TOP SURGERY | Angela Tang-Tan
His body opens as if impatient to begin. The skin parts easily, unzipping at the merest touch of the surgeon’s scalpel. It’s clean, almost bloodless. The subcutaneous vessels burst in tiny scarlet rivulets, which are swallowed in a blink by the suction. The crackle of the Bovie punctuates the tinny pop music playing from the circulator’s computer. Smoke wafts upwards and I catch the smell of meat, sizzling. Iridescent pearls of fat shimmer and drip under the glare of the overhead lights. I place the skin hooks, catching the razor-sharp points on the edge of the skin. I pull upwards and stretch it taut so that the incision gapes wide. My fingers instantly begin to ache. His breasts blossom into two raw flowers, trumpet-shaped and glistening.
I look down and my breath hitches. Beneath my binder, I feel twin lines of fire sear across my ribcage. It’s an echo, a phantom pain, a flinch of anticipation. My body sparks and shivers in recognition.
***
At 7:30 a.m. in the third floor pre-op, I spot a thin man with a shock of bleached-blonde curls and a sparse, dark-haired beard. He sits with his back very straight, in the manner of someone who slouches and is painfully aware of it. He answers the nurse’s questions in a voice almost too soft to hear above the din of a dozen other patients in the surrounding beds. His tattooed fingers creep to the strings of his gown, plucking them apart and retying them with quick, birdlike jabs.
HE/HIM announces the patient chart.
Age: 29
Sex: Female
While the nurse does her work, I slip in through the curtains and linger like a ghost with unfinished business. I am a good medical student—I am forever holding my tongue. I never say a word more than I need to. When the nurse leaves, I tell him my name and introduce myself as the medical student rotating through plastic surgery.
“Congratulations on your top surgery,” I say. He nods politely.
Then, aghast at my own admission, I add: “Someday I think I might get it too.”
It comes out wrong, with a lilt at the end of the sentence, as if it were a question and not a statement. I have never said that before, not here in pre-op, never beneath the harsh fluorescent lights of the hospital at all, and it is as if I hardly know how to form the words on my tongue.
For the first time, his eyes flicker up to meet mine and I glimpse something shy and shining in his gaze.
“Hey,” he murmurs. “I’m glad you’re here. What are your pronouns?”
I tell him, and what I mean to say is it is alright. You can sleep. I know what it’s like to look people in the eye and never know what I’ll find there. I will not let them call you by the wrong name while you are away. I will do my best to watch over your body until you come home to claim it.
I draw breath to say something else, I’m not sure what, but we are already out of time. The resident is here, and the attending with his skin markers. He nods and sheds the chrysalis of his gown. They ask him to stand, sit, raise his arms, lower them. His chest becomes a palimpsest of red, green, and blue. I stand with my back to the wall, drawing silence around me like armor.
***
I take care with the closure. The resident works on the left side, the physician assistant and I on the right. With my right hand, I hold the needle driver between my thumb and ring finger just the way I was taught. With my left hand, I pluck at the edge of the skin with forceps so that I can drive the crescent of the needle into the paper-thin line between dermis and epidermis. It’s a running subcuticular suture. Pierce, pull, pierce, pull. I’ve done it many times before, but this time is different. I need to make it perfect. I want to make it beautiful.
Stitch by stitch, I sew the body back together. I weave into each stitch a prayer for healing, a prayer for joy. Slowly, the incision is drawn together by the dissolving suture until the wound becomes invisible. I wipe the incision with a wet cloth and examine the flat expanse of chest, smooth and unencumbered. It is almost as if the skin had never been broken, as if nothing had happened at all.
We place the drains, finish the closure, and stand by as the anesthesiology resident performs the extubation. He announces: “Alright, she’s about to wake up. What was her name?”
Someone—an attending anesthesiologist—consults the chart and suggests the deadname.
“The patient uses he/him pronouns,” I mutter.
“What?”
“I said, the patient uses he/him pronouns,” I say, louder. I give his chosen name.
I have never corrected an attending before, and my tongue is unfamiliar in my mouth. At once, a craven part of me is wishing that I had not spoken. I feel that I have careened off the brink of something vast and unforgivable. It is a familiar dread, not unlike when you give an answer to a pimp question and know, before the syllables have left your mouth, that you have gotten it wrong. Suddenly, my binder is suffocating me.
“Oh, okay,” says the resident, and he begins to call the patient’s name as they stir. I breathe out. I think of how wrenching it would be, to rise up from the dark lake of anesthesia after top surgery to the cast-off syllables of a deadname.
It happens again as we are wheeling the patient out from the OR. Someone uses his deadname— once, then twice. This time, I do not hesitate when I overhear. I tell them his name, and my voice does not waver.
*
It’s one of my last days on the plastics rotation and I’m dismissed after p.m. rounds. I’m lucky—it’s only been a twelve-hour day. The hospital is winding down for the weekend. The surgery workroom empties as the day team signs off to the night residents. For a minute, I’m tempted to drive home for a shower and a meal. Instead, my aching feet are drawn in the direction of the post-op recovery unit.
“Hey, I remember you,” he breathes. His voice is thick with pain and anesthesia. He is alone and his thin frame is shrouded by a white expanse of bed sheets. The lights in the recovery unit are dimmed, but as I pull the curtains around his bed shut again, I realize that he’s crying softly. Jewel-bright tears are slicing across his cheek and staining his pillow.
“How’s your pain?” I ask.
“Alright. I don’t feel much yet.”
“May I sit down?”
“Yeah.”
I fetch a box of tissues and a warm blanket before pulling up a chair. Then I offer my hand, which he grips in both of his own.
“What’s on your mind?”
He exhales a quivering sigh. “This is just… so much to process. I can’t get the thoughts to quiet down in my head.”
“I’m off for the day. I have nowhere else to be for a bit, if you want a little company.”
He smiles hesitantly. “Okay. That would be nice.”
At first his words come slowly, then faster. Then they pour forth in a great rush, as if they were crowding each other on the way out.
For the next hour, he opens himself to me. He speaks of his girlfriend who lives in Seattle with their two cats, his art exhibition that will open in Europe in September, and his mother who is coming to pick him up from the hospital, who is loving but does not understand. I glimpse the thread of his life, unspooling towards this moment. Behind me, the curtains hold everything else at bay.
Little by little, his breathing eases. Finally, he lets his head fall back on his pillow.
“I should let you rest. You probably won’t remember very much of this.” I say as I rise to my feet.
“You know, I didn’t expect to find someone like me,” he whispers, his eyes half-closed. “Not here, of all places. I’m glad that you were a part of my top surgery. That’s important. I want to make sure that I remember that.”
I reach out and clasp his hand tightly in mine in recognition of the unspoken covenant between us. I imagine our bodies blooming open and folding down into new shapes—better and kinder shapes. And for a moment, I wonder if I have the courage it takes to remake myself, and then the world.
Angela Tang-Tan is a third-year medical student at Keck School of Medicine of USC. She graduated from the University of California at Berkeley in 2020 with a dual degree in Neurobiology and Psychology before becoming an ambulance EMT during the COVID-19 pandemic. She plans to pursue a residency in neurosurgery. Two of Tang-Tan’s poems, “Code OB" and "Pediatric Hemicraniectomy," appeared in the Spring 2024 Intima.