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Tuesday, 18 November 2008

Further Adventures with the NHS

I went today for a psychiatric assessment. I spend a lot of time being evaluated, alas. This one was at a Tower Hamlets Primary Care Trust medical center. It seemed like most of the other people there were for more body-focused medical stuff. It didn't have the kind of security that Dutch mental health centers have. Indeed, the doors opened automatically as I approached.

My appointment letter was for "Ms Celeste," which is better than Miss, at least. The receptionist looked at the letter and looked at me and asked who the appointment was for. I said my name. She looked at me a long second and then said ok and told me to sit.

The shrink was youngish. He had a student sitting in, a man about my age. I said I was ok with that. "Just ignore him" said the shrink. Right.

He had me go on and on about my childhood. Which, frankly, is not that interesting. Any fascinating memoir of my life would start later. I mean, the first time a gender shrink asks you about your childhood, you get to construct a narrative of yourself in regards to gender. Did you always know something was different? Were you blissfully unaware? Did others point out locations of difference that you didn't see for yourself? All of this tempered by the understanding that the receiver of said narrative is a hurdle between you and hormones/surgery/whatever you've come for.

So I banged out a narrative for an hour about how I'm a totally reasonable sane person. He wasn't a gender specialist, so when I said FTM, he asked what that stood for. So gender issues weren't even that present in the conversation. He did use the phrase "Gender Identity Disorder" though, and it got my hackles up a bit.

I don't like being called disordered. At all. The catholic church calls homosexuality "intrinsically disordered," which is a value judgment that I'm not keen on either. Why must every location of difference be called a disorder? Could it be a condition instead? Some other medical phrase? I'm proud of who I am. Indeed, to be different means that you have to be proud or be crushed. My identity is not a disorder, it's just atypical.

Then funding came up. He asked me when my student visa expires and started talking about "planned elective surgery." Which, I mean, Tower Hamlets is not awash in cash. It's one of the poorest boroughs in London. Why should they allocate their tax money to a foreign student? I don't know how NHS funding works, but it seems to be geographically divided. Are the residents of Tower Hamlets the main funding source for their primary care trust? Or does it come out of a large pot and then is distributed by population?

In order to change my documents in California, I need to get top surgery. Also, to be able to go swimming or wear a T shirt ever again in my life. So if the NHS won't fund it, I can . . . wait or self-fund. I don't think it's reasonable to try to get it too far from where I'm actually living, so surgery in California is not a good plan unless I move back there. It's possible for people in the UK to "go private" which means pay themselves for stuff rather than wait for the NHS to decide to pay for it. I have no idea how much this would cost here, nor if it would effect them covering my T prescriptions or anything else. Aside from whether or not I could afford it, there's issues about recovery time. It's long. I won't be able to lift things for weeks. This sort of situation requires close friends and I've only lived here since August. So even if I got NHS funding, it still might not be a reasonable plan. So maybe I'm destined to wait years no matter what.

When I do get it, if I still have savings, the first thing I'm going to do is buy the bike jersey I've been wanting, which I so can't wear right now.

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