From LGB to T in the ER

18 March 2015 (Shot 55)

When I was three years old I was diagnosed with cancer. I learned quickly that being a cancer survivor meant that people looked at me differently – they felt bad for me, they treated me like I was breakable. To healthy kids, having cancer meant you lost your hair, and a shameless teasing similar to the karate, hello kitty, and fake-talking in Japanese jokes that stewed my own internal discomfort of being mixed-race-Asian in a black and white suburban town.  Confiding in others that I survived leukemia was as sacred as confessing my attraction to women would be in my later teens.

Being a cancer survivor meant that I was no stranger to the hospital. Going for annual check-ups was non-negotiable (as was health insurance), and even today I still fight an internal alarm every time I get sick; could this be the “big sick” as I used to call it. Entering my 20s as a gender ambiguous queer person who still checked the “F” box on doctors forms, I experienced my fair share of ignorance and judgement from the medical institution. I quickly learned to take solace in student health centers with their “Safe Space” signs, young-hip staff, and gender neutral restrooms. When I had to go to a public medical center in Florida, I learned to bite my tongue while I held my girlfriend’s hand as the nurse ignorantly spit safer sex tips with a grimace. Despite these challenges, I always went to the doctor.

This past August for the first time I felt the widening divide between the LGB and the T when it comes to LGBT health care. It was a holiday weekend and I needed urgent care. I was less than one month post-op from top surgery and still pretty weak, emotionally and physically. The experience wasn’t malicious, but as I walked out I said to myself, I’m only going back there again if I’m bleeding to death. The moment I thought this I literally stopped in my tracks. I didn’t want to approach health care this way.

Six months later, after a very positive experience I had at SFSU’s medical center, I wrote to UCSF about my past experience and a few easy suggestions to make things safer for trans patients (see below). Last week I had an incredible phone conversation with their directors of patient services and relations about my experience in August, what they are currently working towards to make UCSF ER more trans-friendly, and to participate in future conversations and panels.

[some other good reads: UCSF earns perfect score for health care equality, Do no harm: queer patients and the med school closet]


—————————-Letter to UCSF (edited)

I was a patient at the UCSF Emergency Room in August 2014 and had an experience that I wanted to share.

I’d like to tell you a little bit about me to situate my experience and this story. I am a biology graduate student at San Francisco State University and do research on sea slugs at the California Academy of Sciences. I grew up in the midwest and have called California home for the last 15 years, San Francisco specifically for the last nine. I work part-time at the Academy as a Graduate Assistant and qualify for the UCSF Financial Assistance Program. I’m mixed-race, 33 years old, and FTM transgender. I’m out to my family, friends and colleagues and have a fantastic support network. I’m also a childhood cancer survivor and take my health care very seriously.

Back in August, I had been on testosterone for eight months and was still recovering from the top surgery (bilateral mastectomy) I had in late July. I experienced my first UTI a few weeks after surgery and was treated. Over Labor Day weekend I felt what I thought might be another UTI coming on. I was planning on gritting my teeth and waiting to go to my primary care physician on Tuesday if it didn’t get worse. It did. I was at a friend’s house when the pain suddenly skyrocketed and I started to pee blood. It was a holiday weekend Sunday and I drove myself to the UCSF Emergency Room.

I walked in the door and sat down at the receptionist desk. On the drive over I had been worrying about how to let them know I was transgender. The receptionist said little and our interaction was brief, but she didn’t ask about my gender. I was nervous and in pain as I sat in the crowded waiting room. Then I heard being called out loud across the waiting room, I heard “Ms. Matsuda”. I haven’t been referred to as “Ms.” in a very long time. I couldn’t move out of my seat. I was embarrassed and looked around the room to see if anyone noticed. I felt unsafe and fought the urge to get up and walk out of the building. I sat there frozen until a male patient was called. Then I got up and quietly identified myself to the nurse.

The story of my experience could easily seem anti-climatic, which is in part why it has taken me so long to reach out. I experience a lot of quiet trauma as a transgender man. It takes mental energy and emotional strength to initiate the conversation about being trans and requesting that strangers use my preferred pronouns. That day in the ER I couldn’t muster it. It was especially triggering for me because the medical condition I had come in with directly related to my genitals. Unlike coming in for a sprained ankle, in this case I had to weigh the costs of my fears around how to out myself against getting the right type of medical advice.

Some of the nurses I interacted with assumed I was male, which felt good emotionally, but concerned me medically. I sat alone in the sectioned off part of my examination room listening to the conversation between a young male patient and his friend on the other side of the curtain, fearful about having them hear me when I had to “come out” to my doctor. Luckily, they were seen first and were gone by the time my doctor came in; she was the first person there that slowed down and gave me the undivided attention and safety to let her know that I am transgender.

I know that many transgender individuals are too afraid to access the health care they need. I walked out of the ER that day vowing to never come back unless I was essentially on the brink of death. I caught myself right after that thought crossed my mind; this is not how I want to approach my health care. I’m someone who has a strong support system and the privilege of being in graduate school. I had close friends and family to talk with about this experience to help me emotionally recover from it. I know there are many other trans-identified folks who are not in this position, and how much more traumatic and difficult this experience may have been for them.

There is a big split between the LGB and the T when it comes to accessing the care we need. I spent a lot of time thinking about what I could have done differently to have made this experience less traumatic for myself. I used to think that the LGBT Safe Space post cards that were hung in the waiting room at the health facility at my undergraduate institution were nice but didn’t play a big role in defining safety for me. While I experienced tough situations with health care when I identified as a queer woman, they were never as emotionally traumatizing. I had never gotten to the point of considering not accessing the services I need. I realize that the power of seeing those Safe Space cards rests in knowing that the staff have been trained or at least been made aware of transgender patients. This is something that would make me feel safer starting these types of conversations in an environment that is already charged.

What led me to writing to you today is a very positive experience I recently had at the San Francisco State University health center. I realized that there are some simple and easy ideas that I think would make the UCSF ER a much more positive experience for trans-identified folks. When I arrived at the SFSU health center I checked in on a computer system that began by asking my name and gender identity. The options in the pull-down menu were: Male, Female, Transgender MTF, Transgender FTM, Genderqueer, Decline to Answer, and Additional Category. Their awareness of multiple gender identities was part of my first interaction there and instantly made me feel at ease. I felt comfortable initiating conversations about being trans and talking about the medical side of my transition. I deeply appreciated that they brought it up first. Just like the Safe Space cards, this small gesture goes a long way in facilitating accessible safe health care for transgender individuals. These first interactions at a health facility really set the tone for the entire medical experience.

Thank you for taking the time to hear my story and considering my suggestions for making the UCSF ER a safer space for transgender patients.

All my best, Shayle