In a recent story that made headlines, “Sam” (name changed in the media for privacy), a biological woman who identified as a transgender man, was brought to the hospital by her boyfriend because she had suffered through hours of severe abdominal pain. Her online medical records classified her as “male,” so the triage nurse who was running the tests on Sam naturally thought she was a biological man. Being obese and admitting to have not taken her blood pressure medication in a while due to losing her insurance, the triage nurse “triaged him to nonurgent assessment. Laboratory samples were drawn, including one for human chorionic gonadotropin (hCG) testing, and Sam awaited further evaluation.”

It wasn’t until hours later when the emergency physician came in to examine Sam that they discovered she was pregnant. Her hCG test came back positive, indicating that she was indeed with child. It wasn’t long before it was clear that Sam was in labor and needed an emergency C-section to try to save the unborn baby’s life. Sadly, Sam delivered a stillborn baby.

According to an article in The New England Journal of Medicine, Sam indicated to the hospital staff that she was transgender. The article states:

In Sam’s evaluation, the triage nurse did not fully absorb the fact that he did not fit clearly into a binary classification system with mutually exclusive male and female categories. Though she [triage nurse] had respectful intentions and nominally acknowledged the possibility of pregnancy by ordering a serum hCG test, she did not incorporate that possibility into the differential diagnosis in a way that would affect ensuing classifications and triage decision making. Despite communicating that he was transgender, Sam was not evaluated using pregnancy algorithms. Having no clear classificatory framework for making sense of a patient like Sam, the nurse deployed implicit assumptions about who can be pregnant, attributed his high blood pressure to untreated chronic hypertension, and classified his case as nonurgent.

The problem with this statement is that the authors of the article don’t say when in this entire process Sam communicated she was transgender. Instead, the authors blame the triage nurse for not taking every possible scenario into consideration. Whether or not the triage nurse should be blamed is another issue altogether. What needs to be addressed is the fact that Sam was born a female, transitioned to a male and classified herself as a man on her medical records and forms, and then was rightfully treated as a man by medical professionals because they had no reasonable way of immediately knowing that she was in fact a biological woman.

Biological men cannot get pregnant. It doesn’t make logical sense for a triage nurse to look at a medical form, see the patient classified as “male,” and think that there is a chance this patient is having abdominal pain because of a pregnancy. It seems clear from this tragic situation that when it comes to medical care for individuals who identify as transgender, we should pursue policies that eliminate confusion on what to do in medical emergencies, resulting in more innocent unborn lives being saved.

In this vein, while we continue to fight for science and biology to be the basis of medical care, maybe there should be a box to indicate biological sex, not just gender identity, to hopefully help mitigate these kinds of tragedies in the future.