After ~2.5 years of residency, 1.5 years of building a LGBTQIA+ curriculum, 4 months of advocacy seminars, and a whole lot of barriers, we have finally gotten the okay to start initiating hormone therapy for the purpose of gender affirming care.

This patient is one of two who I had already started the evaluation and informed consent process. We had actually already decided on a plan to start estrogen, but this week the administration approved our official informed consent form so she came in, signed it with my colleague, and got to start estrogen tonight!!

Anyway, I've continued to not only survive residency but also grow as a person and physician. Over the past two years, I have found my niche in family medicine moreso than just my OMT and behavioral health focus (which are both still going strong by the way). I have become one of the only providers of gender affirming care in my area and a fierce advocate for the LGBTQIA+ community.

Because of this, I have started to further my learning through a year-long LGBTQIA+ health fellowship seminar series. This program has requested I post a reflection on a blog after each seminar, and since I already have a blog, I figured why not post here and spread the knowledge to the medblr community.

I have always been most fulfilled by making changes at the interpersonal level. Individual changes are probably the easiest to complete but don't have that same sense of fulfillment and organizational/systemic changes are often a bit too daunting and I become easily overwhelmed with so many changes needed.

I have already made some significant interpersonal interventions since co-creating a LGBTQIA+ family medicine curriculum. The one intervention that really left an impact was just openly discussing the community and their needs with a co-resident who was very hesitant about caring for this community and listening to the bad experiences she had had with a member of the community in the past. She felt heard and was then open to taking in more information and learned that several of her colleagues also belong to the community. I watched her become more engaged through further lectures and start to relate the SGM health issues to issues she has faced as a racial minority. She then graduated and went on to provide care for minorities of all types in Missouri, somewhere that desperately needs open minded people like the amazing doctor that I watched her become.

Shit's starting to get/feel real.

Be stuck in an 18-hour digital replantation case without breaks.

Perform a thousand epidurals on squirming parturients with BMIs greater than 50.

Rub Vaseline on a haggard witch’s crusty bunions.

Spend eternity locked in a windowless cell while forced to watch Cardi B and Kim Kardashian talking American politics. 

Pick dingleberries off of a woolly mammoth in heat.

Listen to a marathon “Florence Foster Jenkins Sings Mozart” concert while locked in a non-air-conditioned car in 110-degree weather.

Be lectured by Macklemore on precisely how un-woke I am. 

Eat a thousand live fire ants.

Share a tiny bunk with a registered sex offender in Guantanamo.