"We were the pride flags..."


“My name is Kim (he/they). I currently live in Austin, Texas and am originally from Texas. I’m a career academic psychiatrist, currently transitioning into a tele-psych position. I graduated from McGovern Medical School in 2008 where I also completed my residency and post-doctoral fellowship. I took a position as an assistant professor there after I graduated from my fellowship. Later, I came to Austin where I was briefly in private practice, but with the advent of Dell Medical School I came back on board as an Assistant Professor.

I’ve made a lot of changes over the past 2 or 3 years to better align my life with who I feel like I am as a person. Part of that had to do with revealing more and living more in alignment with my gender and sexuality, but that has influenced my career as well. It was a very interesting process coming out as a person over 40 in a setting with people who had known me for many years already. The reaction that my workplace had to my coming out was the main reason I decided to make a professional change for myself.


I’d known about my sexuality and gender for a long time. I had been out in college, but when I went to medical school, I only knew one other person in my class of 180 that was out and gay. During that time, I felt some confusion, frustration, and anxiety around my sexuality and gender. I think part of that had to do with a lot of biases I had about my own sexuality and gender presentation that I did not feel comfortable with. It felt like my only option, due to my biases, fears, messaging I received from this new environment of medical education, was to box that part of myself up. Through my medical school and residency experience, there was rampant bias towards the LGBTQIA+ community. And it wasn’t something that was hidden – it wasn’t something that was just from older physicians. This was something that was across the board. I saw it in each one of my rotations and the message sent to me was: this is not a safe environment to be yourself and be out.

During this time, I was married to my now ex, and we both presented together as a cis-heterosexual couple. The image at that time was very in line with what I thought was safe, and lined up with the expectations I believed were expected of me in my profession. I continued to feel frustrated and depressed over my identity, but wouldn’t allow myself to address it. I ended up building a life for myself, professionally and personally, that did not give me room to be myself.

Immediately after coming out 3 ½ years ago, multiple mentors and administrators, like my immediate boss, engaged in unprofessional behavior, like talking about my sexuality and gender to other people in my department without my consent and in a manner of gossip. This took away my credibility immediately. I think that was one of my core fears all along, something that kept me in the closet, that my credibility would be at stake if people found out about my sexuality and gender. And that fear came true. I did what I thought was the right thing, I made an HR complaint about it. My supervisor’s behavior was documented, other people witnessed it. My HR representative, after discussing it with these other people, said that there was not enough proof to say that anything wrong had been done and I was advised that if I didn’t want people to talk about my sexuality or my gender that I should not bring it up. They basically put the blame on me – the reason I was having this kind of discord with my relationship with my boss was because I was being my genuine self.

 

I worked with inpatient high-risk suicidal patients. I was looking around me and I realized that in my unit of 16 patients that I was taking care of, at any given time, 10-20% of them were LGBTQIA. I realized this is a place where people are coming in crisis and they should be able to feel safe. Moreover, of all those people, a lot of them were trans. I talked to my immediate managers about it, I looked at the World Professional Association for Transgender Health (WPATH) guidelines as far as their clinical recommendations, and I got us two pride flags to put up in the nurses’ station that were visible. They weren’t a hazard to our patients or anything like that. Staff really liked it, at least to my face they told me they really liked it – no one complained. But then one day I came in and they were gone. I was told that the custodial staff had taken them down because of ‘cleaning reasons’. I talked to the custodian who I knew really well and asked where the flags had gone. She said, ‘Oh, the COO came and told us we needed to take them down and she has them in her office.’ The COO wouldn’t talk to my face about this issue. Instead, her assistant came to me and said, ‘We were just really afraid that maybe we would have somebody who wasn’t gay who’d be upset by them.’ I asked, ‘Was anybody? Did anyone say anything?’ She said, ‘Well, no.’ I intended to make a statement, to bring this up to higher-levels within the hospital system to say, ‘These are actual WPATH guidelines for treating this population and I think it’s going to be useful.’ But that’s when COVID happened and it was put on the back-burner by administration.


After the COO took our flags down, myself and some nurses on my unit bought as many pins as we could and wore them on lanyards. We were the pride flags. I had 20 rainbow pins, I had trans pins, I had a non-binary pin, I had my pronoun pin, I had all these pins just pinned across me. I had this one patient and she was really sick – she was manic and hadn’t slept in a week, but she looked at me as I walked into her room and she said ‘oh thank god.” And then she pulled up the leg of her pants and she showed me her pink and blue trans socks.


In the last 6 months of my old job, I was pretty close to my current gender presentation – my hair was a little bit longer than what it is right now. I am obviously a part of The Community. The patients knew it. At that point, I didn’t have room on my bandwidth for how people were going to tolerate me, that wasn’t my problem anymore. I just showed up, I was professional, I listened to my patients. I’d grown and I’d been able to listen to myself and them better, and they would comment on it: ‘well you’re obviously gay.’ But they weren’t hurtful. It was just this incredible honesty. There was an understanding that if I was able to be myself, as unique as I am, that I might be able to listen to someone else’s unique experience. And patients would say that to me: ‘I really feel like you can hear me.’ I think it had a lot to do with being my true and genuine self. I think that is so incredibly important no matter who you are, no matter what profession you’re in.

 

I had one patient who made a hurtful remark towards another patient that was trans and I spoke with the one that made the hurtful remark, ‘Hey, this is a safe place for folks that are trans.’ The patient didn’t like that and complained. Administration took that patient out of my care without discussing it with me. There were new decisions being made around me solely because of my gender presentation and sexuality, based on assumptions that I could not provide care the way I used to. I no longer had the privilege of appearing reasonable and non-biased, something conferred to me when I was perceived as cis-hetero. It was soul-crushing. It was a really hard thing to do – to be a part of a system that I had a lot of pride in being a part of building up from the beginning and to know I was not trusted in the way that I used to be. It was then that I thought: ‘There’s some stuff going on here that doesn’t feel good. You’ve lived for so long not paying attention to your needs and not paying attention to who you are. This might be a good opportunity to start unpacking that.’ It was hard to let go of it all. I’d been teaching medical students and residents for years. That has been one of my sheer joys [in life] ever since I got into medicine. It was sad to know that I’d be losing the opportunity to shape curriculum and to be there to watch people grow into themselves. It was a true loss for me. But I had to do it. I don’t regret it.

Now, I do tele-psychiatry work. I work for a company that isn’t even in the state I live in. It gives me a lot of unstructured time, which has been good because I’ve spent it with my son, who has had struggles during COVID and needed more attention than I could give him in my previous job. I’ve also spent it trying to figure out who I am. As soon as I stopped working in-person at that hospital and feeling like I had to conceal myself, I blossomed. I felt like all of a sudden I became the thing that I hadn’t been able to be before. It was incredible. I’ve felt more creative. For example, I really love to cook and I’m starting this queer supper club - what I’m envisioning for the future is this group of quarterly meetings where we have this safe queer space to get together and have a really cool meal with any money and proceeds going to a charity. I am able to imagine myself as something in addition to being a doctor, in addition to being a psychiatrist. I hope in the future that what I’ll have a practice again, but one that it’s informed by who I am. I hope that it’s able to dovetail with who I am because I think that what I was building for myself was stuff that I would absolutely want my patients to have - to just be able to be themselves.

 

I think that if I were to give any advice [to folks new to medicine], I would say you absolutely 100% deserve to be yourself. When you’re looking for spaces to be in make sure you find spaces that will allow it. Additionally, as soon as I was myself, the relationships I fostered with my patients changed fundamentally. It was incredible; it was night and day. They were able to notice it. I was more effective in my job being who I truly am. If there’s anything I can say to anybody going through it is to look for that accepting space wherever you can. You may not have enough privilege in the very beginning (ex. money, time, the know-hows) to start something but it will come. You should always be looking for that space you can offer to others but also offer to yourself.

An undercurrent exists in this pathologization of somebody who has a divergent sexuality or gender presentation. Still, people think: ‘this is a little weird.’ Even before I left the hospital I was working at I’d heard from nurses that some of the doctors there don’t believe in trans people. I thought: ‘They can't see them? They think they’re like the abominable snowman?’ The nurses said those doctors think that it has to do with borderline personality disorder. That was always one of my worries and concerns: that people think if you have this ‘disturbance’ in who you are that it means that a pathology must be causing it. No, the ‘disturbance’ comes from being in an environment where everybody thinks that you need to conform to societal ‘norms’ – that takes a lot of energy, that makes you sick. What’s more, you don’t have trans or queer folks asking those questions. You have cis-hetero folks asking questions like, ‘Sure seems like a lot of folks in the queer community have mental health issues… isn’t that interesting?!’ They should be careful asking that question, because their privilege keeps them from answering it correctly.

As much as I tell my story, I don’t want to warn people out of medicine because it’s so necessary to have queer folks in medicine and in mental health and to make sure that they’re the ones asking the questions. Because if you’re not asking the questions, someone else is and they may not understand or have appropriate knowledge.

For physicians not in the queer community that have queer patients, the best advice I can give is to talk to people in the queer community! Don't just over-talk them, don't assume, don't make any assumptions about their lives. Give them space, notice things for them but don't talk from a position of privilege because it’s your privilege to be there in the room with them (the patient) as they tell their story. You’re in a position to be able to help somebody and make them feel really positive about their experience. Don’t assume that the reason that a trans patient is seeing you for medical or mental health reasons is because they’re trans. That might be part of it, but that isn’t all of it - do they also have bipolar disorder? Do they also have diabetes? Are they being seen because they have autism spectrum disorder? It’s important to not make assumptions about what causes what. What’s important to you may not be important to them. Don’t make assumptions about their needs, rather ask them what their needs are. Sometimes, especially in mental health, we talk about patients with treatment-resistant disorders – that happens a lot in populations where individuals don't have access to care, money, or housing. You can’t then get frustrated at that patient if they may not have the improvements that you want to see in them after you’ve given them 1 or 2 new mediations – there are multiple things that get in the way of them having happiness or decreased anxiety. Make sure that you're knowing them and available to them.

The advice that I can give to people that have been in my position is this: don't feel like you have to be a certain way to do whatever you want to do. There is no ‘certain way,’ especially now. This is such a beautiful time where people are beginning to look at and see who they are – that’s always been the case but right now people are talking about it more and there seems to be a little bit more space for it. You being yourself makes it so much better for everyone else. You being yourself is just going to make you better at whatever you want to do.” -Kim Kjome, Austin, Texas (he/they)


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