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fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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Telehealth from the Driveway

My computer chimed a familiar DING, and my patient’s face flashed up on the screen. They were seated in their car, parked in the driveway of their grandchildren’s home, before they went inside for a visit. My patient eagerly declared, “Today is the day!” A broad smile graced their face. “I’m ready,” they said.

For decades, my patient had been exploring their gender identity. From childhood, they’d felt unsettled in their boy-body, and as an adult, living as a man had never felt right. But they were deeply steeped in a heterosexual cisgendered life—with a wife, children, grandchildren, career, and community—in a cis male body.

At the first appointment when they confided their feelings, many years ago, they’d moved their hands to their face and dreamily sighed, “I can imagine having softer skin.” Their eyes gleamed as they spoke of the rightness in their being when they tried on wigs, makeup, dresses, and bras in the shelter of a bedroom closet. A therapist helped them work through their feelings: How might they share their full self with those in their current life? Would it be possible to take that risk? For years, they’d thought that impossible, but eventually a glimmer of hope had bubbled up and would not be quashed.

My patient diligently read and researched, feeling clumsy and curious while exploring options and ways of being. After leaning into convention and security for all their life, the potential of gender affirmation outweighed their reticence and worries. On the day in question, a few years ago, they were finally ready to take the leap and see where the journey would lead them. Throughout our call, I was struck by the way the morning sunlight entered the car windows and illuminated their face so it glowed.

As we concluded the visit, I prescribed hormone therapy via the electronic medical record and pressed send. WHOOSH. Later, they could pick up their new meds at the pharmacy. Nervously, I hoped with all my might that their loved ones and community would embrace them. I deeply admired their tremendous courage and strength in heeding their inner voice. The honor of helping facilitate their journey and bearing witness to their shedding of that which did not serve them filled me with a light that, like the light inside their car, burned brightly even after our interaction concluded.

Pamela Adelstein 
Newton, Massachusetts

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