Recently I found myself in a situation that many transgender people dread: I was in an accident and required emergency medical care.
On a beautiful snowy Saturday, I went skiing in Southern Vermont and took a bad tumble on a run down the mountain. As I lay in the snow in a tremendous amount of pain and waiting for the ski patrol to come help me, I couldn't stop worrying. I worried about how I would be treated once my transgender status was revealed. I knew I may need to "come out" as a transgender man on my own in order to ensure appropriate medical care. Alternatively, I knew I may be "outed" by the fact that my transgender body is not the same as a cisgender man's body.
I worried. Would I be respected and treated with compassion? Would I be addressed appropriately? Would I even get appropriate medical care?
The ski patrol arrived, assessed me, and bundled me into a basket to ski me down the mountain to the onsite emergency clinic. X-rays were taken before a stitch of clothing was removed and it was determined that I had multiple fractures in my lower leg that would require transfer to a hospital and surgery.
My gender expression, particularly my ski clothing and gear, aligned with my gender identity, and was what we consider traditionally masculine. The gender marker on my state issued ID is "male." It's important to note that at this point, the ski patrol, nurses, x-ray techs and doctors all referred to me as male. I was "passing," which means no one knew I was a trans man.
My lower clothing was partially removed in order to splint my leg and prepare me for the 1.5 hour trip to the hospital. I had been given IV morphine for pain but even then I began to hear the shift in the way I was being referred to. To my face, it was still "Beck" but in the background, some of the caregivers began using feminine pronouns -- "she" or "her" -- to refer to me. Each time I heard them, I'd yell "it's he" as a way to claim my space and dignity in what was truly a frightening situation.
When I reached the hospital Emergency Room I was immediately assessed by the ER doctor on duty. I began our conversation with: "Doctor, I am a transgender man. Do you know what that means?" When he answered in the affirmative, I said "I expect to be treated with dignity and respect -- do you understand?" Again he answered in the affirmative and began to treat my injury.
I'll never forget the nurse assigned to monitor my condition during my time in the ER. She began by saying she admired how I had advocated for myself in the situation. She said she didn't know much about transgender people and had never had training in transgender patient care. She clearly expressed a desire to be supportive as well as her uncertainty in knowing what respectful and appropriate care should look like. I thanked her for her support, told her it would help me a lot if everyone referred to me as "Beck" and used the pronouns "he, him and his" to refer to me. I thanked her for her concern and said I would let her know how else she could help.
The severity of the break meant I had one surgery that very night and a second surgery nine days later. I was in the hospital for a total of 15 days.
My orthopedic surgeon ended up being a woman who, like my ER nurse, deeply desired to be supportive but lacked any direct training in LGBT patient-centered care. One issue that arose was whether or not I could continue hormone replacement therapy (HRT) during the treatment for my leg. The hospital pharmacist and endocrinologist were deeply against it. Again advocating for myself, I encouraged my orthopedic surgeon to speak directly to transgender health care experts at Fenway Health in Boston. Because my doctor took the time to speak with Fenway, I was allowed to continue my HRT and avoid the possible complications of stopping treatment.
As a non-ambulatory patient for 15 days I interacted with a massive team of nurses, certified nursing assistants and physical therapists working with me every day. There were also people who cleaned my room and brought my food as well as various administrative staff.
I came out to almost all of my direct care staff -- nurses and nursing assistants -- and acted as an educator throughout my stay. Once it seemed I had everyone on-board and acclimated, the staffing shift schedule would change and I would have whole new teams of caregivers to educate. And, even with all this work and advocacy, I would still be mis-gendered either to my face or within earshot on an almost daily basis.
Why It's Important for caregivers to be LGBT culturally & medically competent:
Wellness is a holistic endeavor. As a transgender man, when a caregiver mis-genders me by referring to me with the wrong pronoun, several issues come up. One, I don't feel seen or heard for who I am. Our trust is disrupted and in that situation I am less likely to be forthcoming with my needs medically. Additionally, being "erased" and feeling invisible has a depressive quality that is not conducive to the best healing.
Many lesbian, gay, bisexual, and transgender (LGBT) individuals face discrimination based on sexual orientation and gender identity when seeking health care. Fear of discrimination causes many LGBT people to avoid seeking health care, and, when they do enter care, studies indicate that LGBT people are not consistently treated with the respect that all patients deserve. Beyond cultural competency issues, there are also specific medical concerns and needs for members the LGBT community. Doctors and other caregivers require training and education in those issues -- or at least should have access to LGBT medical experts for when questions arise.What Went Right:
- Overall, I had compassionate and engaged caregivers who had the desire to treat LGBT patients with dignity and respect.
- Because my caregivers had the desire to learn, I could advocate for myself and educate. It's important to note, though, that I am an LGBT awareness trainer for a living -- so I am in a unique and privileged position to advocate for myself.
What Needs to Improve:
- None of the hospitals in the vicinity of the ski area where I was injured, including the one I was admitted to, participate in the Human Rights Campaign Foundation's Healthcare Equality Index (HEI). The HEI is the national LGBT benchmarking tool that evaluates health care facilities' policies and practices related to the equity and inclusion of their LGBT patients, visitors and employees. To earn the designation as a "Leader in LGBT Healthcare Equality," a facility must meet all four of the HEI's core criteria, one of which is required training for key staff As part of participating in the HEI, facilities have access to free training in LGBT patient-centered care.
- Medical and nursing schools as well as technical schools that certify EMTs and Paramedics need to incorporate LGBT healthcare and cultural competency into their curriculum
How You Can Help:
- If you work in the health care field, use your insider position to advocate for training and education at your facility/employer. Encourage them to participate in HRC's HEI if they don't already do so.
- If your LGBT friend or loved one is in a medical emergency, note that they may need help advocating for themselves. Be prepared to help advocate for appropriate and respectful treatment. Caregivers may also need referrals to resources for expert medical input (see below).
HRC offers free training through the Healthcare Equality Index
See the report from HRC and Lambda Legal, Creating Equal Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policies that offers best practices in hospital policies to reduce health disparities for transgender patients.