This week has a certain nostalgia for me. I am working the last four shifts in my home, Humboldt County. Nestled between pristine redwoods and dramatic cliffs overlooking the west coast of California, I want to stay here, but cannot. I am feeling the full force of the United States health care crisis. In the four years I have worked here eight of ten obstetricians in the southern half of the county have left, and now I find I am one of them.

Two obstetricians, far apart geographically and serving two different hospitals, are all that is left to serve an area once supporting 10 obstetricians. Both doctors are men over 60, who have a tough future ahead of them. Without outside help there is no way they can see all the patients that will need them. They have to remain within 30 minutes of the hospital and can be told to come to work any time of the day or night. They can never have a moment off, a full night’s sleep, a drink of alcohol to ring in the New Year. Watching a full length movie, or having a nice dinner with the spouse without interruption is a thing of the past. Neither of the remaining doctors can get sick or injured. This is really asking them to be super human and there is no cavalry on their horizon. In fact, if Catholic Health Systems is successful at closing one of the two hospitals, only one physician will remain.

As a young person, I wanted to take my medical skills to a disadvantaged third world nation. Looks like I got my wish-right here in the US. How did we get here?

Assumptions can be dangerous to people who are habitually marginalized.  One of the big assumptions that people make about the concept of “transgender” is that transgender is a subset of homosexual.  It is not.  I do not have data to turn to, but I have heard, as I shared in a diary last week, that about 1/4 of transgender people are gay or lesbian, 1/4 are heterosexual, 1/4 are bisexual and 1/4 are asexual.  

What exactly that says about the influence of the normalized control of gender and sexuality by our culture is something I’ll let other people discuss.

But the assumption has a large impact on the everyday lives of gender-variant people.  Even scientists studying sexually-transmitted diseases jump to the conclusion that transgender women are “men who have sex with men.”  And even direct evidence to the contrary often does not dissuade people from adopting the assumption.

Tonight I have two cases in point.

On the afternoon of September 9 Leticia Alvarado, cashier at a motel in the 13900 block of Francisquito Avenue in Baldwin Park CA, discovered the body of her friend Melony Smith in her motel room.  

Alvarado says that Smith had been staying in the motel on and off for three years.

We became very close.  She called me sister.  I was her sister.

Before I go to work, I always stop by her room and we have breakfast.  That day she wouldn’t answer her phone.

–Alvarado

So Alvarado went to the room and had the maid open the door and found Smith’s body lying on the floor.

She was all bruised up.  She had blood on her head.  She was lifeless.  I could tell she was dead.

–Alvarado

Recently I’ve managed to find some stories with better news among the usual fare of crap that many transpeople face.  

I knew it couldn’t keep going like that.

So tonight we have hard news out of California and Maryland.

The toll?  One dead, two injured, and a state’s transgender population worth of others left endangered.

On the bright side today is payday…and unlike many other transpeople, I actually have one.

[The conversations represented here took place over the last week and are compressed for your reading pleasure. My husband and I are real people and said the things represented here. The rest of the dialogue is provided by intentionally fictionalized characters that are not meant to represent any one person. All sentiments and facts expressed here are genuine to the best of my recollection, but the characters saying them were selected by drawing names from a hat. I, alone, am responsible for this content.]

The Quickening

“They canceled Andrianna’s tubals yesterday,” I inform Steve in the hall outside the conference room. “They didn’t even give her a whole day’s notice so she could talk to her patients before they did it.”

“I got virtually no notice either when they canceled mine on Monday,” he replies.

“Really?” I am shocked by this. I have never heard of a hospital canceling cases so abruptly without involving the surgeon. “Who ordered the cancellations like that?”

“Don’t know. We’re only told the surgery scheduler, but someone gave her the order.”

We enter the conference room to find Norm waiting for us. The other gynecologists filter into the room. Both the hospitals the Sisters of Orange own are represented: the hospital in my town, St. Joseph’s, and the one south of us, Redwood Memorial.

“We had hoped this would blow over but the sisters feel backed into a corner.” Norm starts. “They have no choice but to get tough on this issue.”

“What brought all this on?” Steve asks.

“The edict came down from the new Bishop in Santa Rosa,” Norm says, “but we got targeted when they pulled the diagnosis codes for the hospital. It was obvious we were doing more sterilizations than they were in Southern California.”

“In Southern California you can go down the street from any Catholic institution and run into a secular hospital.” I try to defend us. “The Catholic Church bought almost all the hospitals in this area. For the last six years they’ve been trying to drive the last secular hospital under.”

“Never the less, we were doing a lot of tubals for ‛psychological’ reasons.”

“We were hardly doing a lot of sterilizations,” I say. “Other hospitals preform far more tubals a year. The stigma the Church gives the procedure already curtails many woman from asking for sterilization.”

“So what’s the plan?” Steve says, rescuing the meeting from disintegrating into complaints about the Church.

“Nothing.” Norm states. “This is a game we can’t win. The more public pressure the Catholics face, the more they will dig in. We have to keep quiet and wait. That will take the pressure off the nuns. When you’re approached by the media, and you will be approached, my advise is to refer them to the CMO. That’s what he gets paid for. Don’t talk to the media, or write letters to the editor. Don’t talk to your patients about it. We need to keep the lid on this to stop it from blowing up.”

“Too late. The patients already know.” I inform him. We all know there was an article in the local alternative paper, The Journal. The “real” paper in town, the Times Standard, has been silent on the issue. “I spent half an hour at a Pap smear today with an irate woman who vented the whole time about how this was unreasonable and unfair.”

“I wouldn’t encourage her. And don’t talk to your staff about this either,” Norm says.

“How am I going to do that? I’m taking my patients to Mad River. They all know why I stopped operating at St. Jo’s.”

“What do you say to the patients?” Steve wants to know.

“The truth. I don’t think it’s fair to deny all the women in an entire county a procedure on religious grounds. And the patients agree with me. I have an eighty year old woman who lives as far south in the county as you can go. I told her why I was taking my patients north, but seeing where she lived and considering her age I told her I would make an exception for her and operate on her at St. Jo’s. She told me, ‛Don’t you dare. I don’t want to support that any more than you do.’ This octogenarian wants to drive past the two hospitals the Sisters own to have her surgery at Mad River Hospital.”

“This hospital is facing hard times right now.We’re barely holding on ourselves. We can’t afford to lose any patients. We don’t want to lose patients or doctors.” Norm seems genuinely alarmed.

“Great. Go back to the way it was, and I’ll bring my surgeries back to St. Jo’s.” I feel for Norm, but I will not be moved.

“Look, if they made us take all the hysterectomies to ethics committee, the way they threatened to, then I would do the same thing.” Wendy said. “But it’s just the tubals.”

“The only reason they didn’t is because they found out the insurance companies already reviewed all our hysterectomies and would not pay without an adequate medical diagnosis.” I tell her. “They weren’t being magnanimous. They just didn’t want to duplicate the work.”

“You can’t take your surgeries to Mad River.” Quinn, always the practical one, tells me. “I’ve looked at the labor numbers. St. Jo’s is hemorrhaging money in Obstetrics. The hospital will take the Laborist program away. The only reason you came here was for that program. You don’t want to see it die, do you?”

“I don’t.” Everything he says is true. Medicaid doesn’t even cover the cost of deliveries for most hospitals. The one wing devoted exclusively to women is a loss leader for most hospitals in the nation. Obstetricians get treated like the red-headed-step-children of the family of physicians because we don’t make the hospital any money. Having a Laborist program is a rare luxury. It meant I could sleep through the night for the first time in years, watch a whole movie in a theater, have a conversation with my husband–uninterrupted by the other woman…one with vaginal discharge. I do desperately want to keep that indulgence. “It’s not just about what I want. If they take the Laborist program, there’s little reason for me to be at St. Jo’s at all. I’ll not just take surgery to Mad River, I’ll take my labor patients as well.”

“If we don’t support the hospital it won’t be there to care for us.” Wendy says. “I for one want a hospital here when I retire.”

“Not taking care of the needs of half of the population is not caring for us.” I can feel my control slipping. “If they are unwilling to serve half the population’s health care needs, what are they doing in the business in the first place? They should sell the hospital-preferably back to the community to be run cooperatively.”

“This happens every seven years or so.” Elroy, the oldest member of our tribe, says. “The last time it was a new nun sent to take over the hospital. She had all the tubals canceled too.”

“How did that get resolved?” I ask.

“She died and it got forgotten.”

“So we’re waiting for the Bishop to die? Or just waiting for him to change his mind?” I say with more than a little heat. “The Bishop isn’t the only one with strong feelings on this.”

“The hospital can make it hard for you.” Adrianna has arrived late to the party due to her patients. “Remember Tony? He got in that spat with the hospital and started talking to people-even people in the Foundation. It got back to the Board of Trustees and they dragged him into Medical Executive Committee. Now he has that mark on his record forever.”

I know she is trying to warn me. I’m no stranger to this tactic. Though I have not seen it used at St Jo’s, I’ve seen it used elsewhere to strike fear into doctors. A hospital will use its power to remove incompetent doctors on a doctor who is medically competent but has a disagreement with the hospital. They sacrifice one physician, ending his or her career, to scare the other physicians into compliant silence. There are even courses for hospital administrators instructing them how to do this effectively. I’ve avoided such abuses of power so far, but I’ve seen it used time and again on colleagues.

“Look, it’s not just our patients. I was already scheduled to talk about this subject on a national level. I can’t act like it’s not happening to me on a personal level as well. You see, I’m an editor of this blog…”

The police arrest you for reading the Constitution in a public space during an Occupy demonstration. Later, you get a letter saying that reading the Constitution in a loud voice, in that place, at that time, broke a small statute of the law, and therefore you will be fined $1,500. If you disagree with this assessment, you can plead your case in a letter to the Chief of Police at the station where the arresting officer works. If they don’t hear from you in, oh, I don’t know, 20 days, then they will assume you agree with the fine.

Oh, and by the way, everything in their letter is top secret and you have to get the Chief of Police’s permission to share it with your lawyer, your husband or your…well let’s say readers.

What? You have a problem with that?

So do I…

What is Government?

Why do we submit to the law?

We can’t run very fast. We have no sharp teeth or claws. Long ago it became obvious that it was in humanity’s self interest to ban together for our mutual security. We each give up a small amount of personal freedom, for the greater good of the whole. That is the basis of the social contract.

As citizens, our responsibility is to uphold the laws of government. The government, in turn, also has obligations. The bare minimum of those obligations are to protect the majority of people from enemies both foreign and domestic. What enemies do we wish to protect ourselves from? At the very least hunger, disease, invasion by hostile forces (external security), and threats to our self-governance (internal security).

So how are we doing in that respect? Lousy.

We all but wiped out hunger in the US shortly after the Kennedy administration (ended 1963), but the government intentionally reintroduced it in the Reagan administration to drive down worker wages. What is left of our health care system is sowing the seeds of its own destruction. Foreign NGO’s have been invited by the Supreme Court to financially manipulate campaigns and thus our government. Internal threats to self-governance are too numerous to recount here, and in any case the Supreme Court has abandoned all pretense that this was a democracy and officially ruled the US a plutocracy.

We are in essence living in a failed state. Just because I am writing about the US, don’t think your country is doing any better. Most of the Western world is in the same boat.

Other articles have detailed the complex road we took to get here. That is not the purpose of this series. This series discusses how we get out.

Specifically, how to tell our government “No!”

Cross posted from The Stars Hollow Gazette

The two of the lady state attorney generals took the stage on the talk shows discussing their actions to protect their constituents from the thousands of illegal foreclosures that are crushing their states economies. Massachusetts AG Martha Coakley joined Dylan Ratigan for a lively chat about her lawsuit against five major banks and MERS. Later, AG Kamala Harris explained to Lawrence O’Donnell on “The Last Word” her reasons for breaking from the not-50 State Agreement being brokered by the Obama administration.

The ladies are really on a roll. Just this week it was announced that Ms. Harris has teamed up with Nevada’s State Attorney General, Catherine Cortez Masto, to look into a wide array of abuses, including mishandled documents, shoddy loan servicing, and the questionable ways in which mortgages were bundled and sold to investors. Like New York’s AG Eric Schneiderman and AG Beau Biden of Delaware, the ladies see strength in numbers.

This is the hard work protecting consumers that the Obama administration refuses to do.  

“Duck House”:

I sit on the floor of the Duck House with thirty others, brainstorming for the January action. Neither men nor women dominate the group. We are young, and surprisingly old. Counter-culture and conservatively clad. We question whether it is nobler to seek permits or just show up unannounced. We speak of banners, flyers and street theater-anything to educate the public about our goal.

Even when I still lived in Arizona, I had heard of this place. Democracy Unlimited Humboldt County (DUHC) or “Duck” was on the forefront of the war against corporate power. In 1998, they helped pass a ballot initiative establishing the Democracy and Corporations standing committee in Arcata’s city council here in California.

The Committee’s primary functions are: to research and present to the Council options for controlling the growth of “pattern restaurants” in the community; to cooperate with other communities working on socially responsible investing and procurement policies; to make recommendations to the Council, and/or with the Council’s approval, provide educational opportunities to promote “fair trade”; to inform citizens of corporations with negative social and environmental impact; and to provide advice on ways to foster sustained locally-owned businesses, publicly or locally owned services and worker-owned cooperatives and collectives.–City of Arcata

The committee was hailed by Howard Zinn, Noam Chomsky, and Jim Hightower. Ralph Nader commented, “I look forward to Arcata being a luminous star in the rising crescendo of democracy in our country.”

Embolden by this success, they passed Measure T in 2004. It forbid nonlocal corporations from contributing to local political campaigns. Two corporations immediately challenged the initiative as unconstitutional. Before the case could be decided by the courts, Humboldt’s Board of Supervisors succumbed to corporate pressure and declared this popularly elected law nullified.

DUHC learned from this experience. They won’t be going it alone, this time. They are but one small seed of democracy, but they are amassing with others to change the political landscape in America. They have joined Move to Amend in a miliary campaign, and this time their aim is not a city ordinance in some far off town on the edge of America, but changing the highest law in the land.

November 18th on the Quad at University of California, Davis:

A friend sent me the video. Perhaps because it was my alma mater. It opens on a damp, leaden day, so typical of Northern California in November. Yet, the weather has not deadened the mood of the students on the quad.

The police have come to evict their occupation. The students respond to the dismantling of their encampment by sitting in a wide circle around the officers. They sit with their heads bowed and their backs to the cops destroying their camp. Nothing more than that, just sitting with arms linked. The officers pass through the ring and the students make no effort to stop them. A crowd gathers to watch.

Some officers attempt to remove students from the ring and drag them away. The police seem compelled to force any behavior not scripted for us into submission with force. They never seem to ask themselves if the behavior is dangerous, or if it even matters to their mission. What would happen if the police simply ignored the ring of protestors sitting around them? But the people in the ring are saying “no” to authority with their bodies and that can not be allowed.

The commanding officer waves his men off the protesters. He crosses the ring to spray the entire line of students in the face with pepper spray. He does this with a casual air of a man spraying an insect. Batons are used to pry people apart. Police force the protesters to the ground and kneel on their backs to cuff them.

The hotel shuttle pulls up to San Francisco’s airport half an hour late. I push a dollar into the driver’s hand and grab my bag. Less than an hour remains to negotiate San Francisco’s ever present chaos to make my flight. I join the line snaking back and forth through an infinite channel of nylon belts and down the backs of airline ticket booths, tapping my finger impatiently on the handle of my bag. There are no other flights to Albuquerque until late tonight and that would mean missing work.

I make it past the first ID screening and still the line crisscrosses for a mile in front of me. Then, the Goddess of Travel intercedes. Right in front of me, a TSA officer unclips the nylon belt holding us at bay and announces they are opening a new screening area. I thank the Goddess, and follow the woman beckoning with her hand.

Like a pied piper she leads us past the rows of ticketing desks and into a lonely corridor. We walk forever and I wonder if I actually saved any time.

“Can we get to United’s gates from back here?” a man asks, mirroring my own growing unease as we travel well past the last ticketing booth.

“Yes, all gates from here,” our guide replies with confidence.

Finally, we round a bend in the deserted hall and stop. I suck my breath in and curse the Goddess of Travel.  That witch, she’s tricked me again. The Rape-U scans have finally come to San Francisco.