1/
Grady Hospital, 2004
Paper chart in hand, I leaned against the swinging doors and called out into the waiting room.
Me: “Moreira? Mist. . . .uhh. . . Ava Moreira?"*
You closed your magazine, uncrossed your legs, and stood.
*name changed
Grady Hospital, 2004
Paper chart in hand, I leaned against the swinging doors and called out into the waiting room.
Me: “Moreira? Mist. . . .uhh. . . Ava Moreira?"*
You closed your magazine, uncrossed your legs, and stood.
*name changed
2/
You: “Hello. I’m Ms. Ava Moreira.”
Me: “Umm. . .yes. Um. . .hello, Ms. Ava.”
You: “Ava is fine.”
I nodded and escorted you toward clinic room 3. As you passed in front of me, I took a peek at the ID sticker on the sheet to make sure I’d not read it wrong.
I had not.
You: “Hello. I’m Ms. Ava Moreira.”
Me: “Umm. . .yes. Um. . .hello, Ms. Ava.”
You: “Ava is fine.”
I nodded and escorted you toward clinic room 3. As you passed in front of me, I took a peek at the ID sticker on the sheet to make sure I’d not read it wrong.
I had not.
3/
Ava Moreira | 31Y | M
See, this was in 2004. Long before my eyes were opened to how unapologetically the microinvalidations of trans pts were embedded into our world.
Even by the supposedly “woke” folks like me.
Yeah, man.
Ava Moreira | 31Y | M
See, this was in 2004. Long before my eyes were opened to how unapologetically the microinvalidations of trans pts were embedded into our world.
Even by the supposedly “woke” folks like me.
Yeah, man.
4/
Me: “So Ms. Ava what brings you to urgent care?”
You: “Ava is just fine. I just moved here from Boston and need to get a new doctor here.”
I offered a relieved smile. This was easy. A new doctor.
Me: “Cool. So. . .did you you have any particular concerns today?”
Me: “So Ms. Ava what brings you to urgent care?”
You: “Ava is just fine. I just moved here from Boston and need to get a new doctor here.”
I offered a relieved smile. This was easy. A new doctor.
Me: “Cool. So. . .did you you have any particular concerns today?”
5/
You: “No. I will need refills, though.”
You propped your pocketbook on your lap, unzipped the top, and removed 3 medication bottles. A tendril of your long, silky brown hair fell over your eyes and you swept it back. Then you looked up at me with this inexplicable expression.
You: “No. I will need refills, though.”
You propped your pocketbook on your lap, unzipped the top, and removed 3 medication bottles. A tendril of your long, silky brown hair fell over your eyes and you swept it back. Then you looked up at me with this inexplicable expression.
6/
It wasn’t a smile. It wasn’t a frown either. It was this weird mixture of defiant, hopeful, and determined. And we both knew why.
You: “Here's my former doctor's card from Massachusetts. He should be able to make sense of my whole process for you.”
Me: *staring at bottles*
It wasn’t a smile. It wasn’t a frown either. It was this weird mixture of defiant, hopeful, and determined. And we both knew why.
You: “Here's my former doctor's card from Massachusetts. He should be able to make sense of my whole process for you.”
Me: *staring at bottles*
7/
Me: “Did your doctor suggest a certain person, Ms. Ava?”
You: "Ava is fine.” *clears throat* “I'm uninsured. He knew that so suggested I come here."
*silence*
Me: “Why don’t I examine you? Then I can see the best way to proceed with this.”
You: *tiny shrug* “Fine by me.”
Me: “Did your doctor suggest a certain person, Ms. Ava?”
You: "Ava is fine.” *clears throat* “I'm uninsured. He knew that so suggested I come here."
*silence*
Me: “Why don’t I examine you? Then I can see the best way to proceed with this.”
You: *tiny shrug* “Fine by me.”
8/
Next I performed the world's most awkward physical examination. Not because of you. It was because of me and my own ignorant hang ups.
After the exam, I stepped out into the hallway to gather my thoughts.
Colleague: “You okay?”
Me: "Hmm."
I explained what was going on.
Next I performed the world's most awkward physical examination. Not because of you. It was because of me and my own ignorant hang ups.
After the exam, I stepped out into the hallway to gather my thoughts.
Colleague: “You okay?”
Me: "Hmm."
I explained what was going on.
9/
Colleague: “Refills? Of hormones? That kind of sucks. But you have to consider the risks of clots and all that, too.”
Me: *nodding*
Colleague: “Not our expertise, man.”
And, as embarrassed as I am to admit it today, I accepted that as a reason to tell you no.
Sigh.
Colleague: “Refills? Of hormones? That kind of sucks. But you have to consider the risks of clots and all that, too.”
Me: *nodding*
Colleague: “Not our expertise, man.”
And, as embarrassed as I am to admit it today, I accepted that as a reason to tell you no.
Sigh.
10/
Me: “Ava? I think I need to refer you to a specialist for this.”
You: “An endocrinologist? That’s fine. My last doctor was a generalist but I’m fine either way.”
Me: “The issue is. . .I’m not sure who that would be. I mean, I know some people in the city do this but. . .”
Me: “Ava? I think I need to refer you to a specialist for this.”
You: “An endocrinologist? That’s fine. My last doctor was a generalist but I’m fine either way.”
Me: “The issue is. . .I’m not sure who that would be. I mean, I know some people in the city do this but. . .”
11/
You: “But what? Do these ‘people in the city who do this’ see patients without insurance?”
Me: “Um. That’s the thing. I’m . . .not exactly sure.”
*silence*
You: *sarcastic shrug* “Okay. Sooo . . . . can you find out? And can you at least give me a refill in the interim?”
You: “But what? Do these ‘people in the city who do this’ see patients without insurance?”
Me: “Um. That’s the thing. I’m . . .not exactly sure.”
*silence*
You: *sarcastic shrug* “Okay. Sooo . . . . can you find out? And can you at least give me a refill in the interim?”
12/
Me: “Uhh. . .so. . these are hormones and uh. . .they can have side effects, you know? And . . uh. . .I’m not really comfortable writing for them.”
*awkward silence*
Me: “Like. . .this isn’t my expertise honestly.”
I shifted in my seat.
Me: “I’m sorry, Ms—I mean Ava.”
Me: “Uhh. . .so. . these are hormones and uh. . .they can have side effects, you know? And . . uh. . .I’m not really comfortable writing for them.”
*awkward silence*
Me: “Like. . .this isn’t my expertise honestly.”
I shifted in my seat.
Me: “I’m sorry, Ms—I mean Ava.”
13/
You let out a snort.
You: “Sorry? Sorry about what, Dr. Manning?”
Me: *face burning* “Um. . .sorry that I can’t be more helpful.”
You: “You mean sorry that you WON’T be more helpful?”
The side of your mouth turned up and I heard you mumble something.
Me: "Ma'am?"
You let out a snort.
You: “Sorry? Sorry about what, Dr. Manning?”
Me: *face burning* “Um. . .sorry that I can’t be more helpful.”
You: “You mean sorry that you WON’T be more helpful?”
The side of your mouth turned up and I heard you mumble something.
Me: "Ma'am?"
14/
You: "Tell me. What do you do when you 'aren't comfortable' with other problems? Do you just announce to people that you 'aren't comfortable' and 'you don't know?' Do you? Or do you go look it up? I'm curious."
Ooph.
Your amber eyes were searing and confrontational.
You: "Tell me. What do you do when you 'aren't comfortable' with other problems? Do you just announce to people that you 'aren't comfortable' and 'you don't know?' Do you? Or do you go look it up? I'm curious."
Ooph.
Your amber eyes were searing and confrontational.
15/
Me: "That's not fair. Of course I look things up. It's just that this . . .this isn't that simple."
You swept your medications off of the table into your bag and zipped it shut. Then you closed your eyes and gritted your teeth.
You shook your head then shifted to nodding.
Me: "That's not fair. Of course I look things up. It's just that this . . .this isn't that simple."
You swept your medications off of the table into your bag and zipped it shut. Then you closed your eyes and gritted your teeth.
You shook your head then shifted to nodding.
16/
I felt bad.
Me: "Listen, this isn’t—”
You: "''THIS?' THIS?! You can't even SAY it! 'THIS' is my life. 'THIS’ is as life or death as any of the other things you do to save peoples' lives every single day. The things you 'look up' and learn and find out to keep people alive."
I felt bad.
Me: "Listen, this isn’t—”
You: "''THIS?' THIS?! You can't even SAY it! 'THIS' is my life. 'THIS’ is as life or death as any of the other things you do to save peoples' lives every single day. The things you 'look up' and learn and find out to keep people alive."
17/
You: *chuckling* “You’re SO full of shit. Going out of your way to put ‘Ms’ in front of 'Ava' to show some fake ass solidarity.”
Me: *face burning*
You: *points* “At the end of the day, you may as well call me 'SIR' and subject me to a hernia exam.”
I wanted to cry.
You: *chuckling* “You’re SO full of shit. Going out of your way to put ‘Ms’ in front of 'Ava' to show some fake ass solidarity.”
Me: *face burning*
You: *points* “At the end of the day, you may as well call me 'SIR' and subject me to a hernia exam.”
I wanted to cry.
18/
I tried to speak but my voice came out too tiny and anemic for you to hear.
You: "Ask yourself WHY you've never taken it upon yourself to learn more about . . 'THIS.'” *waving hand in front of body*
*silence*
Me: “I need you to understand that there are risks and—”
I tried to speak but my voice came out too tiny and anemic for you to hear.
You: "Ask yourself WHY you've never taken it upon yourself to learn more about . . 'THIS.'” *waving hand in front of body*
*silence*
Me: “I need you to understand that there are risks and—”
19/
You let out a diabolical cackle which made me stop talking.
You: *squinting eyes* “Do you even KNOW how high the risks are? My guess is that you have NO IDEA. Miss me with your BS excuses, okay?”
Damn.
Now your purse was on your shoulder. You'd been through this before
You let out a diabolical cackle which made me stop talking.
You: *squinting eyes* “Do you even KNOW how high the risks are? My guess is that you have NO IDEA. Miss me with your BS excuses, okay?”
Damn.
Now your purse was on your shoulder. You'd been through this before
20/
In that split second, my mind drifted to the many times I'd read articles about unfamiliar things—all with a goal to get myself proficient with treating a particular condition.
Like the man on my team the month before with porphyria. The one I read about and treated myself.
In that split second, my mind drifted to the many times I'd read articles about unfamiliar things—all with a goal to get myself proficient with treating a particular condition.
Like the man on my team the month before with porphyria. The one I read about and treated myself.
21/
Me: “Can you wait just a moment?”
You didn’t respond. You just remained standing in the near the exam table refusing to give up your dignity.
I picked up the phone before you responded. Next, I paged an endocrinology colleague whom I thought might know more.
Me: “Can you wait just a moment?”
You didn’t respond. You just remained standing in the near the exam table refusing to give up your dignity.
I picked up the phone before you responded. Next, I paged an endocrinology colleague whom I thought might know more.
22/
Me: "This is urgent. My patient is a transgender woman who recently relocated from Massachusetts. She’ll be out of her hormones in three days and it is imperative that I get guidance on how to help."
And you know what? That colleague DID help. A lot.
Imagine that.
Me: "This is urgent. My patient is a transgender woman who recently relocated from Massachusetts. She’ll be out of her hormones in three days and it is imperative that I get guidance on how to help."
And you know what? That colleague DID help. A lot.
Imagine that.
23/
We created a plan and wrapped up.
Me: “I really appreciate your honesty.”
You: “You learn how to stand up for yourself.”
Me: "I'm so sorry, Ava."
You: "Just . . try, okay?"
Me: *nodding*
After that, the exchange was easy. We talked about our hometowns and favorite foods.
We created a plan and wrapped up.
Me: “I really appreciate your honesty.”
You: “You learn how to stand up for yourself.”
Me: "I'm so sorry, Ava."
You: "Just . . try, okay?"
Me: *nodding*
After that, the exchange was easy. We talked about our hometowns and favorite foods.
24/
It’s 2020 now. Grady has a Gender Center. Our EMR indicates preferred pronouns, too.
But.
YOU taught me that unless we confront our biases head on, none of that matters.
Thank you, Ava. 🙏🏾
“Life is very short. What we have to do must be done in the now." – Audre Lorde
It’s 2020 now. Grady has a Gender Center. Our EMR indicates preferred pronouns, too.
But.
YOU taught me that unless we confront our biases head on, none of that matters.
Thank you, Ava. 🙏🏾
“Life is very short. What we have to do must be done in the now." – Audre Lorde
P.S. Shout out to Dr. Jason Schneider (@doctorjss), one of our @GradyHealth Gender Center leaders and teachers who is ALSO the good friend who helped me process this experience back in 2004.
Jason, you may remember this. I'm forever grateful for your counsel then and now.
Jason, you may remember this. I'm forever grateful for your counsel then and now.
