I know some Doctors feel that it really sucks to work Christmas. I have to admit I rather enjoy it. It’s the 4th Christmas I’ve worked since qualifying. The first year I was sumernumary in psychiatry at Christmas and didn’t have enough expertise to locum.

The second Christmas was Obs and Gyne – several babies called Noel and Mary were born that day.

The third fourth and fifth Christmas’s have been in Medicine, I think I’ve got the hang of it by now.

• There is an almost endless supply of food. The nursing staff tend to only do one of the unpopular shifts on Christmas Eve, day or Boxing day. For that shift they will often bring in bits and bobs of buffet often left over from Christmas at home. But if you are working a 12 hour shift covering say 4 wards, that’s 3 shifts of nurses on each ward, which means a selection of a total of 12 buffets. I am sensitive to the fact that they intended the buffets to be for the nursing not the medical staff. But the medical staff are so thin on the ground that when they finally get a doctor they are usually happy to offer them a chocolate, or mince pie, or pringles, or nuts. By the end of 3 days on call over Christmas I was yearning for food that was only 1 step away from a plant. The closest I got was guacamole dip. You do not need a break to eat. Though it is tempting to take a break to stop eating for half an hour.
• Everyone is in a better mood than normal Christmas isn’t a time for turf wars over whether or not a patient with a fractured pubic ramus is ‘medical’ or ‘orthopaedic’.  It’s not the time for power struggles with nurses or bed managers. We all work together a bit better.
• Never break bad news with tinsel in your hair. A good moto for life in general, particularly practical at this time of year.
• On the subject of bad news - it’s even more depressing at this time of year. There’s something so depressing about deaths at Christmas, or at Christmas Eve, when there is a pile of unopened presents by the bed. By 7pm things were so bad I had to eat 6 mince pies.  I wonder whether it’s better to keep people alive for a few hours until after midnight, thus not ruining the remaining Christmas’s of their surviving relatives. I now know that six mince pies is not a cure for depression.
• The whole business is less stressful than a family Christmas. Christmas’s are stressful times of year. The pressure to get the turkey cooked correctly, what on earth to do with the vegetarian. The pressure to have a nice day and avoid rants. I actually found being a med reg far less stressful. When you do finally go home for a few hours everyone is so pleased to see you they stop arguing with each other.
• Pray for the people you discharge. At Midnight mass, whilst experiencing my annual dose of Christianity we prayed for the people who were in hospital. Of course what we should really do is pray for the people we send home. Those that really need a bit more bed rest to get back on their feet are particularly prone to deciding to go home.

One of the questions I’m often asked is ‘why not be a lesbian?’ After all my life wouldn’t be that different if I was a lesbian.

Being a man, or a woman isn’t really about ‘doing things‘ .

When I was a woman I felt wrong, I felt like I was pretending to be something I wasn’t. I was one of those rather pathetic people that lurched from depressive episode to depressive episode.

Being a man or a woman is about ‘being’ something.

Perhaps in the same way I would ‘be’ a doctor even if I wasn’t working as one. When I was a teenager I kept thinking things would be okay ‘if’. If I got a girlfriend, If I got into medical school, then I would feel that life would be worth living. But it wasn’t.

Ironically I felt like I was pretending to be something I wasn’t. Now people would say I am pretending to be something I wasn’t.

My wife and I wrote our Christmas cards last night, we haven’t posted them yet, but writing is a start. This is a marathon excercise, most of my friends are in their 20s so are moving around fairly regularly. So first one has to send facebook messages, e mails and texts to establish what peoples addresses are.

Then there’s the question of ‘do they celebrate Christmas’. Many of my friends have only recently moved to the UK, often from India or Pakistan. Do they want to be included or not? I’m an atheist anyway – so I always send very secular cards, but it’s still a Christian festival. Actually it’s a pagan festival – but we should move on.

Then one has to establish what ones current title is. In a social circle where nearly everyone is a doctor you cannot assume that their husband or wife will be Mr or Mrs. The chances are they will also be Dr.

Those of us who were hoping to be surgeons may have passed their MRCS exam which changes their title back to ‘Mr or Miss/Mrs/Ms’. Established which title female surgeons wish to be known is another challenge. But how does one establish whether one has passed an exam or not?

We seem to have negotiated it all ok though. Hopefully they’ll be in the post sometime next week.

I’m filling in an application form for a PhD, it’s all very PC. In fact when I am asked my gender I am given 5 options

1. Male
2. Female.
3. Transgendered Male
4. Transgendered Female
5. I would rather not disclose my gender

Now I have no intention at all of disclosing my trans status to my employers, so I am of course

It’s good that employers record whether their employees belong to minority groups.

But why on earth would you disclose this when you apply?

I was listening to Jan Morris on the Radio4’s Excess Baggage the other day. Actually I was listening to the podcast of Excess Baggage. I am a child of web 2.0 you know. Well a teenager really.

Anyway, as I said I was listening to this podcast on my iPodlet. And I was struck my two things, once is how very cool it is for Jan Morris to be able to talk on the radio and not be referred to as ‘Jan, formerly James’ Morris. The first 20 or so times I saw Jan  Morris on TV she was referred to as Jan, formerly James Morris. The think I love about Jan Morris is that there is so much more to her writing than being a transsexual, and I find her descriptions haunting and evocative. I love reading them.

The other thing I noticed about Jan Morris on the Radio was that her disembodied voice did sound, er, male. Even however many years post transition. Now I am aware that my voice sounds female because occasionally people assume that I’m female on the phone.

In person very few people assume that I’m trans, because I look male the voice goes almost unnoticed. Though I do wonder if my secretary notices. She hears my disembodied voice every time I do a tape of letters from clinic. I have tried to avoid it. I can type nearly as fast as she can, so it seems silly to have to dictate letters. But I can’t print the letters of and file them in the right places, so I give in and dictate them.

But I can’t help wondering if my voice gives me away. Maybe she knows. Maybe the girls in the typing pool know. Maybe I should just insist on doing my own typing. It’s ridiculous to dictate when I can type at 70wpm. Though I don’t have a login for the automatic send a letter to GPs system the secretaries use.

I was chatting to my boss about my plans to do a PhD, what topic I should think of doing, and how to find a supervisor. Then our colleague joined us and we talked about the new Radiologist that had just been appointed, and who was likely to apply for the vacant job, or perhaps poisoned chalice, of Medical Director.

Except we don’t have a water cooler. We were talking over a tin of Quality Street chocolates, whilst Doris wandered up and down behind us asking what day it was again and again. Every so often we stopped and told her it was Thursday. In the background Rose kept saying ‘Help me’ we went to her and asked what help she wanted, but she couldn’t remember. So we went back to who fancied being Medical Director, and five minutes later Rose was asking us to help her, and Doris wanted to know what day it was again.

Donated by  grateful relatives. Quality Street and Roses are a constant feature on most wards. You should really worry about wards where there is no Quality Street. Forget Audits and Nursing Quality Indicators, the amount of chocolates is the real indicator of the Nursing Care. The very good wards get Thornton’s Chocolates.

A few weeks ago I met my wife at her office. It was very strange. There was no faint smell of urine. There were no demented people wandering up and down. And there were no Quality Street. It was all so false.

I couldn’t work anywhere without Doris and Rose and the faint smell of urine. Though sometimes it takes quite a lot of willpower to resist the Quality Street.

I’m starting to feel that transitioning at 19 makes me a positively late developer. I knew I was transsexual when I was 7, but I’m damn glad I waited those 12 years before I actually transitioned. I’m seeing more and more parents encouraging their children to transition.

It took a whole lot of working out to decide if I was ok with being a lesbian, or if I actually wanted to be a man. I really had to give being a lesbian a go.

Lets just say you are a girl who knows deep down that you want to have sex with girls rather than boys. Most of the people you meet who have sex with girls are boys, so you want to be a boy.

So you really have to meet other lesbians before you decide that you want to be a boy. Try lesbian sex.See if you like it. (There isn’t really any heterosexual biological man who wouldn’t give lesbian sex a go if he could)

Or at least that’s my opinion. Sorting out gender and sexuality is a really important thing to do. Can you be a butch  lesbian, or a camp man. Is that somewhere you’re comfortable being?

I’m not a psychiatrist, so I hope the child psychiatrists that treat transsexual children by letting them transition do know what they are doing. I just worry that they’re being pushed into transitioning without exploring all the alternatives. I know lots of children who start off thinking them are gender dysphoric end up being comfortable with being gay men or lesbians. Lots also end up being transsexual or transgender.

Here’s a link to the sort of thing I’m talking about:

http://www.channel4.com/programmes/bodyshock/episode-guide/series-18/episode-1

My wife and I have decided for a variety of reasons not to have children.

She doesn’t want them and I can’t have them.

In the early days of our relationship we thought it would be a short-term thing and I was only 23, so it just wasn’t an immediate issue. Then it got to crunch time. If I wanted to have a family I was going to have to find another girl. And lets face it men just don’t do that do they? Split up with women because they want children?

Eventually I realised that I loved her more than I wanted to have children – this discussion ended up with us getting married. I still occasionally have a twinge of pain when I see children and realise they’re not going to be part of my life. But by and large it goes away. Sometimes I think of getting more involved with activities for children or being a godlessparent. Sometimes I think of just doing all the things in life that are so much easier without children.

Sometimes I wonder if this feeling is a part of the female me that needs to be thrown in the incineratore like the rest of the bits. I don’t know if men who want children feel this ache just here.

Of course I know what the standard transsexual response is:

The desire for children is neither a male or female one, it’s a human one

There isn’t any doubt that men and women have a different experience of child rearing. There aren’t many women that find that they have a child that they knew nothing about years after a night of passion. Ultimately men impregnate women, who then carry the child for 9 months then give birth. That’s a key  part of the experience of being a biological man or woman. Part of the reason that women in their 30s are very keen to have children is that women have a limited time to do it in, and men have longer.

Of course you can have biological children yourself – before you change sex. Or you can store eggs/sperm in some way. Or you can hope you remain fertile. And we can see the pregnant man fiasco. I admire them for taking the steps that they did.

When I was 19 I decided for certain that I would never have my own biological children. I thought it would be easy enough to raise children – but just not mine. I hated the female parts of my body, and if I grew a children in those female parts I couldn’t be sure I wouldn’t hate the child as well. So I didn’t even have a second thought when I had a hysterectomy. I briefly flirted with the idea of donating eggs to an infertile couple. But I would want to meet the offspring one day and it didn’t seem fair that they would have to find out that their mother was now a man.

I assumed that I would go out with a woman who would either already have children or want them. If they already  had children I would be a step parent, if they wanted them then we would have fertility treatment. If it was down to me I would rather foster or adopt then at least they would be related to neither of us so we would have an ‘equal’ relationship with said children. I suspect that the step parent, or at least the male one anyway, never gets much of a say over the big decisions in child rearing.

At times we have discussed if I could consider being a single parent – not sure how I’d get the child, but I don’t want to be a housewife. I also don’t want to compromise my career.

Then there would be the question of finding a woman to have children with. It’s difficult enough finding a girlfriend when you’re FtM, let alone one who wants children but is ok not going out with a biological man. There are plenty of biological men around, so you’d think if she wanted children she could find one to do the honours.

Can you see the problem here?

So mostly yes, I’m ok with not having children. I’m glad I’ll never have to deal with the whole ‘Daddy used to be a girl’ discussion, I’m glad I’ll never have to deal with ‘You’re not my real parents anyway’.  The whole ‘having small babies and turning them into adults’ seems like an interesting project though. That’s why I have a godlessson, and hopefully some neplings if my brother and his fiancée could just oblige us.

But there’s no point kidding myself that what I’m feeling is what a biological man would feel. It is a totally different experience. It’s bound to be.

A biological male is only going to find out about infertility when his wife or girlfriend wants to have children, and they find that they can’t.

The other difference is that we have to either ‘try’ or ‘not try’ there is no middle ground no, ‘well lets see what happens, a nd let nature take its course’. If we want children we have to find them somehow. If we don’t want children we aren’t going to accidently get them.

I suspect what I feel is  a mixture of what a woman would feel about infertility and what a man would feel who would like children, but whose wife would not. It’s another unique transsexual experience.

But I have no regrets – I am married to the best woman in the world, so the fact that we can’t have children is just a tiny compromise. If I’d wanted them that much I could have done something about it when I had the equipment myself.

Tonight I discovered Lamebook - think Regretsy for facebook. Oh? you haven’t discovered regretsy? Oh dear. It would have been such a productive evening if only you’d not checked my blog post.

Lamebook is a website of a screen captures of face book, think Chealsee (14) annoucing she has genital warts, Kasha showing you pictures of her home waterbirth with little Kelsy watching. It’s great. And it’s finally taught me that teenagers are a different species.

I can’t spell very well, but compared to some kids today I am a master of the art. Also I seem to have got the hang of using capital letters. One at the begining of the sentances, and also for abreviations and the word ‘I’. I have a vauge grasp of ‘you’re’ and ‘your’. Though I sometimes get those two mixed up.  I have never felt the need to TyPe CaPiTaLs and LoWeR CaSe LeTtErS alternately. Neither have I felt the need to use L33t speak, I can’t get Leet speak.

I have, for my sins, found the slim notepad I kept a diary in when I was 18 years old. The time when I lost my virginity, got into medical school. Shamefully it was written in long hand, using a pen – yes a pen. The handwritting was neater than my current handwritting, I’d even underlined the important bits using a ruler. I’m amazed at how much of my life was defined during the time I kept that diary. During that time I had sex for the first time (with a woman, I never did the man thing), and got a place at medical school. If I hadn’t got into medical school I’m not sure where I’d be now. I wouldn’t be me anyway. Yes, it is pathetic to be defined by your job, thank you for telling me.

Anyway yes, Teenagers. I have no idea why I have suddenly taken an interest in teenagers. I see teenagers in 2 circumstances.

1. Overdose. Of paracetamol usually. Stupid thing to overdose on.

2. Diabetic keto acidosis. Occassionally they aren’t known to be diabetic. Often they are and have simply not taken any insulin. Or got drunk, or got a STI. Or all three.

Sometimes I also see teenage relatives of older people. These teenagers are usually quitely crying in the corner.

Being a teenager is shite. Your emotions take you over. Your problems are the most important thing in the world. You get dumped you can’t imagine living and want to kill yourself. You have a row with your friend, you can’t go on and wnat to kill yourself. Obviously if the only teenagers you meet are the ones that are admitted when you are on call you imagine that teenagers spend their time flitting from paracetamol overdose to paracetamol overdose. With only a few days in between.

Until recently I had thought of myself as virtually a teenager.  But the last teenager diabetic I saw was a completely alien creature to me. I just couldn’t comprehend why she wouldn’t let me get a line in to treat her entirely self inflicted DKA. That entirely self inflicted DKA that would kill her if I didn’t get a line in and actually treat it.

The other day one of my school friends contacted me on Facebook and asked why I choose to change sex. I think I muttered the usual cliche about being ‘trapped in the wrong body’ or something. But as far as I can see the real question is ‘Why on earth are you still a woman?’

Because life as a woman was seriously weird. 

Things that were rubbish about being a woman.

1. Make up.  I tend to cultivate stubble when I’m not at work, but it gets hopelessly itchy after a week. Anyway if you think shaving is bad, try having to slather some weird powdery stuff over your face every day. And get this  – it’s for no apparent purpose.
2. Periods. Urgh. Why ?
3. Dying in childbirth. Sorry but any species where 1 in 5 females die in childbirth unless they have medical (or veterinary) help is really seriously badly designed. More evidence that either there is no god or he is a misogynist.
4. High heels. Again, why? What on earth is the fucking point?
5. Breasts. Honestly you can’t really wank over your own breasts. Blokes think you can, and often some even think it would be good to have some. But seriously the sheer freakishness of them growing out of your chest  is just weird.
6. The lack of women willing to have sex with you. 9 out of 10 women are just not willing to have sex with other women, which is really really depressing. When you meet an attractive woman you just don’t bother asking them out because the chances are they aren’t a lesbian.
7. The feeling that if you have causal sex with strangers you are some sort of bad person. If you are a man that has casual sex with strangers (which lets face it is a perfectly good hobby when you aren’t in a monogamous relationship) you are thought of as ‘lucky’ or ‘a stud’. But if you are a woman you are a ’slut’. This means if you are a woman you have to get into a relationship just to have a shag.
8. Black tie events. Ok for men these are easy, just can wear the same outfit you wear for every event. But the bizarre rule for women is that you can’t wear the same outfit twice! How screwed up is that. Oh and when your friends get married you must go out and buy a new outfit. And people look shocked if you tell them it was from Primark. (You probably don’t need to tell them – Mrs Z) but why would you actually spend lots of money on clothes you’re only going to wear once? (One word: Accessories.  You never noticed?  See.  It works – Mrs Z)
9. Hormones. Men have testosterone, this makes you want to have sex. Simple. Women have a variety of hormones that make you totally irrational at random times. I remember one day seriously wanting to end my life because it all seemed so hopeless. And the next day I had a period (which is repulsive) but then I realised that I hadn’t wanted to kill myself at all – it was all just hormones. There is something seriously weird about having hormones that out of control.
10. Netball. Who on earth invented a sport where you can’t move with the ball or touch another player? It’s frankly the most boring sport ever. No one watches professional netball games. There’s a reason for that.
11. Being rubbish at sport – because no one will let you play a proper sport once you turn 10 so you get worse than everyone else and instead expect you to like netball.
12. The entirely weird relationship with your weight. If you are a fat man then it’s a bit annoying because you are likely to die of heart disease. If you are a fat woman you feel that you are worthless as a human being.
13. The way that society makes you feel like you are going to be killed if you go out after dark on your own. It’s so nice to be able to go for a run though a deserted dockyard when I finish work at 10pm without people making me feel like I’m committing suicide.
14. The entirely fucked up nature of societies attitude to child-rearing. Lets face it once you have had a baby you have suffered nine months of hell carrying it to term and then suffered the nightmare that is childbirth. You’d think that the logical approach to this creature that had done this to your body would be to give it to the father and tell him to get on with it.  But no, unless you give up your entire life to raising this creature that has already ruined your body and nearly killed you, you are a BAD PERSON.
15. You get paid less than a man for doing the same work. Oh and women do more unpaid work in the home.
16. Men keep trying to have sex with you. Less often if you are obviously a stroppy teenage dyke. Then they tend to go away.

So the real question is – why does anyone put up with being a woman? In this day and age if you are cursed with two X chromosomes you don’t actually have to go through the horror that is being a woman. I mean I’m glad you do – because I much prefer sex with women. But seriously: Why do you girls put up with this crap?