When the wheel has come full circle…

What’s it like to live on the other side? As far as I can tell, I’m neither trans nor bi; I do not have any genderqueer feelings or aspirations, and for as many years as I’ve been in this body, I’ve been happy with my gender assignation. I’m merely curious about things I have not experienced –about things that I am not, I suppose. Is a rose by another name really the same -really a rose as we have come to experience it? Or would it be more appropriate to phrase it as the converse: does calling something else a rose, make it a rose? Even if it feels it is? It begs the question ‘what is a rose’, doesn’t it? And is the answer –even culturally contextualized- relative, temporal, or in fact, meaningless? Perhaps for someone invested in linguistic definitional stability, the idea of reassigning nouns is more confusing than helpful –notwithstanding the in-your-face examples of homophones and homographs… But I think it is worth exploring.

Jiddu Krishnamurti, the Indian philosopher, argued that naming the Divine -and therefore essentially defining­ it- confined what that concept meant, limited it. I can see parallels with gender appreciation and denotation. But this is certainly problematic for many of my generation who seem to be invested in the immutability of anatomically assigned gender –or perhaps merely question the wisdom of reallocating something that already is, to something it does not appear to be…

Confusing? An interregnum usually is. When those things to which we have become accustomed are swept aside –or, more disturbingly, simply ignored as if their validity had always been in question- there is often a feeling that some moral law has been violated. An ethical boundary crossed. No matter that the boundaries were themselves arbitrary, templates from a different paradigm, to borrow from Kuhn –a different time. It’s not so much that they were wrong, as that they saw the world from a different perspective –much like we might view the customs of another country as being quaint, if not inimical. But, hopefully, when analyzed carefully, there are usually negotiable commonalities. Values which transcend differences, attitudes which, on reflection, are not that hard to accept. Not that different from those we had come to trust.

So, in time, the misgivings fade, and it becomes not only uncomfortable to deviate from the new norm, but to wonder how we had ever thought otherwise –the subtle memory readjustment that neuroscientists tell us occur with time and circumstance.

Many years ago when I first opened my specialist practice in gynaecology, attitudes were different from today. I was asked to consult on conditions that would now be referred to sub-specialists –doctors who have gained added expertise in specific fields. But in those distant times, we were left to deal with things we had never seen in our training as best we could.

It’s when I first met Jo. There were few computers then; my day sheet was typed and the name seemed to have been left purposely vague. But Jo sat straight and proud in the chair, anything but vague -beautiful, in fact. Dressed in a full-length light blue dress, and large, dangling earrings, I wondered how she avoided getting the slowly swaying waves of her long black hair entangled. I could see her bright brown eyes following a little diapered baby crawling erratically across the rug, both of them smiling at each other, both of them obviously delighting in the moment, however fleeting. Another newly pregnant mother, I thought, although in those days, my day sheet was just a list of names and times of appointment –no other details.

Her eyes lit up when she saw me coming across the floor to greet her, and a warm smile surfaced on her face as if it had been carefully wrapped and stored for just this occasion. For me.

I led her into my office down the hall and showed her a seat across from my desk. I have to admit I was smiling broadly by that stage as well –her face was contagious. “So what can I do for you today, Jo?” I started. I hadn’t yet learned the value of the small-talk that often helps to dispel the initial anxiety before having to confront the reason for the visit.

For a brief moment, her smile disappeared, and her eyes examined the window beside her. “I guess my doctor’s note didn’t arrive…” She summoned her eyes and promptly dropped them in her lap. The smile tried to reassume it’s command of her lips, but I could see it was having some difficulty. “It’s a bit complicated,” she said, shooing her eyes from her lap.

I smiled, picked up a pen from the desk and opened her chart to show that I didn’t mind. That I would judge just how complicated it was. It was then that I saw the note from her GP.

But before I could read it, I could feel her gaze leaning heavily on me so I looked up. I remember her expression was almost pleading with me to listen –not write.  Begging me to understand. I put the pen down and leaned forward in my seat.

“I…” she hesitated, clearly wondering how to begin. Wondering if the explanation she had memorized would suffice. “…I’m not what I seem, doctor,” she said, her voice trembling slightly.

I said nothing; I sensed it was a time for silence, even though I had not yet learned its value.

“I don’t think I’ve ever been what I seemed… But I’m 23 now, and I realize that I can’t live like this.”

I watched her face slowly dissolve into tears, so I reached for the tissues I kept on the desk, and handed her one.

She accepted it with a wrinkled smile she found somewhere and wiped her cheeks. “Sorry,” she said, the smile disappearing again despite her efforts to pin it to her lips. “It’s just that my GP didn’t know what to do with me. He said he didn’t know anybody who could help –apparently there’s nobody here in Vancouver…” She took a deep stertorous breath and grabbed another tissue from my desk. “Anyway he said you might know more about it.” Her eyes suddenly perched on my cheeks and stared at me. Through me, as if my eyes were only guardians of the doors into my head. “I’m a man, doctor…”

She –he– waited to see how I would react. She –I couldn’t help but regard Jo as a ‘she’- had obviously had uncomfortable reactions to the revelation in the past. And I couldn’t disguise my expression, I’m afraid –this was not a time of social media or tolerance of any egregious flaunting of norms. Homosexuality was beginning to evince some token acceptance in many circles, perhaps, but transsexuality was still felt to be beyond the pale. Cross-dressing was a deviance that needed to be closeted away.

Jo shrugged and sank further into her seat, as if my reaction had somehow punctured her only hope. “You know, I’m only Jo, doctor. I’m really no different from the person you met in the waiting room… I want to be that woman you greeted so innocently.” Her eyes sought mine again, like supplicants before a judge.

But in that moment, I could not judge. She was the Jo I had first met moments before –the delightful woman in the waiting room engaging with the trusting toddler. “I know,” I said with a reassuring smile, my heart taking over my words. “Let me see what I can do to help.”

And with that simple acknowledgement, Jo straightened in her chair again, her eyes alive as she adjusted an errant strand of hair that had wandered onto her now hopeful face.

Sometimes, there are surprises in all of us just waiting to be discovered.

Gender and Stress

Even the most ardent proponents of gender parity will admit that equality of opportunity does not imply equality of physiology. ‘The worst form of inequality is to try to make unequal things equal,’ as Aristotle said. Homogeneous –likeness, if you will- is not necessarily homogenous (a biological term meaning structurally similar due to common ancestry). Admittedly a semantically fraught distinction, it nonetheless suggests that there may well be differences that do not transcend gender.

For example, there seems to be a sexual discrepancy in the acquisition of post-traumatic stress disorder (PTSD)  http://www.bbc.com/news/health-37936514 -women tend to be more vulnerable to its development than men. A research team from Stanford University published a study in Depression and Anxiety (the official journal of the Anxiety and Depression Association of America) and it suggests that ‘[…] girls who develop PTSD may actually be suffering from a faster than normal ageing of one part of the insula – an area of the brain which processes feelings and pain. […]the insula, was found to be particularly small in girls who had suffered trauma. But in traumatized boys, the insula was larger than usual. This could explain why girls are more likely than boys to develop post-traumatic stress disorder (PTSD), the researchers said. The insula, or insular cortex, is a diverse and complex area, located deep within the brain which has many connections. As well as processing emotions, it plays an important role in detecting cues from other parts of the body. […]This shows that the insula is changed by exposure to acute or long-term stress and plays a key role in the development of PTSD.’ And as I quoted, the changes seem to be different in the two sexes.

The point of all this somewhat detailed background, is to submit that, as the study suggests, ‘it is possible that boys and girls could exhibit different trauma symptoms and that they might benefit from different approaches to treatment.’ Perhaps a sensitive counsellor would recognize this as the sessions continued, but it’s helpful to have some corroboratory evidence to justify any proposed changes.

I have to say that I was woefully ignorant of any sex difference in the development of PTSD. I’m embarrassed to admit that, if anything, I thought of it as largely a male condition –perhaps because of its association with war, and combat -traditionally at least, arenas of male predominance. But of course that is naïve. PTSD is not something confined to combat; it can be equally prevalent in other situations of distress or upheaval. Trauma is trauma, and long term issues can result from such things as natural disasters, car crashes, and certainly sexual or physical assaults, to name only a few. Because the symptoms can be confusing or even disguised, the diagnosis is best left to qualified practitioners, and yet I can’t help but wonder if a greater and more sensitive awareness of the possibility of the condition might encourage more sufferers to seek professional help.

As a gynaecologist, I feel uncomfortable and indeed far out of my depth in discussing most issues pertaining to PTSD, and yet thinking back over my years in practice, it seems to me that I may have suspected something of the sort, but lacked both the vocabulary and training to assign it a label –especially in those women I saw for conditions they suspected may have been attributable to previous sexual abuse: fears that they occasionally admitted to re-experiencing in unrelated events; things about which they still had nightmares; situations that led to unprovoked irritability and anger.

PTSD, by whatever name, has no doubt afflicted humans from time immemorial. Male hubris dictated that it be disguised or denied no doubt –it was a sign of weakness- and therefore unlikely to be mentioned in contemporary accounts. But signs of its presence occasionally snuck into mainstream literature -Shakespeare’s Henry IV being a likely candidate, for example. Perhaps more germane to my specialty, however, was the recognition of the lasting effects of trauma on people other than those involved in traditional conflict: women. The US Department of Veteran’s Affairs in its National Center for PTSD pamphlet states: ‘Most early information on trauma and PTSD came from studies of male Veterans, mostly Vietnam Veterans. Researchers began to study the effects of sexual assault and found that women’s reactions were similar to male combat Veterans. Women’s experiences of trauma can also cause PTSD.’ In fact they maintain that ‘The most common trauma for women is sexual assault or child sexual abuse.’ http://www.ptsd.va.gov/public/PTSD-overview/women/women-trauma-and-ptsd.asp

For too long have the lasting effects of sexual assault been ignored, or at best, trivialized and examined through male eyes in a still-male world. I don’t mean to sound like an overzealous feminist who pins all problems on male dominance, but I think age and a career spent in women’s health grants me a unique –if still masculine- perspective. As with all things, specialists run the risk of deconstruction, overanalyzing the events often with the consequent subversion of their apparent significance -almost a form of historical revisionism, an unintentionally biased and often contextually barren interpretation. One bridge, when crossed by a thousand people, becomes a thousand bridges –we all see the world through our own experiences, our own expectations, our own prejudices.

I think the fact that we can now demonstrate that there are valid reasons to question those often unconscious assumptions is a cause for hope. Much as we have finally realized that the results of many studies carried out only using men cannot necessarily be mindlessly extrapolated to women, so it is becoming increasingly apparent that trauma and its effects may also be non-generalizable. Although not its prisoners, we are after all, creatures of a chromosomal lottery, divergent physiologies, and certainly of different past experiences, so why wouldn’t there be a spectrum of responses to stress?

So, is there a ‘man-cold’? Well, maybe… I know that’s the kind I get, anyway.

 

 

 

 

 

 

 

 

 

 

 

Folk wisdom sometimes gets it right: there is a man-cold… Well, maybe.

 

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 nonetheless in desperate need of pruning. Perhaps it requires 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…”