The Becky Blog


September 18, 2007

Enabled, Not Disabled

It was a good day today in the cath lab. Each case presented its special challenges. None are "routine." I've been doing this for over twenty years, and it's never yet been a chore. Whether I am coaxing a stent into a right-angle turn in the circumflex artery, or testing all around the right ventricle to find the best spot for the pacemaker lead, or crossing a tight aortic valve – I love my work. At the end of a busy lab day I feel energized, not exhausted. And, please don't think it is boasting, but I do believe my skills are improved over what I did prior to transition.

Isn't this as it should be? If we transition to become the person we know we were meant to be, doesn't it follow that we should be fulfilled in our professional and personal lives? But most of us aren't. We all bear our wounds – present company included – and suffer losses of friends and family. If we are fortunate, we will be able to continue our chosen life's work, or even to transition professionally to a more desirable or appropriate type of work. Such transition should be a step up, not a step down. Becoming our true selves should not disable us; yet we all know many examples in which this is exactly what happened. The reasons vary. Perhaps someone was in a hyper-masculine occupation and simply doesn't want to remain there after transition. Perhaps she was forced out of her good job by non-accepting colleagues. Perhaps the entire process took too much of an emotional toll. Whatever the cause, many of us find ourselves unable to continue the work we love and are trained to do. Some take jobs beneath their level of skill and training, rather than compete on the level to which they are trained. Those of us who are enabled by transition to be more than we were before should consider ourselves very blessed.

When I began my transition in 1993, I was aware of one other physician who had completed the process: Dr. Renee Richards. Years earlier I had read Second Serve with mixed emotions. Yes, Dr. Richards was able to continue her ophthalmology practice post transition, and as we know she even had a second career in professional tennis. But she seemed to be one of the most unhappy women I'd ever heard of. Not exactly a positive role model. Later I became aware of a very courageous woman who transitioned between college and medical school around 1980. Other than these two, there was no one else. I truly did not know whether I would ever practice cardiology again. I only knew I had to make the move.

Now I communicate with dozens of physicians in all specialties who have successfully transitioned, both male to female and female to male. Some have had a smooth and easy experience. Most have met with at least some resistance. I've written before about my friend Dr. Deanna, who had to leave her family practice group in a small Southern town. She simply opened up a solo office down the street and had an office full of patients from day one. Dr. Jen wasn't so lucky in the Northwest. She found herself shut out of practice opportunities and had to look all over the western U.S. before finding a fine practice combining academics and patient care. But she's back, better than ever and very happy.

Then there was Dr. Natalie. As a radiologist, she was employed in a large group and lost her job early in transition. Petite and attractive, she would have been able to blend into society as a normal woman. But there were too many emotional scars from previous mistreatment and relationships. She was unable to get back into a satisfactory practice environment. After a long, rough struggle with her personal torment, she brought matters to an end last year.

In memory, Natalie. May we who remember you work to enable our colleagues through transition so they don't find themselves disabled from the healing skills that we all practice and love.

October 1, 2007

ENDA The Line?

So, on Friday the 28th I was at the GLMA Annual Meeting in San Juan, running around everywhere doing Education Chair business, when one of our Board members stopped me. "Did you hear?" She asked. "They are taking transgender protection out of ENDA."

No, I hadn't heard. As soon as possible I went online and started reading the bad news. Barney Frank and Nancy Pelosi had suddenly experienced a last minute revelation: Oh my goodness, ENDA's chances of passing are reduced if transgender protection is included!

Well, duh. Obviously some conservative Congressfolks are going to freak out over their idea of trans protection - a bearded man wearing a dress to work one day and a suit the next; men dressing up to go to the ladies' room. None of this bears any semblance to the reality of transgender experience as reflected in a provision providing protection on the basis of "gender identity." We aren't asking for such bizarre situations. We would just hope not to be fired simply for being who we are. What is needed is some education on what transsexual persons ARE, not a sudden last minute cutting of the rope to our lifeboat.

Including trans people in ENDA may not be the politically safe move, but it's the right and honorable move. Sacrificing your smallest and least powerful group for your own gains isn't the mark of a courageous leader.

But politics is what it is. In a long, rambling tirade, Barney Frank went to great lengths to blame transgender people for having the nerve to make his job more difficult. He didn't seem open to discussion. The other openly gay representative, Michigan's Tammy Baldwin, wasn't touching this strategy change with a ten foot pole.

The Task Force and Matt Foreman weighed in immediately, condemning the "splitting" of ENDA and urging passage of the original bill. So did PFLAG, GLAAD, GLSEN, and Pride at Work. Of course all the trans organizations, led by Mara Kiesling of the National Center for Transgender Equality, were active immediately. Petitions were launched and signed by thousands. A poll in the Washington Blade (not exactly the most trans friendly of community publications) showed nearly 90 per cent of respondents wanted trans protection left in ENDA.

Everyone began writing their representatives. The Republican representing my district is a lost cause, so I concentrated on Arizona Democrats. Finally on Monday a letter went out from the Leadership Conference on Civil Rights, co-signed by 17 GLBT, trans-specific, and religious organizations.

The result? From GayCity News, October 1:

With less than 24 hours to go before a House committee was due to take up the amended version of the Employment Non-Discrimination Act (ENDA), stripped of transgender protections, Democratic leaders in the House have put off the hearing in the face of a storm of criticism from LGBT leaders nationwide.

In a statement released late on October 1, Speaker Nancy Pelosi and the House's two out LGBT members, Democrats Barney Frank of Massachusetts and Tammy Baldwin of Wisconsin, wrote, "After discussions with congressional leaders and organizations supporting passage of ENDA, we have agreed to schedule mark-up of the bill in the Committee on Education and Labor later this month, followed by a vote in the full House. This schedule will allow proponents of the legislation to continue their discussions with Members in the interest of passing the broadest possible bill."

They backed down. Frank and Pelosi grew backbones after seeing the reaction from so many sources. The battle is not yet won; we still have to make our case, but we have more time to do so, without being "thrown under the bus" tomorrow as was originally feared.

Huge thanks to Mara and NCTE, and to Matt Foreman and The Task Force, for your prompt and courageous action.

December 1, 2007

Life After Writer's Block

When I get home, it's already after 7:00. There's dinner, cleanup, paying the bills, and answering a few e-mails, and it's close to 10:00. Such has been life lately. It tends to stifle creativity. But finally I have a new Grace Letter/Christmas Message and I can blog a bit.

Obviously, ENDA did not go well. Barney Frank did let us down, as I suspected he would, choosing political expediency over helping those in greater need. We learned a lot about our friends and foes. Your basic fat cat, conservative gay men like John Aravosis of the arrogantly-titled AmericaBlog have brazenly stated that trans people have nothing in common with gays and lesbians, so who cares about their rights? It's tempting to say, the heck with all of you. But I'm not going to do that.

Somebody has to stay and mind the store until cooler heads prevail on both sides. I am already deeply involved in the greater GLBT issues, continuing to be very active in GLMA as Education Committee Co-Chair (for the third year) and President Elect. That's right, GLMA will have their first trans president, and so far there have been no defections from the ranks. Obviously Aravosis is not a member.

I attended the Interim Meeting of the AMA in November and continue in my role on the GLBT Advisory Committee. When I first took this position, I wrote "this is a ball that cannot be dropped." It hasn't been. The AMA policies and by-laws have been re-written to include gender identity protections for patients, physicians, and medical students. This was a huge step and was quite without any opposition. The AMA has been nothing but wonderful so far. We have another educational opportunity in June 2008 at the Annual Meeting in Chicago, another program on caring for transgender patients.

Oh, yes, the location of the AMA meeting. That would be, um, Honolulu.

We went for a walk on Waikiki Beach and met the Bird Man. For a small fee you can pose with all of his friends and Diamond Head in the background.

A bunch of cute little fellas they were! I wanted to take them home, but they had work to do.

So I will be remaining active in GLBT medical circles. My relationship with HRC is more problematic. I can understand the hard feelings. I'm pretty unhappy with HRC also, especially since their executive director appeared to be saying one thing to a trans audience and something else to the general public. But if all the trans people pull out of HRC, it will ultimately hurt us more than them. I will remind them that THEY OWE US and I hope to hold them to that debt.

Thanksgiving was especially nice this year. Karren drove up from Tucson – she had the holiday off – and the three of us continued on to Sedona, where we joined several families from my work environment for a covered-dish dinner.

My contributions are back every year by popular demand, and they are all available on my recipe site: Mississippi Mud Pie (I think that's what keeps getting us invited!); Pecan Wild Rice; Sweet Potato Casserole; and Cheese Spread on French Bread. It was nice not having to roast the turkey! We all had the most fun. It was wonderful to hear that medical school is going well for Karren. I am so proud of her.

The next morning we awoke to perfect Northern Arizona weather, sunny and 60 degrees F. It was a short drive to the Bell Rock trailhead and we enjoyed the four and a half mile hike around Bell Rock and Courthouse Butte, as you can see. We arrived back in Phoenix around dark, tired, full, and happy.

December 16, 2007

Dan Fogelberg
1951 - 2007

Very few albums have influenced me as much as Dan Fogelberg's "The Innocent Age." Here are parts of two of the most moving songs on this double album from a master singer-songwriter who passed away today.


Sometimes, in the night I feel it
Near as my next breath
and yet, untouchable
Silently the past comes stealing
Like the taste of some forbidden sweet

Along the walls; in shadowed rafters
Moving like a thought through haunted atmospheres
Muted cries and echoed laughter
Banished dreams that never sank in sleep

Lost in love and found in reason
Questions that the mind can find no answers for
Ghostly eyes conspire treason
As they gather just outside the door ...

Every ghost that calls upon us
Brings another measure in the mystery
Death is there
To keep us honest
And constantly remind us we are free

Down the ancient corridors
And through the gates of time
Run the ghosts of days
That we left behind

Only The Heart May Know

Silent sea, tell this to me
Where are the children that we used to be
At picture shows where nobody goes
And only the heart can see

Starry skies, soft lullabies
Where do they go when their melody dies
To a day, far, far away,
That only the heart may know

Friends we knew follow us through
All of the days of our lives
Love we shared waits for us there
Where our wishes forever reside

Falling tears, memories' mirrors
Where are the summers, oh, where are the years?
Carried far to a wandering star
That only the heart may know

R.I.P., Dan, you are free.

December 22, 2007


so much depends

a red wheel

glazed with rain

beside the white

"XXII", also called "The Red Wheelbarrow"
William Carlos Williams, Spring and All, 1923

Williams, one of the great American poets of the last century, was a pediatrician by profession. He was making a house call to a very sick little girl in Passaic, New Jersey. Looking out the window of her sickroom he saw the wheelbarrow and chickens.

What, exactly, depended upon the wheelbarrow? Did the child fight for her life so she could play with it in the yard? Or was it simply a symbol of grounding in the simple, the tangible life in which she had lived comfortably? Of course the girl's life was more important than the wheelbarrow. But the simple accessories of our lives give enhancement to our meaning, our purpose.

So much here depends on two citrus trees. There's an orange tree in the back yard that we inherited when we bought the home, and a tangerine tree in the front that I planted our first spring. It's over twelve feet tall now and chock full of big tangerines. The oranges are smaller, but they have ripened first. Today I picked about two dozen and made a huge pitcher of fresh juice. The sweetness and fresh taste cannot be found in any bottle in the grocery. Every December we look forward to our fresh juice, which most years persists well into February.

So much else of importance vies for my time. I was called in to the hospital at midnight Tuesday and spent the next several hours opening up closed blood vessels. All went well, but I was wiped out by Wednesday afternoon and took a little longer to recover. Yes, I had another birthday this week. Tick tock, Father Time. Although I can still do this, it's especially nice to have the dependable accessories of life at home to refresh and simplify.

February 10, 2008

Shades of Grey

2008 is not starting as one of my favorite years.

As far as work is concerned, the organization is making changes regarding relocation of certain personnel to different sites in our network. I'm not one being relocated, but I will have new and potentially large burdens as a result. I realize the strategic needs and I support the organization. But it's major stress.

(I realized while writing that paragraph that it doesn't even sound like a medical practice!)

There are stress issues related to GLMA, how we will position ourselves in the future, will we be relevant and will GLBT physicians still want to join our efforts. I surely intend a positive outcome.

On a personal note I had, um, a colonoscopy recently. The doctor removed a couple of thingies which turned out not TOO scary, but if I had waited longer it might have been different. Repeat looks will happen. This is anxiety producing. We may give lip service to "we are all going to die some day," but until it gets personal we breeze along, confident in our immortality. Especially with the normal heart cath a few years back, I've been enjoying middle age. Now we have a wake up call. In years to come I will possibly have more experiences from the "patient" side of the stretcher. Oh well, it's the family curse, I shouldn't be surprised.

So, if all that background weren't enough, we arrived at yesterday, the set date for the annual dinner of the Phoenix Human Rights Campaign.

It has not been an easy decision to remain active with HRC. Persons who formerly held leadership positions in the organization have left because of HRC's actions at the time of the U.S. House of Representatives vote on the Employment Non-Discrimination Act. I supported their decisions, and probably would have done the same if I had been in the same situation.

But I wasn't. Margaux and I were simply local members. She has always donated a work of her original art to the silent auction, and her large canvases have been very popular with the bidders.

In recent weeks there was concern over the upcoming dinner: would there be any mention of ENDA and the effects on transgender people? Would there be an effort to educate the attendees on trans issues? What sort of effort? In some other cities there were transgender groups who weren't a part of the HRC function who were permitted to distribute literature. The effectiveness of this was perceived a bit differently depending on whom you asked. At any rate the Phoenix event planners preferred to keep any educational efforts internal - and approached me and Margaux about co-ordinating such efforts.

This wasn't an easy decision. We had no time to print up our own materials, and had to rely on HRC's "Transgender Americans" publication - not bad, but perhaps not as thorough as I would have preferred. If we had had more lead time we might have had plastic bags filled with information, to distribute at the base of the escalators leading to the event. On the other hand, the crowd may not have been receptive to carrying a bag around all night. What was the best approach?

Equally difficult: should we be doing this in the first place? What message does it send that we are still willing to work with HRC? Are we "traitors"? If I thought we were betraying transgender people I would never have agreed to participate. Let's be candid: HRC is not going away. Trans people are not going to "bring down" this organization. We can decide to remain in positions of support, and try to influence strategies over time. Or we can all walk away and leave the possibility of future HRC help hanging. We chose to remain. This may not be popular and we will have to live with that. After meeting with HRC leadership I do believe they are committed to trans inclusion; to educating individual members of Congress about trans issues so that when ENDA comes up under a Democratic administration it won't be stripped of our inclusion again.

Many people see the HRC as the villain: it's all black and white. Margaux and I have been talking about this for some time, and we believe it's not that simple. There's much good in the organization and we need to do what we can to direct it towards the good.

In years past, Margaux's art work has been more or less taken from a "rainbow" theme. Because of the controversies we had to face this year she decided to produce a piece called "Shades of Grey." I think it's some of the best work she has done in a long time. So did the buyer who made the winning bid, someone who has admired Margaux's art for years.

I was able to distribute a good bit of literature and start networking some parties who could be helpful for local trans organizations. Given our contraints, I think the outreach was successful. If we have a year to plan another one it will be much more so.

Some of the speakers at the dinner - especially Representative Gabrielle Giffords, and Alec Mapa, who was just hilarious - were explicitly supportive of transgender inclusion. So, to a degree, was the Executive Director, although I do wish he had gone a little further for us. More will probably be said about this, but for now I have lots to think about.

Definitely not all black and white.

February 16, 2008

The Death of a 10 Year Old

From the South Yorkshire Star:

A BOY of 10 has been found hanged at his South Yorkshire home after telling his mum he wanted to be a girl. Cameron McWilliams had already asked for permission to wear make-up, and been teased after he was found wearing his half-sister's knickers.

His desperate mum Kelly McWilliams told a Doncaster inquest she had bought him girls' underwear to wear in private, but had refused his requests to be allowed to wear make-up.

She said: "It was apparent he was unhappy and said he wanted to be a girl. He did like girls' things."

He had been teased after once being found in his half-sister's knickers, and had asked if he could wear make-up. His mum told him he would have to wait until he was older.

Mrs McWilliams found her son hanging, with a black leather belt around his neck, in his half-sister's bedroom at the family home in Montrose Avenue, Intake, Doncaster.

"When I got in the room he was not asleep, he was standing by the window with a dressing gown on," she said.

"His head was down and I realised something really serious had happened and I screamed."

The court heard Cameron was a lonely boy with no friends outside school. He spent all his time at home listening to music, playing on his XBox and using a laptop computer.

His mother revealed Cameron had been very interested in recent reports of a spate of teenage hangings in Bridgend, South Wales.

She said her son was in the habit of writing her notes if he wanted to discuss something, and added: "He would have asked me questions about hanging but he never did."

When is this going to stop? The child was ten years old. She just wanted to live, to be herself. Her mother didn't get it, and now she is dead.

March 6, 2008

I told you we had enough oranges to last into spring!

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