Choosing to undergo gender reassignment surgery is an intensely personal and monumental decision — one that, understandably, many trans people choose not to reveal much about.
But one brave teenager named Emmie Smith is not only speaking out about her surgery— the 18-year-old allowed a National Geographic photographer, Lynn Johnson, to come along for the procedure and film her and her Massachusetts-based family through the process.
The magazine has since released a nine-minute video documenting the experience, including interviews with Emmie, her identical twin brother Caleb, her mom, and her plastic surgeon.
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Emmie is lucky in that her parents and twin have been very supportive throughout her transitional process, even if it was a shock to come to terms with.
'When I first learned that my child was transgender, I couldn't speak the word, I was so — I didn't know, I didn't know anything about it,' her mother Kate Malin, a reverend at an Episcopal church, says in the video, stuttering out her thoughts.
'Here I was, this "good mother" that researched everything before we, you know, bought a diaper. I was the one in the know, and all of a sudden I didn't know anything and it was frightening and it was other and I didn't want my child to hurt or be hurt or be judged.'
Emmie, formerly Walker, found that she's mostly received a positive and nonjudgmental response to her news.
'Being closeted was one of the worst parts of my life. Being out, it's not so much a personal change, it's a social change,' she said.
She shared the news publicly for the first time on Facebook two years ago, and her social circle seemed to adapt quickly.
'The thing I really remember about coming out, was I was in a play. I went to rehearsal, and they were getting my pronouns right, they were using my name,' she recalls. 'It was just a totally different world. It was incredible.'
'If I was not out, I'm not sure I'd be alive right now,' she adds.
Her brother Caleb, too, has taken the news well. He notes, 'I kind of taking pride in being one of the few identical twin pairs that are boy and girl.'
Despite knowing she wanted to be a girl, though, Emmie wasn't always convinced she actually wanted to take surgical steps to change her body.
'When I thought about why I eventually wanted to get this surgery, because I really didn't at first, I think the reason that I ended up really wanting it to happen, started being something more out of convenience,' she explains.
'As it started to get more real and I got the surgery date and all that, I found a million reasons why I wanted it to happen.'
So, on August 30, 2016, she went under the knife, having a surgeon change her penis into a vagina.
National Geographic was there on the big day, as Kate said she felt 'honored' to accompany her daughter on this journey — adding that they were both 'giddy' and 'nervous'.
'I think people are fascinated by gender reassignment surgery. They also don't know how to have a conversation about,' Emmie said of her decision to let the cameras in.
Before heading into the operating room, Kate and Emmie are seen waiting and praying together. Kate looks like she is holding back tears as she asks God to lead Emmie through.
The surgeon, Dr. Christine McGinn, then explains exactly what happens once the anesthesia kicks in.
'The glans penis becomes the clitoris, the skin of the penis becomes the labia minora and part of the opening of the vagina,' she says.
'The scrotal skin is taken off and used as a skin graft, it's rolled up into a tube, and that's placed in a space that we make at the base of the scrotum... and that's going to be the lining of the vagina.'
The testicles are removed, and the urethra is actually saved, and the flap of the urethra is used to make a hood for the clitoris.'
After all of that happens, Dr. McGinn wakes up a groggy Emmie, telling her the surgery is over.
The doctor explains in a voice-over that though Emmie looked scared, she knows she will be fine — particularly because her family is there for her.
'When people don't do well, after their transition, it's because they have absolutely no support system. Their support system is their families putting on a game face, but they're scared as hell too... She's got everything going for her,' she says.
Outside the operating room, Kate can be seen crying and smiling as she calls family members to tell them the surgery went well.
'I feel like I haven't taken a deep breath in two days,' she says before visiting Emmie and reading her the supportive messages sent by her other family members.
'What my husband and I keep remarking on to each other is this just feels so right, it's so her, it's so the child we've always known and loved, even thought a few years ago we wouldn't have necessarily anticipated this step,' says Kate.
'And that's where I think, again, transition is problematic. Because it presupposes an end point, where at some point you have transitioned. Whereas every single one of us is in constant development. This is obviously a huge, huge moment in Emmie's life, but it by no means the end point. In some ways it's just the beginning.'
Emmie took nine weeks to recover, and is now working at an art museum and taking a gap year before starting college in the fall.
She hopes to study acting and is working with her brother on a musical, and wants her story to help educate others.
'If you’re not living freely that’s time wasted, and I felt my time was wasted pretending to be a boy.
'[Transitioning] was the best decision in my life,' she said. 'It’s not science fiction or mythology. It's what happens to women just trying to be at peace with themselves and their bodies.'
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