-Chapter 4: Upside Down-

Things moved quickly once we got to the hospital. I was rushed back into the emergency department. Everything that happened was a blur to me. They took my vitals, my height and weight, and some blood samples. I was made to put on a hospital gown and placed in a bed, where I was hooked up to an IV due to my dehydration. They confirmed that my difficulty breathing wasn't caused by any fluid in my lungs, nor was I suffering from any coronary complications. Not long after, the doctor administered a sedative to help numb the pain. It wasn't gone, but I was grateful to finally feel some relief. Around forty minutes after we had arrived, my condition was deemed stable. I was admitted to a regular room, and Anna was allowed to come back.

The doctor and nurses stepped out to run my labs, leaving us alone. She sat down in a chair near the bed and offered me a nurturing smile;

"How are you doing?"

I found her concern as touching as the kindness she had shown me that night, returning her smile as I answered;

"About as good as I look."

After a quiet chuckle, we were left in silence. After a few moments, I asked,

"What about you? How are you holding up?"

"Me? I'm fine. A little tired, but I'll tough it out."

I could only offer a warm smile in response. The sense of guilt I'd experienced earlier hadn't gone away. I hesitated for a moment, but I had to say something;

"Anna, I'm… I'm so sorry about… about all of this."

"What do you mean?"

"I mean all of it. I'm sorry about the restaurant, and not answering my phone. I'm sorry I worried you, and I'm sorry for… for all the trouble I've caused you tonight."

She shook her head, placing her hand gently on my shoulder;

"Look, you don't have anything to apologize for. None of this is your fault."

"But if I'd just explained what was going on in the first place, then-"

"You were panicking. Honestly, I don't think I would have acted any differently if I were in your shoes. And of course I'm worried about you! You're my friend, and I want- no, I need you to be okay. I'm here because I want to help you. So don't go blaming yourself, okay?"

I could only stare at her for a moment. I didn't know what to say, or how to express what I was feeling. All I could do was offer a quiet nod.

"Thank you…"

I felt her squeeze my shoulder lightly, and saw her offer up the most heartfelt smile. I'd forgotten what it felt like. To be next to someone who cared so much. To feel needed. Despite all my physical discomfort and the fear I felt for my health and life… I was happy. Her simple words had eased my pain just as much as the medicine the doctors had administered. Maybe even more.

As the moment passed, we both sat there quietly, anxiously awaiting the doctor's return. A few minutes went by. My body still hurt, but I was able to redirect my focus toward other things. The ticking of the clock. The sounds of people passing in the halls outside the room. I would occasionally cast a glance at Anna, whom I noted had mostly been watching me. A few more minutes passed, and I could sense we were both growing more tense. I checked the clock. 3:32 in the morning. About two minutes later, the door clicked open, and the doctor, a man looking to be in his forties by the name of Dr. Hastings, stepped into the room holding some papers. Anna spoke before I could even open my mouth;

"What's going on? Is James gonna be okay?!"

He nodded, but still bore a dire expression;

"Mr. Fuller's life isn't in any danger."

Anna breathed a sigh of relief, and I felt my shoulders relax a little. This time, I was the one who spoke;

"So… what's wrong with me?"

Dr Hastings pulled a stool next to the bed, took a seat, and looked me in the eyes;

"I'm gonna give it to you straight. You're suffering from something known as sexual inversion syndrome."

I stared at him for a moment, unable to comprehend what I'd just heard. 'Sexual inversion syndrome' didn't ring any bells, but the name alone was concerning. I recalled something I had learned in a class I had taken about the history of psychology;

"Sexual inversion? Like, that old theory about homosexuality?"

"No. The overlap in nomenclature is mostly coincidental. Sexual inversion syndrome, or SIS, isn't a psychological phenominon; it's a physical condition."

"So, what does that mean?"

"You are, in no uncertain terms, going to become female."

I looked at him for a moment, waiting for him to crack a smile and tell me this was all a joke. But his face was unmoving, and his expression was serious. My immediate feelings of denial quickly gave way to shock.

"Wh-what are you talking about?! That's ridiculous!"

He shook his head;

"The first cases sprung up early last year. You may have heard about them on the news? Those early instances were kept as tightly under wraps as possible for fear of creating widespread panic. By the time the media circus got a hold of the story, the World Health Organization had already begun researching the disease. They were quick to announce that it wasn't contagious. Public tensions and fears were expected, but any and all mentions of it potentially becoming a pandemic were quickly shut down. That's why it isn't necessarily ingrained into the public's memory. To date, SIS has only affected a little over 1,500 people globally."

His mention did spur my memory a bit. I recalled a few headlines about a freak illness that changed peoples' sexes, and while some were panicked, the general response had been more one of fascination and confusion than outright fear. Of course, recalling that did nothing to address my more pressing concerns;

"Yeah, okay! But what does that mean for me?! What's happening to me?!"

"SIS is poorly understood. I'll tell you what's going to happen based on what we know. Your body is going to change into that of a woman's. While your conscious identity will remain unaltered, every aspect of your physiology will change. As we understand it, this process occurs on a cellular level, possibly even an atomic one. Bit by bit, the cells in your body are going to be removed and replaced, until every single one is altered. Your body is, effectively, destroying itself and instantly being rebuilt."

"That doesn't make any sense! How is that possible?!"

"That's the issue. No one knows why or how this happens. There is no possible scientific explanation for this phenomenon at present. It goes against our understanding of some of the most basic laws of the universe. What's more, the changes include physical characteristics beyond basic biology. Patients experience changes to things like their body language, general affect, and even their hairstyle. It appears as if, without fail, they become an alternative version of themselves."

I stared down in disbelief. My still hoarse voice began to tremble as I spoke;

"That's insane… I don't understand. How? How did this happen?!"

Dr. Hastings cleared his throat;

"No one has been able to pin down a definitive cause. All we know is that it isn't contagious. It can't be transmitted by touch, through the air, or by bodily fluids. As far as we're concerned it may as well be some quantum fluctuation, or black magic, or an act of god."

A realization began to sink in;

"You're saying there's no cure…"

"I'm afraid not. Once the changes begin to occur, there's no means of stopping them. There's no way to undo them either. Those affected by SIS are physically indistinguishable from members of their acquired sexes."

My chest hurt, not just from the changes going on in my body, but from fear. My anxiety only began to increase as I thought about what becoming a woman would entail. I would have to adapt every aspect of my life. What about my family? What about my job? How could I pay for everything? What would I do about my driver's license, or my online accounts, or government documents? What about my name? How much would I have to change my behaviors, even the most basic ones? How would I handle being a woman? Would I even be able to handle it? What if I hated it? This was too much. Tears began welling in my eyes;

"Why…? I don't… What am I supposed to do…? How am I supposed to deal with this…?"

Dr. Hastings waited a moment before speaking up;

"I realize this can be a lot to take in. Our team can handle the legal side. You'll have to decide on a new name, but we can fill out all the requisite documents to have you recognized as a woman by the state of Washington. What you do in the long term will be your decision."

I looked to him with uncertainty;

"What do you mean…?"

"SIS patients often exhibit a number of responses to their changes. Like I mentioned earlier, while your brain chemistry will be affected, your conscious identity will not be. Most patients adjust, slowly but surely, and accept their new bodies. Some cling tightly to their original genders. They may, in many cases, opt to use hormone therapy and surgeries to transition back to what they were prior to SIS. In those most extreme cases, some have, unfortunately, chosen to take their own lives. Should you find yourself feeling that way, you need to contact a medical professional immediately. There is some potential good news, however. Some patients take very well to their changes, and even report improvements in their mental and physical health. Ultimately, depending on which category you fall into, you will have to decide how you want to move forward with your life."

"I… see…"

There was too much going on. I had no idea how I would live after all this. I was too afraid to think about anything like that. Dr. Hastings handed me a clipboard with some papers;

"I'd like to give you these. The first goes over the symptoms of sexual inversion syndrome. The second is a form giving us consent to go through with the aforementioned legal procedures. It includes whether or not there's anyone you'd like us to notify of your condition. The last pertains to what happens next."

"What happens next?"

"Yes. The symptoms you've experienced so far; the nausea, aches, fatigue, and so on; are all indicative of the SIS process. You're still in the early stages of that process, however. Symptoms become much more severe as the transformation advances. The later stages occur at a much faster rate than the earlier ones. Physical activity and exertion slow the changes, but it is impossible to stop them. In a resting state, the process occurs much more quickly."

"So what are you saying…?"

"With your consent, we would like to put you under, as well as administer painkillers. This serves two purposes. Firstly, it cuts down on the physical stress induced by the transition. Rather than taking a full day, they would complete in just a couple hours. Second, being asleep and numbed during the change can prevent any lasting neurological damage. Without getting into the specifics, the brain strongly remembers sensations. If you experience severe enough pain for long enough of a duration, you will likely suffer long lasting adverse effects. Treating these may involve months or even years of physical therapy and psychological treatments. Obviously, it is best to avoid this. Should you choose, you may opt out of sedation, however, I would very strongly advise against doing so."

I offered a meek nod;

"I get your point…"

"Alright," Dr. Hastings said, rising to his feet. "I'll step out for a minute and give you time to read through those."

As he left, I looked over the forms. The first just related information he had already told me, no surprises there. It came complete with diagrams of the male and female reproductive systems, which only succeeded in reminding how uncomfortable I was with everything going on. I filled in the other two forms, indicating that I'd like them to contact my parents and employer, then waited in silence. I had noticed Anna hadn't spoken that entire time. I glanced over and saw her looking back at me with a concerned expression on her face. She smiled, sympathetically. She looked as if she wanted to say something, but before she got the chance, Dr. Hastings returned. I gave him the forms, and he said he'd be back in a few minutes to administer the anesthesia. He left us in silence. We looked at one another for a few moments, neither quite sure what to say to the other. At last, she was the first to speak;

"I, uh… How're you holding up?"

"I… I don't know, this… this is all too much. I don't know what I'm gonna do, and… and, I… I…!"

My voice began to tremble. Tears welled in my eyes and I could feel a lump in my throat. I covered my mouth with my hand and looked away.

"Hey, come here…"

She stood up, leaned over the bed, and embraced me. And the dam broke. I put my arms around her and wept. I don't think I had ever felt as overwhelmed as I did in that moment.

"Shhhhhhhh…"

She held me tighter, her hand cupping the back of my head. I cried and cried, my face buried in her shoulder. She spoke softly;

"Listen, everything's gonna be alright. You're gonna make it. We'll figure this out together."

I pulled back.

"We…?"

"That's right," she said, wiping a tear from my cheek. "I'm gonna help you through this."

I tried to protest, not wanting to be a burden to her;

"But, you don't have to-"

"I'm going to. I told you you were gonna be alright. I'm promising you this, here and now; we're going to get through this. No matter what."

I stared at her. Her expression was so kind and earnest, her words so determined. I was at a loss. I didn't know what to say. She was offering to give me her all. I was terrified beyond belief, in the grips of despair, and she was giving me hope. She was my lucidity in the nightmare I had found myself in. The realization that I would wake up. That things would be okay.

"Anna… I… Thank you…"

She squeezed my shoulder;

"James… I'll always be here for you. Always."

She pulled her chair up closer to the bed and sat down. She reached over, taking my hand in hers. I realized with alarm that my hand felt like it was the same size as hers. This change wasn't going to happen; it already was. The gravity of what that meant began to weigh on me again, my heart pounding in my chest.

"Oh god, Anna… I… I'm so scared…"

Her grip on my hand tightened.

"Hey, listen, I want you to just focus on me, okay?"

So I did. I looked to her, and her calm, gentle expression. She began telling old stories from our time together in high school. Stories about classmates and silly things they had done. Stories about teachers, and school events, and projects, and after school get-togethers, and everything in between. Stories about jokes we found hilarious at the time, even though they weren't actually funny at all. I listened, and laughed, and chimed in a few times, and, in that moment, I forgot about my fear, and dread, and anxiety. There was no SIS to be afraid of. It was just the two of us. She held my hand, and talked with me, washing away all the pain and doubt that plagued me.

Twenty minutes went by. Eventually, the doctor and several nurses entered the room with various pieces of equipment. I was hooked to a heart monitor, and a second IV was placed in my arm. They stayed in the room to make sure there were no complications with my sedation, but I wasn't paying any attention to them. I remained focused on Anna. On her calming smile, and her firm grip on my hand. At that moment, she felt like my guardian angel. I knew, as long as she was there, I would be safe. But suddenly, the realization struck me; when I woke up, I would be someone else. The thought was so foreign and frightening. It didn't make any sense. I wasn't ready for this, but I couldn't stop it. Panic began to take a hold of me. I clenched my teeth, looking to Anna for help, and then… nothing.

…

…

…

It was dark. I could faintly hear sounds, but I couldn't make them out. They became a bit clearer if I focused. There was the slow, steady beeping of a heart monitor. There was the faint sound of birds singing outside. I slowly opened my eyes to see the light gray ceiling panelling. I rolled my head to the right a bit. Soft, pinkish light was peeking in through the shut blinds. My eyes scanned a little farther right, and I saw Anna. She was sitting cross legged in a reclining chair, staring at her phone in her lap. I tried to call out to her, but no sound came out. I tried again, to no avail. Then again. And again. One more time, when, finally;

"Anna…?"

I heard someone I didn't recognize call her name. She looked up at me. At first her expression was one of curiosity and concern, but it quickly softened to the kind, gentle smile I had seen so many times earlier that night. In fact, at that moment in time, that was about all I remembered from the previous night. She spoke to me in a quiet, tender tone;

"Hey… How are you feeling?"

I closed my eyes for a moment, trying to take stock of myself. The more I focused on it, the more everything felt… off. I ached, and it felt like someone had kicked me in the groin with a steel toed boot. But more than the pain, there was a pervasive sense of strangeness I couldn't pin down.

"I feel… tired… sore… and… weird…"

There was that voice again. It was a woman's voice. It sounded soft and smooth, light and feathery, and sweet as honey. I didn't think there was anyone else in the room but us, so who was talking?

"Whose… voice is that…?"

She gave me a bit of a quizzical look before offering a sympathetic smile;

"It's, uh… It's yours."

"What do you-"

And then I remembered.

"Oh, yeah… Right…"

I remembered SIS, and being in the hospital. I remembered the unbearable pain. I remembered being scared, and being put to sleep. The truth hit me. I was a woman now. I knew that, but I was so out of it, I wasn't even alarmed. I was too busy trying to piece together what had happened the night before. I remembered Anna being there. I remembered her coming to my house at two in the morning, and driving me here, and staying up all night beside me. I remembered her doing so much for me, and in that moment, all I wanted to do was let her know how much I appreciated her.

"Anna… Thank you… For everything…"

"James…"

She placed her hand on my shoulder, but it felt strange. I leaned my head over to rest it against her touch, and I felt my hair move in a way I wasn't used to. But, I wrote off those bizarre feelings; I had to tell her how I felt.

"Anna… You're so, so wonderful… And… I-"

There was something I wanted to tell her. Something important. But, as the thought went through my head, I realized it was something I wasn't supposed to say, and I stopped myself. I looked over at Anna. She had a surprised look on her face. It stayed like that for a moment, before she smiled. It was the kind of smile a parent might show toward a child giving them a handmade gift. Sure, the gift looks terrible, but they clearly put a lot of thought and effort into it, and knowing that makes the parent happy and gives meaning to the gesture. A benevolent expression of gratitude toward something innocent and genuine. I wasn't sure why she looked that way, but seeing her like that made me feel happy, and I found myself smiling too. 

Then, I felt tired. My eyelids were heavy, and I was already in a bed, so it was okay to sleep, right? I relaxed my body, and shut my eyes, quickly drifting back off into a dreamless slumber.

…

…

…

It was later when I woke back up. The light from outside seemed a little brighter, and I could hear a bit more foot traffic outside the room. I was a touch more clear headed than I had been earlier. I glanced down at myself. My body was covered, and I saw… boobs. Those were new. Weird. Still too tired to care, though. I glanced at the clock. 8:42 AM. Looking over to where she had been, I saw Anna. She was reclined in her chair. She had taken her hoodie off and draped it over herself like a blanket. Her head was slumped against her shoulder, and her chest was steadily rising and falling. She looked so peaceful when she slept. It made me feel calm, as well. Taking a deep breath, I relaxed, letting myself fall asleep once again.

…

…

…

I finally felt coherent again when I awoke for the third time. Anna was talking to a nurse when they saw me. The nurse left to go fetch the doctor, and Anna sat back down next to me. We talked for a bit, but I couldn't stop noticing how differently my body felt. The feeling of my back and my butt against the bed. The strangely empty feeling around my crotch. The feeling in my hips whenever I'd shift around. And then there was my chest. It was like having a pair of oranges attached to me. Every movement, no matter how slight, seemed to cause a disturbance. Just feeling them shift as I breathed was bizarre. Feeling them occasionally press against each other when I moved about was weird enough in its own right. And don't even get me started on my nipples. They were clearly visible through the hospital gown, and the way the material rubbed against them kept producing occasional, brief itching sensations, much to my irritation. Parts of my body I'd never really thought about before kept demanding my attention, and I only had so much to give! Anna seemed sympathetic to my plight, but she clearly couldn't think of what to say. 

When the doctor came back, he and a nurse helped me out of bed. It took some doing, but they got me standing on my own. My knees felt weak, partly from the anesthesia, and partly from the toll the change had taken on my body. When I was standing up, I suddenly became aware of just how different everything felt. The distribution of my weight, my center of gravity, the hair brushing against the tops of my shoulders, and, yes, my ever present breasts. Then, a realization hit me. I was shorter! A lot shorter! Anna stood next to us, and she was my frame of reference. Before, I had been a few inches taller than her. Now, even through my poor posture I could tell; I'd become the shorter one! That was the straw that broke the camel's back. Before, I had been too nervous about my transformation to consider how much I would actually be changing. But now, with my present clarity of thought, the reality sank in. Every single piece of me was different. 

I brought a hand to my mouth, my new voice trembling;

"This is… this is too much…!"

"Hey!" Anna said, grabbing me by the shoulders. I looked up to meet her gaze.

"Remember what I said earlier? It's gonna be okay! We'll get through this together!"

I trusted her. I believed her. I had to. I sniffled a bit, nodding;

"Yeah… You're right… Thanks…"

I took a second to pull myself together. When the moment had passed, Dr. Hastings addressed me;

"Ms. Fuller, we'll need to perform a routine physical to check for any abnormalities before we can discharge you."

Miss Fuller. That was the first time I'd heard the name, and it took me a moment to realize he'd been talking to me. I agreed, and he and a nurse led me to another room. As we walked, the nurse, a younger woman, turned to me;

"It looks like you've got a very good friend back there."

I couldn't help but smile.

"Yeah… Yeah, I do."

The physical started as I would have expected. We went through the usual check ups, and they once again took my height and weight. I came in at 5'6" and 147 pounds. That came as a shock. Twenty four hours ago, I was 5'11" and weighed about 175 pounds. I was struck by how impossible that seemed. That much person doesn't just disappear, but that's exactly what had happened. SIS really was beyond all current understanding. It came as another reminder of just how much I had changed.

I had known the last parts of the physical were coming, but I don't think anything could have prepared me for them. The breast exam was first. I was surprised by how self conscious I felt about showing my breasts to anyone. The doctor told me to pay close attention, as I would need to perform these exams on myself on a semi-regular basis. I found this somewhat difficult, however, as the unpleasantness of having my newly acquired boobs manhandled, for want of a better term, proved quite distracting. These were not gentle touches, but the firm groping of a professional looking for anything out of the ordinary. This was how these things are meant to go, but I was wholly unprepared. But, hey, if I thought that was bad, I still had the gynecological exam to look forward to! And, hoo boy, what an experience that was! 

See, as a guy, the idea of something going inside my crotch was out of the question. Obviously. Just wasn't happening. And so, there's a good chance I would have screamed had I not covered my mouth when I felt the cold metal of the speculum stick into and promptly spread my lady parts. I'd had a vagina for about four or so hours, and having it poked and prodded and very closely examined was about the most uncomfortable thing imaginable. I understand this is a normal process every woman has to go through to take care of her health. But being a woman was kinda new to me, and I had always been a 'dip my toes into the pool' kind of person. And this? This felt like getting dropkicked straight into the deep end. 

I must have looked pretty shell shocked when they took me back to my room, because as soon as the staff left, Anna ran over and hugged me, patting the back of my head. The whole scene made me laugh. By then, I really, really needed a laugh, and I think my reaction came as a sign of relief for Anna too. I was still overwhelmed by everything that was going on, but at least I had my footing, so to speak. We talked for a few minutes, and I regaled her with my horror story, asking her how women dealt with stuff like that. Apparently, I'd get used to it. More or less. The doctor came back, telling me that everything checked out. He told me to come back tomorrow to finish filling out the official legal documents, and he issued my discharge. The clothes I'd come in no longer fit, so I was given a set of scrubs to wear. It was a little after 12:30 in the afternoon when Anna and I finally left the hospital. I reentered the world, trepidatiously stepping into the first day of my life as a woman.