Better Gomorrah than the Grave

Time is a fickle creature we attempt to wrangle in with memory. 

When I was recovering from my surgery, the hours seemed to stretch out into long ribbons of forever. I spent weeks confined to a bed and its adjoining bathroom, drinking soup made by my friends and wasting money made by my sister. The surgery itself wasn’t the problem; it was the healing that drove me mad, waiting for the fresh wound between my legs to scar before becoming skin, counting each day and the milestone it brought. How many centimeters could I stand to sound; how much pain did it hurt to urinate. How long until the blighted flesh between my legs began to feel like a part of me; how long until I looked in the mirror and felt only joy. 

I was young then, even though I felt so old. I had tasted the false freedom promised and I wanted more. There was so much world waiting for the woman that I had just become, and I carried the burdens of the world on my shoulders.

Then I blinked and lost my grasp on time. It slipped through my fingers like sand, until one day I realized I had become nothing more than a tool for those in power. In the video font of memory, the time it took for me to heal from bottom surgery was the same amount of time it took for me to take the foreign medical boards, finish residency and fellowship, work thanklessly in community clinics before taking a job with the Corporation that has become synonymous with the Government. 

Healing felt like an eternity, but one day I woke up and I was whole for the first time. It was also a slow process by which my dreams and convictions died; I am waiting for the day when the other coin will drop, when I will wake up and realize that I am completely empty. 

-

There is a medical condition called polycythemia vera, which can cause can excess of red blood cell production in the bone marrow. The cure to this condition, obviously, is frequent blood donation. 

In the same way, there is currently an excess of humanity upon the Earth. The solution, then, is for some of us to leave. Donate our numbers to the stars, as the official slogan of the Beyond Earth Project says. Lovingly crafted by my friend, the poet Rosetta Blue, to minimize the colonialist connotations. 

In my youth, Beyond Earth’s promise of mass depopulation of Earth via spacefaring was simply the pipe dream of a nepotistic technocrat, but the movement gained steam after cats suddenly disappeared from the world and songbirds returned to the parks and gardens to roost. Even as famine wrecked the farmlands, the sound of birdsong in the morning inspired the populace to dream of a healing Earth.

Now it is in its second phase, which means the four flagships, the Archives of Earth, are currently being built. Too large to launch out of Earth’s orbit, they assembled piecemeal in space by laborers specially modified to exist in low gravity. Assignments are permanent, because the return on investment in sending someone up and then bringing them home with significantly reduced biomass and unable to return to work is too low. Instead, Beyond Earth has workforce that chooses to leave Earth and spend an indeterminable time out in space, building spaceships the size of cities that they will be too irradiated to board. 

And who will build these launch stations? Who will we sacrifice for humanity’s glorious dream? Our imperfect children, of course. They will have a taste of space before us. Twisted and changed, their own skin’s tint made different to better withstand the cosmic rays. 

It almost feels like the Crusades, the way we speak of the Heavens, and send children to die for the cause.

I overheard Beyond Earth’s director once say over a glass of chilled Chardonnay that in this day and age, any workforce can be sourced if the price is right. And in the case of finding volunteers for his Space Corps, the price is good healthcare.

Since the government’s refusal to support gender affirming care, good medical transition costs an arm, a leg, and a passport. The only exception is Space Corps’ adaptational surgery, which is paid for by the Corporation. Everything related to becoming a spacer is paid for, from room and board to vocational training. All for a lifetime of labor away from Earth. 

I see myself in so many of my patients, even though I know I shouldn’t. I know who chooses to become a spacer well enough to have my first questions be “What name do you want me to call you?” 

It always takes my patients aback, including the young person before me. Mixed race and malnourished, with half of their head awkwardly shaved and an ill-fitting jacket falling off their shoulder. I am using ‘they’ at the moment because there is a button with those pronouns on the jacket.

The child, who looks simultaneously too young and too old to be nineteen, gives me the name on their government ID.

“Are you sure that’s what you want me to call you?”

They eye me with suspicion.

“This doesn’t go in your chart,” I assure them. “I just want to call you by the right name. Everyone deserves that kind of respect. For example, you can call me Dr. Goo.” I give this name out to put my patients at ease. Some people still have problems with Mandarin’s four tones, and the way my first name, Gui, and my name name, Liu, have the same vowels but don’t rhyme.

They finally tell me to call them Rad. I confirm that ‘they’ is the correct pronoun to use as well. 

“And what brings you to the clinic today, Rad?” I ask, even though I know the answer.

“ Aerospace exam,” they reply, hoping their bored tone hides their nervousness. I let them think that they are getting away with it. Kids like Rad need a win these days. 

“Is this your first time at the doctor’s alone, Rad?” Medical guidelines say it shouldn’t be, but I can guess their family background by their company sponsored insurance plan. Kids like Rad get checkups from their commissary and rarely come to bother doctors unless they are about to die, and sometimes not even then.

When I was in medical school, pediatric guidelines stated children should be seen yearly up until the age of eighteen. There are itemized guidelines for social screening questions at each age. Home, school, drugs and sexuality. All the purview of doctors, because health is in everything.

That’s what they taught me in my ivory tower. But I have learned through years of working at the Corporation that what doctors preach and what doctors practice are two completely different things. Not here in the United States of America, where the ability to be healthy is only available for those who can afford it. 

“That’s none of your business.” 

My question has made them defensive. I quickly backtrack.

“I’m your ally here, Rad,” I say gently. “The purpose of this visit is not just to assess your readiness for space, but also to take a general look at your health. I like to get to know my patients a little before we start, is that okay?”

Rad looks down at their watch screen and shrugs.

“Rad?”

From the movements of their pupils, I can tell they are instant messaging someone.

“Can you finish that conversation, Rad? I’d like your full attention if possible.”

Rad rolls their eyes, either at me or as a way to close their messaging app. “My friends told me this is supposed to be quick,” they mumble. “Just say I’m good to go for surgery and I’ll be out of here.”

“I do things a bit differently than my colleagues,” I lie. In truth, some spacer exams take all of five minutes. Abrasive young adults like Rad come in, and after an ECG are given the go-ahead to have all the necessary Space Corps procedures; a four-stage process to prepare the body for extended periods of time in space. Modifications done to the bone marrow, digestive tract, and endocrine system to preserve bodily integrity and decrease cancer risk. Not that cancer can be entirely eradicated from the human body just yet.

Cancer thrives on fast growing cells, which is why the digestive tract is shortened and vulnerable endocrine glands—thyroid, parathyroid, pancreas, and gonads—are removed and replaced by a sequestered neo-organ programmed to supply the body with the necessary hormones.

Though necessary is sometimes relative. Beyond Earth and the Corporation don’t really care what hormones the spacers are getting as long as they can work. If a body that naturally produces estrogen suddenly starts getting testosterone from the neo-organ instead, well, that’s between the spacer and their doctor. 

It’s the open secret that has fed the spacer program since launch. A bargain for bodily control: become a spacer and your body will be healed, you will be fed, and your family will be provided for aboard the Archives. All that we ask for is your body, your labor, and a farewell to life on Earth. 

Sometimes I wonder if the Corporation turning a blind eye to the free gender expression of the spacers is intentional. Maybe it’s a way of separating out the chaff, exploiting those for whom the future is tenuous, and whom those in power do not want in their future. 

Would I have taken the bait at their age? I can’t help this moment of countertransference; I find myself caring more than usual about these trans kids who see becoming spacers as the only way to feeling at home in their bodies, at the cost of Earth itself. 

“So, me about yourself, Rad.”

“I want to go to space.”

“Forget about space, what are your interests?”

“Going to space.” 

I widen my smile to hide the clenching of my teeth. “You really don’t want to talk to me, do you?” 

At last, the child meets my gaze, and I notice some mild strabismus in their left eye. It isn’t significant enough to disqualify them from becoming a spacer; nothing that some free ocular surgery can’t fix. 

“I don’t have anything to say.” 

“You have many things. Where did you grow up? What were your childhood dreams?”

“Here,” Rad says. “I grew up here, just like my parents, and my childhood dream was to leave.” They cross their arms. “What, are you sad I didn’t say doctor or something? I figured out pretty early that I wasn’t smart enough to test into any gifted program, and my parents didn’t have the money anyways.”

“Space is your only escape.”

They smile wryly. “It’s humanity’s escape, isn’t it? That’s why you’re sending us up there to build the launch stations and the libraries or what-not.”

“The Archives,” I correct them, not out of any loyalty to Beyond Earth’s branding, but out of love for my friend Rosetta who named them. 

From the bored eyeroll they give me, I know it doesn’t matter to them. For all they care they could be building a mausoleum. And perhaps for them it is. Rosetta once remarked on how apt it is, the interchangeability between corps and corpse.

“I want to make sure you are aware of the risks of joining the Space Corps,” I say, abandoning my attempt at connecting with them. “To reduce your risk of cancer, we will be removing significant parts of your body. All of your skin will have an underlying selenium mesh. You’ll lose most of your colon and have a bag that collects your feces. Your thyroid, parathyroid, pancreas and gonads will be removed, and replaced with a neo-organ. While it’s generally tolerated, there’s still a 3% chance of rejection, after which you’ll have to receive hormone injections and won’t be able to go to space. All of these changes are permanent, and surgery can worsen any dysphoria you already have. On top of that, there is no data how these surgical changes fare on reentry. Once you go up, you won’t be able to come down.” I pause and study their face, to see if my words have shaken them in any way. 

Rad keeps their eyes on my shoulder as they ask, “I can also get top surgery, right?” They try to hide their eagerness in their voice.

I blink. “Yes, you can opt in for a double mastectomy.” It’s the reason why Space Corps is sometimes nicknamed the T Squad. Corporate insurance begrudgingly covers surgery to remove breasts in the name of prophylaxis; reconstructive genital surgery, unfortunately, is out of question. 

For the first time, Rad’s face twitches into the semblance of a smile. I feel like I’m using a riding crop on a masochist. 

“I want to make sure that you understand the finality of spacer surgery,” I continue. “You will be sterilized, and if you want to have children, you’ll have to pay out of pocket for germ cell storage.”

“I don’t want kids.”

“I understand.” I don’t belabor the point. The younger generation see little point in procreation amidst a dying world. Maybe it’s for the best that spacers are sterilized; the Corporation doesn’t want an ethical nightmare like the children of Mars. “In that case you’ll need to find a place where you can recover from surgeries. Most spacers deploy one year after their last surgery.”

“I’ve got people,” Rad says confidently. “Modify me, Doc.”

I wonder how many of Rad’s friends are like Rad themselves, waiting for a surgery that will change their lives. I wish I can hold all of these children in my arms. I wish I can give them a future beyond outer space.

“You are certain about this, Rad?” I swivel the computer monitor away from both of us. “This decision will affect the rest of your life. If there’s any other way I can help…”

Rad’s face twists into an ugly grimace. Their restless leg increases in amplitude, and their hands ball into fists. “God, stop asking me if I’m sure—I’m sure. I’m sure! I’ve wanted this my whole life.” Their voice cracks during their outburst. They begin to hit their leg with their fists, each word punctuated by a moment of self-injury. “This is the only way to be me.”

  “I’m sorry,” I softly say, at that moment choosing humanity over professionalism. I take off my glasses so Rad can see my face; the prominent brow estrogen can’t undo, the marks first puberty has left on my throat. “I’m transgender too, and I just want you to have a chance at life. You will be deployed into space and likely never step foot on Earth again. And even if you do, your body will have adapted to low gravity. Most returning spacers can’t walk around unassisted.”

Rad looks at me with resentment. Kindred they didn’t ask for. Kindness they don’t need. “Don’t pity me. I’m not making this choice to die. I’m making this choice to live.”

Their words stun me into silence. I have been seeing Rad as a body, a circumstance, thus negating their personhood. By casting them in the role of victim, I was unable to see them for what they truly are: a survivor. 

“Estrogen or testosterone?” I ask, swinging the monitor back in front of me.

“Testosterone,” Rad answers after a pause. 

“Gonadectomy is usually performed during the second surgery. Neo-organ placement occurs one month later, so we’ll have you on weekly testosterone during that time.” I glance at the set of flags stitched on their jacket. “We can then figure out what levels we want to program into the neo-organ. You’ll be seeing a lot me in the coming year.”

“My parents won’t know?” 

I shake my head. “You’re a legal adult. You are sacrificing a lot, but this is the one thing they can’t take from you.”

Rad puffs out their obviously bound chest as they regain some of their bravado.  “I look forward to working with you,” they say.  

I want to hold them so badly. I want to tell them to hold onto their joy for as long as they can. I want to give them a future they deserve, where they do not have to sell their body to be themself. But I have no such power, and so I gather my things and move on to the next patient.

As I leave the room, they pipe up once more. Quieter this time, without the intentional vocal fry they put on to make their voice sound deeper. Small and tinny, the voice of a child, though one wiser than I. 

“Thanks, Doc G. Appreciate you.”

For a moment I feel jealous of them, that in this age of alienation they know their body well enough to make this choice. And maybe they are lucky for it. Families like theirs aren’t guaranteed a spot on the Caravels. At least this way, they have a chance to be among the stars.

-

My favorite mentor once told me, in this profession there will be patients who haunt you. Rad is one of those patients, and I hold them softly in my heart though I try not to show my favoritism in front of them. Our interactions never lose that edge of awkwardness, and I do not see them off when they deploy. It’s not my place. 

I catch them in the cafeteria sometimes, eating and laughing with the other members of their spacer cohort. After my visit with Rad I no longer feel a deep sorrow when I look at these young people in the process of metamorphosis. I used to zero in on the healing scars and the drain lines, but now I see their smiles and hear snippets of their animated conversation, and I am struck over and over with how alive they are.

All I can do is remind myself that in a world crueler than the one I grew up in, people like me are still choosing to live. Rad is making a brave and ugly choice; not the right one, because there is no right or wrong in survival. Only strands of joy so fine they break when you clutch them, but all we can do is cling to them against oblivion. 

On the day of their cohort’s launch, I watch their hormone levels as they are transmitted from their neo-organ, the slow climb of cortisol as they leave the atmosphere. I continue to monitor their physiology for the next three months until they reach the shipyard on Europa, where after a few days their signal, like all others before them, goes dark.