Jane Demuth | Longreads | May 2019 | 23 minutes (5,756 words)
It’s March 13th 2017, the eve of a late season snow storm that will blanket the Northeast and shut down major cities, and I’m on the ninth floor of a high-rise hotel in downtown Philadelphia chugging bottles of laxatives on a tightly prescribed schedule and making regular trips to the toilet. I am alone. As I count down hours one by one, my mind is reluctant either to focus or to rest. I flip through the TV channels briefly, but none of the broadcasts catch my interest. I talk to my brother on the phone several times; he is also in the city, and wants to know if I need anything or would like his company. It is thoughtful and generous of him to offer, but solitude feels like the right choice for me in this moment. I do not know what moods will strike me in the coming hours, but in the past my fears have sometimes coalesced in a fiery blaze of anger, and I do not wish to subject my brother to this. For an hour or so, I listen to music on my headphones, but the songs toward which I thought I would gravitate on this day are not hitting the emotional sweet spots I’d hoped and expected they would. Mostly I nap, on and off, between bottles of laxatives, prophylactic antibiotics, and urgent visits to the washroom. This morning I awoke at home in the Hudson Valley, feeling calm and clear for the first time in months, but a lengthy run of restless nights and a mounting air of anticipation have taken their toll on me. Tomorrow I will be checking out of the hotel early, and although a pharmaceutically induced period of unconsciousness is on the agenda for later in the day, right now I am grateful for actual sleep in whatever increments it offers itself.
I remember my fascination, panic, and excitement when I first learned that people could be surgically altered to transform one set of genitalia into another. I was in middle school and leafing through one of my mother’s psychology textbooks. There was an entry for what was then referred to as sex reassignment surgery, and a grainy black and white photograph of a trans woman. I remember her looking terribly old and terribly sad, gazing out a window at the rain with a vacancy in her eyes. I don’t remember exactly what compelled me to consult my mother’s psychology text, though I was probably looking for information — any information at all — about abnormalities in sex and gender development, and why someone would not feel at home in their body. I wanted to know what was wrong with me, why these shameful urges to wear girls’ clothes (which I’d successfully fought down throughout my childhood) and this complex sense of longing and identification with my female classmates were now returning with puberty. I wanted to know what to do with my white hot terror about the looming apocalypse of a changing body.
I remember my fascination, panic, and excitement when I first learned that people could be surgically altered to transform one set of genitalia into another.
More than anything else, though, I wanted a way to hide. It was 1987. We lived in an enormous and isolated farm house in the middle of the woods, the internet was still a hazy pipe dream in the psychedelic addled minds of computer scientists, and we were not the sort of family to visit either the doctor or the library. What we did have was an extensive and varied collection of books. In the absence of other resources, it was to these that I turned for guidance. Although my parents did as well as they could in teaching my siblings and me that sexuality was healthy, they never delved far into the murkier waters beyond heterosexuality, much less the even more poorly charted territory of gender dysphoria, what was then called transsexualism.
Besides, although they may have been preaching the gospel of open sexuality and gender equality with their words, every interaction of their relationship with each other and their relationships with their children told a radically different story. I learned that to be female was to be lesser and forever scared, and therefore to identify oneself as female in defiance of public consensus to the contrary would be pathological and shameful. The concept of natural, normal, healthy diversity and the possibility of acceptance simply did not exist in my cosmos. There was nowhere for me to turn for help.
My middle school deep dives into psychology texts were entirely clandestine affairs. I did not know what I was, but I knew it was dangerous, and that asking for help was out of the question. Later, when I began to gain a rudimentary and inexact vocabulary to describe my feelings, when the confluence of words on the page and the thoughts in my mind removed the plausibility of denial, secrecy was of utmost importance. If I could have locked these feelings away and never come back to them I would have done so in a heartbeat. I certainly tried. But feelings don’t work that way. Identity doesn’t work that way. The harder I pushed back against what I did not want to be true, the more desperately I wished I could be living a different life.
Back in my hotel room, I’m awakened mid afternoon by the hospital calling me with final preparations for tomorrow. Are you fasting? Following the bowel prep protocol? Yes, I answer honestly. And you’ve been off your hormones for six weeks, right? Yes, I lie. For the past four years, daily doses of sublingual estradiol, a form of estrogen, have taken me through a second puberty, slowly but steadily converting the musculature and fat distribution of my body and the neurochemical patterns in my brain into something far more in line with what they should always have been. My body has softened and rounded out. I’ve stopped fighting against my emotions, and they have rebounded to the surface. As part of my preoperative protocol, however, my surgeon has instructed me to cease taking this medication for the past six weeks. Ostensibly, this is meant to prevent embolism during my recovery (a reported risk of hormone replacement therapy which is not well supported by the data, particularly with respect to modern formulations of estrogen and use in trans populations in the absence of other risk factors). My late aunt was responsible for some of this research in the 80’s when she worked as an epidemiologist; unfortunately, she did not live long enough for me to discuss her conclusions with her. My scepticism about the risks of blood clots aside, skipping the hormones would certainly slide my body back towards its pre-transition state, a state to which I have absolutely no desire to return. Like my aunt, I also work in medical research, and have reviewed the published literature thoroughly enough to know that there is no reason for me to stop my hormonal lifeline. Yet I am wholly reliant on medical professionals for what happens next, and I know if I tell them that I have ignored what they, too, must understand to be a frivolous and psychologically damaging instruction, a door will slam shut between me and tomorrow’s surgery. Ignoring their instructions and lying is the best option I can see.
Lying does not come easily to me. The environment in which I grew up was permissive and relatively liberal in some ways, but harsh, unforgiving, and often brutal in others. When I was 3 and disobeyed my father at a playground, he locked me in a hot car to punish me. Later that year at a family gathering, I tried to recite the poem “A Visit From Saint Nick”; when I fumbled some of the words, he was so angry that he picked me up and shook me to make me stop. I do not remember either of these occasions. My sister, my mother, my grandmother — the other women in my family — told me about them many years later, when I was no longer a child. I do remember that when I was 7 and made an uncharitable comment about another child, my father was again so angry that he didn’t talk to me or even look at me for three days, until my mother intervened. I learned to watch my words, never to lie, and never, ever to make a commitment on which I could not follow through. Above all else, I learned that the fires of rage were a powerful weapon, and that it was pointless to petition for leniency or understanding from anyone in a position of power or authority.
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Petitioning a distant and intractable authority for compassion and care was an unavoidable part of my preparation for surgery, though. I knew when I wrote my first letter to my health insurance company requesting coverage for gender confirmation surgery that my request would simply be rejected as a matter of course. I had higher hopes for the second letter I wrote, appealing their decision. I listed the medical organizations that considered this a necessary part of treatment. I referenced the section of the Affordable Care Act, in the narrow window between its adoption and the legal challenge which rendered it impotent, that prohibited health insurance from discriminating on the basis of gender identity. I cited the corresponding New York State law as well, and the executive order preventing such discrimination against federal contractors, both of which applied to me. I wrote about the horrendously high rates of suicide among transgender people, and the fact that this is a life saving surgery for those with gender dysphoria. But none of this swayed their decision in any way. They denied my appeal with the same sort of anonymous form letter they’d used to deny my original petition. It offered no names and no further hope, apart from a tepid suggestion that I could send yet another letter to start the process over again, because they (not I) had assigned the wrong diagnosis and procedure codes to my original request. Even knowing ahead of time that my odds of success were vanishingly slim, even with the advance warnings of medical professional friends that my particular insurance company was especially heinous to deal with, even having set myself up beforehand not to need their help, to be able to pay for this on my own if need be and never be beholden to an organization with no corporate regard for the best interests of its charges if they interfered with the bottom line of its shareholders, it still crushed me to receive their outright refusals.
It was difficult to stay motivated in this fight with no expectation of success. I remember sitting on a pew in the Notre-Dame Cathedral Basilica on a visit to Ottawa, praying to the two Saints Joan (of Arc, and Jett) for strength and for hope. Later that week, in a park near City Hall, I read these words by Neil Gaiman in his 2016 essay collection, The View from the Cheap Seats: “Fairy tales, as G. K. Chesterton pointed out, are not true. They are better than true. Not because they tell us that dragons exist, but because they tell us dragons can be defeated.” I did not know if the $200 billion dragon of my insurance company could be defeated, but I knew that if I stopped after my appeal was rejected I’d have accomplished nothing but disappointing myself. As hopeless as it seemed, as demeaning as it felt to continue petitioning a nameless, faceless entity for help, as frightening as it was to feel rising within me all of my kid fears of having no support from on high, I knew I had to keep going. It wasn’t time to quit. Not yet.
But neither did I intend to keep applying methods that were not going to yield results. The rules I’d been following so far were clearly established to prevent anyone from succeeding, so I found a different rule set and followed that instead. Because I purchase my insurance through my employer, I turned to them for help when I could make no progress on my own. They put me in contact with our insurance agent, who helped me navigate the system. She smoothed the way to add gender confirmation surgery to our schedule of benefits. Without her help, without my company’s help, I would have kept spinning on a bureaucratic hamster wheel designed to frustrate rather than facilitate.
Although gender dysphoria is by no means new, the medical process of transition is. Devoid of the rich history of other rites of passage, I’ve struggled to find context in the months leading up to this.
This is not to say that the intercession of my employer and our agent made the process simple or painless, though; they only made it possible. My insurance company continued to throw up every impediment it could devise. I had to reschedule my surgery, as the new benefit would only take effect after my originally planned date. This cost me three months. Even with this additional time, it was only a month prior to my rescheduled date — well after I’d had to pay my surgeon up front for her costs — that I received approval in writing that the procedure would be covered. My agent, who made every effort to help me to whatever extent she could, at one point accidentally forwarded to me an email in which one of her colleagues explained that they would set their usual and customary rate for this procedure, the actual cost of which they had apparently not researched at all, at exactly half of what my surgeon charged. This, despite the fact that all surgeons offering this operation in the US charge roughly the same fee. Because my doctor would not agree to such a miserly payout — indeed, there were no surgeons in network who would perform this surgery at that price — my benefits were reduced further to the out-of-network rate of just 80 percent of that 50 percent, meaning I would be responsible for 60 percent of the cost.
By the time I find myself in my Philly hotel room counting down hours, I feel as though I’ve already run a ultramarathon navigating the obtuse logistics of health insurance red tape and begging for the scant mouthful of table scraps they deign to disburse.
I look outside the ninth floor window of my hotel room at the streets below as the sun goes down and the snow begins to fall. I’ve been required to fast all day in preparation for tomorrow, and my stomach has gone through waves of hunger pangs. One of the few permitted foods listed in the thick packet of directions my surgeon gave me is clear chicken broth, which I have brought with me. Because my hotel room has no microwave, though, I am unable to heat it. I take a few sips of thin, cold broth from a paper cup before discarding the rest. I would rather go without. This last supper is meager and disappointing.
Although gender dysphoria is by no means new, the medical process of transition is. Devoid of the rich history of other rites of passage, I’ve struggled to find context in the months leading up to this. Should I celebrate? Grieve? Reflect? Atone? All of the above? None? In my mid 20s, I took an anthropology course on Religion and Culture. I remember my fascination with the section on ritual, and I remember the professor with her thick German accent lamenting the absence of formal rites in modern society. Rites mark transitions, often a rebirth into adulthood. They take place in the liminal, outsider space of cultural tricksters, mediating figures who balance creative and destructive forces. Raven. Loki. Eris. Yoda. Jesus. These are universally marginal characters; if they had been better integrated into society, they would not have had the freedom to question, act, or bring about change. All of this resonates with me as a trans woman on the cusp of major change right now. Transition for me has been a process of both destroying the illusion of who I was and creating from the rubble something new. And it requires no stretch of the imagination to see that society considers us tricksters when the vast majority of states continue to permit the trans panic defence (assaulting or killing an intimate partner upon discovering they are trans). We are among the most marginalized of populations. This is the space from which I am operating. This is the place that I inhabit. All of this reflects my experience, what I have felt and the archetypes that have resonated with me for all of my life.
Prior to surgery, I wondered what rituals I could observe to mark this transition. In the absence of formal, culturally prescribed rites, I did what made the most sense to me. I contacted an ex, the last woman with whom I had been intimate years earlier, and told her that I’d be having this procedure. I’d been open with her throughout our relationship about my plans to transition, so the news came as no surprise. She offered me her support and well wishes. Just before leaving for Philly, I wrote her a brief letter and left it on my kitchen table, to be delivered in the wildly unlikely event of my death in the operating room. I spent months wondering whether to contact my family of origin and tell them of my plans as well. Ultimately, I did. Most were supportive. I took a last yoga class with my favorite teacher, with whom I’d practiced and studied regularly for a decade. And the last thing I did before my best friend picked me up for the drive to Philly was to set up my old, worn sleeping bag on my couch, in preparation for the rest and comfort I anticipated needing upon my return. But none of this felt like ritual, not the way I’d learned about in class — no shamans, no dancing, no trance, no formal and stylized actions. Other aspects of rites of passage — temporary separation from society, enduring considerable pain — I certainly would be experiencing, but these are part and parcel of this experience, not something symbolic of my choosing. What I’ve wished for and sought is an elevated moment of metaphor, of preparing myself through the symbols that hold the most meaning for me.
I think about all of this on the night before surgery as I draw myself a steaming hot bath. While the winter storm unfolds outside, I lower myself into the water and feel my muscles start to relax as sweat beads and drips down my face. There is nothing else for me to do right now; no one to argue with about insurance coverage, no one to contact, no details to manage and no other place to be. Without much in the way of intention or forethought, I begin to thank my body, those parts of it which will undergo radical changes tomorrow, for their service, as one might raise a toast to a comrade before a final battle. And without any conscious thought at all, I close my eyes and begin to sing.
Take my clothes off, one by one
Breath on me, hold me close
Whisper, kiss me, kiss me there
You’re so beguiling
You’re so beguiling
Beguiling. The bifurcated sense of both passing effortlessly through time and creating a deception. My time has rarely passed easily, and the only person I have ever really tried to deceive was myself. Those who knew me best were never fooled. They have always known who I am. None of my coven of best friends so much as batted an eye when I told them years ago of my plans to transition. When I first heard and fell in love with Michelle McAdorey’s band the Crash Vegas in the early 90’s, I had no idea what a crucial role their most haunting song would someday play for me.
Perhaps on the other side of the day ahead of me I will finally be able to experience that other, less fraught sense of beguiling.
Singing myself both out of and back into being with a slow, simple, obscure Canadian folk song in the ersatz sweat lodge of a high rise hotel room bathtub in the midst of a snowstorm is, I realize, the moment I have been looking for. This is my ritual.
I check out of the hotel before six the next morning. The streets are lifeless, dark, and as quiet as a tomb on my walk to the hospital. This is it. All I want in the world right now is to turn around, take a taxi to the airport, and fly away from here, start over again elsewhere, anywhere, but there are no taxis to be seen and my feet keep carrying me forward through the heavy slush of the storm. What I’m feeling isn’t regret or second guessing. I trust that this decision is the right one for me; perhaps more importantly, I trust the way I made it — slowly, methodically, deliberately. What I am feeling is partly a fear of the unknown, but mostly humility and remorse that it has come to this, that my life and my body couldn’t have been different from the start. Instead, now I am choosing to put things right. For anyone else, this might be a moment of empowerment, but for me, it brings back memories of being too scared to act when I was growing up, when taking a stand or making my needs known was a statement of vulnerability, an invitation for the peg that stands out to be pounded back down. How else could I approach this moment, then, other than with reluctance and trepidation? But I am no longer a child. This is my life. If I wish to inhabit a space that feels right to me, one that I truly own, then I am the one who must make that happen. Failing that, it is difficult to imagine that any life I could live would be anything more than the ghost of the one that I want.
So I don’t find a taxi. I don’t go to the airport. I don’t fly away in the childish hope of a magical new beginning somewhere else. Instead, I take a deep breath, kick the snow off my boots, walk through the patients’ entrance to the hospital, and check myself in for surgery. I have no exit strategy. There is no plan B. This is the only time in my adult life that I have walked into a room without knowing exactly how I will be walking out of it. With every other choice, even my backup plans have had backup plans. Right now, though, there is no other way forward for me without this next step, without making myself this excruciatingly vulnerable. I tell myself over and over to remember my training, in yoga, pranayam, meditation, martial arts, or anything else that will help to keep me calm and trust the process, even if I will not be awake for this next significant portion of it. I am in the barrel, past the point of no return, about to plunge over the falls.
Losing consciousness before surgery is less like falling asleep and more like having one’s awareness replaced by pitch darkness and question marks; x’s and y’s in a horrendously complex equation. For me, the simple, quiet, persistent question that equation is attempting to solve is: Why?
As I lie immobile and unaware on the operating room table and my surgeon and her team do their work, the worst snowstorm in years continues to pummel the east coast. It’s March 14th — Pi Day, Taco Tuesday, in the Chinese Year of the Cock. While the campy undertones of that confluence of date, day, and lunar year have allowed me to view my decision to go under the knife with some much needed levity, the severity of the storm outside is underscoring its seriousness.
Beguiling. The bifurcated sense of both passing effortlessly through time and creating a deception. My time has rarely passed easily, and the only person I have ever really tried to deceive was myself.
A year earlier on International Women’s Day, I was sitting in a traffic jam on the 401 in southern Ontario after a weekend of tromping through the Ottawa snow in Doc Martens and multiple layers of sweaters and coats. In the city, province, and country which has always provided me with both an escape and a cradle for my existential questions and doubts, I remember asking myself what came next. After three years on hormones I was wondering about surgery. Was this something I wanted? Was it something I needed? Could I afford it, not just financially, but emotionally — the struggle it would take to arrange, undergo, and recover? A weekend alone filled with long, empty drives and solitary walks through the cold, bright late winter air of my favourite city brought me to the quiet place in my mind where I could hear the answer. Yes, I might be able to be happy without doing this, but I would have a chance at greater happiness if I did. The I Ching of conversation between my prefrontal cortex and my reptilian brain told me to proceed, that it was time, and I trusted that that was enough.
Then, a year later, a week before my surgery, again on International Women’s Day, something unexpected and nearly miraculous happened. A statue entitled “The Fearless Girl” appeared in New York City, staring down the famous Wall Street bull with a graceful look of will and determination. After nearly a year of arguing with insurance, negotiating details, and fighting the cresting wave of my own fear of the unknown, that simple, defiant artistic statement (and the Fearless Girl herself) lent me tremendous strength and relief. And the national conversation that followed her appearance, about the nature and intersection of art and corporate subsidy, reaffirmed for me that whatever shreds of comfort or meaning can be wrested from the clenched fists of corporate personhood are no longer beholden to the thrall of their shareholders or C-level executives.
That was why I decided to do this. Beyond the base judgmentalism of anyone else’s opinion of this procedure (or of gender transition in general), far more profound than the demoralizing and fundamentally mean-spirited hoops through which one must jump to acquire the slightest modicum of medical care in the United States (much less something as vital and sometimes critical as surgical intervention), the act of becoming and all the messiness it entails was ultimately my decision and my responsibility. We are, all of us, not only entitled but obligated to ourselves and to each other to find and create our passion out of fear, beauty out of struggle, and joy out of pain. This is how we continuously give birth to a world that serves us all.
Regaining consciousness after surgery is less like waking up from sleep and more like surfacing from the depths of the ocean after surviving a shipwreck.
In the months leading up to this day, I wondered what profound statement I would make immediately afterwards; however, when the time comes, my first words are “May I have some painkillers please?” The post-op nurse provides me with fentanyl and morphine, and when I awaken again an hour later, my brother’s shining face is one of the first that I see.
I spend the next few months engaged in varying states of rest, recovery, and rehabilitation. My brother stays by my side in hospital for as long as I need him before returning home. Friends take shifts staying with me in the surgeon’s clinic for the following week, and after I return to my own home, I entertain visitors daily. Most of them are astonished that I am capable of doing more than lying in bed, moaning and coughing weakly like a 19th century socialite dying of consumption. My father calls to check in on me every day, and brings flowers when he first visits. My mother and sister visit as well. The post-operative pain does not last long, and the subsequent discomfort is not as bad as I’d feared. I watch Bollywood and samurai movies that my yoga teacher has lent me. I cook and bake for my guests. We play music together. When I am alone, I nap on my couch with my radio tuned to the CBC or with a recording of an arctic ice storm playing in the background. I find comfort and relief in the North, in the cold. I heal and return to life, to my life, the one I have chosen for myself.
Despite the struggles, frustrations, and fears I have faced to come to this place, despite the increasingly rare but no less painful misgendering that continues (I am referred to as “he” by a pre-op nurse, a post-op nurse, and a recovery room nurse while in hospital), despite the fight with insurance that, incredibly, lasts another five months after surgery as they drag their feet on reimbursing me, misdirecting my surgeon’s office on where to send forms and pretending to lose my paperwork while settling and paying in less than a week the inexplicable $120,000 bill my hospital charges them for my uneventful two night stay — despite all of this, in the immediate wake of surgery, my overwhelming sense is of amazement and joy. I have a vagina. I write this in my journal over and over. While I never forget the revised contours of my body for an instant, I sometimes wake up in the morning astonished and amazed that I made this commitment to myself and saw it through; that I actually did this. In my adult life, I have often measured my success by how far I have allowed myself to stray from the brutal lessons in self-abnegation I learned as a child. By light years, by a century, this is the farthest I have ever strayed, the biggest commitment I have ever made to a life crafted around my own passion, beauty, and joy.
As the months pass, however, my amazement fades and I begin to feel a different sensation within me, somewhat more disquieting. It takes me some time to recognize that what I am feeling is exhaustion. After a year of constant concrete, definable tasks and a lifetime of discomfort in my body, I feel lost in this new space of accomplishment and triumph, of nothing left to do, nowhere else to go. My ever present companion, the bottomless well of creative tension that gender dysphoria has provided me, has been largely capped and sealed. This is not something I expected. There are many trans people for whom surgery is a necessary step for fulfillment; I never had the courage to think of myself as one of them. It was much easier to view this process in the same terms in which I’ve viewed other complex and scary periods of growth in my life; as a scientific experiment, a mere proof of concept, with the flimsiest, least convincing facade of detachment to downplay its vital importance. It was much easier to pursue surgery sideways, as I’ve approached anything that was too concrete, too permanent, too scary to look at straight on. For most of my life, I’ve focused on what I’ve had to do to survive, and only begrudgingly allowed myself the most parsimonious of opportunities to truly thrive. Many years of regular yoga practice helped me to forge a detente with my body as it was and to find stillness within ambiguity, holding two opposing truths at once. I didn’t realize how accustomed to and dependent on that creative tension I’d become until it was no longer there. Although I underwent this surgery in the pursuit of happiness, a sense of profound calm resulting from a resolution of that ambiguity was something I’d never allowed myself to hope for or even imagine.
Despite the learned helplessness of my childhood, as a grown woman I am not good at being idle. I am always most comfortable when working towards something, and before now, stillness has never brought me peace. After spending decades denying that transitioning genders was something I wanted, and additional years trying not to think about surgery at all, here I am now on the other side of it, my mind still churning out the questions, What next? and Where do I go from here? Without a goal, a deadline, and innumerable details to tend to, I feel my fire beginning to fade, and it scares me. I have not come this far to resign myself to a dulling of my flame. And so I do what I have always done when I have felt lost, afraid, and unsure of what to do next. In the dead of winter almost a year after surgery, I return to Ottawa, to spend a month walking through the icy winter streets, retreating into the quiet of my mind, and listening in the cold stillness for the calm, clear inner voice to guide my way.
What happens when the fire goes out? Do I spend a lifetime grieving its loss, or dive in to the cold of winter and the promise of life starting anew? I have been chasing after a body, a space, a place that feels like home for all of my life. Now, in the coldest capital city on Earth, during a month in which the temperature is often lower than on the surface of Mars, I am tracking my desire in the frozen landscape of a perpetual polar vortex. Without a grasp on my connection to the fire that has sustained me, I am stumbling for direction. What do I want, if not that which I’ve found? Who am I if not my longing? My world has changed — not from any coarse, physical shift, but because I made a decision, then a commitment to myself, and I followed through. I brought to fruition what was first secret and unthinkable, then merely unspoken and impossible. The darkened museum of false attempts I’ve made to find peace with myself is not just closing, it is burning to the ground. I am standing in the smoke-filled gift shop, gazing at the display cases, asking myself what I want to save, or whether it would be best simply to walk away quietly with nothing but memory, close the doors, and let it burn.
In the comforting, brutal cold stillness of this winter city, the answer unfolds and I embrace it. If I can no longer find my fire, then I will take my refuge in the ice.
* * *
Jane Demuth lives in New York’s Hudson Valley and travels frequently to Ottawa. She is a medical researcher, writer, bicyclist, and roller derby skater. Her writing has been published by Longreads, BuzzFeed, Awosting Alchemy, and Chronogram.
Editor: Sari Botton