Hell was a hospital waiting room.
Ash’s mother gave their hand a squeeze. When they looked out of the corner of their eye to see her face, she gave them a tight-lipped smile.
The two of them had arrived early on the morning of Ash’s thirteenth birthday, at the exact moment the doors had opened, but the doctors hadn’t been able to fit Ash into their schedule. Today, they were there well before the hospital was able to let them in, but they had still been near the end of the line. There were only a dozen selections allotted in a day, split evenly down the middle, and Ash only had so many chances before they no longer had a choice to make.
“Richmond, Arnold?” the receptionist called from her list.
Another thirteen-year-old in a Burberry blazer got to their feet. Ash’s stomach was a fist. Arnold had been in the waiting room already when the rest of the throng had been let into the building. Obviously, palms had been greased.
Ash felt their mother’s hand on their shoulder and wanted to rest their head against her arm. But that was what they would have done when they were a child. They were old enough, now, to know better than to do that in front of so many strangers their own age.
The other kid, Arnold, walked to the receptionist, followed too closely by a tall man in a smart three-piece suit. They resembled each other, even in the tense set of their shoulders.
“Alright, Arnie,” the man said. “You know your mother and I will love you no matter what, don’t you?”
The kid nodded, but they were ghostly pale under cropped blonde hair.
“We trust you to make the right decision,” the man said.
Arnold nodded again and followed the receptionist through the heavy, wooden door alone.
The father watched for a long time—well after the door had closed—before he walked back to the uncomfortable, vinyl seat he had been occupying and sat down with his tablet to wait.
Ash didn’t know what Arnold wanted, but if the father got what he wanted, then that was one less chance for Ash.
“Mochrie, Helen?” the receptionist called. A girl’s name, the first yet, and the kid who stood when called looked at home in an A-line dress and cardigan. Ash tried not to let themself feel relief. They didn’t know anything yet.
“Ash,” their mother whispered.
They looked over. She was still smiling, but the smile was watery and strained.
“Hey,” Ash said. They hated the sound of their voice. High. It sounded so much more like a child than they wanted it to. If they got their way today, the procedure that they endured would change that pitch with time.
Then they would become he.
“What are you hoping for?” their mom asked.
Ash shrugged. They were afraid to say it out loud. If they did, it might not come true.
They knew they were already luckier than some. They couldn’t imagine what they would do if their parents had told them they wanted a daughter.
“If it doesn’t work out today,” she said. “There’s always tomorrow.”
“Kirkland, Randolph,” the receptionist said.
The first three had been rich, Ash knew. They had been sitting in the waiting room well before Ash had. They would have the chance to choose their sexes to match their names. If they had to choose to match their hearts instead, then they could afford to have the names changed.
Ash shifted self-consciously. Hand-me-down jeans—a bit too tight—and a polo were the nicest clothes that Ash had been able to find that morning. They had wanted to dress up, but their slacks were too small on them these days.
“Anderson, Lee?” the receptionist said.
Ash let out a breath. A gender-neutral name meant that the doctors were probably finished with the rich kids for the day. Ash tried to remind themself that this didn’t mean much. They had still been eleventh in line for twelve slots, and there was no way to be sure what would be left when he went back. Still, it was a load off to know that every other person left in the room was in the same boat as they were.
Thirty minutes went by. Then forty. The waiting room slowly emptied.
“Masters, Ash?” the receptionist said, at last.
Their heart stuttered in their chest.
“Oh, hon,” their mom said. She leaned over and planted a kiss on their cheek. “Come back out if you need to, okay?”
They hoped they wouldn’t need to because the one thing that their mother wasn’t saying was that if they weren’t able to be seen today, they would only have one more chance.
The receptionist opened the heavy door and Ash slipped through, following her down a hall, past a row of doors, and into a small exam room. They stopped short.
Sitting on the exam table were two pink folders.
Ash chewed their lip.
“What do you say, sugar plum?” the receptionist asked.
Ash’s throat tightened.
“Um…” they said.
Children were born, each and every one, as smooth below the belt as a baby doll. In the seventh grade, they learned what they could about their options. It was an internationally mandated constructive procedure, performed on one’s thirteenth birthday. Though the mandate did not make it compulsory, it made it the only medical procedure that was offered to all citizens free of charge.
That is, as long as they did it within three days.
Ash stared at the two pink folders, the choice that wasn’t a choice at all. Their mother wasn’t going to be paid for her time off if they came back tomorrow to try for blue. She would do it, but they might not be able to afford the car payment on time that month if she did, and that could put the family finances irrevocably behind unless their father could get overtime at the clinic, which was unlikely.
The receptionist glanced at her watch.
“There’s a waiting list, you know,” she said. “Some kids waiting outside the building who would kill for the chance you’re getting.”
If Ash arrived at school after their medical absence without the procedure done one way or the other, their classmates would know. They always knew. Every year they weaponized the school’s birthday calendar, as at least three eighth graders took it upon themselves to corner newly configured students in the bathrooms and locker rooms of the school. If the student wasn’t willing to prove their sex, the proof would be taken by force. If the others didn’t like what they saw, there would be no hope of a peaceful existence.
“Well,” Ash said. “Better let one of those kids in.”
The drive home was silent. Ash knew as soon as they saw their mother’s face in the lobby that they had messed up. Even so, their heart calmed with each step away from those pink folders. As they had walked past the first of the exam rooms, Ash had noticed a pink folder clipped to the door with Arnold’s name on it.
Ash wondered if her drive home would be silent too.
A knock on their bedroom door woke them from a dead sleep. “Hey, Ash?”
They rolled over, looking up in dull surprise.
“Dad?”
“Hey,” he said. The room was dim even with the bedside lamp lit. Ash’s father sat at the foot of their bed. He was a tall and narrow man, and Ash ached when they looked at him. If they had just been at the office earlier—if they’d just been first in line—they could have grown up to look just like him. “How are you feeling?”
Ash shrugged. They had told themself time and again not to have an opinion this strong about their eventual configuration. They knew how hard appointments were to get. They knew they were setting themself up for heartbreak. It was their mom who had encouraged hope in them and now…
Ash swiped a tear from their eye with their palm before it could fall.
“I know how hard this is,” their father said softly.
Ash could feel their pajama pants against the smooth surface of the skin between their legs.
“Yeah,” they said.
Ash’s mom slipped silently into the room and rested her hand on her husband’s shoulder.
He glanced up at her and she gave the slightest nod.
“Ash,” their father said. “I have a colleague at the clinic who might be able to help.”
* * *
The drive to the clinic that night was silent too, except for Ash’s heavy breathing and their mother’s soft sobs. They sat in the back seat while their father drove, all of them still in their pajamas. Ash could barely contain themself.
Their father said that this man he worked with, this doctor, could do the procedure for them.
That night.
He said that this doctor had done it thousands of times, for people of both configurations, but that he had been licensed overseas. He had not been able to transfer his documentation yet, and was working as a clinical assistant until the paperwork cleared, but he knew how it was done.
He said that this doctor could make Ash exactly who they wanted to be.
But it had to be at night, and it had to be that night. If it wasn’t, then people would wonder how Ash had made their selection more than three days after their birthday and, eventually, the illegal nature of their covert procedure would get back to the authorities. The doctor could lose his chance to get his license transferred, or even be deported.
The car pulled into the lot at the clinic at a little after three in the morning. The engine shut off with the push of a button, bringing the ragged breaths of the car’s inhabitants into sharp relief.
A minute passed.
Then two.
The light in the clinic’s lobby turned on, then off, then on again.
Ash reached for the door handle, but their father held out a hand.
“Wait,” he said.
There was a three count, and then the lights shut off again.
“Let’s go,” he said.
They walked through the clinic in the dark until they reached a windowless scrub room, humming with bright fluorescent lights. Ash was introduced to the doctor, a short, serious man with glasses on a chain that hung behind his neck as they perched on his nose.
“Are we a boy or a girl?” the doctor asked.
Ash took a deep breath.
Ash observed bits and flashes after the doctor hooked up the IV.
He counted down from ten, but Ash only made it to seven.
They could see their father above them, in scrubs and a mask, assisting.
The doctor raised his scalpel.
There was plastic, latex, the smell of blood.
Ash wondered if they should be smelling anything at all.
A tear trickled into their ear.
A machine, beeping. More. Faster.
The voices were unintelligible, but they were growing louder.
Sirens.
Movement.
Silence.
Ash awoke to the sound of a heart monitor and his mother crying.
“Mommy?” His voice sounded raspy but still high. That was to be expected. The hormones wouldn’t start to take effect for some time yet. Ash wanted to smile, but something on his mother’s face stopped him.
“Ash, thank god.” She was at his side with a scrape of a chair against linoleum.
Ash let her take his hand, then glanced above him. He wasn’t at the clinic.
“Mom,” Ash’s voice cracked. He tried again. “Mom, what happened?”
“The doctor couldn’t have known,” she said. She sounded distant, tired. Her face was stained with tears. “He said there was no way he could have known.”
“What, mom?” he asked. He couldn’t feel much of his body below the waist, but he knew that he had been operated on. He could feel the itch of bandages against his skin, the restriction of his movements. His fingers itched to feel what was done to him.
“You had an allergic reaction,” she said. “Ash, you almost died, and the operation…”
Ash couldn’t breathe.
They pulled their hand from their mother’s and began to tug at the blanket. They had to see for themself. They had to see what the doctor had done to them.
“Honey, don’t,” their mother said.
Ash pulled the blanket free. They stared down at the bandages around their waist, and the clear, plastic casing around their brand-new vulva. The sound they made was not a sound that they knew their body contained.
“Ash,” their mother, her mother, whispered. “Ash, it was all they could do.”
Ash’s hand traced the outside of the clear plastic, the agonizing absence of shape, the divot where there should have been a rise.
“They couldn’t save the procedure, Ash,” her mother said. “They couldn’t even get you back to blank. The reaction…it was spreading so quickly.”
Ash stared at her body. The body she had never wanted. She closed her eyes so that she wouldn’t see her mother, the woman that she loved so much and that she couldn’t bear the thought of becoming.
A scream rose like bile in her throat but she bit it back, transmuting it into a growl, as low as she could make it. She didn’t want to hear her voice, not like this.
“Ash?” Her mother’s hands were on her again.
“They should have let me die.”
Hell was a hospital treatment room.
Hell was that voice, speaking her name. A mother’s voice that Ash loved and never wanted to grow into.
Hell was irreparable damage done because an abstract sense of balance mattered more than her entire world.
Hell was knowing that if her parents had had thousands of dollars to spend, then everything would have been different.
Hell was everything from Ash’s waist down, and there was nothing she could do to change that.
Ash grew into money, but never into skirts. The doctor was deported and her parents were put on probation for their role in her surgical butchery.
She hated them for only a couple of weeks before realizing that, for now, they were her only allies.
She would find more allies in time.
When she turned twenty-three, after completing her bachelor’s in political science with a minor in biology on a full-ride scholarship, she wrote a paper arguing that age thirteen should not be the only opportunity a human being had to take control of their destiny.
It was rejected by seven prominent journals before she released it online independently. With the help of a supportive professor from her master’s program, she secured a speaking engagement at her undergraduate Alma Mater, then another at Harvard. Her continued advocacy work enabled her to speak at TED. Her speech was recorded and quickly spread out of control. Her paper became a viral sensation.
“A young woman is upsetting the gender industry.”
“Ash Masters, the young woman who took the world by storm last week…”
“With her controversial views on the selection procedure, Ash Masters…”
She smiled for the talking heads and made her points with poise and grace.
Then at age twenty-nine, she calmly informed a talk show host that she was, in fact, a he.
In a smart jacket and bow tie, Ash Masters took his life into his own adult hands. He opened a dialogue. He renounced the secrecy of the selection process and insisted that it should be a conversation between children and their support systems, but that the decision should always be with the children and, eventually, the adults they grew into.
“It should not be their only opportunity,” he said, in a voice not much different from the voice he heard when his mother spoke. “Many children know who they are by thirteen, but what if they don’t? A three-day period at age thirteen should not be allowed to determine a lifetime. Not when there is so much more time to explore, both before and after that important birthday.”
He received emails every day from people of all ages, of both configurations, who said that he had changed their lives. That they had started going by different pronouns than the ones they had chosen at thirteen, or even that they had returned to the neutrality of their childhoods. Some people were even advocating for the introduction of several alternative configurations, other than strictly male and female.
Ash was a revelation.
Heaven is a body that is your own.
Heaven is a world of your own creation.
Heaven is taking what you are given and making it into something you can thrive with.
As Ash sat in his bathtub, a silicon rise under his palm where a divot had once sat alone, he knew that he had built heaven for himself. He knew that he was building heaven for others. He knew.
Still.
Ten years on, Ash was approached by another doctor.
This physician was internationally licensed. She and her anesthesiologist wanted to work with Ash together, all allergies carefully considered.
The night before Ash’s trip to the hospital, for the second time for that same reason, he stared at himself in the mirror, his plastic set aside, and held his hand at a sharp angle around his vulva.
He looked at it.
His constant antagonist.
This part of him that had healed into his body, but that was not his body.
He said goodbye.
No one had ever attempted a genital reconfiguration before. The only configurations that had been done, and continued to be done every day, were on blank children, and those who had made it to adulthood as blanks and had been able to scrape together the cash for a procedure later in life.
The anesthesiologist counted down from ten, and Ash made it to six.
He awoke only when it was all over, with his father sitting at his bedside, hands clasped in prayer. His mother had passed—proud as could be of her son—three years before.
Ash swallowed.
His father looked up.
“Dad?” Ash asked.
His father looked over at him and smiled.
Theodore Hill is a queer, trans, Jewish writer and librarian who lives in Toronto. His work is primarily horror, with fiction appearing in several print anthologies and online magazines. He can be found on Instagram @theodorehillwriter and Bluesky @probablyharmless.
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