Genital Confirmation Surgery (GCS), March 2019

Beach waves at Monterey, CA

Monterey, CA

I meet with my surgeon the afternoon before surgery. My appointment has been re-scheduled twice; once because traffic is preventing me from arriving for an earlier appointment and then later because the doctor is running late.

This is the second time I’ve met with her and it’s an opportunity to ask any last-minute questions.

Do I have any?

No. We covered everything the time before.

She asks me a question: what are your expectations?

This question gives me pause. I realize I’ve never really thought much about expectations.

I know the whole reason I’m sitting here is because my expectation is that she will re-configure my genitals to conform to what my brain tells me should be there. Beyond that…

‘I don’t know. I don’t really have any,’ I blurt.

She seems surprised by this and starts mentioning a few things that include depth and appearance. I don’t want to look like a complete idiot so I spill out a couple.

‘No infection. Orgasmic.’

‘What about appearance?’

‘That’s out of my control so I don’t worry about it.’

We chat a bit more and she seems satisfied with my answers. My surgery time has been moved from 07:30 to 11:00 since there was a power outage at the hospital today and she had to bump her afternoon surgery. News of a power outage gives me a moment of pause but I’m cheered that I don’t have to be at the hospital at 05:30.

She hands me the bowel prep kit and gives me an overview of how to use it, directions to the local Walgreen’s to pick up some other prescriptions, and then I’m sent off with a, ‘See you tomorrow!’

My friend, who lives in Monterey and who I’ll be staying with, has been patiently waiting and we walk to the pharmacy down the street to pick up the prescriptions and some last-minute supplies. My mind is overfull, and it’s all I can do to focus on where we’re supposed to go.

Waiting in line at the pharmacy, an older woman sitting in a chair waiting for her prescription comments on my backpack by asking me if I’m going hiking. I mumble no. Talking to other people is hard right now.

I wonder how many other trans women have stood in this line waiting to pick up their medications. Hundreds? At least. Thousands? Easily. I see myself as another in a long line stretching back in time and others queued up behind me for the future.

I’m really here. I’m really doing this tomorrow. Right?

The pharmacist says my meds aren’t ready. Maybe fifteen minutes. My friend and I make our purchases and I’m looking at the map app and see there’s an Apple Store nearby. I need the trackpad on my Air fixed so we hike down the street and it’s only after I’ve gotten into the queue that I realize I forgot to pick up my prescriptions.

How the hell could I forget? I guess I’m overwhelmed. I have things on my mind. The years it took to get here weigh on me like slabs of polished granite, squeezing the life ouf of me and compressing me to jelly.

Breathe, Heather, breathe. You’re almost out from underneath them.

My friend holds my place in line and I trot back up the street to the pharmacy. There’s no line and the cashier rings me up and passes them to another counter where I have to get counseling from a pharmacist. I didn’t ask what all the prescriptions were and I pick them up and start to read. Oral antibiotics. Painkillers. Antibiotic ointment.

The pharmacist sees me and comes over. Do I have questions? I don’t and I’m off again. It doesn’t occur to me until I’m back on the way to the Apple Store that for all the trans people that have gone through that pharmacy, I never saw the knowing smile or smirk I sometimes see or heard the gentle condescension I sometimes hear.

Apple doesn’t have my part in the store but Palo Alto does if I want to go there? Or come back in a couple of days? It’s getting late so I thank the nice man for his time and my friend and I head back to the hotel.

There are two doses in the bowel prep kit and I’m supposed to have them about five hours apart and nothing at all to drink after midnight. I was supposed to only have clear fluids all this day but I screwed up and had eggs for breakfast so I’ve been pounding Gatorade to flush everything out.

It’s close to 20:00 so I get mixing and drinking. It tastes awful. A mixture of three different salts, the manufacturer decided to overdose on sweet flavoring to mask the salts. It tastes like salted and distilled Mountain Dew. My first batch goes down reluctantly in about 40 minutes. I decide I’ll start the next batch at 23:00 and I spend the intervening time sorting and packing for the hospital.

I pack a couple of pairs of pajamas, some shirts, underwear, a light sweatshirt, clothes for the morning, and my toiletries and phone. With hindsight, I ridiculously over packed. Besides my toiletries, all I really needed was the clothes I walked in with and the sweatshirt.

23:00 rolls around and I mix up my second batch of bowel prep. I can feel things rumbling from the earlier dose but nothing has happened yet. The taste, if anything, is worse now. The salted and distilled Mountain Dew now tastes like it’s been pumped through unicorn veins and boiled with glucose in spun sugar bowls.

23:45 rolls around, I’ve barely drunk a quarter of the dose, and the osmotic pressure in my bowels reaches a critical point and tells my nervous system to enter high alert: it’s time to go.

And go I do, beginning what turns into an almost all-night liquid sedimentary layer excavation of past meals.

00:10 comes and I’m trying to take small sips and then rinsing with water or orange Gatorade. It’s not working. There’s still easily two-thirds of the dose to go so I dilute it with what remains of the water I’m also supposed to drink. It’s still nasty.

By 00:20, I’ve choked down another quarter of the diluted version, run to the bathroom twice, and watched the color of my effluvium trend clear. I need to finish this. I top it off again, this time with the Gatorade, and this turns out to be the wrong thing to do.

Whatever sweetener in is Gatorade is close to, but not quite, what’s in the bowel prep, and now I’ve just poured high fructose corn syrup into the already devilish brew of sweet.

I valiantly try to complete doctor’s orders but at 00:40 I give up and pour my cocktail of Smurf juice down the drain, swish my mouth out with water, and pound another 16oz of water before dashing to the bathroom again.

I’ve set my alarm for 07:30 to give us both enough time to get ready and get to the hospital by 09:30. Again, my ambition outstripped reality.

Reader, I was up at least every half hour to void myself and it was awful. The cycle was thus: clean myself up from the latest purge, waddle back to bed, sit on edge of bed, do a body check-in, convince myself it was okay to lie down, lie down, feel the urge, struggle to get up and waddle to the throne without dousing myself, and begin the cycle anew, seemingly ad infinitum.

Some people, (mostly cis,) think gender confirmation surgery (GCS)* is the glamorous denouement of the gender journey, where the plucky heroine has surmounted all obstacles to attain serenity and appears dewy-eyed in the recovery room, while her scrappy but tough found family of friends cry tears of joy for her while holding balloons that say, ‘It’s a girl!’

Some people also think Trainspotting glorifies heroin use.

Somewhere around 05:00 I was able to start catching snatches of fleeting sleep, so by the time the alarm went off two hours later, I was a shell-shocked, empty vessel of sleep-deprived nerves with a tender bum. (20/20 tip: use baby wipes at the start, not after it feels like your anus is trending towards becoming a Ring of Fire.)

The brain weasels moved in while I was shaving my crotch in the shower and asked all sorts of questions and offered their unsolicited insights.

To wit:

‘Do you really want to go through with all of this? Are you sure? This is permanent and recovery is long. Sure you can’t just deal with your equipment? Lots of other people do. You might be able to get a partial refund or donate your slot to someone who can’t afford it. Is this worth it? Is this really what you want? You’re afraid. You can bail out right before they put you out, you know.’

Etcetera, etcetera.

Fucking brain weasels.

My transition required me to take agency to transition and not let those that opposed it or tried to deflect or slow me down take it away from me, and that includes brain weasels. So, I pack my bag and we leave for the hospital.

On the way, I realize that most of yesterday I felt a deep sense of calm and happiness. I take this thought balloon and tie it to my wrist.

I check in for surgery. There is little paperwork, it goes quickly, and then I’m off to surgical check-in. The nurse there is sweet and she shares a name with my mom. The last time I was in a hospital was when my mom died and I am overcome and I weep for a bit.

What do I feel? Everything.

It has been a long journey to get to this moment. It feels hard now, but the real hard work is past.

I go to the bathroom. I disrobe and put on a gown that’s impossible to tie without help and I’m grateful again for my friend who is here to help and comfort me.

An intravenous port is installed. I scrub my teeth and gargle a minty antiseptic, and it reminds me again how much I hate mint because of the time I gorged on too many leaves from my mother’s garden and became sick.

My blood pressure is a bit higher than normal, but I’m dehydrated and anxious, so it’s not a worry. There’s some paperwork to sign and then I’m swabbing my nose with an iodine solution and wiping my body down with antiseptic wipes.

I mentally Marie Kondo my penis and thank it for such good use over the years, but it’s time for it to go.

It’s almost 11:30.

The anesthesiologist comes in to introduce herself. I’ve never met her before and she’s about to have my life in her hands. I get a competent vibe from her and her bedside manner is attentive. She explains what she’s going to do and the only new news to me is that I’ll be intubated during the procedure. I hadn’t remembered reading or hearing about that before.

She leaves.

Things are getting more real by the second.

My doctor pops in and asks if I’m ready.


She vanishes and then I’m being wheeled down hallways on a gurney to the operating room (OR). This area is clean and I am comforted. I’ve never liked hospitals. The irony is that I’ve worked in two and been through so many emergency rooms as patient or advocate I’ve lost count. I idly wonder if all that time I spent in them was to subconsciously prepare me for this moment–the moment I dreamt about when I was five.

We enter, and I’m surprised. It looks very high-tech and different than the surgical suites I was in for the cesareans of my children. It’s a big room, easily thirty by twenty feet across.

Besides the operating table, there are a bank of four flat-screen monitors on the wall. Two display vital signs, one is a clock, and one is of a live video feed of the table. There are four surgical nurses arranging instruments on different trays and tables.

They have me hop down from the gurney and ask me what surgery I’m expecting today. Flummoxed, I have to read it off the clipboard, ‘Genital reconstruction surgery.’

I’m introduced to the team and promptly forget all their names because my mind is blank because everything going in is whooshing right back out. I thank them for caring for me as I climb onto the operating table, and they seem appreciative.

I am laying on my back and I’m asked to shift up a bit into a depression on the table around my butt. Properly situated, my arms are spread out wide, a belt is placed across my hips, and it is time.

I stare at the huge surgical lights looming above me. There are three, and each is about three feet across. There are translucent, irregular dimples scattered across the slightly parabolic surface that look like large blobs of slushy water frozen on. To distract myself, I consider why they’re like that and tell myself it’s so the light spreads irregularly through them to reduce shadows.

The anesthesiologist comes in and asks if I’m ready.

I’m terrified and want to say no. How the hell did I end up in an operating room to have my genitals turned inside out?

The question is absurd and asked by fear.

I didn’t arrange my life and make the choices I did to bail out at the last second from fear. That would be absurd.


‘Okay, let’s get going.’

My doctor enters and leans over me.


I want to say no. I want to flee from the room and live a life where I don’t have to worry about my body or my gender.


She asks the room what time it is. Someone answers, ’11:53.’

‘Are you sure?’

I can see the clock on one of the screens. It says 11:56.

‘Uh, 11:56. She came in at 11:53.’

‘Let’s get going.’

Someone moves just out of my vision behind me to the left. I think it’s the anesthesiologist.

I awaken briefly in the alternate universe of the recovery room, relieved I’m still alive. My doctor or someone tells me everything went well. I close my eyes, and open them in my private room. My friend is there, smiling. It’s afternoon and my crotch hurts and is swaddled in bandages. I can tell I have packing in me.

It is done. I did it. I made what I used to think would never happen, happen. I am proud of myself.

For the moment, I am content.

Continued in Genital Confirmation Surgery (GCS) Part 2, March 2019


* Over the years, the surgery was known as SRS (sexual reassignment surgery) for a long time, then it switched to GRS (genital reconstruction surgery) or GCS, which are sometimes used interchangeably. Usage seems to depend on age, (older people tend to use SRS,) or personal preference.

©Heather Coldstream

I’m on Twitter @cistotrans

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2016: Poems from a Year of Change

Uncertain: Poems About Gender Transition

About cistotrans

A Seattle-area trans woman seeking a happy spot to stay at along the path of transition.
This entry was posted in gender transition, health, healthcare, LGBT, personal history, transgender, transition and tagged , , , , , , . Bookmark the permalink.

16 Responses to Genital Confirmation Surgery (GCS), March 2019

  1. “…donate your slot…”? That’s an interesting way to phrase it.:-)

    Hoping for your complete and fast recovery. Good Onya. Girl! (as they say “Down Under”) 😉

    Liked by 2 people

  2. So happy for you!!! I am nervous too. Not looking forward to that bowl prep. Ugh, I hate that stuff. I am at 49 days.

    Liked by 1 person

  3. Emma Gray says:

    I had my GCS along with breast augmentation on 1/31. Not much earlier than you but you expressed many of my feelings in your post. I was in Scottsdale, on my own. Indeed, it was weird that they kept asking what I was there for. In some ways it was really just a “check the box” procedure. But until I had it I knew that I’d wish for it.

    I also know what you mean about their asking what your “expectations” are. I was afraid that I might not give them the right answer. I mostly wanted to loose that unsightly bump in my clothes, and also be able to stop even thinking about it.

    I also wanted to gain two appropriately-sized bumps in my chest. I told them I was aiming for C cups; they said that this is what most everyone asks for. The problem is that as the band size increases so do the actual breast size to fill what’s labeled as “C”. My surgeon therefore gave it her best judgment on the implant size. They were a little larger than I anticipated but their fine. My girlfriends all think they look nice.

    Last Thursday I had FFS in Tukwila, WA which is a short drive from my house in Seattle. That came out okay too and my recovery progresses. I’ll tell you though I’m about as done as I could be with surgeries. I still need some electrolysis – which I hate – but [sigh] I’ll get that done too.

    So many surgeries in a short time, why? Well, I’ll soon be 63 and I just want to make hay while the sun shines, living authentically.

    I wasn’t aware that there is a GCS surgeon in Monterey. I was born and raised in Saratoga and lived in Menlo Park until two years ago. Monterey would be a beautiful place for the surgery, that’s for sure!

    Liked by 1 person

    • cistotrans says:

      Congratulations on getting all that done! That’s a lot – whew!

      I didn’t know there was someone in Tukwila doing that! I’d be curious to hear how satisfied you are with the results once everything heals.

      My surgeon is in Burlingame; my friend lives in Monterey and it was a great place for my initial recovery. 🙂

      Thanks for reading and best wishes healing!

      Liked by 1 person

  4. Congratulations I’m just starting my journey, not sure when I can afford surgery, looking forward to the day, well enjoy the new you 😊💕

    Liked by 1 person

  5. Elene says:

    Wow! I hope you are recovering beautifully.


  6. Pingback: 8 Months Post-GCS | Becoming Me

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