I'm A Nurse Who Cares For Gender Surgery Patients. Here's Why I Love It So Much.

"It’s terribly lonely to have people know you as an incomplete or incorrect version of yourself."
Work selfie
Work selfie
Photo Courtesy of Holly Lorka

I’m an intensive care unit nurse in Austin. I work with the number one gender confirmation surgical team in the world, in a tiny hospital, in the middle of Texas. I get to tell my dad and strangers at parties, “I help make dicks and vaginas,” and that’s really fun, because my dad gets embarrassed easily. But what I should say is, “I help make people whole,” because that’s actually what my job is.

When my groggy patients open their eyes for the first time after surgery, I say, “Congratulations! Want to see?” I gently pull back the covers to reveal their new and appropriate parts and they well up with tears and then I well up with tears and we celebrate with morphine, because gender confirmation surgery hurts. As they nod back off I pat their hand and walk away, thinking, Goodnight, little bunny.

When people ask me why I became a nurse, I have to tell them, “I don’t really know.” My college was paid for by an academic scholarship, and I thought I might use it to become an artist, or a writer, or an archeologist. My parents, who desperately wanted me to have a stable job with an actual income, put me on the phone with my aunt, who was a nurse. She told me all about job security, only working three days a week, and getting to wear pajamas to work. I loved science and biology and pajamas and thought, why not?

After I graduated I was very lucky and got hired into a cardiovascular ICU, where we took care of patients after their open-heart surgery. This was a trial by fire, and I went home after my shifts for the first two years to cry and drink a lot. People were code-bluing left and right, I had to yell “CLEAR” almost every shift (yes, we do that in real life), and I gave countless units of blood. It was hard, but it was also exciting and challenging, and I dug it. I liked it so much, in fact, that I got a tattoo of an anatomical heart on my arm.

Fifteen years into my career as a CVICU nurse, I moved to Austin and took a job at this very small hospital. Three years ago, I found out the gender confirmation team was coming to where I worked. The team wanted a small place with the right culture to ensure the proper treatment of their patients, because trans folks are often discriminated against even by medical professionals, even though gender dysphoria is a valid medical diagnosis.

The team did a check of our facility, realized we were all pretty decent humans who understood that being transgender is an actual thing, and decided to set up shop. My boss called me into her office to tell me and broke out into a big smile when she said, “They’ll need to be recovered in the ICU.”

My boss knows some things about me.

I, myself, am genderqueer. I was born into the wrong body, or more likely without the proper hormones, and ended up with a vagina where my penis was supposed to be. I was a child of the ’70’s, though, so there was no discussion of tragedies like this. I thought I was a monster, I thought I’d have to kill myself ― the usual things.

I felt trapped in a body that I didn’t recognize, and that feeling just got worse with puberty. There was nothing I could do, nowhere I could go to escape, except into my dreams, in which I was the most handsome fuckboy that ever lived.

Luckily, I was blessed with an innate sense of optimism AND really dirty dreams. So, instead of killing myself, I distracted myself with intricate blowjob fantasies and learned to cope, or at least not let my despair consume me, and I made it to the present with a great acceptance and love for who I am. Now, I know I could transition, but I have grown used to who I am and choose instead to live in the middle and have great hair and confuse lots of folks at airport security.

I don’t want to make light of this situation. I am still overcome with waves of great longing for the body I didn’t get, the identity I don’t have. It never goes away. It’s just that I have found a place to put it.

For many people, this is not possible. They cannot abide the overwhelming grief and shame of living as the wrong person; it’s terribly lonely to have people know you as an incomplete or incorrect version of yourself. With the technology we now have ― that this unique surgical team has brought to this small hospital and that I can be a part of ― we can offer people the relief that most take for granted: the chance to be their authentic selves.

Holly's memoir, out in October.
Holly's memoir, out in October.
She Writes Press

So, do you see how all of this is overwhelmingly serendipitous and important to me? I’m helping these people, and in the process, healing the version of myself that thought it had to die all those years ago. I’m using my pain and struggles to relate to my patients and let them know that they’re safe, that they’ll be well taken care of, and that they are seen. I feel so lucky that I get to be the one they wake up to, and I do my best to make it a celebration each time.

Gender confirmation surgery, otherwise known as bottom surgery, is generally the last step in a person’s transition. It’s the grand finale on their very long road. So we have a good time when we can, in between the pain meds and attempting to get out of bed for the first time and the walking in the halls with new body parts. All the while I am almost constantly examining their new dicks or vaginas to make sure everything is going well. I’m a dick expert now, folks! But I’m never getting one tattooed on my arm.

In the time of COVID-19, things are quite different. Because of lower bed availability, the number of surgeries we can do is strictly limited, so those who have been on a year-long wait list are now pushed back even further. I hate this for them.

On top of this, if they are lucky enough to make it onto our schedule and have the date stick and the operation completed, no family members are allowed in as support. Take a moment to consider that ― how frightening that must be, especially if there are complications. I do my best to step up and to be the point guard for the parents, wives and husbands, but my job is busy already. Now I need a secretary to help with all the extra communication. Newsflash: Nurses don’t get secretaries.

We are all doing our best, but this is just a little extra important to me. This isn’t a knee replacement or a cellulitis patient ― these are MY people.

Now I punch into work, get report, and do genital checks with the off-going nurses, just to make sure everything looks right. If it’s a new dick, I get to do the hard work of checking circulation every hour in between asking the patient if they want me to measure it (always met with an excited YES) and coming up with a ridiculous name for it. I love naming dicks, and I’m good at it. Just ask the patients with the dicks named Bilbo Baggins, Louis Batton, or my favorite: 7 & 7, given right after I measured it. I am very professional.

Vaginas are easier to make surgically and need less time and attention, so I don’t get to name many of them. They tend to bleed, however, and we have to put these patients in mesh panties with a pad; you’ve never seen someone so excited to wear a pad.

My job is absurd and amazing, but it can be very difficult if there is a complication. Hands down the hardest part is watching someone who has just had the biggest and most important surgery of their life suffer a serious complication. It seems really unfair that such a thing could happen after someone waits their entire life to that point to be corrected, and it breaks my heart. Even more than the code blues used to.

But when things go well, as they usually do, it’s the best feeling to discharge these patients ― to release them out into the world as their true selves with their new and improved parts.

When it’s time for them to go home, I’m always so happy to help them get dressed. Not because I’ve been staring at their genitals for days, but because it suddenly turns them into not just patients, but people who exist in their lives away from me. People who have struggled and have been brave enough to face a seemingly insurmountable problem and do something big to fix it.

I’m humbled by these people and their courage to become whole, and I get excited to see what they put on their new bodies. The guys inevitably pull out shiny gym shorts. My God, what is it with the shiny gym shorts?

The women, however, pull out all sorts of pretty things: summer dresses, cute slippers, and ALWAYS some great sunglasses ― which I let them wear in the hospital without giving them shit ― because they are newly on parade, and they’ve earned it. They’ve earned all of it.

Holly Lorka is a writer, storyteller, ICU nurse, and retired standup comedian. Her memoir, Handsome, will be released in October.

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