Trans emancipation and hospital wards
In my gender transition I’ve been pretty extremely fortunate. When I first stepped outside wearing a skirt, it was a long flowing almost pleated black thing over long black patent boots (I know, I know..), I was pretty afraid of being shouted at or attacked. OK I was genuinely terrified. I had feared what the media and my limited experience had portrayed, which was that the world treated those who moved across gender lines poorly. For hours I stood at my front door, frozen between what my old colleagues would have called ‘the fear and the wish’ when you come to realise that what you want, what you need, is balanced on the tip of a knife by the fear of it and what it would mean for your life. If you move one way or the other just a little, the knife will fall, and everything that happens after tumbles into place.
On the one side, my career, my relationship, my future, were all built for a man that in truth did not exist, but that illusory person had walked this world for 28 years and had finally found some measure of success. On the other, that part of myself yearning to exist at all had the chance to be born into the world, throwing everything into doubt. Whether this new girl could move seamlessly through this world, whether she would be hated, alone, unemployable, whether she would find friendship, some measure of success, was all uncertain. The decision was focussed like a lens, all narrowed to this moment, to my hand on the front door.
That vigilant part of myself placed a gentle hand on the hilt of her sword, and took mine in the other. We took a deep breath, steeled ourselves, and stepped outside.
I walked up a nearby street, crouched to stroke a passing cat, and walked home.
That was the beginning of a journey that would last a decade. Medical appointments, hormones, a new name and documents, surgery, all landmarks of someone new coming of age. I did experience the marginalisation that is a hallmark of this kind of gender adventure. I was shouted at in the street, had cars blare horns at me, was stared at across bars and in coffee shops. I had children ask ‘is that a boy or a girl?’ and ‘why is that man wearing makeup?’, and I got straight-up bullied by a four-year-old once who danced and sang ‘you’re a boooy!’ in front of me at work. I had a Local Authority want to warn schools that their trainee Educational Psychologist visiting today was transgender. At one point I had police in my living room to help me manage people threatening me and throwing things at me outside my flat. On one occasion two men squared up to me in a car park, filled with fire and fury I had somehow kindled in them: ‘don’t think you’re something you’re not…’
Never one to be deterred by the threat of violence I learned to speak openly about my gender, to make people laugh, to teach big rooms of people about my experience and about the science of gender diversity. I wore my difference like armour, wielding humour like a sword, and disarmed the concerned, the cautious, and the hostile with a little wit and a lot of charm. I finished my doctorate, I found employment, I started to build relationships in the world as myself. Gradually, I became a little more whole.
I became Cora.
I started that journey 15 years ago, at a time when Lavergne Cox was on the cover of Time Magazine, when transition related healthcare took a year to access but was accessible, when Barack Obama was the US president and I still had hope. It looked like gender diverse communities were going to claim their place in this world, be successful, make space for those that come after… maybe even thrive. I was convinced that all the truly brave people had come before me, and that I would crest the wave of their acceptance to power my own. And I would ride that wave all the way to trans emancipation.
And the further I ventured into this move between genders the more the marginalisation fell away. In part it was a world becoming temporarily more accepting, in part it was me becoming more capable of stepping into my femininity with more confidence, in part it was the absence of testosterone and the longer-term presence of oestrogen feminising my form more completely.
I recently met some trans folk who had no desire to pass for cisgender, and they experience much more marginalisation in modern life than I do, in the same parts of the world in which I regularly venture. They are frequently misgendered, shouted at in the street, have children asking those same questions. Only then did I realise what my experience of never being misgendered really meant. I have thrived because I experience the mostly unearned privilege of passing for cisgender, and I can choose whether, when, and how to tell someone about my gender history.
I say all this to offer a context in which to understand my experience. I survive in this world, in part because most people have become more accepting, even if the world itself, policymakers, judges, politicians, have become far less so. But mostly I thrive because I am regularly thought of, spoken to (or over), related to, as a cisgender woman. I thrive because in my daily interactions with strangers in the street people don’t know about my gender history.
But the sense of myself as a woman is still precarious. I transitioned because the world relating to me as a man caused me such existential distress that it carved a space in my soul in which fulfilment should be. I couldn’t breathe, much less thrive, in a world where my authentic self couldn’t be manifest. Transition, for many years, offered me the most wonderful sanctuary. I got to be the woman I am, and for that I have such gratitude that my heart might burst. Even when people knew I was trans, they still treated me as a girl in the world, and I’m so happy just thinking about those experiences. But now, there is an oddly strong group of people, powerful in society, who claim that trans women in particular aren’t women at all. We’re being banned from women’s groups and societies, from women’s spaces, even from our toilets.
I have responded to this recent wave of ‘reasonable concerns’ by working on my voice. I now train it every day and my RollingForInitiative readings of every post are part of that training. I’ve been getting the fit right, working out, getting the voice right, deploying my best tactics to be as stealthy as I possibly can be in this world. I disguise every whisper of my gender history and I hide in plain sight. And for the most part, it works. I shroud myself in a veil of typicality and live there. I live there happily.
However, there is one place in the world where my gender history is always present no matter what I do, and that’s in the doctor’s office. My NHS records somehow, somewhere, make it obvious to every medical professional with whom I interact that I am transgender, ‘a gender reassignment patient’. This makes most interactions with doctors, nurses, consultants, oddly sticky as I am suddenly faced with the possibility that they are going to think of me unkindly. I want to emphasise that I’m treated with abundant kindness by NHS staff pretty much universally. But when you are vulnerable, asking for help, being examined and scanned, it only takes one person revealing their dislike of trans people, referring to you as a man, or suggesting that your transness is obvious to them, to ruin your week.
This week NHS England released their new guidance and every news outlet announced in bold letters, with the BBC putting it on their front page, that transgender women are to be barred from female hospital wards. Trans guys are banned from male wards, too, but they are invisibilised in the narrative, trans women are the ‘danger’, and so we’re the focus.
I have Multiple Sclerosis and so I need to use hospitals from time to time. I haven’t stayed in hospital in the last 10 years, but the time is coming. Now the guidance suggests staff will endeavour to put me in a side room, but who are we kidding the NHS isn’t the Tardis and isn’t replete with rooms they aren’t using for people who need them, and so I will be placed on a men’s ward. Every examination, every time I need to get up to use the toilet, every urgent response to my needs, will all be in a room full of men.
And of course, being placed on that ward reveals our transgender status to everyone. This woman, who most people think of as just another girl in the street, is going to have her gender history revealed to all who see her while in her most vulnerable state.
I honestly can’t think of many labours I’d not endeavour to avoid this fate.
I can feel it already. The part of me so desperate to be realised in this world tugs at me, scared that we’ll go back, that we’ll put ourselves in the horrifying situation where we’re thought of as a man once more. I felt it when we fell off the Rocinante, our manual wheelchair, splayed out in the road surrounded by good, concerned people who saw this woman in need and stopped to help, asking urgently whether I needed an ambulance. I felt that pull to minimise the symptoms, to tell them I was ok, unsure of how much my appraisal of the seriousness of my injuries was being shaped by my fear of what would happen if I went to hospital. I know that whenever I do need an ambulance, or a hospital, or a doctor, I will feel that desperate pull in the back of my mind not to go, to distract myself from the symptom, to grit my teeth and bear the pain and the discomfort and the fear and hope that I can survive whatever ails me without help. Because remaining hidden in this world is how I remain safe. Being seen as the girl I am is how I stay whole.
And this is how this guidance will harm us. Subtly. In the thousand little decisions people make to avoid a healthcare system that has become dangerous to them even when experiencing a symptom they should not ignore. In the choice not to get prompt help, not to seek support, not to take the symptom seriously, to explain away the pain and to brush off the fear it provokes.
I don’t have a quippy retort to what’s happening, no little laugh at the ridiculousness of it all. My people are going to be hurt. Some of my people are going to die.
Marked only by little whispers of ‘it’s probably nothing’.
I don’t regret that decision to push open my front door, to step outside. Even should the world turn wholly against me and my kin, even should it somehow be proven beyond doubt that my MS is the consequence of my transition, even should it shorten my life, I would not regret it. And this is what these policymakers don’t seem to understand. We are. We live. We have always been here and we will always be here. You can segregate us, push us to the shadows, make us afraid to go to the doctor, tell us we aren’t who we know ourselves to be, but if you think you are the first people to do that you are pretty sorely mistaken. We transitioned to a chorus of ‘reasonable concerns’.
So I will not permit this world to push us back to the margins. I have found my place here, found fulfilment where emptiness once resided, and we will not go back. So put me on a men’s ward if you will, NHS, I might be the only woman there, but you don’t get to define me, and I will still be a woman wherever I am and however you refer to me.
And I know I might not be the only trans woman there. If that is where you have put my kin, NHS, then that is where you must put me, to be there for them. I will not let them be there alone, I will not hide in plain sight to the extent that they cannot see me, and I will not allow ‘passing’ to become the benchmark of entry to our womanhood.
So when I need help, when the ambulance needs calling, when I need to go to hospital, I know there will be one of those decisions, my hand on the front door again, fearing the consequences of being a manifest reality for this world to manage. But I am already real, I am already here, and as a trans elder I am not alone. I want to make space for those that come after. So I will smile, along with that vigilant part of myself we will steel ourselves, think of our gender diverse kin…