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.