This post is the second installment of the “Spotlight” series, where I’ll be publishing original content by or interviews with other TGNC folx (as well as some allies). The purpose of this series is to incorporate perspectives other than my own into the site, with the intent of heightening awareness about our community’s incredible diversity. I’m looking for writers and creators of all sorts — I’m happy to share photo essays, music, poetry, and anything else trans-related. If you’d like to feature a post on Trans and Caffeinated, connect with me via the form at the bottom of this post!
This is an author-edited version of what first appeared on the Bioethics.Net Blog, printed here with permission of the author. Em is a transgender, non-binary, queer, disabled health ethicist focused on disrupting whiteness and white feminism in health professions and education. In this piece, Em enlightens readers about the fears and risks associated with being TGNC and disabled within the context of the current global health crisis. Without further ado, I give you Em Rabelais.
Your Co-Morbidity Is My Normative Reality
Note: “co-morbidity” is a term used in healthcare to describe a person’s co-existing health problem. For example, if COVID-19 is one health problem, then asthma is considered a co-morbidity.
I do not know what the cisgender experience is; it’s foreign to me—like some kind of alternate reality? The idea of being cisgender seems morbid, so perhaps it is one of your co-morbidities. As well, I have no knowledge of the non-disabled experience: it makes no sense to me. What is existence in society without unrelenting abstract and literal barriers that persist as part of every component of society (housing, obtaining food, workspaces, recreation, etc.)? To not experience these barriers must also be one of your co-morbidities. Importantly, I cannot separate these—or any of the other—parts of me.
I’m writing here about the disruption and normative oppression that healthcare offers to transgender realities. In the time of SARS-COV-2, the virus responsible for COVID-19, everything becomes worse. Even though I’m focused on trans realities, my fears are already being made real for my disabled family, as we are literally being positioned for destruction. Across the country, hospitals and health ethicists are creating plans to allocate scarce resources. Notably, disability justice advocates and experts are critiquing these protocols—while, at the same time, businesses are finally offering disability-friendly work environments (example: work from home). See #NoBodyIsDisposable to help you and others fight discrimination in COVID-19 triage.
If you are cisgender, then your reality is confusing and foreign to me, so I can only assume that mine is not clear to you. To catch you up to speed on sex, gender, and trans existence as context for trans realities during COVID-19, I first have some basics and background information.
Basics. Sex: it’s not binary. Gender: also not binary; see here for definitions. Fausto-Sterling lays out in simplified terms, and based upon science, why sex is not binary. When it comes to transgender humans, science has nothing to do with providing the shouldn’t-be-needed justifications for my/our humanity. For anyone thinking of commenting, writing hot takes about trans folx, or even discussing with others, please see this guide for helpful tips.
Healthcare while trans is not fun. Trans existence isn’t normal, according to medicine and the other health professions. Our bodies are medicalized. Our knowledge of our own bodies is often deemed irrelevant. Genders that are not cisgender are considered morbidities. Cis-privileging is yet another colonialist approach within biomedicine where The Other isn’t believed. (For background on the term belief/believe, colonialism, and their relationships to biomedicine, see the first chapter of Byron Good’s Medicine, Rationality, and Experience, “Medical Anthropology and the Problem of Belief.”) Clinical biomedicine has so many intentional barriers for transgender folx to even be able to access gender care. Even aside from the lengthy gatekeeping with multiple clinicians literally not believing us (this is worse the younger the trans person is), any care-seeking outside of gender care is treated with “trans broken arm syndrome.” This is not unlike how fat people are treated when seeking health care.
Take me, for example. I came out a few years ago, just after my thirty-ninth birthday: trans, non-binary, and queer. It’s a winning combination, and yet completely confuses clinicians (and friends and family and employers/co-workers and policymakers and and and…). I also have a family history of breast cancer, so my 18-month-old breasts are considered at high risk. So I started breast cancer screening at age 40 with every test so far identifying abnormalities. Why? Well, because any time we clinicians (I’m one of those too) look for something, we find something. Know what else is happening? My breasts are growing! My context includes: cellular age (the older you get, the more chance your cells have of making mistakes when dividing), active and normal breast growth, imaging results during this growth without a baseline or an evidence-base (there’s no science!) to understand these images, that I will always for the foreseeable future be taking estrogen, that the idea of allowing testosterone to enter my body will likely trigger intensive distress and suicidality, and that I have spent 95% of my life gendered incorrectly by society and healthcare (and also myself). Do clinicians even have the skill to reconceptualize their (mis)understandings of social and political bodies within their cultures of biomedicine? The answer is often no, even for clinicians deemed “trans-friendly” or “trans-competent”; those individuals are certainly more friendly to me than others are, but their refusal to believe me and act upon my sociopolitical realities reveals that they are not safe nor competent.
The topic, finally. Trans during COVID-19: now we’re explicitly talking life and death. Gender care is critical, necessary, and not elective. Out trans folx, as well as those considering coming out, will face access problems—even to just talk to a clinician. Once again, gender care, including gender surgeries, are neither elective nor cosmetic. Many hospitals have canceled what they perceive as “elective procedures.” Gender care and surgeries are essential to being who we are, and when we are denied this, mental illness and suicide skyrocket. I’m watching mutuals around me experience despair as initial consults for gender surgeries are canceled. That despair increases when surgeries are rescheduled to future dates when insurance status is not clear. The National Center for Transgender Equality has offered guidance and supportive resources for trans people during this epidemic, including for postponed surgeries; however, they do not address what to do if a surgery is rescheduled for a future date when insurance might have changed or been lost (health insurance coverage information).
Within the context of this health crisis, there are discussions about whose bodies are worth saving. I’ve tried not to pay too much attention just yet, because of the explicit (and very strange) ageism and the always-present and eugenicist ableism that make it difficult for me to trust any bioethicist on this topic. At which point do bioethicists and policymakers decide that transgender people’s gender is a co-morbidity, thus leaving us at greater risk when we do attempt to access care? In writing this piece, am I giving an ethicist the idea to call for me/us to be left to die or extubated (removed from a ventilator) first? Or am I making it easier for others to call out and shame the ethicist who does suggest that we be left for dead? My concerns aren’t overblown. New York Governor Cuomo waived all state-imposed healthcare record keeping requirements, including the expectation to keep medical records “that accurately reflect(s) the evaluation and treatment of patients.” Is this to protect clinician decision-making from lawsuits (although Cuomo’s executive order also grants immunity for injury or death) so that there’s no record of who is denied care? Will those of us relying on hormone replacement therapies be set aside during COVID-19 triage?
Nearly a tenth of those testing positive for COVID-19 in Italy and 13.6% in Spain are health personnel. Will the “friendly” and “competent” clinicians giving us access to gender care make it through these next several months/years? Will personal protective equipment (PPE) production ramp up enough and will United Statesians, who even have the agency, ever follow instructions to shelter at home and maintain physical distance while out? The risks to us trans folk are incredible. No, collectively we do not have cardiovascular or respiratory or gastrointestinal conditions. But we do have what cis-centric biomedicine finds too strange or complicated to try to understand.
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Unlike my initial name change, which took three months to legalize but only a couple of weeks to update all my paperwork, it’s taking months to update everything because anything requiring proof of name change requires mailing my certified name change decree, and because one agency never mailed back my second copy, I can only do one thing at a time. After a month I still have to update my car registration and banking information, because I had to wait for Social Security to mail back my decree. Grrr.