Like any family, Katie and her son Ray had their road trip staples. They always packed sour peach candy. They talked more than they listened to music, and they played a game they called Nature. Anyone who spotted an animal racked up points, though the exact number depended on the species and an in-the-moment car vote.

Katie wanted to win. She looked for turtles as she pulled her SUV onto the highway around 9 one morning in early May, but her eyes went blurry with fear. She couldn’t make out anything in the distance.

“I’ll play once we get closer,” she told Ray.

Katie had done all she could to prepare for this trip. She’d asked a relative to pick up her two younger boys from school. She’d researched how to change a tire, and she’d spent hours on Google Maps, searching for the closest Walgreens in Alabama. She’d finally found a destination in Thomasville, a rural town nearly 200 miles from their suburban Mississippi home, but much remained unclear. Would they make it by noon for Ray’s telehealth appointment? Would the pharmacy give him testosterone?

Katie looked at her boy, a thin 17-year-old with wavy hair and an easy grin, and she asked herself the question that had begun to matter least: Was she breaking the law?

Two months earlier, Mississippi had banned transgender young people, like Ray, from accessing hormones or other gender-transition treatments. By mid-spring, nearly half the country had passed similar bills, according to the Movement Advancement Project, and now, 1 in 3 trans children lives in a state with a ban. Conservative lawmakers said they’d pushed the bills to protect young people, but Katie felt like they’d done the opposite. Testosterone had allowed her son to embody himself for the first time. Ray was present, happy. The ban would take that happiness away.

Across the country, families were doing everything they could to protect their trans children. Some uprooted their lives in red states for the promise of protections in blue ones. Others filed lawsuits. Katie couldn’t afford to move, and she needed a solution faster than the courts could offer, so she’d settled on a cheaper, quicker plan: She’d take a day off from her nursing job, and she and Ray would travel out of state for his medical care.

“It says we’ll be there by 11:48,” she said.

She knew that Mississippi’s law contained a rare aid-and-abet clause that prohibited adults from helping a minor transition. She didn’t understand the particulars, and she didn’t know what would happen to her if she broke it, but she cared less about penalties than she did about Ray, and so, the day the ban passed, she decided she’d do anything to keep her son well. (Katie and her family spoke to The Washington Post on the condition that they be identified by only their first names out of concern they could face legal consequences.)

Initially, Katie didn’t know where to go. Nearly every state within 700 miles had banned gender-affirming care for minors, and a trip to Illinois would have taken three days. She didn’t have vacation time or hotel money to spare, so the Midwest was out. The best option, she decided, was a tenuous one. A year earlier, Alabama lawmakers had passed one of the country’s first bans, but a judge had temporarily blocked the legislation, which meant teenagers could still get hormones there, at least for now.

“I guess I’m just going to Meridian, then a little farther,” she said. “I know how to get to Meridian, right?”

“I have faith in you,” Ray said.

He reached across the console, and Katie’s stomach twisted. She had told Ray she would fix this one way or another, and he believed her. But Katie couldn’t control lawmakers, and she had no idea what the pharmacist would do.

The border appeared a few minutes after 11, and Katie relaxed just a bit. She grabbed Ray’s hand.

“Welcome to sweet home Alabama,” she said. “Where you’re safe, for now.”

Care disrupted

Katie used to think Ray was lucky to be born when he was. Earlier generations of trans people had little or no access to gender-affirming care, but by 2019, when 13-year-old Ray told Katie he was a boy, even conservative states like Mississippi had a handful of providers who knew how to help him.

Nearly every major medical association has endorsed gender-affirming care for minors since 2012, and by the time Katie and Ray’s dad, Jody, found a pediatric endocrinologist at an LGBTQ clinic at the University of Mississippi Medical Center, the treatment was fairly standardized. Ray saw a therapist for a year, then, when he turned 15, a doctor prescribed Depo-Provera, an estrogen suppressant sometimes used as a puberty blocker. The clinic staff monitored his bloodwork and bone density.

At the time, no state prohibited transgender children from taking puberty blockers or cross-sex hormones. But in March 2021, a month after Ray started blockers, Arkansas passed a ban.

Katie figured Arkansas was an anomaly. A year passed, and in February 2022, she gave Ray his first testosterone shot. Then, seemingly overnight, the mood shifted. Texas authorities opened child abuse investigations into families with transgender children, and Alabama lawmakers approved the country’s second ban. Human Rights Campaign workers told Katie they believed Mississippi might be next.

No, Katie told them. Mississippi wouldn’t do that. The trans community was so small, it hardly seemed worth the public resources. Ray didn’t know any other kids receiving gender-affirming care, and public hospital data shows that the LGBTQ clinic treated just nine minors in fiscal 2020, and only 15 in fiscal 2023. None had surgery.

Katie understood some Mississippians might be slow to accept trans people. She hadn’t wanted to believe Ray at first, and her heart broke when he first cut his hip-length blonde hair to his chin. But she’d listened to him, and she’d trusted his doctors, and she’d seen the difference the care made in his life.

Before Ray came out, the physical world pained him. He coughed every two minutes, and he blinked nonstop. He spent so much time with imaginary animal friends, a teacher once told Katie he needed “help.” After he started blockers, Ray joined a theater group, and he seemed present in a way he never had. He stopped coughing and blinking. He made real friends. He earned straight A’s.

Katie figured they had time. The legislative session didn’t start until early 2023, and she believed that lawmakers would listen when she and others told them about their trans children. But in October 2022, someone from the LGBTQ clinic left a voice mail for Jody and told him they would no longer treat Ray. (Katie and Jody are divorced but share custody.)

The person didn’t say why, but a Mississippi Today investigation later found that hospital officials halted treatment after conservative lawmakers demanded to know how much state money went to the clinic. Mississippi spent just $1,215 on the clinic last fiscal year, according to a legislative report, and Medicaid paid the clinic $24,122 in claims over the last three years.

Hospitals across the region were doing the same thing, Katie learned. A gender clinic in Dallas closed after Texas Gov. Greg Abbott’s office began looking into it. In Tennessee, Republican lawmakers pressured Vanderbilt University Medical Center to pause gender-affirming care for minors. And in Oklahoma, Gov. Kevin Stitt threatened to withhold $108 million in coronavirus relief from one of the state’s largest hospital systems if it did not stop providing gender-affirming care to children. The hospital complied.

Katie panicked after officials at the LGBTQ clinic said they would no longer treat Ray. Didn’t the doctors worry about taking a kid off hormones with no notice? What if Ray spiraled? He already became depressed every three months when his puberty blocker wore off. If he had to stop testosterone, his period would return, and Katie didn’t know what would happen to his body. Desperate, Katie and Jody found another LGBTQ clinic, a small one two hours south.

It didn’t take insurance, and it didn’t offer therapy or bone density scans like the hospital had, but the nurse practitioners there could write hormone prescriptions, so Ray and his dad drove down one Monday last November, and Katie met them at the clinic.

That solution was short-lived. Three months later, in February 2023, Mississippi passed the Regulate Experimental Adolescent Procedures Act. The law not only barred Ray from medically transitioning in Mississippi before he turned 18 but seemed to prohibit his parents from helping him find care elsewhere.

Katie knew she’d do anything to help Ray. Still, driving out of state felt like a temporary solution. How many times could she risk it? And what would happen if Alabama’s ban eventually took effect?

The appointment

Half an hour into Alabama, Ray spotted two turtles, and Katie eyed her phone with alarm. The map had shifted their arrival to 1 p.m. Maybe she’d missed a turn, or maybe they’d lingered too long at a gas station where they’d stopped to use the restroom. She wasn’t sure, but the map seemed firm. They were nowhere near Thomasville.

Katie had planned to do the noon telehealth appointment in the pharmacy parking lot, but now they needed a new plan. She looked out the window. She saw a long stretch of pine trees and little else. The highway lacked even a good shoulder.

“I don’t know where we’re going to pull over to do this appointment,” Katie said. “Where do people go to town around here? Where do they Walmart?”

Ray handed his mom a sour peach. She took it but didn’t eat it.

“Well, we’ll definitely see some nature this way,” he said.

Technically, Ray could see any doctor in Alabama, but the last few months had made Katie suspicious. She didn’t want to take her child to someone who might reject him, and so, with the help of the nonprofit Campaign for Southern Equality, she’d found a company called QMed that offered online appointments to patients in 26 states.

Izzy Lowell created QMed six years ago because few providers across the South treated trans patients. Even without laws restricting their care, many trans people had to drive hours to find an affirming doctor. Lowell got licensed in a dozen states, including Alabama and Mississippi, then offered virtual appointments to patients who couldn’t or didn’t want to drive long distances for health care.

Lowell eventually expanded to half the country, and for years she mostly treated adults, but that changed as states banned young people from receiving care. Teenagers now make up 20 percent of her caseload. Still, Lowell is beholden to state laws, so she couldn’t see Ray — even virtually — if he was physically in Mississippi.

Katie had talked to Lowell on the phone, and the doctor had explained the particulars. As long as Katie and Ray were somewhere in Alabama, Lowell said, they could log into the telehealth app, and Lowell could treat him.

As they rambled along the highway, Katie fretted. Logging trucks clogged the roads, and the horizon looked bleak with possibility. The map didn’t show a single city.

She feared they’d never find a place to pull over, but then, at 11:56, a country store appeared. It had a tin roof, an old gas pump and a dozen handmade signs, and Katie was so overwhelmed by the sight, she sped past it. Half a mile down the road, she reconsidered.

“Should we have stopped there?” she asked Ray. “Should we turn around?”

Ray looked as uncertain as Katie felt, but he nodded, so she swung a wild U-turn and headed back. She pulled into the gravel parking lot with just a minute to fill out his intake forms.

“It’s asking me for your vital signs,” she told Ray. “I have a stethoscope. I could listen to your heart. I’m just going to guess the others.”

“Alive,” Ray said. “Is that an option?”

She tried to enter his height and weight, 5-foot-6 and 135 pounds, but the app screen went blank.

“Oh, no,” Katie said. “We’ve only got one bar out here.”

She held her phone out the window, but the service didn’t improve. Katie clicked over and over again, and at 12:04, Lowell’s face flickered into view.

“Can you hear us?” Katie asked. “How are you doing? Can you hear me?”

“I think our connection isn’t great,” Lowell said.

Lowell’s video crackled, then disappeared, but eventually, the service stabilized long enough for the doctor to ask Ray when he realized he was a guy.

“I’ve always leaned on the masculine side,” Ray said. “I would steal my brother’s clothes. I refused to wear dresses. We realized I was trans about 12 or 13, and then I went to the gender clinic, and after eight months with a therapist, I got the diagnosis of gender dysphoria. A year later, they put me on puberty blockers. So from 15 to 16, I was on those blockers. I received a shot every three months. Then at 16, they put me on testosterone. I continued the blockers for a while with the testosterone. And then my world fell apart with the laws. And now we’re here.”

Katie looked at Ray, and she felt a frustrating mix of sadness and pride. He was far more mature at 17 than she had been, but she worried he’d matured because he’d had to.

“So, Ray,” Lowell said. “What dose are you on currently?”

He blushed and pointed at Katie. She’d administered each of his testosterone shots.

“That’s a question for my nurse,” he said.

“We’re doing point three mills weekly,” Katie said.

Lowell asked how Ray felt on that dose, and he flashed a thumbs-up. His voice was deep, and he’d grown a rough blonde stubble, but he hoped to get labs done so he could know how his testosterone levels looked. He’d had an appointment scheduled for March, but after the law passed, the nurse practitioners at the new clinic explained that they weren’t even allowed to talk about gender-affirming care.

“We could have gotten bloodwork done, but nobody could have communicated with us about it,” Katie said. “I know some lab values, and I guess I could have tried to look at it, but that’s kind of crazy.”

Katie’s hands shook, and the phone jerked side to side, but Lowell remained calm. She told Katie and Ray she could read the lab results. The treatment for gender dysphoria isn’t complicated, she explained, even if the rash of new laws has made acquiring it so.

Lowell asked Ray a string of questions about his medical history, then she suggested they pause the appointment so she could submit the prescription, and Katie could call Walgreens to see if there would be any issues. Ray had legally changed his name two years earlier, but his dad hadn’t been able to update his health insurance yet. A pharmacist might balk at filling testosterone for someone with a female-sounding name, so Lowell wanted to address any problems before Katie and Ray drove to Thomasville.

“Okay,” Katie said. “Awesome.”

She used Ray’s phone to call the pharmacy, and it rang so long, she thought she might vomit.

“Hi!” Katie said, a little overzealous when a pharmacy tech finally answered. “I had a prescription called in for my child, and I wanted to see if you guys have started on it yet.”

The tech put Katie on hold, and as she waited, the telehealth app connecting them to Lowell went black. They’d lost the connection.

“No, no, no,” Katie said. “How stupid am I? I didn’t even think about being in the country.”

Ray told her the cell service would come back. Lowell would help them, and Walgreens would come through. He smiled the big, beaming way he’d learned in theater, and Katie sank back into the driver’s seat. She wanted to believe he was right.

“It says it needs a prior authorization,” the tech said. “I can send that to the doctor, and she can fill out the paperwork and send it to the insurance. Once they do all that, they will send it back to us with a fax and a paid claim within 24 to 48 hours.”

“No, no, no,” Katie said again. “We got to get it today. How much is it out of pocket?”

The tech laughed.

“Uh, $400,” she said.

Katie had received a grant from Southern Equality to pay for the $250 telehealth visit. She didn’t have a spare $400 to spend on testosterone, and a night or two at a hotel was out of the question. She needed to get back to work and her other sons.

Ray slumped in his seat, and Katie thumbed through her wallet, as if one of the cards might present an answer.

“Katie? Ray?”

The telehealth app reconnected, and Lowell’s face sharpened into view on Katie’s screen.

“I found a GoodRx coupon,” the doctor said. “I’m looking here. It’ll cost you $76.”

The tech took down the coupon information and said the prescription would be ready in half an hour. Katie’s stomach turned as she hung up both phones.

Federal regulations prevent patients from stocking up on testosterone, and Katie couldn’t afford to make day-long trips to the pharmacy every month. She had credit cards to pay down, and she needed to work every nursing shift she could. Plus, the Alabama law could go to trial this summer. The temporary injunction might go away.

She had decided that this was the last road trip they could do. Ray’s dad had taken a job near Washington a few months earlier. In July, after Ray finished his sophomore year of high school, he would move to Virginia to live with him.

Katie hadn’t slept more than a few hours at a time since they’d decided, but she didn’t see another way. She couldn’t keep Ray in a state whose leaders legislated against him.

“I feel nauseous,” she told Ray. “Maybe we should eat?”

The country store sold lunch, so they went inside. Katie ordered a barbecue sandwich with a Diet Coke, and Ray chose pimento cheese and a bottle of sweet tea. No one else was around, but Katie craned her neck, vigilant, as they sat at a table with a blue-checked cloth.

How would Mississippi go after people for aiding and abetting, Katie wondered. She’d heard people could sue her for violating the law. Did driving count, or did the clause specifically apply to administering medication? If Ray learned to give himself the shot, would that be okay?

Ray swigged half the bottle of tea in one gulp, and Katie set her drink down. As hard as this day had been, she would miss moments like these with her boy.

“You know,” Katie said, “in Virginia, they won’t have sweet tea.”

She barely got the sentence out. Ray looked up, and when his blue eyes caught hers, Katie buried her face in her hands, and cried.

One last road trip

After lunch, they climbed back into Katie’s SUV, then headed south. Katie spotted a pasture full of cows, and Ray claimed points for three goats. When a gigantic something smacked across their windshield and left behind a residue, they yelled “Nature?” in questioning unison.

Katie worried she didn’t have much time left to be his mother, so she used the drive to dispense advice.

“In the future,” she told Ray, “if you’re ever in a wreck, you have to call the police and call me. Actually, call me first.”

Ray nodded. He promised he would, but they both knew he wasn’t a reckless driver. He was careful with everything — his school work, his siblings, the homemade pastas he made once a week. He’d told the younger boys he’d be moving soon, and his 12-year-old brother cried every time it came up. The youngest was only 4, and Ray worried he’d forget him when he was gone.

“We’re going to spend as much time together before you leave, okay?” Katie asked.

“I know,” Ray said.

He picked at the hem of his jeans and stared out the window. He wanted to leave Mississippi. He’d read online that Virginia had a Republican governor but a Democrat-dominated legislature, and he assumed they wouldn’t pass a ban there, at least not before he turned 18. But Mississippi was his home. He’d miss his brothers and the Okatoma Creek, the food, his friends.

“I’ll always hold a fondness for the state of Mississippi,” Ray said. “But it doesn’t welcome me with the same arms that I welcome it with.”

“But you won’t come back,” Katie said.

Just after 2 p.m., they drove into Thomasville, where a sign claimed that the 3,500-person town was “Southwest Alabama’s Success Story.”

They passed a catfish restaurant and a tractor supply store, then the Walgreens appeared around a corner.

“I want you to stay in the car,” Katie said. “I feel like they’re more likely to fill it if it’s just me.”

She was anxious to know how it would all work out, but she took her time making her way to the pharmacy. She used the restroom and stopped to look at a Pride display of rainbow caps and bow ties. She often wore a rainbow sticker on her badge at work, and straight people usually didn’t say anything, but she didn’t know if that would change. Conservative pundits had begun calling for boycotts on anything Pride-related.

Today, at least, the display seemed like a good sign. She turned toward the pharmacy and approached the counter with a nervous hello.

“We just had a prescription called in?” she said.

A pharmacy tech searched the computer system, then walked away to talk to another tech. Eventually, the tech returned with a bag. She stared at the name on the front and held up the bag with a questioning look.

“Is this you?” the tech asked.

“It’s my child,” Katie said.

The tech waved at the pharmacist, then pointed at the bag. The pharmacist shrugged.

“Are you taking this to the doctor’s office to inject?” the tech asked.

“No,” Katie said. “We do it at home.”

The tech asked how she planned to inject it, and Katie said she had plenty of needles at home. A minute went by, and the tech didn’t say a word. Katie’s arms and legs shook. She told herself the Diet Coke was a mistake.

“Okay,” the tech said finally. “You’re all set. It’s going to be $76.92.”

Katie’s shoulders relaxed. Her legs stopped shaking, and her voice lilted up.

“Thank you,” she said. “Thank you so much.”

She felt dizzy with joy. She smiled at every customer, and she waved to the clerks as if they knew how big this moment was. She pushed through the doors into the bright afternoon, and when she made it to the parking lot, Ray opened the car door and jumped into her arms.

“You did it,” he said.

They hugged until they were both crying, then Ray pulled the vial out of the bag.

“We did it,” Katie said. “We did it.”

On the way home, Ray texted his boyfriend about a Cajun goat cheese alfredo he wanted to cook, and Katie smiled until her jaw ached.

“I feel more relieved than I have in months,” she said. “I can’t think of a single thing I have to worry about.”

She knew that relief was temporary. Soon, Ray would be gone, and she’d be left with a hole where her sweet teenage boy should be. For now, she tried to enjoy the last hour of their road trip. They talked about road kill and theater camp, boys and a new Greek restaurant they wanted to try. Eventually, once they crossed back into Mississippi, they went quiet.

The sun sank on a field of donkeys, and three cows sat, waiting on rain. Katie and Ray claimed every point they could, but in the end, nobody won.