"Okay, everybody." "We're starting in ten minutes." "Ten minutes to start!" "Come on, Gabe, triathlon's about to start!" "Hey, Max." "How are you, honey?" " Who's that?" " That is Ava." "She works at the club." " She's pretty." " Yeah, she is." "Lookit, there's Mom." " Whoo!" "Hey, boys." " Yes." " Hello." " Whoo!" "It's almost time." "You've got to give her a pep talk." "Okay, lay it on me, kids." " Try to be a gracious loser." " Yeah?" "Remember what happened last year?" "The police will not always be so gracious." "Okay, I'm feeling it." "Put it here." "Great talk, great talk, great talk." " Whoo!" " Go get 'em." "I got this." "Dr. Millicent Silvano..." " Watch out, people!" " Hello..." "Coming through, coming through, coming through." "And welcome, everybody, to St. Matthew's Free Clinic annual triathlon." "Even County General, who this year will eat our dust, losers." "I digress." "LA's hospitals have contributed their finest tricyclists, hippity hoppers, and roller skaters..." "Woo-hoo!" "To this fierce sporting spectacle." "The clinic gets the entry fee, the winner gets the bragging rights." "So, does every tricyclist have a bedpan?" "Okay." "Ready, steady..." "Go!" "Go, Forester!" "Go!" "Oh, man down!" "Hey, Marty." "Grab your big ball and get in position." "There's this stupid story about last year's intern." "The hippity hopper who dropped the bedpan." "They eventually found her body, right?" "Her body?" "Yeah." "Her career?" "No." "Oh, God." "Doctor?" "Nurse?" " Administrator?" " Consultant." "Oh, that's how you spell "ringer."" " Give it to me!" " Here!" "Whoa!" "Back off." "Yeah, go, Mom!" "Go, Alex!" "Go, Alex!" "Don't, I'm pregnant!" "Ha, ha, ha!" "Hey!" "Don't screw this up, Alex!" "Hey!" "Come on, Alex!" "Yes, come on, Alex!" "Sorry, are you okay?" "My backside's a bit sore." "Would a kiss make it better?" "Whoo!" "That's right, baby!" "I won." "Alex, Alex!" "Are you really pregnant?" "I'm just..." "I'm gonna get you water." " Hey, babe." " Hey." " Sorry, I'm kind of busy." " Yeah, we're swamped, I know." "I'm so sorry I upset you." "Yeah, it was a joke." "I get it." "I like to win." "I won!" "And sometimes I say things, and..." "Look, Al, it's all good." "Yeah?" "Exam room two." "All right, looks normal." " Hi, I'm Dr. Panttiere." " Hi." "I know you." "I work at the Waiting Room part time." " Right." " You put down "dance teacher."" "Was." "When it gets slow, Brian lets me wait tables." "You didn't finish filling out the form." "Here, sorry." "Hospital rules." "The part where it asks male or female?" " Your form needs more boxes." " Ah." "I was assigned male at birth, but I've always identified female." "I take hormones and I'm in transition." "Cool." "Which pronouns do you prefer?" ""She" and "her." Thanks for asking." "Of course." "Okay, where does it hurt?" "It's just along my ribs here." "Okay." "Excuse me." "There's some contusions." "I'm gonna press lightly along your ribs." "Okay?" "See if there's a fracture." "Let me know if there's any sharp pain." "The whole area is just sore." "What's this?" "That's my right breast." "No, the hard tissue." "I want to do a fine needle aspiration and some imaging studies to be sure." "It might be nothing, maybe just fibrous tissue, but let's not take any chances." "Ji-Sung will schedule the appointments, and once we get your results, we'll take it from there." "Okay?" "Okay." "Hey, excuse me." "Didn't we collide at the track?" "A woman never forgets a man that makes her see stars." "Do you need to see a doctor?" "Just did." "All better." " That's beautiful ink." " Yeah, thanks," " I'm a tattoo artist." " Really?" "No way." "Tribal, portrait, floral, geometric?" "What's your specialty?" " Transformative." " Wow." "I fractured my forearm; the scar was permanent." " So I did this." " That's beautiful." "People come to me with scars, amputations, things that make them feel unattractive." "So I take those wounds and transform them into beauty." "Do you ever transform old tattoos?" "All the time." "All right, I've got something I want to show you." " Is it a tattoo?" " Yes." " I didn't mean..." " Uh-huh, no." " Sorry." " Call me." "I want to see what you've got." "Still talking tattoos?" "I thought Brian was back." "He's got another couple days." "But it looks like he's going to get that club, fingers crossed." "Well, you're a very good boyfriend and a hell of a husband, should you need a reference." "Hey, Ava." "I've been trying to reach you all week." "You missed two appointments." " I've been busy." " Hey, if you need time off..." "And you haven't returned my calls." "Ava, the cytopathology report is worrisome." "There are some atypical cells." "It doesn't mean cancer, but we need to do a more definitive biopsy, sample more of the tissue to find out if cancer is present or not." "Dr. Zhang is the best breast surgeon in the business." "I personally recruited him from Baltimore." "His incisions are tiny and they heal beautifuly." "How does he feel about trans women?" "The same way he feels about any woman, or I wouldn't let him near my hospital." "Okay?" "Come on, after everything you've been through?" "You know, caught early, most breast cancers are curable." "But the fear of letting that cancer spread and metastasize?" "That bitch kills." "I'm glad we caught this early." "Oh, no, Ava." "How long have you known?" "Well, I had..." "I had a little lump when I was still a boy, but I didn't think that men could get breast cancer." "Breast cancer doesn't respect gender." "Has there been any significant growth recently?" "Yes." "This is your room." "You remember Ji-Sung." "She'll help you get settled in." "Hello again." "Your skin is beautiful." "No, that's... that's crazy." "Really?" " Your pores are really tiny." " You know what, you can go." " I got this." " Yeah, just..." "Thank you." "How tiny are they?" "It's very kind of you to meet me here." "Oh, no problem." "It's on my upper back." "So..." "Jesse, nakedness goes with the job." "I can handle your bare back." "Okay." "Ah, outline of a hat." " Yeah." " Is that a bowler derby?" "Sort of." "Which signifies?" "Just a crazy moment." "Ah, was it a girl?" "Could be a guy, I'm not judgey." "It's complicated, but, uh, yeah, it was for a girl." "Hmm." "But she never actually saw it, so..." "Not much shading and the lines are clean." "You could get it lasered off." "No, I don't want to pretend it didn't happen." "But I think it's time to move on." "Okay, then." "I have some design software." "I could show you some possibilities." "Mind if I take some photos?" "Sure, that's what they all say." "Ah." "Wrong room." "Okay, people." "You know the drill." "Budget distribution comes down to relative value units for each department." "So, rack up the points." "Because medical care and World of Warcraft have so much in common." "What kinds of points were you racking up yesterday, Jesse?" "Sorry?" "I walked into an examination room and there he was, half naked with a woman touching his body." "Wait, half naked?" " Which half?" " It's not like that." "She's a tattoo artist." "Wait a second, you've got tats?" "A tat." "I've got one tat." " Do I want to see it?" " That's not gonna happen." " Oh, he's ashamed of it." " Whoa, whoa, whoa." "There's nothing to be ashamed of." "Completely innocent question." "Is this an imaginary tattoo?" "Yeah." "You're not gonna let this go, are you?" " No." " Show us." "Yeah, show us." "All right, sure." "You're really gonna take it off." "Oh, he's taking it off." " Oh, God." " Oh, my God." "What's that, an Afro?" "Or..." "A hat?" " What is that?" " I like it." "It's edgy and it's English." "Wait, is it ironic, or what?" "I don't..." "Did you lose a bet?" "Nerd alert." "So how about you, Panttiere?" "A bowler hat?" "Okay." "Must mean something." " Okay, that is not true." " Yep, it is." " You're just lying to me." " No, I'm not." "Dad!" "Dad!" "It's not fair." "I'm the oldest, so I get to slice the cake." " Right?" " Not fair." "The oldest gets to slice the cake." "Oh, yeah!" "What did I tell you?" "While the youngest gets first pick." " Dad!" " Oh!" "So I would make sure that both those slices of cake are completely equal." "Why would you even say that?" "That's not even a part... you're just making this up." "By the way, this is your one hour of video games for the night." "Are you sure you want to spend it arguing about a piece of cake?" "Man, you are a natural-born father." "Well, I've always kind of grooved to the crazy kids." "Did you always know you wanted them?" "Yeah." "How about you?" "I mean, kids were never that important to me." "My sisters got two, I mean, they're great kids." "But it was never like" "I had to have one, you know?" "Yeah, Alex is pretty clear about the fact that..." "That, I do know." "Before she agreed to go out with me, she said I needed to know three things." "One, she spits on other people when she gets excited." "She hates being called "Alexandra."" "And she's done having kids." "And you said okay." "It's okay." "Things change, Pierce." "I mean, I love Alex." "And I want kids." "You said it out loud." "How'd that feel?" "I don't know, I don't know." "Give it to me!" "Do I want to know?" "Both:" "No." "Your flash mob would have rocked." "Maybe next year." "When I was a dance teacher..." "You taught dance?" "Mostly kids, so sweet." "Why did you give it up?" "Well, one summer Mr. Andy went away and Ms. Ava came back." "That was a little hard to explain to the parents, so the studio let me go." "I still miss it." "Well, anyways." "Do me proud and show me your moves." " Ready?" "Okay." " Right." " Five, six, seven..." " Ready?" "In pre-op, we're supposed to help the patients relax, which is why you're all leaving." "Get out of here." "Farewell, hookers." " You mean "hoofers."" " No." "Um, Ava, you can't wear makeup in surgery." "I need to get a nurse to take it off." "Please, I can deal with anything if I feel beautiful." "It's hospital rules." "Anesthesiologist needs to see the color of your skin and lips to make sure your blood is properly oxygenated." "If it's your kids you should take it." "One quick text, and thank you." "You promise you won't laugh?" "I want four kids, a mini van, and to be, like, the most glamorous soccer mom that all the other moms hate." "Oh, you don't need to be glamorous." "They'll still hate you." "Because you work, and bring lousy snacks, and once, one time," "I parked in the handicap spot because I was running late." "Four kids?" "Big families are the best." "Are you gonna have more?" "I thought I was done, but my boyfriend and I have some issues we need to explore." "Oh." "Ava used the words "makeover."" "I don't remember the rest." "Am I... am I pretty?" "That lipstick is nice." "But you can't wear any." "I'm sorry." "We're gonna have to take it off." "Whoa, whoa, whoa." "How about a compromise?" " Hey." " Bad memory." "When I was still a boy in the schoolyard." "It's recess, and the boys don't pick me for dodgeball and the girls don't want me touching their dolls, and recess just never ends." " Did you get the results yet?" " No, but..." "Can anything be done about it until we do?" "Then allow me to live in hope." "I love hope." "I also love spa days." " Ding!" " Is that my makeup kit?" "Yeah." "I figured a woman as pretty as you knows a thing or two about makeup, maybe even threading eyebrows." "We could do that." "Or we could, and it's just a suggestion here, get rid of your mustache." "Both:" "Mm-hmm, mm-hmm." "I don't have a mustache." " Mm, mm-hmm, mm-hmm." " Just little one." "Mm-hmm." " No, a couple more minutes." " It's itchy." " I think I'm done." " Trust me." "No one knows more about hair removal than a trans woman." "Go." "You said you always knew." "When did you let other people know?" "I was nine." "And I got into my mother's makeup 'cause I wanted to make myself look pretty for Sunday night dinner with the family." "They weren't even surprised." "The thing is, I looked pretty." "I looked right." " And you never had any doubts?" " Zero." "I mean, I'm a woman." "What nature confused, hormones put right." "Wow." "In my entire life," "I have never been that sure about anything." "I've noticed that about you." "Yeah?" "Do you know what I've noticed about you?" "Your muzzy was out of control." "Whoa." " Hey." " Hey." "You're killing me." "Am I making those smacky sounds again?" "You're not making any sound." "You're the one who always wants to talk about his feelings." "What happened?" "I learned from you." "Come on, Harrison." "Talk." "You were up front from the beginning and told me you didn't want any more kids." "And I was okay with that, because I wanted you." "On whatever terms, I wanted you." "Okay, but now?" "The minute you said you were pregnant, I saw her." "Who?" "Our daughter." "I'm holding her in my arms." "She's got your smile, your eyes." "She's got my great hair." "She yelled at me for making smacky sounds." "She's beautiful." "If you tell me you named her..." "Your patient's in trouble." "We used your new 3D breast tomography..." "Great images, by the way." "She's got a suspicious lesion on the other breast that the digital mammogram missed." "I biopsied both sides, and they both came back with invasive ductal carcinoma." "Poorly differentiated." "Her genetic testing shows she has a BRCA gene mutation." "She's genetically male, and the BRCA 1 and 2 gene in men increases the risk of breast cancer." "I'm gonna recommend a bilateral mastectomy." " Yeah, of course." " Because of the aggressive nature of the disease and the tumor size." "I'll talk to her." "You want me to do it?" "She's my patient, thank you." "Good work." "Alex, do it now." "You want to cut off my breasts and leave scars across my chest?" "There are reconstructive surgeries and implants, Ava." "Will the hormones that I take allow me to grow my natural breasts back?" "No." "I mean, the hormones, you have to stop taking them." " What?" " Hormones can accelerate the growth of cancers in the body." "Hormones don't cause cancer." "No." "Emphatically, no." "But what we found, it could've already existed before you began the transition." "Continued use could accelerate growth of cancer." "Nothing is worth that." "I'm sorry, Ava." "We'll manage a gradual withdrawal, but you need to stop using hormones." "You're telling me to give up my identity as a woman." "I'm telling you we can fight this and win." "Win what?" "Without my hormones, I don't have my soft skin," "I don't have my roundness, I will not be a woman anymore." "You need to do this." " Okay." " So?" "There are a lot of possibilities." "Is that a clown car?" " Spaceship." " Spaceship." "I don't know, what would you choose?" "Come on, you're a tattoo artist." "I want your professional opinion." "This is why amateurs should not get ink without using their mind or their spirit." "Whoa, this took a turn, all right." "Body art is the most personal statement you can make." "You're writing on your flesh to tell the world something indelible about yourself." "You don't ask another person what that should be." "This Maori tattoo, a boy from New Zealand." "These bougainvilleas, a cousin I lost too soon." "This stupid goldfish, summer theater camp." "I regret nothing, especially my mistakes." "Your bowler hat?" "Something touched you so deeply that you wanted a record of it, so you wrote it on your body." "Not in glitter, but in ink." "Permanent ink." "Now you want to change that?" "Let's find the thing that you want more, and we'll write that on your body." "You know, not a lot of therapists would let me have a session while shooting hoops." "I discovered it was the best way for my stepson to talk to me, too." "I didn't know you had a son." "Trevon was from my ex-wife's first marriage." "After we split, she wouldn't let me see him." "The woman has no problem cleaning out my pockets to pay for his private school." "Sorry, I had no idea." "He's a good kid, so I deal." "Well, before your marriage, how important was being a father to you?" "Hmm, I couldn't imagine it before it happened." "Now I can't imagine my life any other way." "Am I missing something?" "Am I gonna regret not having kids?" "That's the question I should ask you." "Do me a favor and don't." "Any chance of Alex changing her mind?" "What are the chances of you changing yours?" "Max, you got my message." "Thanks for coming." "I need all the help I can get convincing Ava to have the surgery." "Oh, uh, when was the last time you talked to her?" "This afternoon." "What's going on?" "There's not going to be any surgery." " Ava..." " I get it." "I'm gonna die young and it's not gonna be pretty." "But I'm gonna die the woman I was born to be." "Will you talk to her?" " You think I haven't tried?" " I don't understand." "If your offer to take me home still stands," "I'd like to go." "You know, for the first time, I don't believe you're a woman." "Excuse me?" "What does being a woman mean to you?" "You have no idea how entitled you are." "Okay, maybe." "But owning my gender identity has nothing to do with hair or makeup or clothes." "That's drag." "Did you just compare trans to drag?" "All I'm saying is real women fight." "Real women endure hardship to live another day." "You want to own your identity as a woman?" " Stay with me and fight." " I don't care what you do or you don't understand." "This is me saying no." "This is my decision, and it's no." "Excuse me, I'm here to see Dr. Shane." "Actually, I'm a little early." "He said I could set up in exam room four." "I'll take her." "How far along are you?" ""Don't, I'm pregnant."" "Yeah, yeah." "I'm not pregnant, just a thing I wish I hadn't said." "I figured, but hey, you pushed me into Jesse's arms." "So, thanks for that." "I looked you up." " Did you?" " You're good." "The work you do with amputees is amazing." "You're an artist." "Ah, that's what Jesse said about your suturing." "Did he?" "Most surgeons sew your body back together, he said." "But Alex sutures like she could restore your soul." "Did he mention everything I know, I learned from him?" "He left that part out." "Come on." "Come on." "Come on, come on, come on." "Okay." "Ooh, ooh, eee, eee!" "No!" "Whoa!" "You don't have to kick the thing." "It's got feelings too, you know." "Inanimate objects don't have feelings." "Like your heart." "That's where you're wrong, Panttiere." "You've got to be one with the claw." " "Be one with the claw."" " Feel the negative space." "Yeah." " Compensate." " Compensate." "Compen... what?" "Yeah." "You see that?" "You had a seriously misspent youth." " What, you don't want it?" " Yeah, I want it." "Hmm." " It's a stupid bowler hat." " Ha." "It's a tiny bowler hat with a hair clip." "You're missing the point." "Is that an actual smile?" "I forgot you knew how to do that." "You know what my days are like since I was banned from surgery?" "I change dressings on venous stasis ulcers." " That smells." " I plate sputum." " Hopefully in a petri dish." " I disimpact bowels manually." "You know, you've got to triple glove yourself if you're gonna do that." "And you know what?" "I can't even go to Cleveland, because you wouldn't recommend me." "Oh, stop your whining." " I saved you." " Saved me?" "Mclntyre was gonna fire your ass, and I got her to change it to a probation." "You keep your head down for six months, and you'll be fine." "Without you." "Yeah, without me." "You know what I have to say about that?" "I can't." "I can't, you're leaving." "This never happened." "It happened, all right." "And that's the john." "Shoot." "You can't prove it." "Jesse!" "Oh, you're finished." "What did he change it to?" "I think that's a question you need to ask Jesse." "Yeah." "Probably not." "The bowler hat!" "That was you?" "It's been a strange day, and it's about to get stranger." "I'd like to ask you a favor." "I love you too." "Congratulations." "That was Brian." "He made an offer on the club." "Vegas, baby!" "Come on, everybody loves Vegas." " Sin City, huh?" " For a weekend." "Hey, Ava." "You got a moment?" "Grilled cheese is today's special." "That'll raise your spirits and your cholesterol." "I want you to meet someone." "I'm Ruby." "I'm a tattoo artist." "Would you like a table or a booth?" "I'd like to show you some photos of the work I do on people with surgical scars and amputations." "And women with mastectomies." "I'm not doing this." "You should take a look at these, Ava." "They're really pretty amazing." "This woman took shrapnel in Afghanistan." "Even with her flak jacket, her chest was crushed." "Now look, a phoenix rising." "And this boy, his arm was nearly severed in a car crash." "And now it's beautiful blue bolts of lightning." "These photos are just examples of how people have turned loss into beauty." "Something you already know." "None of these people planned to look like this." "But something happened, and their plans changed." "They could've gone the rest of their life feeling ugly, or they could redefine what beauty is." "You were born in the wrong body and you made a change." "You can make another." "I won't look like a woman." "Nothing can change what's true." "Fine." "Hydrangeas." " Hydrangeas?" " Hydrangeas." "Easter Sunday, my mom used to wear a hat that looked like hydrangeas." "She looked like a movie star." "Why do you care so much?" "Because a good woman is worth fighting for." "Let's see what the pathology says." "I believe I have negative margins." "In terms of closure, inversion sutures following the chest contour might prevent hypertrophic scarring." " I'm aware of that." " I know it's not protocol, but I'd like to do the closure myself." "Allow me to observe your technique." "Is that a 5-0?" "I want a 6-0 monofilament." "Oh, Alex." "Max called when you were in surgery." " Is something wrong?" " No, no, no." "Gabe pulled his tooth out in school." "Oh, my God, he did?" "They make such a big deal about it when a kid loses a tooth in school." "They give the kids this fake plastic tooth to put it in, and everyone congratulates you..." "You don't know." "Huh?" "This is gonna be a tough one to get around." "Yeah, but it doesn't mean we can't get around it." "Can we put this on hold?" " Yes." " Okay." "But we're coming back to it." " Okay." " I need to." "It must feel tight, but that's just the swelling." "It'll go down." "This is gonna help a little bit with that soreness and back pain, okay?" "We customize the breast forms to fit your body." "I know it's been a rough two weeks, Ava, but you know all about transitions." "It's gonna take a while." "You say that like there's gonna be an end to this." "There is, I just got your pathology report." "Now, you'll still need radiation and tamoxifen, but we got it." "I'm not talking about the surgery, Alex." "Wait!" " Ava!" " Wait!" "You can't leave until we dance for you." " Are you crazy?" " We're not crazy." "We are Hip House Hospital." "Hit it." "Keep your day jobs." "Thank you." "Was that a vote of confidence?" "Hello, ladies." "Ava, this is your new support group." "Welcome to breast cancer survivors." "Okay, let's just get this out of the way, because some of you might not want me in your group." " Why is that?" " Because I'm a trans woman and I make zero apologies for that." "Did you have a mastectomy?" "Yes." "Ava, in this group that makes you just one of the girls." "Just one of the girls." "So, I hear you have new tattoo." "What does it look like?" "A lot like the old one." "Someone told me I should only replace an old tattoo with something that means more." "You kept the bowler hat." "You did this, didn't you?"