Elias Joel Donstad
Elias Joel Donstad is a second-year PhD student at the University of South Dakota. His poetics involve the body and the way it is perceived by the self, family, and medical professionals.
He is the recipient of the 2022-2023 Wolfe Scholarship and 2023-2024 Standing Proud Scholarship. His piece Need(le), chronically the start of HRT and falling in love, is in the 'Red Noise Collective'.
Intention with the Parts
About
"Intention with the Parts is a collection of poems chronicling my dysphoria, family relationships, and bodily experience surrounding gender-affirming top surgery. Several of the poems are erasures and reclamations of documents and letters acquired and required for top surgery.
The product of Parts is my physical and mental processing of surgery. The experience of composing the poems was intimate and reassuring. While I took control of my body, shaping myself to be my home, I was able to control the narrative through writing. A lot of the recovery process made me feel helpless as I could not dress or bathe myself. Yet, the poems gave me mobility."
Pre-Op Dysphoria
1.
Why do facts of physicality refuse to be ignored?
Because people talk down to you
since you are a little girl.
You don’t like this but don’t know why.
2.
You are ten.
Mother leads you to the women’s section
in Macy’s to pick out a training bra.
She doesn’t tell you why.
You hate going to the mall
hate picking out clothes
wonder why women and men
are separated in the store
and why you aren’t allowed
to look at the boy’s section.
Mother picks one out though
you swear never to wear the contraption.
You fight the bra until she threatens
to keep you home from school
if you do not yield.
Tell your classmates about the bra even though
none of them understanding
because they do not develop breasts
until seventh grade.
You’re supposed to be embarrassed when
sharing the facts of your body
but you don’t understand why.
Do not wear the trainer again until
months later, your breasts grow a cup size.
3.
Become overwhelmed by your body,
by the way your breasts look beneath your shirt.
Buy a binder online and shimmy yourself into it.
Look at your new silhouette in the mirror for the first time.
Feel like you’re looking at the most beautiful stranger you’ve ever seen.
Want to feel like this always.
Try to feel like this always
Before you read online:
Don’t bind for more than six hours a day
Don’t bind more than two days in a row
Don’t sleep in your binder
Don’t exercise in your binder
Under threat of bodily harm.
Realize being comfortable in your body means
physical discomfort
and risk of injury.
4.
Cover the mirrors.
Don’t think too hard when you get dressed or undress.
Avoid the mirrors when you do this.
Don’t look down at your body.
Release the breasts
you’ve contained by binding for ten hours
adding pressure to your ribcage
and compresses your lungs.
Hope you have not caused permanent damage to your body
yet.
Never leave bed
without binding
because you cannot handle
having the silhouette of your breasts
visible under your shirt.
5.
Go into the kitchen.
Pick up the knife.
Put it back down.
Know you can’t preform
the surgery yourself.
Know you could bleed out
before the ambulance could save you.
Cry yourself to sleep on nights when
being trapped inside your body is too much.
Wonder if self-mutilation is the answer.
Remember some think surgery is a form
of self-mutilation.
Cry harder.
6.
Call the Sioux Falls Surgery Tower
to schedule a consultation for top surgery,
a double mastectomy.
Get offered several dates and times to schedule.
Take the first one available.
It’s in over five months.
You’ll see the surgeon October 12th at 1:15pm.
You need surgery scheduled before the first
of the new year before
insurance has a chance to change.
Worry you’ll never have a body you’ll love.
7.
Look at yourself in the mirror with your hands attempting
to cover your large breasts
pulling them to the side
leaving a flat gap in the center of your torso
creating an illusion of flatness.
Imagine scars where your breasts hang
like the ones you’ve seen on your friends
and on strangers in online support groups
or trans celebrities on Instagram.
Imagine loving what’s reflected in the mirror.
Dear [DEADNAME REDACTED]: an erasure
Dear [DEADNAME REDACTED],
you probably expected this email
I have hesitated with you for too long,
tried to be gentle,
afraid of pushing you away
your progression from a girl
to now wanting to mutilate your body
be a guy
completely incomprehensible
We prayed
warned you
you are
hell bent
destroying yourself
self destructive
you are [DEADNAME REDACTED], not Elias
you bought a lie
you will regret this decision
rid yourself of this community you have put yourself in
I love you daughter,
but removing your breasts is not the answer
you are looking for
I cannot come along side, or condone
this thing you are contemplating
We cannot walk this path with you, but you will need us when
things fall apart
and we will be here
come back to The God of the Bible
Love,
Your Dad
Irreversible Damage: a gift from my father
Therapist’s Note
June to October
months of waiting
of browsing top surgery forums
typing into search bars
questions to ask during surgery consultation
how to prepare for a surgery consultation
what to do before top surgery
requirements for therapist note for top surgery
therapist note top surgery templates
therapist top surgery note examples
what to know before surgery consultation
months spent in Ben’s office
co-writing a letter
to bring to the consultation
for insurance to cover the cost
Dear [SURGEON],
I am writing you today to assert my full support for [DEADNAME REDACTED],* who identifies as Elias, to receive a gender confirming top surgery. Elias is 25 years old living in Vermillion, SD. Elias is an English graduate student working towards his** PhD. Elias has a support system*** of his partner and close friends who will be taking care of him during the surgical recovery. My clinical assessment is that Elias Donstad is diagnosed as having F64.9 Gender Dysphoria.**** Elias***** meets the criteria set forth by the WPATH****** Standards of Care for gender confirming surgeries. He experiences extreme distress and dysphoria as he does not identify
*I hate seeing that name
on documents
required to help me become Elias
**at least I see my pronouns
even if I have to be wrongly named
***chosen family
****the mental illness required to receive care
******my real name
*******the institution that
judges whether my
mental and physical
distress is enough to
confirm my need for
surgery
with the sex assigned at birth and has felt this way since age 12 which is why he is seeking approval for this procedure. I have had an ongoing therapeutic relationship with Elias for nearly a year. Elias has been out and has identified as male for 9 months. ******* He spoke with me about his desire for surgery to ameliorate everyday living. Top surgery would aid in mitigating major dysphoria as well as relieve continuing pain and alleviate potential damage due to chest binding.
Informed consent was provided by [DEADNAME REDACTED], and he has the capacity to consent for treatment with surgery. A release of information is included with this letter.
Elias is aware of the risks, benefits and after care needs of this procedure. Furthermore, I do not see any confounding diagnoses [ANXIETY AND DEPRESSION] that would complicate this process of approving him for surgery.
He will have continued access to my services for care and support. I am available for coordination and welcome any appropriate communication with your office. I can be contacted at [EMAIL AND PHONE NUMBER REDACTED] if you have further questions. Thank you.
Sincerely,
[THERAPIST]
I take a printed copy with me
to the consultation
hoping it will be enough
for the surgeon
and insurance
*******this might not be enough time for the surgeon or insurance
Surgery Consultation
Bring the letter to the surgeon
cowritten with my therapist
to meet insurance requirements.
Wear my most masculine clothes:
the men’s jeans I got
before I knew I was trans,
a baggy shirt to hide the contours of my binder
with inconspicuous black and white chucks,
and a black beanie from the men’s section in Walmart.
Try very hard to look like a man
because I am
because I want my body to look like a man’s
because I want the doctor to know I’m serious
because I’ve read on top surgery forums
that appearance is important
that surgeons need to be convinced
you are who you say you are.
[SELF-DIAGNOSIS IS NOT ALLOWED FOR TRANS PEOPLE SEEKING SURGERY.]
Wonder how to label myself to get
the most understanding
whether nonbinary trans man aspiring FTM transmasc
is too complicated and contradictory
to explain to a cisgender doctor
and inaccurate to my transition
since I want all medical interventions
available to change my body.
Decide after remembering my chart marks my gender as
“transgender male”
and my real name is in quotes
like an alias
behind my legal name.
Worry “transgender male” will mean
the doctor will require me to be on hormones
for at least a year before
considering the surgery
like many of the guys on internet forums.
Hope for the best as I enter the surgery tower in Sioux Falls, SD.
Dr. Liu sees me at my scheduled time
spends ten minutes in the room with me
assesses if I am mentally ill enough
for the surgery to be warranted
but not mentally ill enough for me to be
incapable of making this decision.
I want to cite my therapist’s letter
that Ben does not see
“any confounding diagnoses
that would complicate
this process of getting approved for surgery.”
Keep my mouth shut
afraid of saying anything wrong
and getting a chance at surgery taken away.
Dr. Liu pauses too long on my list of medications
for my diagnosed anxiety and depression
questions me about my mental health
making me argue for my (in)sanity to get the surgery.
Dr. Liu and I reflect on my solitary month of HRT
asking why I stopped
(my parents found out and I
couldn’t break their hearts more)
asking if I want to start
(I have an endocrinology
appointment on the books)
telling me HRT is not required by WPATH’s standards
thank god for nonbinary and trans people
who don’t want HRT
but get top surgery
for making this possible.
I assure him I’m incapable of living with breasts
but not in the way where I’m self-harming
[LIES]
even though I think that should be
the greatest implication
medical action needs to be taken.
Dr. Liu notes on my chart that he
had the pleasure of seeing [DEADNAME REDACTED]
‘Elias’ in the Plastic Surgery Clinic
a 25yr old transgender male
who has lived as his identified gender
since January 2022
presents today for consultation regarding
bilateral gender-affirming chest reduction surgery
has been contemplating mastectomy for a while
currently binding his chest daily
denies any personal or family history of breast cancer
has a letter of support for the surgery from his
current mental health provider.
Leave with instructions:
wait 6-12 weeks on insurance to approve surgery
based on WPATH’s standards
get a mammogram
schedule a physical
within one month of the surgery
once the date is set.
Panic because it’s October.
The hospital will hear from insurance
the last week of November
leaving a month left to schedule the surgery
because December is the last month I have
insurance that will cover surgery
if they approve it
based on my therapist’s note
and the surgeon’s recommendation.
Rejoice when the surgeon’s office calls
with the news insurance approved it.
Get offered dates to schedule the surgery.
Take the first one available.
Go under the knife December 8th, 2022.
Top Surgery
I sent my rack back
subtracted 853 grams from the left
857 grams from the right
fibroadenomas removed
fibrous stromas reported
with fibrous nodules
lumps biopsied
at the age of 17
which showed no cancer
but nodules had cancerous potential
pain lodged in my body
I sent my rack back
trading breasts for scars
running armpit to armpit
making it impossible for me to
raise my arms for weeks
unable to shower
clothe myself
or get in and out of bed
without assistance
temporarily
like the pain
and the opioid prescription
while my scars last forever
I sent my rack back
in exchange for a body
that’s truly mine
after 15 years of protrusions from my chest
my hands can lay flat on flat skin
I sent my rack back
like it was the wrong order at a restaurant
like it wasn’t mine or meant for me
because that was true
First Week Post-Op
The day before my surgery, you showed me your chests, lifting your shirts together like it was a synchronized act, you with two flat lines that intermissioned in the middle and your partner’s Peri-areolar chest with nipples that looked like they’d never been tampered with, scars barely visible.
I looked more closely at you, hoping that I would look as beautiful as you after surgery since our breasts were nearly identical when we had breasts.
For the first 72 or so hours post-op, you take turns administering the opioids the doctor provided with the muscle relaxers on the strict schedule prescribed on the bottle, rotating night shifts to assist me when I needed to use the bathroom, helping me out of bed and pulling down my pajamas before I went to the toilet then returning me to bed, finally pulling up the covers since my arms didn’t have the strength.
Every night you measure my fluid output, empty my drains, comfort me when I wince while you stroke the tube to get all the blood and plasma into the container that dangles by my hips.
You reminisce about your drains, about how you could have gotten them out days earlier if it hadn’t been Christmas time. Talking distracts me from the process, and I am thankful for the stories you and your partner share about your post-op healing.
Four or five days after surgery, you help me bathe. Your partner’s shower seat for his disability aids us in our endeavor. You tell me to bend my head forward so you could wet and wash my hair for me. I do my best to bend without pain, but everything hurts. Your partner scrubs my back and lower legs. You turn your backs to give me privacy while I clean more sensitive areas
even though you have seen all there is to see of me.
You and your partner accompany me to the one-week post-op appointment where we submit our paperwork that tracked my fluid output. The surgeon deems me ready to be released from the drains. You offer to hold my hand while the surgeon positions himself to yank out the drain,
but I decline out of a sense of pride. It hurts and creates two new open wounds near my armpits. But now I can see myself.
The surgeon and nurse help me sit up, and you watch as I look at my chest in the mirror for the first time, observing the two scars feeling euphoric, a replacement for the past dysphoria that haunted where my fresh incisions lay.
Now I’m beautiful like you.
Dear [DEADNAME REDACTED]: an erasure II
I do not know if it [THE SURGERY] has happened
I hope not
we do not support this
it is wrong
1) It is not going to make the difference you think.
2) You will regret this, there is no doubt in my mind.
3) Until they put you under, you can change your mind, and not do this!
4) We are here for you.
We cannot walk this path with you, but you will need us when
things fall apart
we will be here
this [YOU] is [ARE] a train wreck that has only one conclusion.
[WHAT IS THAT CONCLUSION? REGRET? DETRANSITION? TELL ME.]
we love you and will not leave you
come back to The God of the Bible
Jesus loves you
Love,
Your Dad
2-4 Weeks Post-Op Back in my Apartment
Amelia drives me home,
a stuffed animal protecting my chest
from the biting seatbelt
during the hour-long drive
on icy interstate
Amelia has to open
my apartment building’s door
to allow me inside
since I don’t have the strength
My two cats greet us
as we enter my apartment
where I see Jackson the cat sitter’s care
in the filled food bowls
and clean litter boxes
as well as his and his father’s kindness
in the placement of the recliner
several feet away from the wall
so I have a place to sleep
where I am least likely
to accidentally injure myself sleeping
Before Amelia leaves
they walk through the apartment
with me to check
what necessary items
might be above elbow level
to lower them
so I can take care of myself
As I heal, Jackson continues to
come over to feed the cats
clean litter boxes
take out the trash
Nova who used to be a CNA
comes over to bathe me
after I hurt myself
washing my hair in the sink
They make me gnocchi bake
that yields a week of
leftovers to sustain me
They take care to wrap and rewrap
my bandages every day
to make sure I’m sufficiently
compressed
Phantom [****] Syndrome
third week post-op
well enough to start to move
out of a semi-catatonic state
still fighting a haze*
feel phantom DDDs hanging from the chest
the sting of the tumor on the left side
move arms to accommodate
the mass of 850-something grams
that used to protrude
from each side of the chest
severed from the body
but still holding on**
phantom chest
belonging to a phantom self
made phantom on the operating table
dysphoria turning into a haunting ghost***
ask transmasc friends
if they ever had a buffer period
where the body doesn’t know it changed
and the surgery feels like it never happened
be told no
feel hopeless
look at the mirror to relieve the sensation of breasts
because that’s the only thing that ameliorates the sense of distance from one’s own body
*is it leftover from the opioids
or the abundance of sleep
mixed with an endless string of bad movies
that just fill the time
giving me something to hear and see
while my body lays still
with sutures and bruises
fresh under bandages?
**hitting my sternum with my hand while crocheting
without my breasts to thwart the movement
***will I ever be free from my breasts? will I ever be free in my body?