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Before we get into this book, we'd like to pause to make sure we're all on the same page. As a rule, the respectful way to discuss transgender people is by using the name and pronoun they specifically identify with. Caitlyn Jenner should always be referred to as Caitlyn, no matter which era of her life is being talked about, and Laverne Cox should always be referred to with feminine pronouns, whether we're talking about her rise to fame or her early childhood. That said, since we're analyzing a text here, we're going to refer to Lili Elbe as both Lili and Einar as needed for the sake of clarity. If we were writing Lili's bio, though, it'd be all Lili, all the time.
Something is rotten in Copenhagen, Denmark, and it's Greta Wegener's painting career. She is married to Einar Wegener, a famous landscape painter, but her own portraits sit in his shadow. Hey, at least the paint won't fade from being in the spotlight. Commissioned to do a portrait of a famous opera singer, Greta needs help. Her model is busy bellowing her lungs out, so Greta convinces her husband, Einar, to put on the opera singer's dress.
And he loves it. Greta thinks he looks so dang pretty that she calls him Lili, after the bouquet of flowers he's holding.
Einar decides to dress as Lili (sans bouquet of lilies) and venture out in public sometimes. Greta supports his decision, and starts to paint portraits of Lili. The paintings gain attention from an art critic in Paris, and Lili gains attention from a male painter named Henrik. However, Lili doesn't want to admit to Henrik that she is actually a man, so she breaks up with him.
Greta tracks down Einar's childhood friend, Hans, in Paris. Hans is now an art dealer, and Greta and Einar (and Lili) move to Paris, where Greta's paintings are becoming very successful. Meanwhile, Einar has quit painting. Instead of painting, he visits a peep show, watching women strip, not for sexual reasons, but so he can learn to move more like a woman. If only he were alive today, he could just take pole-dancing classes.
However, Einar becomes more and more depressed with being Einar—he wants to be Lili all the time. Sadly, he sits in a park by himself and decides to kill himself if he can't be Lili. Thankfully, Einar has support: Greta and her brother, Carlisle, take Einar to various doctors. One thinks he can X-Ray the big gay demon out of him, another doctor wants to commit him for schizophrenia, and a third wants to give him a lobotomy. Holy malpractice, Batman. Greta finally finds a man named Professor Bolk who has developed a surgery to physically change a man into a woman.
Einar takes the choo-choo to Dresden, where he meets Bolk at the Municipal Women's Clinic. Before checking into the clinic, Einar visits the Brühlsche Terrace, where he looks at the Elbe River and gives Lili a last name: Elbe. Lili Elbe. Then he has surgery to remove his male parts and replace them with female ones. It turns out that Einar actually has a pair of ovaries inside him, so he already was biologically part female. The surgeries are successful, and Lili returns to Copenhagen with Greta.
The two women are divorced but still live with one another. Greta thinks she needs to stay to take care of Lili, but Lili reunites with Henrik and wants to marry him. When Henrik proposes, Lili finally tells Greta that she wants to leave with Henrik and go to the United States, where he is moving to pursue his art career.
But first Lili wants to have one final procedure: Bolk wants to transplant a uterus into Lili so she may have children. Greta thinks that is a terrible idea, and even though Lili asks Greta to accompany her, Greta refuses. Lili returns to Dresden with Carlisle instead. While she's gone, Greta decides to go with Hans to New York and leave her life with Einar behind. However, they make a pit stop to Einar's childhood home before leaving Denmark. If Lili won't remember Einar, Greta will remember him instead.
In Dresden, Lili has the final surgery and—are you sitting down?—a terrible infection sets in. It's fatal, but no one tells Lili about it. Instead, Carlisle takes Lili outside the clinic, which is against the rules, for a walk outside. On what's most likely her final walk, Carlisle pushes her wheelchair to the Brühlsche Terrace so she can appreciate nature one last time. As the book ends, we're led to believe that Lili won't survive much longer after we close the book. Those little spots on the cover of our copy of the book? Those are tears.