Brenisha Hall looks up from her mother’s arm in the form of a tattoo as the woman she fought and died to become.
It’s a place where, even in death, Hall is celebrated and recognized as her identified gender, her face feminine, her hair long.
Her mother, Lessie Hall, buried her in men’s clothing. God sent Lessie a boy, she says. So she sent God a boy back.
It’s been four years since Brenisha Hall died in New Orleans from silicone pumping, a dangerous practice often undertaken by many trans women that involves injecting silicone, sometimes mixed with substances like Fix-a-Flat as a lower-cost alternative to plastic surgery.
Earlier this month, Armani Nicole Davenport, the trans woman who injected Hall, was sentenced to probation after pleading guilty to negligent homicide for her death.
The sentence is unusual in such cases, which historically end in murder convictions with prison sentences. Last month, a Dallas salon worker was convicted of murder after a woman she injected with silicone died. In 2017, a Florida woman was sentenced to more than 11 years in prison for killing an Atlanta drag performer with injections. The same year Hall died, a transgender woman from Mississippi was sentenced to life in prison for administering fatal injections.
But in only one of those cases (Florida) was the deceased a trans woman, and in that case, she was light skinned or white. In the Mississippi case, the woman convicted of administering injections was a trans woman.
Lessie Hall feels that if her child were white, the outcome of the case would have been different.
In Hall’s case, Criminal District Court Judge Paul Bonin told Davenport he felt sending her to prison would serve little purpose, the New Orleans Advocate reported.
“I am trying not to diminish that somebody’s life was lost through your actions, but I am satisfied that your actions were not intentional,” he said. “You did not mean to kill. And that’s a huge difference.”
“I didn’t even stay in the courtroom to hear the sentence,” says Lessie Hall. “I did not get justice.”
For Lessie Hall, the sentence was a slap in the face. Her child, desperate to transition, was injected by someone who had no business or authority treating anybody.
Doctors do use silicone, but in those cases, it is typically contained or injected in very small doses. Silicone, when injected loose into the body in a large quantity, can have devastating consequences. Infections can require hospitalization, but more serious, the silicone can travel to the heart, lungs or brain.
Lyon-Martin Health Serves serves the LGBTQ community in San Francisco and puts out some of the only information on pumping. The health center notes that when silicone travels and causes Acute Silicone Syndrome, 25 percent of patients treated in the hospital die.
More alarmingly, one study in San Francisco found that one in six trans women had pumped somewhere on their body. But many hospitals are so unfamiliar with the practice, that Lyon-Martin recommends that patients experiencing the symptoms of Acute Silicone Syndrome bring their flier on silicone pumping to the hospital for doctors.
Nick Gorton, an ER doctor and a primary care physician at Lyon-Martin, sees complexity in cases like Hall’s where transgender people are literally dying to become themselves.
“I feel horrible for the woman who died, and I feel horrible for her family, but I also feel horrible for the woman who did [the injection],” says Gorton.
Insurers increasingly cover transition-related medical procedures like mammoplasties, facial feminization, and implants. And the Affordable Care Act has increased the number of insured people in the U.S. Consequently, fewer have turned to pumping.
But for the uninsured or those whose plans don’t cover procedures, the choice can look like pumping or non-existence, since the thought of not transitioning is unbearable.
“I don’t know how to do an appendectomy,” says Gorton. “I’m an ER doctor. That’s just not my thing. If you took me and my husband and put us down in Antarctica, and there aren’t other doctors there, and he had appendicitis, I’d read a book and YouTube it, and try to figure out a way to do it because I wouldn’t want him to die.”
But for many, the dangers are not even apparent when deciding to pump. They weren’t for Vixen Marcille who paid $100 for injections in a basement in Newark, NJ when she 16. Another trans woman, Marcille’s “gay mother” at the time administered them.
“There was no conversation,” says Marcille. “They were just saying if you get this done to your face, you’re going to look more feminine. In my head, I thought, ‘okay wow.’ She kept telling me, ‘you’re going to look like me,’ and she was so beautiful.”
She wasn’t wrong. The effects were pretty immediate.
“It gave me a lot of confidence,” says Marcille. “It really did. For a couple of years, before I noticed anything.”
But then someone pointed out to her that her face was uneven. She realized the silicone on her right cheek had slid.
Over time, Marcille watched her gay mother starting to have her own silicone removed, and she started to understand it was dangerous. That was 14 years ago. Marcille is still saving up the money to get her own removed.
By the time Brenisha Hall was rushed to the hospital, her kidneys failing, her left side headed to paralysis, her body was full of silicone, says Lessie. She spent 14 days in a coma and a month in the hospital before she died.
When she did, Lessie buried Brenisha in men’s clothing, against Brenisha’s stated wishes. The tattoo Lessie got of Brenisha, while it shows her after transition, also bears her male-assigned birth name. Since Brenisha died, Lessie has reverted back to using male pronouns for Brenisha.
“He’s never going to know that because once you’re deceased, you’re in a deep sleep,” Lessie says.
The contradiction here, that Brenisha died to transition but could not escape her assigned gender, is not lost on Lessie.
“I can only imagine what he went through in his mind,” Lessie says. “It damned near tore him apart. You know, you’re in a body that you don’t want to be in.”
Lessie struggled when Brenisha started identifying as a girl at age 10, but she called Brenisha by her name in life and tried to help her transition. She had no idea Brenisha was pumping, that her friends were pumping.
“They were all out there dancing and popping and stuff,” Lessie says. “They were hurting on the inside. That stuff is deadly.”
If preventing deaths like Brenisha’s looks like increasing access to transition-related medical care, it also means rethinking transition entirely, says Marcille.
“It’s a lot of work,” she says. “Name change. Change the sex. And then you got to go to all the places that have your old name and transfer all that over. You have to really be on and be willing to go through all these things.”
Cutting through the red tape to access surgery is overwhelming for many already living on the margins. Silicone is cheap, accessible, and its effects immediate. That’s a stark difference from the hours women spend standing in lines and sitting in doctors’ office waiting rooms.
“They really want to be a girl or the girl or the star,” says Marcille. “It is life or death for some girls.”