Rae Nudson | The Atavist Magazine |December 2023 | 1,950 words (7 minutes)

This is an excerpt from issue no. 146, “Damages.”

1.

Debra* had hoped that her medical nightmares were over. In 2009, she was diagnosed with breast cancer that had spread to her lymph nodes. The disease was estrogen positive, which meant that it was feeding on her reproductive hormones. After six months of chemotherapy and a double mastectomy, the cancer was declared in remission. To keep it that way, doctors put Debra on tamoxifen, a hormonal drug used as a prophylactic against certain types of breast cancer. She expected to be on it for about five years.

Debra has a wide smile, dimples, and thin, arched eyebrows. She likes high heels and she likes to talk. She used to work as a hairstylist, a job well suited to someone who falls easily into conversation with strangers. She is also a mom to two boys, and always wanted more kids. Patients on tamoxifen are advised against becoming pregnant; Debra, who was in her early forties when she started taking the drug, planned to conceive once she’d completed treatment.

Then, about halfway through her tamoxifen regimen, Debra got a letter in the mail with bad news: The results of her latest pap smear were abnormal. She had undergone the procedure, which involves scraping cells from the cervix, during a routine visit to a Veterans Affairs medical center near her home in Portsmouth, Virginia. (Debra was in the Air Force from 1988 to 1992.) An abnormal pap can indicate the presence of cancerous or precancerous cells; follow-up testing is usually recommended.

Debra knew that even with the tamoxifen, there was a risk that her cancer might come back, possibly in a part of her body other than her breasts; oncologists call this a distant recurrence. So she took the pap results seriously. When the VA referred her to two ob-gyns, Debra reached out to both. One had a monthslong waiting list, but the other had immediate availability. His name was Javaid Perwaiz. 

Dr. Perwaiz’s main practice was in a small redbrick building near a strip mall in the city of Chesapeake. The parking lot had 14 spaces, including one for handicapped drivers, and cars came and went in quick succession. Perwaiz had a reputation for working fast: An established patient could expect to arrive for an appointment and be back in their car in under 15 minutes. The waiting room was small, with a vaulted ceiling, a bank of windows, and walls painted a soothing mauve. Many of Perwaiz’s patients were Black women on Medicaid. Debra fit that profile.

When she met Perwaiz in July 2012, Debra felt confident about him as a doctor. He was in his early sixties and short, with a thick, well-groomed white mustache, bushy eyebrows, and a comb-over. During appointments he wore a white coat. He was matter-of-fact but not cold. He remembered details about his patients’ personal lives and asked about their loved ones.

According to Debra, after performing some tests, Perwaiz told her that she had precancerous cells on her cervix that would likely develop into cancer. He said that there was no drug she could take to stop that from happening. Given her history of breast cancer, he recommended a hysterectomy.

Debra was shocked and scared. She didn’t want to lose her ability to have more children. But she also wanted to live to see her sons grow up. After subsequent appointments with Perwaiz, during which she underwent additional tests, she agreed to have surgery, but said that she didn’t want her abdomen cut open. The doctor who performed the C-section during the birth of her first son had used a “beautiful subcutaneous suture” to close up the incision, resulting in a faint scar. “You couldn’t even tell that I’d ever had a surgery,” Debra told me. She wanted to keep her stomach the way it was. According to Debra, Perwaiz assured her that he could perform the surgery through her vagina; no abdominal incision would be required.

Debra trusted what Perwaiz told her. From their conversations, her understanding was that he would remove only her ovaries, because decreasing the estrogen in her body might diminish the risk of her cancer recurring. In fact, a hysterectomy by medical definition involves the removal of the uterus. But Debra didn’t know this going into surgery, because, she said, Perwaiz never explained it to her.  

On the morning of December 29, Debra arrived at Chesapeake Regional Medical Center and filled out the required paperwork for her procedure. One of the nurses was someone she knew from church, a friendly face. Then Debra was prepped for the operating room and given the sedative propofol. Hospital staff were wheeling her on a gurney down a hallway when she saw Perwaiz.

“What time do I need to tell my friend to come back and pick me up?” Debra asked him.

“That’s not the surgery you signed for,” she remembered Perwaiz replying.

She wasn’t sure what that meant. The propofol was making her sleepy. Then everything went dark.

When Debra woke up in a recovery room, she knew something was wrong. Groggily, she moved her hands to her stomach. She found tape covering an incision. Debra didn’t understand. She began to cry.

She was discharged the next day, and only then did it fully sink in: Perwaiz had performed an invasive surgery, slicing into her abdomen. Within a few days, Debra felt persistent, agonizing pains in her lower belly. The area also became swollen and tender. Debra was alone most of the time—her elder son had already moved out, and the younger one was in school during the day. She had trouble getting out of bed.

Debra called Perwaiz’s office for a prescription to help with the pain. When the medicine didn’t work, she called again. According to Debra, she spoke with Perwaiz directly. “Women all over the world go through this,” he told her. “You are just going to have to get used to the pain.” She was so out of it that she let the comment go. “I didn’t have the wherewithal to chew his head off,” she told me.  

One day a friend called to check on her and was alarmed to hear Debra cursing and not making sense. The friend drove to Debra’s house, and when nobody came to the door, she persuaded the landlord to open it. Inside, Debra was lying down; her skin was turning blue, and her stomach was so distended that she looked nine months pregnant. Her friend called 911, and an ambulance rushed Debra back to Chesapeake Regional.

Debra wondered if she was dying. In her head, she could hear a hymn her grandmother used to sing: 

I know it was the blood,
I know it was the blood,
I know it was the blood for me;
One day when I was lost
He died upon the cross,
I know it was the blood for me.

At the hospital, Debra learned that Perwaiz had removed more than her ovaries: Her uterus, cervix, and fallopian tubes were gone too. A diagnostic scan showed that a large amount of fluid had built up in her abdomen, and labs indicated that she had severe acute renal failure. There was also a perforation in her bladder—one of six, she later learned, made during her surgery. She was in sepsis.

Debra remained in the hospital for several days. She slipped in and out of consciousness. At one point she thought she saw Perwaiz at the foot of her bed. He looked nervous to her; his hands were clasped. “He might have been praying, ‘Please live,’ ” Debra said.

She did live. She had to wear a catheter for several weeks, but she got better. The long recovery gave Debra time to think on what she wanted to do about the man who had hurt her. “I’m gonna get this motherfucker—that’s how I was feeling in my head,” she said. “You don’t want to mess with me. I got teeth. I spit sulfuric acid.”

She requested her medical records and was stunned to find discrepancies with what Perwaiz had said to her during appointments. Most glaringly, she didn’t see any mention of precancerous cells on her cervix; the tests Perwaiz performed on her had come back normal. “If I was normal,” Debra said, “why did I have a surgery?”

There were other inconsistencies. One form from an appointment described Debra complaining of back and pelvic pain, which she told me she never did. Another document dated the day before her surgery stated that she “insisted on having those ovaries removed through the abdominal wall incision and not vaginally,” and that the “consent obtained after entirely counseling the patient [was] for abdominal hysterectomy.” In fact, she had requested the opposite surgical approach, and she recalled no such conversation with Perwaiz; the only time she’d spoken with him in the lead-up to her procedure was in passing in the hospital hallway.

Debra was sure she had a malpractice case. She went to several lawyers, but none of them would take her on as a client. “So many men—man after man saying, ‘You had a decent amount of care, and that’s all you’re afforded,’ ” she said. Frustrated, she came up with a new plan: “I said, ‘Alright, I’m going to learn how to sue this bastard myself.’ ” (Perwaiz declined to comment for this story.)

Debra enrolled in a paralegal program at Tidewater Community College. She learned how to research case law, how to write briefs, and how to file a suit. She didn’t have an Internet connection at home, so she used a law library at a nearby university to access everything she needed. She meticulously highlighted key phrases in her medical records and made notes in graceful cursive. When requesting materials for her case from health care providers, she signed emails “respectfully,” but she was not sorry to bother anyone. She followed up. She was tenacious. To get anything done, she knew that she had to rely on herself. “I was now acutely aware that people can’t be trusted,” she said.

As it is in much of the U.S., the statute of limitations for malpractice in the state of Virginia is two years from the date of occurrence. Debra filed her suit on December 23, 2014, six days shy of the cutoff. She asked for $1.5 million in punitive damages and to be compensated for loss of enjoyment of life, loss of the ability to reproduce, and diminished sexual intimacy, as well as lost wages and medical expenses.

Someone told her to file the suit in state court, but Debra declined. She knew about the history of coerced sterilization in America, of doctors persuading women of color to undergo unnecessary hysterectomies or performing the surgeries against their will. She couldn’t help but see her case in that context. She believed that the suit belonged in federal court because Perwaiz had violated her most fundamental rights.

A judge disagreed. In January 2015, Debra was asked to provide a valid reason why hers should be a federal case, and not one decided by a lower court. She responded with documentation explaining her position, but that May her case was dismissed for lack of jurisdiction. She appealed the decision, until one day she missed a filing deadline. According to Debra, she hadn’t received paperwork she needed to complete until the day before it was due, and there was no way she could get it to the court on time.

Just like that, her legal campaign to hold Perwaiz accountable was finished. But there were more patients like Debra, more women Perwaiz had injured. There were numerous dots waiting to be connected—someone just had to come along and do it.

In October 2017, Smith became one of three founders of Church Ekklasia Sozo in Charlotte. Its name roughly translates to the assembly of the healed. The church’s founding documents outline a mission “to teach and preach the gospel to all people, conduct evangelistic activities, license and ordain ministers of the gospel, provide religious, charitable and humanitarian services, provide programs and assistance in fighting opioid addictions.”

Smith said he formed the business as a church because it was the easiest way to grow across state lines. “You’re just exempt from a whole lot of stuff,” he said.

By the following summer, Smith’s partners were gone. He now controlled the company, which offered Suboxone prescriptions written by a cadre of licensed doctors, nurse practitioners and psychiatrists the business enlisted as contract workers. 

Smith chose Dr. Henry Emery of North Carolina to serve as medical director. He and Smith had something in common: Months earlier, one of Emery’s patients had died from a cocktail of drugs he prescribed, according to records from the North Carolina Medical Board. The year before going to work for Smith, Emery gave Medicare patients more oxycodone than 98 percent of prescribers in the nation, Medicare data shows.

Almost from the start of Emery’s partnership with Smith, he wrote more prescriptions for buprenorphine than the DEA allowed, federal investigators’ records show.

I don’t mean to discount the delight and power of a transcendent hallucination. Many people who’ve tripped on psychedelics describe the experience as among the most meaningful of their life. And in several studies of psilocybin for depression, the intensity of the trip correlates with the magnitude of the therapeutic effect. A trip is an extraordinary, consciousness-expanding experience that can offer the tripper new insight into her life and emotions. It also feels pretty damn good. But it’s far from the only effect the drugs have on the human brain.

But we are far from freely administering psychedelic medication—getting the appropriate dose to the right patient will require a tremendous amount of fine-tuning. But for people to someday be able to use these drugs for therapy, without the hallucinatory side effects? What a trip.

While some entries can be bleak—particularly for harder drugs like meth or heroin—the vast majority are written in a companionable, curious voice that will be familiar to anyone with an older sibling or cousin who likes to test the limits of consciousness from their own backyard. The testimonials include highly specific descriptions not just of the chosen amount and imbibing method, but also the subtle shadings of each experience; sometimes with humor, but always with rigor, vibrancy, and clarity, often down to the passing minutes. These are good faith arbiters, truly interested in exploring the variance of human perception and making sure others can do so safely. There are none of Hunter S. Thompson’s “fools or frauds” here, though any one writer tends to give the distinct impression of being a bit of a weirdo.

Around midnight on Jan. 31, 2021, Dass’s water broke. Bieniasz rushed them to Verde Valley Medical Center, and the baby was born 11 hours later, weighing almost seven pounds. She had her mother’s light brown skin, her father’s slightly drooping eyes and nearly perfect scores on her Apgar tests, a standard assessment of newborn health. Dass couldn’t stop staring at her daughter. “She was a part of me, like if someone took my heart and it was now separated from me and I could see it over there,” Dass told me.

Dass was still cradling her newborn an hour later when a nurse announced the baby might be transferred to another hospital if she showed signs of withdrawal. Dass was stunned. Her daughter, according to medical records, lacked any withdrawal symptoms. Both of them had been drug-tested, and the only substance in their urine was Suboxone. She was planning to breastfeed and begged the nurse not to take the baby: “She needs to be with her mother.” Dass was so upset that she barely registered what else the nurse said: They would be contacting the Department of Child Safety, Arizona’s child-welfare agency. Verde Valley, like many hospitals throughout the country, was required to report newborns exposed to substances in utero, including prescribed medications such as Suboxone.

A child-welfare report can result in little more than an assessment of a family’s circumstances and referrals to services. But other times, a report can lead to an extensive investigation. No agency tracks how many new mothers have been investigated for taking legally prescribed medications, but after sending 100 public-records requests to every state and the District of Columbia, I found thousands like Dass who have been referred to child-welfare authorities, their lives suddenly under scrutiny, their newborns sometimes placed into foster care for weeks, months or indefinitely.

Jeremy had started following AFLD online after listening to podcasts that promoted conspiracies about COVID-19. At the time, the group was producing slick videos on social media, falsely claiming that U.S. health agencies were withholding life-saving treatments, and that doctors refusing to prescribe them were like “good Germans who allow the Nazis to kill the Jews.” Jeremy, who worked as an industrial sandblaster, became convinced that hydroxychloroquine and ivermectin were the only effective treatments for the virus.

On Aug. 26, 2021, Jeremy paid $90 for a consultation through AFLD’s online telemedicine portal. He was connected to a doctor named Medina Culver, 33, an osteopathic physician and Instagram influencer based in Henderson, Nev. Culver did not see or examine Jeremy. Over the phone, she prescribed him hydroxychloroquine for COVID-19 treatment or prevention, according to a receipt reviewed by TIME. Soon after, Jeremy received a prescription for 200mg of hydroxychloroquine in the mail from Ravkoo, a Florida-based pharmacy chain partnered with AFLD. According to his widow’s lawsuit, he took those hydroxychloroquine pills the night he died.

Jeremy’s family is suing both AFLD and Culver in Nevada district court for in excess of $30,000 in damages. The lawsuit, which was filed in February on behalf of his estate and cites TIME’s 2021 investigation, alleges that his death was linked to the falsehoods spread by AFLD as well as the doctor who prescribed it. “They didn’t even examine him. They gave him something that he used as they prescribed, and it killed him,” Jelena Parker-Hatfield says. “How can they not be held accountable for something? How in America can this be a system that works, that everybody is okay with?”

I gave my all to sustaining my donor hearts despite daunting odds, and the hearts rewarded me with extraordinary years. I have been so lucky.

But now I lower my chin and whisper the words malignant … metastatic … lungs … terminal. It is the end of the road for my heart and me — not because we didn’t achieve and maintain sparkling cardiac health. But because the sorry state of transplant medicine took us down.

Organ transplantation is mired in stagnant science and antiquated, imprecise medicine that fails patients and organ donors. And I understand the irony of an incredibly successful and fortunate two-time heart transplant recipient making this case, but my longevity also provides me with a unique vantage point. Standing on the edge of death now, I feel compelled to use my experience in the transplant trenches to illuminate and challenge the status quo.

Over the last almost four decades a toxic triad of immunosuppressive medicines — calcineurin inhibitors, antimetabolites, steroids — has remained essentially the same with limited exceptions. These transplant drugs (which must be taken once or twice daily for life, since rejection is an ongoing risk and the immune system will always regard a donor organ as a foreign invader) cause secondary diseases and dangerous conditions, including diabetes, uncontrollable high blood pressure, kidney damage and failure, serious infections and cancers. The negative impact on recipients is not offset by effectiveness: the current transplant medicine regimen does not work well over time to protect donor organs from immune attack and destruction.

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Once upon a time, I wanted to be a doctor. Never mind my terrible grades in all things science. Never mind that I decided this in my second year of college, after deciding that the music school that I’d wanted for years wasn’t for me. It was 2006. It was the age of Dr. Gregory House. 

I love a good medical drama. My mother, a nurse, raised me on ER and General Hospital, always pointing out all the plot lines that “would never happen in real life” but were really cool to watch on TV. My mother credits ER with pushing her toward her decades-long career in the operating room. So when I, a poor lost college sophomore who had gone to school to play French horn (French horn!) and found it wasn’t what I thought it would be, I did what I knew best to do and turned to TV. And on TV, I found House. 

House had it all: a painkiller-addicted doctor with a smart mouth and a slap-worthy face, medical mysteries solved via CSI-style case-of-the-week format, and a beleaguered crew of sidekick physicians whose instincts were never quite as good as House’s. I would spend each episode studying the setup and trying to unravel what the medical culprit could be before the ultimate reveal. Instead of realizing that what I might want to be was a writer with a good plot, I missed the mark and decided I wanted to be a doctor. 

Reader, I did not become a doctor. (That fizzled out after one year of biology classes and a stint working in a local nursing home.) But I remain a lifelong medical mystery buff. Here, then, are a few of my recent long-form favorites — enjoy the game of whatdunnit. 

Swamp Boy (Kris Newby, Now This News, October 2022)

One day, a 14-year-old boy with no previous physical or mental issues informs his parents that he is the “evil, damned son of the devil” and he needs to kill himself before he destroys them all. Thus begins the onset of a massive medical manhunt to uncover exactly what is causing the boy’s psychosis and physical symptoms, which include OCD, shortness of breath, chronic pain, frequent urination, intense headaches, the belief that he had green vines growing under his skin, the belief that he was a bird, and the belief that the family cat was ordering him to kill everyone around him — including the family fish. 

Complete with vivid graphic-novel-styled art illustrating some of the reported hallucinations, this piece has it all, including a father’s fight against the medical establishment and an ending you’ll never see coming. In other words, it’s about as close as one can get to a real-life episode of House. 

Meanwhile, back at home, now more than seven months after his son’s first psychotic breakdown, Scott could finally clear his mind, and began to focus his analytical skills on Michael’s case.

To the medical experts, his son had been a ten-inch-tall stack of paper annotated with clinical notes. Each expert had examined one piece of Michael—his brain, his stomach, his heart, his immune system, his gut, his spine, his skin, his eyes. Scott, meanwhile, was determined to analyze Michael as a whole. “I knew I had to figure out what was wrong, or I’d lose my son,” he said.

It was during one of his many conversations with doctors about Michael’s potential treatment that Scott had an epiphany: Maybe no one could help their son because they were treating the wrong illness.

What Happened to the Girls in Le Roy (Susan Dominus, The New York Times Magazine, March 2012)

On an ordinary day in Le Roy, New York, a high school cheerleader begins twitching. Another cheerleader develops tics a week later. And another after that; and another after that. It spreads past the cheerleaders and on to the art kids, a boy, kids in neighboring schools. Is there something in the water? Is it those mysterious bins labeled with hazardous waste from a nearby factory? Is it that strange orange ooze coming up from the ground on the football field? Or is it all in their heads? 

Featuring media vans, Dr. Drew appearances, familial finger-pointing, women’s least favorite H-word (hysteria), and a cameo from legal crusader Erin Brockovich, Dominus’s reporting takes us into the mystery that consumed a small Northeastern town, while still making the science accessible to lay readers. 

How could one person’s illness be reflected in another person’s neural pathways, playing a trick on consciousness, convincing the host that it originated in her own body? In the last decade, scientists have begun to explore the concept that regions in our brain once thought to activate only our own activity or sensations are also firing what are known as mirror neurons when we witness someone else perform an action or feel a sensation. Mass psychogenic illness could be thought of as the maladaptive version of the kind of empathy that finds expression in actual physical sensation: the contagious yawn or sympathetic nausea or the sibling who grabs his own finger when he sees his brother’s bleed.

The Pre-Pandemic Puzzle (W. Pate McMichael, St. Louis Magazine, August 2007)

No, not that pandemic. Pate McMichael looks back at the teenager who may have died of AIDS more than a decade before HIV gripped the nation. But where did the virus come from? How did a young boy who was not a drug user, had not left the state, and never received a blood transfusion contract a virus that wouldn’t be detected in the United States for another decade? Furthermore, why did the news break in the mainstream media before the scientists who first identified the strain even had a chance to understand what was in their lab?  

This piece combines two of my favorite things: a medical mystery and an ethical quandary. It pulls back the curtain on how the scientific establishment studies new diseases and how and when they release that information to the public. Add in that historical lens — doctors seeing a new and potentially terrifying disease in the 1960s, the echoes of Hurricane Katrina in Pate McMichael’s 2007 writing — and you’ve got a winner. 

A few years later, in 1973, Elvin-Lewis and Witte presented Robert R.’s case at a lymphology conference and published a journal article on his systemic chlamydia in The Journal of Lymphology. The paper they presented actually raised as many questions as it answered. Why had Chlamydia spread throughout the body, when it normally stayed near the port of entry? And why did this young man have these purplish, malignant lesions called Kaposi’s sarcoma, as the alert pathologist had discovered during the autopsy? Kaposi’s sarcoma was known as an old man’s skin disease, typically affecting Jews and Italians. The pathologist decided that Robert R. had an African variant that affected children and primarily targeted the lymphatic system. That decision suggested an intriguing question: How did a black 15-year-old from St. Louis acquire Kaposi’s sarcoma?

Doctor Donor Fertility Fraud (Kudrat Wadhwa, The Verge, June 2022)

A woman seeking her familial DNA for a clinical trial learns that not only is her father not her biological father, but her bio dad is actually her mother’s fertility doctor. All together, now: Yikes. Worse, she finds out that she is not alone; several other children conceived via fertility clinics have also discovered that their fertility doctors are their real fathers. One doctor, featured in the Netflix documentary Our Father, sired over 90 children. 

This piece grapples with ethical questions and hard-to-draw lines: Is it medical rape to inseminate someone with fraudulent sperm? Do these doctor-fathers owe their scores of children anything? Should these children, once the fathers are discovered, seek a relationship with their bio dads? And what if the bio dad wants nothing to do with them? What if these men fail to see their behavior as a violation? 

Not a mystery, but still riveting — and a good case study around the meaning of consent. 

Not everyone who is watching Our Father has a personal connection at stake, but they are drawn in regardless. Fertility fraud rivets audiences because it channels the mysterious allure of genetic inheritance, crossing it with the perverse power relations between a doctor and their patient. Conception — so often an intimate act — is made impersonal and medicalized in the context of the fertility clinic, and then made intimate again through the abuse of the doctor-patient relationship. 

Every child of fertility fraud is a baby who was desperately and deeply wanted by their parents. The exploitation of that desire is devastating; the fact that the body becomes evidence of the transgression is all the worse.

Sick To Our Stomachs: Why Does Everyone Have IBS? (Natasha Boyd, The Drift, June 2022)

If Rule 34 of the internet is that there exists porn for every possible interest, then Rule 35, according to Jo Piazza of the podcast Under the Influence, is that there exists an influencer for every topic — including diarrhea. 

Why yes, Hot Girls do have IBS, and you can hear all about it on TikTok, Instagram, and pretty much anywhere else there is to make money off of “bloating positivity.” (Truly, if there was ever a sign that we really are in late-stage capitalism, this has to be it.) But really, why do so many hot girls (and other mortals) have IBS these days? This essay takes a look at the history of digestive discomforts, all the way back to the 1700s when The Gentleman’s Magazine examined why all the “well-to-do Ladies” complain of stomach “[d]iagnosticks … neither visible or certain” and to our new era of “normalizing bowel function” (finally!).

It has a name, but not much else. IBS is a so-called “functional disorder,” meaning that it is a condition without identifiable cause. Unlike with inflammatory bowel diseases such as Crohn’s or ulcerative colitis, patients diagnosed with IBS have no medically detectable signs of damage or disease in their digestive tracts. Essentially, IBS is diagnosed when tests come back normal; it’s what’s written down on a chart when there’s nothing else left to identify. Many people with IBS struggle with the implication that their symptoms are made up — especially as IBS both relies on self-reporting and presents differently from patient to patient. It is a catch-all term for a variety of gastrointestinal ailments, including cramping, bloating, intestinal gas, diarrhea, and constipation. Statistically, it affects more women than men, and is most common in people under 50. Regular exercise, cognitive behavioral therapy, yoga, and meditation have all been shown to alleviate symptoms. Even so, “IBS is not a psychiatric illness,” says Dr. Arun Swaminath, director of the inflammatory bowel disease program at Lenox Hill Hospital in New York City, “though stress and depression can make symptoms worse.” Despite its growing prevalence — IBS is the most frequently diagnosed gastrointestinal disorder — some doctors and digestive specialists question its utility as a medical construct, since the diagnosis does not elucidate anything about patients’ physiology or the causes of their discomfort. It is, however, very profitable: in the United States, the annual medical costs associated with IBS exceed $1 billion.

Lisa Bubert is a writer and librarian based in Nashville, Tennessee. Her work has appeared in The Rumpus, Texas Highways, Washington Square Review, and more.

Editor: Peter Rubin

Copy Editor: Krista Stevens

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They brainstormed responses to the argument that gender-affirming care reduces suicide — an assertion that is backed up by research. Peer-reviewed studies have repeatedly found that trans and nonbinary youth with access to gender-affirming care are significantly less like to seriously consider suicide than those who did not receive such care. A larger analysis, using online survey data from over 11,000 trans and nonbinary youth, found using gender-affirming hormonal therapy was associated with lower rates of both depression and suicidality. Yet one team member called the argument that gender-affirming care reduces suicide “abusive”; another argued it was a way for doctors to coerce parents to consent to gender-affirming care for their child. 

Van Mol, the doctor, suggested Deutsch reply to the suicide prevention argument with a rebuttal published on a defunct anti-trans blog: “Why weren’t the 1950s a total blood bath for suicides if non-affirmation of everything is the fast train to offing one’s self?” Van Mol asked, paraphrasing the blog post. 

Another doctor in the working group, California endocrinologist Michael Laidlaw, had gained attention for his writing against gender-affirming care after parents at a charter school in his region raised complaints that they hadn’t been notified before kindergarteners were read a children’s book, I Am Jazz, about trans teenager Jazz Jennings. Last fall, when the state of Florida called on Laidlaw as an expert witness in a lawsuit over its anti-trans Medicaid policy, a federal judge concluded that he was “far off from the accepted view” on how to treat gender dysphoria, in part because Laidlaw had said he would refuse to use patients’ preferred pronouns. In his South Dakota testimony, Laidlaw compared gender-affirming care to Nazi experimentation and the Tuskegee Syphilis Study. In emails to Deutsch and the group, he railed against doctors who prescribe puberty blockers — which are used to delay unwanted physical changes in gender-diverse kids and give them more time to explore whether or how to transition — accusing them of “willfully harming” children, even if kids and their parents consent to treatment. “The physician is the criminal in these scenarios and must be prosecuted by the law,” he argued.

Medicine has a long and sorry history of bias and discrimination on the basis of sex. Given that ME and other functional and medically unexplained disorders are known to be much more prevalent among women, it is not surprising that patients with these conditions routinely report receiving poor treatment and even abuse at the hands of the healthcare system.