Chapter Eighteen

The walls of the waiting room were painted in a pastel pink so light and subtle, Ethan was convinced he was the only person who even noticed. He nudged Francesca’s knee with his own.

“Hey, put down Ladies Home Journal for a second and look at this.” He gestured to the wall. “You seeing this?”

“Seeing what?” She combed a hand through her hair as she gazed forlornly at the office walls of Dr. Henry Bergen, plastic surgeon. “All I see are a bunch of housewives with too much time to consider their noses. And maybe a bunch of former soldiers with unseen injuries. At least, I’m getting that from the way they flinch at each noise. Is that what you mean?”

“No, just that the room is pink. With blue trim around each door. Seems too fitting, like a gender conspiracy.”

Francesca rolled her eyes. She picked up her magazine and went back to browsing house décor ideas she’d never use.

Ethan’s stomach panged with disappointment. A joke like that would have made Francesca howl two months ago. Sweetheart, everything is a gender conspiracy, especially for trans people. That’s why we gotta have surgery in the first place, lest people get too confused. Francesca used to do a wicked impression of a suburban mom named “Sandra” who didn’t understand anything beyond the Bible after each CAMH meeting, especially when the doctors or insurance providers seemed to go backward in time to the 1950s. What do you mean you’re a boy? She’d squeal in a high-pitched falsetto. She’d often put a hand to her chest or forehead in mock horror as she parroted Sandra’s ultra-feminine character voice. You don’t wear plaid all the time and you don’t drive a four-wheeler. And how can you be a woman without those pearls and Betty Crocker apron? Now, honey, please adhere to your gender role or I’ll be so very confused. When they’d moved to Fort Erie together, her impressions of Sandra became tinged with a religious fervour which made every last gendered bathroom stall or sex marker on an ID seem like a grand conspiracy on par with the supernatural pamphlets about alien implantation. The queers and the crazies just wanna watch the world burn, as long as birth certificates with dead names get taken town in the same flames.

But now Francesca was eerily silent—and not for lack of material. They had arrived at the doctor’s office two hours ago and already faced a housewife in the waiting room who had given Francesca the side-eye, as if turning her head could magically shake away Francesca’s gender and reveal who she was underneath. The walls were painted in pink and blue, for God’s sake. There may as well have been a gender reveal cake with an all-seeing Big Brother eye on it. The place was a stereotype as much as it was a necessary side-quest in Ethan’s seemingly never-ending gender journey.

Ethan booked an appointment with Henry Bergen the day after the money from Barry had cleared. With a little over ten grand in his account, he could afford to put down a first installment on his top surgery for the surgeon he had chosen years ago. Henry Bergen’s practice had moved since then, but that only gave Ethan confidence in his choice. It didn’t matter that he needed to drive over an hour away from Fort Erie and pay over half the procedure upfront; it signalled a happy client list and state-of-the-art procedure rooms. And if everything went well, he would only need to make this trip one other time. Then he could live the rest of his life never thinking about pink and blue gender conspiracy rooms ever again.

Today he was supposed to meet Dr. Bergen for the cursory look in order to assess what exact procedure would be required. Ethan was hoping, since his breasts had always been small and had atrophied from years of testosterone shots, he’d be a candidate for keyhole surgery. The healing time for keyhole was nearly half that of the bilateral mastectomy, and he wouldn’t have to contend with large scars that instantly outed him every time he took his shirt off to those more savvy. He’d measured his breasts (with the tape and everything) before making the appointment, as the doctor required, and he came in at the line for keyhole. So it was possible—but he wasn’t going to know for sure until he got in the office.

“Hey, Frannie. You’ll look after me no matter what, right? Keyhole or normal?” Ethan asked. His voice was small, cowed now by the magnitude of the request.

Francesca put down her magazine, her gaze serious. “We’ve discussed this. Just like I’d ID your body, I’ll take care of you after the procedure. We have to have each other’s backs.”

“And fronts,” Ethan said, pleased at his bad joke. “I’m glad you’ll have my front, then.”

Francesca nodded, but she didn’t laugh. “So long as you give me enough warning for the surgery date, I can book those days off. Not all of us can call in sick like it’s nothing.”

“Oh. Yeah. That’s fine.” Ethan understood now where her sudden attitude was coming from. He’d been going to work on the new schedule Chelsea had given him, but he’d suggested to Francesca on the way over to the doctor’s they may need to call in sick tonight. The consultation could be five minutes or two hours—he had no idea. But he also had no idea if Francesca could call in sick, or if she could afford to. “You can go early if you need to.”

“Please, Ethan. I’m not leaving you here.”

“I’m sorry if cutting out of work has bugged you. I swear I’m coming around though. Won’t be that much longer before I have all the cash I need.”

“Uh-huh. I just don’t want you fired.”

“I won’t be. And even if I was, I’m fine. I still can afford this.”

“That’s half of what worries me.”

“What?”

Francesca looked around. No one seemed to be paying attention to them so she used the magazine as a makeshift shield in order to whisper, “Drugs, Ethan. That’s not exactly the most stable career choice.”

“And night shift at the duty-free shop is?”

“At least it’s legal. And we have the opportunity for growth.”

“Don’t believe the lies Chelsea’s been telling you. Nothing is a transferable skill. And honestly, all that gunk sounds like the shit they tell kids about their gender in elementary school. Boys are born boys and girls are born girls. Genitals are destiny. How else will you know you’re a man?”

Francesca smiled; moments later, as if she remembered she needed to be upset, she frowned. “I just worry about you. You’re too trusting. This guy could be bad news.”

“Jacob? Nah. Jacob is a sweetheart.”

“A sweetheart? Now I’m even more suspicious. You don’t get scars across your face being a sweetheart. He sounds like a comic book character, complete with leather jacket and smuggling drugs. Jesus. Next thing you’ll be telling me you’re in some underground layer or starting a new kind of Fight Club.”

Ethan shrugged. He didn’t want to speculate on how close the underground layer actually was. When someone came out of the doctor’s office, they stopped at the front to talk to the admin assistant but soon left. Ethan bounced on the edge of his seat, wondering if he was next.

When a different name was called, he deflated. They’d been in the waiting room for at least half an hour, and they were five minutes early for the appointment. “Look, Frannie, if it makes you feel better, I won’t call in sick anymore.”

“You won’t?”

“Sure. We can both make it in time for the shift if we get out of here by four. Considering it’s almost one thirty now, then I think we’ll be safe. Even if it takes forever for me to be called.”

“Sure, but I thought you wanted to go out and get a celebratory lunch afterward? Wasn’t that why we were going to play hooky?”

Food made Ethan blanch. He’d had some breakfast before getting Francesca, but it was all too much now. “I think I’m past lunch. I kind of feel like I’m going be sick. Must be nerves…or excitement.”

Francesca gave him a sympathetic stare. She discarded the magazine and sat closer to him, all so she could rub his back. Ethan leaned forward on his legs, shocked at how fast the wave of nausea came over him. He rubbed his fingers against his temples, trying to balance himself. Just nerves. Just excitement. When the next person came out, he raised his gaze. The nausea went away as soon as his name was called.

“Just in time,” Ethan said to Francesca. “I didn’t think I’d last another second.”

“Don’t speak too soon,” she said. “It’s still far from over.”

The nurse led Ethan down the hallway to an examination room, where she gave him another set of forms he had to fill out. They looked like the same ones he’d been given over email, but he didn’t care. He wrote out all the information with lightning precision, already knowing every last answer by heart, including his measurements. Ethan lifted his sealed therapy letter from his back pocket and placed it on the clipboard when he was done.

Dr. Bergen came in ten minutes later. He greeted Ethan with the ease of a private surgeon, someone who worked on other people’s money and spared no expense in the process. When he realized Ethan had filled out the same set of forms twice, he apologized profusely.

“We should have been more attentive,” he said. “My staff is better than this.”

“No worries. I’m used to repeating myself in this scenario.”

“I see that. I read your file about the CAMH rejection. That’s a shame.”

“It’s pretty standard, actually. A lot of people get rejected.”

“Trust me, I know. You don’t have to explain it because my office sees a lot. Still a shame, no matter what, though. Oh,” Dr. Bergen said, grasping the letter Ethan had handed over with his forms. “About your condition?”

“Yes. Always have it ready to go, we were told.”

Dr. Bergen opened the letter and read it with the glasses at the edge of his nose. He nodded along and soon placed it on the side. Ethan knew what it said without actually having to read it. He’d seen so many online and read medical textbooks describing his “condition” with the competency of a med student. Gender dysphoria, requires bilateral mastectomy in order to live in chosen gender. He could recite it in his sleep. But Dr. Bergen seemed uninterested. Ethan wasn’t sure if that was good or bad.

“Thank you for this. We can file that away. Now, I’d like to give a brief examination and then go over what surgery entails.”

“Sure, sounds good. But is that it?” Ethan asked.

”Yes, that’s it. You don’t need to prove anything else. You’re an adult, and you can do what you want with your body, especially when you’re paying for it out of your pocket. In theory, we don’t even need the letter. The health ministry discontinued the practice about four months ago, unless going through CAMH.”

“Really? I had no idea.”

“I suspect not. Most clinics want to keep the letter for posterity’s sake, in case someone reverses their decision. But as a private clinic, we already fold that kind of legalese into our typical consent forms. We will keep this though. Always good to have a back-up.”

How had he missed this? CAMH wasn’t going to undo its rejection, but he’d always thought the letter was another hurdle he’d have to overcome in time. Money had been the only thing stopping him, and now that money wasn’t an issue, thanks to Jacob, everything was different. Even the colour of the walls became clearer. Nothing was a conspiracy anymore—it was within reach.

Dr. Bergen rose from his seat and gestured for Ethan to do the same. He tugged on a stethoscope around his neck and produced a marker from his pocket. “Top off, please. I’ll do a primary examination and mark the type of surgery you require.”

Ethan had never removed his clothing so quickly. He hated standing in front of anyone without his shirt, but the fact that Dr. Bergen was going to be the one removing this part of himself, the last piece of overburdened femininity from him, made it worthwhile. Doctor Bergen moved efficiently as he listened to Ethan’s heart and lungs; he examined his breasts for lumps. He read off the measurements on the chart before he took a marker to Ethan’s underarm area where he sketched out the incision spots. He detailed how long the scar would be, how long it would take to heal, and how to clean the wounds. Everything that Ethan already knew.

“No keyhole surgery?” Ethan asked. “I don’t qualify?”

“I would have said yes, but I think your measurements are off by an inch.”

“I took them two months ago. I didn’t think they’d be off.”

“It’s odd, I admit. But perhaps your breasts have grown. This could be a minor difference depending on time of day, on your cycle, and even a result of water weight. When has your last injection been?”

Ethan shut his eyes. “I’ve been missing appointments. My doctor in Fort Erie insists I go in for the injection, and I keep sleeping through the times. Or I’m working through them.”

“Understandable. If you’re out of a ’script, I can prescribe. Maybe even something like a topical gel, so you don’t have to worry about needles.”

Though Ethan never liked the topical testosterone, he’d learned to never say no to a hormone prescription. Ever. After a nod, Dr. Bergen wrote several scribbles on his medical pad. Ethan was shocked when he was given enough for the next six months.

“You won’t want to fall behind when you’re recovering from surgery,” Dr. Bergen explained. “And I have a feeling your previous doctor may have had an outdated idea about administering your hormones. There should be no need to go into the doctor’s office. It’s not like they’re opioids and you become addicted. It’s a hormone your body needs.” Ethan wanted to hug Dr. Bergen, but he was already speaking again. “I’m thinking we’ll have an opening in the next month or two for you. Is that enough time to gather the rest of the funding? To take time off work? The non-keyhole surgery needs a bit more R and R.”

“Yeah, yeah. That’s all fine. I have someone to take care of me and a job that will net me the rest.”

“Then I’ll get you scheduled in with the admin staff.” He made another note on Ethan’s chart and, without looking up, added, “In the meantime feel free to get dressed.”

Ethan could barely contain his happiness. When he slid his binder on over his skin, his breasts ached. He’d been wearing a binder for the past ten years and had never had a problem, not even breathing difficulties and only minor bruising. But within the past month, since getting the shipping jobs, everything ached. It was as if his body finally realized it could be free and wasn’t tolerating being trapped in this way anymore.

“Stop by the admin desk at the front, and they will find a more specific time that works. You should receive the surgery package that details the event in the mail closer to the date,” Dr. Bergen added. He lingered by the door, not quite ready to leave. His ever-present smile faltered as he sighed. “I apologize, but I have to ask one last question. In your chart, it says you still have your uterus.”

“Yes, that’s true.”

“Were you also planning on getting that removed at some point?”

“Truthfully, I hadn’t decided.”

“That’s fine. I hesitate to ask because childbearing can be a contentious issue, but still something you should think about in your future. If that’s something you want.”

Ethan furrowed his brow, the comment seeming odd to him. He was well aware that transgender men could have kids—there was that Oprah show a long time ago—but the idea still seemed like something that couldn’t happen to him. Even when he stopped his testosterone, he didn’t menstruate. Not even right now, and he had missed at least two months of shots. So the fact that his body could breed something, anything, was still odd and foreign to him.

“We don’t do that kind of surgery here,” Dr. Bergen added, “but if you ever do need a referral, I’d be happy to give it to you.”

“Oh, well, okay.” Ethan wasn’t sure what else to say. Not only because he hadn’t thought of that aspect of his surgery, but because Dr. Bergen was being so nice about. So forthcoming. All the doctors at CAMH wanted to hear a song and dance routine about how much his gender meant to him and how he was going to be a good man as soon as he got the surgery. Dr. Bergen didn’t care about his masculinity. He wanted to perform the surgery.

And get paid, of course, Ethan reminded himself. This was still a business. But there was so much less bullshit here. He wanted to cry with relief.

“Anyway, think about it. I’ll see you in about two months, Mr. Cohle.”

“Thanks. See you.”

Ethan stayed in the dressing room for a long time, processing what had gone on. When he stepped into the waiting area, Francesca was still reading the same Ladies Home Journal, her boredom evident on her face. Ethan made the appointment for early August, over a month and a half away, and thanked everyone profusely.

“It went well?” Francesca asked. “Man, you’re practically glowing.”

“Really well. I’m so happy.” He handed her the card with his surgery date. She eyed it surprisingly.

“So soon?”

“Yeah. Can you get that date off?”

“I’ll try. But you’re gonna have to try first, you know. Come in more and keep me company at work.”

“Sure, sure.” When Ethan bent down to pick up his backpack, his stomach lurched. He cursed, nearly falling over before he got to his feet again.

“You okay? Francesca asked, her voice low and sceptical.

“I’m fine. Just…” Ethan closed his eyes. He tried to balance himself. After so much excitement, this was only natural, right? He groaned. He needed to get to a bathroom and quick.

He found one around the corner from the waiting room. He threw up his breakfast before he spent at least five minutes dry heaving. When he was sure he was done, he splashed water on his face. The black ink marks from the doctor’s plans were visible; some of the marker must have smudged and gotten onto his neck in the process. His excitement won over his nausea again.

Francesca waited for him in the hallway, her arms crossed over her chest. “You done?”

“Yeah, I’m fine. Just a little woozy.”

Francesca rolled her eyes. She didn’t speak to him again until they were on the elevator going down to the parking lot. Each jolt of the elevator made Ethan close his eyes and steady himself. He’d never wanted gum more in his entire life.

“Are you on drugs?” Francesca whispered even though they were alone. “Going through withdrawal? Or are you always drunk?”

“I’m not on drugs or drunk. God, I’m not even drinking or smoking that much anymore.”

“That much. Huh. That’s a large margin of error. Maybe it is withdrawal, not the type I thought.”

“It’s not. But fine, whatever. Don’t believe me,” Ethan snapped. The elevator doors opened. He longed to march out and ahead of Francesca, toward their rented car, but his stomach felt nailed to the ground; his body would not let him move. His dramatics would have to wait as he practically crawled toward the parking lot.

“Okay, I know the car’s in my name, but you’re going to have to drive back.”

“Great, fine. Whatever.” Francesca sat in the driver’s seat and adjusted it so she could reach the pedals. By the time Ethan sat in the passenger seat, only ten minutes had passed since he’d thrown up, but he felt as if he could do it again.

“Okay, Frannie, I’m sorry, but I really have to call in sick for work.”

“You can’t,” Francesca said. Her dark eyes were wide, concern written all over them. “Chelsea said she’d fire you if you came in late or missed another shift.”

“She told you that? Even with my unfortunate circumstances?”

“Yeah.” Francesca shrugged. The way she did, though, made Ethan wonder if he was missing a side of the story, as if Francesca had told Chelsea the sick relative story was a lie. He didn’t have time to contemplate it. They’d pulled out of the parking lot and his stomach had ceased to feel better. The afternoon sunlight stung. He placed a hand over his eyes and leaned back in the seat.

“This is your job,” Francesca said. “I know you don’t feel well, but if you’re hocking drugs, anyway, Chelsea is going to get suspicious.”

“So fine. Let her fire me. I have my fucking surgery date, and that’s all I need.”

“And you’re going to forget about me? You only care about yourself now?”

“No, I’m calling in sick because my stomach is a nightmare, and I feel like shit. Even if I dragged myself into work, Chelsea is apparently going to fire me anyway. So I may as well save myself the embarrassment of showing up and throwing up into a pair of Uggs.”

“You don’t get it, do you? She doesn’t have to fire you. You could be honest with her and with me and with everyone else, but you’re quitting. It’s not your job, it’s me, it’s the store, it’s everything, Ethan. And now your body is quitting you.”

Ethan wanted to roll his eyes, matching Francesca’s teenage drama, but the action made him sick. He turned away from the sunlight and tried to dial his phone while keeping whatever was in his stomach down. When Chelsea picked up on the other end, he spoke in a low raspy voice, one he didn’t have to fake or disguise this time around.

“I’m sorry, Chel, I’m feeling pretty green.”

“Well, okay. But do you have a doctor’s note?”

“Not exactly. I had an appointment though.”

She let out a tut-tut on the other side. “I don’t know if I can keep doing this. You know the risks. You’ve been given a lot of warnings and a lot of second chances.”

“Fine, whatever. That’s great but this isn’t an afterschool special where I will change my ways and promise to get clean. None of it changes the fact that I still can’t come in tonight.” When Chelsea was silent on the other end, he huffed. “I guess I can make time to clean out my locker later this week though. Bye, Chel.”

Ethan disconnected before Chelsea could say anything back. His cheeks flamed from embarrassment. Other than his family and their ongoing tragedy, the only other important thing he’d been rejected from had been CAMH. He didn’t like being irresponsible and letting people down, especially for something he really tried to be good at, like being a boy. He may have hated the duty-free store in theory, but he liked working alongside Francesca. He liked the back room and the quiet shifts. He even liked the strange weirdos who showed up at night. He’d found Jacob in those weirdos, and Jacob had made so much possible. Ethan tried to hide it, but his disappointment raged underneath his skin. He ran a hand over his stomach, feeling another wave of nausea flow through him.

“I can’t believe you gave up like that,” Francesca said. “I don’t even know you anymore.”

“Bullshit you do. Please spare me the melodrama. You know exactly who I am. And I know exactly who you are.”

“And what’s that?”

“We’re fuck-ups who were always only into one another for ourselves. We both were rejected the same round, so we bonded through bullshit. Now that I’m getting out of this, you think I’m changing. But I’m not changing. I’m getting what I finally want and what you still don’t have. I’m still the same asshole you met years ago. And honestly, you’re the same superficial bitch I met then too.”

“Fuck you,” Francesca said. “You’re a sad pathetic man. I don’t even know what to do with you right now.”

“Well, a nice person would drive me home. But I think you’d much rather take the car by yourself, since you wouldn’t want to be late for work. So you should take it. Drop me off at a rest stop, and I’ll call someone to get me. You won’t have to take care of me anymore. Just return the car when you’re done.”

Francesca took a long time to make the decision he’d always known she’d make. In a hundred different scenarios, in a hundred different lives, she would always flick on the blinker and turn off the highway to drop him off at a rest area complete with a McDonald’s and coffee shop. Ethan left as soon as she pulled up to a parking spot, not even waiting for her to put it into park. He managed to maintain his composure until he got inside the coffee place and on a stool near the door, but then the world came crashing down. His friend was gone. His job was gone. He called a car to come pick him up and when they came, he gave them Jacob’s address. If Francesca had looked back at all, he was nothing but predictable—just like her.