In the Darkroom (38 page)

My father chose surgery in Thailand largely for the cost: $8,000, a third of the tab in Europe or the United States. She found Dr. Sanguan Kunaporn, a sex-reassignment surgeon at Bangkok Phuket Hospital, the same place she'd acquired most of her preoperative knowledge about transsexuality: the Internet.

A driver from the hospital collected my father at the airport. Steven had a lot of luggage. Along with an extensive double wardrobe—men's clothes for before, women's clothes for after—he had in tow all the cargo that would later alarm the denizens of Melanie's Cocoon: several cameras, a tripod, a videocam, a computer and DVD player, and a suitcase full of films, music, and opera recordings:
Das Boot
,
Otello
,
Don Carlo
,
The Abduction from the Seraglio
,
The Land of Smiles …

The Land of Smiles
?

“
Franz Lehár's operetta,” my father told me. “
Das Land des Lächelns.
” She reviewed the plot: a Viennese countess weds a Chinese prince but flees his palace when she realizes he must take other wives; the prince is heartbroken but abides by his local custom: “No matter what, you must always smile! ‘
Immer nur lächeln
'!” Lehár was Hungarian.

The operetta's credo was hardly a Hungarian sentiment. In my visits to Budapest, I'd come to recognize a certain sulky melancholy in the Hungarian personality. (It takes one to know one.) “
Sírva vigad a magyar
,” as the old maxim went: “Magyars take their pleasures mournfully.” If nations were known by their gestures, Hungary's would be Das Land der Sullen Shoulder Shrug.

“They call Thailand ‘The Land of Smiles,' ” my father said. “And it's true—people are always smiling at you.”

“That's nice.”

“Waaaall, they don't really mean it. … But they know how to fake it.” A high compliment, coming from my father.

The afternoon he arrived, my father went looking for a Buddhist monastery. “I wanted a monk to bless me.” He found a temple nearby, but was informed that the monks were too busy. My father decided he'd just have to rely on the blessings of another faith: “Before I left, I told Ilonka to pray for me in church.”

After an electrocardiogram and a stress test, my father unpacked in one of the “tastefully decorated private rooms” or “VIP suites,” as the hospital's promotional packet billed them. He set up his computer on a bedside table. The packet had also advertised excellent Internet service, but he couldn't get the computer to connect, and the hospital staff wasn't much help. “They just smiled a lot,” my father said, and told him the server might be down. It never came up. At first my father was upset, but after a while he decided it didn't matter. “There was no one I needed to e-mail.”

At eight p.m. the first evening, Dr. Sanguan stopped by the room to discuss the logistics. The operation, he told my father, has two phases. Stage One, an eight-hour procedure, would take place the next morning: it would begin with the breast augmentation, then move on to the “vaginoplasty” (the creation of a vaginal tunnel), the “penectomy” (the removal of the penis), the “orchidectomy” (the castration of the testes), the “labiaplasty” (the construction of a clitoris, clitoris hood, and labia minora), and the “urethroplasty” (the creation of a new pathway for urination). Dr. Sanguan specialized in male-to-female surgery. The doctor reviewed the procedure with my father: He collects the tissue and nerves from the penis and the prepuce, or foreskin, and fashions them into female sexual organs. The top of the penile glans becomes the “Neo-Clitoris”; the underside, the inner section of the labia minora. The scrotum he sets aside for safekeeping. Later, he peels the scrotal skin and puts it on ice—or, as the literature the hospital provides puts it, “safely refrigerated at 4 degrees Celsius (approximately 39 degrees Fahrenheit), where it will remain healthy for up to three weeks.”

Seven days after the first set of operations comes Stage Two, the skin graft to line the vaginal tunnel. The scrotal tissue is retrieved from the hospital refrigerator and thoroughly scraped of hair follicles—“thus preventing hair growth inside the vagina.” Dr. Sanguan said that by grafting the penile and scrotal skin, he generally can create a “Neo-Vagina” with a depth of four to five inches, but sometimes that's “not enough skin” and then he would have to resort to other options.

“Not enough?” I asked.

“Like if you are circumcised,” my father said.

If additional “harvesting” is necessary, the patient must undergo one of three increasingly tricky procedures. They are detailed on Dr. Sanguan's website. The least invasive is a “full thickness skin graft”: the surgeon cuts “excess” flesh from the patient's stomach, hip, or groin. But sometimes this method doesn't suffice, and the surgeon has to resort to option two, a “split thickness skin graft,” in which he makes a deep gouge in the patient's thighs or buttocks, leaving a scar of “eight to sixteen square inches” that looks like “a deep abrasion or burn injury.” Sometimes that doesn't work either, and then he asks the patient to wait six months and return for a “secondary colon vaginoplasty”—a section of the patient's lower intestine is removed and sutured onto the Neo-Vagina. The patient winds up, Dr. Sanguan's literature relates, with “a scar similar to that for women who have given birth by Cesarean [
sic
] Section.” The procedure can lead to numerous “complications,” among them “leakage of anastomoses” (a leaking intestine, which can cause life-threatening infections), “fistulas” (another dangerous condition in which small tunnels form between organs that shouldn't be connected, like the colon and the bladder), and, in some cases, “temporary colostomy cannot be avoided.”

Dr. Sanguan skips over such details in the YouTube informational video I watched, attesting to his skills as a sex-reassignment surgeon. (By the time it was posted, in 2010, he'd operated on more than seven hundred male-to-female patients.) “You will be happy,” he assures prospective clients in halting English. “You will go back with a beautiful face, beautiful body, beautiful breasts, with very inexpensive cost, spend just thousands of dollars, not ten thousands of dollars. … Please feel free to come to Phuket for any surgery you dream for.”

The night before the surgery, my father said, Dr. Sanguan asked a few questions about his general health. Then he took out a plastic container and spread its contents on a tray: gelatinous discs of breast implants, arranged in ascending sizes. My father picked the largest. “I had brought some padded bras with me that I used to stuff to make them look even bigger,” my father told me. “I even had a very nice Victoria's Secret bra, bright pink. But after the operation, they were all too small.”

My father gave me a sideways glance.

“You could use them.”

I said I didn't think so.

“It's a waste of money for them to just sit in a drawer. Take them home with you.”

“No!”

The morning of May 7, orderlies wheeled my father into the operating theater in Bangkok Phuket Hospital's plastic surgery wing. About ten hours later, she awoke in a recovery room. She was immobilized, catheterized, in great pain, and alone. “No one came and no one came,” my father told me. “The bed felt so hard.” My father's back hurt so much, she thought she was lying on stone. When a nurse finally materialized, my father begged her to find a new mattress.

Stage Two, seven days later, was supposed to be the easier operation. It didn't even require general anesthesia, just a local.

My father lay under a floodlight, numbed from the waist down. When she lifted her head, she could just make out Dr. Sanguan at the foot of the bed, pulling hairs out of her former scrotum. “I am lying there under these harsh bright lamps,” my father told me, recalling it in the present tense, as if it were still happening, as if it might never stop happening. “They are all doing their work around me. No one is saying a word to me. And all of a sudden, I get this horrible feeling. This horrible realization. No one can see me. I've disappeared.
Maybe I'm dead.
” After a while, my father's terror-stricken eyes caught the attention of a nurse. She told my father to take some long, deep breaths, and rearranged the pillows so she wasn't staring straight into the surgical lamps. Gradually, the panic subsided. Later, my father asked one of the other nurses about it. “She said it was probably a reaction to my feeling nothing beneath my waist. She told me, ‘It's like half of you isn't there.'”

My father showed me a photograph of herself, a few days after the second operation. She is lying on her side in a hospital gown, her face a waxy sheen. She looks up at the camera with that strained half-smile.

A week into the recovery, Dr. Sanguan arrived with bad news: the penile tissue wasn't sufficient to fashion all the female body parts. He told my father that after several more weeks of recovery, she would have to return for a “full thickness skin graft.” In the meantime, she had to find a place to wait in Phuket. Which was how my father came to stay at Melanie's Cocoon.

Melanie's other guests, my father recalled, were half her age: “One of them came with a boyfriend, with an engagement ring! And there was one who was a real whiner, crying all the time.” Another guest later had good reason to cry. Her vaginoplasty hadn't worked; her scrotal tissue had thawed during a hospital blackout. She had to fly back to have the procedure redone.

“The youngest one there,” my father said, “he was always talking—
she
was always talking—about how she'd told her psychiatrist she just wants to be a woman like her mother,
not
independent. She wants to be a good housewife, and make the sandwiches for her husband. She said she had her bridal gown all picked out.”

“And a groom?”

“Waaall”—my father rolled her eyes—“he said—
she
said—she had a couple of guys in mind back home. But then she said she thought one of the nurses in the hospital liked her, so maybe she'd run off with him. The nurse was probably just being nice without meaning it.”

Land of Smiles.

My father's skin graft worked and, after ten more days of rest, she was informed she could go home and start “a new life.”

“I already
told
you,” my father said. “It's
irrelevant
.” We were back in her office under the eaves. I was asking about the psychologist whose letter was never submitted, the letter that I'd secreted in my purse.

“Why?”

“I didn't send it in.” An airy wave of the hand. “There was no need. The other therapist was a higher rank. He was a university professor.”

The other therapist, a professor of psychotherapy at Semmelweis University, was the second mental-health professional my father had sought out for an evaluation. And he, my father said, had approved the operation.

“But don't you need
two
evaluations?”

“That first psychologist, she was some lady shrink,” my father continued, ignoring the question. “I had to go see her in an
insane asylum
. Full of old ladies, draaagging themselves around in bathrobes. It was someplace way out of town. She was probably put there because she was no good.”

“And what happened?”

“She asked me a lot of questions. But she didn't know what she was talking about.” Or rather, my father didn't like what she had to say.

My father went to the file cabinet and pulled out the “Changes” folder again. I hoped she wasn't looking for the letter I'd filched. She extracted a short, typed piece of correspondence and handed it over to me with an I-told-you-so look.

“This is the one that matters. Dr. Simon is the ranking authority.” Dr. Lajos Simon, the Semelweiss professor.

“And what did Dr. Simon think of the psychologist's letter?”

“He told me that it would make trouble for me.”

“Because she didn't recommend you for surgery?”

“Waaall,” my father said, “Dr. Simon probably knew that lady shrink was some kind of nut.”

She unfolded Simon's letter and began to translate it.

“Waaall, technically, it was only nine months,” my father annotated. Not the one year of pre-op hormone therapy that is the minimum recommended by the Standards of Care.

“You see? ‘
Changed clothing regularly
.' You have to say that.”

“But did you?”

“Maybe. Yeah, a little bit. I said it, but it's aaalso true.”

The translation resumed.

“Actually,” she interjected, “it's more accurate to say that during that time I had
no
sexual relations.” And was divorced, more accurately, in 1977. Later, the report continued,

I wondered what “certain circumstances” meant. The Standards of Care stipulate that sex-reassignment candidates should live “continuously” and for a minimum of a year as the opposite gender before progressing to surgery, a period referred to more colloquially as “RLE,” or Real Life Experience.

“Did you?” I asked.

“Waaall, sometimes at home, when I'd take pictures of myself.”