by Jess Row
It takes me a moment to respond. He seems to be in no hurry.
I did, I say, finally. When I first met Martin. Now I almost take it for granted.
Isn’t that astonishing? he says. Your mind takes only a moment to acclimate. Modernity at work. All that is solid melts into air. You know that quotation? Marx? Sometimes I think I should have that on my business card. Even if it makes the investors uncomfortable.
Martin gives a short chuffing laugh. I don’t think anyone would mistake you for a Communist, he says.
Really? You never know. They are still everywhere, you know. Radicals and dreamers.
Suki comes clacking out onto the balcony with a fresh pitcher of tea, and hands Silpa a note, which he glances at, folds, and slides into his shirt pocket, so smoothly that it almost seems rehearsed.
I was thinking, Kelly, he says, earlier today, about how I wouldn’t want to have your job. I mean, on a practical level. There is too much to say, isn’t there? I mean, what question should you ask me first? Where do we begin? The conceptual level, the cultural level, the actual nuts-and-bolts part? You have complete access, you know. We are going to do this once and do it right. Want to watch some surgery? Fine. No confidentiality laws here. Want to interview the staff? No problem.
I’ve been trying to place his accent, and now I’m hearing it: upstate New York. Rochester, I remember; he did his residency at the University of Rochester. There’s that slight midwestern nasality, the crisp, definite, let’s-lay-it-out tone of an actuary or a school principal. And, at the same time, the wry melancholy that comes from surviving nine months of lethal winter, the heaps and barrows of snow, the rusting city with its empty museums and obsolete innovations. This is a Thai man, of course, and we’re in Bangkok, in the throbbing heat of mid-morning, birds chattering around the edges of the roof, but if I turned ninety degrees and listened to him without looking I could swear we were standing in a silent white-tiled hallway, next to the emergency eyewash station, watching snow fall over a parking lot in a blue-black winter afternoon. He has a little winter madness in his voice.
I appreciate that, I say.
I’m not sure that I’m doing you a favor.
No, in a way, it is. I mean, my focus is still on Martin. Of course. So all this stuff, this operation, as you say—it’s all about explaining the process step by step. It’s not a magic trick. It’s not science fiction. It’s not, like, an illusion.
He stares at me again for a long moment.
No, he says, no more than anything else.
From a Buddhist point of view.
I suppose. I would have said from a human point of view.
Well, folks, Martin says quietly, if you’re going to keep philosophizing, I’m going to be on my way. More houses to see. I only came to introduce Kelly, in any case. He hitches up his elbows and makes ready to stand, with a wry, ingenuous smile. I knew you would hit it off, he says. Now you see, Kelly, why I said you had to come here? I mean, I may be the face, but Silpa’s the voice. I prove that it’s possible, but only he can prove that it’s right.
He’s like a fawning graduate student, I’m thinking. A disciple at his guru’s feet. That combination of terror and glee in the presence of the master. Okay, I say, trying, again, not to sound as annoyed as I am. Should I take a taxi back?
No, no. Silpa says. One of our drivers will take you.
Best not to take a taxi in Bangkok, Martin says. Not on the highways, anyhow. The drivers are all on yaa baa. Burmese meth. It’s like letting a toddler onto the Autobahn.
Silpa smiles, a wide, still smile, as if to say, you said something. No agreement or disagreement, no concern or unconcern. And Martin walks away, silently dismissed.
—
For lunch, he says, we have to go outside, meaning out of the building, away from the groaning traffic on Sukhumvit Road, and down a series of narrow alleys to a bigger alley, a side street, properly speaking, where cooked-food vendors have set up plastic tables from one sidewalk to the other. You can call it a Thai buffet, he says, gesturing up and down the row of stalls. Whatever you like. Shrimp? Barbecue? Whole fish? Papaya salad?
You pick. Surprise me. I still have moments of dizziness, the world sliding around at the very edges of my peripheral vision, but my stomach seems to be settling, now that I’m back on the ground, at street level.
Good. Smart man. He leads me from one huge tray to the next, pointing and calling out to no one in particular. There are heaps of fragrant long beans and Chinese broccoli, enormous prawns swimming in a marigold-colored curry, shrimp poking their feelers out of piles of grated mango, crabs, eels, whole fried frogs, chicken wings, duck webbing. When we finally arrive at our table there are seven dishes waiting for us, magically, steaming hot, with a basket of sticky rice in the middle, and a sweating bottle of Pellegrino with two plastic cups.
Do we pay afterward? I ask him.
Oh, he says, they have me on credit. I come here nearly every day. Every month or so I settle up my bill, and then they get a big tip for Songkran. That’s Thai New Year, you know. It was just three weeks ago. The end of the dry season. You don’t mind eating here, do you? I dislike restaurants. Anyway, Thai food has to be eaten outside.
It reminds me of where I lived in China.
Of course, he says. In hot weather you are supposed to live outside. Do everything outside. When we lived in Rochester, in the summer, my wife and I, we used to shock the neighbors when we did the dishes on the back porch. Bucket of dishes, bucket of soapy water, and the hose. That was our sala. People used to come over and tell us to put screens on our windows. Because of the mosquitoes! I said, look, do you have malaria here in Rochester? Do you have dengue fever? Fire ants? Pythons? To them it was as if we’d stepped out of National Pictographic.
National Geographic.
Right. And speaking of pictures, I have something for you. He reaches into his briefcase—in all this time I’d hardly noticed him carrying a briefcase—and hands me a slim, heavy, blue three-ring binder. Unmarked on the outside. I open the cover and read, in large bold letters, Case History of Martin Wilkinson.
I had Tariko put it together, he says. Took quite a bit of time, but I think it will make your life much easier. I’m quite proud of it, too. You could say it’s my Dora. My most famous case. Though probably more successful than anything Freud ever did.
Because the criteria are different?
Excellent question! He beams at me, like a professor who’s discovered a bright student in office hours. Who can say, if we want to get terribly theoretical, how much aggregate happiness we could provide to the world, if we gave people the option to be something other than what they are? But watch out, the food’s getting cold. Eat this. Here. He passes me a bowl of finger-sized fish, served whole, tails facing up. They’re marinated in lime leaves for twenty-four hours, he says. Put the binder away. You have plenty of time for that later. Take ten minutes and just eat.
At the other end of the block, where the street meets another broad avenue splashed with midday sun, there’s a low, disorganized clangor: a sound of cowbells and paint buckets and frying pans pounded by amateurs, with no beat. A stream of red-shirted marchers comes into view, carrying signs, banners, and flags—also red—flooding the sidewalks and spilling onto the pavement. Air horns begin shrieking. The people around us look up for a moment and return to their food. Silpa scoops up a hunk of rice and rolls it delicately into a perfect ball.
Who are they?
Oh, he says, the People’s Party. On their way to the parliament building.
Do they do this all the time?
There’s a crisis at the moment. A look of sour boredom appears on his face; then he shakes it off, as if reminding himself who I am. With the prime minister. About rice and the commodity market. Frankly, I’m no expert. You’d do better to read the Bangkok Post. But are you interested, really, in polit
ics?
As context, at least.
Deep background, as the reporters say? He laughs. Well, Kelly, I have a deep-background question of my own. I’ve been waiting a long time to ask you this, and I can hardly stop myself.
Go ahead. Why wait?
Did you ever find out what the miao character means?
I look down at the binder, which I’ve placed under the table, between my legs, as if the answer is hidden somewhere in there. And then, without wanting to or meaning to, I begin to laugh: a deep, froggish belly laugh, rising up from my diaphragm, a sound I don’t think I’ve ever made before. A group of businessmen stooped over bowls of noodles at the next table look up at me with wary curiosity.
It’s publicly available, you know, Silpa says.
Only if you have access to the right database.
That part was very simple. That’s what assistants are for.
I can’t stop myself from laughing; I wipe the tears away with my sleeve. Dr. Silpa—
Just Silpa. Everyone calls me Silpa.
What could you possibly want out of my dissertation?
He gives me another of his bland, detached smiles.
Homo faber, he says. We are what we make, right? We are what we produce. Look in that binder and you will find me. How do I come to know a person—a writer, a scholar? How else? You think I’m interested in you as a hired hand, an employee. I’m not, really. That’s just circumstantial. Do you know what the Buddha says about karma? If you brush by a person on the street, that’s because you knew them in five hundred previous lifetimes. You think you just met Martin out of nowhere, for no reason, in some parking lot in Baltimore? Life doesn’t work that way. You present yourself to us. We present ourselves to you. It’s an opportunity, not an accident. So the question is, what next?
You make it sound like a conspiracy, I say.
And as soon as the words are out of my mouth, I realize that that’s exactly what it is. For a moment I feel the sour taste of Phran’s fruit under my tongue again; to squelch it, recklessly, I take a forkful of ground-pork salad, dotted with red onion and tiny green chilis. Why not? I’m thinking, as the white heat shoots up into my nose, my sinuses, my eyes leaking tears. If I’m going to get burned, I’m thinking, without quite knowing why, let me be completely burned. Nothing left.
Silpa rummages in his briefcase and hands me a packet of Hello Kitty tissues.
No, he says, still smiling. The laws of the universe aren’t a conspiracy. But they are laws.
3.
In the morning, after ten hours of dreamless sleep, I stay in my room, reading, till eleven. Phran brings me a thermos of chamomile tea and half a loaf of milk bread, still in its wrapper from a Chinese bakery. For your stomach, he says, tapping the thermos. Julie-nah made.
It’s been a cloudy morning, with intermittent bursts of sunlight; now a soft rain is falling. The beginning of the monsoon season, I guess. I set the binder down on the writing desk, open my laptop, let myself down into the swivel chair, and switch on the light.
CLINICAL REFERRAL
Patient: Martin Lipkin
Evaluated by: Jorge Lopez, M.D.
Assistant Professor of Plastic and Reconstructive Surgery, Johns Hopkins Medical Center
Gender and Reconstructive Surgery Clinic
April 24, 2001
Dear Dr. Silpasuvan,
I’m writing to refer the above-named patient, Martin Lipkin, to you for evaluation at Mr. Lipkin’s request. Mr. Lipkin contacted me at the GRS clinic because he was unable to find any other surgeon in the United States who was willing to do a consultation on his condition.
Mr. Lipkin is a twenty-eight y.o. male of Ashkenazi Jewish (p) and unknown-other Caucasian (m) descent. At my request, previous to our consultation, he was evaluated by the GRS clinic psychiatrist, Dr. Tomasi, and found to be suffering from mild but detectable clinical depression but otherwise free from psychological factors that would constitute comorbidity. He is not suffering from any physical complaints other than occasional insomnia and anxiety that he describes as “not debilitating.” He is a recreational user of marijuana but almost never drinks alcohol and does not use tobacco. His family medical history is almost entirely unknown. His mother and father separated when Mr. Lipkin was an infant. He is not in contact with his mother. His father (according to Mr. Lipkin) died of AIDS-related septicemia in 1995 at age fifty-two and left no extant medical records.
Mr. Lipkin believes himself to be suffering from what he himself has titled “Racial Identity Dysphoria Syndrome.” That is, he believes that he was born into a physical identity of the wrong race. He states that for as long as he can remember he has had a vivid but obviously repressed sense that he is living in the wrong body and has recently realized that he is, in fact, internally, African American. He wishes to seek out options for surgical reassignment so that he can appear physically African American.
To my knowledge (and as I informed Mr. Lipkin) there is a) no such diagnosis, and b) no surgeon in the world who would perform any procedure based on such a diagnosis. When he inquired whether it would be possible to pay for cosmetic surgeries that do exist, I told him (as I believe to be true) that the standards of care in plastic/reconstructive surgery would make it nearly impossible to find a surgeon to provide reliable care under these conditions. Mr. Lipkin is a very well informed patient and a very persistent self-advocate and that is how he brought your name to my attention.
It is my understanding that since leaving U of R (where you doubtless knew my former mentor, Martin Trumbull) you established a clinic in Bangkok for radical psychosomatomic disorders. I was not able to locate any recent publications of yours on the subject, but Mr. Lipkin showed me your website, and since I know that you had excellent training, I am recommending Mr. Lipkin to your care with the strongest possible reservations. I refuse to believe that any such syndrome can exist. Notwithstanding Mr. Lipkin’s evaluation, I believe he is suffering from some kind of intellectual or cognitive (if not technically psychiatric) delusion. I do not believe that Mr. Lipkin is a good candidate for surgery of any kind.
Yours sincerely,
J. Lopez
Preliminary treatment plan
Patient: Martin Lipkin (Goal Identity: Martin Wilkinson)
Lead physician: Binpheloung Silpasuvan, M.D.
Agreed to and witnessed March 2, 2001
Mr. Lipkin (hereafter Mr. Wilkinson) has agreed to the following surgical procedures in order to achieve his stated goal of a new identity, “Martin Wilkinson,” an African American male, appearance determined through MorphTech software and certified as the final version by himself and Dr. Silpasuvan.
Mr. Wilkinson will receive subcutaneous injections of melanotomanine (afamelanotide sulfate) three times daily for one month, together with daily UV exposure sessions, to stimulate melanin production, beginning immediately.
Mr. Wilkinson will be scheduled for initial facial surgery in six weeks, assuming no contraindications from the above treatment. This surgery will involve alteration of the palatine and vomer bone structures and the addition of muscle mass to the orbicularis oris (upper and lower lips), as well as ordinary rhinoplasty with nostril augmentation. Recovery time from surgery is estimated to be one month.
Following successful recovery from facial surgery, Mr. Wilkinson will proceed with the “Real-Life” transitioning plan agreed to with Dr. Silpasuvan. This transition period may take up to four months.
Mr. Wilkinson will be scheduled for hip and buttock augmentation following the completion of the above recovery period. This procedure will involve collagen injections to achieve the desired appearance, as well as extensive scar corrections to make the augmentation as invisible as possible. During this procedure, any existing skin abnormalities, discolorations, etc., will be identified for further treatment or treated in situ if possible.
For the above t
reatment, Mr. Wilkinson has agreed to pay Silpasuvan Medical Associates a flat fee of USD $100,000 in three installments.
RACIAL REASSIGNMENT SURGERY: POSSIBILITY AND REALITY
BINPHELOUNG SILPASUVAN, M.D.
Cosmetic surgery for the purposes of changing one’s racial or ethnic identity has been an established practice in Western medicine for more than a century, since the first cosmetic rhinoplasties were performed by Jacques Joseph in Prussia in the 1870s. However, medical professionals in the cosmetic surgery field have long avoided referring directly to the racial or ethnic implications of popular and widespread procedures, for understandable reasons. The purpose of this article is to argue for a new era of honesty and demystification about the potential for altering one’s identity through cosmetic surgery and related practices, on the one hand, and on the other to introduce the obviously controversial idea that there may be a need to invent an entire new category of cosmetic surgery, Racial Reassignment Surgery, to meet the demonstrable psychological needs of contemporary patients.
The best way to introduce this second theme, I believe, is to make reference to a theoretical case study, which I have assembled as a composite of many patients I have met in the course of my practice. For the purposes of this case study, the patient is a young British man from London, with characteristic normal Caucasian features, who grew up in a public housing estate among West Indians, works as a DJ playing dancehall music, and is exclusively attracted to West Indian women. This patient displays a strong desire to reduce his feelings of isolation and stigmatization through a change in physical appearance so that he may “pass” in that community.
According to current clinical practice and social reality, this person would be treated in the following way:
If seeing a psychotherapist, his struggles with identity would be treated as psychopathology and not referred to a surgeon.