#009: Stone Jaw: Trans Healthcare And Other Cognitohazards

A short piece on alcoholism, dysphoria, and other things I've been trying to find an excuse to talk about.

I’ve honestly hesitated to write about this topic; it’s a personal one that’s heavy even by my standards, and on top of that it’s not an easy thing to talk about. With that stated, it has kind of colored my output (when it hasn’t outright prevented me from creating work at all) for the past few years, and to be quite frank I’m going to end up covering it (or aspects of it) in one of my upcoming books anyways. I suppose it’s also offset by the fact that, despite the overall depressing nature of this topic, I did make it out the other end, and even if that weren’t the case I honestly don’t really know where else I could even begin to write about it if not here and now.

Fair warning: the following segment is incredibly heavy, and directly discusses eating disorders, alcoholism, severe dysphoria, and suicide. I usually try to keep this particular blog a bit lighter and goofier than the heavy subjects I usually touch on in my books, but I wanted to talk about this and get it out of my system. However, I’m putting a disclaimer here so you have the opportunity to skip this piece if you’d like. If you aren’t in a good place or are affected by these types of heavier topics, I would skip this post entirely, and go read one of my happier or goofier ones.

The past three years have seen me battling alcoholism and my eating disorder harder than I honestly have ever have had to. I’ve been an alcoholic of either the on- or off-the-wagon variety for most of my adult life, and the past few years have been very much a time where I’ve been either chasing after the wagon screaming at the driver to slow down, barely clinging onto the side for dear life, or face-down in the gutter on the side of the road, so drunk that I forgot there was a wagon at all.

I’ve been pretty open throughout my career and in my work about my battles with depression and mental illness–hell, I literally released an album called “Suicidal” during my stay here in Colorado–but one thing I don’t talk as much about is how gender dysphoria factors into both my depression and my alcoholism. A large part of why I drink is rooted, ironically enough, in survival. I drink so I can forget things that have happened, drink so I can forget that some things never will happen, drink so that I don’t have reasons to live in times where I don’t have things around me to keep me distracted and keep me alive. Drinking was how I got through the years when I knew I was trans but wasn’t in a safe enough place to risk coming out. Drinking was how I got through some of the times when my dysphoria got so bad that I had to cover all of the mirrors in the house just to avoid looking at my reflection so I didn’t break down. And drinking is how I’ve gotten through most of my time in Colorado without dying.

I also have spent most of my adult life battling something I usually don’t talk about. Those who have followed me through the years have probably noticed that, every three or four years or so, my weight has fluctuated to degrees that a body isn’t supposed to in that short of an amount of time. Part of this is survival as well, albeit of a very different kind. There have been multiple times in my life where I have had to work multiple odd jobs, sleeping very little and eating enough to keep myself going through twenty-plus hour stretches. The beginning of the pandemic saw that happen repeatedly. By the time I released the aforementioned Ophelia Drowning record “Suicidal”, I had had to switch my schedule four times in less than two months in order to get enough hours at the odd jobs I was working to pay my rent.

The rest of that was because…well, I have an eating disorder. Since I was a teenager, I have alternated between periods where I take militantly good care of myself–eating a proper protein-heavy fitness diet, going to the gym, shedding pounds, and doing everything I can to take care of my body–and periods of violent depression, binge eating, over-exerting myself in the gym to grow my muscles to threatening proportions, and bulimic episodes when it finally hits me that growing my muscles in order to appear threatening so people don’t fuck with me are literally the worst thing for my dysphoria.

The circumstances of how I ended up in Colorado are a topic for another article (or book) entirely, but suffice it to say that the events in which I ended up here and the other happenings of the two years afterwards were bad enough to plunge me into one of the latter periods. When I arrived in Colorado in the fall of 2019, I was a fairly slim 170. Three years later, in the early months of 2022, I weighed at around 215. I was tossing on 60lbs of weighted equipment and slamming my strongfat body shape through hours worth of weighted cardio, and then getting home and pounding multiple glasses of Canadian Club, cans of Olde English, or whatever other cheap whisky or malt liquor I could afford until I threw up. I was inordinately dysphoric, almost cripplingly agoraphobic, and hated myself.

Around the spring of 2022, I somehow managed to get a consultation appointment for FFS. For those of you who don’t know what that is, facial feminization surgery, or FFS, is a surgical procedure which re-arranges certain bones in the face in order to “feminize” it. Square stonejaws (like mine) can be softened, rough edges can be softened, Adam’s apples sanded down. For someone like me, something like this would be considered medically necessary by most trans healthcare providers–when I said last paragraph that I often find myself in a position where I have to cover all the mirrors so I don’t see my own reflection and have a breakdown, I’m not joking. It’s also something that, in most places that I’ve lived, has been perpetually off the table. I’ve spent most of my transition (and adult life in general) in and out of homelessness, and there have been entire years where I’ve not even had access to hormone therapy, having to crash in a van or a car while the testosterone in my body slowly takes back over and rots me from the inside. Something like FFS was something I honestly thought I’d never have access to, and it also, according to the doctor I was somehow able to see thanks to Colorado’s policies of covering transgender care, would supposedly be covered by Colorado Medicaid. It was something that probably would have permanently changed my life for the better.

Would have, had things not gone downhill. Unfortunately, the slope started the minute the surgeon walked in the room for the initial consult.

I mentioned before that I’ve not had consistent access to adequate medical care for most of my life, and as a direct result I’ll be the first to admit that I am not exactly acquainted with the ins and outs of decorum and politesse that surgeons are advised to abide by. I am, however, fairly certain that, if you are intending to drag a random med student into the consultation room as a “teaching moment” after the nurses take down initial information, you’re supposed to inform the patient and get their consent first before dragging the medical student in. I’m also fairly certain that repeatedly making remarks about the “residual fat” in the patient’s face in front of said medical student, as well as repeatedly interrupting the patient, misgendering them, and referring to parts of their facial structure as “masculine” as you take a pair of measuring calipers to their face in front of a random onlooker the patient did not want there, is also not exactly considered the height of bedside manner. Hell, if your patient is in your office for a fuckin’ gender dysphoria diagnosis, it might not be what one would consider appropriate to tell them to take their wig off in front of the aforementioned nurses who didn’t bother leaving the room, a random medical student who shouldn’t have been in the room to begin with, and God himself, and then loudly commentate to said audience the “very masculine” measurements and hair patterns of the back of the patient’s exposed skull which was ravaged by male pattern baldness from an abnormally young age.

To put it in a type of phrasing that belies my lack of an Ivy League education and upper-class manners: were it not for the fact that I had the ability to cry beaten out of me as a child over a decade and some change prior, I probably would have broken down in the exam room. Hell, a decade and some change ago, a much angrier me would have attempted to personally re-arrange his jaw. And while the current, older version me is very proud of the progress I’ve made with my anger since taking an oath of nonviolence all those years ago, I don’t think I would have thought ill of twenty-year old me for busting him one in the chin.

But I didn’t. I went home, I drank, and I ate too much. I woke up the next day, and I drank again. And at some point in the next few months of drinking, I probably cried.

Over the next few months, I struggled between drinking myself into oblivion and relapsing into a new kind of eating disorder. The doc told me I was manly and fat, and I didn’t want to be fat or manly, so I didn’t eat. If I did eat, I compulsively counted calories, including the calories I drank. The doc told me that there would be a pre-checkup a month before my surgery, and if they found nicotine in my blood they would cancel the surgery, so I stopped smoking, leaving me without the closest thing to ADHD medicine I had access to, and as a result I became irritable, started missing deadlines, and stopped being able to focus on my work. To compensate, I went to the gym. I spent more and more time in the gym when I bothered to leave the house, which was rarely if ever if I wasn’t going to the liquor store, just to keep my ADHD under control; and when that failed to reign in my ADHD, I drank.

I spent more and more time drunk. I drank alone because I had no one to talk to, and I had no friends to talk to so I drank. I had struggled with maintaining professional networks pretty heavily over the past two years, but as I struggled more I had more and more breakdowns, and I distanced myself from my peers and they distanced themselves from me. The distance made me lonely, so I drank to forget I was lonely and I drank alone. I had reached out multiple times in the previous two years to try and talk to folks around me, try and get some help, someone to listen to, but eventually I suppose I grew tiresome to talk to and the folks I went to for help stopped responding, so I drank to forget that help wasn’t coming. I tried multiple times to go to local gay bars, trying my damnest to make sure I wasn’t drinking alone if I was going to drink myself into oblivion, but try as I might no one found me worth talking to and I ended up drinking alone anyways. There were multiple nights where I would pound whisky on an empty stomach because I refused to eat. There were multiple nights where Autumn had to leave a bucket next to the floor that I had passed out on so I didn’t projectile vomit all over the floor again in my sleep. There was at least one night where I wandered through Colfax, headphones on, blasting Sinatra’s “Where Are You”, wasted out of my mind, stumbling into random bars trying to find someone–anyone–to talk to so that I wouldn’t be alone, and eventually gave up and wandered into the road in the hopes that a car would hit me and I wouldn’t have to do this anymore.

I desperately tried to get the docs to change my surgeon. I did everything short of lodging a formal complaint, mainly because if I had a dollar for every time a member of the office responded to my request for literally any other surgeon by going on a rant at me about how the surgeon in question “was a very intelligent and well-respected member of the medical community” and refused to tell me how to actually file a complaint, I’d have had enough for a pint of brandy and a twenty-ounce of Coke Zero to drown it in. You would think that it would not be a difficult matter to get a patient who is visibly uncomfortable with a specific doctor another doctor, but the closest I got was them moving the surgery date to nearly six months after its original date so that another surgeon could “be in the room with and supervise” the surgeon who I repeatedly stated I did not want anywhere near either knives or my face. Despite the fact that no one clearly was listening, however, I kept bitching. Usually, I’ve found that, if you bitch loud enough, someone will listen and occasionally someone, and I’ll take the fact that I have a stone jaw will bother doing something about the issue at hand. And, eventually, I was proven right. Someone in the office did do something.

Specifically, they “lost” the Medicaid paperwork to get my surgery approved, and outright canceled my appointment three weeks before it was supposed to take place.

I have zero idea who in the office did this. In fact, I’m honestly surprised I got it out of the lady who I even managed to get on the phone after two days of repeatedly dialing the office, and I get the feeling that the fact that it was mentioned at all was the type of slip that she was specifically instructed not to make. Retaliation in medical care is usually the kind of thing malpractice lawsuits get filed over, and to be quite frank I don’t know how you manage to “lose” a patient’s Medicaid filing when your office directly worked with the patient to compile all of the paperwork necessary almost nine months prior unless someone in your office simply wishes to be rid of a meddlesome faggot. I have to assume that they were banking on the fact that a Medicaid patient doesn’t have the money for a lawyer, and that a poor kid with a history of mental disorders was too stupid to know either how the paperwork they claimed they had “lost” worked or how to track down and file a complaint about it.

Their bet was–mostly–a safe one. I didn’t file a complaint. I didn’t seek help. I didn’t do much of anything. I knew they were full of shit, I knew it was retaliatory and more than likely illegal, but I didn’t do anything about it.

All I knew is that I got a message on their online portal a week after they were supposed to have me come in for a pre-surgery checkup telling me that my surgery had been cancelled. All I knew that, after two days of calling the office, panicking and losing my mind, I finally got someone on the line who let it slip that no one had any idea where my paperwork–of which I’m pretty sure had a copy on the online portal–was, and that there would be no rescheduling. All I knew is that–despite being told that I would finally have an opportunity to fix my body, that I would finally get help–I was told that I was not getting any help, and there would be no surgeon, no rescheduling, no surgery, and no hope.

I just drank. I drank, I starved myself, I covered the mirrors with blankets, and I cried. At some point, I deleted all of the photos of myself I could find from the Internet. I didn’t want to see my face anymore. I knew it would never be fixed. I was never going to be worth fixing.

In the beginning of December, I finally put down the bottle. I don’t remember what day I did, exactly, but I remember that I didn’t want Autumn to have to put up with me being drunk anymore, especially not for the holidays. I knew taking reality raw was not the smartest move, especially seeing as the Christmas season isn’t exactly easy for orphans like myself, but I was tired of drinking. I wanted my sister to at least have Christmas without all this shit. She kept me alive through all of this bullshit. It was the least I could give her.

I haven’t touched the bottle since.

I haven’t mentioned the fact that I’ve been sober publicly until now, mainly because I’ve tried to get sober so many times I’ve lost count. Taking the first step towards sobriety is something people care about the first time you do it. Fail at it enough times, start the counter over enough, and people stop expecting you to succeed, stop responding when you tell them about it hoping for encouragement. I suppose, in part, I didn’t think I’ve deserve to mention it until I hit some arbitrary number. Six months is long enough of a number, I reckon. Hopefully the count will keep going up, but this is at least long enough to talk about it in my mind.

At some point, I stopped working my arms and back and started just doing cardio. I didn’t want to need my strength anymore, and so I just stopped working my arms and focused on being lithe and feminine, whether people try to beat the shit out of me for it or not. Autumn’s been helping me to realize I don’t have to be a tank anymore to survive, and I would rather be lithe than a tank.

Eventually, I stopped counting calories, too. At last weigh-in, I’m a bit below 155. I don’t binge-eat anymore, thankfully, but it’s been a struggle to make sure I do in fact eat enough. Some days, I don’t, and I’ve had to learn to be gentle with myself during those days. I’ve been doing a lot of learning to be gentle with myself in general.

I still struggle with severe dysphoria, and I still haven’t exactly made much in the way of friends here in this town–Autumn and Polyhymnia are still all I have–but we’re leaving this state in a couple months and who knows, maybe I’ll be able to have access medical care there, maybe I’ll make some friends, have a community, not be so fuckin’ miserable. I’m going to give it another shot, at least. I’ve moved so many times and started again so many times that you’d think I’d have given up on trying to find somewhere I belong, but I guess I’m just stubborn. If I’m gonna be stuck being alive, I’m gonna keep tryin’ to make a life worth living.

Regardless, I don’t think I’ll ever have another opportunity to get FFS, or any other gender-affirming surgeries, whether I end up finding my way off of Medicaid or not. To be honest, at this point even if it ends up on the table I don’t think I’ll take it. I don’t want to go through all that shit again, whether the doctors think I’m worth fixing or not. I’ll keep my stone jaw.