1. Ladin, Joy


Gender: it's not an emergency, is it?


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The chest pains-short, sharp, and frequent-had started in the early afternoon. I had been painting my children's faces and pulling a picnic together at the home of my wife; we're separated. When she appeared in the kitchen, I went home, shaved, changed into a skirt and blouse, rushed on some lipstick and foundation, and drove myself to the hospital.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Neil Brennan.

Our local hospital is small and familial. All three of our children were born there. It was an early summer evening and business was slow, so as a woman with chest pains I got a lot of attention.


"Next of kin?" the intake clerk asked me. "Husband?" she asked, smiling, when I gave her the name. "Wife," I replied (my wife's name is gender neutral). I was grateful that marital laws in Massachusetts enabled me to pass as a married lesbian. "Oh, that's fine," she said, her tone carefully neutral, and handed me off to the ED intake nurse.


"Are you still having periods?" she asked. "No," I said. It was the truth, more or less.


They gave me a room and a gown right away. No one likes hospital gowns, but for someone with a female chest and male genitalia, they hold a particular horror. I decided to leave my skirt on.


A nurse wheeled in the electrocardiograph. We joked as she placed cold adhesive sensors all over my chest. "I don't have to expose anything," she said, as her hands moved toward my breasts. Unfortunately, she did. "I have to ask you some really bizarre questions now," she told me. The first was about ethnicity. "The state requires it," she said apologetically. She glanced down at the next question on her list.


"Are you physically male or female?" I hesitated. This was the first time anyone had questioned my gender, at least to my face. I wondered how I'd given myself away. I'd put on my lipstick correctly, the hair on my head was long enough, and the hair on my face was sparse enough. My voice was strained, but I'd hoped they would attribute that to stress rather than to my do-it-yourself voice training.


"Physically male. Unfortunately," I said. "I'm trans."


Hoping I sounded curious rather than humiliated, I added, "Why did you ask?" The American Medical Association, after years of reports of transgender patients dying because physicians refused to treat them, had passed guidelines stating that treating people like me is a professional obligation. But transphobia is more deeply ingrained in our culture than homophobia, and I had no desire to encounter it when I might be dying.


"Oh, they make us ask everyone that question," she answered. "We're trying to get these questions changed. The only one that's relevant is ethnicity." She was wrong. Gender, I was discovering, is relevant to every aspect of emergency health care.


She left me alone, and about a half hour later another nurse arrived. I wondered how much she knew about me.


"Do you shave your arms?" she asked. And suddenly I saw what she saw: patches of the short black hair that seems to spring up the moment I stop running the razor over my skin. Testosterone-inspired body hair is different from estrogenized body hair; it's darker and coarser, and it grows every which way. "Yes," I answered at last, my strained voice shredding. Real women don't shave their arms.


"Are your feet cold?" she asked. I hadn't realized it, but they were. She slid a pair of thick, beige socks across to me.


She was smiling. Why was she smiling? "Heart attacks," she said, "present differently in women than in men. The symptoms are vaguer, and we"-she emphasized the word slightly-"are much more likely to ignore them." She laughed. "We're just stronger than they are." I tried to match her conspiratorial smile.


"You have to ignore pain to take care of kids," I said. It was the truth, but it felt like a lie.


"That's for sure," she agreed.


"I waited as long as I could," I said, wanting some kind of affirmation-or was it absolution?-from her. "The pain kept getting worse," I croaked, "and I finally decided-" I broke off.


"Of course you needed to come in," she said. "Someone's taking care of the kids, right?"


"Yes," I said thickly.


"Well, then you have to take care of yourself." I couldn't speak anymore. I just nodded.


"Does it hurt to talk?' Very little was left of the voice I'd worked so hard to develop.


"No," I said, although it did. 'This is the way I always sound when I'm upset."