The University of Iowa

'Transitioning,' both as a doctor and a human being

May 2nd, 2013

Guest Opinion by Nicole Nisly for The Iowa City Press-Citizen

Nicole Nisly

Nicole Nisly

I met my patient whom I will call “Luna” about three years ago. She identified as a transwoman and had transitioned about 10 years earlier — after living most of her adult life identifying as a man, having been married and raising now adult sons and daughters.

I feel it necessary to describe my initial sense of discomfort.

Having practiced medicine for more than 30 years, I have met patients from a multitude of backgrounds and nationalities. I enjoy a collaborative practice with my patients, and I love to incorporate their philosophical and cultural beliefs into their health care.

Yet, I felt uncomfortable caring for her.

I felt unprepared to provide her with the care she needed. I had to weigh my words carefully, so as to not offend her by using the wrong pronoun or by addressing her by the wrong name. I could sense that my own uneasiness had affected the quality of our patient-physician relationship and I worried that she was not receiving the best possible care.

One evening in November 2011, I attended a seminar organized by Transcollaborations, an Iowa City group led by young people who primarily identify as gender non-conforming. They shared with the audience the challenges faced when interacting with the health care community. They specifically described their sense of apprehension, of feeling unwelcome, and of knowing that the provider there to care for them was ill prepared.

I couldn’t help but think that my patient Luna felt the same way. I sat there listening and pondering my own sense of unrest and lack of adequate training.

That is when Dr. Katie Imborek and I decided to develop a Tuesday night clinic at the UI Health Care, Iowa River Landing facility in Coralville where we would be well prepared. Our mission was to create a welcoming space for all lesbian, gay, bisexual, transgender, queer and questioning folks — but especially gender non-conforming folks — where there was a sense of ease among patients, health care students and practitioners.

Here is where I “transitioned,” both as a health care provider and a person.

I immersed myself in books and encounters with folks identifying as “trans.” I heard their stories and for the first time began to see from their perspective. I began to understand their painful struggles as well as their courage, joy and fulfillment to realize a gender expression that was in congruence with their gender identity — an identity that may defy the norm in a binary society, but an identity that is as true, strong and as real as mine as a cisgender woman.

Transitioning is a journey that takes time. My personal “transition” began as I got to know members of the trans-community as colleagues and friends, and in turn I learned their language, aspirations and culture. There was so much I learned from their generous and patient teaching.

“They” became “us,” all of us — the rich community we have here in Iowa City.

Soon, it was again time to see Luna for a scheduled exam. I think that was the very first time I really saw her.

I finally saw her as she saw herself, as a woman. I no longer had to toggle back and forth in my mind between the man identity I had seen and the woman identity she carried. I saw her as the true woman she was.

I no longer worried about using the wrong pronoun. She was true, vibrant and real, as I finally transitioned, to a physician able to see her as she really was.

This and other fascinating topics will be discussed during the next live broadcast of WorldCanvass, “Remaking the Body: Identity and Body Modification.” Join us at 5 p.m. Friday in the Senate Chamber of the Old Capitol Museum.

Nicole Nisly is a professor of internal medicine at the University of Iowa Carver College of Medicine.