Gender Affirming Surgery – Recovery at Asclépiade

As mentioned in the previous blog there are two main phases for recovery while under the care of GrS Montreal. The first 2 days in the hospital (CMC) and the longer time at Asclépiade which is 6 days. I won’t be able to go through the details of each day, but this post will still be long.

Day 2

After coming over to the recovery house, there is a quick realization. You are not only more independent but there is a steep learning curve. There is medical observation, and they take your vitals regularly for the first 24 hours but after that you only see the nurses when you need some help, request them, learning something new, or if they are dropping off medication.  The medication cycle happens regularly (4x daily). It is a good opportunity to ask questions in private, otherwise, you are at the nursing station talking to them through a plexiglass wall.

Because there were only a couple of other girls like me coming over from the hospital side that day, the recovery side was filled with women that would have had their surgeries the week before. When I got into my room, the main nurse had me lie down and take my vitals and checked everything out. Then, my blood drain came out.

*** next part is a little graphic so if you are squeamish (Cathy, I’m talking to you) you might want to skip it ***

The blood drain is a tube that enters in through the abdomen and is directed to the area around the clitoris and the packing. I was warned when it was being removed, that this part would be the most painful part of the week. The nurse asked me to take a couple of very deep breaths, and then she slowly started pulling the tube out. It seemed to take a good 30 seconds but it might have been 5 for all I know. The sensation was something I’ve never felt before; not severe but just a really odd sensation of pressure, pulling, and yes, pain.  A quick bandage was placed over the area that needed to be changed every ½ day or so and that was it.  This drain caused some pretty colourful bruises over the next day.

The rest of the day was really about getting acquainted with the new environment.  At meals, there is an announcement so that everyone could come and eat in the dining area. It was uncomfortable in so many ways – not knowing anyone, not being able to sit, etc. One of the ladies that was leaving the next day grabbed me something to drink. Another suggested that I come to another area to use a ledge to stand while eating. Sitting was just too painful early on. I was very grateful to have those ladies there at first to help show some of the tips and tricks of making the stay as comfortable as possible. Having others who know what you are going through and guide you the first day, is a smart way that the hospital arranges the check-ins and outs. Over the next couple of days, other women that were moving to the recovery side had that same look on their face that I would have had. I was happy to show them what I had learned and it was a good way to make introductions.

Day 3 & 4

The first night’s sleep at Asclépiade was easily the worst that I had while here in Montreal.  Because I was stuck on my back in an older hospital bed, it was tough to get comfortable enough to fall asleep and then stay asleep.  Also, I was in a room that was close to the nurse desk which means their phone would often ring through the night.  Earplugs and eye mask can only take you so far.  The morning of Day 3, I spoke to the nurse about it and she told me a tip that I used and then shared with a couple of the other girls in here.  Roll up a spare blanket and tuck it behind so I could get at least a 45 degree angle and still be comfortable.  It’s not side sleeping, but that did work and the nights got better afterwards.

The rest of these days are about rest and recovery. Nothing eventful really happened except for a session that we had in the lounge area where we were able to share our stories with the group. Not everyone came, and not everyone felt the need to share which was more than acceptable. I’m glad I went because I learned something new about myself. When I’m in a situation where others are afraid to speak, I have no issue speaking for or with the group. This is especially true when it’s a topic such as being trans, something I like to talk about. I think this session brought the whole group together and as a result I think we will remain in touch after we all leave this week.

The other part of these days which I enjoyed was the walks which were required 3 times a day. It was nice to get out with Cathy around the complex and see things other than the inside of the recovery home. On one occasion, when no one was looking, Cathy jumped into the hospital bed with me and cuddled while I napped.

Day 5

This was the day that I had been looking forward to.  On Day 5 the packing that was sutured in place in front of the surgery site is removed.  This is jokingly referred to as the brick to the patients here.  Having tiny scissors cut the sutures around this area was very strange feeling especially when the skin releases.  I would say that, of the 100% discomfort I was feeling at the start of the day, about 60% left with the removal of the brick.  All the patients still have a waddle after this point, but walking is much more manageable.

With this packing and material all removed, I was then permitted to take a 10-minute shower; the first shower since the morning of the surgery. It was so enjoyable to feel clean, to wash my hair, and to get rid of the funk from the past 5 days.  They limit it to 10 minutes as the heat/steam can often make patients a little dizzy plus they don’t want to expose the surgery site to too much water as moisture is the cause of many of the complications post-surgery.

But for me, the best part about day 5 is actually getting to sleep on my side for the first time since Sunday night six days ago. I wasn’t 100% comfortable as there was still some pinching and pulling from the remaining sutures, but that night finally brought some decent sleep.

Day 6

This was the best day of the recovery week in terms of progress.  Day 6 the vaginal mould was removed relieving the pressure and removal of a few more uncomfortable sutures holding the mould in place.  These remaining sutures were made tighter with the removing packing the previous day so I was very happy to see them go.

Now comes the training which will become a big part of my next year. Dilation exercises. If you think about when your ears get pierced, you need to have something in place through the hole so that it doesn’t close up, – at least for the first 6 months but preferably a year. When they create a vaginal cavity this is very similar, though a person can’t be expected to keep something in place 24/7.  I have heard of other programs for dilations from other surgeons, but GrS Montreal’s is pretty much the same across the board. It’s a 30-minute period with icing beforehand, douche and sitz baths afterwards and then 45 minutes of air drying.  This is to be done 4 times daily during the first month, 3 times for month 2-3, 2 times until the 6-month mark, then once a day for the rest of the year.  This may seem excessive but I’m not about to question a doctor that has been doing this procedure for 15 years plus.  GrS does provide a video on how to perform the dilations and then a nurse is with you the first time. A second nurse on the next shift will then monitor you on your next round of dilations and add any suggestions that might make it easier. I found that this part of the recovery was well done and well explained.

As a big surprise that morning, I asked to have my catheter out and the nurse said she believed that it could be done.  I did take medication the night before to relax the bladder so I knew it would be a possibility, but it was not a guarantee. It was known that the removal of the catheter is not a pleasant feeling and was discussed a few times during my time there.  When she started to remove it, I could see why. It is almost like a burning feeling similar to a Urinary Tract Infection.  It was also very similar to the feeling that I had while using the valve on the catheter so I was more than happy to go through this bit of pain to negate the pain of using the catheter in the future.  Next thing I knew, it was out and I was a free girl! No more attachments, moulds, packing or drains. What an amazing feeling.  Don’t get me wrong, the surgery site was still painful and the remaining stitches caused discomfort, but none of that mattered at that moment.

I had read that the first time going pee with my new equipment would be a bit of a challenge.  All I can say, is that I didn’t quite make it to the toilet in time the first go around.  It’s so strange to no longer being able to control the urge to pee and the flow itself. With my old equipment, I felt that I knew that it was coming and I could sense that I was about to pee, but with the new equipment, you just have to think it, and it starts to flow. I would now have to teach my body how to control this in a new way. But I wouldn’t have it any other way!

Day 7 & 8

Day 7 is really in place just in case there was a delay in removing either the stent or the catheter.  Since I had mine removed on time Day 7 ended up being a day of waiting. It was nice to have another day to chat with the other trans women at the facility and continue to share stories but Cathy and I really wanted to get home. Because we became a pretty close group of women, we decided to record everyone’s contact information so that we could keep in touch after the fact.

Finally, Day 8 arrived and we could pack up and go home. Who am I kidding, Cathy did all of the packing for the trip home.  Having to get in 2 dilations and a consultation for potential future breast augmentation surgery was probably a little too much for one morning but we did it in time and managed to get home safely that night.

In some ways I will miss my time at GrS Montreal. The food was great, it was like a home cooked meal every night. The nursing staff was pleasant and helpful even though there was a bit of a language barrier with a couple of them. But mostly, it was the other patients that made the time worthwhile. Even though we had a wide age range (from 18 – 61), and we were from all over Canada, we all shared this same experience at this same time so there is a bond there.