Roller coasters are not my thing

An essay written before I blew the whistle

In October 2022, I stepped down from my position as Case Manager at the Pediatric Transgender Center at St. Louis Children's Hospital to accept a clinical research role at the same university.

Shortly after leaving the center, but before I decided to publicly blow the whistle, I wrote this piece.

Roller coasters have never been my thing. Prone to motion sickness, I've usually found myself at the exit, holding the hats of the thrill-seekers, watching from a distance as they revel in their adrenaline rush. At Six Flags St. Louis, I climbed aboard those steel beasts enough times to remember the slow, creeping dread of anticipation in the queue—the temptation to retreat, to slip away from the line, or even to step into the coaster’s seat just to leap out the other side. Yet, there's that fleeting whisper of excitement, a glimmer of hope that perhaps this ride will be different. But soon, the familiar nausea sets in, the clammy hands, the color draining from my face, and the overwhelming desire for the ride to just stop.

My journey at the Pediatric Transgender Center in St. Louis spanned four years, four months, and thirteen days. The first two years felt like the slow ascent up the roller coaster's initial climb—a time I've since labeled "when I still drank the Kool-Aid." I wish I could pinpoint the exact moment when my perspective shifted, like the transition from "Team Gale" to "Team Peeta" in a beloved saga. It was gradual, like the creaking gears slowly pulling the cars to the zenith. But, at that peak, clarity struck with a force that left no room for doubt. There was nothing positive in this ride, not for me, not for our clinical team, not for the parents, and certainly not for the patients.

My tenure began in June 2018 and concluded in October 2022, a year after the center itself opened. I was the second to hold the title of Case Manager, often feeling I must be one of only two in Missouri navigating these waters. There were times I contemplated the uniqueness of my role, with just one other center in Kansas City complementing our efforts in St. Louis.

Looking back, I wish I had had the foresight to pen a letter to my future self when I started, to capture why I believed in the program, why I thought medically transitioning children was a noble pursuit. Perhaps those convictions would still hold some water, or my younger self could have persuaded me to remain in blissful ignorance, to "suspend disbelief."

"Suspending disbelief"—a phrase uttered by a doctor I worked alongside for years. She said she had to do this each time she entered a patient's room. Initially, her words felt like the first drop of the roller coaster—shocking, unexpected. For the first two years, I never felt the need to suspend my belief; reality was not a script to be questioned. Her statement, though, sparked the beginnings of a quiet anger within me.

I began to realize that, for her to continue, she had to actively set aside her doubts, engage with her patients, listen, and then proceed with medicalization despite her instincts screaming otherwise. A doctor, silencing her own intuition.

Even if I had never stepped into that role, someone else would have. Perhaps someone even more ideologically aligned with the prevailing winds of the time. I cannot undo my past, nor the part I played in the medical transitions of children. Now, I sit with the worst of the roller coaster's sensations—the nauseating churn in my stomach.

I am still watching the rollercoaster load more riders. I am only so far removed to be sitting on the bench very close to the exit, willing the vomit not to come. Willing myself to take slow deep breathes, try to allow my clammy hands to dry.

Sit and try to figure out what to do next.