I opened the email and felt nauseated.
“I can no longer support your hospital,” it read. “Why are you carving up children?”
I took the question personally, even though the letter was addressed to anyone at the hospital where I worked. We were under attack because we offer transgender care to patients under 18 years old.
If you had told me six months before that this hospital ― one that’s saved thousands of children’s lives ― would receive death threats and bomb scares, I would have shaken my head in disbelief. Yet here we were. I tried to assume most people had good intentions ― that they genuinely wanted to protect children. I yearned to jump on my keyboard and fire back an answer. But I could not respond.
A friend once told me, “The further you are from an issue, the easier to stoke outrage.” I think about his comment now as we are faced with this massive, organized, misinformation campaign around transgender care at pediatric hospitals.
I couldn’t be closer to this issue. Aside from working at a hospital receiving these threats, my son is transgender. Though, at the beginning of our journey, neither of us knew that.
In 2014, I ran a business out of our home, which allowed me to be with my kids after school. M was 13 and began retreating into an oversized closet we had turned into a clubhouse -- curling up so tight all I could see was a dark curtain of hair and a pair of small black and silver sneakers. I chalked it up to adolescence. What kid doesn’t turn moody at the onset of puberty? Depression had touched me as a young teen. But M’s went deeper. My bright child pulled away from a close circle of friends and sunk into anger. The same child who, a year earlier announced, “I’m going to write a book about wolves!” now refused to go to school.
One day I saw dotted lines of blood crisscrossing M’s arms, and I realized M was self-harming. My child had fallen into a hole I couldn’t reach. Even M didn’t understand what was wrong.
When your child hurts that much, your priorities change radically.
Do well in school becomes please, wake up.
Becomes please don’t hurt yourself.
Turns to how can I save you?
Then, at 14, M announced he was a boy.
“What makes you think that?” I asked, remembering first grade and how M insisted on wearing only pink dresses. We washed them repeatedly, deep coral fading to blush.
“I just am,” he replied.
The more certain M was, the more confused I became. Where had this come from? I blamed the internet, YouTube, Instagram and my limited powers as a parent. I blamed the culture at large for making M believe something that couldn’t possibly be true. At camp that summer, a boy expressed interest in M. I smiled, thinking of my first crush and my first tentative kiss in the woods. Why would my child ruin that by announcing he was male?
That fall M begged for chest binders. He wrapped his chest so tightly he could hardly breathe. The cutting continued. Why would he harm what I considered his beautiful, God-given body? Because his body betrayed the core of who he was.
It took me so long to understand that.
Gender is central to our identity. When a child is born, we ask Boy or Girl? Imagine how devastating, then, to feel at conflict with the body you grew up in. Like any loving parent, I would try anything to lift the anguish that had taken M to the brink of suicide. Although I didn’t know it at the time, 82% of transgender people consider suicide. Over 40% attempt it.
That fall, I reached out to the gender care program at our children’s hospital. Their waiting list was long ― they only treat a few hundred patients a year because of their slow, deliberate process. They required six months of an outside therapist before seeing M. They laid out steps. Therapy. A psychiatrist. A social worker. Medical exams. Endocrinologists. Assessments.
I questioned every decision.
“But how do we know he’s a boy ― really?” I asked.
“That’s why we do careful evaluations.”
“How many change their mind in adulthood?”
“Less than 1%.”
“What about having children later — and can a 15-year-old even make that choice?”
“We work to give every person the option of children later.”
One night, as we sat on the sofa, M said softly, “Mom, I’m just a few chapters ahead of you.” Meanwhile, M was growing into the person I dreamed of when he was young: funny, creative, expressive. He was becoming — there’s only one way to say it — more himself.
Later that year I got a new job — coincidentally at the same hospital that was providing M care. I had never worked at a hospital, was never drawn to medicine, even on the administrative side. The opportunity had seemed like kismet at my stage of my life, when my business felt less secure and health insurance felt more urgent. I didn’t discuss M’s transition with co-workers, I simply referred to him as my son and shared the usual milestones over the years:
He got his first job!
He’s going to prom!
We’re looking at colleges over spring break!
Working at the hospital was a revelation, and confirmed for me that this was an extraordinary place. I had been a patient there when I was young. My oldest child had been treated for epilepsy in their neurology department. But I hadn’t understood the jaw-dropping breakthroughs that happened daily ― how the doctors and nurses, technicians, aids, researchers and every single person employed there ― had dedicated their lives to healing children. They worked relentlessly to add decades to a child’s life. They gave despairing families hope.
When he was nearly 17, M begged for top surgery. His social worker and psychiatrist advocated for him. He had been consistent in his identification as a boy for many years by then. His body had stopped growing. And he would be completely healed before he left for college. We found a plastic surgeon outside the hospital.
The surgeon performed his work like an artist. The process reminded me of my former business partner, who had her breasts removed after they found aggressive cancer. And it reminded me of myself: Doctors peeled open my back when I was 15 and inserted a “jack” to straighten my spine. Most of us wear scars of brokenness and healing.
Can you imagine if the government had told my friend or me that we could not get those treatments? Yet some politicians ― against medical evidence and very far from this issue ― claim parents are performing child abuse when they seek care for their child suffering with dysphoria.
The summer before M’s senior year of college ― and three years after his flawless surgery ― the world broke apart. The hospital’s Facebook posts were flooded with ugly, false accusations about the gender program. A post about a child with cancer was riddled with comments so vile that the hospital paused on posting anything. M’s doctor — not even part of his gender affirming care — received death threats and had to relocate to protect her own children.
I shook with rage, but I could not reply either personally or as an employee of the hospital. None of us could. Any response — however reasonable ― was tsunami’d with lies and vitriol.
People — and I genuinely believe, in my heart, that many were well-meaning —had taken the bait and swallowed the lies. They had turned into unquestioning megaphones.
The only way for the hospital to quiet the storm was to resist engagement. Meanwhile, trolls located the addresses of caregivers. Threats continued to flood into inboxes. When bomb scares occurred, all treatments ― including cardiac surgeries, blood transfusions, physical therapy and chemotherapy ― had to be halted. I couldn’t square those ideas in my mind: that someone who claimed they wanted to protect kids could justify killing or harming caregivers or interrupting treatments for sick children.
I used to believe my reasonableness was a strength. I strived to consider the other person’s point of view. Now, I don’t know. When do I give someone the benefit of the doubt, and what do I do with my anger?
Our family gathered for Thanksgiving last year. M stood in the bright doorway and laughed with his uncle. All of us ― M’s stepfather and older siblings, even his grandparents ― only want him to thrive. I told our social worker how surprised I was by my conservative parents’ complete acceptance of M. She smiled. “Grandparents are often the most understanding,” she said. “They know how important happiness is.”
I pulled M in close. He has always been a good hugger and that has not changed. He held me tightly and said, “Love you, Mom.”
M is now in his final year of college. He has more tattoos than any reasonable person should have (at least according to me, his mother). He stays up all hours and sleeps ridiculously late on weekends. In other words, he’s a healthy, 21-year-old guy.
Why would anyone deny him life-saving treatment?
I imagine reaching out to every person who questions the hospital’s mission of healing. I want to tell them ― parent to parent ― my son’s story and my journey: doubt leading to understanding, acceptance turning to gratitude, despair becoming joy.
I still want to believe in the power of stories and what they can do ― how they can change minds. I still want to respond to that email that asked, “Why are you carving up children?” It was a question phrased in a way that does not want an answer. And, yet, here is what I would say: They aren’t carving up children. They are rescuing them from self-harm and suicide. They are being thorough, careful healers. And, while I appreciate your good intentions, please, don’t tell them how to care for my child or how I should be a parent to this human being you’ve never met.
My son is thriving and happy. He is alive.
Toni Fastner is the pseudonym of a writer who works at a pediatric hospital in the U.S.
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