Male or Female, always a doctor Top physician tells colleagues, patients at Kaiser that he is finally becoming a woman Janine DeFao, Chronicle Staff Writer Wednesday, March 16, 2005 Dr. Judson Lively, a surgeon and one of Kaiser Permanente's leading Bay Area administrators, stood nervously before 100 colleagues in a Walnut Creek conference room Tuesday and told them it was no accident there were butterflies on his black tie. Lively told them a fable that was in essence the story of his life, of being trapped inside the body of another, yearning for a transformation to be set free. "I stand here before you today to inform you of something that I have kept hidden from the world and virtually everyone else, with the exception of my family, for virtually my entire life," Lively, flanked by his wife and daughter, told the hushed crowd. "I'm 48 years old. For over 40 years I have known that I am a transsexual woman. My heart and soul really are those of a woman." In two weeks, the surgeon will return to work as Dr. Judy Lively, physician-in-chief for more than 350,000 Kaiser patients, 550 doctors and 6, 000 staff in most of Contra Costa County and part of Alameda County. She will trade her ties for scarves, wear subtle makeup and handmade beaded jewelry, and finally let her hair down. Lively is shedding the male persona she once worked so hard to cultivate -- Army surgeon, skydiver, whitewater kayaker -- and will reemerge not as a new person but one who has always been there, hidden away. While some transgender people take a "stealth" approach to their transitions -- leaving behind their old lives to reappear elsewhere as their new gender -- Lively's method is becoming more common, as society becomes more accepting and anti-discrimination laws are approved. Lively said she had no choice but to make a very private decision public because she doesn't want to give up the job, home and family she loves. She plans to have a sex-change operation after completing a required year of living full-time as a woman. "I've spent 40-something years living a double life, hiding something from my friends and family. I don't want to replace it with another double life," she said. Lively grew up the only son of a Southern Baptist minister who was a career Army chaplain. Lively had his first inkling of being uncomfortable in his body during a 4th-grade game of "show-me-yours-and-I'll-show-you-mine." He found a luxurious blue silk scarf of his mother's and loved to drape it around himself. But he knew to do it only when no one was watching. In high school, he went on one date. He earned top grades and played varsity sports but was "a social misfit because I didn't know what I was," Lively said. College and medical school were much the same. He dated a homecoming queen, a platonic relationship for appearances, and slept in comfortable cotton nightgowns behind closed doors. During his surgical residency in Cleveland, he met Karen, the head nurse in the burn operating room. They fell in love and were married the next year, in 1985. Karen's 3-year-old daughter, Jennie, was the flower girl. Lively hadn't told Karen his secret, a major regret to this day. "I thought we'd get married and this would never come back into my life. I was hopeful it would go away, and it didn't," Lively said. Karen never suspected a thing. "He was pretty much the macho surgeon, well thought of, did 72-hour shifts," Karen recalled, sitting Saturday with Lively on the couch in their Sonoma County home, one of their eight cats curled between them. Once before they married, Lively mentioned he tried on a nightgown he bought her to see if it would fit her. She found it odd, but it never came up again. Then on Halloween, a year into their marriage, Lively showed up on their front steps wearing a bad wig, denim miniskirt, red sweater and "makeup that looked like it belonged on a hooker," Karen said. "I didn't know if it was a joke because it was Halloween or if he was trying to tell me something." "It was plausibly deniable. If she reacted horribly, I could blame it on Halloween," said Lively, who was then an Army burn surgeon stationed in Texas. The Halloween stunt led to a conversation, which led to nearly two decades of soul searching and exploration for the couple. "Never would I have dreamt it was going toward being female. But it progressed year after year, and we took it as it came," Karen said. Three years ago, Lively started seeing a therapist who confirmed she was transgender. She began taking female hormones, with Karen's support. "She's my heart. We've been married almost 20 years. This is the person I fell in love with and that's never going to change," Karen said. Once Lively's adopted daughter, Jennie, turned 21 two years ago, the couple broke the news to her after watching an HBO movie about a transgender woman. Jennie asked if her mom was OK with the change, then said she was, too. Judson began living as Judy outside of work, and Jennie started calling her "Mum." "I wasn't close to my father. I never knew him much. He was never home," she said. "Me and my Mum are so much closer than me and my dad ever were." Karen, too, believes her relationship with Lively is better. "The more feminine she became, the better our relationship became. The person I knew was there finally surfaced. She's more comfortable with who she is and allows her emotions to be there," she said. When friends ask about their changing sex life, Karen tells them to ask a lesbian. She thinks people are too hung up on labels. Fifteen years ago, doctors wouldn't perform sex-change surgery on married transgender patients unless they divorced. While that has changed, it is uncommon for couples to stay together, although more are doing so. The Livelys have been pleasantly surprised by the reaction of friends and family. Karen's father, a staunch Roman Catholic, bought them a knife set for Christmas, engraved for Karen and Judy. But not everyone has been supportive. Some relatives have said they're glad they live 3,000 miles away. Others have stopped calling and sending Christmas cards. Lively let her straight blond hair grow long, wearing it in a ponytail at work. She grew her nails slightly longer and hid her developing breasts behind her dress shirts and ties, using an elastic band and a sports bra. She began to blur the lines between her male work voice and her female voice at home. To her knowledge, only one person, her co-physician in chief, David Niver, put the clues together. But Niver, who confided in his wife six months ago that he thought his colleague was transgender, said the emotional changes once Lively started taking hormones were more obvious than the physical ones. "There was something about it that finally added up," said Niver. "He was very cool and unemotional, very steely 10 years ago. ... She has allowed more of her personality to leak out." But several colleagues said Tuesday they were stunned. That was the reaction of co-worker Hollis Harris when she nearly literally bumped into Lively, dressed as Judy, at a bead show five months ago. Lively said hello. "It took me a moment to place this woman as Dr. Lively," said Harris. "I don't think I would have made the connection if she hadn't made the effort." Harris is supportive, and hopes others will be as well. That is also the hope of Dr. Robert Pearl, chief executive officer of The Kaiser Permanente Medical Group, which has 3.2 million patients in Northern California. "I judge people by their quality of care and their integrity. Dr. Lively is outstanding in both those areas," Pearl said. While there are bound to be patient or colleagues who have trouble accepting Lively's transition, Pearl said the organization is large enough to accommodate them. Lively told two patients this week. He plans to contact others in the coming weeks, and hopes they react as well as Amrik Pooni, 59, of Oakley. Pooni's infected pancreas could have killed him before Lively operated in 2003. He underwent more than 10 surgeries and was hospitalized for four months. He sees Lively monthly for follow-up. "He performs miracles. He's the best there is," said Pooni. While surprised by Lively's revelation, Pooni said he has no hesitation about keeping his doctor. "As far as I'm concerned, he's still my doctor and my friend. This doesn't change a thing," he said. "I'm going to call him Dr. Lively. It doesn't matter what his first name is." Lively's co-workers had a similar reaction Tuesday. They erupted in applause, leaping to their feet in a standing ovation. They asked questions tinged with humor, and smothered Lively with hugs. Following more announcements this week, Lively will take a week off. She will legally change her name, start the process of changing her medical license, get a new hairstyle, and redecorate her office with a butterfly theme.
		©2005 San Francisco Chronicle E-mail Janine DeFao at jdefao@sfchronicle.com
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