For the past two months, physician assistant Mia McDonald and Dr. Ly Pham – one in North Carolina, the other in Louisiana – have been steady warriors in a battle with a beast that has ravaged this nation.

Their spirits have sagged with defeat, been buoyed by hope. There have been moments of calm, hours of exhaustion.

But an uneasy reality haunts these LGBTQ health care workers on the front lines in the coronavirus pandemic: They are employed in states where they could be fired for their sexual orientation and gender identity.

The U.S. Supreme Court is expected to rule soon in a trio of landmark cases that could guarantee federal protections to LGBTQ workers such as McDonald and Pham. The timing couldn’t be more urgent, advocates say. 

“Like all health care providers, LGBTQ people are standing up to personal and professional challenges in this pandemic. They are risking their lives and lives of their loved ones so patients get care they need and deserve,” said Hector Vargas, executive director of GLMA: Health Professionals Advancing LGBTQ Equality.

“It’s unacceptable that they are providing care today and face potential dismissal tomorrow,” he said.

Almost half – 47% or 386,000 – of LGBTQ health care workers live in states that have no legal job discrimination protections, according to GLMA and The Williams Institute at UCLA. That means the workers could be fired, rejected for a promotion, refused training or harassed at their jobs.

Those numbers mirror the dynamic for all LGBTQ people: 28 states, including North Carolina and Louisiana, lack explicit state laws prohibiting employment bias based on sexual orientation and gender identity, according to the Movement Advancement Project, a think tank maintaining a database on equality laws.

Justices are expected to rule on challenges from New York, Michigan and Georgia involving workers who say they were fired because they were gay or transgender. The cases center on whether Title VII of the Civil Rights Act of 1964, which outlaws employment discrimination based on race, color, religion, national origin and sex, prohibits bias against LGBTQ people.

Before the pandemic, the cases were viewed by many as consequential as the court’s 2015 gay marriage ruling. Now, this extraordinary public health crisis has raised the stakes, said Kasey Suffredini, CEO of Freedom For All Americans, a bipartisan campaign for nonbias protections for LGBTQ people.

“These vulnerable LGBTQ health care workers are out there trying to keep everyone safe,” Suffredini said. “It is a moment where the collective well-being for everyone … means we have to follow CDC safety measures. We need every health care worker possible.”

'Worried I wasn't able to help everyone'

Emergency rooms are the office for McDonald, 36, a physician assistant at Moses Cone Hospital in Greensboro. During flu season pre-pandemic, the main ER could be packed with more than 300 patients a day, she said.  

While the volume has decreased somewhat, McDonald said, the stress levels are high. The ER is seeing a steady stream of COVID-19 patients and last-minute emergencies such as a ruptured appendicitis. There are fewer heart attack and stroke patients.

“People don’t come to the ER now unless they absolutely have to,” she said. “The community is scared. They don’t want to be ‘where the virus is.' ’’

McDonald normally clocks in at 10 p.m. and travels to several ERs in Cone Health's network. She keeps her PPE in her trunk, walking into work past the cars of family members now forbidden to enter the ER. 

“You have to keep going. But there is a mental anguish you feel when you go into your shifts. Patients are by themselves; you have to give them news by themselves,” she said.

“There was a point I just felt so low. I was worried I wasn’t able to help everyone, was worried about the community,” she said. ”You just don’t know what happens to these patients, so it leaves you with this big space where you continue to worry.”

McDonald, who identifies as a cisgender lesbian, said she is starting to rebound thanks to a supportive work environment – and a partner of nine years, to whom she got engaged in December.

But the Supreme Court cases are “definitely always in the back of my mind,” she said. “I am fortunate to have a job right now, but things in the health care world are changing every day. I was the only person not furloughed or laid off on a conference call last week with 12 people.”

'Try to stay on the hopeful side'

Pham, 32, who identifies as queer and non-binary, is an internal medicine physician at Ochsner LSU Health Shreveport.

The hospital’s level-one trauma center was busy pre-pandemic. Now it’s “crazy busy” with a constant “looming stress” since COVID-19 erupted, Pham said.

Pham’s days usually crank up at 8 a.m. and can run to midnight when they are on call. One of the hardest things Pham has had to deal with is “saying no” to family members who want to visit sick ones at the hospital.

“I try to stay on the hopeful side. But you can slide down,” Pham said. “Every time you take a step into the hospital it’s an extra layer of stress.”

While Pham lives in a city with a nondiscrimination law, Louisiana has no such workplace protections. They bump up against bias on a regular basis. “I’m misgendered everyday by patients and co-workers.” 

Pham relies on music and a supportive fiancee who is a mental health counselor to help unwind. The couple are planning their wedding and an eventual move to Los Angeles.

A favorable Supreme Court ruling will assure that they would “not have to hide” in the workplace and beyond, Pham said. “l want youths to know it’s possible to be yourself and still be a successful doctor in any field.”  

'A moment Americans can relate to'

McDonald feels for LGBTQ people who can’t be “out” on the job, especially health care workers toiling during the coronavirus crisis. “What are things like at home, how are your kids, how are you coping – I can’t imagine not sharing what is going on beyond the walls of the hospital.”

But she can relate to those feeling forced to be closeted.

McDonald came out when she was 25 – but not to her father, who was ill. Family members warned her not to come out or “it would kill him,” so she stayed silent about her true identity for years.

“Every time you are on the phone, there is always a lump in your throat … don’t let it slip,” she said.

She finally told her father in the spring of 2017 when she was in PA school. His poignant reply through her tears: “Mia, I have known this for years.”

McDonald’s dad passed away in January 2019, but the memory still resonates.

“Having to do that for years on a personal level, I understand what it’s like for others to work in a place without protections,” she said.

Suffredini said the weight of the hour should not be lost.

“In every moment of crisis, we have always seen LGBTQ people on the front lines helping out other Americans,” such as Mark Bingham who fought hijackers onboard a United flight on 9/11, he said.

“I hope this is a moment when Americans can really relate to being afraid you could lose your job or you could lose health care for reasons you can’t control,” he said. “I hope Americans make that connection.”