Waiting on the Edge

I was told yesterday, for the second time, that I was being referred for gender-affirming surgery and that the next thing that would happen is that I would receive confirmation of the referral and information on next steps. I should be delighted, or at least marginally happy. These are not the emotions that I am feeling at this time. Rather, I am exhausted and anxious and afraid. I am teetering on the brink of an abyss. And there is absolutely nothing that anyone is prepared to lift a finger to do anything about it. I am exhausted. At the time of writing, It is 32 years since I came out, 27 years since I sought what is laughably known as care, 26 years since I socially transitioned, 25 years since I started medical transition and later detransitioned (or as a shrink put it delicately the other day ‘paused’ my transition), 10 years since I self-referred to Sandyford (when that was still possible), six years since I transitioned again, five years since I restarted HRT. And that's actually OK. Or at least, I can blame myself for not going through with it in 2000. And, do I blame myself for it. I've done the negligible hair removal and voice training on offer. I'm on amythical waiting list for the adam's apple, which no-one offers in Glasgow on the NHS. I waited patiently for facial feminisation surgery, but decided that if my daughter and I share the same resting-bitch-face, I was doing it for the wrong reasons (and anyway, there was supposed to be another shrink referral, but that never happened either). I've done seven years of self-funded facial electrolysis. And that's OK too: the residual traces of facial hair are at least something I can actually do something about. It's probably not healthy to take a vindictive pleasure in destroying them, but I do.

I am exhausted. After any given Sandyford appointment, there is no telling when or (it seems) if you are ever going to hear from them again. Emails disappear into the ether, never to be returned. Promised actions never materialise, or, just to keep you on your toes, they happen, but they don't inform you about it (‘Oh, you've been on that waiting list for two years’). Most years, there seems to be some virtual sweeping out from beneath the sofa before the Christmas holiday, and you might be recontacted, but since they haven't taken your bloods in months, we have to start the latest cycle over. Or, you have a second opinion and are referred for surgery. Except that you are not. So you raise it with the next health professional you see twelve months later. ‘I'll look into it and get back to you.’ Except he doesn't. So you email, and wait. And, lo!, you receive an email back with a half-arsed apology and an explanation that they don't know what happened, but I should have had yet another sign-off meeting, because the first and second opinions need to be in the same twelve months—which, dear reader, if you have read any of my blog posts, you will know is practically impossible given Sandyford's normal mode of operations—and because it is more than 12 months since the second opinion (because, you know, I don't like to be pushy, and I respect their lack of resources), I now need two appointments. As a tacit admission that they have fucked up, these are arranged for me in a month's time over the course of eight days.A miracle!

Excursus: as followers of trans healthcare will know, waiting lists are multi-year, just for a first appointment, and then additional waiting lists are built-in at every stage of treatment. Gender Identity Clinics will say that they are under-resourced, have been hit with a massive surge in demand, and there is no political will to do anything positive about it. They have recruitment problems. They need more admin. All of which may be true, but it does not answer two fundamental questions: i) given the lack of resources, why are processes set up to be maximally inefficient, with multiple unnecessary appointments and supposedly regular check-ins handled by senior staff, and ii) why are senior staff so wedded to a system that is so patently not working? On this note, the relevant policy from the referral service appears to be that referring organisations may rather than must have both appointments in the past 12 months; I just leave that here for consideration.

But I am exhausted. Between the notification about the two new appointments and them taking place, there was the Supreme Court decision, and the ECHR interim statement and consultation. Like so many of us, life has become a mix of the day job and full-time political activism, as we try to chase our political representatives on one side, and seek to persuade our institutions, on the other, not to comply in advance with the ECHR's attempt to bounce us into a segregated world. And my hopes appear to be founded on the Good Law Project, and my fears are founded upon the reach of fascism, and this is all starting to sound like Gandalf's letter to Frodo telling him to get out of the Shire by the end of June at the latest.

So I am exhausted. I have now had the two unnecessary extra appointments, and, remarkably, nothing has changed since I had the last set. ‘You'll have done thousands of these’ said the first shrink gaily. ‘Eight,’ I said stonily. There was a kind of apology for the unnecessary meeting; lack of funding and admin were duly mentioned. I wasn't conciliatory. I did raise the question of whether the Gender Identity Clinic was the right model. ‘Well, if you can persuade our political masters to do something different, I'm sure we'd be delighted.’ I pointed out that both from conversations with their colleagues, plus reports from inside the consultation on trans healthcare, some healthcare professionals seem rather wedded to the traditional format. ‘Oh, well...’ Anyhow, I did get to relate some of the fun with Mr Suck-it-and-see in Oxford, the Lion Man at Charing Cross and the joys of being pursued by the Daily Heil and the Sun. I actually almost miss Charing Cross and its patronising patriarchal bullshit. Hey, i am an Oxford-educated classicist, and we do patronising, patriarchal bullshit for breakfast.

Yet, I'm exhausted. Let's stagger on to the final(?) throw. I'm running on traces of adrenaline, and I can feel the body is screaming (the lymph nodes are starting their journey to Frankenstein's monster, a tell-tale stigma gifted by a violent episode of glandular fever in my first year of DPhil). ‘Has anything changed since you,er, saw my colleague last week?’ ‘Well, there was the EHRC.’ ‘The what?’ ‘The Equalities and Human Rights Commission.’ ‘Yes,’ (sadly) ‘it's very difficult.’ We fall to discussing the impact of the Supreme Court decision on my mental health, and I relate the three-way debate: toss myself off the Kingston Bridge, flee the country, or try to tough it out. And my decision to stop using sertraline as a personal crutch for dealing with political reality. Cue anxiety over self-harm, and, I'm asked, ‘Would you engage with mental health professionals if you have these feelings again?’ ‘Let me, at this point, just express scepticism about mental health services.’ (Almost wailing) ‘But we're supposed to take care of you. ‘Uh huh. But let me not suggest that we simply chatted about the state of the world. I got to select a hospital, which will be punted up to the UK referrral service (Scottish nationalism, famously, does not extend to its gender service). Did I have any questions? ‘Well,I looked at the list of surgeons, as instructed, but I couldn't see anything about wait times.’ ‘We're not allowed to know.’ ‘Wait, what?’‘Referring organisations aren't allowed to know. You might be able to find out as a patient, if you ask the Trust yourself.’ ‘What??’ I was reassured that someone was trying to work on this, but without much conviction. And did I have any more questions? Well (this time, I wasn't doing my usual docile patient impression), I understood that different surgeons had different requirements about electrolysis in the relevant area, and how was that to be managed? This was also a mystery, and the unit that I had been to before for facial hair removal (as above) had ‘been retired. At this point, i am having visions of Martin Sheen dying in his hotel room and the bloated Brando shot from below, in the dark. Was this just a function of the Yourkhill ghost hospital, or had For Women Scotland (Ltd) terminated representatives of NHS Greater Glasgow and Clyde—with extreme prejudice? I would be informed.

I'm exhausted. I had to leave this one video conference and step directly into another where I was supposed to be quizzing one of our PhD students about their thesis on the US far right and their (ab)use of Classics. Great topic. I was totally not in shape for this. We were talking about a piece on an influential neocon ancient historian and their work from the Cold War era. ‘It's not exactly something Mary Beard would write,’ was one observation. It was too much. I think it is three or even four years since she promised that we would talk about her ableism and transphobia. I was atill trying to be reasonable in those days, and we were tooth-achingly polite at each other; but I am still waiting.

It's exhausting. So, I am left wondering, did I go too far? I've been around this block long enough to nod and smile, say the right things and not give an inch on mental health. Don't be angry, or even moderately passionate. Will either letter by either of these practitioners ever be written, and at what time scale? Will there be some subtle (or not so subtle) implication that I am a bad risk? Will NHSGGC actually fund this? Will my preferred unit actually accept patients within this decade? Will there still be trans healthcare by that time? And will it be Swinney or Streeting or Starmer or Farage who will put the final nail in the coffin. How wise is it to stay in the UK on the off-chance that this surgery will still be available while there is still achance of getting out?

This should be one of the happiest moments of my life, and all I see is a gaping chasm of darkness. Doom, doom, go the drums in the deep.