“You can’t just have the genitals you prefer,” said the admitting nurse behind the bulletproof glass. “You have to take the genitals that Medicare For All has available.”

My activism kicked in. Strong.

“You’re telling me,” I said, stunned but still brave, “that a transperson with gender dysphoria in a trans friendly hospital can get sex-reassignment surgery, but not their preferred genitalia?”

“Yes,” said the nurse, and I could feel her empathy from behind three inches of polycarbonate. “Because it’s transphobic to have genital preferences and, unfortunately, the genitals you requested six months ago aren’t available right now.”

“But I’m …!” I started.

“Yes,” said the nurse. “I know. Gender is purely a social construct, but you’re trapped in the wrong gender. And you requested a penis but all we have in stock are vaginas.”

My outrage went to 11, and my inner voice said it’s counter to medical science to use chromosomes, hormones, internal reproductive organs, external genitalia, or secondary sex characteristics to override gender identity for purposes of classifying someone as male or female.

The nurse was still talking.

“Truth is whatever you say it is, but you believe there’s a real self to be discovered inside your person,” she said, pushing a stack of endless, odious paperwork at me. “Sign these and we can get started.”

My inner voice spoke again, this time from a deeper place, suggesting — so gently that I ignored it — that maybe the activist outrage I felt was really cognitive dissonance.

“You have to understand that under universal health care not everyone can get what they want,” the nurse was saying. “Sometimes you get what you need.”

“I need a penis,” I said, feeling my emotional needle approach 12. “You — okay, not you specifically — promised me that Our Revolution would give us free healthcare, nonbinary identity documents, and help us ruthlessly enforce acceptance of transgender ideology. You have to give me a penis or …”

“Or what?” the nurse said, her empathy fading. “Your real self may be something other than your physical body, but the dialectical materialism of the revolution says the material world has an objective reality independent of identity, and that ideas can arise, therefore, only as products and reflections of material conditions.”

My inner voice reflected on the truth that my transgender identity used to be at odds with my physical sex, but, over time, it essentially became the determinant of my physical sex.

But the nurse was still talking.

“And the material condition is that, yes,” and she paused, pointed her finger at the glass, and stated emphatically, “We. Have. No. Penises. Today.”

She paused, and I could feel the empathy return.

“But we can give you a vagina,” she said, pushing the stack of papers another inch toward me.

“But I already have a vagina,” I said.

“Yes,” said the nurse. “And you’re not transphobic, are you?”

I signed the papers, took my seat in the waiting room, and told my inner voice to shut up.