gender determinations that cannot easily be made if we set our attention to it.

Consider the face.  You recognize the difference between male and female faces, but if asked why you think a face is male or female, you either draw a blank or tend to mention things (shape, for example) that are not particularly potent predictors of gender.  At any given moment your eyes are picking up subtle details and your brain uses this information to calculate ratios which you have probably never considered.  There are nearly 4 billion male and 4 billion female faces on the planet.  They are so unique that even genetically identical twins can be recognized by close contacts.  Somehow, your brain recognizes them as male or female, familiar or unfamiliar and may instantly assign a biographical file to a face before you have a moment to think of it.  And, to today’s topic, you assign gender to a face almost instantaneously, despite the fact that there are four billion men’s faces that don’t look all that alike and four billion women’s faces with the same degree of variance.

Certain patterns tend to hold.  Women on average have smaller heads with smaller features.  The male hairline is a relatively higher “M” to the female’s upside down “U”.  The male forehead slants backward subtly compared to the relatively vertical female counterpart.  The female mandible is narrower, culminating in a somewhat more v-shaped chin.  The male nose to lip distance tends to be longer.  Without even considering the relatively obvious marker of facial hair, there are patterns and ratios which, taken together, help to form a gender impression.

I write today five days post facial feminization surgery,1 still a bit bruised and sore from 6 hours under anesthesia during which dozens of millimeter scale adjustments were made to my features.  When next we meet, you will still recognize me, but your brain will tend to classify me differently.  Some of the changes (higher brow, smaller nose) will already be present, whereas some (lower hairline, narrower chin) may take six months or more to settle.  Although most people have never heard of it, FFS is often the surgery most coveted by male to female (MTF) transsexuals.  It is expensive, painful, and unlike GCS, aka “The Operation,” impactful in day to day social interactions.

Unfortunately, it is also widely considered to be purely cosmetic and elective.  Insurance rarely picks up the tab, and it can run anywhere from $15,000-$50,000 depending on what is done, by whom and in what facility.  Personally, I opted for a fairly limited course, concentrating on the upper part of the face, particularly the forehead, which seems to play a crucial role in how the brain processes gender.  Most transwomen never get the opportunity.  I write this fully cognizant that I am a woman of great privilege.

I also had the procedure done in a local office, which given the length and intensity of the surgery was not the sort of caution I would have preferred, but I am not immune to the economic argument.  And, I seemed to have escaped death, for at least the period of time that I would likely have been hospitalized elsewhere.  It is not my intention to review here the care of my surgeon, but Kathy and I were drawn to him for his reassuring demeanor, his thoughtful listening, his artistic eye and ultimately, his training in complex craniofacial procedures.  I appear to have won the bet, and saved thousands over what the same care would have cost in my hospital system, which as I mentioned, wouldn’t financially support it anyway.

The bruises and swelling are still too extensive to permit much of a look, but I like what I can see.  Mostly, I see my eyes, but the way I think they were meant to look.  The pain is intense, but I was never particularly afraid of that–a few butterflies the day before at most.  My biggest fear was that I would wake up with regret, thinking that I had made some sort of a mistake.  I don’t.  Not one bit.

I hope that my surgery will help you to see me differently, but ultimately it was more about greeting the person I see in the mirror each morning.  I want, in the words once given to me by my friend Anne, to feel at home inside my skin.  Time will tell, but the deed is now done, I am convalescing, and I am feeling very grateful.  I do hope that you will not think me vain.  I am of course, but it’s still uncharitable to think that.  This fixes for me something that was existentially broken for 50 years.

Perhaps my new lines will persuade your brain to accept my femininity.  Nevertheless, I remain ever hopeful that you will accept it for the best reason of all…because I asked.

Sweet Anonymity

Published / by rmaddy / Leave a Comment

It’s the closest thing to a high holy day for me these days, not that this is saying much.  I don’t have much use for the concept of holiness anymore, with its haughty sense of untouchability, distance and separateness.  Are you apt to swear by “all that is holy”?  Name-dropping of the highest order, IMO.  Perhaps we ought to swear by more verifiable commodities like the greenness of grass, the jerk in accounting or Amazon Prime.™ But I digress…

The (un)holiday to which I refer is, of course, Pride, which also stretches the definition of holiday by extending for the entire month of June.  Practically speaking, though, it amounts (in Minnesota anyway) to a two-day festival of which the most popular event is a roughly half-mile parade down Hennepin Avenue.  Depending on the mood of the LGBT community and the weather, it can be a raucous affair indeed, drawing hundreds of thousands of people.  In 2013, the parade came on the heels of the legalization of same sex marriage.  I remember stepping out into the street at the end, and being one of a somewhat tall disposition, I was able to look far up and down the street, revealing a sea of people that simply dwarfed the crowd of a large stadium, decked out, for the most part in epic rainbow.  Last year, a similar number gathered, yet palpably in the shadow of Orlando.

This year, clouds and wind better suited for late-April provided a tangible reminder of turbulent times.  Stung by the acquittal of a police officer who gunned down a man for calmly complying with instructions to produce a driver’s license, we were forced to reconsider the role of the police our festivities.  Those of us more recent to the festivities have typically experienced  the police as a benign presence at Pride, marching alongside us and dispensing a seemingly limitless supply of smiles.  Still, we recall that Pride started at Stonewall, a direct result of systematic discrimination and police violence, particularly against transwomen of color.  Polite applause greeted a cadre of protesters claiming to represent Black Lives Matter.  Nevertheless, viewers in my immediate vicinity expressed frustration as the parade stalled for more than 60 minutes.

By the time the parade resumed, I was freezing, despite having layered up.  Dykes on Bikes led the procession as always with a roar, producing the usual response of thunderous applause.  The various flags were next.  As the transgender flag passed by, I saw a chance to warm up.  I walked out into the street, grabbed a handle, and marched the rest of the way to Loring Park.

From then on, it was business as usual, as in Target, Delta, Best Buy, health organizations (including those that still deny transgender benefits) and dozens of churches.  I got my 30,000 steps in.  I ate corn dogs and gyros.  I kissed a daschund.  I kept hoping for some great random conversation, but mostly I just made small talk with the various shopkeepers.  Whether there were more present this year or not, police seemed to be ever present, most of them grinning from ear to ear and many with dogs.  And why not?  Pride is always crawling with canines.  I regret that Scooter did not make the trek this year as he has in the past.  Most of all, I reveled in the annual opportunity to walk around and garner no reaction whatsoever.  Sweet anonymity!

I meant to post this summary before June slipped away, but better late than never.  Belated Happy Pride to my readers, who sometime within the past few months hit my pages for the 10,000th time.  I am honored by your clicks and comments.  I do apologize for the slacking pace of this blog.  Chalk it up to a combination of things–at some point one feels that there is very little to say, and at some point the desire to recount my transitional thinking starts to feel like performance art.  I intend to continue writing, but a growing impulse for privacy is competing with my desire to disclose, slowing me down somewhat.  Until next time…


Dunsinane. Within the Castle.

Published / by rmaddy / 1 Comment on Dunsinane. Within the Castle.

His elbow caught me more or less in the center of my abdomen.  Instantly, accident scene reconstruction commenced.

Option #1.  I walked into somebody.  Sure.  I do this, particularly but not exclusively when I am lost in thought.1 Ordinarily my well-honed reflex to beg pardon would engage at this point, but paradoxically the moment of contact found me unusually dedicated to interpersonal spacing.  Specifically, I had chosen an opening at the luggage carousel where I would have the best chance of extracting my heavy ass suitcase without risk of jostling or be jostled.  The elbow did not compute.  My brain sought more information.  It came as I made eye contact with the other party and noted that rather than registering the expected surprise, he was smiling.

Option #2.  I must know this person.  Memories of past chance encounters in the airport begin to percolate towards the surface, only to be superseded by the frantic urgency of identifying the face before me.  This is not a talent for which I am recognized.  I feel a bit queasy, whether from the potential embarrassment of being recognized without recognizing or an increasing insistence by my usually passive abdominal wall that I suddenly pay attention to it.

He is short.  Slightly built.  Blond.  Roughly twenty-five.  The only friends I have in this age group are musicians and wannabes.   A patient perhaps…then why the touchy-feely familiarity?  A co-worker’s spouse?  Dammit.  No match.

The encounter approaches the ripe old age of four seconds.  He starts circling to my left, eyes locked, smile shifting ever so slightly into a display of teeth, holding a distance of 20-25 feet. I recall the elementary school playground and those TV specials about hyenas.  Option #3 begins to take shape.

I voice it first as a question:  “Oh my God…did he just hit me?”  My subconscious runs with this, and starts laying the groundwork for a shift from “What?” to “Why?”  It will have precious little time to proceed.  He is about to speak, thereby signaling the end of the internal inquisition.

Good luck with the operation.

He continued to my left, and while I considered whether to believe my ears, he repeated it, so as to register his preference that I do.  Well, thanks…I suppose…although I didn’t recall bringing it up.

That’s as far as the story goes.  If the dissection of my thoughts seems overly detailed, it is only because there is nothing else to report.  In striking me in the center of my spare tire, he chose the one target where he was least likely to do much damage, his elbow bouncing harmlessly away like a pebble on the roadway.  Parenthetically, this happened not in the ruby red state of Texas, from which I had presently returned,2 but in brilliantly purple Minnesota.

I don’t know what impression will linger in the months to come, but the early verdict is that I had no good options.  Whereas my youthful self was directly and indirectly trained to resist a bully, it now occurs to me that most often resistance really is futile.  I am aging and recently, quite achy.  My size no longer protects; it only identifies me as a target.   I have also acquired just enough wisdom to know that answering petty violence with more petty violence would put me on level with this little cretin.  There was nothing whatsoever but to wait for the end of the scene.

I offer this story with no moral attached unless it is that shit happens.  I’ll brood, and verbally process and move on.  Eventually something else like this will happen and I’ll go right back to Square Fucking One.  Repeat until you can’t.

Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.


Check the Math

Published / by rmaddy / Leave a Comment

[There are] lies, damned lies and statistics.  –Mark Twain

It will not surprise you to hear that I follow a number of transgender news feeds.  Staying abreast of happenings within one’s broader demographic requires some discipline, particularly when one’s “broader demographic” is rather narrow.

As with news in general, transgender news reads a bit dark.  Violence makes good television, at least if ratings are any clue.  Following this trend, it has become increasingly common for transgender murders to be not only reported, but counted, as in, “This marks the ___th murder of a transgender person this year.”  The final tally last year, according to The Advocate, was 27.

I understand what The Advocate and others are trying to do.  Shining a light on anti-transgender violence is part of the process of curtailing it.  Further, each death represents a grim loss–first and foremost for the individual, then outward to their families, friends and society in general.  I applaud that they are individually remembered and lamented.  I feel their deaths somewhat more closely than the average murder because I identify with the class struggle which often lies beneath it.

But let us not too quickly get lost in the numbers or gloss over ridiculous phrases such as “the average murder”.  The reason that some of you might not have choked on these words the first time I used them owes largely, in my opinion, to the fact that murder is anything but rare.  In 2015, there were 16,000 murders in the USA, and by all accounts the final numbers for 2016 look to be higher.

Each one of the victims reflects an epidemic of violence that we, as a nation, have done little if anything to address.  Indeed, we tend societally to respond to rampant violence by buying guns, a remedy which has been proven to double the likelihood of being murdered and triple the chances of dying by suicide.  Of course those stats don’t apply to us, right?

Let’s do the numbers:  27 transgender murders.  16000 total.  This means that, if reported accurately, transgender people, who represent perhaps 0.3% of the population, account for less than 0.2% of US murder victims.  The problem isn’t necessarily that we have a transgender violence problem specifically, but rather that we have a violence problem in general.

By all means, let us mourn and remember the dead, not just as numbers, but as individuals bursting with unrealized promise and potential.  Let us feel the outrage inherent in the fact that someone was killed for being who they are.  Nevertheless, let’s not get too parochial about it:  Trans people really are killed for being trans, but likewise children are killed because they are children.  Women are killed because they are women.  The poor are killed because they are poor.  Murder is the ultimate affront to egalitarianism.  Somehow, somewhere, someone was deemed to be expendable.

That.  Let’s stop that.