Religious Freedom in an Emergency Department

I worked as a staff nurse in a pediatric emergency department from the time I graduated nursing school through when I received my master’s degree in nursing, in total between 6-7 years. I started at age twenty-two.

I enjoyed being twenty-two. I lived in a left wing land with Obama soon to be entering office and even though I attended school in very conservative upstate New York I never really internalized the level of conservatism that abounds in most of the country. I was working in an inner city hospital in the Northeast happily back in my liberal bubble.

The Emergency department was a hodgepodge of characters. Attendings, residents, nurses, techs, EMTs, police, security, administration, social workers, psychiatrists, surgeons, pharmacists…you name it and we had them at some point working in the emergency department. At that age and in that geographical area I basically assumed every one was pro-choice, pro-LGBT rights, and pro-healthcare for all.

I was wrong.

One day I was taking care of a patient who was raped. She was young (children’s hospital being under 18), and scared, and traumatized. The physician spoke to her mom and her about all the options available to her. Rape kit, medications, etc. One of the options was the morning after pill which prevents pregnancy from occurring. The mom and the patient wanted to discuss it and they agreed to certain things but initially did not want the morning after pill. No one pushed it, as that’s not our role.

Later, after all the tests and interviews and near time for discharge the mom approached me and said they decided she would take the morning after pill. I said sure, and went to the desk where the physicians were sitting. The Attending and the resident were sitting next to each other making my life easier. I told them the patient changed her mind and wanted the morning after pill.

The Attending looked awkward and said, “Okay, but I can’t order it,” and he looked at the resident, and she looked awkward and said, “Yeah I can’t order it either,” I stared at both of them like they had two heads and genuinely asked, “Is there something wrong with your computers?” They both shook their heads and avoided eye contact with me. I stood there staring at both of them and said, “Well some one has to order it because this kid was raped and she doesn’t want to get pregnant. So what’s the freaking problem?”

It still had not penetrated my head that they couldn’t order it because their religious beliefs prevented them from ordering it. I literally was still thinking there was a technical issue and for some reason the system was not allowing them to order it. I know it sounds so stupid, but I was young and naive and hopelessly liberal.

Another Attending overheard our exchange and likely heard my statement, and saw me standing there with my hands on my hips glaring at the computers and the doctors, and quietly said, “I’ll do it.”

That’s when I got it.

I remember walking away silently to the medication room. Later I was with the Attending who ordered it and I asked what would have happened if it was night shift and they were the only two doctors in the ED? He told me they would have ordered it. But I wasn’t so sure. I’m still not. I’m thinking if it was night shift and they were the only ones in the ED I’d be trekking up to the ICU and finding one of their Attendings to place the freaking order.

This happened eleven years ago. I still remember it vividly. For many reasons.

For starters I never envisioned patient care being affected by some one’s religious beliefs. I remember we had a travel nurse from North Carolina. She told me they don’t even offer it to rape victims where she worked down south. I thought that was shitty. Still do.

If birth control is against your religious belief I would hope that murder, rape, pedophilia, burglary, tax evasion, etc. are also against your religious beliefs. Do physicians regularly screen their patients for committing tax fraud? Because let’s be real, everyone in America who owns a business probably has kept cash for themselves and not reported it as income. Do you not treat them because they are stealing and committing tax evasion? Do you not treat men who’ve committed rape when they arrive in the ED for a heart attack? Do you not treat the man who arrives in the ED after having a heart attack while he is screwing a prostitute who also arrives with him, but quickly exits when she hears the wife is on the way (Yes that’s happened)? Why is it that you can pick and choose what religious beliefs you follow at work and which you don’t?

You shouldn’t, hence why religious beliefs should not affect the delivery of healthcare.

Here’s one that will totally trip you up- would you refuse to treat a pregnant transgender man who wants to have the baby? What about all that pro-life chatter? Or does pro-life mean you’re only going to treat the lives that matter to you? 

The Health and Human Services Department recently formed a committee to explore religious freedom within healthcare. Per LamdaLegal article the aim of the committee is to protect from consequences health care providers who refuse services to patients due to religious beliefs. It makes me sick that in the United States we have one of the highest Maternal mortality rates in the Western world, but no we aren’t going to form a committee to save women’s lives during childbirth.

In 2009 a study out of Harvard wrote that about 45,000 deaths in one year were attributed to people not having health insurance. But we are focused on decreasing access to care instead of increasing it. Psychiatric hospitals are losing funding, states are shutting down facilities, families with severely autistic individuals have no long term plans for placement. The United States has one of the highest infant mortality rates in the Western world. But we can’t focus on that. Our current administration is instead focusing on restricting care.

But I digress. My patient got her medication preventing pregnancy. Thanks to an Attending who was not conflicted about ordering it.

My heart aches for the number of people within the LGBT community, who if this committee actually makes progress, will hesitate to receive healthcare services because they are fearful of being refused services.

Religious freedom is a beautiful component to American society and the foundation on which our country was built. But religious beliefs do not belong in healthcare delivery. Science, education, and clinical experience should be the basis of medical decision making.

 

LGBTQ in the Days of #45

The FBI published data last year that hate crimes were on the rise. According to their report entitled, 2016 Hate Crime Statistics, there were roughly 1400 hate crimes directed toward the LGBTQ community defined as crimes perpetrated due to sexual orientation or gender identification. Now in the grand scheme of our population 1400 may not sound like a lot. But those are 1400 individuals who were attacked and/or assaulted and/or murdered due to their sexual orientation or gender identification. That is 1400 too many.

That is also a 5% increase from 2015.

When this was published in 2017 the rate of murder of transgender individuals was already increased from the previous year.

I believe the actual number of hate crimes is higher, but many are not reported.

I personally don’t think it’s a coincidence that there is an increase in hate crimes toward the LGBT community after we elected officials who are openly anti-LGBT.

In my clinical practice I’ve heard many individual’s stories of discrimination and being victim to assaults due to sexual orientation or gender identification. I’ve heard from clients and in my own personal life that they have been spit on, punched, thrown against walls, jeered, followed, etc. I’ve yet to meet some one who has reported any of these experiences to the authorities.

I’ve met people who have come away with black eyes and broken bones or dislocated joints, and they have not reported these crimes. I’ve actually never met someone who has pressed charges. This is why I think this is a gross underestimation of actual hate crimes.

The saddest stories are those where the perpetrator is a family member who reacts with violence when their child comes out to them. I have spoken to individuals who have walked away with broken bones after coming out to their parents.

This happens in the United States. Not just in the South. But also in the Northeast. It happens in towns and homes right next door to you.

I’ve been questioned by transgender clients in the past year about what my medical record will say and who it could be released to. They have said they live in fear of our new administration and they don’t want to be put on a list somewhere by the government.

I thought it was cool when my medical record system added gender identification as an option. But to my clients it is a vulnerability.

The Queer community feels unsafe. I see and hear it daily.

Nothing will change this uncertainty and fear unless we vote. Vote in the 2018 elections. Vote in the 2020 elections.

Don’t turn a blind eye to the hatred fostered by this administration. It is real, we are feeling it, and it hurts.

Holding Hands with my Wife

Before I dated my wife I dated men. I went on dates in public places with men including places like the beach and the movies. At all of these places I engaged in public displays of affection otherwise known as PDA. This could be as simple as holding hands or as much as kissing, or cuddling. I never thought twice about it.

I have been with my wife for ten years. A full decade. In that time I can probably count on both hands the number of times I’ve held hands in public or engaged in any type of PDA.

I am by nature private and am not one to be extremely affectionate in public. But being married to a woman has made me even more cautious.

Recently a friend who I hadn’t spoken to in awhile messaged me on facebook and told me how much they were enjoying my blog and how much they really had no idea what my wife and I went through to be together. That’s not the first heterosexual friend to tell me that since I started this blog. Many have told me they had not idea that I didn’t dance at their wedding because it was a heterosexual wedding full of heterosexual people, or that they didn’t know about the decisions we made when selling our home in terms of our family pictures, or about the decision to be an “out” provider. That’s basically the point of my writing. Heterosexual individuals including some of my dearest friends and beloved family members, take for granted the hetero-normative culture we live in.

I vividly remember my wife and my first date. It was at a restaurant. I felt like we had a big neon red sign flashing over our table, “Lesbian Date Here” and I was terrified. I had witnessed too much discrimination with my friends and sister who were gay to be relaxed. I waited for someone to peg us as being on a date and start making comments.

We didn’t go on another date for a long time. I mean, we went out places, but I kept it very neutral in public. I still do to some degree.

In a decade we’ve been on countless dates to the movies, the beach, vineyards, hikes, etc. As I’m sure any couple who has been together a decade can attest to, we’ve spent a lot of time together privately and in public spaces. I can say that unless we were in a gay bar though, we were not holding hands, we were not putting our arms around one another, we were not pecking on the cheek if she dropped me off a coffee at work, or any other hundreds of reasons why we interact on a daily basis in public.

Not all lesbian couples are this way. Many don’t give a shit and more power to them. I personally am generally hyperaware of other people and I just don’t want to deal with discrimination. If we are with another lesbian couple we are more likely to feel comfortable holding hands, and definitely if we are in a gay space.

Something that has brought this to the forefront for me lately is our sons. We are a very affectionate family in general. Our sons are all over us and we are all over them. Since we had them and since we started venturing out in public with toddler twins I’ve realized that I still care about facing discrimination as a result of PDA, but I also don’t want my sons to see me acting differently than they are used to. They’ve sort of turned our world upside down in every possible way.

I’m not going to turn into a PDA slut, and the point of me writing this is not to be some major transformative moment for me. It is to bring awareness to my hetero-audience.

You take for granted your freedoms.

If you know a lesbian couple who has been together a long time you should take stock of what you’ve witnessed in terms of PDA and recognize if there’s a general lack of PDA that it’s not because they are not or do not want to be affectionate.

It’s because they don’t feel safe being affectionate. 

Straight people have privilege to be natural all the time. If you want to reach out and touch your spouse’s hand as they walk by you in a crowded room, out of reflex, you can. I have been with my wife for ten years. I have literally held her hand in public less than ten times. If I really sit here and think about that it brings tears to my eyes. Next time you hold someone you love in public think about the freedom that gives you the opportunity to do so and don’t take it for granted.