This is the story of Penelope. It is a true story, although the names of everyone involved have been changed for the sake of telling it to a wider audience. It traces Penelope’s experience of self-empowerment in the context of a healthcare setting.
For many transgender women, Penelope’s story may resonate with their own experiences. In particular, it may resonate with the experience of feeling judgment in a life setting, the healthcare system, which should be a sanctuary from stigma, discrimination, and emotional trauma.
Unfortunately, many health care providers carry their own biases and may lack the education, training, and empathy required to understand, sympathize, and treat their clients or patients with good will. Taking charge of how one is treated in a healthcare setting takes a lot of guts and sometimes it does not happen right away, but unfolds over time, as was the case with Penelope.
SCENARIO 1
Scene 1:
Penelope was not feeling well. She was having severe stomach pain and decided to go to a local clinic for a check-up. She had difficult experiences in the past in healthcare settings and was not looking forward to the stares and comments she may have to endure, but her pain was bad. She hoped to get guidance from a medical professional.
[Penelope is on a public bus heading to the clinic]
As she entered the bus and sat down, Penelope was thinking to herself: I really don’t feel like going through all of this today—dealing with these judgmental people. But I must see what is going on with me. My stomach is killing me. And, it’s just my luck that I have to get on this bus at the same time that the high school kids are riding home from school!
After a long and uncomfortable bus ride, during which Penelope was verbally abused by the high school kids on the bus, Penelope feels very drained and is experiencing a high level of anxiety. At this point Penelope is feeling over it and it tempted to turn around and return home, but she really must see the doctor.
Penelope pushes herself to keep going and finally makes it to the clinic to check in. The receptionist greets her by using the wrong pronouns and shouts out her dead name when it is time for her to go to the back to see the nurse.
Conversation:
Nurse Rudley (in an accusatory manner)
Hello, I looked at your chart and it looks like you haven’t had a doctors’ visit in 3 years. Why is that? Also, tell me what's bothering you today, Sir.
Penelope
“I have been having stomach aches for 2 weeks and it burns when I pee.”
Nurse Rudely
(Rolls hers eyes and smacks her teeth, shaking her head) “And you're just coming to check on yourself after all this time? When was the last time you had sex?”
Penelope
(feeling confronted and embarrassed, puts their head down.) “This morning.”
Penelope engages in sex work for survival because no one would hire them but does not think this is information they can share with Nurse Rudely.
Nurse Rudely
“Well, obviously you have an STI so we will take some samples and give you a shot, but you need to think about your life choices, Sir. Have a good day.”
SCENARIO 2: ONE YEAR LATER
Scene 2:
It has been a while since Penelope was tested for STIs. She was dreading returning to the clinic, the only one she could afford, but since she recently had unprotected sex, she felt she should. She had recently started attending a transgender non-conforming support group. The group members had been encouraging her to advocate for herself in medical settings.
[Penelope is waiting for a ride to the clinic that was arranged by her new case manager]
During the ride Penelope is thinking to herself, "I am so glad I started attending those TGNC support groups. I have learned so much. I didn’t realize how many people like me have gone through the same horrifying experiences just trying to stay healthy. Well, I am ready to take charge of my health and I am not going to let anyone get in my way!"
Conversation:
Receptionist
“Good Morning, Sir. How can I help you?”
Penelope
“Grand rising to you, Dear. My pronouns are she, her, or you can just address me by Penelope. Thank you very much. What are your pronouns?”
Receptionist
“I'm so sorry. I didn’t realize I offended you. Please forgive me. My pronouns are she, her. What is your preferred name so I can include it in our data base?”
Penelope
(Sighs with relief realizing all she needed to do was speak up) My name is Penelope Cruz and I am here for my doctor’s appointment. [NOTE: A client, patient, or partner should not have to educate health personnel about how to be treated with respect]
Receptionist
“Thank you so much. I have added your name to our database. I promise that it will not happen again. Please have a seat and I will wave my hand to let you know we are ready for you.”
Nurse Rudely
“Good morning, Sir. I see you’re back. Are you having stomach aches again? (rolling her eyes)
Penelope
(Taking a deep breath) “Ok, first and foremost, my pronouns are she and her, or you can refer to me by my name PENELOPE. I really do not feel comfortable discussing my personal life experiences with someone who will judge me for them. I would like to request another nurse or doctor to speak with, please. Have a nice day.”
Nurse Rudely
“Well I didn’t know all that. You should have just told me. I just assumed.”
Penelope
“Well you never asked, and that’s why I want to see someone else.“
Nurse Rudely
(Realizing her job could be in jeopardy and quickly beginning to apologize) “I’m sorry. What can I do to rectify this?“
Penelope
“You can get someone else to finish my visit. Thank you.”
SCENARIO 3
Scene 3:
Penelope has established good rapport with a doctor, Dr. P, who treats her with dignity and respect. She is heading to a check-up with Dr. P and is planning to address a number of aspects of her health, including her sexual health. Because she is so comfortable with Dr. P, she has begun to schedule preventative visits, instead of waiting until she is sick. Today’s visit, she feels, would be a good opportunity for her to get tested for all STIs and to address her sexual history.
Penelope enters the clinic, thinking to herself, Ok, I wrote down everything I need to discuss with Dr.P. I hope I didn’t forget anything. Oh, yes, we did just welcome our third partner last month. I should talk about that with Dr. P. Oh, and I can’t wait to hear about Dr. P’s vacation to Brazil!
Conversation:
Dr. P
“Good morning Penelope. How was your weekend? Did your commute and check in go well this morning?”
Penelope
“Yes, I met another lady in the waiting room, Ms. Milfred. She is such as hoot. She told me she mailed one of her famous pies to that nurse that was fired for her awful culturally incompetent bedside manner. What was her name? Nurse Rudely, oh yes! My commute was great. Thank you for setting me up with a case manager. The rides he provides me really help me out a lot. Check in was great since you all sent that clerk up front to training on cultural competency. How was your vacation?”
Dr. P
“Thanks for asking. It was a much-needed break. Now I feel like I can really focus on everything 100%. So, let's go over our last visit and are there any updates on your health?”
Penelope
“Yes. My main partner and I just welcomed a third partner, so we want to make sure we are all clear for our first group extravaganza! So, I would like to set up a couple’s appointment for us to have a conversation about risks and precautions we can take. We have all agreed to get tested together.”
Dr. P
“That’s awesome! Congrats on your new addition. I can set that appointment up for you today.”
Penelope
“Yes. My main partner and I just welcomed a third partner, so we want to make sure we are all clear for our first group extravaganza! So, I would like to set up a couple’s appointment for us to have a conversation about risks and precautions we can take. We have all agreed to get tested together.”
Dr. P went over Penelope’s medical chart with her, discussing her sexual history thoroughly. Then, Dr. P conducted an exam, all the while ensuring that Penelope felt comfortable and that any questions she had were answered. Penelope left the appointment feeling confident and empowered.