Eeny Meeny

I have always been fascinated by the idea of choice –the philosophy of choice. What does it mean to choose? Does the act of embracing one thing necessarily exclude the other, or merely prejudice it? Blemish it? Dishonour it? Alternatively, given an either/or situation, is it possible to throw the pair into a box and merely choose the box? After all, that’s (sort of) what Set Theory allows mathematicians to do –group together unlike things with common properties for analysis.

It seems to me there are several types of choice that range from necessary to frivolous, each with its own particular reason for being made, and each with its own particular set of consequences. Some choices are imposed from without, and some from within; some have to be made, while some are voluntary. Personal. The most compelling ones –for me, anyway- are those in that box –that set

The issue surfaced again for me after reading another BBC news article on non-binary gendering: http://www.bbc.com/news/magazine-37383914  I published another essay on this topic in July, but there I was more concerned with managing its language eccentricities: (https://musingsonwomenshealth.com/2016/07/13/non-binary-gynaecology/ ) I realized even then that there was much more to it than language, but the more recent BBC article really brought that home. How can you choose between two things when you are both? It would be like choosing between your son and your daughter –a Sophie’s Choice.

And yet, it would seem that Society feels more comfortable with identifiable categories –in this case, they’re usually anatomically assigned, so from that perspective, they’re not exactly arbitrary… Just unfair. Insensitive. Closed…

Perhaps my long career as an obstetrician/gynaecologist has blurred the gender boundaries as thoroughly as it has the social, economic and ethnic ones. When you get right down to it, we’re all more alike than we might like to think, and categories eventually leak like unwaxed paper cups.

I take the bus a lot nowadays –I’m not sure why, really, except that I enjoy watching those around me. And listening. Sometimes I feel a little like Jane Goodall, only my country is the bus, and my subjects, are people, not chimpanzees in deepest Africa. The other day, I happened to be on a rather crowded vehicle just after the local public schools had opened their gates. Standing next to me in the aisle were two young girls, both around eleven or twelve years old judging by their looks. Each was wearing jeans, sneakers, and coloured ski jackets, and both were hugging their backpacks to their chests, for some reason. One, a rather tall girl with short, brown hair and horn-rimmed glasses, was rummaging in her pack for something while her friend –a blond with hair that she had tied into a rather messy ponytail, watched with interest.

“Do you have any gum in there, Cindy?” the blond said, peering into the caverns of her own pack.

“No… I was just looking for some lipstick,” she said proudly, glancing at me as she said it.

“What! Your mom lets you wear lipstick?”

The tall girl blushed at the response. “Well it’s just reddish Chapstick, but it, like, reddens my lips, too…”

The blond nodded collegially, and then pointed at the two seats in front of me that had just been vacated. After that, only scattered bits of their conversation filtered back to me.

“Yeah… sometimes, I do Cindy,” the blond said, nudging her friend.

“But you said…”

“I said sometimes!”

Then Cindy elbowed her softly, as if she understood completely. “I’ve sometimes wondered what it would be like…”

“It’s kinda confusing -every so often, anyway…”

“You mean choosing which…?” Cindy seemed puzzled.

I could tell that the blond had to think about that. Then she shook her head thoughtfully. “No, more like who I am when I try to think about it…”

Cindy looked at her for a moment and then straight ahead, as if she was suddenly embarrassed. “Aren’t you just ‘Connie’? I mean no matter what you feel like, aren’t you still a Connie?”

Connie was quiet for a moment. “I guess…” They were both silent for a bit. “I don’t think names really matter though, do you Cindy?”

Cindy shrugged and looked at her. “I suppose as long as you answer…”

I could hear Connie giggle at that. “I’m still Connie… But whatever you call me, it’s still me inside.

Cindy nodded slowly but I could tell she was still perplexed about her friend. “Have you…Have you told Father Simms?”

Connie immediately shook her head vigorously and the little ponytail almost came undone. “No way! He’d just tell my parents.”

“How about your mom and dad then?”

“Mommy thinks it’s just a phase –hormones kicking in or something…”

“Well…”

“Cindy I’ve always felt like this; I just didn’t say anything.” She glanced out the window and nudged Cindy again. “Better pull the cord. It’s the next stop.”

Cindy looked up and then obliged. But as they passed me, I could hear Cindy’s concerned whisper -as if it wasn’t something she dared to say it in a normal voice. “But how come you don’t think like the rest of us in the church?”

“How do you know I don’t?” Connie said with a laugh, and they both stepped off the bus, giggling.

I thought about it for a while before my stop came. If I hadn’t just read the BBC article on non-binary gender, I would have assumed they were simply talking about God. But now that I’ve had more time to replay the conversation in my mind… I’m not so sure. Maybe I was granted a privileged audience with someone very special.

 

 

Acknowledging the Mind’s Eye

Sometimes, in the midst of a problem –in the midst of an era- the resolution derives not so much from the answer as from the acknowledgement that there is an issue to begin with. I find it interesting that Nature has given us an ability to adapt more efficiently -to ignore, I suppose- that which arises gradually than that which falls upon us as an event –interesting, because that allows us to discount something until it results in complications. Difficulties. It is the Janus view of evolution, I suppose.

An article in the BBC news alerted me to one novel approach to encourage acknowledgment of an issue that has plagued some societies for what seems to be millennia: sex selection –or perhaps, more honestly,  destruction:  www.bbc.com/news/world-asia-india-37034444

It got me thinking… We tend to cherish and preserve what we value; we neglect, or abandon that which we don’t. Denigrate it, even. Perhaps an occasional nudge in the ribs may cause us to look around and see where we have wandered –realize that there is really no need to stand so close to the edge.

But it does give one pause for thought –how do some of these things become imbedded in a culture? Surely they don’t start out as intentionally malevolent. Or is that being revisionist and unduly naïve? I’d like to think that some of the customs, however egregious we find them now, were products of a different time when other priorities required precedence. Confusing times, perhaps, when we barely knew who we were in our overarching need to identify and fend off them. Troubling times beneath the roiling waters in which we are just beginning to be able, however slowly, to surface for air.

And the problem, as always for those of us less afflicted, is acknowledgement –recognition that there is more to do. There is always more to do…

Despite being a gynaecologist for more years than I can remember, I suppose I have always lived in a man’s world. It’s hard not to wear the clothes you were assigned. And yet, every so often, that usually-locked door is knocked ajar briefly, and the light from within is blinding. Unintentionally heuristic.

I was sitting in a busy coffee shop recently and managed to find a tiny unoccupied table against a windowless and shadowed wall in the corner. Perhaps it camouflaged me -made my presence less noticeable, my gender less obtrusive- but as I sat there staring silently at the busy room, fragments of conversation from the next table floated past like dust motes in the feeble light. Two women were catching up on their lives. I didn’t mean to listen, but sometimes words are beacons: currents, vacuuming up the air between –meant to be heard, meant to inform. It’s hard to ignore words when you sit in shadows.

“And so how is Janice doing now?” a grey-haired woman in pigtails wearing black track pants and a yellow sweat shirt asked between gulps of coffee and grabs for the oversized chocolate cookies she had balanced precariously on her plate. She clearly had little need of more calories, but the presence of her more sizeable friend likely justified the debauch in her mind. It works for all of us, I think.

Her friend just shrugged amicably. “You know what it’s like, Dory,” she said, and launched into her bagel as if she were packing a box. “Kids are kids…”

Dory munched softly on a cookie and considered the issue. “She’s hardly a kid, now, Alice. She’s, what, seventeen?”

Alice nodded her head equally thoughtfully and her long dark hair slid back and forth over her shoulders like a wash cloth. Although considerable larger than her friend, she carried her weight gracefully, and with the gravitas that suggested a person of authority. Dressed in what seemed in the dim light to be an expensive white silk blouse I could make out little ruffs on each wrist. I don’t normally notice such things, but with each movement of her arms, they risked coating themselves with cream cheese from an impertinent bagel, now lying in fragments in front of her. “Eighteen…” She took a delicate sip from her coffee and sat back on her chair as if the subject required a little more thought.

“Still, she should know where she’s headed by now…” Dory left the question of direction open, but her eyes betrayed her opinion. “I mean, who she is…” she added, italics begging for attention.

Alice sighed and leaned forward again to pack another item into her waiting mouth. “I think she’s always known.”

“And how about you?”

Alice smiled and nodded. “Some things a mother just knows, Dory.”

Dory was obviously trying to understand, but her confusion was apparent, even to accidental eyes watching from the shade. She shook her head, disapproval hovering over her like a cloud. “Did you ever to speak to her about it, Alice?”

Alice’s eyebrows both rose at the same time. “Whatever for, Dory?” she said, genuinely puzzled at the remark.

It caused Dory to sigh rather more loudly than necessary. “Well, I would have thought…”

Alice refurbished the smile she’d sacrificed to the bagel and leaned an elbow on the table. “Thought what?”

Dory straightened her back like a boxer ready to receive a blow. “Well… that…”

“That my daughter would think the same way as her mother? She learned the Theory of Mind when she was five, Dory.” Her friend visibly winced at that. “The world is different for each of us, Dor,” she said, reaching out and grasping Dory’s hand. “And the question should not be why, but rather, how can I best negotiate it…?”

Dory tried to smile, but even from the shadows I could see her lips twitching with the effort. “Do you think if…” But she was clearly too embarrassed to finish her thought –and anyway, I could see Alice shaking her head and squeezing her hand affectionately.

“Somethings just are, Dory. And my main duty as a mother is to help her to accept them.” She let go of Dory’s hand and picked up her coffee for a sip. “And to help others to accept her…”

“But…” There was a hint of helplessness in that one word.

“But what’s not to love, eh?” she said, glancing towards the door and standing up to wave at a smiling teenager gliding towards them like a boat about to dock. And then Janice waved back, just like anybody else…

Non-Binary Gynaecology

There was a time when I thought I had a handle on gender, but things change: it’s no longer constrained by only two choices. And then I thought I understood the variations on the theme of sexual preferences. I even learned their names. Now I’ve discovered that no less an authority than the New York Times has decided to recognize that the use of ‘they’ might, at times, be acceptable in referring to a person without disclosing the sex (and therefore prejudicing the choice)–as in, say, ‘When the leader of the delegation announced the agenda, they did so in English.’

I thought I was keeping up. I thought I finally understood the intricacies of gender politics, but I realize that I am still challenged. I am still floundering in the choppy waters of an incoming tide. I’m going to have to stop reading the BBC news online:  http://www.bbc.com/news/magazine-34901704

Okay, I realize that having to use the ‘he/she’ device in the interests of universality (biversality?) makes for some tough slogging for the reader and makes an article, or a story, almost unreadable. But, in my naiveté, I assumed this was just a way of being inclusive: a way of recognizing that past generations had assumed the use of ‘he’ as a universal designation was a convention that was not meant as an exclusion –more like an unthinking shortcut that nobody had challenged.

So I have to say that I was certainly not expecting ‘they’ to evolve so rapidly into the demand for non-binary pronouns; the concept of American universities embracing signs like ‘Ask Me About My Pronouns’ caught me completely off guard. As the BBC article attests, ‘The alternatives to “he” and “she” are myriad.’ Indeed, ‘A linguist at the University of Illinois, Dennis Baron, has catalogued dozens of proposed gender-neutral pronouns, many – including “ip,” “nis,” and “hiser” – dating back to the 19th Century.’ Who would have thought…?

Fortunately –for me, at any rate- ‘[…] Baron calls the gender-neutral pronoun an epic fail and reckons that new pronouns such as “ze” may not survive. But both he and Sally McConnell-Ginet, a Cornell University linguistics professor who researches the link between gender, sexuality, and language, think the singular “they” – as used for example by Kit Wilson – has a chance of success.’

But languages change; preferences and acceptabilities mutate: ‘…English has a precedent for a plural pronoun coming to be used in the singular – the pronoun “you”. Until the 17th Century a single person was addressed with “thou” and “thee”. Later “you” became perfectly acceptable in both plural and singular.’ And then of course, the obverse ‘you-all’ (or the highly recognizable ‘y’all’ in some southern U.S. states’ dialects) -a merging of singular and second-person pronouns.

Now I suspect that much of my confusion at all of this probably stems from my perspective at the night-robed end of the age spectrum. From this spot, there is a tendency to view change as either unnecessary, or spurious -change for the sake of change. I admit my hesitation to embrace the need for even more twigs on the already-gnarled and pot-bound grammatical family tree which is already in desperate need of pruning. Perhaps it needs another pot entirely. Maybe that is what is intended.

I suppose I should have been prepared, though; I think I had a foretaste of it several years ago in my office.

Lynne and Elin were so alike, they could have been twins. Both sat entwined like ivy in a shadowed corner of the waiting room. They weren’t conspicuous or inappropriate, just, well, close. As I busied myself at the front desk with some forms I had to print, I noticed others waiting nearby stealing glances at them while pretending to be absorbed in some magazine or other. Both with short dark hair, identically-coloured light blue shirts, unbuttoned at the neck, and loose, black jeans they scattered no useful gendered clues to the increasingly curious audience.

They both shook my hand when I approached, and both quietly accompanied me down the corridor to my office. I encourage patients to invite their partners to come with them to the consultation, but in a gynaecological practice, embarrassment –or a desire for privacy- often limits the participation of one of them. But not with these two. It was like inviting the flower without the stem.

Even when they seated themselves in front of my desk, I was still uncertain of their identities. Who was Lynne, and who was Elin was only part of the puzzle. I suspected that Elin might be a male partner, but when I heard him/her speak, I couldn’t be certain. Then I entertained the possibility that they were indeed twins –although more likely not identical ones- and that, like many twins, they did things together, whatever their gender.

It was Lynne who had been referred, however, so trying to be respectful of their homogeneous appearance, I stared intently at my computer screen to avoid their eyes, and asked which one of them was Lynne.

A knowing smile passed between them, and the one on the left put up his/her hand like she/he was in a class. “I’m Lynne, doctor,” she said, looking amused. “And this is my partner Elin,” she added, looking proudly at him/her and then reached for their hand.

I was speechless for a moment, but I tried to hide it with a smile and then a nod in his/her/their direction. “I see,” I finally managed and then, looking at Lynne, promptly crossed some sort of a line when I continued with, “I glad you invited her to be with you.” I said it to be polite and inclusive, but I suppose I also said it as a way to establish Elin’s gender. They both stiffened immediately.

“Elin does not recognize gender identity, doctor,” Lynne said in a tone that brooked no contradiction.

“Nor does Lynne,” Elin tossed at me.

“I don’t want to be limited in who I am,” Lynne chimed in. She wasn’t trying to be provocative I don’t think, but I know she realized the effect it would have on me, because her eyes hardened and her forehead wrinkled like a professor introducing a new concept to a fidgeting, skeptical class. “Sometimes I’m both, and sometimes neither… I am what I am in the moment.” She said that with such fervour that one eye actually closed with the effort.

I think she was daring me to question the possibility of a modern-day Janus -the two-faced god of transitions. Instead, I was intrigued and I could see it surprised both of them.

I nodded in acceptance, smiling to myself all the while. I’d never considered the idea before, and I found it fascinating. “So, if I may acknowledge my naiveté in such things, may I ask how you would refer to Elin –in conversation, for example? Which pronoun would you use –masculine or feminine, or…?” I left it open so she/they could offer her/their preferences.

“Well,” Lynne started after a long look at Elin, “we considered ‘ze’ as kind of a neutral pronoun at first, but it sounded sort of… weird. Then we tried ‘ey’ –sort of a slurred mixture of the conventional choices- but everybody seemed to think we had just mispronounced ‘she’ or ‘he’ and tried to clarify it for us.” Lynne shrugged and squeezed Elin’s hand. “I hate binaries,” she added as a sort of postscript.

“So we’ve decided just to use our names instead of other gender-obfuscating pronouns,” Elin said and smiled, satisfied that using the word ‘obfuscating’ somehow deposited the problem behind them. “I mean, if you think about it, even the concept of ‘binary’ suggests that there are only two choices: male and female. We know that is no longer the case,” he/she/they/ey/ze concluded. And I suppose for them (I am allowed to use ‘them’ apparently), it wasn’t.

Lynne suddenly looked at her/their watch and glanced at Elin. “I’m so sorry doctor, but we have to catch a bus to the airport to meet Elin’s mother. I didn’t realize the appointment would take so long…” It was obviously a lame excuse – an escape mechanism, they’d probably used before, but I let it pass. Whatever Lynne’s gynaecological problem, she/Lynne/they felt it could clearly wait for another visit.

Actually, I didn’t think it had taken any time at all –I hadn’t even asked her/them/Lynne why she/they/Lynne thought she/Lynne/they been referred. But I guess pronouns are slow-moving beasts, so I just smiled and asked her/them/Lynne if she’d/Lynn’d/they’d like to schedule another appointment at a time when Lynne/they/Elin could stick around a little longer. I didn’t say it like that, of course –it would have taken far too long and they/Lynne/Elin were obviously in a hurry.

Lynne/Elin/They smiled at me when they/Elin/Lynne left so Elin/they/Lynne obviously didn’t feel they/Lynne/Elin were not heard. And I, at least, felt I’d taken the pulse of a new and perhaps metastasizing condition; I had learned something new about the world. I have two regrets however. One of them is that I never saw them/Lynne/Elin again so I couldn’t pursue my gender education any further; but mainly, I never was able to discover whether Elin was male or female… not that it would matter to either of them, I guess.

 

 

 

 

 

The Yang of Yin

We are, it would seem, a binary species and we live in a binary world where opposites define each other. Think, for example, of up and down –the one depends on the other for its very existence: there is obviously no up without a down with which to contrast it. Good/bad, in/out, light/dark, near/far… even the code written into our computers -the list of inter-dependent binaries is endless.

Perhaps the most famous –and arguably the earliest- recognition of this interdependence is the Chinese concept of Yin and Yang. Without pretending an esoteric knowledge of historical linguistics or an abstruse Sinological background, the meanings of Yin and Yang can be superficially understood as ‘shady’ and ‘sunny’ respectively, and seem to date from sometime in the fourth century BCE.

I suppose the reason this complementarity is so fascinating to me is the implied rejection of the rule of the Absolute. One would seem to need, say, a seller for the concept of ‘buyer’ to exist. And by extension, perhaps, the presence of evil for good to become manifest –although I recognize that to be a bit of semantic trickery. But at any rate, it is an interesting idea to play with.

Binarity –to neologize- has its limits, however. Or at least its two components can be seen as bookends that confine an entire shelf of not-quites. The concept, as we often find after sufficient investigation, can be that of a spectrum, with intermediates melding imperceptibly into their shelf-mates.

Labels, while they help us to identify things, can also lead us astray. I will cover this idea more fully in a later essay, but suffice it to say that a label can be merely a societal/cultural attempt at categorization –a name that simplifies the issue of what to make of the entity. Where to put it. How to interact with it.

For now, however, I would like to touch briefly on whether or not the hitherto necessary binary assignation of gender is anachronistic. There was a helpful BBC News article that brought this to my attention:  http://www.bbc.com/news/health-35242180  and while I have certainly touched on gender issues in past essays, https://musingsonwomenshealth.wordpress.com/2014/07/03/the-asexual/  and https://musingsonwomenshealth.wordpress.com/2013/01/18/gender/ for example, the idea that gender is a labile concept is one that my generation, at least, often finds challenging.

And yet, if one can step back from the anatomical signposts that have directed us for millennia, is the binary assignation of male or female really all that important a predictor of who, or for that matter, what a person is? We’ve always known that different people manifest different characteristics and we even apply societally accepted terms to allow them to maintain their positions within the otherwise ordained sexual designations. We use such terms as ‘effeminate’ for a man who seems at odds with the perceived norms for masculinity, or ‘tomboy’ for a young girl who seems to run with the other team –although I admit I haven’t heard that word applied since I was young myself (perhaps the term is now ‘butch’ although I find it offensive and somehow demeaning). My point, though, is not what words we use, but that we have always found ways to describe someone who does not quite fit into normative –or what the majority may describe as normative- assignations. In other words, a tacit realization –and acceptance- that gender cannot be captured by genitalia alone.

It is not a new concept in any society as the BBC article attempted to illustrate. Sexuality and, indeed, sexual orientation has always been a fluid concept –and both an intriguing and compelling one, as the recent and untimely death of David Bowie has served to remind us. Maybe the time has come to reconsider things. I wonder why it has taken us so long to realize that what we treasure in people and what we find so important is not their gender, not their sexual orientation, and certainly not their appearance, but their energy. Their spirit, I suppose.

We can never agree on everything, perhaps, but as with Shakespeare in The Winter’s Tale, I say, ‘When you do dance, I wish you a wave o’ th’ sea, that you might ever do nothing but that.’

 

The Gyne Weed

I think most of us have a rather Schadenfreude relationship with weeds: on the one hand, they are undesirables, illegal aliens usurping land otherwise dedicated to something useful; but on the other, some of them are quite pretty -even beautiful. Especially in someone else’s garden. Of course it’s all a matter of context, isn’t it? It’s a weed here, but not there -a productive member of one society attempting, uninvited, to switch allegiance to another. In a way, you have to admire their resourcefulness and courage. It must take a lot of self-confidence to show up where you’re not wanted and then make a success of it.

Weeds, however, are not often seen as courageous –quite the opposite: they insinuate themselves into an unsuspecting and vulnerable population and spread dissent. They’re obvious targets for discrimination. Persecution. They are generally regarded as anathema everywhere they go. Period.

I am more ecumenical when it comes to weeds, however. As a male gynaecologist, I too am in foreign soil; I too am a weed. But the idea never occurred to me at the beginning of my career. I thought anybody was welcome to grow there.

And then I met Suzy. I liked her as soon as I saw her in my rather under-populated waiting room. She would have stood out even in a full one. With pig-tailed, red-brown hair, face done up in freckles and a toothy smile, I was immediately reminded of Anne of Green Gables. But she was rather short and plump and was wearing severe black clothes that belied her expression and said ‘Back off’.

And yet we’re all a study in contrasts aren’t we? At that time, I had a mop of long curly brown hair that barely covered the single earring in my left ear. Oh yes, and a reddish beard that fought with the hair for attention. Looking back those many years, I’m surprised the Department even hired me. Equal opportunity stuff, I guess. But I digress.

Suzy did not seem at all surprised when she saw me walking across the empty waiting room to greet her. In fact, she seemed almost relieved at being seen before her appointment time. Well, perhaps ‘curious’ describes it better.

When her eyes interrogated mine for the reason, I muttered something about the last patient not showing up. Actually, the last three had not showed up either, but I wasn’t going to admit that to her. Her eyes then toured my body and flitted back to rest in their little cages, twinkling at their efforts.

“These things happen, doctor,” she said to break the tension, but I could tell she understood.

“So why did you come to see me, Suzy?” I said as she settled down in an uncomfortable wooden chair across from the desk in my office.

This seemed to take her by surprise. It was if there were preliminaries that hadn’t been observed before settling in for business. Like the weather, I suppose –or maybe what she did for a living. “I’m an actress,” she said as if I’d asked the question. I nodded politely and put on a fresh smile to show her I found that interesting. She studied my reaction for a moment and then settled back into the chair as if she could make it more comfortable. “I try to take on roles that challenge me…Challenge Society…” She left the sentence dangling for some reason. “You know, gender stuff…” Another dangle.

“I see,” I said to show that I was listening, but I wasn’t sure why she was telling me this.

“I’m a lesbian,” she suddenly blurted out, and checked my face to see if she had shocked me. It was a time before people were as open and proud of it as they are today.

I have to say I blushed at her honesty, but I wasn’t shocked and she could tell. A huge grin exploded on her face and I could see her snuggle further into the chair. “So, I’ve never had sex with a man…” She stared at me in obvious defiance, and then relaxed into the the smile once more. “But my GP insists I have another pap smear.”

I sat back in my own more comfortable chair and put down my waiting pen. “Did you tell your GP you are a lesbian?”

Her eyebrows shot up. “You kidding?” I sat up straighter. “Our whole family goes to see her. She even delivered my younger brother. So, even though I’m twenty-four, I know she’d tell my parents.” She blinked as if she couldn’t believe my naïveté. My innocence. “We live in a small town, doctor. There’s religion bubbling up everywhere. Serious religion!” She smiled and looked out the window for a moment. “That’s why I asked to see someone in the city…” She thought about it for a minute or two, wondering whether or not to elaborate, I suppose.

Then she locked eyes with mine again. “I’m a weed, doctor. They don’t want anybody like me to take root there; I’d endanger their carefully cultivated crop of souls… Spread the seed…”

I hadn’t thought about gender preference like that before -or more accurately, I hadn’t thought much about it at all. I suppose it must have shown in my expression because she immediately smiled again. This time, mischievously. The twinkle was back in her eyes, and a dimple I hadn’t seen before suddenly appeared in one cheek. “We’re both weeds though, aren’t we doctor? We both crossed a line somewhere.” She sighed and straightened up. “I think I just needed to tell someone who’d understand.”

My expression must have reassured her she was right because she immediately started to button up her coat. “I agree there’s probably no rush to do a pap smear, Suzy…But what should I tell your GP?”

Suzy shrugged and stood up. “You’ll think of something, doctor. Weeds are nothing if not resourceful.” She hesitated before going through the door, looked over her shoulder, and winked at me conspiratorially. “Tell her I wouldn’t let you. Maybe I’ll get her to do it -after all, I’ve already sewn the seed…”

The Asexual

Well the annual Pride Toronto Festival has come and gone again; we had one here in Vancouver as well, but this year’s Toronto iteration apparently broke all records for attendance, parade, and participation. I have to admit to my own feeling of pride that Society is making such progress in accepting –even welcoming- diversity. Especially, it would seem, in Canada.

The LGBTQ (have I got those initials in the right order?) community has done a wonderful job of publicizing and integrating their orientations in the public’s mind. Gay marriage –an unthinkable concept only a few years ago- is now accepted in most areas with barely a glance. That a loving couple should be able to legally dedicate their lives to each other with all the rights normally accorded to a marriage seems now so obvious and compelling that it is hard for many of us to countenance a time when it was restricted to heterosexuals.

But the orientation diversity has not run its course; there are other voices finally audible now that the din of battle has dimmed somewhat –voices that I, at least, had not heard before. Readers of this blog may recall my essay on Gender in January 2013, when I had to admit to an age-dependent naïveté concerning gendered public washrooms –you know, designating separate rooms for male and female toilets. I had always thought of the arrangement as being eminently sensible until disavowed of this by a patient, indignant that she had to accept the arbitrary (she felt) assignation of the female room by the accident of her (unchosen) chromosomal array. So I felt that I had witnessed the final frontier of the orientation choices: none. No-name toilets for the sexually unassigned.

I was wrong –again. My innocence was dragged to the surface once more when I heard a CBC radio interview with a woman who was feeling unaccepted even by the LGBTQ group because she identified herself as asexual –i.e. none of the above. Well, to consider oneself as a non-participant is fair enough I suppose, but the absence of something really doesn’t give one much to identify with I would have thought. How ignorant of me; how unsophisticated! I mean there was an unfilled niche there just begging for attention… And there is a growing community of asexuals, some of whom apparently marched in this year’s Toronto Pride Festival parade.

But I suppose I shouldn’t have been surprised. As with most issues, I am often exposed to them first in my office. And under those circumstances, they don’t seem odd or aberrant –just interesting.

Thinking about it now, I suppose I was first introduced to asexuality several years ago -during an investigation of infertility of all things.

There are many causes of infertility. Some are complicated and require referral to a specialized infertility clinic for more intensive investigation and treatment. Others are less onerous, less worrisome and after taking a thorough history and doing a detailed physical exam need only a few simple investigations followed by a large dollop of patience and reassurance. Needless to say, it is this latter group that I prefer, if only because I feel that dialogue is still useful; I get a chance to show that listening, interacting and empathizing is part of Medicine.

Of course, sometimes the reasons for infertility seem blindingly obvious -like the frequency of intercourse. Infrequency, I mean…

“Oh, we don’t have sex very often, doctor,” the sweat shirt and blue jean clad woman said almost proudly. And when one of my eyebrows crept up involuntarily –I try to stay neutral, but sometimes I am weak- she scowled and explained that she didn’t really like sex. “It’s not who I am,” she added, staring at me defiantly. “Once a month is plenty…”

I intended to follow up with a question about whether or not she found the act painful, or whether there might be some impediment to her enjoyment of sex but I felt the mood change in the room. Or at least the mood on her face changed.

I thought maybe I should play the ‘please clarify’ card rather than the ‘I don’t understand’ one which seems to annoy people nowadays. I pretended to read from the notes I had just written. “You say you are only sexually active once a month…?”

“Only when I’m ovulating.” She interrupted before I could finish the question. “That’s when the best chance to conceive exists,” she continued, as if perhaps this was a thought about fertility that hadn’t occurred to me.

I nodded in agreement, but my expression must have remained puzzled because she sighed and sat back in her seat as if exasperated. “Not everybody enjoys sex, you know. For some of us it is simply a means to an end: a baby.” She continued to stare at me –defying me to disagree. “I don’t enjoy washing dishes either, but if I want to have dinner…” she added somewhat cryptically.

I put my pen down on the chart and decided to sit back in my seat as well.  “Well, so far everything seems completely normal,” I said helpfully, hoping to diffuse the tension. I was trying to reassure her that she would likely be able to conceive –but with such infrequent exposure to sperm, might have to be patient or change her frequency. “You may just have to start washing more dishes,” I added carefully. I thought it was a humorous and inoffensive rejoinder to her example. I said it with a smile and with what I hoped was a twinkle in my eye. But to tell you the truth, I couldn’t resist. 

She shot forward in her seat, her eyes narrowed, and I could see her face hardening like concrete. “I had hoped you of all people would understand, doctor!” She said the ‘doctor’ word through clenched teeth.

“I’m sorry…” It slipped through my mouth involuntarily as it often does when I’ve inadvertently crossed some line or other. I actually meant it as a query –as in, ‘Pardon me?’- but when her face relaxed a little from my apparent capitulation I decided to lie fallow. I had no idea what had enraged her, however. Had I been Aspergerially inappropriate and insensitive? Or had she wanted some other more easily acceptable regimen?

She got up from her chair, picked up the little backpack she had worn on arrival and walked to the door. There she hesitated and I could see her tension dissolving. She turned to me and almost whispered, “I’m sorry, too, doctor. It’s just that I’m an Asexual.” She said it as if it were a noun rather than an adjective. And then she left –not angry, not frustrated… More sad that I hadn’t known.

I never saw her again, and I may never understand what she was going through, but I hope things have worked out. I hope she eventually had the child she so desperately wanted and that they went to this Toronto Pride Festival to watch the parade. And I hope that she has at last achieved the recognition and validation of her orientation that she obviously needed. The one that society evidently needs to offer.

Gender

I am a prisoner of my age, a hostage to my generation; I never thought I’d say that, but I suppose none of us do… We are as contemporary as our minds and experience will allow.

My own epiphany came, as I recall, when a patient engaged me in a discussion of gender. I had not intended to be controversial; neutrality -or at least impartiality- had been my intent in our exploration of her problem. I am, after all, a male meddling in female affairs so I must needs approach it as a visitor to a foreign land: respectful of its customs and willing to learn. I even used those words, I think, but it seemed they were the points of contention, however. Unbeknownst to me, I had innocently strayed into a minefield.

“Why do you have to feel as if you are a stranger?” she asked, eyes ablaze.

I thought about it for a moment, but I have to admit my response was weak. “I suppose because I am a man and was brought up as one…” I left the end of my sentence open, hoping she would not ask for further clarification. I was mistaken.

“But that’s just my point,” she said, rising briefly off her chair in her enthusiasm. “We’re both human, and despite the difference in our ages, both equally entitled.”

I could have wished she hadn’t felt the need to comment on our age difference, but entering into the spirit of the discussion, I put down my pen. “Entitled to..?”

Her face crinkled for a split second before she could rein it in. “Well, entitled was probably the wrong word; entitled implies that there is someone who is allowing, permitting, something. What I’m suggesting is that there should be no gender split…” My eyebrows must have moved, because the wrinkles reappeared on her face and stayed put. “No gender discrimination,” she added, as if that would clarify her meaning and win me over.

I don’t need to be convinced there is egregious gender discrimination throughout the world, but I suppose I assumed that the worst of it took place somewhere else: developing countries, or places still troubled by malaria -naive in the extreme, I  must confess, but a topic not often front-and-center in my everyday life. I believe in equality of opportunity for everybody, gender included, but I recognize that the platform from which I regard this is that of a white male in a position of relative authority and privilege -something so taken for granted that I no longer see it. Or don’t want to…

“I don’t see why the absence of a Y chromosome should relegate me to a particular role in society.”

She said it with such vehemence I couldn’t think of a suitable response at first. There are some things about our dealings with the world that are hard to express, much less analyse dispassionately. “How would you change things,” I asked finally, hoping she would understand my quandary.

She crossed her arms defiantly. “The very fact that you had to ask, is part of the problem,” she said, trying her best to smile politely. “How do you change things when the very institutions that you want to change, don’t think there is anything wrong?” She pinned me to the wall with eyes like spotlights. “Why should I have to behave a certain way, just because I happen to be female? Why is there an expectation that is constrained by gender? Limited by gender? Imprisoned by gender?”

She was becoming very excited and agitated across the desk from me, but all I could do was smile in what I hoped was a sympathetic way and show I was open to her indignation.

“I mean washrooms, for god’s sake!” She rolled her eyes; I remained silent, not knowing what she meant. “Why is there still washroom discrimination?”

I have to admit I hadn’t thought that was even a problem. I just go into the one with the little man sign; there is usually a woman sign right beside it, so it’s not like we have more of them. And if there’s no sign, no indication of sexual preference, I assume it doesn’t matter. End of story. “Is…” -my tongue floundered about, looking for the right question- “Is that usually a problem?” I couldn’t think of anything else to ask.

Her arms folded even more tightly across her chest. “Not usually!” she snorted, eyes locked on mine as if we were wrestling. For once I was glad my desk was so wide. “But there’s no need for two types of washrooms.” I watched her as passively as I could manage, given the tight hold she had on my face. “But washrooms are only the part of the iceberg that’s showing. Society discriminates: it assigns roles; Language discriminates -you know: chairman, fisherman, fireman

 “I thought we’d changed those,” I said, feeling suddenly compelled to defend Society, or something. “You know: it’s Chair, and Flight Attendant… That sort of thing…”

“Yeah, but inside, you’re thinking chairman, or stewardess aren’t you?”

I shrugged. “Maybe I am, but that’s because those were the words I grew up with; younger people probably don’t even know we used to call female flight attendants stewardesses.” I decided to cross my own arms to make the point. “And besides, language evolves alongside Societal trends -Societal demands, if you will. It means a shift is occurring, however slowly, don’t you think?”

Her face softened and a twinkle appeared in her otherwise steady gaze. She had, after all, come to me with another problem for which she sought help and guidance. Perhaps coming to a male for her gynaecological issue meant that she saw me as gender neutral after all. “Would you mind if I asked you a rather personal question, doctor?”

I shook my head -affably, I hope- but with a sinking feeling in my chest; I could feel it coming.

“Would you go to a female doctor for your prostate?” I suspect I blushed, because she suddenly smiled and visibly relaxed in her seat. “It’s a very slow shift…”