A Weird Fit for Medicine

Editor’s Note: This piece was awarded an honorable mention in the Pulse writing contest, “On Being Different.”

Whenever the most recent piece of anti-LGBTQ legislation passes, the silence is a familiar song.

In November of 2022, we had the Club Q shooting in Colorado Springs—soon to be followed by a nonstop onslaught of legislative attacks on the LGBTQ communities’ right to exist. After each one, the silence blared.

I remember walking into work the day after the Club Q shooting. As I met my co-residents for 6:00 am patient sign-out, I felt weighed down, needing to will myself to focus. I was greeted with the usual smiles, heard the usual laughter, listened to the usual small talk. I did my best to reciprocate as I internalized a message that I don’t believe anyone intended to send: No one cares.

When it was announced that there would be a debrief on the shooting for any residents who were interested in attending, my heart leaped up; it sank again when I was the only one to show up. I continued through my workweek, surrounded by my colleagues but feeling very alone.

Sometimes that’s what being different is: being alone.

As a queer physician, I know this experience of isolation is not unique to me or my community, but though the experience may be common, that makes it no less lonely. Whether the attacks on LGBTQ people are physical or legislative, they weigh on me as I worry for my community. I carry that worry to work, and when it doesn’t even make it into the workplace conversation, I sometimes feel like I carry it alone.

Many would say, “If you want to participate in a conversation, start it yourself”—and I don’t disagree. Having thrown myself into creating dedicated space for LGBTQ residents, giving lectures on LGBTQ health, and writing testimony against anti-LGBTQ legislation, I’ve found ways to use my voice. It’s helped me to find my tireless allies and allowed me to answer questions that are asked in good faith, and it has even occasionally led to slow change for the better.

And sometimes that’s what being different is: being an educator.

In my time as a resident, I’ve watched my co-residents and faculty add pronouns to their badges; I’ve heard residents gain confidence in counseling LGBTQ patients and watched our LGBTQ patient population increase as we work toward better inclusivity. I’ve poured my energy into creating the environment for queer physicians and patients that we should already have, and I celebrate the small wins as we inch toward equity.

Of course, not everyone is receptive to my efforts. I’ve been told that my discomfort with homophobia and transphobia are simply a result of my being a “weird fit” for medicine. I’ve been told that some of my colleagues care about me, but can’t condone my choices. I’ve been told that I am just confused about my own gender identity and sexual orientation. I’ve been told that my commitment to LGBTQ health shouldn’t be forced on other physicians. I’ve been told that my concerns about my community don’t matter. I’ve had patients tell me, “I wouldn’t ever want a queer physician” when they didn’t know that I am one—and when they did. And that’s all just within hospital walls.

And sometimes that’s what being different is: being a target.

Each comment leaves a wound, but rather than expressing the anger and hurt that these ignite, I have focused the resulting energy on hours of conversation. Most of these are, quite simply, polite discussions about why my community and I have a right to exist. As a queer physician, I don’t always feel that I have the luxury of anger, because while I don’t speak for my whole community, I know that much of what I say or do will be generalized to include them. Any misstep or perceived slight could keep attitudes towards queer patients and physicians from getting better. And they must get better.

As a physician, I feel that I have a privileged window into my patients’ lives. I hear personal stories, I see trends in health concerns, and I am invited into people’s lived experience, even if only for a brief time. This can allow physicians a unique insight and sometimes lets us start to see patterns before they fully reach general medical awareness.

One such pattern I see time and again, after each new piece of anti-LGBTQ legislation passes, is an increase in the number of queer adolescents I admit to the hospital after suicide attempts. Of course, my experience is anecdotal, without documented evidence of causation, but that doesn’t change my feelings of hurt and outrage, seeing queer child after queer child coming to the hospital after deciding that this life isn’t worth living.

And sometimes that’s what being different is: bearing witness.

I feel that anger and hurt swell with every admission. I want to be able to erase my young patients’ pain, to silence their opponents and to promise them a better world. But sometimes the best I can offer is just being present.

During one such admission, a nonbinary teenager had ingested a number of medications in a suicide attempt. He’d had an extended stay in the emergency department before being admitted to the hospital medicine service to wait for a psychiatric bed. He was tired, he was miserable, and I felt I had very little to offer.

When I introduced myself as his doctor, he gave me his name and said, “I use he and they pronouns.”

The expression on their face was one that I know has often crossed my own: It was a combination of tension (was I about to say something awful?) and exasperation (how much was he going to need to explain to me?), over an undercurrent of exhaustion.

“It’s she and they for me,” I said with a grin.

I watched their tension melt away, to be replaced by relief—and, despite everything, they smiled back at me.

Because sometimes that’s what being different is: being the one that’s there to make someone else feel a little bit less alone.