WASHINGTON (AP) — A middle-of-the night trip to the emergency room, with her 9-month-old son coughing and laboring to breathe, gave Pam Yorksmith her latest reminder of why she took up the fight for same-sex marriage.
Before baby Orion could be treated for croup, the hospital had to call his birth mother — Yorksmith's wife, Nicole — "to get permission to treat my child," Yorksmith said.
Although the Yorksmiths started their family together through artificial insemination, hospital records and Orion's birth certificate don't list Pam Yorksmith as a parent.
Beyond the right to wed, gay and lesbian Americans in the 13 states that continue to define marriage as the union of a man and a woman confront obstacles across the course of their lives, from adoption to hospital visits to death benefits.
The Yorksmiths live in Kentucky and work in Ohio, both states that ban same-sex marriage. That complicates school enrollment, benefits, travel and tax matters, as well as medical care.
They are among the 19 men and 12 women whose same-sex marriage cases from those two states, plus Michigan and Tennessee, are expected to be decided in the coming days. Many of them spoke to The Associated Press about their cases before the justices heard arguments in April.
Some sued for the right to marry, while others are fighting to have states recognize a marriage performed elsewhere. They include young parents and grandparents, as well as a couple of grieving men who already have lost their life partners.
Some have never known a moment's fear about living life as an openly gay person.
Others, like Luke Barlowe and Jimmy Meade, still don't hold hands in public, even after more than 40 years together.
"We grew up in an era where you didn't show your affection for a same-sex person," Barlowe said. "We've never gotten over that."
Barlowe and Meade met in 1968 at the Gilded Cage, a gay bar in Lexington, Kentucky. Both retired, they married in Iowa in 2009 and live about an hour outside of Louisville.
"We wanted to do this not for us — it does nothing for us — but we wanted to do it for the kids coming up behind us," Barlowe said.
Once the couple signed up for the lawsuit, they finally felt they could stop living in the shadows.
Meade had a doctor's appointment recently and Barlowe filled out his paperwork. In the blank asking for their relationship, Barlowe did something he hadn't done before. He wrote "husband."
"It was the strangest feeling," he said. "Even after all these years."
April DeBoer and Jayne Rowse were not planning to challenge Michigan's ban on same-sex marriage when they went to court to win the right to jointly adopt each other's children. A federal judge transformed their case into one about the right to marry, and the nurses have become celebrities in their Detroit suburb of Hazel Park.
"We've been stopped multiple times at our local shopping center with people just telling their story. These are people's lives that we've changed," DeBoer said.
They live with their four adopted children, ages 2 to 6, and a foster child. Each woman has adopted two kids, but Michigan ties joint adoption to marriage.
"We decided that not doing anything would do more harm to our children than standing up and saying we're going to fight," DeBoer said.
DeBoer is a part-time neonatal nurse while Rowse works full time as an emergency room nurse. They hope to adopt a fifth child soon.
"These young children usually have medical needs," DeBoer said. "We have training. We have room. We have the love."
Sgt. 1st Class Ijpe deKoe and Thom Kostura were married in New York in 2011, just before deKoe deployed to Afghanistan with the U.S. Army. The Army has since moved them to Tennessee.
They have a game they play on the many road trips they take from their home in Memphis.
Each time they cross into another state they declare, "We're married!" or "We're not married!" — depending on whether the state recognizes same-sex marriage.
"I wish we could register for gifts every time we cross a state line," Kostura said.
Those trips mimic daily life for deKoe, an Army Reserve sergeant on active duty. His marriage is considered valid while at work at a military base in Millington, Tennessee. But back home in Memphis, there is no legal recognition for his nearly 4-year-old marriage to Kostura.
In 2013, Jim Obergefell and John Arthur were watching TV news about the Supreme Court striking down part of the federal anti-gay marriage law. Obergefell leaned over, kissed the man he had loved for more than two decades, and said, "Let's get married."
They knew they didn't have much time. Arthur was in the final stages of Lou Gehrig's disease.
Ohio voters had banned same-sex marriage. So within weeks, a medically equipped plane carried them to Maryland, where Arthur's aunt waited to officiate. Arthur lay on a gurney as the couple exchanged their vows inside the plane, on the tarmac.
Less than four months later, Arthur died at age 48. Obergefell was listed on the death certificate as his surviving spouse; the couple had won a court order before Arthur's death to make it so.
That victory was overturned by the federal appeals court in Cincinnati, which upheld the same-sex marriage bans in Kentucky, Michigan and Tennessee as well.
Obergefell also has run into problems with survivor benefits and he worries about being excluded, after his own death, from a family cemetery plot that Arthur's grandparents set aside for married spouses and direct descendants.
None of it was a fight Obergefell and Arthur were looking for.
"No one could ever accuse us of being activists," Obergefell said, smiling. "We just lived our lives. We were just John and Jim."
Associated Press writers Claire Galofaro in Louisville, Kentucky, Travis Loller in Nashville, Tennessee, Dan Sewell in Cincinnati, and Ed White in Detroit contributed to this report.