A Different Plane of Existence

By Karen Page

(revised January 2005)
Edited by Angel O'Hare

Part Two

About an hour into the operation the theatre telephone rang. "Theatre Four," answered Anna Jones the theatre administrator, "Dr Millard and Dr Fielding are operating."

"This is Dr Adams from East Sussex hospital in Redhill. Please relay a message to Dr Fielding that we are loosing Helen Turner. I believe he is assisting on Simon Turner. Helen is Simon's mother. She has a donor card and I wonder if Simon needs any transplants as they appear to have almost identical tissue matches"

"Dr Fielding, Dr Adams is on the phone saying that Simon's mother, Helen, is about to die. She is a donor and an apparent tissue match to Simon. Dr Adams is giving first refusal on any needed organs."

"Is Dr Adams a qualified harvester?" Dr Millard asked Dr Fielding.

"Yes but we don't need anything do we?"

"Since they have almost identical tissue we could try and help Simon regain the ability to have children. We could harvest Helens complete womb and ovaries and attempt to transplant into Simon. We have attempted this once before but the tissue match wasn't close enough and she suffered rejection."

"How much tissue is required? I take it isn't just the organ but some of the surrounding tissue."

"Correct. Would you mind if my assistant Dr Barbara Smith assists. She was involved on the previous attempt and is aware of what is required to be removed."

"Anna, please tell Dr Adams that we do require a transplant and that he will have a specialist with him shortly," instructed the doctor.

While they awaited the harvested organ the two doctors continued the delicate operation. Blood vessels were diverted and eventually the remains of his penis was removed. Next Simon's prostate was removed as its function would no longer be required.

"Normally the penis isn't removed like this as we invert the skin to create the vagina wall. Since the organ will contain this tissue we will not need to do this. Actually this will have the added affect of not having to retrain the tissue so Simon won't have the inconvenience of dilation."

When the organs arrived they opened the bottom half of Simon's torso rather like a caesarean section. They placed them in the body and began the mammoth task of wiring them up. More blood vessels were moved and added. With the work finished Simon was closed. The external work was relatively simple as most of the external facet was also part of the transplant. Simon would indeed be able to enjoy sex as well as a female.

Eight hours later the operation was complete and as Simon was wheeled into the recovery room the pressure and adrenaline that had kept the team going faded. By the time they had removed their gowns there wasn't much anybody wanted to do but sleep. Dr Millard's secretary was her usual efficient self and had organised taxi's to take everyone home. Driving in this level of exhaustion would be very dangerous.

In the recovery room Sam Ivory took over as the on duty anaesthetist. Simon was brought out of the anaesthetic and as he came round was given a sedative to keep him asleep for another twelve hours. Sam knew that the doctor would want to be available when he came round.

***

Tom Millard was in his office writing an article for the journal Nature. It was ten hours since the end of the operation. The doctor was already known as one of the best surgeons for transsexuals. However, he hoped that this transplant would make him as famous as Christian Barnard. His thoughts were interrupted by a sharp knock on the door.

"Enter," barked Tom putting his fountain pen down and putting his first draft onto the side. In the room entered a young lady who looked no more than thirty.

"Dr Rachel Ruiz. I believe you spoke to my boss about a paediatric psychiatrist assisting in a difficult case?"

"Thank you for coming. Please shut the door and take a seat. The case is subject to a judicial gagging order to help protect the child. What you hear about the case mustn't be discussed without authority especially not with the press."

"I never discuss cases," replied Rachel in a hurt tone. "It isn't ethical and I resent you questioning my professionalism."

"Sorry that I didn't phrase it very well. I'm obliged by the injunction to reiterate the confidentiality."

"Apology accepted. Now can you explain why you need a paediatric psychiatrist in a ward for transsexuals? Wouldn't it be best to get an expert from the Portman Clinic at St Georges?"

"Their psychiatric department has nobody free for a cross site visit and this case may require more intensive intervention which I am told you are better qualified for. Did you see the details of the incident at Gatwick yesterday?"

"Yes. Does this case involve that child who was trapped in the rubble and whose parents died?"

"Yes. There was a metal building strut that had pierced destroyed his genitals and functionality of the penis. Since his legal guardians where unavailable the judge, under advisement of the Official Solicitor, opted for SRS. Simon was advised before being anesthetised that SRS was a possibility. Since he wasn't a transsexual the surgery is probably going to cause him intense psychological issues."

Rachel thought for a moment and said "I'm also concerned about potential suicide. Leaving aside the SRS he has just lost both his parents. Is there any other family?"

"Not that anybody has been able to trace. Social Services are already trying to get involved but are being obstructed by the judge till you have judged his mental state."

"Social services will need to be involved but I agree that at this time they would just complicate an already dire situation. Back to the surgery; has any other cosmetic surgery been performed such as breast augmentation?"

"Other surgery will need to be decided when Simon understands what we have done to him and what options he has. He is still sedated and will be asleep for about another couple of hours."

"Okay. I've another patient to visit so can you page me when he is awake?"

As Tom Millard nodded Rachel handed him her card and got up to leave when there was a knock on the door.

"Enter."

A nurse, who was wearing a ward sister's uniform, entered the room.

"Sorry to disturb you but you wanted a report every two hours on your special patient. Pulse and other vital signs are still stable."

"Thank you Sally. Sally Archer this is Dr Ruiz. She will be helping with Simon when he wakes up."

"Hi Rachel," said Sally. "Dr Ruiz and I share a flat so we already know each other."

"Excellent," responded Tom Millard. "Well this should help with you both being involved with Simon."

Rachel and Sally left while Tom thought about the boy for a moment and then continued his article for Nature.

***

Around four Simon started to wake up. The on duty staff that had been monitoring him during his sleep was aware that he was the boy from the terrible accident and that he wasn't aware of his true fate. Being a ward for post operative male to female transsexuals it was very unusual to have a person with a male name. The nurses had put together an internal sweepstake for which girls name he would choose. Fifty pounds went to the winner. The nurses were not aware of the transplant as the doctors didn't want the news to leak, especially as there was supposed to be a press ban on the boy.

As Sally Archer was walking past the private sideroom that Simon was occupying she heard a faint groan. She entered the room and saw his open eyes.

"Hi Simon, I'm Sally Archer," introduced they 28 year old nurse. "I'm the nursing sister on the ward where you will be staying while you recover."

"I feel thirsty. Can I have something to drink?"

"Of course," she relied. "Just lie there for a moment while I get you a drink. I'll also get Dr Millard who operated on you last night. He has asked that I call him when you awaken."

A few minutes later Dr Tom Millard walked into the room with the nurse and another lady.

"Hello again Simon. I take it you find the bed more comfortable than the floor of a collapsed building?"

Simon nodded.

"Okay. Sally is going to help you sit up and we will discuss what happened since Trevor put you to sleep. After that I will need to examine you. I know that sitting up is going to hurt but it is important that you do."

Simon winced as he was helped into a slightly sloped sitting position. Two nice plump pillows kept his back comfortable from the metal backrest. Once in a sitting position Sally left the room and closed the door behind her.

"I have several items to discuss with you. It is important for you to understand what I say so please don't hesitate to ask as we go along."

Simon nodded and before the doctor could start he asked, "Before you start I have not been introduced to the lady who came in with you."

"Sorry. This is Dr Rachel Ruiz. She is a hospital psychiatrist and is here to make sure that I don't overwhelm you with information. She is also here to be somebody that you can talk confidentially to. As long as what you discuss is legal or does not involve imminent danger to you or anybody else then she will not tell anybody."

"This must be bad," thought Simon to himself. "I've got my own shrink and the doctor is talking about me being an imminent danger to myself? Why would I think about suicide? It must be bad."

The doctor explained how they had removed him from the metal strut and taken him to Charing Cross hospital and they had operated. "While we operated we discovered that we couldn't save your penis. You already knew that your genitals were destroyed. Therefore there was a choice to be made. To either leave you with no method of sexual pleasure or perform a sex change and give you the opportunity of future fulfilment."

"What about creating a replacement penis so I could still have sex as a man?"

"Artificially created penis are not able to give you much pleasure and compared to what you had would leave you feeling deprived. It would be a constant reminder to you of what you had lost. Also without the genitals you would not be able to create sperm to make a baby."

"But I can't create a baby now anyway," said Simon sounding rather upset.

"What I am about to tell you isn't known to Rachel but we performed a special sex change on you. This had only been attempted once before and had failed. We won't know for a few more days if this attempt will work but we have high hopes. I will explain the details in a moment but let me just say that you could have a baby."

Simon who had been looking towards Rachel saw a look of shock on her face. It was obvious that this wasn't something she had been forewarned of.

"I need to tell you more information first. As you are aware your mother, Helen, was taken to surgery when she was rescued. However while we were operating on you she died due her injuries being so severe. Since she was a donor card holder her organs could be used to help people with identical or nearly identical tissue type. You were compatible to her and her reproductive system was transplanted into you."

Simon was too shocked to cry or even feel the pain. "What about my father. Has he been rescued yet?"

"I'm sorry but you fathers body was discovered during the night. He was dead."

Simon couldn't believe what he had heard. Both his parents were dead and his body had been mutilated. "Can you both leave me alone," he asked his voice bitter with resentment.

Rachel signalled to Dr Millard to leave. "I'll need to check you over later to confirm that you are healing nicely," stated the doctor as he left the room.

"You seem quite upset," opened Rachel. "This must have been a big shock."

"Upset!" spat Simon, his eyes flashing with passion. "That doesn't begin to even start describing my feelings. I need to think about how this affects me and I can't do that unless I am alone. I asked you BOTH to leave so close the door as you exit."

Simon turned his head away from the psychiatrist adding an extra signal that he was terminating the discussion. This was all too much to take in. How could his mother be dead? Weren't they discussing his childhood less than a day ago?

Sensing that she wasn't going to get Simon to talk about his feelings Rachel walked round the bed and placed a small plastic box with a button onto the bedside table. "This isn't a doorbell", she quipped, "but this will page me if you feel the need to speak with me. It works twenty-four hours a day, seven days a week. Just press the button and I will be with you as quick as I can. I will have a nurse put an inbound telephone into the room so if it is going to take me more that fifteen minutes to get to you I will be able to telephone you to let you know."

With that Rachel left the room and headed into a small observation room next door. Inside Sally was monitoring the situation through the one way mirror. "He's not taking it very well, is he?" Sally asked.

"No." responded Rachel. "He appears to be quite intelligent for his age. I recommend you are very truthful with him as he will eventually spot any lies and that will not help build the trust which we need to help him overcome any fears. I'll watch him for a while and go back in and see him soon. I hope he will open up to me soon."

"We had another medically induced SRS operation about two years ago. He lost his penis and genitals in a shooting. He committed suicide a few weeks later. His wife had refused to see him and decided it would not be good for the children to have a freak as a father. We installed the observation mirror and CCTV system into this room after that occurred. There will always be somebody at the desk watching for signs of suicide."

"Tonight is going to probably be the worst night as he has just lost his parents and his genitals. Unless he talks about it today I would not be surprised if he makes an attempt tonight. For that reason I will sleep on the couch in my office so I can be here as quick as possible."

They watched as Simon stayed in the same propped up position that he was left in. His stony face failed to indicate to the observers what he was thinking about or his emotional state. Eventually Simon did move but only to retrieve his watch from the bedside cabinet. The effort needed was tremendous as any movement in his body caused excruciating pain. The watch was left to him when Simon's grandfather had died and he only wore it for special occasions. It looked undamaged and was still ticking. Since it needed to be wound daily one of the nurses must have been in while he was asleep. This watch was Simon's link to his family. When his grandfather had died the family were just him and his parents. Now he was the last surviving member. Simon didn't need the watch to tell the time as there was a clock on the wall. No he needed the watch as a link, a remembrance, to those that he had lost. Simon just sat there staring at nothing, holding the watch reverently in his hands.

An hour later, Simon had started to calm down. He knew that the doctors weren't the cause of him being trapped in the building but they were an easy target to lash out at. He however still held resentment at the fact the doctors weren't able to save his manhood.

The door opened and Dr Millard entered the room with Sally. "Hello Simon. Is it okay with you if I check your wounds and see how they are healing?"

Simon nodded and the doctor said. "I'm going to help Sally manoeuvre you back into a lying position. Then we will need to bend you legs at your knees with your legs spread apart. That way we will be able to check you out."

Simon was manhandled and was soon lying down. The pain from the move was less this time but it still was painful. The doctor lifted the gown and removed the bandages which were promptly put into a yellow medical waste sack. Sally pulled down the inspection light and turned it on so the doctor would have a clearer view during inspection.

"Ah, thank you Sally." The doctor continued to inspect for another few minutes carefully inspecting the stitches and the catheter. "Things are still quite sore so I won't perform a more detailed inspection today. Hopefully by late tomorrow morning things will be healed enough to perform a more tactile inspection."

Sally handed Tom some padding and some bandage. The doctor deftly applied them to the groin and fastened with tape. After he had finished Sally switched off the inspection light and pushed it towards the ceiling.

The doctor then lifted up the gown a bit further and started to look at the abdomen. "Well you seem to be healing well here. You should be able to start sitting up a bit more now. However no walking till I have removed your catheter. Do you have any questions before I continue my rounds?"

Simon thought for a moment contemplating if to ask for confirmation in what he had concluded in his earlier musings. His eyes narrowed as he decided that now was as good a time as another. "Yes doctor I do have one. Since I now have a fully functional female reproductive organ I presume I will be naturally producing female hormones. Is that correct?"

"We assume that it is fully functional. This is a first and we will have to wait to see if it functions correctly. However you are correct you will now be producing female hormones."

"So with no testis to produce male hormones and a body full of female hormones I will start to grow breasts?"

"Correct."

"So my options are reduced even further?" Simon spat out his eyes flashing again as his anger swelled within.

"Sorry I don't understand."

"According to you my testis and penis were destroyed or damaged beyond repair so you were going to give me a female looking groin. If that was the case my hormones would have to be self administered and I would still have had the choice of living as a male or female. However, since you kindly gave me my mother's womb I now naturally produce enough female hormones not to have a choice. I will have to live as a girl."

"How you decide to live is up to you," said Dr Millard gently, trying to placate Simon's anger, "If you feel strongly enough then medical intervention can occur. I only perform male to female operations but I can get a colleague of mine to talk to you if that is what you desire. However we need to make sure that you are fully healed first. I think it would be best for you to talk with Dr Ruiz tomorrow about your thoughts and emotions and see where that leads us."

Simon nodded his head in acquiescence and the doctor with Sally trailing behind left him to his thoughts.

Simon noticed that it the time was approaching seven so he painfully reached across and grabbed the television remote control. He turned it on expecting to only have four or five of the terrestrial channels but to his surprise there was also a limited selection of satellite channels to choose from. He decided against VH1 and selected BBC News 24 hoping to find more information regarding the crash.

Simon watched expressionless at a report on the current Iraqi crisis; more soldiers and civilians killed and an instigation of marshal law. However what followed was more interesting.

"Yesterday's incident at Gatwick airport, where three people were killed and ten people were injured; three seriously, continues to cause chaos in the area. Some flights are expected to resume from the south terminal tomorrow now that the Health and Safety Executive have completed their onsite investigation. Investigators from the Department of Transport are expected to give a news conference in about thirty minutes with preliminary conclusions to the cause of the crash."

"Removal of the destroyed terminal building started about an hour ago and the bulldozers will be working through the night clear the site. The airplane was towed to a remote hanger where a full structural inspection has started. Early indications are that the plane has suffered too much damage and specialist will be brought in to break up the plane."

Simon tuned out the rest of the news. He had a thirst for knowledge about the cause of the plane crash.

He tried to sit up a bit straighter but found the pain emanating from his lower abdomen still quite uncomfortable. Not wanting to be beaten Simon gritted his teeth and tried again. This time he moved his pillows that propped him up and was able to succeed. Wondering why his pain was in the abdomen and not in his groin he lifted his hospital issue gown and noticed his groin was well bandaged. Emanating from the groin was a small tube attached to a bag; must be a catheter. As he lifted the gown higher he saw the stitches from his operation.

Simon lowered the gown as he noticed that they had switched to the imminent Department of Transport press conference. The picture showed a room full of journalists with an empty top table. The news presenter continued to drone on about the incident and the impact it had on flights out of Gatwick. As she continued five people trooped into the room and took their positions. The middle person started to speak and the camera slowly zoomed in towards him. However the presenter didn't switch the sound feed.

In his frustration Simon shouted at the screen, "Turn on the voice feed."

Unfortunately Simon's vocal outburst didn't reach the presenter and it was another twenty seconds before the voice feed was switched.

"The two flight recorders were recovered from the site and investigations in conjunction with the airplanes manufactures have shown-"

Then there was silence and the picture froze for a few seconds before going back to the presenter. "I'm sorry but we seem to have experienced a problem with the feed from the press conference. We will endeavour to re-establish the feed but in the meantime we will continue with other news."

Simon picked up televisions remote control and turned the television off. Why did the hospital only have one twenty-four hour news channel? Why didn't they have Sky News or CNN? All the frustration was too much and he hurled the remote control across the room.

For the first time since the accident his façade of emotional stability slipped and he felt his eyes sting with salty moisture. His thoughts went back to the last time he cried when he found himself trapped under the rubble and his later conversations, still while trapped, with his mother. His mother's voice wouldn't be there to comfort him anymore. The moisture in his eyes grew and turned into a steady trickle down his stubbly face.

***

Sally was just finishing her handover to the night sister, Jasmine, when she saw Simon throw something across the room. As she watched she saw him struggle against his emotions and fail.

"Oh hell," she muttered and as she rushed towards Simon's room. "Jasmine, call Dr Ruiz on speed dial 13912 and get her down here immediately."

When Sally entered she rushed over and made sure that Simon hadn't done anything foolish. On seeing that he was physically well she sat next to him and took his hands in hers. Not saying anything she just let him know that there was somebody there if he wanted to talk. It also was a restraint if he wanted to harm himself.

In five minutes Dr Ruiz walked into the room and sat slightly in front of Simon who was beginning to calm down. The sobbing caused by built up anguish and repressed emotions settled into a steady but gentle tickle of tears. Rachel looked around and saw the remote control lying by the far wall with the two batteries close by.

"Do you want to talk about it?" asked Rachel.

Simon nodded. "Do you want Sally to stay or would you rather talk privately?"

As if she was a magician Sally produced a box of tissues and Simon extracted one. He cleared his face, wiping the streaming mucus which was threatening to enter his mouth. Sally purposefully placed them within his reach; he would need them later.

"If she doesn't mind staying then I think it would be nice. She's been a comfort to me."

Sally who was still holding Simons hands released one and poured him some water into his plastic cup. Simon gratefully took it and took some sips.

"What upset you?" opened Rachel.

"I was watching the news. I was trying to find out what they were saying about me and my parents. Also if there was any update on the cause of the accident."

"And why did the news report cause you to throw the remote control?"

"There was a live press conference on the planes failure to stop. They were going to reveal the cause and they lost the feed. I waited half an hour for the conference and I still don't know the cause."

"That upset you?"

"I cried a bit and that brought back some memories from yesterday."

"Tell me about yesterday."

Simon looked at her in surprise and blinked his eyes as a solitary tear ran down his cheek. He took a deep breath as he attempted to regain his composure and get some control of his emotions. After another sip of water Simon answered in a flat unemotional voice, "A plane failed to stop, crashed into the terminal building causing it to crash. My parents died and I was mutilated."

Sally flinched at Simon's description of being mutilated.

"Don't you think that mutilated is rather a strong term?"

"No. My manhood was removed. It was mutilation."

"I thought Dr Millard explained that your penis and genitalia were beyond repair."

"I bet that Dr Millard couldn't wait to attempt to perform the world's first sex organ transplant," Simon spat out, his anger starting to rise again. "It was probably very risky to attempt the transplant."

"Dr Millard had already assessed that your own organs were irreparable before he got word of your mother's death. Your mother's death didn't cause him to decide on the SRS route. The risk was negligible. A thirty-two year old woman whom was going to receive chemotherapy had some ovarian tissue removed and frozen. After she was given the all clear she had the tissue transplanted back. It was announced a few months ago at the European Fertility Conference in Berlin that she is now pregnant."

"So I'm not the first?" said Simon starting to calm down again as he began to doubt his previous assessment of Dr Millard.

"You are the first to receive a complete reproductive organ transplant. The lady who is being treated in Brussels only had part of her ovary frozen. Also she was getting her own tissue. What was implanted into you originated from your mother."

"But I know Mum and Dad were trying for a baby. What if Mum was pregnant?"

"That isn't possible," said Rachel. "When they transplant an organ they clean it to remove any old blood. The doctors don't want any possibility of infection. There is no chance that you're pregnant."

Rachel saw that Simon was still in shock and bewildered with the sudden change in his life. Acceptance and being able to move on was still a long way off but at the moment he didn't appear to be suicidal.

Rachel glanced at her watch and saw it was nearly nine. She walked over to the remote and placed the batteries back in. With a quick flick she turned on the news channel. They were showing the weather for tomorrow.

"They will have the headlines at nine and they will probably show the summary of the press conference."

"Thank you." Simon might have been a superb sportsman and relatively man's man but his parents had instilled a good set of skills. Politeness was just one of them.

A few minutes later, "The headlines at nine. Preliminary findings show that mobile phone interference caused a corruption of the onboard computer communication system leading to a systemic failure of the onboard computer. Without the computer, which controls all aspects of the fly-by-wire system the pilot lost the ability to break. Other onboard systems were seriously impacted and emergency steering systems were one of the only controls that worked."

Sally had been watching the news with Simon. Rachel however had moved to one side and was quietly observing Simon's reaction. As soon as he heard the results Rachel saw Simon let go of his grip on Sally's hands. His brow, which had been tense, relaxed.
"I think we should call it a night," said Rachel turning off the television.

Simon nodded as Sally lowered the back rest so he could lie-down. As Simon settled for the night Sally and Rachel left the room leaving him under the careful watch of Jasmine.