Madeleine Mendelow

For years, I never really thought about my gender—or lack thereof—or considered the gender binary as a concept. I had never questioned my pronouns or the effects of language on me and my well-being. However, I did know I was different from what was expected of me based on my appearance, which made me deeply uncomfortable. Through reading and discussion, I learned more about gender as it exists as a spectrum—and I knew I was nonbinary.

Outside intersex individuals, sexes are primarily divided into male and female based on anatomy. Gender is separate from sex. Sex is what we 

tell new parents during an ultrasound when we discover the genitalia of their future child. What we say, however, is a gender: “It is a boy,” or “it is a girl.” Many love to engage in gender reveals, with pink or blue defining the identity of an individual who has not yet had the chance to give their input and define who they are on their own. With language, we define someone’s gender for them—and when that individual is uncomfortable with this imposed identity, society labels them the exception to the norm. This can have a devastating impact on our patients’ mental and physical health.

The gender binary can certainly be comforting. For example, it means everything to my trans patients when they are finally seen as the same gender on the outside that they are on the inside. But for many patients, we leave room for discomfort when operating solely within the binary. With gender seen as a spectrum, however, there are infinite genders in between the two most of us think of. This makes way for individuals to define their own identities. One could argue that most people are nonbinary if gender is a spectrum, or that gender does not exist at all.

We use language that reflects our identity by way of pronouns. During clinical rotations and in forums where individuals discuss pronouns, there is often confusion surrounding those outside the gender binary. He/she pronouns are intuitive for most individuals; they match what people usually think of as singular and man/woman. However, when an individual adopts “they” pronouns, we often stop to question: Is “they” singular? How can we use “they” outside plurality? We do this all the time without thinking, and we have done so for hundreds of years across many cultures. Recall the last time you found an object that did not seem to have an apparent owner. We say, “Someone lost 

 [object].” We know this is a singular individual, but because the gender of the individual is unknown to us, we assign the nonbinary “they.” We opt not to use, “He or she lost his or her wallet.” The singular, gendered version might sound even more unnatural to you here. Like driving a car, when we start to think about the act, it suddenly feels odd to us, like we have never driven before. It is the same with language.

So how can we better serve our nonbinary patients? We can start by adopting more inclusive language in our fields. For example, in ob-gyn, we talk about women’s health and pregnant women—but it is not only women who can become pregnant or use these services. Trans men and nonbinary individuals also need us. Although it takes effort because it is not our habitual way of thinking, adopting language such as “pregnant people” can make all our patients feel more included.

Respecting someone’s pronouns is vital to respecting the person in front of us and their identity. Gender has a different meaning to everyone. There are many different pronouns, even beyond they/their/them—for example, zey/zeir/zem. Many nonbinary individuals may fall slightly on the feminine or masculine side of the spectrum and adopt both she/they or he/they pronouns. Some individuals are more gender fluid, adopting he/she/they pronouns.

I have found that the best way to know what someone uses is to introduce myself with my pronouns and then simply ask the individual about theirs. Then I practice, accepting that I often get things wrong, but knowing that I am trying my best.

 is a third-year medical student at the University of South Carolina School of Medicine Greenville. She received her bachelor of arts degree in romance languages and literatures and international studies from the University of Michigan and practiced as a licensed aesthetician before medical school. She hopes to pursue ob-gyn and incorporate her love of psychiatry into her practice.

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“Respecting someone’s pronouns is vital to respecting the person in front of us and their identity. Gender has a different meaning to everyone. There are many different pronouns, even beyond they/their/them.”

Medicine Beyond the Binary

Throughout medical school, I found myself the happiest during my OBGYN rotation, especially in labor and delivery. Nothing can describe the pure joy that comes with being there for the most important day of someone’s life. Although medical providers are technically not family members, in OB, when delivering someone’s child, it feels so close. Most of the sentiments I came across in this field can only be wrapped up by the word 

. However, when OB is sad, it is devastating.

It was not until later this year in my rotation through the emergency department that I examined someone and knew she was miscarrying. The ensuing silence was deafening. No amount of empathy can ease the pain for someone losing a much-wanted child along with the hopes they had for their future, for that day in labor and delivery when they would have started or grown their family.

Many of us pursue medicine because we envision ourselves helping others. I had not yet had an experience in which I felt more helpless—although I am sure I will. Patients go through the most at the end of the day, and it is an honor to be trusted to care for them in these moments. OBGYN, and medicine in general, will always be worth it. But moments like these deserve time for reflection. As providers, we see so much. We empathize with patients who are going through hardship hundreds of times every day. The hardest moments we witness, however, should be a reminder to extend that empathy to ourselves so we can continue to care for others.

is a third-year medical student at the University of South Carolina School of Medicine Greenville. She received her BA in Romance Languages and Literatures and International Studies from the University of Michigan and practiced as a licensed esthetician prior to medical school. She hopes to pursue OBGYN and incorporate her love of psychiatry into her practice.

When helping patients in the hardest moments of their lives, it is important to have empathy for them—and for ourselves.

Psychological Reflections on Miscarriage

collaborative care_charactervectorart/Adobe Stock

This poem came to me during Women’s History Month and is based on my experience rotating on an elective with only male colleagues. I was mistaken for a nurse several times in one day during rounds. Stories of my colleagues being mistaken for other staff, such as environmental services, are not mine to share. It is a reflection of my own white-passing privilege to simply be mistaken for a nurse.

Nurses are as vital to the team as physicians—this in no way denotes any disappointment in being mistaken for one. It is even a compliment. However, this is an observation of how society unmistakably perceives white men as doctors based on historically defined gender roles and systemic racism.

I used to avoid wearing my white coat. It is often difficult to keep clean, and I worry at times that it promotes the spread of nosocomial infections. But to wear the white coat is a privilege. After that week, I began to wear it deliberately, proud of the steps that my predecessors took to make way for those in this wonderful field who do not fit the form of “white man.”

Will they have a different profession today?

White Coat

For years, I never really thought about my gender (or lack thereof) or considered the gender binary as a concept. I had never questioned my pronouns before or how language affected me and my well-being. However, I did know that I was different from what was expected of me based on my appearance. This made me deeply uncomfortable. Through reading and discussion, I learned more about gender as it exists as a spectrum. I knew that I was nonbinary.

Outside of intersex individuals, sexes are primarily divided into male and female based on anatomy. Gender is separate from sex. Sex is what we 

 tell new parents during an ultrasound when we discover the genitalia of their future child. What we say, however, is a gender: “It is a boy,” or “it is a girl.” Many love to engage in gender reveals, with pink or blue defining the identity of an individual who has not yet had the chance to give their input and define who they are on their own. With language, we define someone’s gender for them—and when that individual is uncomfortable with this imposed identity, society labels them the exception to the norm. This can have a devastating impact on our patients’ mental and physical health.

The gender binary can certainly be comforting. For example, it means everything to my trans patients when they are finally seen as the same gender on the outside that they are on the inside. But for many patients, we leave room for discomfort when operating solely within the binary. With gender seen as a spectrum, however, there are infinite genders in between the 2 most of us think of. This makes way for individuals to define their own identities. One could argue that most people are nonbinary if gender is a spectrum, or that gender does not exist at all.

We use language that reflects our identity by way of pronouns. During clinical rotations and in forums where individuals discuss pronouns, there is often confusion surrounding those outside of the gender binary. He/she pronouns are intuitive for most individuals—they match what people usually think of as singular and man/woman. However, when an individual adopts “they” pronouns, we often stop to question: Is “they” singular? How can we use “they” outside of plurality? We do this all the time without thinking, and we have done so for hundreds of years across many cultures. 

Recall the last time you found an object that did not seem to have an apparent owner. We say, “someone lost 

[object].” We know this is a singular individual, but because the gender of the individual is unknown to us, we assign the nonbinary “they.” We opt not to use “he or she lost his or her wallet.” The singular, gendered version might sound even more unnatural to you here. Like driving a car, when we start to think about the act, it suddenly feels odd to us, like we have never driven before. It is the same with language.

So, how can we better serve our nonbinary patients? We can start by adopting more inclusive language in our fields. For example, in OBGYN, we talk about women’s health and pregnant women—but it is not only women who can become pregnant or use our services. Trans men and nonbinary individuals also need us. Although it takes effort because it is not our habitual way of thinking, adopting language such as “pregnant people” can make all our patients feel more included.

How can we better serve our nonbinary patients?

Beyond the Binary

I was diagnosed with Graves’ disease in 2015. At the time, I was grateful to receive a label for everything I had been feeling for the past months and relieved I had the opportunity to treat it. Ultimately, Graves was the disease that led me to a love for medicine and guided me to medical school.

Over the years, however, with medical bill after medical bill and one endocrinology appointment after the other, the gratitude I had for this label that changed my life slowly morphed into frustration. Trips to the pharmacy to fill my prescription for methimazole and the time I spent managing this disease felt wasted. There were life decisions I would not let myself consider because I was on a medication that could have devastating effects in certain situations. Then there were the times when I would feel hypothyroid: I thought, 

maybe my Graves was finally burning out this time

—only to find my antibody level result higher than previously. Hope became devastation. I felt like Graves was controlling my life and emotions, just as it had prior to my diagnosis.

During my psychiatry rotation, I was fortunate to work with a wonderful psychiatrist: Frank A. Clark, MD. His love of poetry inspired me to try my hand at my own. Throughout my third year, I have found that writing about my experiences has helped me embrace my creativity and cope with challenging cases I see, as well as document the joys in my life, such as this: In the 6 years since my diagnosis, my thyroid antibodies dipped into normal range, and my endocrinologist talked to me about coming off methimazole. This poem is about the hope I feel knowing this disease will finally come to an end.