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April 16 was the day Spencer was supposed to be getting a hysterectomy. It was a long-anticipated day for Spencer, a transgender Portlander, since he had been on a waiting list for the procedure—a necessary part of his medical gender transition process—for two years.

As it became clear in March that COVID-19 would upend normal life in Oregon, he learned that he’d have to keep waiting. Spencer, who asked the Mercury not to use his last name because of privacy concerns, got a call from Kaiser telling him that his procedure date was postponed indefinitely. The news came as a crushing blow.

“I deal with pretty intense mental health issues,” Spencer said. “Having the surgery date for the hysterectomy was the one thing I was looking forward to… I worked so hard for this for so long, and I was finally getting there. And now, they are pretty much like ‘We can’t give you another surgery date, because we don’t know what the future holds.’”

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Hospitals and medical systems across the state are pausing all non-urgent medical procedures in an effort to make more space for coronavirus patients and slow the spread of COVID-19. That means Spencer is one of many Portlanders who are seeing delays in medical care that, while not life-threatening, take a toll on their mental and physical health.

Spencer said he understands why his surgery needed to be postponed, but that didn’t lessen his serious disappointment.

Adding to Spencer’s uncertainty is the fear that he’ll be laid off from his job in childcare before socially distancing ends, and will lose the insurance coverage that makes his medical transition affordable. He said that his insurance coverage is the only reason he’s remained at his current job.

“It’s just scary not knowing what the future holds, and not knowing if this is going to be an option when this is over,” he said.

Portlander Danielle Marcus has also seen her mental health suffer during the pandemic. Marcus gave birth to her first child in February, after a 30-hour labor that included complications and left her with physical and emotional trauma. In March and the first half of April, several follow-up appointments with Marcus’ doctor were cancelled because of COVID-19. Her doctor offered to do telehealth visits via video call instead, but Marcus said that option “would be pointless,” since those appointments required a physical exam.

On top of the missed medical appointments, the general isolation that comes with social distancing was particularly hard on Marcus, who experienced depression and anxiety even before giving birth.

“Postpartum recovery is hard enough under normal circumstances— you’re sleep deprived, stressed out, hormonal, and trying to let your body physically recover from trauma, all while caring for this brand new life that is entirely dependent on you,” Marcus wrote in an email to the Mercury. “It’s also one of the most isolating periods women can experience. But then add into that everything that’s going on with the coronavirus and you have a recipe for mental health crises.”

Marcus said she’s turned to online support groups for new parents, which help her feel less isolated.

“However, recently all they’ve been discussing is COVID-19,” she wrote, “which can have more of a fear mongering effect than a feeling of support.”

After experiencing swelling that she feared was a serious infection, Marcus was able to finally schedule an in-person appointment with her doctor in late April. But she still has no guarantee of regular follow-up appointments, and she continues to feel isolated in her daily life.

Medical delays experienced because of COVID-19 can include serious hardships like the ones Spencer and Marcus are facing. But even for more mundane issues, the effects of waiting for treatment can add up.

Rachel Hand, who recently was laid off as an assistant manager at McMenamins’ Oregon City pub, has orthodontic braces that she paid about $5,000 for. But as her routine adjustment appointments continue to be pushed back, she’s increasingly worried her costs will increase. Every eight weeks she goes without an adjustment, she said, likely represents an extra couple hundred dollars she’ll have to pay to keep her braces on longer.

On top of that, her braces grow more uncomfortable with each week that she doesn’t receive needed adjustments.

“Whenever your teeth shift, the wires they put at the back start to poke at the back of your mouth,” Hand said. “Before I got braces, I thought I had a high pain tolerance. But I don’t think I do anymore.”

Hand doesn’t know when her orthodontist will begin seeing clients for non-emergency issues again. She said that when she calls the emergency number her orthodontist gave to clients, they tell her to “push through it.”

The Mercury spoke with another trans Portlander who, like Spencer, fears a key gender-affirming surgery will be delayed. (She asked to be kept anonymous because of privacy concerns.) Hers is scheduled for July, and hasn’t yet been canceled.

“I haven’t really allowed myself to start thinking about the possibility—and probably the likelihood—that my vaginoplasty is going to be canceled this summer,” she said. “But when it hits that point that it will be canceled, that’s just going to break me. That’s going to hit really hard, because I have been waiting pretty much my whole life for this thing.”

In addition to likely missing her scheduled surgery date, she is also currently missing electrolysis, or hair removal, appointments. Hair removal is necessary for vaginoplasty, meaning that even when social distancing ends, she’ll have catch-up work to do before she can get the surgery she’s spent the last two years on a waitlist for.

Her dilemma is just one example of how medical care delays from COVID-19 create a “domino effect,” she said.

“It’s a bigger ripple effect than just the time when we are in quarantine,” she added.