In special education we work off of a principle called Least Restrictive Environment where we look at what type of environment a student with a disability is best served in. There is a continuum of options starting with keeping them in their regular classes and extending all the way to attending a special school. In a perfect world, we want all students spending as much time in their regular classroom as possible. Any time we remove a student from their regular class, we consider it to be moving them to a more restrictive environment, even if it is just for 30 minutes.
Here is the catch: not all students can function in a regular class, and by putting them there, we are limiting their ability to learn and make progress. So for a student who needs a much higher level of academic or behavioral support, an environment on the continuum that we consider to be more restrictive is actually their least restrictive environment. Though we want all students to be in regular education classes, that isn’t what is actually best for all students, and forcing that principle on everyone does some students more harm than good.
A similar, yet differently applied principle exists in the medical field: do no harm. In this, the least invasive protocol is followed to bring maximum benefit. Only after less invasive or protocols are found to be ineffective do medical practitioners allow for more intense options to occur. It is a pretty solid premise-but I have to wonder this: how do we assess harm, and does harm look the same for all?
I had a phone consult with a physician this week about my request for a hysterectomy. Part of our conversation included them saying that the practice of do no harm means we should be trying other alternatives before moving to surgery, and that because this person assumed it has been a while since I had tried other medicinal solutions, there was still more work to do before I could have a surgery, especially since my complaints of bleeding and PMS could be eliminated by medication. This sounds totally reasonable, however I am not someone who takes medications unless absolutely necessary, and as someone who is in good health, that is rare. Im sort of a hippie- I love essential oils and natural remedies. I am more than open to trying anything that isn’t chemical or pharmaceutical based. I have tried multiple things to manage my menstrual symptoms, and even though I am in a pretty good place with what I am doing now, I still get a period. I don’t want a period, period. I don’t feel like my body should be bleeding every month- and the clear solution, to me, is to remove the parts of my body that allow it to bleed.
Given my lifestyle choices, it is significantly less invasive for me to have a surgery and deal with a year figuring out how my body reacts without a uterus than to take medication regularly for the next 20-30 years until I hit menopause, in which I will have to take a sleuth of other medications to manage that. The thought of taking medication daily, weekly, monthly, and putting chemicals into my body without a clear idea of how they will react in my body (I have some idea because I’ve been on birth control before; it wasn’t fun) sounds FUCKING MISERABLE. And yet, that is the only solution being offered to me. It is a one size fits all prescriptive plan to health care and I’m not okay with that. Medication is not my least restrictive form of health care.
At what point do I get to say I am done experimenting with drugs and exercise my bodily autonomy to make health care choices that I want?! In the health care system, bodily autonomy only extends as far as other people deem to be acceptable and permissive. In a lot of ways it is a good system, but IT DOESN’T WORK FOR ME. My students and their families get to have discussion with a team of providers both inside and outside of school who work with them to decide where the student is best serviced and what least restrictive looks like. We look at data and other factors to determine best course of action for out students. All I get out here in the real world is some doctor, ONE doctor, who gets to make decisions based on a pattern of practice within a one size fits all model.
Its hard being a transgender or nonbinary person having to navigate a world that wasn’t made to accommodate us. It is hard having opinions and desires that go against the grain of what is considered normal or reasonable. The more I seek medical treatment, the more I feel like what I want is wrong or that I am wrong for wanting it. I am not uneducated, I am not naive; I am me, and I have a much deeper understanding of what I want and need than anyone else ever could.
Part of me wants to throw a big fuck you to the medical community, and to the people who I have in my life who don’t seek to understand or accept why I want to make the changes to my body that I am seeking. I am not sure how far anger will get me, especially if it is turned in a direction that pushes people away instead of pushing me forward in proactive action. I am not sure what my next move is, but I know I am much too fired up to be able to make decisions not based on feelings. I am tired of jumping through Kaiser’s hoops for nothing but frustration. I am tired of not being heard or understood. I am tired of being judged. I am tired.
I am tired.