I'll stand with you: Equal access to health care for LGBTQ parents

Last month, the Spanish government announced that restrictions barring lesbians, singles and couples in which one member is transgender from fertility treatments under public health insurance programs have been rescinded. Although for most people even in Spain that news may herald only a minor change, I know from experience that for those it does affect personally, it is life changing and fraught with powerful emotions. 

A Spanish gentleman posted an article about the announcement to an American progressive group I frequent. Instead of the passing support I would expect from progressives, the post was attacked by some members of the progressive group, ostensibly because some people objected to fertility treatments in general. They made no overt mention of the LGBTQ rights aspect of the new law, but simply opposed it because it constituted an expansion of medical fertility treatments, which they see as unethical.

I was confused at first. I can understand that some extreme religious types might object to treatments like IVF as "playing god" or something of the like. But I couldn't fathom what progressives would find wrong with it. 

Creative Commons image by  Niklas Montelius

Creative Commons image by Niklas Montelius

Adoption, apparently.

The naysayers were convinced that those who can't otherwise have children are selfish to pursue IVF. They should adopt "the numerous children waiting in orphanages."

The terms of shame employed against transgender people and lesbians who pursue fertility treatments were "selfish," "unethical" and even "stupid." These "progressives" hadn't voiced a problem with fertility treatments for straight people, married couples or for the wealthy who can afford them without insurance. But they felt some people should "just adopt."

The tirade of shame for people struggling with infertility brought it all back.

I woke up disoriented and pinned on my back in a dark room. Tubes and wires were attached to me from either side. I couldn't sit up or even roll over, so I couldn't see anything except distant lights and the lumps of people lying on beds on either side of me. The sound of a steady electronic beeping was interspersed with shrieking laughter.

Vomit rose in my throat and I fought it back. It would be terrible to throw up while immobilized on my back. Slowly I pieced together what had happened. After my first harrowing IVF treatment was successful, I was pregnant for nine weeks. Then a routine check-up resulted in a frantic dash for the hospital. Something was wrong and I was told that I would have a miscarriage, one that would be dangerous and bloody if I didn't go in for surgery. I had gone, filled with grief and despair. 

And I woke up here in the dark and with no way to escape either the physical pain or the gaping loss.

I had been promised that it would be quick and I could go home with my husband afterward. But instead I was in pinned down, it appeared to be night and my husband was gone.

The pain came to me slowly. Dull pain in my womb and sharp pain in my throat. Finally, the shrieking laughter materialized into a gaggle of night nurses, barely old enough to be out of high school, from what I could tell, let alone nursing school. They told me I was in the ICU. Something had gone wrong.

Well, more wrong than it already had been. So I was stuck there, and no, they wouldn't give me anything for the pain.

I survived that night, the longest and worst hours of my life so far (let it stay that way, please). And it was only the beginning of the years of misery and despair in which I fought the monster of infertility because my body and soul needed a child, needed more than just me and my husband and my distant childhood family as "family." 

All in all, I spent six years in infertility, three of them in various stages of IVF. They were some of the loneliest and most painful years of my life. I was geographically cut off from my family and most of my close friends. When I did visit family and friends and made any mention of the all-consuming medical struggle my husband and I were undergoing, I was often met with silence and quick changes of topic. While I could think of nothing else, most people, unsurprisingly, had a lot of other things on their minds.

Never having thought much about it before it happened to me, I was surprised to learn that the topic of infertility makes most people very uncomfortable. It is a medical issue and the subject of genitalia seems too close for easy conversation. Infertility is a misfortune and it may make those who didn't struggle with it feel inexplicably guilty.

But more than any of that, I discovered, many people who have never been faced with the problem themselves feel that those who can't easily have children should do their part to mitigate the human population surplus by gracefully accepting their fate. Someone has to make the sacrifice after all and it's easier to contemplate if that someone is someone else.

To make it even lonelier, IVF is not as simple and painless as it is often described in the media. It is a long and arduous process involving hormone therapies that cause exhaustion and often debilitating mood swings, self-inflicted injections, followed by surgery, extremely precise schedules and many trips to distant medical clinics.

Even when it is "covered" by insurance in countries with universal health care the co-pays are steep and where it isn't covered by insurance tales of mortgages and eventually lost homes are frighteningly normal. Finally, IVF and other fertility treatments often entail enduring exaggerated symptoms of early pregnancy and then miscarriage... repeatedly. 

And that says nothing about the wrenching emotional and psychological process of desperate hope, almost always followed by at least a few devastating losses. 

In some places there are support groups for those undergoing these difficult experiences, but in our area there wasn't anything like that. That made the discomfort of my friends and family around the topic hard to bear, even though I knew that my focus on IVF verged on obsession. I tried not to go on about it, but I couldn't help thinking about it every waking moment.

Even among those who were also struggling with infertility I found a lot of silence and reticence to share. I knew three other couples dealing with infertility at the same time. But two of them found the topic too painful and private and wouldn't either talk about it themselves or listen to my struggles. The one couple I could talk to lived several hours away and we saw them rarely but gladly. 

Their conversation and mutually supportive hugs were a light in a long and painful darkness. The one topic that these friends wouldn't discuss was the diagnosis of their infertility. It's a sensitive subject for many, so my husband and I didn't press them. But one day over lunch at our house, my friend--who had been my colleague as well for five years--turned to me and revealed the truth. One half of the couple was transgender, making normal procreation impossible. 

My friends struggled under the same conditions of IVF that my husband and I did, the same forced silence, the same pain and fear and loss. And to add to that they faced the warranted anxiety that this hidden fact might bring down harsh judgment on them, even from those people who shared their struggle.

I will admit that I was astounded by the revelation. Transgender identity was another thing I had never spent much time thinking about or had any close experience with. My friends were so utterly normal that they broke all the stereotypes I had acquired from the media with that simple declaration. And once all secrets were on the table, our friendship was closer than ever.

My husband and I eventually lost that struggle to have a biological child, though our friends succeeded. We went on to adopt children from a local orphanage. The people engaged in shaming others for struggling against infertility might well have been gratified by us.

But they clearly don't know the reality of adoption in today's world. "The numerous children" waiting to be adopted in the United States where those voices hailed from are either not legally cleared for adoption or they are overwhelmingly older or carry with them costly medical issues. 

I would love for all children without families to be adopted but only into families prepared for them. Older children in the adoption system invariably have complex psychological and emotional needs. People battling their own medical problems and deep losses of dead babies are not the ideal candidates to provide the unconditional nurturing and rock-solid safe homes that those children need and deserve. Such families are also often not equipped to deal with children with extensive medical needs.

Pursuing fertility treatments instead of adoption is neither selfish nor unethical in any other way. In fact, if you do adopt, as my husband and I did, there will be those who will point accusing fingers at you and scream those same words of shame because you adopted.

Just as my husband and I tried to do the right thing in seeking medical help for our difficulties, we made every effort to navigate the adoption system ethically. We went through official channels and waited patiently to be assigned a child in need. We did not pay massive amounts of money to be able to make the choices ourselves. This is no doubt what the shamers and blamers think they would support. 

In the end, we adopted two children--one with complex disabilities and one who came to us after being drugged and neglected in a poorly run orphanage for ten months, who screamed in terror almost without ceasing for the first year. It has been and continues to be a rugged road to family. And yet, there are those who would shame us still. 

Our children needed homes and families primarily because of structural racism and discrimination in the country where we live. Neither of them were true orphans with dead parents. Almost none in the adoption system are.

They came from families facing a vicious system of employment, educational and housing discrimination, who then could not care for their child because of desperate circumstances. Those families sent their children into the adoption system in the hope that their loss and agony might result in their children having a better future. And so, finally we built our family on the ashes left by structural racism and egregious social injustice. Such is our supposedly morally superior path. 

But the fact was that these children were alone and abused in a terrible situation. Not taking them would not have resulted in the salvation of their birth families or communities. And after picking up the shards of our lives shattered by infertility, we felt we had the strength to do this. 

Those who never faced such choices, such pain or deep despair, will judge. But our friends who went through IVF with us, just invite us to stay and our kids build forts together in the construction materials for their new house.

Oddly enough, another friend, this time a single lesbian woman also went through IVF though not at the same time as us. And of the many friends who have appeared and drifted away, these two families are two that stayed in our circle without judgment and linked to us by bonds of solidarity and hope.

That is why I didn't let the issue lie when the tirade broke out shaming transgender people and lesbians in distant Spain. Some people did ask me why I went to the mat over that obscure issue so fiercely. I am not transgender or lesbian and I adopted children. The comments were theoretically praising me. 

But there is one point of honor and ethics that I hold higher than any other. I will always stand up for those who stood by me in hard times. If there is ever need, LGBTQ people will not stand alone, not in this or in any other defense of equal rights.

Clash: Conversation between the wealthy and the poor at the dawn of a new class war

I love cultural experiences and I've joined a lot of different groups in order to understand different perspectives.

Recently I had a conversation with a group of wealthy intellectuals who I had come to know and enjoy, though their culture is quite different from mine. Yet in this case the clash of cultures and understanding proved too great for much accord and the divide worries me. 

Creative Commons image by Hamza Butt (

Creative Commons image by Hamza Butt (

I will not use names or other identifiers here because the point is not to call anyone out but rather to show a crucial gap of understanding that is developing in our society, due to different groups living inside social bubbles of their own race and class. Because in this particular conversation there was little or no variation between members of the group, I will use an agglomeration of real statements to both shorten and clarify the discussion.

As such, this is a recreation of a lengthy discussion I had with a group that is essentially a foreign culture to me. We are all either Americans or Western Europeans. We are all intellectuals and significantly educated. Most of the group previously had expressed support for the US Democratic Party and/or liberal-leaning views. So we share a great deal, yet I was an exception in the group because I am not of the same economic class. 

I will call one side in this discussion Wealthy Liberal Intellectual (WLI) and the other side Scraping-by Progressive Intellectual (SPI) to illustrate where the divide is, although I was the only person in the latter group at this time. 

Here is how the discussion went:

WLI: Trump's attack on health care is unfortunate. We should be compassionate on health care. However, I doubt the media reports about people in the US being denied essential health care before the ACA are entirely true.  I have certainly never encountered a real person who was denied essential health care in the United States.

SPI: You may not have previously encountered a person who was denied essential health care, but now you have.. I can give you several specific examples in as much detail as you would like. About ten years ago, for instance, I was injured in a fall in the US. My shoulder was partially dislocated, two ribs were broken and one punctured my lung and the lung collapsed 10 percent. I was driven to an emergency room and eventually had an X-ray that showed these issues. I was given a sling and proscribed pain killers. This cost was $3,000. I couldn't pay all of it right away and some was paid for by an emergency fund. However, I was not kept in the hospital for observation. My shoulder was also not repaired but left to heal badly and crooked in a way that causes permanent deformity, pain and weakness in that shoulder. When I later sought advice for the pain from doctors in Europe, I was told that A. the shoulder needed to be operated on immediately to prevent long-term harm and B. the lung issue was life threatening at the time and I was lucky to have survived without adequate medical care. Those interventions would have been extremely expensive and they were beyond what I could pay at the time. I was told that my lung was in a dangerous condition and that I should probably stay in a hospital overnight, however, it would take months to find out if an emergency fund would cover it and I would have to risk putting my family in serious debt to stay. I was not informed at all about the need for an operation to my shoulder. I can give other examples from just my own life and that of my nearest family and friends. This is the reality of the majority of people in the United States before the ACA.

WLI: I'm sorry that you feel life has served you so poorly. You were given health care. You probably shouldn't be complaining about it. And as you can see there was an emergency fund. that you benefited from.

SPI: I didn't say life had served me poorly and I am not complaining. I'm merely presenting the facts of a case. According to medical doctors in Europe this did not constitute "essential emergency medical care." It resulted in long-term harm and deformity. My shoulder is still not the right shape and it never will be because the surgery cannot be done once the injury has healed poorly. There was a very small and inadequate emergency fund. These are simply facts. I have been very fortunate that I did not have much worse complications. In fact, I was fortunate to live and not lose the rest of my sight due to that particular accident. I am also fortunate to have access to European health care, something most Americans don't have. Far from saying life served me poorly, I'm saying I am one of the lucky ones who survived this disastrous system. These problems affected at least half the US population and still affect some. It is immeasurably worse for families with serious and chronic illnesses, such as cancer. 

WLI: This is, if anything, an isolated case. I wonder what you're trying to prove and why it is so important to you to go on about this.

SPI: I read your statement saying that you had not encountered a real person in this kind of situation. I wanted to give you this information and experience outside of your previous experience, because it is the experience of a great many people in the United States.

WLI: Many people still come to the US for health care from countries that have universal health care. Many of our members live in countries, like the UK or Canada, with universal health care. There are major problems there and the United States is still the world leader in medical technology. We would not be able to provide this technology if it didn't offer significant profits. 

SPI: I have experience in a country with universal health care as well, in the Czech Republic, which is not even a particularly wealthy country. I'll admit that health buildings here are often a bit spartan and hospital rooms can be small or if they are large they are shared by multiple patients. But the quality of actual care both in terms of human care and technology is sate of the art. Last winter I had high-risk eye operation to save my residual sight. There have only been about 500 similar operations in the whole world and it is one which requires very specialized technology and a precisely skilled surgeon. 

WLI: You should respect the experience of those who know more than one system. I have heard of there being long wait times for critical procedures in some countries with universal health care. I wouldn't want to give up the benefits of the American system.

SPI: You dismiss any facts I present. When you won't look at specific cases, it is no wonder you haven't noticed any person who was denied health care in the US. Ignoring the facts and continuing to promote this system, when you have said you are for human rights... It's disgusting. It is a life and death issue for a great many people. I have experience with more than one system, in the US, in the Czech Republic and in Germany, even in Zimbabwe and Ecuador. Why is my experience invalid compared with the experience of others? And can you give any specific examples of problems in countries with universal health care? I have never encountered long wait times in countries with universal health care, except for transplants which always entail a wait. 

WLI: You need to apologize. You just won't listen and you want everyone to feel sorry for you. I don't see why we can't all contribute to society, why you seem to think some people should get everything for free. 

SPI: I think it is important to gain experience from beyond your own circle of friends and your own bubble of experience. This is why I'm presenting these facts. I can give details and other cases if that would help. 

WLI: You just honestly don't get it, do you? The group feels you need a time out. 

SPI: I have been considering leaving this group. I have noticed in the past that this group is very dismissive when I post about climate change, even though you claim to be concerned about these types of issues. However, I enjoy other parts of this group and I like to know people from beyond my usual circle as well.

WLI: I have no doubt that our children will have it easier than we do, just as we have it easier than our grandparents did. That really isn't an issue worth worrying about.

SPI: Climate change is already having a devastating impact. You are intelligent and you have seen the data. You know that we have incurred ecological debts that someone will have to pay in the end. 

WLI: There will be other resources in the future. Once it was coal and iron. Now it is oil. In the future it will be wind and solar. Each generation uses different resources, so each generation will be better off than the one before. There is no ecological debt.

SPI: I am not sure the endless resources theory will work in practice, but even if it did, this is more about human-induced climate change, which is already impacting a great many people and making life, let alone business, much harder. It is growing year by year. Do you still say that the next generation will have it easier?

WLI: My son and daughter are successful in business and my granddaughter is looking into modeling. Sure, I think they will have wonderful lives. You think you are the only one who has had a difficult life and had to struggle to get somewhere. That isn't the case. It's just that you talk so much about how rough you've had it. 

SPI: It takes my breath away and makes me sick to my stomach to read this. I don't think I've had it bad. I am much more concerned about the next generation.

WLI: I've had enough of your insults. You're blocked. Have a good life.