“Usually there’s nothing wrong,” the doctor said.
Mrs. March sighed and smiled at her daughter seated in the office chair next to her. Lizzy March smiled demurely back.
“But,” he went on and Mrs. March’s head snapped right up. “In the interest of full clarity, we’ve done the tests anyway just to make sure. And in Lizzy’s case there turned out to be a real problem.”
“What?” Mrs. March’s voice vibrated with a barely controlled note of alarm. “She looks fine – broad hips, narrow shoulders, more than adequate breasts. She just hasn’t had a period yet.”
Lizzy smiled again but embarrassment had made a home in her face. It weighed on the corners of her mouth and eyes. “Mom.”
The doctor nodded, slowly, solemnly. He spoke slowly, solemnly. “A regular baby machine. I know. Looks like. But isn’t. She’s never going to have a period. Genetically, she’s a boy.”
“What?” Lizzy and her mother spoke almost in unison. It made the single syllable reverberate in the quiet air of the office.
“What?” Mrs. March repeated.
Lizzy clasped her lips tight, listening to the further declaration of her fate in silence.
“Lizzy’s carrying the XY chromosome and testicles not ovaries in her abdomen.”
“How is that possible?” Mrs. March asked, her voice a dazed monotone.
“She’s got some defect in her endocrine system that made her insensitive to testosterone in the womb. She never responded to the hormonal cues that would have masculinized her brain and body as a fetus. So she developed outwardly as a female.”
The doctor hesitated and then added cheerily, “Female is the basic form in humans, you know. We’re all females unless tweaked otherwise.”
“At this moment, I don’t find that fact as reassuring as I might otherwise.” Mrs. March’s dry chuckle sounded like a death rattle.
The doctor cleared his throat. “I understand. I do.”
“What do I do?” Lizzy asked in a small voice. “What am I?”
“What do you feel like doing?” the doctor asked trying to put as much empathy into the question as he could muster. “What do you feel like being?”
A sob caught in Lizzy’s throat making her answer sound breathless. “I feel like being a girl. I’ve always felt like a girl.”
“Then you just go right on feeling and being one.” The doctor insisted. “No one need ever know.”
“But she’ll never have children,” her mother said.
“So she’ll be a barren woman. She can adopt if she wants.”
“But I’m not really a girl and I won’t be a real woman.”
“Reality,” the doctor said pragmatically, “is what you make it. It’s just that in this case that’s going to be a more literal proposition than in most.”