Friday, 6 December 2013

A Transgender Patient in the ER: 12 Hours

I try to keep this blog as positive as I can, because I feel that this is the best way to move forward to greater understanding and tolerance in general. By nature I am an optimistic person and I prefer to highlight what is going well. Yet life is not always rainbows and butterflies. Sometimes we must tell our sorrowful stories in addition to those of gratitude and joy.

Trigger warning: This post is about a pregnancy loss.

We got our positive pregnancy test on Thanksgiving Sunday (Canadian). We had been in our new home just a few weeks at that point, and decided it was meant to be. We moved to this beautiful forested property with a cute red barn, and of course we were newly pregnant!

We told some family and close friends. I had a little nausea but nothing as bad as with our first. Now I remember reading a few years ago that the more sick you feel, the less likely you are to miscarry. Vomiting is a particularly good sign.

Last week we had our first meeting with our midwife, at around 10 weeks’ gestation, and discussed having a home birth outside the city limits. We talked about the logistics of a potential hospital transfer as well as how quickly the midwife could get from her home to ours.

I told her that in terms of care, the biggest deal for me is pelvic exams and how much I hate them. I don’t think anybody enjoys them, but for a lot of trans people they are particularly excruciating. The midwife accepted this well and said that only under rare circumstances would she really insist on doing one – if there was a huge amount of bleeding or if the baby’s heart rate suddenly tanked. That sounded fine by me. We left the appointment feeling happy. The pregnancy seemed much more real, and we told more family and friends.

A few evenings later I noticed some light bleeding. It wasn’t much, but I had been feeling poorly all day and wanted to go to the hospital. I just really wanted to go. We didn’t yet have our midwife’s pager number, so I wasn’t able to talk to her about what I should do. I drove myself into town and left Ian and Jacob on their own for the first time overnight.

The intake nurse asked me what was going on. Here. We. Go. “I am transgender. I was born female and transitioned to male.” I paused and looked at her. “Is that ok? Do you understand that?”

She nodded.

I once saw a walk-in clinic doctor about a urinary tract infection and erroneously assumed that he knew what ‘transgender’ meant. Then I realized part way through the visit that he was utterly confused about what I have ‘down there’. Ever since, I’ve spoken more slowly and spelled out my situation clearly. I always stop for a moment and give the care provider time to absorb what I’ve said. Then I ask as gently as I can if they are ok and if they know what I’m talking about. I try to leave space for the person to admit that they don’t have a clue.

I told the intake nurse that I was pregnant, experiencing bleeding and feeling unwell. She gave me a paper wrist bracelet and told me to wait.

After a couple of hours, I got moved to an exam room, where I waited another three hours without speaking to anyone.

A nurse came in and asked why I was at the hospital. I started again from the beginning – transgender, born female, pregnant, 10 weeks, light bleeding, one previous healthy pregnancy, no testosterone for years. She said a doctor would see me in a while.

Another nurse came in later to check my vitals. She, too, asked why I was in the hospital. I went through the same spiel, and she, like the others, was professional and respectful.

A student doctor came in and asked what was going on.

“Ummm… Do you know the background at all?” Did I really have to come out as transgender to each of these people, one at a time?

“Well, yes, I do know the backstory a bit.”

“So, you know I’m transgender?”

“Yes.”

“Are you ok with that?” I asked him.

“Yes. I did a bit of research, but I think I am caught up.”

Cool! He looked in the chart ahead of time, realized he was unfamiliar with transgender folks, and decided to look us up. Then, within a few minutes of doing some reading, he was able to use the correct pronouns and have a frank discussion about my medical problem. THANK YOU, whoever you are. YOU will be an awesome doctor when you are all grown up.

He asked me lots of questions, including checking several times that I had not been taking testosterone recently. I confirmed that I haven’t taken T since well before conceiving my toddler.

He asked if I’d had any surgery, so I told him about my top surgery from a few years ago. He seemed genuinely interested to learn what that was all about – what the procedure was like and how it differs from a double mastectomy.

“Have you had anything done on the… bottom? Anything that we should know about?”

“No.” Thank you for asking politely rather than making assumptions because you find this embarrassing to talk about.

The teaching doctor came in and said something like, “So I understand you are pregnant.”

Thank you for signaling to me that I don’t have to start by discussing my genitals at birth with you.

We talked about what was going on, and the doctor said he would order an ultrasound. He thought everything was probably fine given it was very little bleeding, but he wanted to be sure.

I was moved to a waiting area in the hallway near the nurses’ station. I saw a doctor arrive in his coat and scarf, coffee in hand. He was wearing a pair of black Blundstones, the same kind of boots that I use for riding horses. They seemed incongruous to me in a hospital, but I suppose they must be much more comfortable than traditional dress shoes. Another doctor asked him how he was, and he replied that he'd spent two hours cleaning up vomit in the middle of the night – his kid had been sick. Still, he and the new nurses coming in for the day looked much more cheery than the night shift had.

 The student doctor came up to me and said that they would be discussing my case with the next set of doctors coming in. “So you might hear us talking about you.”

I watched and listened to it all. Not a single wrong pronoun, no poorly-covered laughs, no unnecessary discussion of my body or my transition. In comparison, the last time I had to go to the hospital for something, I heard the doctors and nurses laughing about me in the hallway, not even trying to be discreet.

The doctor in the Blundstones sat down next to me and said I would need a Winrow shot because my blood type is Rh negative and I’d had some bleeding. “It will not only protect this pregnancy, but all future pregnancies as well.”

Thank you for understanding that this pregnancy was planned and wanted. Thank you for accepting that I deserve the right to have children as much as anyone else.

I called Ian. I was anxious to hear how he and Jacob did overnight.

“We saw FOX!” Jacob said over the phone.

Jacob had been very brave and did not cry at all, even though he woke up in the middle of the night a few hours after I left. He also did not want to lie down in bed. Ian held him for the rest of the night in the rocking chair by our front window. At one point Ian looked out and saw a fox standing there, very near the house. He woke Jacob so that he could see it, too.

I was relieved to hear Jacob sounding so happy. I said I would call back when I had some information.

Finally they were ready for me to have the ultrasound. The technician put goo on my belly and started taking pictures.

“Are you sure the baby isn’t 5 weeks instead of 10?”

I knew this was bad. I was sure about our dates. He wasn’t finding a 10-week-old fetus.

He said we needed to do a vaginal ultrasound. I told him I was not so comfortable with that procedure. He said he didn’t like doing them either but it was important to find out what was going on with the baby, and he couldn’t get a good enough picture otherwise. He asked if it would help to have another person in the room, male or female. I said no. Thank you for asking. Thank you for considering it from my perspective, and helping me make my own choice.

It wasn’t as bad as I thought it was going to be, except for that the room was very cold for someone wearing a paper gown. The technician said that I should go and talk to the emergency room doctor, who would get the ultrasound pictures soon.

A half hour later, the Blundstone doctor told me, “I don’t have all the pictures yet on the computer, but I can see what they wrote on the file. It looks like a healthy 6 week fetus. You probably just have the dates wrong. It happens all the time.”

I had trouble holding back tears. “I don’t see how I could have the dates wrong. We were trying for this, so it’s not like I wasn’t paying attention. I don’t see how this is possible.”

The doctor said he would wait for the images to be on his computer, and he would look closely at them.

Another 30 minutes later he took me aside to a separate room.

“You were right about the dates. The fetus stopped growing at 6 weeks. I’m so sorry. We almost never know why this happens. I’m going to call for an OBGYN consult. This happened 4 weeks ago but you have only had very light bleeding. Have you heard of a D&C before?”

I had. Vaguely. “I’ve heard it is really unpleasant.”

“Yeah. I’m sorry. There might be an alternative. There’s a medication you might be able to take instead. It depends on certain factors. We’ll see what the OBGYN recommends.”

I called Ian and told him. I felt like I was stabbing him, giving him such painful news. I’ve never heard his voice sound so broken the way it did that day. He and Jacob got picked up by a friend and came to the hospital while I waited for the OBGYN.

The doctor and student who came to talk to me were profoundly sympathetic and kind. They discussed the risks and benefits of both the D&C and taking the medication, and left the choice up to me. I chose the medication. Jacob and Ian came in and I got some amazing, big hugs. Jacob nursed a ton while the various doctors and nurses gave him adoring looks.

The doctor said, “We usually give this medication as a vaginal injection, but we looked it up and found that you can also take it in pill form. So we can give you a prescription for it and you can take it at home when you are ready.”

Wow. They get it. I don’t have to say anything. YES, a trans guy will likely prefer a pill. Why that isn’t normally available for cis women as well, I have no idea. I am only grateful on this day.

They told me what to expect and how to contact them if I had any questions. On my way out I thanked every nurse and doctor I saw. I caught Dr. Blundstone in between tasks and I said, “Every single person here has been so respectful and understanding. I really appreciate it. I’ve had some pretty bad experiences in the past…”

“You will have them again. You know that. But I’m glad that people were good this time. I think things are changing. We are getting much more education about trans health care in med school and it is making such a difference.”

Ian, Jacob and I ate sushi with our friend and her son in the hospital lobby. We picked up the prescription and some heavy pads and then went home. I was exhausted from staying overnight in the hospital and decided to wait until the following day to take the medication. That was another process to go through. We all needed to rest and have time together first. We had to somehow catch up to the realization that for the past four weeks, while we were planning and dreaming about a new family member, our baby was already gone.

20 comments:

  1. Oh Trevor, I am so sorry for your loss. But it warms my heart that around such a difficult time, you actually had some amazing and understanding care providers. Big love to you, friend. <3

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  2. I am so very very sorry for your loss. Such a hard and terrible thing to go through. Thank you for your courage in talking about miscarriage, and I know you have the strength to get through this with the love and support of your wonderful family. Take care

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  3. Dearest Trevor, Ian and Jacob,
    Thank you for sharing such intimacy with the world. The wonderful experience you had with the medical staff makes me smile. Such simple acts, such reverence for the person rather than blissful ignorance. <3 Trevor and family, my family is saddened to hear of your loss. Take time to heal individually and as a family. Love on yourselves, and know that you are an amazing and loved family. <3

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  4. <3 Trevor <3 Thank you for sharing so eloquently and frankly your journey. It is surely a beautiful one. Blessings to you and your family for healing and a rainbow following the rain. It makes my heart glad to hear you were treated with respect and compassion. So much fierce love and respect... <3

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  5. I don't know you and I don't know a lot about transgendered people but I have always been acepting. I lost a bb too my experience was much different and not as accepting so knowing that their are people like them out there warms my heart. I am also very happy that you decided to share this painful story to show us that.
    You are an amazing person and i am sorry for the loss you and your family have suffered. The pain won't ever go away but it does numb a little. You will see your bb in heaven

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  6. So sorry for your loss. I went through a very similar miscarriage last summer. Nice to hear that you were treated with respect during such a difficult time---I wish it could be that way every day.

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  7. Much love to you, Trevor. Sorry to have come across your blog for the first time at such a sad time in your lives. I'm an Rh- cis woman who had a loss with my first at 29 weeks - I WISH I had had this sort of treatment - and THANK YOU for thinking of us! Pelvic exams and a general lack of respect can be equally unpleasant for cis. You are certainly not alone there. Jacob's story is inspirational, though - YOU are an inspiration. Thank you for sharing so much of yourself to help others - including your sadnesses. I wish you all well for the future. Pregnancy after loss can be nerve-wracking...somehow, you're never quite the same. But the kids...they're worth it.

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  8. Oh, and if it helps you any, for future reference - with my last pregnancy I requested a scan to check cervical length as I was concerned about preterm contractions following a stomach bug. I had a fair idea the scan would be transvaginal. This is extremely triggering for me and I was NOT letting someone else see me and touch me - especially as there were some cultural sensitivity/English language issues and I was told abruptly to 'remove my underwear' without even being shown to a separate room. Well, it's my body and this was not happening. I asked for a sheet, pushed my underwear to one side and inserted the probe myself. He manipulated it which I was not happy about as I could have done it easily with direction, but I did keep one hand on it the whole time to maintain my sense of control. And no one touched me or saw my genitals. I would be even more assertive in future. As you've found, vaginal exams are rarely necessary. I'm a home birther turned UCer after trust issues developed with my last midwife.

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  9. I am so sorry for your loss. Thank you for being so patient and considerate with the health care providers when you were so vulnerable.You deserved only the best of care and I am glad that your experience was a positive one during this loss. May a baby be making its way soon to your family.

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  10. Deepest sympathies on the death of your baby. What raw and horrible pain. While I hate that you have a story of loss to share, I am thank you for sharing it. My deepest sympathies. MM

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  11. Trevor, I am so sorry to hear about the death of your baby. Deepest sympathies to the entire family.
    In this moment of grief, I am so very glad everyone was so respectful to you. Every patient deserves respect, every single time.

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  12. I'm so very sorry about the loss of your baby. It's a pain I have felt and I wish you a fast recovery to both body and spirit. I'm so glad that during this difficult time you were surrounded by true medical professionals. It's so disheartening to hear about the horrible experiences that some have had.

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  13. I am so sorry for your loss and also grateful you received such compassionate care. Best to your family.

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  14. So sorry Trevor, but thank you for sharing your experiences. I am also grateful that in a time like this, the stress of a horrible hospital staff didn't add to your pain.

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  15. My condolences, Trevor. I lost my first baby at 18 weeks & kind hospital staff made the experience less painful than it could have been. I'm happy to hear that you were treated with respect & I hope that you'll find the same again should you ever need medical care in hospital. Thank you for sharing your story. I hope you find peace soon & another baby comes along when you are ready.

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  16. Oh I qm so sorry for your loss but grateful that you were treated with such respect. Thank you for sharing with us even though it must have been difficult.

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  17. Thank you for sharing your story Trevor, I'm sorry for the loss of your baby. Every health care professional needs to read this...

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  18. I am so sorry for your loss Trevor <3

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  19. I've been following your story for awhile but just read this entry today. I'm so sorry for your loss. But at the same time, how wonderful that the hospital staff were so professional and respectful. Would that all doctors and nurses were that understanding. Thank you for sharing a very difficult experience. And now, take as much time as you need for physical and emotional healing.

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  20. i'm so happy for you that the hospital staff were so wonderful and respectful. i'm so very sad for you that you had to be there in the first place. that must have been really hard. i'm new to your blog and think it's wonderful; thanks for sharing your life with us!

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