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This article is the opinion and experience solely of the author and does not reflect the position of her unit, the United States Army, or the Department of Defense.

I'm transgender. Chances are, you're not. I'm a lesbian. Chances are, you're not. I'm also in the Army. Chances are, you're not. The thing is, none of that matters.

The bottom line up front, or BLUF, as we say in the Army, is this: We are all more the same than we are different. We all have challenges and defining moments. We all go through transitions. It's what we do with those experiences that matters.

Think back to the last time you experienced something difficult or something that just made you pause ever so slightly. It doesn't have to be a big dramatic event, just something that you noticed. What did you do with that experience? Really think about it. Did you learn from it? Did you grow? Did it change how you think about the world or how you interact with people? Did it change you?

It took a massive event in my life for me to change — my coming out as transgender. I'm going to share some of my story with you in hopes that it will stir something in you. Perhaps it will remind you of yourself: maybe your best self, or your worst. Maybe it will remind you of a patient. Or a friend.

My story is one of a big, public shift that resulted in me changing my life, but I strongly believe that the only thing required for us to meaningfully change is to pay attention. We don't have to have some dramatic life event; we just have to choose to be attuned to someone else's world.

Being a technically competent therapist is the easy part of our job. It's the emotional labor of truly knowing and caring for our patients that pushes our care from average to excellent. I think you already know this. I hope my story reminds you how much it matters.

I came out to the world as transgender for the first time in May 2017. Some people knew before then, but for me that was the first time it was public. As a kid I knew I was supposed to be a girl, but I had no language for that. It was just a feeling, a knowing in my gut. I couldn't find the words until my ex-wife encouraged me to go to therapy to sort through it.

That was in 2010, though, so when I figured it out, there was nothing to be done. I was in the Army, and at the time I could have been discharged for coming out.

Then, in 2016, just before I graduated from the U.S. Army-Baylor DPT program, the Department of Defense's policy changed to allow open service by transgender people. This was significant to me, because for the first time I would be able to serve in my chosen profession as who I actually am.

When I arrived at my first clinic, I came out to my boss (who was incredibly supportive) and began the administrative, medical, and legal process of transition.

Transition is difficult for a lot of people because of the systemic discrimination in and barriers to medical care, housing, social support, and employment. I mentioned before that my qualifications and experiences in the Army have granted me significant privilege in the system, and here is where it mattered: I was able to proceed through transition relatively quickly and easily. I had fewer hurdles to jump, and they were lower. It was more difficult for people to tell me no, or even for them to simply be rude or make things difficult for me.

For me, the difficulty in transition has been the internal reckoning. The increasing awareness of how big the gap is between the person I am becoming and the person I used to be. More important, transition was a trigger that has enabled me to be more attuned to the experience and context of those around me.

Most often, my awareness happened in little ways. For example, the first time after transition that I felt cold.

All my life, I have been hot far more often than I have been cold. After transition I realized that I instead was frequently cold: in public spaces, in my home, in other people's homes. I hadn't changed the temperature of my thermostat, and it was unreasonable to assume that everyone else had. The only logical explanation was that starting hormone replacement therapy (I began taking estrogen, as well as a medication to block testosterone production) had caused me to experience temperature differently.

Accompanying that realization was the deeply uncomfortable and embarrassing fact that in years past I had been wildly insensitive and dismissive to many women in my life when I had written off their opinion or feeling that "it's too cold in here" as inaccurate or unimportant.

As I continued to have many more big and small epiphanies, I went back and apologized to the people I dismissed or ignored or even shamed. And I have chosen to be better: I have stopped acting that way and instead tried to channel these experiences into advocating for other marginalized groups — most often women and the LGBTQ+ community, but also (important in my context) young soldiers who may not be able to advocate effectively for themselves.  

When I hear conversations about the experiences of marginalized communities, I am quite clear and vocal about agreeing with those communities, to say, "No, you should believe them, they're telling the truth."

Because of course they are. They've always been telling the truth. What I didn't realize prior to my transition was that I had been so attuned to my own experience or context (as a presumably heterosexual, cisgender male) that I just assumed it was "normal," and universal. I recognize this is cringe-y: it makes me sound arrogant, self-absorbed, and inconsiderate. As I look back, I am certain that I was arrogant, self-absorbed, and inconsiderate. As impossible as it seems, I somehow didn't realize that 50% of my peers experienced the world in ways that were radically different from the ways I did, even though I'm quite sure many of them told me so repeatedly.

I just wasn't listening.

So, I changed. I started listening. And, when you start listening, the world changes.

When people feel heard, they will talk. They'll tell you things that they've needed to say out loud but haven't dared. They'll ask for help. They'll tell you the things that matter most, the things they're most proud of, most ashamed of, most afraid of. As I listened, I realized there was a whole world I had previously missed. Everyone else had a "normal," too, and those normals weren't the same as mine. Here are just a few of the things I've heard, and observations I've had, once I really started listening:

"You're the first medical provider in my career who has believed me." (You mean to say that people haven't believed you all this time? What if my doctors hadn't believed that I am a woman?)

"No, it's not really better, but I feel better – I just needed someone to listen." (Me too – sometimes I just need to be able to say it.)

"I haven't been able to have sex with my spouse for a year, and I haven't felt safe telling anyone until you asked." (Whoa. That's a lot.)

"My sibling is transgender – how can I help them?" (This has nothing to do with why you're here! But somehow you feel safe enough to ask this. Let's talk.)

"No, you're right – I'm not the same guy I used to be. Nothing in my life has felt the same since that concussion on my last deployment. Can you help me?" (Oh, no. I mean, I suspected it. But I was really hoping I was wrong. I hope we can help you.)

I've found sexual harassment and assault to be so common that it is unusual when my female patients don't have that in their history.

I have yet to meet a woman in the Army who, when I ask, doesn't have a list of stories about how she has been treated unfairly because of her gender.

I have been surprised to find how many of my male patients are afraid to talk about what's really happening with them physically, medically, or emotionally. Yet when given the opportunity to do so, they are deeply grateful for the opportunity to safely talk.

These experiences have changed how I practice. Being open and authentic with my patients, being present and truly listening, has increased my awareness and my empathy.

When I showed up in the far north of Afghanistan to treat some patients, the first thing I asked the folks there was, "When do you want me to be available to treat you?" I could have showed up and announced what my clinic hours would be. But I knew there was a high likelihood they were on a reverse sleep schedule, working at night.

They were shocked that I was willing to shift my sleep schedule to accommodate them, and it meant the world to them. It meant that they actually showed up to get care.

I had a patient arrive one day and tell me during the subjective exam, "I haven't slept more than two hours a night for the last two days and I'm exhausted." After treating his back pain I offered to turn the lights off and let him sleep in the exam room on the treatment table because my next patient had cancelled. He was asleep before I got out the door.

Another time, at the end of her appointment, a patient said to me, "I don't want to take up your time, but you're an older woman I trust — can I talk to you about something? I've heard bad things about the place I'm going next and I'm worried about getting raped." I told her she could have as much of my time as she wanted. There was nothing more important than being there for her in that moment.

So, here's the thing: Remember when I said that my being a gay, transgender woman doesn't matter? That this applies to everyone? My being transgender doesn't have a thing to do with my technical skill as a physical therapist. But becoming a better human being has everything to do with being a better provider: how I responded to that experience, my choice to reflect and change and become attuned to other people's worlds.

You don't have to be transgender, or gay, or have had cancer, or have lost a child, or any number of other difficult things to become a better human being. You just have to make the choice.

Come back to that experience I asked you about at the beginning. That thing that caused a brief flicker of something in you. Did it change you?

If it didn't, don't beat yourself up. Just get to work. When the next moment comes, pay attention. If you do, it just might change your world. If we all do, we can change the world.  

Alivia Kate Stehlik, PT, DPT is a board certified orthopaedic clinical specialist. She is an active duty Army Major currently serving as the physical therapist for the 3rd Security Force Assistance Brigade at Fort Hood, Tex. You can reach her at aliviakate16@gmail.com.

(Interested in empowering the LGBTQIA+ community in physical therapy? Members of the APTA Health Policy and Administration Section can participate in PT Proud, an advocacy group supporting equity, education, and community for LGBTQIA+ patients and practitioners. The PT Proud website is open to all.)


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