Parallel Lines

A Tribute to
Lloyd Wade Kitchens, Jr., M.D., MACP


It was a bit of a surprise that Lloyd, a remarkably versatile "Renaissance man," made no effort to become fluent in the language of cyberspace. I have a few e-mails which he sent on his son's AOL account. Most were on the order of "TELL ME IF YOU RECEIVE THIS." Lloyd was a verbal person and loved to communicate face to face or on the telephone. The messages I've saved on my answering machine are as eloquent as any lecture he gave at Baylor Medical Center.

One evening in January 2001 I found one such message, shorter than many previous ones, but so typical for my friend.

"Becky? Kitchens! Do you still live here in America? I do... we've been out of touch for far too long. Call me sometime at your convenience. I think of you often and fondly and hope you are well. We are well... except for the osteomalacia that keeps me fracturing one major bone or another.

Connie is doing very well. She's quite selective in the roles she accepts, but she gets wonderful reviews in everything she does. Ben is growing in wisdom and stature and favor with God and man. He's doing well on the piano and learning guitar. You would enjoy talking music with him.

I hope you are going to the ACP in Atlanta. It seems that, through some terrible mistake, I have been chosen to get an honor at the annual meeting there. I know Connie is going to sing the National Anthem at the convocation, and I'm going to play the piano for her. I know you need to go to the heart meetings, but the ACP is no slouch, and you would enjoy it. Anyway, we would love to see you. I'm... I'm not sure how many more chances we will have. Give me a call this weekend."

I called Lloyd right back and confirmed that I would see him in Atlanta. Nothing would prevent our time together. I didn't realize how accurate his estimate would prove to be.

1. Innocence

The summer of 1963 was a time of transition in my Mississippi world. We were yet untouched by the terrible events which would unfold in the next year, but we had experienced a foretaste of trouble in the fall of 1962, when James Meredith enrolled at the University of Mississippi. No black person had ever before attended a "white" school in the state, and this action angered some white Mississippians enough to provoke a violent response. For them, the Civil War never ended, and their lives revolved around the preservation of a glorious "Southern Heritage" which always seemed strange to me.

Even then, I was of a different world view. Why do we still concentrate on this war? In the first place, we lost. Men died on the battlefields. Women starved at home, or were raped and murdered. It was a dreadful time. And for heaven's sake, we were fighting for a dreadful cause. Don't tell me we were fighting for "states' rights." Sure we were - the "right" to permit human slavery. Of course, I didn't articulate these views to just anyone. It would have been hazardous to my health.

So I was not upset by the fact of a black man attending Ole Miss. I was shocked, however, at the violence which erupted in rioting in Oxford, leading to the deaths of two persons, neither of whom were college students. All this because someone simply wants to go to school? At the time I thought no one else in Mississippi felt as I did.

The racial integration of Ole Miss did not result in black students attending the white public schools in Mississippi until several years later. My all-white class in Greenwood High completed our junior year in the spring of 1963 and anticipated our year as the Big People On Campus - our "glory days" as Springsteen would later sing about.

The American Legion organization sponsored programs each summer for selected students entering their senior year. In a summer camp atmosphere, Boys' State and Girls' State brought together teenagers from all over the state, often meeting for the first time kindred spirits with whom we would share later college and life experiences. I was fortunate enough to be one of the representatives from Greenwood High.

We were divided into twelve "cities" of about thirty students each, all named after state political figures. Two cities made up a county, so there were six counties in our mock state government. The entire week was a living civics lesson, as we ran for offices, campaigned and voted, and passed legislation which would be signed or vetoed by the "governor."

When we arrived on Sunday, I was immediately aware that some schools took the Boys' State elections very seriously. Campaign posters were already scattered around the Hinds College campus. Lacking preparation, and lacking the aggressiveness and ambition for a major campaign, I decided to limit my campaign to a county office, and to my surprise I was elected "chancery clerk" of Stennis County. This suited me, because I didn't really have any specific duties as chancery clerk, and I got to observe our "legislature" in action.

I realized immediately that most of the boys debating and voting on bills were true sons of the South, preserving the status quo in a way that would make great-grandpa proud. I was glad to hear, however, one other student who was not afraid to voice his opinion on the lack of social progress in our generation. In this way I met Lloyd Kitchens of Crystal Springs, Mississippi, for the first time.

The similarity of Lloyd's world view to mine ensured I would remember him after I had forgotten many of the "good old boys" of the power elite. However, I had no assurance that I would encounter him again, since our plans for college were then undecided.

My senior year at Greenwood High was as rewarding as I had hoped. I was very involved with the high school band as first-chair alto saxophone player. Every week we practiced marching and learned a new halftime routine for the football game on Friday, which sometimes meant travel as far as Meridian or Jackson. In addition to band, my class schedule was very full with senior English, second year Spanish, physics, trigonometry, and mechanical drawing (at that time I was considering a career in architecture).

November 22, 1963, was a dreary and rainy Friday in Greenwood. There was no football game that night, and we were looking forward to an easy weekend, but it was not to be. The announcement on the loudspeakers after lunch told us of the shooting of President Kennedy.

You may have heard stories of school children in the South applauding when they heard that news. I can tell you those stories are true. For once in my early life I found the courage to speak out for an unpopular cause as I shouted "What are you doing? This is terrible. This is our President." My words had no effect on the youth of the Confederacy who still resented John and Robert Kennedy for their role in the Ole Miss drama of the previous year.

For us, life went on. We had a new President, with the same name of Johnson as the new Mississippi governor. Paul Johnson Jr. had been lieutenant governor in 1962 and, despite an attitude and point of view that was rather progressive for our state, had become something of a local hero when he had journeyed to Oxford to try to prevent the enrollment of Mr. Meredith. I had suspected he was instructed to do so by the governor, Ross Barnett, a Southern stereotype if there ever was one. At any rate, Paul Johnson ran for governor in the summer of 1963 on the slogan "Paul Stood Tall Last Fall." I swear that's true. And he won.

My school year continued successful and recognitions came from local honors and college scholarship offers, including the Carrier Foundation Scholarship to Ole Miss, at that time the largest grant in the state. Of course I accepted the Carrier, and chose the road that led me to pre-medicine at Ole Miss rather than pre-architecture at Mississippi State. "And that has made all the difference."

In Crystal Springs, Lloyd Kitchens received a National Merit Scholarship, and could have attended any university he chose. He gave serious consideration to several Ivy League universities. However, Lloyd even at 17 was a true Southern gentleman and family man, and he knew his parents wanted him to remain closer to home. He honored their wishes and decided to attend Ole Miss also.

2. Fast Track

My home state remained a center of attention for the world in the summer of 1964. From all over America, idealistic young adults came to help in the effort to bring black Mississippians the same rights enjoyed by their neighbors. Many local whites were less than neighborly, however. Rocks were thrown, curses shouted, crosses burned in yards. And one terrible July night, two young white men from the North and the black activist working with them disappeared. Weeks later, their bodies were found buried under a new earthen dam in Neshoba County. The murders produced a stain on Mississippi which won't wash away, even today.

I tried to stay far away from the troubles. We were sheltered by the successful efforts of the local press to minimize reporting of the events. Still, TIME and LIFE magazines found their way into Greenwood, and I read with horror the national newsmagazines' version of our events. I didn't even know, until I read about it weeks later, that a young Bob Dylan had marched in my hometown and given an impromptu concert in a cotton field outside Greenwood. If I had known, of course I couldn't have gone. I stayed home and concentrated on getting ready for my first semester as a college student.

In the 1960s at Ole Miss, as on many college campuses, student life revolved around the "Greeks" - the fraternities and sororities. New members were selected each year in a process called "Rush Week" which preceded the actual start of the academic year.

I arrived for rush week feeling less than comfortable. In high school I had been voted "Most Intellectual." That pretty well sums up my reputation. Today I would have been called a "geek" or, in the expression popular just a few years ago, a "nerd." This did not connote popularity. I knew I would not be chosen for the most influential fraternities like Phi Delta Theta or Sigma Chi.

I was quite correct. After the first couple of cycles of rush parties, the process of choice was operating in both directions. Between the groups that I had cut, and the groups that had cut me, I was left with two choices: Phi Kappa Psi or Beta Theta Pi. Both were medium size groups with some very decent people as members, but for the most part they weren't the sons of bankers, lawyers, doctors and the movers and shakers of Mississippi. Just average folks - like me. I began to feel more at home.

Beta Theta Pi - the "Betas" - occupied a brand new chapter house just off Fraternity Row. The chapter ranked first among all Ole Miss fraternities in grade point average every semester. They sent many people to graduate and professional schools every year. It seemed to be an ideal match for me - my kind of people.

As I stood and talked with the Betas, someone spoke directly behind me. "Bruce? I remember you from Boys' State, don't I?" I turned and saw Lloyd Kitchens. It was such a pleasant surprise to see a famliar face.

Lloyd was planning to pledge Beta, and I was strongly considering doing the same. We chatted for a few minutes. "What did you do during the summer?" I asked him.

"I went to Mississippi College and took fourteen hours in summer school already."

I was feeling quite the lazy slacker for my easy summer spent working part time in Greenwood. "You've really gotten off to a fast start."

"If I go straight through, taking 18 to 20 hours every semester, and 12 to 14 more every summer, I will have enough to get into medical school after just two years."

I had never thought of going through that fast. As far as I knew, I would be at Ole Miss for the full four years. I couldn't imagine finishing so quickly.

When I left the Beta house that afternoon I had every idea of pledging that fraternity. Then I went to the Phi Kappa Psi house in the early evening. There were few top scholars in Phi Psi, just a bunch of average guys, many from out of state. I liked the idea of having friends from far away places. To this day I couldn't tell you exactly why I chose to join Phi Psi rather than Beta, but I think it was a shock to everyone, myself included.

Despite our being in different fraternities, I was still able to maintain friendship with Lloyd. We shared some classes over the next two years, and then, just as he had planned, he was accepted to medical school beginning in the fall of 1966. I supposed he would graduate two years ahead of me.

In my third year at Ole Miss, however, I found that my success in the classroom and on campus (I was president of Phi Kappa Psi by that time) would give me a good chance for acceptance to medical school in 1967. I went ahead with the application process and was accepted. In retrospect, it was not one of my better decisions. If I could do it over again, I would remain in college for a fourth year, and take more humanities courses. But I had also rushed through in sciences; not as quickly as Lloyd, but enough to give me admission to medical school after three years of college.

3. Introduction to Medicine

My college days finished on a high note. The Taylor Medal is an award Ole Miss bestows each year on the undergraduate in each major field whom the faculty deems most outstanding. I was fortunate to receive the award in biology in 1967. My parents actually drove up from Greenwood to see me accept the medal. This was a very major occasion, because Mother didn't drive, and Daddy had lots of chronic back and leg pain which kept him from making long trips. I was so happy to see them on campus.

Our happiness was not very long lasting. When I packed my trunk and left Ole Miss at the end of May, I had no way of knowing that within three days my father would check into the hospital in Greenwood, and would never be discharged. The pain in his back turned out to be metastatic lung cancer. In those days it was possible to spend months in the hospital, and Daddy was there for nearly four months before he passed away in September. In the evenings I would come home from my summer job in the City Engineer's office and go to the hospital with Mother, to visit with Daddy before he was able to get some sleep.

In this way, my parents and I spent the Summer of Love. The term took on a special significance for me, although not in the sense of the Haight-Ashbury crowd. It is one summer I will never forget.

I had to begin medical school, and so I moved into a little apartment in Jackson, ninety miles from Greenwood. My mind was not on my studies at first. I drove back and forth frequently, and after a couple of weeks I simply left Jackson and remained at the Greenwood-Leflore Hospital, sleeping on a cot in the lounge. On September 24, one day after his fifty-eighth birthday, Daddy passed away quietly in his sleep.

I remained at home long enough after the funeral to be sure Mother was all right. She and I were of identical temperament, and I knew she would lose her sorrow by throwing herself back into her work, as I would. When I finally made it back to Jackson I had a lot of catching up to do, but somehow I managed to avoid any damage to my grades.

My dear friend, Lloyd Kitchens, was not so fortunate. In my preoccupation with my father's illness, I had not given thought to contacting Lloyd, who had already been in medical school for a year. In the first week I was back in school full time, one of our mutual friends asked me, "Have you heard about Kitchens?"

"No - What are you talking about?"

"He's in the hospital. He has been having severe G.I. bleeding."

After class I took the elevator to the ward where Lloyd was a patient. I had to brace myself to keep from flinching when I saw him. He had lost so much weight, and the resemblance to the weight loss my father had experienced was frightening. With the history of gastrointestinal bleeding, it seemed likely that Lloyd had cancer also.

When I sat down to visit, I learned that his doctors had made a different diagnosis: regional enteritis, an inflammatory bowel disease which affects the small and large intestines. It would later come to be known by the name of the doctor who described its features: Crohn's disease.

Lloyd was very calm and accepting of the diagnosis. He knew a great deal about Crohn's disease, not only from the reading he had just been doing, but from the fact that his father, Lloyd Sr., had been suffering from the same condition for years. Mr. Kitchens had had several abdominal operations and multiple blood transfusions. Lloyd couldn't help thinking about his own future.

He felt certain he would be back in class soon, but it was not to be. The bleeding would not stop, and soon Lloyd had the first of many abdominal operations. Pain became a feature of his daily life. Simply sitting down on a wooden chair could be agonizing. Lloyd missed the entire school year 1967-68, but was recovered enough to return as a second year student with my class the next year. During his year away from school, he worked in the Blood Bank and had the opportunity to see the treatment of many cancer patients. This solidified his desire to become a specialist in medical oncology - cancer medicine.

Also during this year away from school, Lloyd married the girl he had met in chemistry lab at Ole Miss and had been dating for several years. Joyce and Lloyd would remain married for about ten years and would have two children, Elizabeth and Lloyd III (Tré). Through the rest of medical school and internship they would remain some of my closest companions.

In that year of 1967-68 I had been preoccupied with my own problems. The stress I experienced with my father's illness and death was the catalyst that brought into the foreground of my psyche the most intense gender conflict I had experienced in years. As a child, I prayed and wished to be a girl on a daily basis; wore my mother's clothes at home often; and read the stories of Coccinelle and Christine Jorgensen, dreaming with envy. All this came to an end in high school (or so I thought) when I discovered the power of guilt to destroy one's dreams. I must have been a terrible person, I thought; and I prayed for forgiveness.

Somehow, my successes at Greenwood High and Ole Miss allowed me to confine my dilemma to a small corner of my spirit. Daddy's cancer destroyed that façade. In times of stress, dysphoria becomes much worse, and my first year of medical school was the year I "knew that I knew that I knew" that I was afflicted with the condition called transsexualism. Unlike Lloyd, I could completely hide my "illness," and my Baptist background still persuaded me that God would heal me. Healing didn't seem to be immediately forthcoming, however, so I did some research into the medical literature.

Every medical school library has its "stacks" on levels below the main reading room. In the halls of the stacks are back issues of all the major medical journals, as well as less commonly used textbooks. There are desks and lamps at the end of each aisle. I would bring my Guyton's Physiology and Grant's Atlas of Anatomy to one of the little cubicles and study each night. Unlike my classmates, however, my Guyton and Grant had companions: Benjamin and Stoller. I spent hours reading each chapter of The Transsexual Phenomenon and Sex and Gender.

The early sexologists were beginning to understand the difference between gender identity and sexual orientation, but they were still confusing the two conditions. The tendency was still to consider transsexualism as a variant of homosexuality. In the mind of a non-transsexual, it was inconceivable that a man would want to become a woman. They presumed it must be so he could have sex with men. Some even tried to get transsexuals to accept themselves as gay men rather than to transition. They would have dismissed as hopelessly sick anyone who wanted to change sex but wasn't interested in having sex, or who was still attracted to women in lesbian relationships. They just couldn't process this.

The language with which we were described reflected the disdain with which they regarded us. Transsexualism was a "perversion" or a "deviation." We were portrayed as marginally viable in society, able to survive only as entertainers, sex workers, or if we were very lucky, some man's companion. I read their words with disgust. As someone who had succeeded academically and planned to be a successful physician, I could not see myself entering such a world. If that's what being transsexual meant, then by God, I wouldn't be transsexual!

It didn't occur to me that Benjamin and Stoller might have been wrong.

My plan to have a normal life involved two distinct efforts. One, as I've already mentioned, was the spiritual effort to pray for a "healing" or even a "cleansing" of this "perversion." I even went so far as to ask God to cast the demons out of my life. These prayers took me down a misleading and dangerous path, which could have left me suicidal if I had not come to understand the difference between a loving God and those persons who claimed to speak for him but didn't understand his love.

The other effort led me to make the most serious mistake of my life. I refused to consider the medical reality of my condition, and treated it as a behavioral aberration which could be corrected by behavior modification. What better way to stop feeling like a woman than to act like a man? And what better way to act like a man than to become a husband?

Sandy and I had been dating for several years. She was a perfect match for me in temperament and tastes. We were both exemplary young Baptists. And I truly, truly did love her as much as I knew how to love. In my desperate desire to have a normal life, I involved an innocent person in my life's intimacy, and we both paid a terrible price many years later.

4. We've Only Just Begun

Sandy and I married in December of 1969, midway through my third year of medical school. We settled in a little house on Meadowbrook Road which rented for the now-incredible sum of one hundred dollars a month, and set about making friends with other couples. Joyce and Lloyd Kitchens became our closest friends. Joyce had been involved with the students' wives' group for a long time (note the implication that all students were men - not true even then) and helped Sandy become a part of the group. Our tight budgets wouldn't permit dining out often, and so we visited in each other's homes frequently. Lloyd was able to hide his pain quite well, but I knew what difficulty he faced constantly.

With the beginning of the 1970-71 year, our final year of medical school, our thoughts turned to the future. What would we choose for a specialty, and where would we learn it? We were allowed to travel to interviews during the fall quarter. My first trip took me east to Duke, North Carolina, and Emory. All were superb training programs, but all required their interns to be on call every other night for the entire year. Knowing that an intern on call does not sleep, I wondered if I could survive the year.

I planned my second interview trip to Dallas. It would prove to be my last trip, for I found what I was looking for at Parkland Memorial Hospital, the teaching hospital of the University of Texas Southwestern Medical Center. Parkland was equally as renowned as the programs back East, and they had what I was seeking - interns took call every third night. Much better!

My second interview in Dallas was at Baylor Medical Center. I interviewed with Dr. Tompsett, the chief of medicine, and Dr. Reese, the director of the residency program. Dr. Reese was a younger physician who was also an oncologist. I made note to tell Lloyd about Baylor when I returned to Jackson.

It so happened that Lloyd was already aware of Baylor. His good friend from Ole Miss and his first year of medical school, Richard Joseph, was an intern at Baylor that year. Lloyd had been giving consideration to remaining in Jackson at University Hospital. He was also looking at a hospital in Cincinnati which had an outstanding oncology program. After we talked, he went to interview at Baylor and made up his mind to go there for internship. It was the beginning of a relationship which would last for thirty years.

Of our graduating class of seventy, there were nine of us who matched for internships at one of these two Dallas hospitals. We drove down Interstate 20 to spend a weekend hunting for living arrangements. Of the seven married couples, six of us came to the same decision and ended up in the same apartment complex. The Ivanhoe apartments on Park Lane were convenient enough to both Parkland and Baylor.

Lloyd and Joyce were then the only parents among us, Elizabeth having arrived the previous winter. They settled in a two bedroom apartment, and the rest of us found one bedroom units in the Ivanhoe. It was a mixed blessing. There was benefit to having a support group of people who shared our background, but it prevented us from getting out and making friends among the other young couples at the hospitals.

Lloyd's illness was under treatment and relatively stable in those days. He was taking high doses of prednisone. This made him gain weight and acquire a puffy-cheeked facial appearance very different from his gaunt, lean look in medical school. He resembled someone with excess cortisone production by the adrenals, the condition we knew as Cushing's disease.

He was able to find some humor in his situation. On the infrequent weekends we were both off duty, we would spend time in the billiard room in the apartment complex, where he would usually whip me soundly. I joked about one of his good shots, calling him "Minnesota Fats" after the famous pool player. With a straight face he replied, "'Mississippi Cushingoid' would be more like it."

Sandy and Joyce found companionship with the other wives at the Ivanhoe: Grace Clark, Marilyn Hull, Buzz Highbaugh, and Jamie Coffield. We even found time to enjoy some free time in Dallas. I remember the Texas State Fair, the Northpark shopping center where Sandy worked at Colbert-Volk, and the restaurants such as Il Sorrento and the Old Warsaw. When it came time to continue our training, however, most of us made the decision to return to Jackson and pursue residency training at the University Medical Center. It's another decision I would make differently if I had to do it again; staying at Parkland would have been a better career choice.

Lloyd and Joyce decided to remain in Dallas, where Lloyd continued his training at Baylor, completing internal medicine in 1974 and oncology in 1976. Tré Kitchens was born in 1972, and the family moved into a comfortable little house in the suburb of Garland. We visited them numerous times in the years that followed.

Sandy and I returned to Jackson and I entered my internal medicine residency. In 1973 our son Michael was born. How I loved that child! He hated to go to sleep at night, and we found that taking him for a ride in our little Chevelle Malibu was the best way to settle him down. He would sit next to me in his little rear-facing infant seat and look at me until he fell sound asleep. I tried so hard to be a good father to Mike, and I don't think I did too badly.

The Vietnam War was still raging, and I wondered if I would be drafted to serve as a combat physician. One of my fellow Parkland interns, Fred Corley, had volunteered and was already in the field hospital in Da Nang. He sent me a photo of himself in combat gear with automatic weapons. It was not a comforting sight. With the photo was a letter describing how he couldn't play tennis on the hospital courts any more, since the courts were full of shell holes.

Along with several of my colleagues in residency, I applied for the deferment known as the Berry Plan. Doctors were chosen by drawing lots, and those selected were guaranteed they could finish their residency and go into the service as specialists. Of the four of us who applied, I was the only one not chosen. What rotten luck, I thought, gritting my teeth and awaiting the call. It never came, and the war ran down to its ignominious close. My colleagues finished their residencies and served two year commitments as military physicians, and I went straight into practice.

I had many misgivings about our presence in Vietnam, but if drafted I would have served. So would Lloyd, who also loved his country deeply, but military service was not an option for him with his medical problems.

In 1974 Lloyd and Joyce met Sandy and me in San Francisco for the Annual Session of the American College of Physicians, or ACP as we abbreviated it. We were both still in our residency programs, and could attend one national meeting each year at the expense of the training program. This large gathering of internal medicine specialists was an excellent educational experience. It was also the first of many trips I would make to one of my favorite cities. We rode the cable cars and took the ferry to Sausalito. It was one of the highlights of my residency. I didn't tell anyone else about my side trip to Finocchio's while they were sightseeing...

5. Do They Have EKG Machines There?

Lloyd had known for years that he would specialize in cancer medicine. As I approached the end of my residency, culminating in a year as Chief Resident, I had no idea which subspecialty was most appealing to me. I liked them all. I could flip a coin as one of my colleagues did ("Well, I had to do a fellowship in something," he said), but I chose not to choose, and looked for a practice in general internal medicine. What I found was the Physicians and Surgeons Clinic of Amory, Mississippi. Up to that time, P and S Clinic was all obstetrics and pediatrics, and they wanted to expand to include internal medicine and general surgery. The offer seemed reasonable compared to what groups in Jackson were offering at the time.

But - and this was quite a But - Amory was a town of barely seven thousand persons, in far northeast Mississippi over three hours from Jackson. I would be the first internist in the history of the county. There were four older - much older - general practicioners in town who weren't impressed by the young hot-shot. And only after I signed my contract did I learn that the relationship between the physicians and the hospital board of directors was bizarrely dysfunctional. The chairman of the board paid me a visit early in my practice to let me know he considered all doctors "contemptible." He smiled and looked at me for my reaction, which was probably quite shocked. I recovered enough to let him know I didn't consider myself contemptible, but what he thought was his business. Thus did we begin life in Tiny Town in the summer of 1975.

Lloyd was convinced I had lost my mind. "What is an Amory? Do they have an EKG machine for you?" Compared to Dallas, Jackson was a small town, and Amory wasn't even on the map. He finally congratulated me for courage in being a pioneer internist. I think he knew I wouldn't make it my entire career long before I knew it myself.

Life got better in Amory. In a small town there are no outside diversions, and so you entertain yourselves by making friends and spending time with them. There were two couples who had been our friends in college already living in Amory, and this made the transition much easier. We formed a supper club and spent evenings in one another's homes. This was good because there were no movie theaters. For that matter, there wasn't even a McDonald's. For culture we drove to Tupelo, 25 miles away.

Lloyd and I remained in contact. We both were active in the ACP. He was awarded Fellowship in 1978 and was one of my sponsors when I received my Fellowship designation in 1980. Lloyd rose in the leadership of the ACP, serving over the years as Governor for the North Texas region, chairman of the Ethics Committee, and member of the Board of Regents.

My own involvement in general internal medicine began to wane in 1979-1980 when I started to read the reports coming from Dr. Andreas Gruentzig's laboratory about the new procedure called PTCA, or percutaneous transluminal coronary angioplasty. The era of therapeutic cardiology was beginning, and I finally knew what I wanted to be when I grew up. I loved everything about cardiology, and now I could do more for my heart patients than ever before.

During this time period Lloyd and Joyce decided to bring an end to their marriage. I didn't ask why, and never really wanted to know. We remained friends with Joyce until she gradually stopped contact with us. As for Lloyd, we were as close as ever. He entered into a second marriage which was brief and unfortunate, and then was single for several years.

Fellowship programs select their applicants two years in advance. After much introspection and questioning, I decided to go ahead with the interview process in early 1983. I knew my chances for fellowship were best back in Jackson, where I still had a good reputation from my years in medical school and residency. I interviewed with my long time friend Pat Lehan, the chief of cardiology at University Medical Center, and when all the candidates had completed the application and interview process I received a phone call telling me I was accepted for the program starting in 1985.

To say that my decision to leave my practice was unpopular in Amory would be a colossal understatement. I had long since left P and S Clinic and formed my own Amory Internal Medicine Clinic, with two younger internists joining me in 1980 and 1982. They were not at all pleased with the idea of buying out my part of the practice. It was very hard to explain to my patients why I would leave. "We thought you were happy here," they would say. The hospital personnel, with whom I had established a very good relationship, wondered what they would have to do to change my mind.

It was heartbreaking to explain to Mike that we would be taking him away from his friends of the past ten years. He was only two years old when we left Jackson, and remembered nothing of it. I was sure he would adjust to life in Jackson, but it would be a traumatic time.

All of us were big fishes in the small pond of Amory. Mike was very popular in his middle school class, and was the star pitcher on the Amory youth baseball team which made it to state tournament most years. Sandy was president of the Amory Junior Auxiliary and served on many civic boards. I was a Rotarian and had been chairman of deacons twice at First Baptist Church during our time there.

I've often wondered why I felt it necessary to make the change. Was it, as I thought then and still believe, that I truly loved cardiology and wanted to spend the rest of my career as a cardiologist? Was it that the small town life had become so stifling I had to escape? I didn't think so; there were many times when I felt it would have been so pleasant to remain in the comfort of simplicity and familiarity.

Or - and here is the hard question - was I just so unhappy with myself internally that I had to make some sort of change in order to survive? My time in Amory had been marked by numerous bouts with severe gender conflict, which I managed to keep completely to myself. One very ill-prepared attempt to bring up the subject with Sandy in 1980 was such a disaster that I retreated into my shell for years. It was eating me alive, and it continued to worsen even after the move.

I'm certain that my decision to leave Amory was the beginning of the end of my marriage. Sandy was very opposed to the move, and was so unhappy for the last year we were in Amory, continuing for years after we moved back to Jackson. Going from a physician's income to a trainee's income definitely didn't help. I felt so powerless, to be unable to make her happy.

The only person who completely supported my decision was, of course, Lloyd Kitchens. "I always suspected you would end up in one of the procedure-oriented specialties," he told me. "I just didn't know whether it would be cardiology or gastroenterology."

"I like the associated body fluids better in cardiology," was my reply.

6. F.N.E.J.

The mid years of the Eighties brought happier times to Lloyd, who found the love of his life in Connie Coit. If you've spent time in Dallas, you will recognize the family name: Coit Road is one of the major east-west thoroughfares on the north side of town.

In an interview with the Baylor University Medical Proceedings, Lloyd described his introduction to Connie:

Connie is a Dallas native. Her maiden name, which she uses professionally, is Coit. Her grandfather's family were some of the original settlers in Dallas. She lived in New York for about 8 years before we met, working in “the business,” and was pretty successful. In 1984 a new theater opened here in town, and she was invited to come as a guest artist and do Mabel in Pirates of Penzance. I had supported that theater because I had some friends on its board. On the opening night of Pirates, which was the inaugural evening for that theater, I was there with a date. My best friend's son was Connie's co-star. My best friend's wife had been Connie's voice teacher when she was in high school. They all wanted me to meet Connie, who, I believe, was very skeptical of meeting me because I had had 2 children and 2 divorces and, furthermore, wasn't much to look at. We met that July night and got married the next December.

I considered Connie a dear friend from the first time we met. In 1986, she and Lloyd were blessed with a son whom they named Ben. It was a happy time, but Lloyd's illness continued to plague him. From the many blood transfusions he had received over the years, he developed hepatitis C. This chronic, disabling disease was incurable, but could be improved by treatment with Interferon. Unfortunately, the side effects of the interferon were severe, with high fever and bone-shaking chills. To continue his practice required great courage and strength.

In 1990 Lloyd and Connie asked us to meet them at the ACP session in New Orleans. We were accompanied by Mike, who was finishing his junior year of high school. I still remember our evening at La Louisiane restaurant. Lloyd and Mike were seated across the table from me, and during the conversation, Lloyd asked Mike if he had thought about his career choices.

It was the first time I ever heard Mike give a direct answer to that question; he had always tried to avoid commitment with his parents. I almost choked on my creme brulée when I heard him answer, "I will probably go into medicine." I never knew he would want to choose my profession. I was grateful for Lloyd's influence on Mike at that time.

It was a blessing to see Lloyd's well deserved happiness. At the same time, I felt that our lives, having run in parallel for years, were about to diverge.

Our family settled into life in "F.N.E.J." (fashionable northeast Jackson) when I completed my cardiology training and accepted a practice position there. Mike was doing very well at Jackson Prep and, as far as I could tell, was quite happy. To look at us, one would think we had reached the peak of success. Inside me, the conflict was growing steadily. I didn't know how long I could go on, but I promised myself I would not do anything as long as Mike was still home and in high school.

The only time I had peace of mind was during out of town medical meetings, when I could "be myself" by stretching the trip out an extra day or two. Even then the sadness was overwhelming as I would look at myself in the mirror and think, "not in this life." I really didn't think I could succeed in a transition, but I knew I couldn't continue much longer in the old life. I felt terrible for presenting myself to Sandy as someone I wasn't inside. It was at this time in my life that the thoughts of suicide became more prevalent. I even knew my method: close the garage, start the car, get stinking drunk and pass out forever. Because I never had the nerve to carry it out, I'm still here writing these words. And I'm very glad.

I knew I wasn't the only person in the world who felt this way. I just didn't know how to reach out to others. In the pre-Internet world of the early nineties, I thought there was no way to make contact.

I found the way in the fall of 1991, at one of those out of town meetings. At a bookstore in Los Angeles I found a copy of Transgender Tapestry magazine, and began a whole new learning process. I learned quickly, and soon I was corresponding with other transgendered people all over the country. And at this time Mike had graduated from Prep and was in college at Ole Miss.

As my understanding of my identity progressed, my home circumstances grew much worse. Finally, in 1993, I felt that I had to move out and make a life on my own, knowing where that move was going to lead. I knew that the good people of F.N.E.J. would not understand or accept me once news got out about my transition. I suppose they thought I was out of my mind to opt out of their society.

7. A Little Help From My Friends

A sure way to find out who your friends are is to tell them about your upcoming gender transition.

You can write that one down as Experiential Truth.

In the spring of 1993 my closest confidants were four men, only two of whom knew one another. I had known them in one way or another for many years, and I needed their understanding and support for what I correctly perceived would be a major life crisis. I wrote to each of them, explaining what was happening in my life to the best of my ability. I gave as much medical information as I could, described my personal experience, and called on them to continue to support me in a time of need.

Each response was quite different.

I had known Julian since 1975, when I first moved to Amory. Julian was about my age, and had been practicing law there for a short while. A former professional football player, he was a celebrity in the small town. Julian and Steve, whom I will discuss later, became my closest friends. We would sit for hours and talk about events of personal and cosmic significance. Mostly we talked of spiritual matters - from a Baptist perspective. Julian had a gift for speaking, and after a few years he felt he was being "called to preach" so he uprooted his family, sold their home, and went away to seminary for a couple of years. He returned to another Mississippi town as pastor of a Baptist church, and after a few years moved to a larger pastorate in Louisiana. Julian seemed destined to be a rising star in the Southern Baptist hierarchy, until in 1992 he suddenly resigned his pastorate, moved back to Mississippi, and re-entered law practice. I don't have an explanation, but I supported him in doing what he felt he had to do.

Because Julian had had some turbulence and change in his life, I had hoped he would have some compassion for my circumstances. At first he seemed to do so. He drove down to Jackson and read my letter in my presence, and commented, "I can't imagine going through all this." He thought he could call me by my new initials and gradually build up to "Becky." When he left, I was very hopeful.

Unfortunately, within a few days a letter from Julian arrived, informing me that I was "being deceived" and needed to pray to be healed. He let me know, "I will not be a part of the deception, but I will be a part of the healing." I tried writing him back, telling him again how many times I had already been down that road fruitlessly. He never replied, and never has since.

Steve and I had been friends since 1965, in physics class at Ole Miss. Steve was a pharmacy major, so he and I had a number of classes together. He eventually became a member of my fraternity, Phi Kappa Psi, and later followed me as president of the chapter. Steve and his wife Cynthia were already living in Amory when we made the decision to move there; they were one reason we made the decision. Steve later left the practice of pharmacy to become a stockbroker, and has helped me manage my finances ever since then.

Steve also came to Jackson to talk to me in person. I knew he was genuinely concerned for me and for Sandy, and hoped our marriage could be revived. The news I gave him on that day made him sick, literally, but as he excused himself to the bathroom I knew it wasn't because of revulsion but because he was so upset for his friends.

We parted as friends on that day, and have remained in contact. Having a business relationship didn't hurt, but I think Steve would have remained my friend regardless. He stays in touch with me from time to time, and twice on visits to Mississippi I have stopped by his office for a visit. He's always very kind to me. I must say, however, that I know I wouldn't be welcome in his home. I can't blame Cynthia for feeling the way she does; in her mind I broke up a couple which were very close to her and her husband. It's not possible for her to see it any other way.

Steve means very well. Little slips of the tongue let me know he still doesn't get it, like his references to my "lifestyle." But he is trying, and that's a lot more than I can say for some.

My oldest friend of the group was Alec. We had been close pals since seventh grade. We shared a love of music, and were in the band and church choir together. Our third "running mate," Tommy, was another kindred spirit; and we all supposed we would retain friendships as adults. When Tommy "came out" by coming to one of our early high school reunions with his significant other, Bob, I wanted so much to show him my support and friendship; but I was still too deep in cowardly denial and trying to be the good role model. I never got to have a deep discussion with Tommy before he died. Alec and I resolved to continue our friendship and share our deepest thoughts.

Alec and his wife live in Clinton, adjacent to Jackson. It was an easy drive for him to come over to my apartment. He initially thought I was going to tell him I was gay also, and wanted to try and talk me out of a life we had seen bear fatal consequences. It didn't take long to convince Alec that something quite different was facing me. I had made a pie similar to what he and I had shared from my mother's kitchen, and we sat and had a little educational class on transsexualism. Soon Alec felt better about Becky and gave his blessings to my new life. Each time I go back to Jackson for a visit, it's always a highlight of the trip to spend time with Alec. Sometimes the oldest friendships are among the best.

Once again, the only one of my old friends who never questioned me, who gave his enthusiastic support to me from the first word, was Lloyd Kitchens. (I was not surprised.) "You know that Connie and I will do anything we can to make your way easier. I hope we can spend some time with you when we are back for a visit in Mississippi."

Indeed they did, taking me to lunch at a Jackson restaurant in the earliest days of my transition, making me feel so at ease. Lloyd used his influence with the ACP to get my certificates changed to my new name before any of my other professional organizations. Despite being busy with his work, and under physical pain and stress, Lloyd would telephone me frequently and write occasionally, just to keep up my spirits which he knew were embattled.

If all my older friends had been like Lloyd and Alec, my transition would have been so much easier. But then I might not have even left Jackson, and wouldn't have met my new friends and experienced life in Arizona. We go down one fork of the road, and we don't look back.

8. Down, But Not Out

Although I had moved to Atlanta in late 1993 for my transition, I had several trips back to Jackson during the months that followed. One of those trips coincided with a visit by Lloyd and Connie to Lloyd's mother in Crystal Springs, close to Jackson. They insisted on driving up to take me to lunch. I was anxious over their seeing Becky for the first time, but they both put me at ease immediately. It was a wonderful visit, but I was concerned for Lloyd because I thought he looked very pale.

There was reason for concern. Within a few months Lloyd developed a skin ulceration on his left ankle that would not heal, and it became secondarily infected with Streptococcus. This led to the feared complication of toxic shock syndrome. Lloyd was hospitalized in intensive care at Baylor for three weeks, on the ventilator part of that time, and Connie was truly afraid she was going to lose him. He finally pulled through, although he required multiple skin grafts to the ankle area.

This episode of illness weakened Lloyd so much that he was unable to return to the demands of his oncology practice, and he reluctantly retired from active practice. He remained on the teaching staff at Baylor, and did a lot of the administrative work for Texas Oncology. Especially he remained active in the American College of Physicians. Lloyd had read extensively on medical ethics, and he was asked to serve as national chairman of the ACP Committee on Ethics and Human Rights. He had also served as ACP Governor for the North Texas Region, and was elected to the Board of Regents. For a physician who spent his career in private practice, rather than academic medicine, this was a remarkable record.

Lloyd was serving on the Board of Regents in 1998, when the Annual Scientific Session of the American College of Physicians was held in San Diego, just a short hop away from my home. By this time I was back on my feet professionally and well established in cardiology. I usually attended the major cardiology meetings such as the American College of Cardiology, but a few phone calls from Lloyd and Connie persuaded me to attend the ACP Session for the first time in fifteen years.

The meeting was excellent, and I enjoyed catching up on general internal medicine. Of course, the meeting content for me was secondary to seeing Lloyd and Connie, and for the first time, their son Ben, who was at that time about eleven years old. Ben's parents had thoroughly briefed him about Becky, and he was the same open-minded free thinker I knew Lloyd to be. Ben and I got along quite well, especially since his developing tastes in music were more like mine than those of his parents. It was such a highlight for me to spend time with the Kitchens family. I was honored that Lloyd made room for me in his busy schedule as a Regent.

The next two years brought a gradual deterioration in Lloyd's overall health. He had severe osteomalacia, due to failure to absorb protein and other nutrients from what was left of his gastrointestinal tract. The osteomalacia led to easily broken bones. Lloyd underwent bilateral hip replacement surgery and used a cane to ambulate safely. For long walks he sometimes needed a motorized scooter or cart. As I mentioned, from blood transfusions he contracted hepatitis C, and developed progressive liver insufficiency. He was given treatments with interferon, a very toxic medication which caused high fever and diffuse aching and pain. Lloyd, with his brilliant mind and objective self-analysis, knew his time was running short, but he maintained a courageous public presence and continued to travel to official ACP functions.

So in early 2001 Lloyd learned that the ACP planned to confer on him its highest honor - Master of the American College of Physicians, or MACP. There are hundreds of Fellows awarded FACP status each year (Lloyd and I had been FACP for over twenty years), but only a dozen or two Masters. It was a singular achievement, the highlight of his professional career. I could sense the pride in his voice, despite his characteristically downplayed words:

"Becky? Kitchens! Do you still live here in America? I do... we've been out of touch for far too long. Call me sometime at your convenience. I think of you often and fondly and hope you are well. We are well... except for the osteomalacia that keeps me fracturing one major bone or another.

Connie is doing very well. She's quite selective in the roles she accepts, but she gets wonderful reviews in everything she does. Ben is growing in wisdom and stature and favor with God and man. He's doing well on the piano and learning guitar. You would enjoy talking music with him.

I hope you are going to the ACP in Atlanta. It seems that, through some terrible mistake, I have been chosen to get an honor at the annual meeting there. I know Connie is going to sing the National Anthem at the convocation, and I'm going to play the piano for her. I know you need to go to the heart meetings, but the ACP is no slouch, and you would enjoy it. Anyway, we would love to see you. I'm... I'm not sure how many more chances we will have. Give me a call this weekend."

I was on the phone immediately promising Lloyd I would see him at the convocation. "You certainly will," he told me. "You'll be sitting on the front row with Connie and Ben and my mother."

Before the week was done, I had my meeting registration and my hotel and airline reservations for Atlanta. The time passed quickly. Soon I was on a Delta flight to my old home base, Hartsfield International Airport.

9. Until Next Time

What a delight it was to be back in Atlanta, after an absence of over six years! The late March weather was - surprise - cloudy with showers. We're not in Arizona any more, Toto. I rented a Dodge Intrepid (nice car!) at Hartsfield and drove into the city, stopping for a long visit with my friend Ginny Buckner. Later I checked into my hotel, the Hyatt Regency, where I had last been a guest in 1978. There was a comfortable familiarity to the atrium lobby and the balconies on each floor.

I registered the next day at the ACP meeting site, the Georgia World Congress Center. There was already a message waiting for me. I knew before I answered it that Lloyd was its author, and for a moment I was afraid he was telling me he couldn't be present. But instead he was giving me his hotel location - the Marriott Marquis across the street from the Hyatt. I called him in his room and got instructions on where to meet him prior to the convocation ceremony. He also wanted me to go to dinner with his family afterwards.

I went back to my room and dressed for the evening, then caught the shuttle back to the World Congress Center. The convocation was set to begin at 7:00 P.M., so I was in the auditorium by 6:00 and found my way to the front seats. I recognized Ben right away.

"Hi, Dr. Allison," he greeted me. "Mother and Dad are rehearsing. They will be out in a few minutes. Sit here with us."

Lloyd's extended family was present in force. Atlanta was an easy drive for Dick Kitchens and his family from Huntsville, Alabama. His brother Jim made the short flight from Jackson and brought their mother. I had met Mrs. Edith Kitchens several times, all before my transition. To my delight, I found that she was very comfortable with me, and we enjoyed each other's company greatly.

After a few minutes I saw someone push aside the curtain by the side entrance, and Connie entered the auditorium. She turned and held the curtain for Lloyd. My friend walked very slowly, with the aid of a cane, straight to his family and me. Lloyd seemed so changed from the way I remembered him in San Diego three years earlier. His illness made him appear much older than 54. But he still looked wonderful to me as he gave me a long hug. "Thank you for making this trip, Becky. I know it wasn't for the program."

As the convocation ceremony began, and all the new Fellow candidates filed in dressed in academic robes, Lloyd took his place at the piano beside the podium, and Connie sat with us until everyone was in place. Then she stood by Lloyd at the microphone and together they performed "The Star Spangled Banner" for the thousands of assembled physicians and guests. I glanced at Mrs. Kitchens and could see in her smile the pride she took in her son.

Lloyd took his place on the podium with the other Masters honorees. When he walked up to receive his award, the applause grew louder than before.

After the ceremony we made our way to the shuttle buses which would return us to the hotels. The shuttles were all the way on the other end of the World Congress Center from the auditorium, and Lloyd had arranged for an electric cart so he wouldn't have to walk the distance. He kept the cart at walking speed so we could keep up.

Lloyd had made reservations for a late dinner at the Steakhouse at the Marriott. The table for twelve included his family; another couple from Dallas; and me. Lloyd occupied the chair at the head of the table, and I sat just to his right. During the meal we had time to discuss our common views on politics and world affairs. Lloyd was one of those rare people, a popular physician in Dallas who happened to be a liberal Democrat. Some things never changed. It seems a lifetime ago, and the world has turned upside down since then, but we didn't know the future as we once again found ourselves in agreement on the state of the nation.

After too short a time, our meal was over. Lloyd and I were making plans to meet in Jackson in September 2001 for our medical school class reunion. "I'll be your date for the weekend," he promised. We hugged goodbye and he let me go with, "Until next time."

"Until next time," I agreed, not knowing that this was the last time in this world.

10. Autumn

The spring and early summer of 2001 passed quickly, and I made my reservations to fly to Jackson for the reunion on the weekend of September 21-22. I called to check on Lloyd and was distressed to hear he hadn't been doing well, and might not be able to attend. Still, I knew Lloyd had been very ill in the past, and had fought his way back. It was only when I got the voice mail message from Connie in early August that I knew this time was different. Lloyd was hospitalized with end-stage liver failure. He drifted in and out of consciousness, and in a clear moment he whispered to Connie, "I think this time I'm going to see Jesus." On Thursday, August 23, Lloyd quietly slipped from this life into the next.

I was able to get a flight to Dallas on Friday, unable to arrive early enough to see Connie and Ben that evening; but I found a hotel just a few blocks from the Highland Park United Methodist Church, where a memorial service was scheduled for Saturday morning.

The church was nearly packed a half hour before the service began. The program described it as "A Celebration of the life of Lloyd Wade Kitchens, Jr., MD, MACP." Indeed, it was much more of a celebration than a time of mourning. The entire adult choir of Highland Park UMC was present, showing their love for Connie and Lloyd, long time choir members.

In keeping with Lloyd's love for great music, the service was filled with masterpieces. A soloist performed Allitsen's "The Lord Is My Light," and the choir selections included "How Lovely Is Thy Dwelling Place," from Brahms's Requiem, and John Ness Beck's "Offertory" based on Micah 6. One of the highlights of the celebration was a piano solo, Beethoven's "Sonata in G: Allegro," by Ben Kitchens.

Lloyd's brother Jim is accustomed to public speaking from many years as an attorney. I listened to his poignant, humorous accounts of their early years, thinking of the similarity of Lloyd's and Jim's voices. Jim was pure magnolia Southern accent, and Lloyd's voice was tempered by years of Texas twang, but the inflections were identical.

Lloyd's pastor, Reverend Barbara Marcum, had some wonderful words of faith and assurance; she was preceded by Lloyd's daughter, Elizabeth, who read from the book of Matthew a passage so appropriate for the life of one who had given himself to the care of people with cancer:

Then shall the King say unto them on his right hand, "Come, you blessed of my Father, inherit the kingdom prepared for you from the foundation of the world: For I was hungry, and you gave me meat; I was thirsty, and you gave me drink; I was a stranger, and you took me in; naked, and you clothed me; I was sick, and you visited me; I was in prison, and you came unto me."

Then shall the righteous answer him, saying, "Lord, when did we see you hungry, and fed you? Or thirsty, and gave you drink? When did we see you a stranger, and took you in? Or naked, and clothed you? Or when did we see you sick, or in prison, and came unto you?"

And the King shall answer and say to them, "Truly I say to you, inasmuch as you have done it unto one of the least of these my brethren, you have done it unto me."

The service concluded with Handel's "Hallelujah Chorus," and the postlude was the magnificent "Toccata from Fifth Symphony" by Vidor.

The reception afterward gave me a chance to visit briefly with all the family members, but so many persons were seeking to give Connie their support, I didn't have time for much conversation. We spoke by telephone a few weeks later, and I know we will remain in contact.

Just over two weeks after Lloyd died, our whole world changed when terrorists destroyed the World Trade Center and damaged the Pentagon. I would have loved to know his feelings about this new world.

I did not cancel my reunion plans; I went ahead with the flight to Jackson, and met with many of our medical school classmates. None of them had seen me since my transition, but all were completely friendly and accepting. I took the opportunity to tell everyone about Lloyd, and how he had hoped to be present.

Now, back in Phoenix, I go about my work and see my patients. There is still an appearance of normalcy, but now there is an underlying sadness mixed with anxiety. What will be our own future, with no one safe from the attacks of those with an irrational hatred of our society? Will any of us be here a few years from now?

I cannot see or talk to Lloyd to discuss my fears. My belief system tells me that I will see him again one day. We will both be young, and strong, and then Lloyd and Becky can keep that "date."

For now, I have wonderful memories of Lloyd over so many years. As always, I use music to help me voice my memories. While I love and appreciate classical music, I've always been more of a popular music fan than Lloyd was. This was reflected in the music we enjoyed in the innocent early years of the 1970s, such as the Carpenters' "We've Only Just Begun" and the Beatles, singing in "Across the Universe": Nothing's Gonna Change My World - Nothing's Gonna Change My World...

But the world, of course, has changed profoundly and permanently. Perhaps more in keeping with my feelings for Lloyd would be these lines from the Moody Blues.

The summer sun is fading as the year grows old
And darker days are drawing near.
The winter winds will be much colder
Now you're not here.

I watch the birds fly south across the autumn sky
And one by one they disappear.
I wish that I was flying with them
Now you're not here.

Like the sun through the trees you came to love us.
Like a leaf on a breeze you blew away.

A gentle rain falls softly on my weary eyes
As if to hide a lonely tear,
My life will be forever autumn
'Cause you're not here.

"Forever Autumn" © 1978 by Justin Hayward

Lloyd, I'll continue to try to do as you did, to minister to the sick, the hungry, the captives, those who need what I can give. Until the day we are together again. Until next time.