pronoun espionage

why i sometimes let people (especially bosses and doctors) misgender me so I can gain valuable intel

I moved across the country this year, after living in Seattle for 7 years, which is the longest I lived anywhere as an adult. As such, I’ve been slowly rebuilding my life, including such important things as “making new friends” and “finding new bagel places to be a regular at” and “going to a bunch of new doctors.” All of these are a bit of a pain, obviously. I’m the kind of nebulously disabled/chronically ill where I don’t have a neat and tidy single diagnosis that explains all the stuff that tends to happen to my body, and I’ve stopped trying really hard to change that, but I do need between 3 and 5 doctors to kind of maintain my shit.

Moving for my new job also meant changing insurance (after being on the same insurance for a very long time), and getting used to new medical institutions.

My old Seattle healthcare system has me marked down in the following ways:

Preferred name: Kirby

Sex assigned at birth: Not entered

Gender identity: Gender Queer

Sexual orientation: Not entered

I’m pretty okay with that. It doesn’t have anywhere I can put in my own pronouns, but I get the impression that on the providers’ ends it has a spot for pronouns. In Seattle, I had a number of different Health Events and generally had to go to a lot of doctors more frequently than most nondisabled people. Providers would ask me my pronouns pretty frequently, usually while doing intake/triage type things, and always seemed to imply via gesture and body positioning that it was one of the questions they were filling out on a standard form. It absolutely wasn’t perfect — I’ll share below some of my experiences where I got misgendered a lot in Seattle healthcare settings, and how that aligned with the quality of care I received — but there are also some slight contrasts with Philly that I want to highlight.

I’m in a healthcare network in Philly that uses the same software for patient online care portals — it’s the eCare thing. I know it’s the same portal because 1) the UI is completely identical, and 2) I’ve been able to cross-reference my care portals from Seattle to Philly such that my providers here can see my whole medical record there. I really like that, actually, it allows for a continuity of care that my ADHD ass absolutely wouldn’t be able to access if it were up to me to fill out a form and ask half a dozen Seattle doctors to fax shit to half a dozen Philly doctors. I note that it’s the same software because my patient info in the Philly system is this:

Legal sex: Female

Sex assigned at birth: Unknown

Gender identity: Nonbinary

Sexual orientation: Bisexual

Note two things about the differences: first, there’s no spot for preferred name. Annoying, but I have “Parents guessed my name right on the first try” privilege, so I don’t have to try and fight for a name change at least. Second, notice that there’s “legal sex” and “sex assigned at birth.” One of those I was allowed to input (the blank one) and one of those was input by someone else — I genuinely don’t know who, or based on what information — and I’m not allowed to change it. (Similarities between Seattle and Philly: no space for me to put my own pronouns, UI makes it weird and hard for me to actually change any of this info on my own.)

Now, in Philly so far I’ve only been here for a year, and have had blessedly only one ER visit and no emergency surgeries yet, so I have considerably less data from Philly than from Seattle on just face to face social practices; my impression thusfar, though, is that I don’t get asked my pronouns in as many of the intake formalities, and fewer providers have asked to double-check my preferred name or anything like that.

So, on to the actual pronouns thing. This may surprise you, but I actually basically never correct strangers about my pronouns. This is quite a personal choice, not one I’d deign to make (or even give advice) for any other trans or nonbinary or questioning person. But here are my reasons for that:

• I’m a linguist. Sorry, yeah, it’s always going to be the first thing on lists of why I do whatever I do. I’m a walking sociolinguistics experiment, and I find it very interesting to see what people do when left to their own devices. I just like kind of mentally keeping track for… personal research reasons, essentially.
• Whether someone proactively asks about my pronouns gives me information about the training they’ve received regarding trans healthcare.
• Whether someone asks my pronouns tells me a bit about how they’re interpreting me, just as much information as them taking a guess without asking. Sometimes asking is a bad thing, by the way — if someone pointedly asks me and no one else, that tells me something about how they’ve internalized ideas about transness (or whether they are parsing me as trans)
• If someone asks my pronouns and then repeatedly gets it wrong, that gives me information about some of their unconscious biases that they might not be aware of
• If someone gets corrected (storytime on this below) and keeps messing up, that tells me a lot about how seriously this person takes things like my autonomy or my input on the care they’re giving me.

Being a chronically ill patient with no particular diagnosis (other than “fat and joints hurt”) puts me in an interesting position with regards to how providers treat me in general; I interface with them often, often have to advocate for myself in certain ways, and have to combat my internal warring urges to either minimize my pain or make myself even more vulnerable (and possibly get accused of malingering). Every time I interface with a healthcare provider, it’s layered on top of the many times before when I’ve been in a shitty little gown, sleep-deprived, dehydrated, in pain, and trying like hell to convince this person that I am a reliable source of information on my own experience. I can never not bring that perspective into the room with me. Being trans compounds it in an interesting way, especially because of how big healthcare institutions have to sort of filter me through the shape of a database before they can figure out what to do.

One thing that means, for example, is the intake questions I get asked. I am always asked when my last menstrual cycle was. I have to try and explain, every single time, that I don’t menstruate. A couple months back, I got the same medical assistant for two appointments in a row, and on the second time I had the same answer, and asked her if there was any way to skip that question in future appointments. She showed me (not up-close, I think that’s against the rules) the options on the form — it’s an unskippable question, she can’t proceed to the next part of intake without clicking something. There’s no “other” option. The options for explaining non-menstruation include stuff like post-menopause, hysterectomy, prevented by hormonal birth control. None of those are exactly accurate, so we debated this for a couple minutes and decided that the last option was the closest to the truth.

What does this have to do with pronouns, Kirby? Well, pronouns are a good indicator to me of how someone’s categorized me, and how their categories work in general. If someone asks all patients their pronouns, and asks mine, and never messes up after asking the first time, that tells me that they have at least some level of mental system where gender and sex aren’t rigid binaries. It might be an indication that they’re less likely to deny me care because they don’t understand how trans health works. It might be an indication that they’ll take my autonomy and self-reported experiences seriously, and work together with me in managing my care in a collaborative and respectful way. I have been lucky in both Philly and Seattle to have had PCPs who fit into this, and I’ve been very glad to work with them.

If someone asks me my pronouns but repeatedly messes up, that tells me that they might have some idea that there’s something “up” with me, gender-wise, but they unconsciously are thinking of me as some underlying inherent category that they can’t really rearrange at will. Those are the people who I worry about doing things like basing their advice on memorized binary sex-based risk factors, instead of really thinking about underlying systems. I also tend to assume that those are the people who, if I ask them a question like “will this med interact with my HRT?” will have no idea, nor will they put any particular effort into trying to find out. They’re also people who I assume I have to try harder to communicate things like pain or stress in a way that’s more easily legible to allistic people.

If someone doesn’t ask my pronouns, just kind of guesses a binary one and rolls with it, they are (in my experience) very likely to have many of the same problems as the group above, but also on top of that be generally surprised that my trans body might have any trans-specific health needs at all. Those are the people who I am braced waiting for them to suddenly start asking questions about transness unrelated to my care, or telling me extensively about how they just don’t understand their trans nephew (while misgendering him). I am often braced, with these people, to have to put on my hat as an educator while I’m half-clothed and in pain, because if I am surly or unresponsive that’s going to go into their little personal leger of “a trans person was rude to me once.” Ditto for people who keep misgendering me after having been corrected — by someone besides me, mind you, because I don’t bother anymore.

So, story time, on that last point. In 2020 I had gallstones. It took me nine months of uncomfortable symptoms that disrupted my life and work to finally get a diagnosis. The diagnosis involved a middle-of-the-night ER trip (that I had to be really talked into). It was that ER trip that taught me the extent to which I apparently minimize my pain; that’s a whole other story. Anyways, due to absolute nonsense paperwork shenanigans, it took me almost a month (during which I was too sick to work — which was incredibly disruptive, as I was teaching a 210-person lecture at the time) to finally get scheduled for surgery to get the whole stupid organ out.

Being as this was 2020, I had to get a covid test before I was allowed to get surgery; I had to bus downtown in the Seattle rain to get it outside, because tests were still very hard to come by. The testing location was supposed to send the results to the hospital in advance of my surgery, which was scheduled at like 6am. I showed up to the hospital and got all checked in (at 6am, after not having been allowed to eat or drink water since the night before). Then I waited for hours — apparently the issue was that the testing center didn’t send the covid test results to the hospital in time, and by the time they came through hours later, the surgeons were already booked and couldn’t operate. As a result, I was checked in, in pain, starving and dehydrated, in the hospital for about nine hours before they sent me home and told me to try again the next day. All of this is just to give you the context that I was having a shitty fucking day, and was hanging out and not allowed to leave or even get dressed or walk around for hours.

During this time, because I was there for so long, I got to know a bunch of the nurses on the surgery wing. One of them, a head nurse, was a little older (but not significantly) and she’d me all day. Others — including several residents, a couple of other nurses, and the surgeons, they’d me perfectly consistently. It was especially uncomfortable when the one nurse was sheing me and another was more and more pointedly theying me in the course of a conversation. This went on for hours, from 6am well past noon. The nurse who was sheing me was also the one I had to ask, like, can I have juice? No, okay, can I have water? Can I have my phone? Can I have IV fluids? Can I have a blanket? Can my partner come hang out with me for a bit? Can I go walk around? Can I be unhooked from the IV to go to the bathroom? Being completely dependent on this person for the absolute smallest of creature comforts meant I absolutely did not want to piss her off or appear difficult.

What finally happened was that, during a shift change, one of the residents had to kind of… re-intake me, because I’d been there waiting for so long. The resident was wearing a pronoun pin himself, and made a point of asking my pronouns while the original nurse was still in the room as well. The nurse didn’t say anything in that moment, but came back alone about five minutes later to do… the whole song and dance.

The whole song and dance is this: singular they is really hard for me, I just really can’t wrap my head around it, I don’t really know what it is — it’s a plural pronoun, I can’t refer to a single person that way, it just doesn’t make sense. To me, in 8/10 pain, in my sixth hour of waiting for surgery that I was supposed to have gotten three weeks ago. While I was physically unable to get away. I did what I often do in this situation: I went into teacher mode. I can’t help it. I tried to talk to her about language change, and how lots of people are in her position. I told her if she wanted to practice, there are ways to rewire your brain a bit to make it easier. I told her (and I regret this) that I knew she didn’t mean any harm by it, and it wasn’t a big deal, it’s just a natural variation in peoples’ mental grammar. It didn’t feel like I was having a cool LingComm teaching moment, it felt like I was showing my belly to try and stop someone with significant immediate power over me from seeing me as a problem.

I hope she hasn’t done this to another patient after me, though I feel that it’s extremely likely. I don’t know how to explain how it feels to be misgendered when you are physically, literally trapped and dependent on the person doing it. It feels mainly dangerous: it feels like a good indication that this person I depend on does not fundamentally understand me and is not particularly interested in trying. It feels like they don’t really see me as a full person, with thoughts and feelings. That’s a very scary feeling when that’s the person who gets to decide if I’m allowed to have water.

Would it have helped if I had corrected her the first time? Probably not. What if I had corrected her every single time she did it? I mean, very likely what would have happened is she would have found that annoying, and come by to check on me less, and I would be trapped in that little cubby alone with nothing, in pain, and would have fewer opportunities to ask for my phone. Or if I was really annoying, she could have simply told me I wasn’t allowed to have a phone or book. Or IV fluids. Correcting her likely would’ve accomplished very little except to make my own day even worse than it already was.

So. This is very personal, obviously, but: I choose not to correct people in part because the very act of correction can be dangerous in some situations, and because letting people tell me their unconscious biases and priorities is a helpful strategy sometimes.

I don’t like that this is the way our society is organized. I hope that when we achieve basic human decency like universal healthcare, that will free up some of the need for healthcare providers to exert control over patients. But this is how I’m choosing to navigate this shitty system as we have it now, and, like, I dunno, at least I get some data out of it. If nothing else, it is soothing to me to pretend that I can approach this as a scientist.

This was long and pretty personal, so thank you for reading! If you want to read shorter or more abstract pieces I’ve written about pronouns, may I recommend:

• pronouns aren’t gender; please get better at looking at birds, about how to rewire your brain a little and hopefully get some better linguistic awareness (or bird awareness)
• put a coin in the pronoun jar, about what it feels like to notice every single time anyone uses a pronoun
• how do i make people stop misgendering me? — does what it says on the tin

This work is supported by my ko-fi tips. You can also follow me on twitter. This work is licensed under CC BY-SA 4.0.