Lil Kalish

Last September, Riley headed to their clinic at Vanderbilt University Medical Center, which was usually brimming with chatter about the day’s research and patient needs. 

But that fall morning, Vanderbilt was thrown into chaos, and the clinic for gender-affirming surgeries, which serviced both trans youth and adults, had been shut down for the day. The health care worker, who is using a pseudonym in fear of retaliation from their employer, said the atmosphere among their colleagues in the trans health clinic was a mix of “fear and concern.” 

Riley’s clinic remained open, and their colleagues debated whether they were safe at work or should go home. Riley said local police were lined up outside the medical center’s doors, serving as extra security for employees. 

All day people whispered about the social media posts by right-wing blogger Matt Walsh, which had gone viral the day before for claiming that doctors at Vanderbilt’s transgender health clinic “castrate” and “sterilize” children.

At the time, Riley hadn’t heard of Walsh. They didn’t have social media and rarely watched the news.

But over the next year, Riley would witness firsthand — again and again — how misinformation and right-wing attacks on the transgender health clinic severely restricted the kinds of care they could provide at Vanderbilt. In those months,trans Tennesseans have felt more intimidated and desperate than ever, as they have been forced to decide whether to pack up their lives to find a place where they can exist without the fear of the government, or right-wing provocateurs, meddling in their private medical information. 

One of the first changes Riley saw was Vanderbilt moving the stand-alone transgender health clinic inside the university’s main campus in Nashville, Tennessee. The clinic also adopted new security measures, including an armed guard behind the desk, and required patients and providers to be buzzed inside. 

Riley said the medical center has even canceled appointments for certain surgeries for cisgender youth that currently do not fall into the category of gender-affirmation but that critics could see as “pathways to gender affirmation.” 

By the end of September 2022, Tennessee’s attorney general, John Skrmetti, said his office had opened an investigation into Vanderbilt’s transgender health clinic. Over the next few months, Skrmetti broadened the scope, first requesting specific patient medical records, and then information on Vanderbilt employees and volunteers at the transgender health clinic. The following spring, Republican Gov. Bill Lee signed a ban on gender-affirming care for transgender children, effectively suspending all operations at VUMC’s pediatric transgender clinic. 

Riley said they were one of more than a dozen clinicians who were told by Skrmetti’s office that their emails could be subpoenaed as part of the investigation.

“It feels like a witch hunt,” Riley told HuffPost. “What are you going to find in my emails? Obviously, there’s not a conspiracy here.” 

‘That Is Why I Am Working With Matt Walsh’ 

In September 2022, Walsh, a prominent Nashville-based right-wing talk show host and blogger, accused Vanderbilt University Medical Center’s transgender health clinic of only existing to turn a profit. He also claimed that Vanderbilt doctors “castrate, sterilize, and mutilate minors.” 

In a series of tweets, Walsh argued that the clinic was drugging and sterilizing children, and used language that LGBTQ+ advocates and Vanderbilt employees say grossly distorted the reality of pediatric transgender care. Walsh posted a video of one Vanderbilt doctor ― Dr. Shayne Taylor, who founded the clinic in 2018 ― discussing how gender-affirming surgeries, like double mastectomies and genital surgeries, could bring in “a lot of money” for the medical center. (In this video, Taylor, who did not respond to HuffPost’s request for comment, was mostly referencing surgeries for trans adults, as Vanderbilt never performed genital surgeries for minors.) 

In another video Walsh posted, a different doctor cautions that employees who don’t want to treat transgender patients on the grounds of religious objections “probably shouldn’t work at Vanderbilt.” At the end of the thread, Walsh wrote that the clinic’s peer support group, Trans Buddy Program, was in fact a “gang of trans activists” acting as “surveillance in order to force compliance.” 

Walsh tweeted later that evening that his “report” was just the beginning. “We are not going to let up,” he wrote. “We will shut this down.” 

The next day, Vanderbilt released a statement refuting Walsh’s claims. “Vanderbilt University Medical Center is now the subject of social media posts and a video that misrepresent facts about the care the Medical Center provides to transgender patients,” the statement read. “VUMC began its Transgender Health Clinic because transgender individuals are a high-risk population for mental and physical health issues and have been consistently underserved by the U.S. health system.” 

Walsh did not respond to a detailed list of questions for this story. 

Even when gender-affirming medical care for minors was legal in Tennessee, the first step was still typically social transition, such as a change in name, pronouns, dress or hairstyle. Once a child hit puberty, their families might begin the long process of consulting with behavioral health specialists, endocrinologists and primary care doctors about taking puberty blockers ― medication to temporarily pause the effects of puberty ― while weighing whether hormone replacement therapy might ease a child’s gender dysphoria later in their teens.

Over 30 major medical associations have deemed these standards of care medically necessary and “lifesaving.” 

Puberty blockers, which stop the body from making sex hormones, help slow unwanted secondary sex characteristics. They do not, as Walsh suggested, “sterilize” or “castrate” children, though the medication could pose some risks to fertility if they are administered too early in puberty. Studies show the effects are largely reversible, and the World Professional Association of Transgender Health recommends that providers talk with patients and their families about fertility preservation before starting medication. 

In the years since VUMC began providing gender-affirming care for transgender youth and adults, it grew into a holistic network of care, not only involving health care providers, but also spiritual care from a staff chaplain, weekly support groups, and insurance specialists, according to a panel of VUMC practitioners at an LGBTQ+ health equity conference this fall. 

VUMC performed fewer than a dozen top surgeries, or double mastectomies, each year for transmasculine patients in their late teens, according to Riley. Such surgeries require patients to undergo months of therapy beforehand, and a study published this summer showed that top surgery patients had little to no regrets decades after the operation. Both Riley and a VUMC executive, C. Wright Pinson, said that the hospital never performed “genital procedures” on minors. 

But Walsh’s claims caught the eye of Republicans in Tennessee, which, with its Republican-controlled legislature, had become a paragon of a one-party state. 

Hours after the tweets, Lee called for a “thorough investigation” into VUMC, and Skrmetti vowed to use the “full scope of his authority” to ensure the medical center was complying with state law. 

The investigation appears to have started as early as the following morning, according to emails from Republican state Sen. Jack Johson, which HuffPost obtained through a public records request. “The Governor has already opened an investigation into Vanderbilt and I will be filing legislation to prohibit this when we come back into Session in January,” Johnson wrote to one supporter on Sept. 21, the morning after Walsh’s tweets. (The governor’s office told The Associated Press that day that it had passed along concerns about VUMC to the attorney general. Lee’s office recently told HuffPost over email that the attorney general has the “statutory authority” to open an investigation.)

The following day, Johnson responded to emails from supporters who were shocked by Walsh’s allegations, reassuring them that he was on the case — and had help.

“I absolutely agree that these surgeries should not be allowed on children,” Johnson wrote to one. “That is why I am working with Matt Walsh to introduce legislation in our upcoming legislative session to ban these transgender surgeries on children in Tennessee.” 

Skrmetti’s office has said it began its probe in September 2022 after receiving a report about a Vanderbilt doctor who “publicly described her manipulation of medical billing codes to evade coverage limitations on gender-related treatment,” which raised concerns about possible fraud in the state’s Medicaid plan, TennCare. (The plan specifically excludes “sex change or transformation surgery.”) 

In August 2023, a reporter with Nashville’s News Channel 5 interviewed Skrmetti. The segment showed portions of the video that Skrmetti says instigated the report: In it, Taylor discussed how she supports patients whose insurance plans don’t cover transgender health care, including saying she might write that a patient has a hormonal disorder for billing purposes so that she can order lab work for patients. 

Skrmetti, in the interview, said it was “very easy” to initiate the investigation because his office was “already aware of the potential billing issues there.” He acknowledged that the probe into medical records is “probably terrifying” for patients but said there is “no political exception to the fraud laws.”

When reached for comment, Skrmetti’s office referred HuffPost to the interview with News Channel 5 and did not respond to other questions for this story. 

As the investigation went on, Skrmetti requested the private medical records of more than 150 Vanderbilt patients who used TennCare. John Howser, a Vanderbilt spokesperson, said the clinic was “compelled” to produce copies of the records, while also complying with state and federal law including HIPAA. However, many LGBTQ+ and privacy advocates across the state and country signaled they were upset that VUMC didn’t fight harder to prevent turning over patient information in the investigation. 

Riley said they were “flabbergasted” to learn about the attorney general’s inquiry into the center’s billing process. “There’s so many levels of oversight and protection from that kind of false billing,” they said. “It doesn’t pass the test of reason. Providers don’t do the billing. There’s a whole department of people that review the documentation and the code.”

Patients were not told until June of this year that their records had been turned over to the attorney general. Skrmetti’s office had said it kept its “run-of-the-mill” investigation private in an attempt to avoid a “media circus” — even as it continued to broaden the scope. The attorney general requested additional patient and employee data, including the names of patients who had been referred to VUMC’s trans clinic but did not seek treatment there; information on insurance claims to TennCare; employee tax forms and emails about gender-affirming care, as well as employees’ resumes and employment contracts; and information about the clinic’s Trans Buddy volunteers.

Skrmetti’s investigation and Vanderbilt’s release of records have been criticized as an egregious overstep, and the latest ― and largest ― use of data requests by a state to undermine access to gender-affirming care. 

“Trust between patients and their doctors is essential to quality care, and we regret any concern this may have caused for our patients,” Howser said in a statement to HuffPost.

In the past year, as Republican-led states have increasingly passed anti-trans legislation, GOP officials nationwide have leveraged data requests about transgender residents as one of their many tools to restrict access to medical care. In Missouri, the attorney general requested and failed to obtain medical records on trans youth, while in Florida, Gov. Ron DeSantis probed state universities for data on how many students sought out gender-affirming care on campus clinics. More recently, 19 Republican attorneys general ― including Skrmetti ― signed a letter pushing back against a federal rule that would shield states from requesting data on patients seeking abortion out of state. 

Many trans health advocates inside and outside the state said Walsh’s posts about Vanderbilt not only seemed to provide pretext for the probe and ban on gender-affirming care, but that his inflammatory language and framing took the doctors’ words out of context and grossly mischaracterized the kinds of care that minors were receiving at the clinic.

“The biggest thing I’ve seen is just the sheer amount of terror of families of trans youth. People are really terrified that the state is going to either try to take away their children from them or put them on some kind of watch list or try to invade their privacy. There’s just a lot of fear in Tennessee right now with families,” Lucas Cameron-Vaughn, a staff attorney at the ACLU of Tennessee, told HuffPost in July. 

Cameron-Vaughn is one of the attorneys representing the families of trans kids in L.W. v. Skrmetti, the American Civil Liberties Union’s ongoing lawsuit against the state’s ban on gender-affirming care for transgender youth. The ban was recently upheld by a federal appeals court ruling.

“It may sound extreme to you when I say that we’re living in a totalitarian state,” Democratic state Sen. Heidi Campbell told HuffPost. “Before I became a state senator I don’t think those words would have come out of my mouth. But it’s really just the truth. There are no checks and balances in this government anymore. We’re seeing that with Skrmetti, who is hired by us to protect the people who live in this state, and is actively attacking our own citizens.” 

‘State-Sponsored Intimidation’ 

On Sept. 21, 2022, just one day after Walsh’s initial “report” about VUMC, he tweeted that he had met with Johnson and Republican state Rep. William Lamberth to work on a bill to end gender-affirming care for youth. A few weeks later, ahead of the state’s midterm election on Nov. 8, Lamberth penned an opinion piece promising he would “partner” with Walsh to halt that care for minors if he were reelected to the House.

Cameron-Vaughn wasn’t surprised that Walsh’s posts lined up neatly ahead of the state’s election. “It seems like this sort of campaign against Vanderbilt was designed to scandalize Vanderbilt University Medical Center’s gender clinic by creating a deliberately false narrative right before the election,” he said. 

Lamberth and Johnson both won their bids for reelection, and filed identical bills to ban care for minors months before the start of the 2023 legislative session. In February, as the bill passed swiftly through committee meetings, Walsh attended a House meeting to give an expert testimony. 

State Rep. John Ray Clemmons, a Democrat who represents Nashville, was one of few legislators to question Walsh’s expertise and knowledge of best practices for transgender youth during a committee meeting on health.

“What qualifies me is that I am a human being with a brain and common sense and a soul, and therefore I think it’s a really bad idea to chemically castrate children,” Walsh said during questioning. 

“You don’t use [your research] to get clicks on your publication?” Clemmons asked. 

When the bill passed swiftly through each chamber of Tennessee’s government, it was clear to Clemmons that Walsh was something new. He was the gasoline reigniting an already burning fire in Tennessee. Republicans had long been trying to pass various bans on gender-affirming care, but had been largely unsuccessful. In 2021, Tennessee succeeded in barring doctors from prescribing hormone therapy for prepubescent minors — which in reality, advocates say, was not even happening in the state. 

But this opened the door for Lamberth and Johnson to go further. Their legislation allows the state to ban puberty blockers, hormone therapy and gender-affirming surgeries for all transgender minors. Youth who are already receiving care will have to terminate it by March of next year, and providers have already begun weaning adolescents off hormones. 

Walsh’s voice had eclipsed the dozens of opponents to the bills ― including transgender youth and their parents, LGBTQ+ advocates, and clinicians ― who showed up each week at the statehouse to share their stories about how access to gender-affirming care was very often the buffer between life and death. 

Clemmons said he watched with horror as Walsh and his media outlet, the Daily Wire, helped steer conversations among some of his colleagues.

“Obviously the attorney general in this state is taking marching orders from him, which is embarrassing considering he’s not even elected,” Clemmons told HuffPost, referring to Walsh. “This is a new brand of extremism that’s very dangerous, that openly admits to wanting to burn books on the House floor, that openly admits to wanting to limit people’s rights. It’s scary.” 

“This is state-sponsored intimidation and that’s never played out well in history,” he added.

The attorney general’s office declined to comment on its relationship with Walsh. 

Lee, the governor, signed the ban into law at the beginning of March.

“This kind of bill had been filed in previous years and did not pass because there were divisions among Republicans on intervening in medical decisions. But there was an almost complete lockstep unanimity that they were going to pass the bill in 2023,” said Chris Sanders, the executive director of the Tennessee Equality Project. 

“So Mr. Walsh is the first mover on this in a lot of ways in terms of getting a consensus built in the Republican caucus. He is not the first to think of it, but he’s partly responsible for jelling the consensus in Tennessee.” 

By the end of the session in April, Tennessee had also become the first state to pass a ban on drag performances, in addition to enacting laws that defined sex as a person’s “immutable biological sex,” and allowed teachers to misgender students. 

Since 2015, Tennessee has enacted 19 anti-LGBTQ+ laws, more than any other state in the country. 

‘An Attempted Hostile Takeover’

This all might not have been possible if Walsh’s workplace hadn’t been given a royal welcome to the Volunteer State. 

The Daily Wire, a one-stop-shop of conservative entertainment and merch — including original documentaries, TV shows, children’s programming and “woke free” razor blades ― has been likened to the right’s answer to Hollywood with a roster of conservative hosts including Walsh, Candace Owens and Jordan Peterson. 

The company, which was co-founded by columnist Ben Shapiro, relocated its headquarters from Los Angeles to Nashville in 2020. The next year, Tennessee state lawmakers passed a resolution to embrace Shapiro and his “truth seekers,” and celebrate their move out of “liberal California.” 

“We congratulate Ben Shapiro and his associates at The Daily Wire on their relocation to Tennessee and extend to them our best wishes for continued success in discovering and disseminating the truth,” the resolution stated. 

Campbell is highly critical of how her colleagues rolled out the welcome mat for the conservative company. “This is an attempted hostile takeover of Nashville because they really want Nashville to be their first right-wing big city,” she said.

By the time Walsh moved his family to Nashville, he was already practiced in “exposing” the ills of same-sex marriage and laws that protected transgender Americans’ rights to use the bathroom that aligns with their gender. 

“Millions of Americans have lost their grip on reality,” he wrote in a 2014 blog post arguing that trans people don’t exist. “This is the real crisis, and it’s far more urgent than most of what they’re talking about on the news right now.” 

In the past few years, however, Walsh has turned toward a “just asking questions”-style attack on trans people. He built up mainstream notoriety and a career of lecturing at colleges after the release of his 2022 documentary, “What is A Woman,” which also sows doubt about the existence of transgender people. A self-described “theocratic fascist,” Walsh has also argued that trans people are “groomers” and part of a cult, and made posts mocking immigrants and Black people. 

And last August, Walsh responded after the right-wing account LibsofTikTok posted a barrage of false claims about the care Boston Children’s Hospital provides. He called on his followers for “an organized effort to fight back against the drugging and mutilating of children.” Then the hospital, which is the country’s first pediatric transgender health program, received two separatebomb threats. Walsh brushed off the threats as a “leftist hoax.”

Tennessee Republicans have echoed similar anti-trans rhetoric.

At the end of 2022, the Tennessee Republican Caucus sent out a survey, asking constituents for their opinions about a number of issues including abortion and parental rights in schools. In a section called “protecting children,” the survey asks conservatives if they favor policies preventing “minors from cutting off healthy body parts in order to change their gender identity.” There weren’t any questions about guns or firearm reform in the survey, even though the Tennessee Department of Health found that the leading cause of death for children in the state was homicide, 86% of which were due to gun violence. 

Late last October, Nashvillians had a glimpse of what Walsh’s version of the Music City might look like when he held his “Rally to End Child Mutilation” at the state Capitol, which garnered around 1,500 protesters, including some Proud Boys. 

There was Walsh, the bespectacled and bearded 37-year-old, standing on stage alongside Johnson and Lamberth, as well as other conservative figures including Sen. Marsha Blackburn (R-Tenn.) and former Rep. Tulsi Gabbard (Hawaii), who announced that she was leaving the Democratic Party last year. Other right-wing media stars, including Chloe Cole, an 18-year-old detransitioner who has testified across the country in support of bans on transition care for minors, also took the stage to speak.

“We are all here today because of this information that Matt brought forward and showed what was taking place just down the street right here in Nashville, and showing how the radical left is trying to put their woke agenda on every single family in this country,” Blackburn told the crowd.

State Sen. Janice Bowling (R) was also present, passing out fliers with what she called “graphic” photos of genital reconstruction surgeries some transgender people may choose to undergo. After the event, she wrote to Johnson that many of the rally’s attendees didn’t know “about the assaults these surgeries are on the bodies of these children,” according to emails obtained by HuffPost. (Two Vanderbilt employees have confirmed to HuffPost that the center never performed genital surgeries on children, as is standard among clinicians of trans care.) 

“Upon looking at the photos, their resolve to ‘stay the course in our opposition’ was magnified,” Bowling wrote. “A picture is truly worth a thousand words.” 

‘Misinformation Is Like A Snake’ 

Patients were shocked to find out that their personal medical information had been shared with the attorney general — and some experienced emotional whiplash when they learned they might have been misinformed about their records being turned over. One family of a trans teen who spoke to HuffPost was first notified in June that Vanderbilt had turned over the teen’s records; two months later, the medical center told the family the teen’s records weren’t among those given to Skrmetti. 

By then, the family, which requested to remain anonymous due to concerns for their safety, had already driven hundreds of miles to North Carolina to make sure their child could continue hormone therapy. 

“We depend on our care providers to be honest with us,” the mother told HuffPost. “They have precious lives in their hands. I don’t know whether to believe this or not.” 

In early September this year, a spokesperson at Vanderbilt confirmed that not all of the 150 records that were originally requested by Skrmetti were shared with his office. 

“We have since confirmed that records for only 82 of these patients were provided to the Attorney General’s office,” said Howser, the spokesperson for VUMC, in an emailed statement to HuffPost. “After learning of this, we notified the remaining patients, whose records were requested but not provided, that their records have not been produced to the Attorney General’s office.”

Howser did not respond to further questions about why only 82 records were shared and whether the records of the remaining patients could be shared with the attorney general in the future. 

“Obviously the attorney general in this state is taking marching orders from [Walsh], which is embarrassing considering he’s not even elected.”

– Democratic state Rep. John Ray Clemmons

The chaos, fear and lack of clarity surrounding the investigation has affected how VUMC operated over the last year. In addition to changes in health care offered, the medical center has removed some information about gender-affirming care from its website. 

Riley said they can understand why Vanderbilt did what it could to avoid unwanted attention ― but said such changes did a disservice to those who might look to the clinic as a resource.

“Because of people like Matt Walsh, it forces that whole practice into the shadows, which has a negative impact on patients in that now they may not know about the practice because there’s no media presence about it,” Riley said. 

Even with multiple statements rejecting Walsh’s claims, it has been an uphill battle to dispel the factual errors about the clinic. “Misinformation is like a snake,” Riley said. “It just moves and shifts and you can say anything you want about facts and have all the patients that have had excellent outcomes…but it doesn’t make a bit of difference to the attorney general.” 

Though the clinic can no longer provide gender-affirming medical treatment for youth, Riley said they and their colleagues are “more in it than ever before” as they continue to service trans adults. 

“We’re more supportive even if we’re not able to do all the things we were able to before. It kind of galvanizes a community of people to say, ‘This is wrong. We’re going to keep doing the right thing,’” they said, emphasizing that the care they provide complies within the bounds of the state’s law. 

Clemmons believes that Skrmetti is “abusing his discovery powers that require no judicial oversight,” and the state’s actions are ushering in “a whole new day of invasion of privacy.” But he is hopeful that the time will come, not too far down the line, when the flames fan out. 

The results of the national midterm elections showed that running on anti-LGBTQ+ rhetoric has been a losing battle for Republicans. 

Still, right-wing media continues to influence voters in a way that has shifted their political ideology to further extremes ― and now politicians are trying to play catch-up. 

Ari Drennen, the LGBTQ program director at Media Matters, who has spent much of her time tracking Walsh’s rise, said Walsh was able to capitalize on his boost in followers after the Boston Children’s Hospital incident and translate that into a similar push of vitriol in his home state. 

“I think part of the dynamic is that many Republican politicians, including in the presidential race, are competing in a field of voters who’ve been radicalized by personalities like Matt Walsh and who are expecting to hear the same rhetoric from politicians that they’re hearing in podcasts and on YouTube,” she said. “And so I would say that it’s a case of politicians chasing Walsh’s audience more than the other way around.” 

“Nashville has fought hard to be a community that welcomes everyone, and Matt Walsh has just come in and disregarded that by homogenizing the politics in the city.”

– Roberto Che Espinoza, a trans divinity scholar and Baptist clergyperson

The impact of Walsh’s rhetoric ― and Skrmetti’s ongoing investigation ― could not be any more palpable than in the stories of transgender youth and adults who are trying to find the ways to relocate to more trans-friendly states or venture on long journeys to receive medical care elsewhere. 

The Tennessee family of a trans teen said their out-of-state trip was only possible with the help of a $500 grant from a nonprofit. They worry about future appointments, which will be expensive and are increasingly challenging to find. States across the South — including North Carolina, which had for many been a safe haven in the region — are banning transition care for youth. 

“We’ll probably have to shuffle some things around to pay for it,” the mother said. “We will still have electricity and running water and a house to live in. There may not be as many fun or extra things going on.”

Vanderbilt is now the subject of a larger federal investigation by the Department of Human Health Services for its allegedly “unauthorized” release of medical records. And in July, two former Vanderbilt patients filed a class-action lawsuit against the medical center, alleging it had violated their privacy by turning their records to Skrmetti. The suit is ongoing but VUMC’s attorney has filed motions to ask the judge to dismiss the case. 

Howser, the Vanderbilt spokesperson, declined to comment on the federal investigation or the class-action suit. 

‘Weaponization Of Religion’

For some Tennesseans, the only path forward is to leave.

Roberto Che Espinoza, a trans divinity scholar and Baptist clergyperson, left the state last month after learning his medical records had been shared with the attorney general. (Espinoza, who is in his 40s, has not received an update about his records from Vanderbilt.) 

Espinoza lived in Nashville for six years. He was active in the local LGBTQ+ community and often participated in social justice movements across the South, including protesting against white supremacists at the “Unite the Right” rally in Charlottesville, Virginia, in 2017. 

When Espinoza saw Walsh’s posts about Vanderbilt, he went on Twitter to speak up about what he saw as a hateful distortion of Christianity.

“I was really vocal about the weaponization of religion and the dehumanization that the extreme right is peddling,” he told HuffPost. “I just tried to do my part as both a Christian minister and for my fellow trans comrades who are just trying to live their fucking lives.”

After that, Espinoza said he started getting harassed on Twitter. 

“Nashville has fought hard to be a community that welcomes everyone, and Matt Walsh has just come in and disregarded that by homogenizing the politics in the city,” he said. 

The week before he was set to receive gender-affirming surgery at Vanderbilt, Espinoza said the Proud Boys targeted him on Telegram. His wife told him, “I don’t know how much longer I have with you.” 

Espinoza said he went from being active in Nashville’s queer religious community to feeling like a prisoner in his own home: “It was a very scary time and no way to live.”

The release of his medical records this summer was the last straw. Espinoza crowdfunded $12,000 to leave the South. 

He and his wife have been building a new community in the woods. Espinoza has been enjoying grilling outside and lifting weights, and is grateful for the mundane moments of life. “I am sleeping at night and eating three meals a day,” he said. “I am able to leave my house without anxiety. It’s wonderful.” 

At certain times of day, Espinoza cannot help but feel those twitches of grief. He never wanted to leave the South. He misses the “slow time.” He misses porch visits. But he would rather be “exiled” in the north than feel the weight of fear and anxiety he shouldered not too long ago. 

Riley, however, is determined to remain in Tennessee, even as they worry that they and their colleagues will one day be pushed out of the state because of fear for their own personal and professional safety. 

“I think the right thing to do is to stay,” they said. “If we all leave, then that’s exactly what they want. It just becomes one homogenous place.”