Prairie Oysters

“Remember,” Dr. Laura Ellis tells the surgical team, as they lift her onto the operating table for her genital reassignment surgery (GRS), “I'd like my prairie oysters served on rye toast when I wake up.”

        Eyes crinkle in smiles behind six surgical masks. “High time we knocked you out,” the anesthesiologist says, and places a rubber mask over Laura's face. In moments she becomes just another paralyzed subject. The team clicks into high gear. A nurse fastens Laura's legs into stirrups, raises and spreads them, then shaves and swabs the site with disinfectant. The scrub tech lays out trays of stainless steel surgical tools. Tubes are stuck down her throat and into her veins. And every part of the body, except the penis, under the bright surgical lights, is covered in layers of blue sterile sheets.

       This GRS operation does not take place at some swanky San Francisco, New York or LA hospital. Instead patients must fly into Denver, then drive three hours south on I 25, passing the Air Force Academy and the “Focus on the Family” headquarters in Colorado Springs, then on, past endless cattle-studded rangeland, to a town just above the New Mexican border, where a welcome sign ironically says: Trinidad: We Kept The Best For Last.”

       If you're just an ordinary, full-bladdered tourist, walking by the once elegant stone and brick buildings on Main Street, you'd have no reason to catch the irony. But if you are born with gender dysphoria , and feel your body does not reflect who you are inside, then the motto of this former mining town must ring a reverberating truth.

      For Trinidad, population 9500, is the Sex Change Capital of the World. In the last 35 years, over 5000 transsexuals gained their genital birthright here at the local Mt. San Rafael Hospital.

Twin-Souled

Dr. Laura Ellis, elegantly dressed in a business suit and a white lace blouse, asks her patient, a construction worker suffering from allergies, to put a finger in his one ear as she peers into the other with a scope. “Otherwise the light will spill out and I can't see a thing,” she deadpans. He complies, then smiles, as he catches the joke.

      Three months ago Dr. Ellis moved to Trinidad from Central Florida, where she was Dr. Brian Ellis, a senior partner in a multi-specialty medical group, with a wife and two kids and the American Dream firmly in his grip. But since the age of four, when she felt so good wearing a towel like a dress and her mother beat her for it, Laura knew she was born in the wrong gendered body. For decades, living as a highly successful man, she kept her gender dysphoria a secret.

       People who are born transsexual – about 1 in 2500 births – feel their physical sex does not match their internal gender identity. What causes this birth defect, or “gender giftedness,” is still not fully understood.   “But,” Dr. Ellis explains, “we know all fetuses begin as female. Then, between the twelfth and sixteenth week of gestation, hormones turn half the fetuses into males. But if certain hormones are not present, or if there is a hormonal imbalance during this crucial period, the brain will remain female even as the body becomes male.” Laura describes recent autopsy studies of male-to-female transsexuals that show parts of their brains are actually structurally closer to genetic women, which points to a possible biological cause of transsexualism.

       Causes aside, the social misunderstanding and internal pressures transsexuals face are immense. And when the brave few decide to transition – changing their bodies to match their minds – many lose family, community and work, and must daily confront society's judgment and scorn. Yet in many traditional societies these “twin-souled” people were regarded as gifts from the gods and became the shaman, able to translate the secrets between male and female, matter and spirit.  

      Two years ago, when the pressure to free Laura from the prison of her male persona became uncontainable, her life unraveled. She, as Brian, could no longer sleep, grew depressed and her marriage wavered. That Halloween, when on impulse, she dressed for the first time publicly as a woman, she looked in the mirror and thought, “My God! This is who I am.” That night she slept well for the first time in months.

       No longer willing to live a lie, Brian decided to transition permanently to Laura. She started taking female hormone pills, had breast augmentation and face feminization surgery, while enduring dozens of hours of electrolysis. For the past year she has lived legally as a woman. And now she completes the physical transformation by undergoing GRS here at the hospital in which she now practices.

Pencil Sketches

How this cowpoke, dying mining town become the place to turn your penis into a vagina, or visa-versa, all started in 1969, when Dr. Stanley Biber, a Korean War M.A.S.H. surgeon, opened a practice in Trinidad. He did all the usual baby deliveries, fracture reductions, and gall bladder removals.

      Then, one day, the hospital social worker pulled Dr. Biber aside and explained that she was born a woman with male genitalia and wonders if he could fashion her a vagina. The good doctor agreed, and wrote to John Hopkins Hospital – at the time the only place in the country doing sex change operations – asking for advice. They sent him a few pencil sketches, which he studied, then donned his surgical scrubs and began cutting and stitching.

      Seven hours later what was male became female; operation a success. Word spread, and in the next thirty years Dr. Biber performed over 5000 sex change operations. Three years ago, at the age of eighty, he passed his scalpels on to his protégée, Dr. Marci Bowers, an Ob/Gyn doctor from Seattle.

On The Edge

Dr. Marci Bowers strides into her consultation room wearing rhinestone sandals, a black mini-skirt with a sleeveless blouse, and has her long, blond hair pinned casually just so.

She is hot and no nonsense and until 1998 lived as Dr. Mark Bowers.

       She questions and examines Laura one last time before the scheduled operation the next day. “You'll be surprised how little pain you'll feel after the surgery,” she reassures Laura. “We've gotten quite good at these, so much so that the post-op swelling and bruising is normally quite minimal.”

       To date Dr. Bowers has performed over 200 genital reconstructive surgeries, making significant modifications to Dr. Biden's techniques, and is widely regarded as the best GRS surgeon in the world. “Partially because she has transitioned herself,” Dr. Ellis tells me later, “Marci brings a perspective and compassion that is unique to the field.”

     When Laura undresses, I go next door and talk to Julie Savage, Dr. Bowers' ginger-haired practice manager. She drinks her coffee black, drives a badass red Avalanche truck, and in a thick Louisiana accent, calls everyone “dear” and “sweetheart.” We sit in Dr. Bowers' office under a Mesopotamian Goddess statue and a sign on the wall that reads: If You're Not Living On The Edge, You're Just Taking Up Space.

      Julie describes what Dr. Bowers does as humanitarian work. “No one chooses to be born this way. No ordinary man willingly risks everything just for the kicks of dressing like a woman. Give me a break! People who come to us suffer from a birth defect. Dr. Bowers helps correct that, matching their bodies with their minds and their hearts.”

      “But how well does the surgery work?” I ask, “I mean, can they like still, you know…”

       “… have an orgasm?” Julie finishes. I nod.

       “As long as I've been here,” she says, “every patient that's reported back to me experienced orgasms after they have healed, and most claim that it's stronger than it was when they were a male.” I shake my head. “Unless you've actually witnessed the transformation, your brain can't imagine it. We've had former patients go to their gynecologist who cannot tell that what they see before them was once a penis.”

Outside Inn

Sabrina Marcus greets me at the door of the Morning Glow Guest house. A former NASA engineer before she transitioned, Sabrina has the presence of a large, blond, Italian opera singer.   “Excuse the construction mess,” she says as we step over piles of sheetrock. A dusty print of Botticelli's The Birth of Venus hangs over the mantle. Sabrina, with her business partner Dr. Laura Ellis, are in the middle of renovating this three-story Victorian mansion, which once housed a hair salon, into a sanctuary where post-op transsexuals can come to recuperate. “We thought of first calling this place The Outside Inn,” Sabrina says as she guides me down the basement stairs, “but thought that would be a little risqué for our neighbors.”

        Laura is in the basement laundry room cooking a four-course pre-op celebratory meal on a camp stove. Even though she can't eat, she insists on cooking. “It's what I love to do,” she says. She introduces me to her daughter Erin, aka, Wild Child, who describes her dad as “the hottest chick I know.” The love between them is fierce and fiery like the tomato, cilantro and jalapeño soup Laura stirs. She keeps calling Laura Dad. “I mean, da, she contributed the male part of making me, what else should I call her?” I leave that pronoun ball of twine for someone else to unravel.

       We eat at a sawhorse-and-door table covered with a pink tablecloth adorned with a vase of fake roses someone found in the attic. Along with Laura and Erin and Sabrina, the rest of the family joins us. There is Aunt Jo Anne in her red-wigged splendor; a former truck driver, now resident carpenter. And Jessica, from Colorado Springs, who, intoning the Jewish New Year blessing, hands out slivers of apple and honey for Rosh Ha Shana. In two days she too will spend $15,500 on her GRS surgery. And there is Peter, recently divorced, former cop, now local chocolate shop owner, who tells me “these people are the closest I've ever come to true family.”

        Between courses and sips of wine Sabrina tells how a few weeks ago a local fundamentalist church elder tried to circulate a petition to stop sex-change operations in Trinidad. He believed the practice brought “reproach” and “stigma” to the community. The town folk, outraged, sharpened their pencils and sent a flood of letters to the local paper, insisting that transsexuals are a vital and welcome part of the community. “Last I heard,” Sabrina chuckles, “the church elder moved out of town.”

      Sabrina, a devout Catholic, is a welcomed member at the local Catholic Church. “The church is like a father you'll always argue with, but can't stop loving,” she says. “But without my faith I'd never have had the strength to transition as a woman.”

        Over a baked-tortilla-and-melted-Snickers-bar desert – Laura's invention – I ask Jessica if she won't miss her penis. “That's such a typical guy things to ask,” Jessica says. “But I'm not losing a penis. I'm gaining the vagina I always knew was my birthright.”

       “How long have you wanted a vagina?” I ask.

       “Emotionally I've had one my whole life. But it's not about want. Want is a nice dress, a piece of chocolate cake, a boyfriend,” Jessica explains. “I have to have a vagina to live a life that's not a lie.”

        She describes going earlier that day to the recovery ward at the hospital and talking to the post-op patients. “The feeling in the ward was the same I experienced when I first visited my new-born son in the nursery. Every woman had a glow of serenity, like they'd just been born into their true selves.”

       As we eat and laugh and discuss, I watch Laura turning inside, going to that place an ordinary man cannot comprehend. In twelve hours what wrongly defined her as a man for half a century will rise as smoke up the chimney of the hospital's incinerator.

The Other Side

Like the first line of a joke, a tranny gal and a skinny blond guy enter a Trinidad bar called The Other Side. Cowboy hats and dirty baseball caps turn and stare. Sabrina and I order purple martinis from Debbie the barmaid. She's all curves and pout with sad bedroom eyes, and every patron watches her cocktail-shaking, beer-pouring moves, and dreams and desires.

      During the first smoochy jukebox song, Sabrina asks Debbie to dance. Like courting cranes they swirl and shimmy, compelling attention. Women watch and cheer, men watch and mutter into their beers. What's the world coming to when the only one with the balls big enough to seduce Debbie is a big, blond transsexual? Back at the bar, blotting her glowing brow, Sabrina says, “I just love making ridged assumptions shatter,” and orders another martini.

      We watch the courtship game around us. Like two strange tribes forced to trade without a common language, men and women circle each other, stiff-legged and awkward. Each drink holds the promise of comprehension, but delivers compounded confusion. Only Sabrina knows both languages. Like an emissary between Mars and Venus, she talks politics and sports with the guys, and a moment later huddles with the girls in the Ladies Room. “As a tranny woman, I straddle both worlds, which many find attractive,” she tells me. “But few people are secure enough in their identity to fully open to what I have to offer.”

      During lulls between orders, Debbie sits on Sabrina's lap and they make out like teenagers. “But it's just fun and games,” Sabrina says, when Debbie walks back to the bar. “She knows I can take her to places no man ever can, but she too is afraid.”

Sculpting Flesh

In the pre-op room, Erin rubs her father's feet, as the nurse inserts an IV needle into Laura's hand. “Emotionally I feel excited to be doing this,” Laura says. “But part of me thinks, What the hell am I doing here?” She pauses, looks at her daughter. “But I know this is right.”

        Erin wipes away tears and hugs her dad one last time before a nurse wheels Laura into the operating room.

        When the patient is unconscious and the site prepared, Dr Bowers enters, regal and contained. Her mesmerizing eyes, between mask and cap, are alert as a hunting cat. A nurse helps her into a surgical gown and latex gloves. She sits down, back erect, on a cracked vinyl stool, scoots between the raised legs, and like a maestro before an orchestra, raises her hands over the spotlit penis, and begins.

      No instructions are needed, no verbal requests necessary. Each person knows exactly their role to enable the surgeon to wield her tools as effectively as possible.

      With a purple pen Dr. Bowers draws a complicated Y that intersects where the scrotum meets the penis. “Get this right,” she says, “and everything else falls into place.” The scrub tech hands her a scalpel. The blade touches skin, splits the purple line, and what has never been seen, lays revealed, wet and red, under the bright surgical lights.

     Like the sacrilegious thrill of looking under the alter cloth, or as a child playing Doctor-Doctor for the first time, you watch enthralled as the surgeon peals back skin to reveal what is hidden and forbidden and taboo.

      Dr. Bowers uses both a scalpel and a tool like a soldering iron – called a Bovie – to cut and shape. It sizzles and sparks through fat and muscle, sealing veins, coagulating blood, and the smell of burned flesh fills the air and lingers in the nostrils for hours. Condense the skill of a concert pianist, a sculpture, a cabinetmaker, and a sushi chef, and you begin to grasp the high art of those blood smeared hands transforming flesh.

        But obscure the surgical site and it's just eight people in a small room for too many hours, doing what they have done countless times. Just like on a construction site or in a restaurant kitchen, they joke and jive, trade humorous tales of inept politicians, swap hospital gossip and tease each other mercilessly. On a cheap radio Van Morrison sings something about “taking it down to the very marrow”.

       Once the scrotum and testes and the erectile tissue around the penis are removed, Dr. Bowers trims the penis head, still attached to a thin ribbon of nerves and veins, down to the size of a clitoris, which she then fold up and pins into place with a few stitches. “This way you will still get all those yummy feelings,” she says. And that's the trick, because what once was the fetal clitoris, but then wrongly became a penis, now becomes an orgasmic clitoris again.

      Next Dr. Bowers cuts and shapes and delicately tunnels, millimeters below bladder and above rectum, a new body cavity where there was once just connective tissue obscuring potential space. As she works, surgical assistant Mark Horn stretches what was the scrotal sack over a plastic dildo – like a cobbler's last – and with needle and thread sews a vaginal canal. The hair follicles, not killed by the pre-op electrolysis, he zaps with the Bovie.

      “We're somewhat playing Mother Nature” Dr. Bowers says as she inserts the new vaginal canal into the gaping cavity. She then flips what was the base of the penis inside out, turning it into the vaginal opening and sews the two together. Next she stretches down the penis skin, fastens it, and what was a bloody mess now looks featureless as a naked department store mannequin. “Sometimes it all comes together so well,” Dr. Bower quips, “that these guys go home hungry to their wives,”

       “I've seen this eighty times,” Mark, the surgical assistant says, shaking his head, “and it still blows me away every time.”

       A stillness comes over the operating room, as Dr. Bowers then snips an opening for the urethra, and another, further up, where the new clitoris pops out. Then – like fashioning hand puppets from an old sock – she stitches and pinches and sews a clitoral hood and delicate labia lips, transforming what was a misplaced penis, into a woman's flower made whole. In that moment this surgeon, with her bloody hands and totemic tools, becomes that old tribal shaman who, through the passage of blood, cuts these In-Between-Ones into their rightful selves.

…End