Abby (patient) (2:50)

But with something like facial features, those are chiefly defined by the size and proportions of the bones. You know, your facial bones developments during puberty. For me, that I just can't, I can't undo.

Rebecca Mead (3:08)

Abby had been taking Hormone replacement therapy for months by the time I first talked to her, and it had had some major effects on her appearance, her skin was much softer. She'd taken other steps towards transitioning socially. She'd changed her name legally. And she told me that in the summer of 2017, she'd finally crossed an invisible line whereby she was more often addressed by a feminine pronoun than by a masculine one. And yet there were still things about her face that she was deeply unhappy with.

Abby (patient) (3:43)

It's all those extremely subtle cues that when you meet someone for the first time, you know, the fraction of a second, and that's what informs you of who this person is, how they should be addressed. And one of the ways that the world chiefly interacts with you is by your face, right, Is by looking at you.

Rebecca Mead (4:02)

So she's naturally a very outgoing person, a very friendly person, an open person, but she became more withdrawn and there were even things about her mannerisms that changed. She told me that she no longer wanted to turn her head because when she did that, her Adam's apple bulged out. So instead of turning to look at something, she would just flicker her eyes to the left or to the right and she would keep her chin tucked down. She demonstrated for me, and she looked like she was an actor playing a character in a Jane Austen movie. And I think that for her, she became more self conscious and less social and less willing to make eye contact with others because she felt that she was going to be judged or evaluated or wondered about.

Abby (patient) (4:50)

I'm just very, very aware of how much visibility there is for our community out right now, which is really great. But also, at least in my opinion, I think it makes it harder, a little bit harder for trans individuals just to go about their daily lives. In the past, you would walk down the street and kind of view somebody as just being, oh, you know, that person's atypical or looks, you know, just a little, you know, unique or something like that. And now I think there's just more scrutiny to really trying to like, oh, is that one of the people that I've heard about in the news or I've read about, is that one of them? Or, you know, it's kind of voyeuristic and. And we don't want that attention.

Rebecca Mead (5:37)

Abby isn't her real name. She's very security minded. She's aware that there is a disproportionate amount of violence committed against trans people for her. She wants to be able to move through the world without drawing attention to her gender And a friend of hers had had surgery, had had what's called facial feminization surgery, and had been very pleased with the results. And so Abby started to look into it for herself. And she's a teacher of biology, and she could really understand what the procedures that she would be undergoing. Dr. Deshaun Brawley is a craniofacial surgeon and is trained in repairing faces that are deformed by congenital abnormalities or even by accidents. And he trained under a surgeon named Douglas Osterhout, who in the 1980s was a pioneer of facial feminization techniques and chose Dr. Deschamps Braly as his successor.

Ada Limón (6:49)

Superficial temporal artery. That's okay.

Rebecca Mead (6:54)

There's a light board that has Abby's X rays up on it and schematic drawings that the surgeon has done to show him where, you know, a millimeter needs to come off here and 2 millimeters here. And there are also these photographs that are taken of Abby, digitally altered pictures of her as he is aiming to have her be six months from now. By 8:35. He has finished with the tracheal shave and moves on to her brow and cuts into her face just below the hairline. Quick slice down one side, sort of down the hairline, then behind her ear, and then another cut on the other side. And this is the point at which, if you're a listener who is squeamish, be warned. He starts to peel her forehead away from her skull. It looks like peeling the skin of a mango away from the flesh of a mango. So there's this kind of fleshy flap that is coming down and exposing the bone beneath. This is the point at which the whole thing starts to feel rather like a science fiction movie. Having been terrified that I was going to be a puddle on the floor, I was completely riveted. Her forehead is now being lifted off her scalp and folded down over her eyes. Dr. Decham Brawley looks at the images on the wall and takes out a little pencil and draws the shape of the planned incision on her. Boy, you know, a typical masculine forehead has a much more pronounced brow ridge than a typical feminine forehead. He uses something called a reciprocating saw to cut away a piece of bone. He lifts it off and cuts this piece of bone into four and then reshapes it, ties these pieces back together with stainless steel wires and then puts it back in her forehead and flaps her face back up over it, smooths it down and sort of eyeballs it just to see how it looks. Cool. All right, so I'm going To give it a washy wash. Let's change gloves. Is it or is it not a kind of beautification surgery? Is that the wrong way to think about it?

Abby (patient) (10:06)

To an extent it is a little bit of a beautification only because I think our society tends to view more typically feminine faces as being more beautiful. There's definitely an aspect to the surgeries that have to do with that. But my motivations just aren't cosmetic. My motivations aren't superficial. For is to relieve dysphoria, to help the world see me as who I am.

Rebecca Mead (10:40)

So gender dysphoria is a clinically recognized condition best understood as a severe dislocation between one's inward sense of self and one's outward appearance. The difference between ordinary dissatisfaction with what you see in the mirror and genuine gender dysphoria is the difference between not really liking your thighs and feeling like your thighs do not belong to you. The these are not your thighs.

Interviewer/Companion (11:13)

You have this really strong mental image.

Abby (patient) (11:15)

Of, of what you look like, how.

Interviewer/Companion (11:17)

You act, everything just this kind of like sum total, you know, your mental image of yourself. And then when you look in the.

Abby (patient) (11:25)

Mirror or look at your face or.

Interviewer/Companion (11:26)

Something, it projects like the extreme opposite of that mental view of yourself can feel like just extreme, extremely intense and extremely negative emotions. You know, anger, frustration, depressed and angry, upset, and usually it's all at once. And they roll together and roll from one to the next and it's completely debilitating, completely crippling.

Rebecca Mead (11:57)

So after the surgery, what do you hope to see when you look in the mirror?

Abby (patient) (12:05)

Myself.

Rebecca Mead (12:10)

This is a really long surgery. Seven hours in total. And around 11:30, Dr. Dechampt Brawley takes a break, goes down to the hospital cafeteria and grabs himself a Coke and a packet of peanut butter crackers. By noon, he's back in the operating room. Abby has quite a strong lower jaw. He opens her mouth wide and cuts the flesh that connects her cheek to where her teeth are. He calls me over to take a look. I can see her skeleton. And he's cutting away the bone of her jaw with a reciprocating saw. It's quite forceful. He tapers her jaw and then he gets to the middle, which is her chin, and then excises this T shaped piece. It's quite a large piece of bone that gets pulled out and it's like watching a piece of gristle being pulled out of a meat pie. There's a specially designed little piece of metal, like a little bracket that joins the bits of bone together and cinches them together so that the chin is smaller. Five weeks after the operation, I went to see Abby at home.

Interviewer/Companion (13:53)

It's in a biohazard bag.

Rebecca Mead (13:56)

She'd kept the bone as a memento.

Interviewer/Companion (14:00)

Plastic container, Zykomye sticker with my ID on. Still blows my mind that they were able to go cut all this out, take it all out, sew it back up, and everything's fine.

Rebecca Mead (14:14)

When I saw her, she'd just started back at work. She had told a few close colleagues what she was doing, but for the most part, she told anybody who asked or needed to know that what she had undergone was a corrective surgery. She was a little self conscious about the swelling in her face. Although to my eye it really didn't look very swollen at all, given what I'd seen her go through. It is amazing to see you because you look. It's so. I mean, it's just.

Interviewer/Companion (14:49)

What are your impressions?

Rebecca Mead (14:49)

Incredible.

Interviewer/Companion (14:50)

I'm curious.

Rebecca Mead (14:51)

You look well, you look lovely.

Abby (patient) (14:54)

Thank you.

Interviewer/Companion (14:55)

I'm fishing for compliments.

Rebecca Mead (14:56)

Yeah, no, I know. You look completely beautiful, obviously, but it's. I'm trying to find words for it. I mean, you look familiar and yet not the same. I think you look more different than I thought you were going to.

Interviewer/Companion (15:14)

Yeah.

Rebecca Mead (15:16)

So her whole face is very different. Although the changes, the actual surgical changes can be counted in millimeters, the way that she holds herself has already changed. You said to me before you had this done that you sometimes had these moments where you would see your reflection and then it made you unhappy to.

Interviewer/Companion (15:38)

Yeah.

Rebecca Mead (15:38)

And I wonder whether you have that.

Interviewer/Companion (15:43)

I haven't had that same experience since. It's just not there, you know.

Rebecca Mead (15:49)

Other patients of Dr. Duchamp Brolly, who I'd interviewed, had told me that the experience of seeing themselves revealed for the first time when the bandages came off was incredibly emotional and moving. And one person told me that she had burst into tears. Abby did not have that experience. You know, finally when she looked in the mirror, all the bandages were taken off and she looked at herself in the mirror, she thought, oh, yeah, that's my face.

Interviewer/Companion (16:19)

One of his medical team told me something really interesting. When they have CIS patients, you know, non trans patients, and they have some type of surgery done, you know, if you're in a car accident and you, you had to get your nose altered in some way or your chin or something changed, it just like takes time for you to kind of get over that mental image of who you were. And now you're looking at your reflection and those two things aren't matching. So you start freaking out. They told me that that really doesn't happen as much with their trans patients. It'll just like, like, oh, cool. It's just, it's like over and done. Their trans patients just tend to just to accept, you know, their quote unquote new face.

Rebecca Mead (17:05)

Yeah.

David Remnick (17:17)

Rebecca Mead wrote about Abby and a of lot in the technique of facial feminization surgery. You can find her article@newyorker.com we altered Abby's voice to help protect your privacy. This is the New Yorker Radio Hour. Stick around. I'm David Remnick. And next time on the New Yorker Radio Hour, we have something very special lined up, an interview with James Comey. Comey has a new book about to come out and there's going to be a lot to cover. The election, the Russia investigation, Hillary's emails, Donald Trump, and the future of Robert Mueller's investigation. I'll be talking with Comey live at Town hall in New York, and you can hear it all the next day at newyorkerradio.org or wherever you listen to the show. Don't miss it. For today, we're going to close things up by getting outside with the poet Ada Limon. Limon grew up in California and then spent a long time living in New York City. Some years back, she left New York to live with her boyfriend, now her husband, in Lexington, Kentucky. Fewer rats, more horses.

Rebecca Mead (18:39)

Hey there.

Ada Limón (18:40)

Hi. Cactus. Beautiful quarterhorn.

Abby (patient) (18:43)

You know why I call him Khaki?

Rebecca Mead (18:44)

Why? That's his name.

David Remnick (18:50)

Limon's last book was called Bright Dead Things. And it's all about adjusting to a new home, a new relationship, and the constant talk of thoroughbreds.

Ada Limón (19:01)

We're standing in front of the main entrance here to Keeneland, and they've got this beautiful stone walls, and it kind of looks like a castle. Keeneland, I think, is one of the prettiest race courses in all of the United States. Now, this isn't where the Derby happens. Churchill Downs is where the Derby is raced. But Keeneland is a beautiful old track that has this very historic, stately feel in the middle of beautiful horse pastures all around. Feels like spring might actually come. The sun's not quite up. It's a little cloudy. Being here when it's empty is kind of lovely. So right now we're walking through the main track area before we get to the actual racetrack. So this is where you have the concessions, where you get your popcorn and your Kentucky's burgoo, which is a sort of legendary Kentucky food. I'm Not a huge fan. Don't tell anyone. You get soft pretzels and popcorn and, you know, soft ice cream for the kids. And then as we keep walking up here, you'll see all of the bedding windows. I grew up going to the track occasionally with my stepfather, who loves to play the ponies. But we would go to the Sonoma County Fair and go to the track out there. People always ask me, you know what? You have so many horses in your poems. What are they a metaphor for? And I think it's. They're not really a metaphor, like, out here. They're just horses. The very first time I came to Keeneland, it was here to meet Zenyatta, who's a famous filly who I just adore. She's famous for having won the Breeders Cup Classic, the only filly to have won the Breeders Cup Classic. And she was sort of an icon of mine, and so it was fun to get to meet her. And that was actually the very first time I came to Keeneland. I think one of the things I love about watching them race is the thrill that they seem to get from it. Like, they actually seem to be enjoying the race. So right now, I am looking at the main track, which is a dirt track, has almost like a reddish quality, and it's loose dirt. Even though we got some rain there, it looks like it's. It's bouncy. They try to keep it so it's healthy for the horses to run on. And then the track right behind it is the turf. Now, right now, we've got thoroughbred going by thoroughbred racehorse. There's something about them that is so beautiful as they race and as they just stand there in the pasture. And out here in Kentucky, you know, they're about as common as birds. This area right here is the apron, and this is where if you just pay general admission, you can come and sit and stand on the rail and root for your horse. On a busy day, it will just be packed and loud and ruckus. It's a great sound. I kind of like coming out here when there's no one here. It feels like there is some sort.

Rebecca Mead (22:56)

Of.

Ada Limón (22:58)

Ghost of energy within the space, as if it's. You could almost hear the echoes of roars, people screaming with joy because they actually won big for the first time. This is a poem I wrote for the Kentucky Oaks Day, which is when all the Phillies race. And it's one of my favorite races, how to triumph like a girl. I like the lady horses best, how they make it all look easy, like running 40 mph is as fun as taking a nap or grass. I like their lady horse swagger after winning. Ears up girls. Ears up. But mainly, let's be honest, I like that they're ladies. As if this big dangerous animal is also a part of me. That somewhere inside the delicate skin of my body there pumps an eight pound female horse heart giant with power, heavy with blood. Don't you want to believe it? Don't you want to lift my shirt and see the huge beating genius machine that thinks no, it knows it's going to come in first.

David Remnick (24:29)

The poet Ada Limon at Keeneland Racecourse in Lexington, Kentucky. You can find the poem she's published in the New yorker@new yorker.com I'm David Remnick. Thanks for joining me. Catch you next time.

Narrator/Producer (24:50)

The New Yorker Radio Hour is a co production of WNYC Studios and the New Yorker. Our theme music was composed and performed by Meryl Garbus of Tune Yards with additional music by Alexis Cuadrado. This episode was produced with help from Johnny Vincevans, Malik Baji, Jenny Cataldo, Michelle Moses, Emily Mann and Jessica Henderson. The New Yorker Radio Hour is supported in part by the Churina Endowment Fund.

Rebecca Mead (25:16)

Lord.