(Editor’s Note: A shortened version of this interview appeared in the July/August 2018 issue of the magazine.)

One of the first things I want to talk about is the Trans Equality Now award [received in May].

It was incredibly moving for me to accept that award. Obviously, the award’s named after Andy Cray, a Wisconsin native and my late spouse. To be able to get that award and to have it be given to me by Andy’s mom and step father was a really special experience. I think more than anything else, I felt truly unworthy of that award because as hard as I’m working, I still marvel at the accomplishments and the advancements that Andy made and had his fingerprints all over. I ask myself every day, “What would Andy do?” whenever I’m confronted with a question or a dilemma. Hopefully I make him proud more days than I don’t. I certainly am asking myself that question at every turn. To be able to get that award was just… Honestly, words can’t express how it felt to me, and I’m usually not at a loss for words.

I was really excited when I saw that you were getting the award. I had just finished reading your book [Tomorrow Will Be Different: Love, Loss, and the Fight for Trans Equality], and I had only briefly heard of Andy before it came out. I got to see all the great things that he had done, and I was really excited for you.

Thank you. Mara called me to tell me that I would be this year’s honoree, and she said, “We were trying to think of someone to give this award to, and one of our fellows was like, ‘What about Sarah?’” Mara said, “We’ve already given Sarah the award.” Then she thought briefly, and she’s like, “Wait, have we?” They realized that they hadn’t, and Mara’s like, “Oh, well duh, that makes sense.” It was really special. I don’t know if you’ve ever had a chance to meet Mara Keisling [founder and executive director of the National Center for Transgender Equality], but she is a dear friend of mine. She was the first out trans person I ever had an extended conversation with. I met up with her for lunch less than a week after I came out to my parents. A mutual friend put us in contact, and she has been a constant source of guidance and mentorship for me since I came out. She was there in the beginning, she was in Andy’s hospital room when he passed away. She’s really been there at every major part of my life. NCTE holds a special place in my heart, and Mara in particular.

That’s very sweet. Can you explain briefly what the award is for and what NCTE is for?

The award was named after Andy the year after he passed away. It recognized advocacy around expanding access to complex and inclusive healthcare to transgender people, which was obviously Andy’s life work. It’s awarded by the National Center for Transgender Equality, which is a major policy advocacy organization in Washington, DC, working on behalf of transgender people across the country

The other big topic that people want me to cover is the upcoming conference, Transforming Faith [August 18 at First United Methodist Church in Madison].

I’m incredibly excited to come out in Madison for the conference, for a number of reasons. One, my own faith community had been incredibly important in my own family’s journey since I came out as transgender. In fact, the first people that my parents called after I came out were our family pastors. Fortunately, we’ve been members of a progressive, inclusive Presbyterian church, and both of the pastors at our church affirmed and provided excellent friendship and pastoral care to my family as I came out, and demonstrated what I think is at the center of so many different faiths, which is this notion of the fact that we are all God’s children, that we should treat one another the way we want to be treated, and that’s exactly how those pastors responded to my family.

I’m excited for the second reason because Wisconsin is near and dear to my heart, given the fact that it’s the birthplace and home state of my late spouse, Andy. Third, because voices of faith and communities of faith are incredibly important in moving equality forward, both on the ground level and legally. LGBTQ people are people of faith, people of faith are LGBTQ allies, and we need to demonstrate that being a person of faith and supporting LGBTQ equality are certainly not mutually exclusive, and frankly go hand in hand.

That’s very uplifting to hear. What is your role going to be in the conference?

I am giving a keynote address at the event, and I’m gonna share a little bit about my own story, about the challenges that LGBTQ people oftentimes face in their faith communities, but also the positive affirming role that so many faith communities and people’s faith are playing in this movement. I think the vision is to move forward in a way that includes diverse voices, including voices of faith, so that we can build inclusive bases for LGBTQ people on every corner of this country, including in welcoming and affirming faith communities.

That’s a wonderful goal. Have you had an opportunity to speak with [organizer] Joanne Lee?

I know Joanne personally. She is a member of the Human Rights Campaign, Parents for Transgender Equality Council, which we launched in November of 2016 with some of the leading parent advocates across the country to help amplify those incredibly important voices in the fight for trans equality. She is a fierce fighter for justice, she is a loving and caring person. Of course her story and her journey toward advocacy is incredibly heartbreaking, and I think, underscores the urgency and the stakes of this fight.

Absolutely. Yeah, it was very touching that all of this happened in Madison, and the award that Skylar [Joanne’s child, who committed suicide in 2015] had been given was done through GSAFE, one of the organizations here in Madison. I attend their dinners and so it was all very touching to hear about how all of those come together.

I’ve heard Joanne speak a few times about her family and Skylar, and about her journey. I tell you, you can see in people’s eyes when a speaker is opening their eyes and changing their minds. Every single time I see Joanne speak and tell her story, I can see just how impactful she is and how much her remarks are expanding people’s understanding and empathy when it comes to transgender equality.

That’s incredibly important because a lot of discrimination is fear-based, and once you know someone who is trans, it gets so much easier to support transgender rights.

Absolutely. One of the things we know is that in the fight for trans equality, knowing someone who is transgender in your own life changes the way you think about transgender identities and about the challenges and issues facing transgender people. Over the last several years, the percentage of Americans who say they know someone in their own lives who’s transgender has gone from single digits to 30-40%. There’s really no better correlation between support for transgender equality than personal relationships with transgender people. When you know someone who’s transgender, you understand that, behind this conversation on transgender rights, are real people who love and laugh, hope and dream, fear and cry, just like everyone else. When you understand that, the caricatures that anti-equality politicians try to sow fears around begins to dissipate, and you understand that this is just simply about treating people with kindness, fairness, and decency.

It’s been very heartwarming to see the attitude in the nation change over time. I don’t remember if I read it in your book, but I remember hearing that more Americans believed in ghosts than they did in transgender people at one point.

Yes! More Americans had said they had seen a ghost than had known someone who was transgender, is the stat that I did include in my book. It’s true, and I think the fact that so many more Americans now say they know someone in their life who’s transgender is a reflection of two things: One is a reflection of a growing alliance that we are building by living authentically. I think it’s also a reflection of the fact that we have made progress because it’s demonstrating that more and more transgender people are coming out and they’re feeling comfortable living openly in more and more spaces within their communities. That’s a reflection of a changing landscape for transgender people.

Now, obviously, far too many transgender people still do not feel safe coming out. Far too many transgender people face violence and discrimination if they do, but it is a reflection of a not insignificant amount of progress that we have made towards building a world where every person can live openly and authentically. If we’ve made that progress, then I know we can continue to make progress and continue to drive up that percentage of Americans who say they know someone who’s transgender and increase the number of inclusive laws and expand the spaces where transgender people are safe from violence and discrimination.

I really appreciate all of the work that you’re doing on this front. I initially became aware of you because of your speech to the Democratic National Convention [2016]. Reading your book helped me realize how much you have done to help. That as a trans person, I deeply appreciate all of the work that you’re doing. I think you definitely deserve the award.

Well, thank you. As I talk about in my book, and as I try to always say, coming out and my journey as a transgender person was the hardest thing that I had ever done up until that point, but it was still relatively easy compared to the experience of so many people. I feel that those of us with the kind of privilege that I have, have a responsibility and a duty to make sure that the privileges we have been granted are no longer a privilege, but rather a right guaranteed to everyone.

I feel grateful to have had the experiences I’ve had, and I feel hopeful that more and more people will have the kind of journey that I’ve been able to have, which is a journey that I think has affirmed generally the goodness of most people. I hope that we can continue to tap into what I believe is the most powerful human emotion, which is empathy, and make that kind of experience a reality for everyone. I appreciate your saying, but truly no thanks are necessary because for me, it’s just a basic responsibility given all that I’ve been given and all that I have.

The first chapter of your book is your coming out story. It was very touching. I cried through almost all of it, and I also feel blessed in that a lot of my experience has been very positive. I’ve been very fortunate in that way. Hearing your story is, I think, helpful for other transgender people to see different ways that this can happen, in addition to the wider community and giving them more trans experiences.

I appreciate you saying that. Like we were talking about, I think that while one trans person’s story is just one trans person’s story, I do believe that it can be through personal stories that people can enter into this conversation in a way that changes the way they think about it. I’m glad that that spoke to you and my hope is that there’s some things that every trans person can find in the book that speaks to them. Recognizing my own privilege, recognizing the differences in experiences, recognizing a whole host of things that make all of our journeys so unique. My hope is that everyone, whether they’re trans or cisgender, can find something in that book that speaks to, stays with, or resonates with them.

The other part of your coming out story that I really appreciated hearing was the struggles you went through of trying not to be transgender. That is something that I struggled with quite a bit. I always knew that my gender and my outward presentation didn’t match up, but I didn’t ever feel like I was trans enough. Hearing you go through similar struggles was really touching.

I’m really glad to hear that. One of the things I always try to tell young people when I meet them, and they say, “What advice do you have for someone that’s coming out?” I say, “Well, first off, there are two pieces of advice I have for you, and they’re gonna seem really vague. First is that you are the best expert on who you are and what you need. The second is that there’s no wrong way to be yourself. There’s no one way to be trans.”

I would have so benefited from someone really clearly saying that to me because early on I went through–as I think most folks do–this significant period of my life where I tried to deny being trans and hide my identity and suppress my identity. Then once I came out, I was worried that I wasn’t expressing myself in the right way or describing my journey in the right way, or expressing the right feelings.

It was something that I was quite nervous about, and I think for me, and I’m sure with other people, there’s this feeling that you have to conform to a pre-existing narrative and a pre-existing way of feeling and wanting to go about things and needing to go about things. It keeps all of us from having the kind of transition and care and journey that we truly need. It’s so important, I think, for me as someone who went through that to express to other folks that are coming out that you might feel this pressure, but that there isn’t one way. There’s no wrong way. Everyone’s transition, everyone’s journey looks different.

That’s a great message to share. I, in particular, appreciated your comments about how you felt like you were being forced into a feminine role, like there’s one right way to be feminine. I struggled with that as well.

Right. I think as trans folk, particularly as trans women, we’re caught in between this rock and a hard place where, as I talk about in the book, if we’re not feminine enough, we’re told that we’re not real women. If we’re too feminine, we’re told that we’re caricatures. There’s no winning. I consider myself to generally be a feminine person in my gender expression, but not universally. There’s policing of everyone’s gender expression in a way that we are constantly having to juggle almost mutually exclusive demands in terms of safety, in terms of being seen as who we are, in terms of the politics of it, and what trans exclusive radical feminists will say, and what anti-equality conservatives will say. All of these demand that are just so unfair, and like I said, you can come out of the closet only to find yourself stuck in a kitchen. It’s true. It’s a broader reflection of why the fight for trans equality is so inextricably linked to the fight for gender equality.

I appreciate you sharing that message ’cause I think it’s a valuable one. The other part of your book that really touched me was about you telling the story of what life was like going through Andy’s illness. I have a serious liver disease that we found out about last summer and I’ve been in the hospital for it. While nowhere near as serious as what you went through, it was still very much appreciated hearing your story. I was very thankful that you were brave enough to tell it.

I think for me, in writing the book, it was a journey back to hope. As weird as it sounds, in many ways, I wrote the book from January 2017 through June of 2017, right after the election. I was feeling particularly helpless and dispirited. It was actually through writing about my journey, writing about the pains that I had seen, but also writing about the challenges and the hardship and Andy’s illness in particular, that I really came to remember an important point that my brother told me in the last months of Andy’s life, which is that this is gonna be incredibly difficult, but look around you and take stock in the acts of amazing grace that you will see.

Yes, I read that line in your book and I immediately started crying.

Yeah. That line was stuck with my since then, but really the last year and a half because it taught me that all of us, even in the darkest moments and the most troubling times, can bear witness to acts of amazing grace. It reminded me that hope only makes sense in the face of hardship. As difficult as this moment can seem in the work that I’m doing and in our country, those experiences taught me to find the light in the darkness and to remember that even when there are challenges, if you take a moment to look around you, you’ll see those acts of amazing grace.

I think we’ve seen that over the last year and a half. I think I see that every day in my job. I know that it’s through those acts of amazing grace that we’ll be able to advance in ways that presently seem unimaginable. For me, it was actually a cathartic healing experience to write about that incredibly difficult time in my life and in many ways, helps me re-find my hope.

That’s wonderful to hear. I know that transgender people’s experiences in hospitals can be fraught and frustrating and scary. I remember the various times I would have to go into surgery and was told to undress and wear a gown. I was terrified half of the time of what was going to happen.

Right. I remember, as I talk about in the book, I remember when Andy was first starting to go through his cancer treatment. With every new doctor and every new nurse, we were worried about what does this person think of people like us? Will their personal opinions impact their professional care? I think people who aren’t transgender probably tend to think, “Oh, well doctors abide by the Hippocratic oath and even a doctor who doesn’t have affirming or inclusive opinions or positions on transgender people, they’ll still treat a transgender person competently and respectfully in their care.” That’s just not how things work.

Everything we do is impacted by our personal beliefs and our personal opinions. If you hold deeply problematic and deeply hateful opinions about a kind of person, that is going to impact the way you treat them, sadly. Seventy percent of transgender people in one survey reported experiencing some kind of discrimination or mistreatment in a healthcare setting, and that includes healthcare professionals refusing to touch them, even. We know that transgender people face discrimination, mistreatment, and in some cases, subpar care at the hands of healthcare professionals simply because they’re transgender.

I think of a transgender man named Jay Caleo, who I knew and who actually Andy knew, who died from cancer. A cancer that went undiagnosed for several weeks because the healthcare professional who did the initial test saw that the results showed a transgender man had cancer, he didn’t call him. Once they eventually reached him, the doctor said, “When I got the results, I thought about referring you to a psychiatrist, not an oncologist.” These types of stories are far too common. Jay’s since passed away. Who knows what role that delay in care potentially had in the progression of his cancer.

As surprising as it seems, and certainly while most healthcare professionals, or the vast majority of healthcare professionals, are providing generally competent, respectful, inclusive treatment to transgender people, there are too many who don’t. That is unacceptable and can have, in some cases, deadly consequences. As Andy always felt throughout his life, even before he was a diagnosed with cancer, there are few places more important for trans people to be protected and for trans inclusive policies to be adopted than in healthcare settings.

Healthcare settings are particularly risky because often times, you need to disclose that you are transgender in order for the physicians to provide appropriate care. There’s no secrecy to protect you if you need it.

Right. In many cases, it’s relevant in terms of past medical history, in terms of medication one might be taking. That are often times relevant and at least for the doctor to know, if it’s not directly relevant to the specific care. You’re right, it’s a situation where you’re putting yourself out there, you’re exposed, and you’re already worrying about an illness or a disease or a chronic pain or an emergency. You shouldn’t also have to be worrying about whether your identity is going to impact the kind of care you get.

The thing that reminded me of this, though, was that I’ve seen the change in public opinions about transgender people being mirrored in the public opinion among healthcare. One of the things that I’ve had the fortune to work on is making health care software better support gender identity and legal sex, and sex assigned at birth, and all those other things that are important to the transgender community.

Well, that’s fantastic. I’m so glad that you’re doing that and that you’re working that.

Honestly the greatest outcome of writing this book and having this book out there for me has been the people who come up to me at different stops and say, just very simply, thank you for introducing us to Andy. It provides me a lot of comfort and it means a lot to me to know that people are seeing and meeting a person, the person who for me is the best person I’ve ever known in my life. And in many ways that helps to continue to keep his legacy and him alive. So thank you, and thank you to everyone who’s read this and has taken the opportunity to meet Andy and to go on that journey with me. And to learn from him the experiences we have together.

Randi Hagen is proud trans woman, storyteller, geek, programmer, athlete, sister, mother, and wife. She’s a developer for Epic by day, notably on healthcare interoperability, providing better support for queer patients in the medical record.