The background music they play in the surgery suite is a Golden Oldies mix of dance tunes from the 1930s and 1940s. Blaring trumpets and saxophones with a rhythm section of piano, bass, guitar, and drums. My 16-year-old twins look at each other and frown. "What is this music, Mom?"
"I think we're hearing Duke Ellington. This is the kind of music your grandfather grew up with, and he loved it," I say. The twins and I pace around the plush, super clean waiting room on an upper floor of a skyscraper while my husband, Robert, talks to the receptionist at the front desk. With its high glass windows looking out to other skyscrapers, its tall, broad-leafed plants, and its streamline, ultra-modern, all-white furnishings, the suite seems more like a hotel than an outpatient surgery unit.
Talking to the twins about big band music is a welcome distraction from the matter at hand: Noah, my transgender son, who is biologically female, is about to have his breasts surgically reduced so he can look more like a boy. It's my goal to remain calm for Noah, to not panic. I'm afraid something might go wrong with the anesthetic and Noah won't wake up after the surgery (unrealistic). I'm afraid the surgeon will mistakenly cut into an organ or artery (extremely rare complications). I'm afraid Noah will endure terrible pain (unlikely). I'm afraid that Noah will come out disfigured with breasts that aren't aligned, or develop thick, purple scars (equally unlikely). The only realistic fear I have is that Noah will regret having the surgery. He might be dissatisfied with his new chest. Will he ever be content with his appearance?
A nurse comes and leads the four of us to a small, private waiting room near the end of a hallway, where there are double doors. Now we're hearing Bing Crosby's version of "As Time Goes By," the theme song to Casablanca: "You must remember this . . ." I can imagine my father in his tremulous baritone singing along. Though I miss him greatly, today is one of those days when I'm relieved that neither of my parents is alive. It would have upset them to know that one of their darling, identical twin granddaughters, Margaret, became Noah, with hormones no less, and now, surgery.
"Why would a pretty girl not like her own body?" My parents would have asked. However, I know that Noah's desire to be a boy is as strong as a hurricane. There's no stopping it. And attempts to do so only backfire in causing Noah more distress. All teens in my experience, most adults, too, struggle with some degree of debilitating self-consciousness about aspects of their bodies they don't like. Multiply this disapproval hundreds of times and there's Noah's gender dysphoria. The best way to manage that whirling hurricane in Noah's mind is to allow him to change.
And so here we are, listening to Bing Crosby because the majority of clients receiving cosmetic procedures here are senior citizens. My purple-haired Lydia, who can be a bit theatrical, is trying to cheer up her pale, anxious, and jumpy brother by reading from brochures in a falsely cheerful voice: "Enhance your Golden Years! Look as young as you feel inside! Consider these age-reversing treatments: facelifts, breast augmentation, post-mastectomy breast reconstruction."
Noah reads from another brochure: "Reclaim your youth! Are you distressed by skin bulges hanging down? The tummy tuck may be for you." Despite myself, I laugh. It feels like we're at the dinner table at home.
Then comes a nasty jolt. Before I've had a chance to throw my arms around my son, a nurse appears and leads him toward the double doors.
"Why is this happening so fast? We haven't even talked to the doctor," I tell the nurse.
"You will. And you'll see Noah again. He's just being prepared," she says.
I take a breath. Sure enough, the nurse soon returns and ushers my husband, Lydia, and I into a tiny examining room that smells antiseptic. The illusion of visiting a hotel is gone. Noah, wearing a cotton, blue-and-white striped surgical gown sits calmly on a chair. He's so petite, and his arms and legs so skinny, he appears far younger than 16, too young to make a drastic choice. I suppress the urge to call off the procedure. What's happening is truly in Noah's best interest.
I've never met the surgeon. Earlier this summer, Noah and Robert had interviewed three prospective surgeons and, on their own, chose Dr. Carroll. So, when a man in his late-thirties or early-forties enters the room wearing white scrubs and a cap, I assume it's Dr. Carroll.
"I'm Dr. Beauman, Noah's anesthesiologist," he says. Where do I know that face? I realize he looks like Lydia's and Noah's ninth-grade Latin teacher, Randy Wallace. The twins, who no doubt have come to the same conclusion, are giggling. "What's so funny?" the anesthesiologist asks.
"You look a lot like my children's Latin teacher," Robert says.
"Yeah, only a little younger," Noah says.
"And without the red tie," Lydia adds.
"Oh, well, I did take Latin many years ago," he says and smiles.
At least the morning is not without its comic moments. I admire the man's cheerfulness. It's a good thing I'm not a doctor as I could never put a child to sleep before surgery.
The anesthesiologist questions Noah to make sure he's had nothing to eat or drink, then talks about the general anesthesia, its aftereffects, and after-surgery pain medication: Percocet, as needed for the first day, then Tylenol or maybe nothing.
The anesthesiologist exits and then Dr. Carroll appears. He is an older man, at least 60, tall, robust, and his age, coupled with his calm, authoritative demeanor, reassures me a little. This is what Noah wants, I remind myself. His body, his choice.
"We'll all take good care of you, and it will be over soon," the surgeon says. Then, "It's standard medical procedure that I ask. Do you know what surgery you'll be having today, Noah?"
"Keyhole laparoscopic surgery for breast reduction," Noah answers. Then he launches into the particulars, how the surgeon will insert long, thin instruments, a laparoscope with a light and a video camera, through the small incisions. Looking through the "keyhole" of the camera, and using it as a guide, the doctor will remove breast tissue with liposuction.
"I'm impressed with how much you know," Dr. Carroll says and grins.
"Thanks," Noah replies.
The doctors are both jovial. Noah is ready and willing to proceed. Once more I'm struck by the contrast of my own feelings to those around me. How can they be so light-hearted when I'm feeling such dread?
The surgeon answers more questions from Robert and Noah. Yes, Noah's nipples will remain intact. Yes, his nerve sensation will be maintained. His chest will feel sensitive for at least six weeks after the operation.
Lydia looks at me with big, frightened eyes. Perhaps she's feeling a bit queasy over the medical details. Or maybe she's worried the surgery may not go as planned. I know that she's completely in favor of her twin's gender transition. I offer her a half-smile, though I'm clenching my jaw. I try to calm myself. Meanwhile, Robert, a molecular biologist, and Noah, who will likely pursue a scientific career, further discuss the laparoscopic equipment, as well as the draining tubes that will be inserted into Noah's armpits and exit his chest from under his pectoral muscles. Extra blood and fluids from the lymph nodes will collect in reservoir bulbs at the end of the tubes. The tubes will be taken out a few days after surgery.
Lydia, Robert, and I give our final hugs and kisses to Noah, and the nurse rolls him into the operating room in a wheelchair. I look at my watch. In three hours, the surgery will be over. The four of us should be home by lunchtime.
Lydia and I take seats in the private waiting room, where we'd been earlier, and Robert goes to the lobby for coffee. Pretty soon he's back with Lydia and me, pacing about, and I'm relieved when he says he's going for a walk outdoors. My husband and I are both anxious individuals in our own ways, and we don't have the ability to calm each other.
The big band mix is still wafting from unseen speakers: Benny Goodman, Tommy Dorsey, Glenn Miller.
I'm glad for Lydia's company. She plays games on her phone, then stops to read a fantasy novel. I sit quietly in meditation and prayer for a very long time. When I'm done, uncharacteristically, I don't check messages on my cell phone or text anyone. Today I will focus on Noah; I don't have the energy to converse with my friends who are worried about me.
I flip through magazines, then attempt to read an article. "I can't focus. I keep reading the same page over again," I say.
"The same thing is happening to me," Lydia says.
Aside from getting up to use the bathroom nearby, Lydia and I spend all our time in the waiting room. We want to hear news of Noah the minute someone opens those double doors.
I hear Glenn Miller's Moonlight Serenade, another of my father's favorites. When I was a child, my family inherited my grandfather's Ampico baby grand player piano. Over 100 yellowed rolls of tunes from the 1930s and 1940s came along with it.
Earlier today, I was enjoying the big band music. Now it's annoying me. I'm in a never-ending time warp. Somehow, two and a half hours pass.
Robert appears. "Any word?" he says.
"Not yet," I say.
Just when I think I can't wait another minute longer, the nurse appears. "The surgery is over. Everything went great."
"I'm so glad!" I say.
I let out a big breath. Lydia looks at me with relief in her eyes.
Another fifteen minutes go by. Lydia is the first to push open the double doors and bolts into the recovery room as soon as the nurse gives the okay. The nurse brings Noah inside in a wheelchair. There he is! He is, of course, very much alive and himself. His hair is disheveled. "Hi," he says. He's in a good mood. In fact, he seems remarkably animated. Apparently he isn't feeling any pain. Oh, thank God. I let out another breath.
I love Noah so much. And I'm very proud of him, despite being continually surprised and shocked by his choices in the past few years.
Noah's robe conceals his chest and tubing, which is a relief as I don't feel prepared to see his new, flat breasts.
"The word 'civil' comes from civis, which means citizen," says Noah, his speech slurred. "In the final decades of the Republic . . . as Mr. Wallace was saying . . . the Emperor . . ."
"Noah, you're drugged! This isn't Latin class. That doctor isn't Mr. Wallace." Lydia's laughing so hard it seems she'll cry. She's overwhelmed with relief it seems, and I feel the same.
Noah babbles on and on. "They trained gladiators somewhere outside of Rome . . . "
Dr. Carroll enters. "The surgery went well. Noah's a bit dopey but will soon be thinking more clearly." The doctor opens one side of Noah's robe. There's a bandage neatly wrapped over Noah's now-flat chest. Poking out from underneath the bandage, I see tubing and an egg-shaped reservoir bulb that is half-full of bloody fluid.
Dr. Carroll shows Robert the markings on the reservoir bulb: the scientific conversation once again. My husband, who has volunteered to empty the bulbs, will record how much fluid is draining and at what rate. This way the surgeon will know when the tubes will be ready to be taken out.
"How do you feel, Noah?" I ask.
"Hi, Mom, I'm feeling fine," Noah says, a bit too loudly. "You know, if I keep up with Latin, I can go to Italy. Mr. Wallace is planning a trip a year from now. Can Lydia and I go?"
I laugh. "We'll talk about that another time."
The nurse comes in and says she'll take Noah to get dressed. My husband says he'll get the car in the garage and we should meet him in front of the building. Soon we will wheel Noah out of the examining room, through the double doors, down the hallway, past the sitting room and into the lobby, where the big band music is playing, and into the elevator. We've all survived this ordeal, and I can bring my flat-chested son home.
Will Noah be pleased with the results of the surgery? He probably will be. Not that the surgery will completely solve Noah's gender dysphoria, but his new chest may give him the energy to go back and face the world again, as a soon-to-be tenth grader, and, incidentally, a second-year Latin student.
What's next for Noah? What will life have in store for him, for any of us? I don't want to know and I don't need to know. I've learned that I can handle many different kinds of challenges. Most likely, I'll be able to cope with whatever happens in the future. For now, I'll focus on the trip back to the house and making lunch for the family while Noah rests.
Permitte Divis Cetera. Leave all else to the gods.