Don't get caught up in the machine. And if you think you're stuck, or that you don't have any other options because you can't get out of your job, or (insert reason here), just simply start talking about what you want. You might be surprised how quickly people want to be part of it, and who would be willing to help you get there.
After today you might want to rethink the charms of the Show Me State. For the last year a local coalition has been pushing adoption of LGBT-welcoming policies at hospitals. In this week's release of HRC's Healthcare Equality Index, Missouri zoomed from 37th in the country to sixth in the number of local LGBT leader hospitals.
With midterm elections four months away, there are signs that a bitterly polarized electorate will again deliver a government incapable of working together. This is our era's sad twist on the maxim "all politics is local." You can win local elections at the extremes. But you can't govern from there.