"You are worthy of having an identity."


"I graduated medical school in 2015, did my residency in anatomic and clinical pathology, and am sub specialized in forensic pathology. I just finished my first year out of training as an attending pathologist at a medical examiner’s office.

Being a pathologist means I am a type of doctor that specializes in everything that can cause disease in a human being, and then my subspecialty, forensics, focuses my work on any disease or injury that can cause death. I spend my days performing autopsies, signing death certificates, and potentially even testifying in court based on my findings. Since I am just starting out, many of my cases have not yet come to court, and I wonder what it means to do my job as a gender nonconforming person? I wonder, 'what do I do when I'm in court?' Can I show up in a bow tie instead of pantyhose and heels? Do I introduce myself by my title and my pronouns in court? Is court an inappropriate place to do that? Because right now the fear is that if I were to introduce myself with they/them pronouns, it would be interpreted as me trying to make the trial about me when it’s anything but.


What I’ve come to understand is that many people have had similar feelings to my own about gender and gender nonconformity, realizing that I've had these thoughts probably since I was a child and didn't have a vocabulary or words to use for them until my 30s. I think about memories from when I was three years old and shaving my face with my dad; and when I was 10 I wanted to make a restaurant in the house, so I needed a mustache because that was a necessary accessory for the maitre d’. My family was always supportive of their 'goofy baby girl'; my dad even helped me make gender queer clothes and costumes and my mom was always there taking the pictures. But they both still told me all the time what I was, their baby girl, and what I was becoming, a beautiful woman. It wasn’t until I moved two thousand miles away that I started questioning that and realizing how uncomfortable I was with those labels.

I found other influencers who had experiences that were close to mine. Initially, I was so stuck in the gender binary that I thought my feelings meant I was a trans man. But the more and more I read, the more I realized my experiences didn’t match with the experiences of other trans men I was reading about. I thought about what it would feel like to completely transition, and I realized I wouldn't be comfortable on either side of the binary. That's where I learned about gender nonconformity and how gender is a spectrum, like a dial, rather than a switch. It was sort of a mind blowing moment for me, and jumping from that to actually telling people who I was - asking people to use my pronouns, informing them that this is who I am - has been a huge challenge especially outside of a friend group. Even in my friend group and being around people who support me and whom I trust and love, even that was difficult. Bringing that into places like your work is just a different issue entirely, especially in medicine, where as a physician in training they do everything they can to break you down as an individual. Because at the end of the day it's not about me, it's about the patient.


I spent a very long time the first couple years after I came out, hiding and being in the closet at work because I was under the impression that being queer was unprofessional. And I think that that has been one of the biggest barriers that I have faced in healthcare. I know now that I can be out, I can fully be who I am, and I can be a professional. It doesn't shift the focus away from the patient onto me.

 

First and foremost, I am simply a person. For the doctor, I am an AFAB person. I don't hate parts, and don’t plan on getting surgery to have any removed, but I also don’t want to be reminded constantly about what I have or don’t have, or who I am based on those parts. You think who would have the audacity to just get in your business and try to tell you what you are? But it’s something that just happens all the time.

In medical school I thought of myself and my identity in a more clinical way rather from a holistic standpoint. I don't think it was necessarily wrong for me to acknowledge this absolutely true difference between society’s perceptions of gender, biology, and the interactions of both in clinical medicine. I was learning how to be a doctor though, and while medical school pushed me to acknowledge and value a patient's humanity, I was still expected to sacrifice my own. So I did.

For the longest time I compartmentalized many aspects of my life. Just as gender is separate from biological sex, so is being a person separate from being a patient. If I'm at the doctor’s office, I assumed my physician didn’t care about my personal identity. I’m just going to be a uterus-having person and they need to treat my uterus, so why would I need to tell them my gender outside of this office? I just assumed that I would just treat my body clinically as a bag of parts. And there was a huge part of the problem. As a medical community, we have a tendency to treat people as bags of parts instead of individuals with rich histories.


Recently though, when establishing care at a new office, I decided to just go for it and say, 'I am gender non-conforming.' I got an interesting response that confirmed how necessary it is to treat more than just my biological organs. Menstruating as a uterus-having person is really dysphoric, so having a physician that is going to be on board with the treatments I need to prevent menstruation is really reassuring. With that extra context the pain or trauma that I might go through is quite different. Easier to manage even.

And I know so many people out there who have horror stories about when they try to tell their physician that they are gender non-conforming or trans, and I feel fortunate and privileged that I happen to see a physician that had a lot of empathy and has my pronouns in my chart. They don't get it right every single time, but they will correct themselves and move on. That's how everyone should be, you know, yet I see the legislation happening right now in places like Texas and Arkansas, where they're trying to make it illegal to even receive gender-confirming care in any way.

We are starting to see changes in the medical field. Even while I was in residency training I saw the gender field in the medical record switch from a M/F radio button to a free text pronoun input. Of course all of these shifts are happening very slowly, but the fact that they're happening in academic institutions means that they’ll continue to progress more and more towards that place of inclusivity.

As a queer patient, I feel like I am now a de facto queer advocate. Just like I needed a safe space, I feel like it's my responsibility to pay-it-forward and also be a safe space. I'm in a unique scenario because my patients are dead, and I happen to be their last doctor. I’m the one who signs their death certificates and writes their last notes. At that point without a representative like me, they are just a body. How can I be a safe space for someone who isn’t alive anymore? Unfortunately as we’ve discussed, seeing a body doesn't tell me anything about their societal or contextual journey. Sometimes depending on whether or not they felt safe to be out, I may never get those details from the family or from the ones who survive them. And I can’t ask them directly.


In my reports, I am obliged by the conventions of my field to describe certain things. I have to describe the body’s characteristics, and that means I am often ascribing a gender to a decedent based on a combination of reports of history from the family and the genitals that I see on exam. If I know someone is trans, I will respect that, but you can’t always know.


And this is what we're working at, you know. I’m at a small office of three doctors where I try to bring up these uncomfortable conversations during our conferences. I try to fight the battle from within, maybe I change the minds of one or two people. Maybe they start to have those conversations If they move to other offices. The reality is that this is a big beast that isn't going to be changing very quickly.


It’s so easy for grieving families to assume that I don’t care, but the fact is that I do care. I've been fortunate to have been trained by lots of forensic pathologists who share that sentiment. And in caring so much, we do the things that we do, we go to court to represent our findings, and we testify so that, hopefully, justice can happen. The memory that someone leaves is a very big responsibility, and what I want to do, first and foremost, is to honor my patients who cannot speak.

 

Listen.


Not everybody will be in a safe position where they can come out safely or even access a safe space for that to happen. So barring that, the first thing is to listen to yourself. Acknowledge who you are to yourself because, like me, you are worthy of having an identity. You are not just a machine that goes to work and does work and presses buttons. You are a person who is different from every other human being out there, and that person deserves to be heard even if you’re the only one listening. Sometimes it takes a while to find your voice, but when you do find it, don't ignore it.” -Cori B. (they/them), Forensic Pathologist,


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