The coldest winter in Chicago’s history did not keep Natalia Nicholson indoors. Instead, she boldly confronted the cold on Saturday, February 15th with her performance “Drowning Mid-Air.” A graduate student in the performance department at the School of the Art Institute of Chicago (SAIC), Natalia and I first met on a panel called “Trans @ SAIC” last fall.

For her performance, Natalia wore a white slip dress, long white gloves, and angel wings, and stood on the edge of Michigan Avenue in high heels with a 40 pound block of ice tied to her genitalia. A taut white rope extended back from between her legs, connecting her body to the block of ice, situated about ten feet directly behind her. For fifteen minutes, her legs stood frozen in place in front of SAIC’s building at 112 S. Michigan, across the street from the famed museum. Her arms made slow, spiritual movements, outstretched and open to the grey sky.

natalia 3

Cars honked, pulled over, and almost collided while drivers watched Natalia’s performance. Passersby stopped to watch, took pictures, and made comments. A man misgendered Natalia to his son, people worried that she was freezing, and several women complimented her bare legs, which didn’t even tremble. One man stated succinctly, “She’s brave.” I am not sure he knows how brave she truly is.

My role was to keep time. Natalia asked me to walk up to her every five minutes, place my hand on her back, and ask, “Are you okay?” I did this three times throughout the performance. This simple gesture reminded me how important it is for trans people to check up on one another. Each time, Natalia responded, “Yes, I am okay.” But I know that’s not the full truth.

“Drowning Mid-Air” was not just a performance. It was a public protest, drawing attention to SAIC’s failure to address the immediate health concerns of its trans students, who make up 1.5% of the school’s student body—seven and a half times the national rate, according to the National College Health Assessment for 2013. That amounts to about fifty students, which doesn’t include trans faculty and staff at the school.

Natalia’s performance specifically targeted the exclusion of gender confirmation surgery from SAIC’s student health coverage. Fifty one colleges and universities in the country provide student coverage for hormones and gender confirmation surgery. At the panel last fall, I sat next to Natalia as she publicly declared, “What I want is someone from the administration right now to promise me that you will help me get my surgery.” Administrators never agreed to that promise. She broke into tears, realizing the school would not help her. In that moment, I turned to her and asked, “Are you okay?”

As a direct result of being denied access to gender confirmation surgery, Natalia is experiencing a worsening depression and persistent suicidal thoughts. Unfortunately, 41% of trans people have attempted suicide, compared to 1.6% of the general population. A recent study by the American Foundation for Suicide Prevention and the Williams Institute found that suicide rates for all trans and gender nonconforming people are “exceptionally high,” regardless of income, education, or relationship status.

natalia 2

At the panel last fall, Joe Behen, the executive director of the Wellness Center at SAIC explained, “You’d be hard pressed to find another school with as many LGBT people in a population as you’ll find here…We should be a model for support for LGBT students…What you’ve raised for us is the awareness that we’ve neglected; the T in LGBT.”

Behen has publicly stated multiple times that the school is working on updating its insurance policy for the fall of 2014 to cover hormones and gender confirmation surgery. That will be too late for Natalia. She will have graduated by then. In response, Natalia said, “I am not angry anymore. I am just doing the work necessary to ensure this history of discrimination isn’t erased by [the administration’s] intentions for fall 2014. I have been left behind, and I don’t want them to ever forget that.”

Natalia has not stopped fighting for access to the care she needs. She recently found out that SAIC’s insurance policy might cover her surgery if it is considered a “medical necessity.” This means she has to submit letters from her doctors to prove the surgery is necessary for her survival.

About her time at SAIC, Natalia said, “I never really had half a chance to learn while here. Imagine, in order to get the surgery, I must show that I have been suicidal and can’t survive without it. The notions of being able to engage fully in learning and being suicidal are totally incompatible.”

While Natalia’s ability to learn and her mental health have been negatively impacted by the lack of trans healthcare at SAIC, her tireless efforts have helped educate the school about the needs of trans students. She also noted, “although suicide was a constant presence in my thoughts for the three years I’ve been here, I’m still alive.” I hope to hear her repeat those last three words for many years to come.

Editor’s note: A version of this essay originally appeared on Original Plumbing’s website.