One and Only

Chapter 2 - The Time Vacuum

Despite our water-based adventures that morning, I still had plenty of time to get ready for work and to eat a small breakfast and prepare my lunch before my clinic started at 8 am. My clinic schedule for the day was jam-packed with an eclectic mix of patients:

8:00 and 8:20 - 6 month old twin girl well child checks one after the other at the start of the day

8:40 -  46 year old female with diabetes 

9:00 - 72 year old female with hypertension, depression, diabetes and follow up osteoporosis

9:20 - 26 year old male for follow up HIV PrEP

9:40 - 24 year old new patient to establish for transgender hormone therapy

10:20 - 32 year old male with depression/anxiety

10:40  - 16 year old male for a sports physical

11:00  - 36 year old female with an acute respiratory tract infection

11:20 - 22 year old transmale for follow up hormone therapy 

11:40  - 32 year old female with UTI symptoms 

The afternoon was equally packed, and equally varied, with a few more anxiety/depression patients thrown in for good measure. When I had joined my residency program 2.5 years ago, I had made sure that serving the LGBT community would be apart of my training, since I knew that this was a community that I wanted to serve when I "grew up." But I really never expected to be able to see such a wide variety of LGBT patients in Salt Lake City, owing in large part to my own preconceived notion of what "type" of people lived in Salt Lake. I was thrilled to be wrong. 

I particularly enjoyed working with my transgender patients, who had backgrounds as diverse as the medical ailments present on my schedule this morning: some came from families who were incredibly supportive, others who had been disowned by their "birth families" but adopted by their chosen families. Some who had known that they were trans since they were three years old and others, who had figured it out much later in life, sometimes in their teens or twenties, some even as late as their 50s. Ethnically, my trans patients were maybe less diverse, but I still had patients from Polynesia/Hawaiian Islands, Latinx, and a very small handful of African-Americans.

The other thing about caring for the LGBT population was that it was a small break from the mental hardship that goes along with serving the economically disadvantaged, namely my refugee and Medicaid patients. It's not that I did not enjoy serving this population – on the contrary, I often looked forward to seeing these patients, helping in whatever way I could – it's just, it takes its toll on you, as a provider, to know that what ails your patients isn't really diabetes, or depression or heart disease but larger more endemic problems like poverty and loneliness, and to know that small adjustments to their diabetes medications or to their anti-depressants, are not likely to make those bigger issues go away.

In fact, with my trans patients, it was just the opposite: you got to be ring-side as they discovered the fullness and beauty of who they really are, and to see them come out of their shell and explore their world authentically, unapologetically and with such indominable fierceness! It truly was the greatest gift that they gave to me, to let me be a part of their journey.

The other part of my LGBT patient population was divided 80/20 with mostly young gay men on HIV PrEP and older lesbians who were primarily professionals. I enjoyed these interactions too, since for the most part they were healthy, and doing well, so we could sometimes spend our visits chatting about this or that, without having to rush from one disaster to another.

Today, as I looked at my schedule, I knew that my 9:00 patient would pretty much derail the whole day. She always had a lot going on, and boy was she a talker. I was glad that there was an "easy" PrEP patient after her, followed by a new trans patient, as this meant that there was a chance that I could make up some lost time that would inevitably occur during her visit.