41
No one was ever in any doubt about how Charmabutra Hospital acquired the capital to buy that fine twenty-story complex and all the state-of-the-art medical equipment it stores, even though its main product never appears on the glossy brochure.
“What is a transsexual?” Dr. Surichai asked me, raising his arms and hunching his shoulders. “Opinions differ, even in the medical profession. Especially in the medical profession. Is she a fully functioning human being who has finally achieved the gender identity which should have been hers at birth, or a freak, a medieval eunuch pumped full of estrogen?” Dr. Surichai placed a forefinger across his lips as if he were considering the question. His face brightened. “Some shrinks think my patients are all psycho. To them there’s no such thing as a woman born in a man’s body. They think what I do is criminal.” With a brilliant smile: “Or ought to be.”
“What is your opinion?”
A frown. “My opinion is that the whole issue is complex beyond anyone’s capacity. As you would imagine, I’ve thought about it a lot. You have to start with the question: What is gender? There’s anatomical gender: breasts, vagina, womb, ovaries, penis, testicles. Then there is chromosomal gender, which is as fundamental as you can go. Here you’re talking about the nuclear building blocks of the body, but the outcome of chromosomal analysis is not without ambiguity and doesn’t necessarily conform to the anatomy. You can have a chromosomal male with a woman’s genitals, in other words. At the end of the day, the chromosomal approach is only really used in tests for professional sportsmen and -women—you have to have some criterion to decide if your champ is top of the men’s league or the women’s. Then there’s hormonal sex, which is purely a matter of chemistry and can be changed simply by taking a few drugs. And there’s psychological sex. In other words, what gender do you feel yourself to be? How do you respond to the world, as a man or a woman? The big question is, what comes first? For most of us, it’s never an issue, we conveniently experience ourselves as being the gender of our bodies. But supposing you don’t? Supposing you have a nicely functioning, full-size penis, and spend your waking life believing yourself to be a woman in the wrong body? This is not a new phenomenon, there are records from ancient times, especially in Asia, of people who were basically transsexual in an age without the technology to make the change. The only difference today is that we have developed the technology. All I do is to adapt the body, in such a case.”
“What do you do exactly?”
“I cut off their cocks and balls. It’s called vaginoplasty, meaning to make a vagina. I use the skin inversion technique. Basically, we skin the penis—deglove it—invert it and sew it into the vaginal cavity. All men have a vaginal cavity, by the way. We open it, line it with the skin of the penis, use the leftover skin to mold a mucosal flap for the *oris, even give the little darling a hood and Bob’s your uncle. Well, not quite, but that’s the basics. There’s a lot of preparatory work, mostly involving hormone injections and psychiatric tests.”
“Tell me about the tests.”
“Well, like I say, there are psychiatrists who just don’t buy the whole ‘woman in a man’s body’ argument, but they’re considered square. The profile of a true transsexual is really pretty simple. The perception of being the wrong gender starts amazingly young—between the ages of three and five. The need, interestingly, seems not to be sexual. A lot of transsexuals are not interested in sex at all. In the M2F—sorry, male to female—category, which is the only one that really matters at the moment, the desire is simply to be accepted as a normal woman, which is almost perverse, because there is nothing more challenging to normal identities than a transsexual. They are the true revolutionaries of our time, the ones who make even gender a flexible proposition.
“It’s quite sweet really. A gay queen who cross-dresses goes to pubs and clubs to show off—he’s really simply a showman, an extrovert. But a true transsexual cross-dresses and takes the dog for a walk on his own—he really feels more at home in women’s clothes and does all his ordinary things in them. In his dreams he is a heterosexual female, and by the time he comes to me he will do anything—absolutely anything—to live inside the body of a woman. Since these men are often husbands and fathers, the whole thing can mean giving up his kids as well as everything else he’s made of his life as a man.”
“It doesn’t happen the other way—women who think they should be men?”
“Sure, but up to now the operation is much more complex. It’s really quite easy to make an artificial vagina out of a cock, almost impossible to make a fully functioning penis. Generally F2M is pretty messy at present. I have no doubt that once we learn how to produce a full-powered dick and stick it on, they’ll be lining up in the street. This is the age of dissatisfaction after all. Everyone wants to be something they’re not.”
The doctor didn’t look as if he’d ever wanted to be anyone else. He was slightly plump, in his forties, but what impressed most was the golden glow that seemed to emanate, a man for whom poverty was not even a concept. When he spoke of his work his Thai was interspersed with Western medical terms and often American slang as well; sometimes he broke entirely into English, once he saw that I understood.
“And in this case, did she/he satisfy all the requirements?”
An almost imperceptible hesitation. “Of course.” A wave of the hand. “He was shemale when he came to us.”
“Shemale?”
“A horribly trendy-sounding word, I know. We’ve taken to using it, since everyone on the street knows what it means. Basically, a shemale is a man who has taken all the hormone treatment, started to develop breasts, but has no present intention of following through with the operation. The hormones are there to give the appearance of femininity and to make him feel feminine, but he retains his sexual organs for the purpose of orgasm. Naturally, in a homosexual relationship he would tend to take the passive role.”
“And your patient—Fatima—she was in this intermediate condition when she came to you?”
“You can’t call it intermediate, necessarily. A lot of men live their lives like that. They go on taking the estrogen until old age, sometimes.”
“So Fatima might have fit that shemale category? She might not have intended to go through with the operation, except in very favorable circumstances?”
Dr. Surichai frowned, tapped his desk. The desk was almost the only part of the office that wasn’t white or beige. Even the curtains on the windows were beige, the walls were white, Dr. Surichai wore a white coat and his sculpted plastic chairs were white. The desk was light too, of some kind of varnished pine, and the picture rails were picked out in gold. The clinic achieved perfectly the intermediate condition between a modern hospital and a world-class hotel.
“Look, I know what you’re getting at, but what can one do? This is the age of access to knowledge, the Internet. More and more people come already knowing the answers to the questions—they’ve looked everything up on the Net and they know all that I’ve just told you. So someone like Fatima is bound to say: Yes, I first wanted to be a woman at the age of three, and when I cross-dress I don’t go to the clubs to show off, I just go for a stroll in the park.”
“But Fatima was a street kid, a male prostitute with little education?”
Dr. Surichai shrugged. “If you’re asking do I think she was coached, the answer’s yes.”
“By whom?”
“Who d’you think? Like you say, she was a street whore, there was no way she was going to be able to afford me without help. The only way these creatures get the kind of medical treatment she got is by finding a sponsor. Thailand is the world capital of GRS—that stands for gender reassignment surgery. We have the microsurgery here, and some of the best surgeons in that field. People come from all over the world. Montreal is good and there are some fine hospitals in the States specializing in these techniques—Johns Hopkins is world class, of course, but the Anglo-Saxon world is terribly hung up and confused about this sort of thing. The psychological tests are terrifying and last three months. The whole induction process normally takes two years in the U.S. People don’t necessarily want to expose themselves to the men and women in white coats for that length of time, so they come to us. As a result we get the practice. We do a thousand operations where an equivalent clinic in the West would do only a hundred. Naturally our surgeons are more practiced. Also”—a smile—“Thai doctors are rather good at cutting people up. We’re the neatest in the world. Must be those Asian genes. All of which makes our clinic rather expensive to locals—dirt cheap to Westerners of course. Generally, the local business from the street goes down-market to one of the other clinics. The results in those places can be hit or miss.”
“You met him, then?”
This was the first question that seemed to surprise the doctor. “Met him? You mean the marine? You’re not kidding I met him.” I raised my eyebrows. “I saw more of him than I saw of my patient. When he wasn’t here consulting me, he was calling me up on the phone. I made the mistake of giving him my mobile number. I got calls in the middle of the night, as if I was some kind of G.P. or something.”
“Is that unusual?”
“The intensity was unusual. He was a very intense man. A perfectionist. Sometimes he didn’t seem like a soldier at all, but then I would think, Yes, that’s exactly how the very best kind of professional soldier would be, attending to detail, never letting anything slip by him. He had an eye, though, which you don’t usually find on a soldier. My god, he had an eye. He practically designed her, and I have to admit that by the end of the process, he got the perfect product. Without a doubt Fatima is my finest creation.”
“Also his creation?”
“Yes, that’s correct. He looked everything up on the Net, he got professional-class software for his damned computer and would come out with stuff I’d hardly heard of. He mastered all the medical Latin, understood every detail of the skin inversion technique I just told you about, and about the voice stuff too.”
“The voice?”
“That’s the real problem. Sexual organs are not so complex, they hardly vary between us and the other mammals, they’re one of the oldest organs, been around ever since God divided the world into male and female and we know a hell of a lot about them. They’re also rarely modified for social reasons. The voice is something else. I’m not a shrink, but if you want my opinion, the voice is far more important as an identity than whatever you’ve got between your legs. I could cut your bits off and make you the most wonderful p-ssy, but you wouldn’t be happy if you sounded like a man every time you opened your mouth. The Adam’s apple can be shaved—in Fatima’s case only a little shaving was needed, just a local operation with the teeniest little incision on the anterior neck.”
He pointed to his own Adam’s apple and moved a thumbnail down it for a quarter of an inch. “She was a natural really, hardly much of a bulge at all. I left her with the teeniest, weeniest concealable scar—she wore necklaces at first to cover it up, but it really did fit with the natural creases when it healed. I don’t think anyone would necessarily notice, or know what it was even if they did see it. But that didn’t deal with the voice, of course, only the cosmetics of the anterior neck. For the voice you need therapy, perhaps combined with a rather tricky little technique called ‘indirect cricothyroid approximation.’ Basically, you tighten up the vocal cords to produce a slightly higher range.”
A pause while Dr. Surichai seemed to examine my neck. “It’s a misperception that a woman’s voice needs to be higher than a man’s to sound womanly, however. Some women have very deep voices and manage to sound wonderfully female. Gender identification through voice is something we start to do from an early age, there are a million subliminal instructions we absorb. It’s the voice which really tells the world who and what we are, far more than genitals or even dress. Your voice, for example, Detective, is exactly modified for the purposes of your profession. You are polite and firm, you can intimidate without raising your pitch, I bet you know how to terrify merely by introducing a certain ice into your speech, no? Teaching someone to project the opposite sex through speech without sounding phony or like a drag queen is the most difficult task. Fortunately, it’s not a surgical problem.”
“Fatima speaks exactly like a woman, there’s nothing male about her voice at all.”
“Correct. You really have to admire Bradley for that above all things. Frankly, on the surgical front he was a pain in the neck. He got exactly the tits he wanted, but it took about twenty hours of discussions, drawings, diagrams, e-mails of nipple details—would you believe? To do a really good breast job you have to follow the natural contours of the torso—it’s really an aesthetic problem, so you need an artist’s eye. Bradley thought he was the only one who understood the laws of beauty, I was just a glorified butcher. He got on my nerves, frankly, although I have to admit he knew what he was talking about. With the voice, though, that was different. He put in a lot of work himself, used a tape recorder and sent her to a voice therapist after we tightened her vocal cords a notch. I think that’s where she learned such good English, the therapist was an American. Mainly, though, either the therapist or Bradley, or probably both, understood the aural contours of the female identity and transmitted it to Fatima. That’s her real secret, which people don’t usually spot. They’re fixated on her long legs, perfect tits and Afro-Modigliani face—they don’t realize that the full force of her sexuality doesn’t hit until she opens her mouth. That’s the trigger and the reinforcement, the signal which says: ‘This is a real woman.’ It still gives me a thrill when she speaks, that Negroid texture, and very, very female.”
“Please think about this question, Doctor. Did you ever have the impression that someone apart from Bradley was helping in Fatima’s design?”
I watched his brow furrow while he cocked his head to one side and stared at me. “Really, that is a possibility? I never thought of that, but I did wonder where the marine was getting some of his ideas from. Sometimes he spoke more like an art dealer than a soldier.”
“Any idea where the name Fatima came from?”
A bright look. “Curious, isn’t it? I was present when they decided on her new name. Bradley said: ‘What you gonna call yourself, honey?’ And she said: ‘Fatima, daughter of the Prophet.’ She took us both by surprise, as you would imagine. I realized afterwards that as a Karen she would have been subjected to all sorts of missionaries, Muslims as well as Christians. Bradley said: ‘You sure?’ And she said yes. It was the only thing she was ever uncompromising about.”
He stood up. He was unexpectedly short, no more than five-six; sitting down, he projected power and authority with a fashionably sleazy touch; standing up, he was a small guy with something to prove. “Look, if this is relevant you can have copies.”
On the other side of the room Dr. Surichai kept his computer, a tower on a desk next to a twenty-inch flat screen. I caught a glimpse of a diagram of a penis while the doctor moved the mouse and made keystrokes. He went to a file manager program and called up a file named Fatima. He ran quickly through some graphics of sexual organs, Adam’s apples, then stopped at a diagram of a breast.
“This is the sort of thing I mean.” He nodded at the screen.
Someone had used a computer program to map out the contour of a breast against a green matrix of crisscross lines which seemed to represent a torso. “This is breast diagram number seventy-six. I’m not kidding, he numbered them and sent them to me via e-mail. They’re large graphic files and clogged up my system before I got broadband. You see, this is merely the outline. If I click on the nipple, like so, I get nipple detail.”
The image changed to something which might have been a broken tower from an ancient monument. The dimensions could be measured by reference to the green matrix grid. “You see, he even worked out what size nipple he wanted, how long it should be, the size of the areola. See?” Now the screen was filled with what was recognizably a giant nipple with black areola. “One thing you have to say for the guy, he wasn’t hung up about being black. He was proud of his African roots, which was one thing I rather liked about him.”
“The only thing?”
The doctor shrugged. “As you can imagine, I get all sorts. The fanatically involved lover is a standard character in my line of work, although he’s rarely as intelligent or persistent as Bradley was. What I couldn’t quite get used to, though, was a layman looking on the surgery with such a cold eye. Surgeons have to be like that, but if the patient was my lover, or someone close to me, I don’t think I’d be quite so obsessed with the aesthetics—I’d just want to make sure they achieved the gender identity they craved, on their own terms, to give them psychological relief. After all, that’s what the operation is supposed to be all about. Now look.”
The image changed to a full breast outline, with arrows and incision marks. “He’s even working out exactly how he wants the saline bags to be placed. You see, in breast enlargement you put the saline inserts behind the mammary gland, lay them on the chest cage itself. They’re kept in place by the breast, but they move a little, which gives the realism, which is why everyone these days prefers saline to those ridiculous silicone inserts which set like concrete and actually echo when you tap them!” The doctor made a face of professional revulsion.
“But Bradley here is going one stage further. He wants to measure the precise position of the saline bag, down to the tenth of a millimeter, as if he’s positioning a gun emplacement or something, to achieve precisely the breast contour he’s aiming for. I’ve never come across anything like it. Frankly, when it comes to breasts, there’s a certain leeway—most patients realize that real breasts change shape all the time, depending on whether the woman is standing, sitting, lying down, et cetera, and they’re happy if an enlargement more or less follows nature. But Bradley was aiming for something specific—I suppose a personal erotic image, the tit of his fantasies. Now, you see?” The image changed to a representation of a full torso against the grid, seen from side and front. “He’s actually very good. This is the effect, as he explained to me many times. The breast has to be just slightly large for the torso, but only slightly, giving the appearance of a full, firm bosom, but not something too flappy—that was his word, ‘flappy.’ A lot of men have their own idea about tits, but I’ve never known anyone to analyze it in such detail. Firm, but not unnaturally so, friendly, in other words soft and yielding, large but not so as to make her look top-heavy or overblown—another of his words. I told him he was seeking the impossible—if you want soft and yielding, you have to give up on firm. If you want large and soft, you’re not going to get a constant shape at all, it will change all the time. He would say, ‘I know, Doctor, I know, you have to aim for the perfect balance, that’s all.’ We spent hours, days on her breasts. He really drove me to extremes of detail I’ve never gone to before. In the end we got his perfect tits, and they are rather nice, don’t you think?”
Suddenly I was looking at Fatima, naked to the waist, her familiar breasts pointing at me, that slight smirk on her face as in the portrait opposite Bradley’s bed. “Just tell me, Doctor, while all this was going on—what was Fatima doing? After all, it was her body you two were discussing.”
“ ‘Passive’ is too insulting a word. But she wasn’t inclined to assert herself much, either. Bradley usually visited me on his own, but when she came with him, he was careful to include her. ‘That okay, darling? You’re gonna knock ’em out’—that sort of thing. I think she believed he genuinely wanted the best body for her, and probably had a better understanding of beauty than she did. Also, you have to bear in mind this guy was a very powerful presence. A giant and maybe even a kind of a genius in his way. It was hard for me to argue with him or contradict him. And she adored him, you could see it in her eyes. This guy, this god, came out of the night, turned her whole life around, gave her self-respect—after all, we’re talking about a street prostitute who never had anything, transformed into a kind of a star. She was ready to go along with him in just about everything. I wouldn’t say she was without personality, though. Not passive, just appreciative.”
“You never saw them argue?”
The doctor thought about that one. He frowned. “Not argue exactly, but you have to bear in mind the cultural divide here. Fatima has jungle roots. She would talk about them having sex when it was all over, she would go right to the point of the exercise in other words, and he was a bit of an American prude. He didn’t like to talk about their intimacy in front of me, which Fatima and I both thought was odd. After all, I was building the body he was going to worship, when it was all over. Fatima wanted to be sure her new vagina would satisfy him, would give the full pleasure, but he wasn’t comfortable talking about that. In all our discussions, it was the visual aspect he was interested in, he hardly mentioned what the experience of sexual intercourse was going to be like.”
“Is that unusual?”
He nodded. “Yes, very. The big question after ‘Will the patient be able to experience orgasm?’ is ‘Will the vagina feel real?’ The answer is yes in both cases, by the way. We use erectile tissue from the penis to provide the sensation of pleasure and orgasm. Since we use skin from the penis to form the vagina, it feels just like a real vagina, so long as a lubricant is used.”
“Sorry, I forgot to ask. When Fatima came to you she had already been taking hormones—estrogen I think you said—for some time. Was this something Bradley started her on?”
That frown again. “I don’t know. You’ll have to ask her.”
“Didn’t you ask her?”
His mouth tightened. “I didn’t need to. She was taking estradiol, which is a plant-based estrogen widely used in the U.S. and Europe. It’s quite sophisticated. Most local estrogens are still made from the urine of pregnant cows. There’s no difference in effect, but some evidence to show that the synthetics like estradiol are safer.”
“In other words, left to her own devices, Fatima would have taken the local variant? It does look as if she was coached from an early stage, doesn’t it, Doctor?” A grunt. “That didn’t bother you?”
It seemed that I had finally succeeded in piercing the doctor’s urbanity. He abandoned the intermittent English phrases and broke out in pure Thai. “Bother me? That she was the creature of her lover? You’re talking like a farang, perhaps because you’re half farang. Which of us isn’t the creature of someone else? He was giving her a better life, the life she wanted, that was the only issue for her, and she was prepared to pay any price. Those were my patient’s subliminal instructions to me, the rest is just farang nonsense, bullshit they cook up over there to justify an army of consultants, all of whom cost the earth. Thank god Thailand hasn’t come to that yet.” A swallow, then in a more temperate tone: “Do I really have to remind you what kind of life we offer to penniless illegitimate half-castes, Negroid half-castes, in this land of compassion?”
“Thank you, Doctor. Sorry for one last question, it really is the last: Did you have any idea how Bradley was able to afford you?”
I watched carefully for signs of insecurity and found none. Dr. Surichai simply shrugged. “He was an American. Americans have ways of getting hold of money, even if they’re poor. Perhaps he had a rich relation or something? It wasn’t my business to ask. He paid my bills regularly, on the dot.”
“About how much? Roughly, I don’t need the exact figure.”
Dr. Surichai rubbed his jaw. “Well, I had to charge for all the extra time spent with Bradley, all those two-in-the-morning conversations when he’d woken up with some new idea, or some aesthetic issue that was nagging him. About one hundred thousand U.S.”
“Compared with how much for a more average client with no lover to complicate things?”
“Maybe five percent of that.”
“Five percent? You and Bradley really went to town on Fatima, didn’t you?”
“Like I say, he was obsessed and could afford it.”
Jones is quiet for a long while after I finish. We’re almost at the outskirts of Krung Thep when she says: “That’s what you saw the other day at Warren’s shop? You took one glimpse close up and saw she was a transsexual? I’m a woman and I couldn’t tell. Even now, if I didn’t know and I spent a day with her, I don’t think I would realize. But you saw it and understood the case right away, didn’t you?”
I raise my hands, then let them drop. “The whole case, no. The outline perhaps.”
“You’re gonna tell me it’s your meditation makes you so sharp?”
“Not meditation. I’m from the street, like her.”
“Is that what it takes for a woman to turn you on, she has to be from the gutter? Don’t answer that. So, we have a designer victim?”
“Yes,” I say.
“And a business partnership intended to produce product after product, just like with the jade?”
“Life is cheap in this kingdom, and the life of a male whore particularly cheap.”
“Take a throwaway body, turn it into the object of your fantasies, do what you like with it, then when your sponsor the big boss says it’s time, let him use it in his own unique way, trash it and get ready for the next one? Play God and the devil both at the same time?”
“Yes,” I say, “exactly. What could be more intoxicating for men who, in their different ways, have had the best of everything? Except it didn’t work.”
“You give up your gender, your genitals, turn yourself into a eunuch for the man you adore, then find out what he has in mind for you.”
“By which time you have also found out he is a coward and terrified of snakes.”
“Yep, I would go for the cobras.”
“Me too.”
“But why and how the python? According to the autopsy, the python didn’t even hurt him, it just happened to be on the point of swallowing his head when you guys turned up.”
“Python and Khmer?”
“Python, Khmer and a video?”
Not for the first time Jones has surprised me with her acuity. I wait for her to continue the thought, but do not want to press the point myself. I think that after all she’s not as sharp as all that, when just as she’s about to drop me off at my project, she says: “Makes you wonder why Warren’s here at this time, doesn’t it? I mean, you’d expect him to stay away at least until you’ve finished your investigation.”
On an impulse I really ought to have suppressed, I took her hand and kissed it when I said good night. Her hand snapped over mine like a steel trap and for a moment she refused to let me go. I had to tug to escape, by which time a mean look had appeared on her face. “Don’t take this the wrong way, Sonchai, I’m just trying to get a hold on local customs, but would I be right in thinking that there weren’t too many professions open to you when you joined the workforce?”
“Whore or cop,” I snarl as I leave her.