Pat James had a doctor's appointment May 11 when the television news beamed into the waiting room announcing that Delaware's governor had just signed a same-sex civil union bill into law.
Two patients sitting across from her shook their heads in disgust. "Can you believe that?" one said to the other. "It's terrible what they're doing!"
James bit her tongue.
She's 60 years old and tired of challenging everyone who makes homophobic remarks. Whether they're intended to hurt or, as in this case, simply careless, the assault of a thousand tiny cuts feels relentless.
"Each of these incidents," she said, "brings a little exhaustion, disappointment, and anger."
James, director of education for the Pennsylvania Horticultural Society, and her wife, Karin McGowan, who is director of microbiology for Children's Hospital of Philadelphia and professor of pathology at the University of Pennsylvania, have been together for more than 25 years. Three years ago, on a trip to Toronto for a medical conference, they married. The city's proximity to the border and its reputation as gay-friendly draw large numbers of American LGBT couples to tie the knot. McGowan and James were struck by how much more at ease they felt there than at home in Philadelphia.
"Everyone in City Hall was so courteous and happy for you," McGowan said.
"Even though the justice of the peace was doing dozens of these marriage ceremonies, he made us feel like we were the first," James said.
"It was amazing," McGowan said. "I realized, I'm not in Pennsylvania anymore. Sad but true. You could never convince me to retire in this state." Despite their stable relationship and solid work history, she and James have had hassles obtaining joint mortgages and health insurance and the tax benefits offered to straight couples. "The problem is legal," she said, "but it's also cultural."
"Every time I produce my medical card, it requires an explanation," James said.
"You have to out yourself every time," McGowan said.
The two are seated in McGowan's sunny corner office at Children's Hospital. Framed awards and citations, honoring her as a scientist and mentor, cover the walls, along with her multiple diplomas - including a doctorate in both microbiology and immunology. She oversees 22 technologists and runs the laboratory that identifies patients' infections. A full professor on the medical school faculty, McGowan has won most of the major teaching awards and written a textbook on medical microbiology. Only 12 percent of the medical school faculty full professors are women.
These days, she said, she gets respect. But it was not always so.
She first came to the University of Pennsylvania system in the late 1980s because it was one of the few institutions offering health coverage to domestic partners. Shortly after she arrived, she recalls, a senior physician, knowing she was within earshot, announced, "No way in hell will a faggot make it to full professor."
McGowan let it slide. "But I wondered if I'd made a mistake coming here."
A tomboy as a little girl growing up in rural Pennsylvania, she always knew she was different. She was 11 when she found a magazine article about a lesbian couple. "One was divorcing her husband to be with her new partner, and her husband was fighting for custody of the kids. I remember saying to my mother, I don't understand, and she explained the politics and terminology to me. That's when I understood who I was."
Her parents, a master carpenter and a health-care administrator, both of whom were Catholic, sent her to a parochial elementary school but allowed her to switch to a public high school where she could study science. She was in her 20s when she told her mother she was a lesbian. "She was fine with it, but worried about how I'd be treated by others."
"Your mother is so cool," James said. It took James much longer to come out - not only to her family, but to herself.
Raised in a Methodist family in Minnesota, she dated boys. "But I kept pushing to the back of my mind other attractions. This was all pre-Stonewall and being gay was a diagnosable mental illness. I read about it in Reader's Digest."
James moved to Philadelphia in 1971 as a Vista volunteer and met the man she would later marry. "This is the part that's heartbreaking," she said. "The hidden victims of homophobia are those who love us." Too many LGBT people like her, afraid to be themselves, keep up the charade for years, if not entire lifetimes. "My husband was so hurt when I left, yet I know he wasn't surprised."
She had been working with her church in Mount Airy, helping Central American refugees, when McGowan appeared one day in 1985 to volunteer. McGowan's father had taught her carpentry and she thought her skills might be useful.
"Honest to God, it was love at first sight," James said. "Just look at her!"
McGowan blushed. "Oh, stop."
"I went home to my husband and told him, 'I just met the most amazing woman today.' And do you know what his first question was? 'Is she a lesbian?' "
Within a year, James and her husband divorced, and she and McGowan moved in together.
"I wish I'd had more courage sooner to face the truth about myself," James said. "The pain I caused him was so profound, the sense of betrayal so complete, there was no coming back from it."
Even after coming out to their families and friends, both women said, they grew to understand the importance of standing up publicly.
For McGowan, the moment came in 1986, when a student she'd taught in a laboratory class dropped out of medical school. She found out later that he was gay and was convinced as a result he would never fit in as a doctor.
"If I had been out in a big way, I might have been more of a role model. The next year," she said, "I showed up with a pink triangle on my lab coat and mentioned my partner right away in the hope that maybe it would help students feel less alone."
"They need to know it does get better," James said.
McGowan nodded, "Yes, it does. And I love that website." She's referring to a series on the It Gets Better project (www.itgetsbetter.org) that features videos by various celebrities and ordinary people, many LGBT but not all, telling encouraging personal stories and giving supportive advice to teenagers and young adults struggling with their sexuality.
"Because I had been in the closet for so long, I decided to be both out and visible," James said. "I'm willing to let people find out, and I make sure people find out. It felt so joyful to finally embrace who I really was. It was like being underwater for a long, long time and finally come up for air."
She nudges McGowan to tell the story of her acceptance speech at Penn's Focus Award ceremony, honoring her for the advancement of women in medicine.
Reluctantly, McGowan agreed. "The audience was nearly all young women. I told them, 'This is what a full professor looks like at Penn. I'm working-class. I put myself through college. And I'm a lesbian."
She couldn't help thinking about that senior physician, now long gone from the school, and smiling to herself.