Olivia Madeline Abigail

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This story contains descriptions of surgical and medical trauma, specifically surrounding bottom surgery, healing, and blood loss.

Therapeutic Phlebotomy

In the orange-pink light of the smart LED bulb, her blood clot was true black with a thin corona of deep, deep red. Resting on a fold of toilet paper, it reminded her of a seed, or the thorax of a bloated tick. On the one hand, it was too spherical to be a seed, but on the other it was too tapered to be a tick. When rolled between her thumb and the paper, it mimicked the soft body of a tick. Still, she enjoyed the feel of the clot too much to accept such an unsettling comparison. She loved watching the stripes of bright red it left on the paper as she kneaded it, and the faint metallic smell it gave her thumb, layered with the earthy scent of her convalescing vaginal mucosa. Once she’d pushed a blood clot from her vagina that she insisted was the size of a human finger—and not a pinkie either! Tragically, she lost that one to the toilet bowl, but it was large enough that she could remember how it felt leaving her body and she’d been able to pick it out amongst the shit and toilet paper. 

The thing about having a vaginal canal constructed from the internal lining of your abdomen and the skin of your penis, inserted between your bladder, your asshole, and the muscles of your pelvic floor, and then stitched to those muscles and that abdominal lining. Is that it fucking hurts. And you lose a lot of blood. And that goes on for a while. So. You get on board with the blood and the pain and you try to learn to enjoy the parts of it you can. Which is not to say this approach works all that well, but. 

Sophie knew she’d have to set aside the clot and get to dilating soon or the lube on the hard plastic wand she held in her other hand would dry out, but she couldn’t bring herself to do so just yet. There was always a moment before she began pushing the dilator into herself when she was able simply to exist with her new vulva, watching in the hand mirror as it pulsed ever so slightly with her breathing. 

Her relationship with her vulva could be adversarial. Especially while dilating, she could not keep from her head the image of her vaginal canal as an open wound, screaming fire at her with each hard-won half-inch as she worried, in a deep part of her mind, that she had been wrong. That her penis hadn’t been a cosmic mistake and that the gates which fell shut around her mind anytime she or anyone else touched it were the result, not of biological happenstance, but of insufficient love for her own transsexual body. 

What if, whispered the acute unease radiating from her crotch, what if all you needed to do was unlearn your transphobia? Sure, other girls need bottom surgery and that’s all well and good but can’t you feel how much this hurts? How wrong it feels? You tell people, “It’s hard right now, but I don’t regret. Not for a second.” But you don’t mean that, do you? Because this was a mistake, and you can tell just from the way your body is rejecting it and you regret it. Poor little Sophie just needs a vagina to make everything alright; poor little Sophie, won’t do the work to be okay with herself just like all the other girls. So scared of herself and her own body that she ruined it instead. 

She grabbed for the hand mirror, only to find that the dilator had not moved. All five dots still showed and already she could see dark blood from her urethra pooling on the green plastic. Grimacing, she pressed her right hand harder into the base of the dilator, clenching her left around the mirror’s handle as she forced the wand one dot deeper. Her knees butterflied out to the sides and her ass clenched hard enough to lift the small of her back off the bed. Her pussy howled its hot red protest. And when she finally eased the dilator from her vagina, her canal protested again, causing her to exhale hard into the pain. She wiped streaks of blood from the wand and set it aside. Warmth seeped down to her asshole in a red stream of blood, lube and discharge. She sighed and pressed toilet paper against the wound, waiting for the bleeding to slow. 

Climbing into bed an hour later, after she had pissed, shit, and cleaned herself, she felt warmth spread quickly between her legs. Her heart dropped and she cast quickly about the room for where she’d left her pads. When she pulled off her panties, she knew she would be bleeding freely from the dehiscence in her vagina. A dehiscence, she had learned a few weeks prior during a panicked phone call with her surgeon, was a complication in wound healing in which a stitch or stitches bursts or comes apart. He’d called it “wound separation.” She grabbed a pad, unwrapped it and yanked her panties down, ready to quickly press the pad into her crotch so that blood wouldn’t spill on the floor. 

But when she pulled off her underwear, there came the insistent sound of liquid dripping to the floor, followed by a feeling of release in her crotch that she couldn’t place. She froze, pad in hand, as she heard it – the sticky sound of skin peeling. Then something solid and warm came to rest against the insides of her thighs. Steaming hot blood soaked her legs to the ankles, and the smell of metal turned her stomach. She looked down. 

Swinging gently between Sophie’s legs, as if in a soft breeze, hung the fatty folds of flesh that moments before had been her vagina. Her baby blue panties, still around her knees, were black with the spilled blood pooling at her feet. Through the wall, she heard her neighbor guffaw at something on the television. A lightness spread from her gut through her chest, arms and legs, tickling gently at her fingers and toes. Tendrils of inky blackness crept in at the sides of her vision. Do I need to go to the hospital? she thought. Because they won’t know what to do. 

Then, the lightness reached her head and she fell like a stone into the puddle of blood at her feet. 

***

“Sophiesophiesophiesophiesophie,” someone was saying as Sophie’s eyes fluttered open. The face was so close to hers. Its eyes were wet, its brow furrowed, its mouth like a motor. There were hands on the back of Sophie’s head. 

“Sophiesophiesophie sophie sophie sophie?” Jules’ mouth slowed. “Sophie. Sophie you – your – you, are you ok? Like does it, I mean, does it–” 

“Jules, fucking stop,” someone said. Elle was in the doorway, their phone to their ear. “Get paper towels.” 

“Mmrphm,” Sophie said. 

“Ok, ok, yeah, ok,” Jules said, letting Sophie’s head drop to the floor with a crack as she stood rapidly. She dropped back to her knees. 

“Oh fuck Sophie I’m sorry are you ok?” 

“Ok,” said Sophie. 

“Jules!” Elle snapped. 

“Ok!” Jules said, darting from the room. Sophie heard Elle giving someone on the phone an address and apartment number. The tops of Sophie’s knees jutted into her field of view, caked with drying blood. She began to wriggle, trying to push herself up on her elbow. 

“Sophie,” Elle said, watching her. “Sophie, don’t.” 

But she did. There was a slick peeling sound as her back came off the floor, and she saw that the pool of blood in which she lay extended down past her feet and up to where her head had been. She’d left an imprint of her torso in the congealing mess. 

Snow angel, she thought. Blood angel. That’s going to stain the wood. Elle motioned firmly for her to lay back down as they kept the phone to their ear.

Sophie ignored them and looked at her crotch. There was too much blood to really make out any detail, but she did see a strip of flesh draped lazily over her left hip crease. The blood on it looked mostly dry, its tip an angry pink. She stroked it. It tingled. 

“Sophie, lie back down,” Elle said, slipping their phone into their pocket. “Seriously, the paramedics will be here soon, just stay down.” 

She let Elle ease her back to the ground, gazing through them to stare at the ceiling. “They’re gonna flip,” Sophie said. “They won’t know what to do.” 

*** 

The paramedics did look concerned when they arrived, but they got to work quickly, taking her vitals before lifting her onto a stretcher, where they gently wiped down her wound to get a better look. 

“She’s not bleeding at all,” one of them said, shining a pen light into her crotch. “How long ago did this happen?” 

“Um,” said Elle. “I don’t think more than twenty or thirty minutes?” Behind them, Jules shifted from foot to foot, clutching a wad of paper towels, her eyes red. 

“No,” he said, still shining the light between Sophie’s legs. “No that can’t be right.” “It really couldn’t be more than forty minutes,” Elle said. 

“No,” the paramedic said again. 

Elle rode next to Sophie in the ambulance, squeezing her hand. No one spoke much.

*** 

When Sophie hit the ER, everything was a blaze of lights, doors, ceiling tiles, and firmly communicated vitals. Elle hurried alongside the gurney through the maze of sterile corridors, observing silently. The rush was broken for Sophie when a nurse began tapping the back of her hand, looking for a vein to place an IV. She did not like needles. The nurse placed the line without much trouble, but when Sophie saw the familiar speckled phlebotomy collection tubes come out, she protested. 

“Wait wait,” she said, as the nurse attached the collection tip, “I lost so much blood, do you have to take more?” 

“Yes,” he said, positioning the first tube, “it’s normal, don’t worry.” 

“Hold on,” Elle said from the corner, rising halfway from their chair. “She basically painted the floor. It doesn’t seem safe to take more, can we please get a doctor’s assessment before you take any blood?” 

The nurse stepped back from Sophie’s side, but kept a hand on the collection tip, supporting its weight. He sighed. 

“Look, we can hold off and wait for the PA, but it’ll be at least half an hour, probably longer, until she gets here, and when she does she’s almost definitely going to ask for bloodwork, given how quickly the bleeding stopped. That’s a red flag for abnormal clotting.” 

“Half an hour? Have you seen her–” Elle stopped themself short. “I mean, come on. This is pressing.” 

“Elle,” Sophie said, quietly. 

“I hear you, but right now,” the nurse said, “right now Sophie is stable. Her vitals are stable, I mean. Her blood pressure is a little low but that’s to be expected given the bleeding, but in general, she’s doing okay.” 

“Okay…” Elle said. 

“So, to be honest, the fastest way to get Sophie seen is if I take blood now. And we’ll have her on IV fluids. So the amount of blood I need, it shouldn’t make much of a difference.” 

“Okay,” Sophie said. “It’s okay, Elle, I’ll just do it.” 

Elle sat quietly disquieted through the blood drawing and asked only clarifying questions through a number of medical exams, during which were thrown around phrases like abnormal wound separation, alarmingly rapid scarring, and once, chillingly, potentially inoperable. The nurses, physician assistants, doctors, and specialists who were called in to examine her into the wee hours of the morning kept a papery drape over her lower half as they pushed, lifted, prodded and scraped the flesh between her legs so that even if she wanted to see what they were working with—and a part of her did—she would be unable. 

As far as Sophie could gather, while the final assessment would come from her surgeon, the situation down there was not looking good. She was confused by the references they continued making to scar tissue. When the exams were finished, Elle was finally sent packing and Sophie was told she should try and get some sleep. In the dim light of her hospital room—at some point she had been admitted and moved from a curtained ER vestibule to a full room—she closed her eyes and tried to rest. She was quickly overcome by roiling anxiety in her guts and the taste of bile rising in her throat. She turned her head from side to side, hoping she needed simply to adjust herself, but she felt sure she would not sleep a wink. 

***

She woke to a breeze as the air conditioning kicked in. In the gloom of light from the bottom of the door, Sophie surveyed the room. There was nothing of particular significance in the room—a couple of standard hospital chairs, a small sink and a minifridge by the door, an array of monitors surrounding her bed, and a TV hung high on the wall. Elle had thought to bring a change of clothes, which lay neatly folded on one of the chairs. 

The room was quiet, save for the low beeps and thrums of the hospital machinery around her head. It was so cold she had to raise her hand to rub warmth into her nose, which was when she felt the IV wiggle in her hand. The skin surrounding the flexible catheter was swollen to a small bubble. She had thin veins, a nurse had told her during her hospital stay after surgery. They burst easily. In a fading dream she ran up a steep hill, scorching her legs with lactic acid, pushing herself forward faster every step. But this slipped away quickly as the IV flexed and she noticed light filtering under her door, reminding her where she was. Her awareness snapped to her ruined vagina, expecting to find agony in her crotch but finding instead a dull ember of discomfort, beating lightly with her heart. 

As quickly as she could manage, which in fact wasn’t very quickly at all, she began inching her fingers down her hospital gown, at the same time bunching the loose cotton bit by bit, drawing it up her leg. She did wonder, as she did this, whether she really, truly wanted to investigate whatever awaited her beneath the gown, but her fingers moved on their own and soon they touched the soft skin of her belly. There were still crackling streaks of dried blood here and there, tracing their way up from her nethers, but at some point a nurse must have wiped her down. Her fingers continued their morbid exploration. 

When she felt the first flap of flesh lying softly on her stomach she recoiled, but in surprise more than in discomfort. Rather than the pain she expected, she felt a pleasant jolt jump from her finger and run to her center, circling up through her heart and sparking out against the soft material of her hospital gown. She touched it again. Same jolt, slightly weaker. She stroked the soft, springy tissue. Fire crackled to life and her cheeks flushed. Moving her finger in small circles, she began to open herself—the pleasure emanating from her finger working its way through the rigid muscles of her pelvic floor, inviting them to relax. Electricity flashed rhythmically through her body, setting off a pulse somewhere deep in her center. Though her finger moved no faster, her muscles pulsed with a frequency and intensity which soon became overwhelming and which, even when she stilled her finger, continued to increase, so that soon the fatty tissue which had once formed her outer labia, and before that, her balls, ached to be touched. 

So she explored herself, flipping over hanging skin to stroke her labia, dancing her fingers nearer and nearer to her center. There, she found her soft little clit somehow very much intact, jumping to meet her finger. Sophie felt true lighting then. And fire, and deep, black storm-driven waves, twisting together and prying her apart with a thousand hands as they pulsed hard into her churning maw. She shoved first one finger inside herself, and soon after, a second and a third. She pushed them to their base and still she ached for more, sure that if she could not be full she would rip at the seams. 

She pulled out her first three fingers and collected all five to a point. She pushed them into herself against not gentle resistance and burned around her fist. Deep muscles convulsed with dripping pleasure, pulling her in to her wrist, sucking greedily for more. They pulled with such force that her back began to lift from the mattress, her shoulder cranking inward until her arm formed a sharp angle, her hand now lost to the mid forearm. She opened her mouth to scream, but as she did, an orgasm shot through her and choked off all sound and all sight. She saw only black, burnt through with circles of orange. She heard only the rushing of blood through the capillaries of her inner ear. A bone snapped somewhere inside her clenched fist. Every muscle in her body squeezed itself to breaking, ratcheting tighter with each tachycardic beat of her heart. 

She felt herself grow thin at the edges. As if she were being stirred into a glass of water, her center of gravity spiraled out from her core in concentric circles as her fingers and toes tingled away from her body and her breath unknotted itself from her throat. A night sky of sparkling stars filled her vision, spinning in all directions, growing and growing in number, forming bands across her consciousness. A great spiral hung in the infinite sky ahead, blazing into her as a hand presses itself through sand, allowing her to flow through its gaps and embrace it entirely, sliding over its fuzzy barriers and back into herself. She pulsed with tension at the same time that she gave with ease, reflecting endlessly off herself into a vacuum that she filled completely. 

***

At shift change, the morning nurse entered the dark room, setting off the automatic lights. She found, lying quietly in the crook of the angled hospital bed, a large bulb of pearlescent scarred flesh, heavy and full at its base, at its apex tapered to a soft point. It glistened, but when she touched it, it was dry. Its surface was marked here and there with small indentations, pocked like a hairless strawberry. She stroked it absentmindedly as she surveyed the thing. It was warm to the touch. She couldn’t figure out what the hell it was, let alone where the odd patient the other nurses had been telling her about was. Hesitant to go into much detail, they told her only Make sure you stop by 324 at some point. Make up some excuse why you’re there if you need. She ought to tell someone that the patient was missing and that there was …well whatever this was … in their place. But she felt it could wait. She wanted to figure out first what this thing reminded her of. It was too round, she thought, to be in the shape of a seed. Maybe some sort of insect? But the feel of the thing under her hand was too pleasant, really, to make that comparison.