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The Bundle of Joy by Karen Page "Here comes another contraction. Use it to push," instructed Sally. "Ahhhh," Penny screamed, pushing as much as she could. After fourteen hours of labour, she was coming to the end of the delivery. "You're doing really well," soothed Ian, Penny's loving husband. "It'll soon be over." "Oh shut up, you pig. You're the one that did this to me." "I know it's not easy," said the nurse, as they waited for the next contraction. "But try not to scream, as it uses up your energy. Channel your energy into pushing instead of screaming." Penny was about to scream an obscenity at the nurse, but another contraction took hold and she felt the uncontrolled urge to push. "Pant," suddenly ordered Sally, as the head forced its way out. Ian, still holding his wife's hand, even though she'd squeezed and pinched him, panted along with his wife. He remembered the importance of this from the prenatal classes. When she was panting, she couldn't push, and that would let the midwife check that the cord wasn't wrapped around the baby's neck. "You can stop panting and start pushing again," said Sally. With the next few contractions, the baby came out a bit more. "One more push and you'll no longer be pregnant." "Ahhhh," this time the scream wasn't that of Penny, but that of the baby. "Ian, do you still want to cut the cord?" Sally asked the sobbing father. "Oh, yes, please!" Ian thought it would be like a grand opening of a shop, but it was certainly a lot messier. There was blood all over the sheets. The cord was quickly clamped in two places and Ian cut in-between. It was rather symbolic, as Sally marked the place in the middle of the cord, with plenty of gap between the mother and baby. Sally clamped the cord closer to the baby's abdomen, trimmed it shorter, and then wrapped the baby before passing the bundle of joy to Penny before reaching across and pressing the call button. "I'll just give you the injection to help you push out the placenta," said Sally, keeping things busy. Once the placenta was out and checked, Sally cleaned things up. "Is it a boy or girl?" Ian asked Sally, cuddling up to his wife to get a closer view. He had gradually stopped crying and was beaming with happiness. This was one of their happiest times. It was an obvious question, which they had forgotten to ask. They'd expected to be told when the baby was delivered. "I'm not really sure," replied Sally, her heart sinking. This was the first time she'd seen this condition and now her training seemed inadequate. "I'm going to have to get a paediatrician down to check the baby over." "You're not sure?" Ian looked up in shock. "What do you mean, you're not sure?" "I'm sorry, but I really need to get the doctor down to explain. The baby seems very healthy and scored a nine in the APGAR scale." Another nurse came into the room and Sally went across to see her. "Julie, I'm having trouble identifying the sex of the Penny's child. Could you get a consultant down?" "Are you sure?" "I'm afraid so. Can you also tell Vicky?" "Sure." Julie disappeared and Sally moved back to the parents. "How are you doing?" "How do you think?" Ian retorted, his wife crying slightly. "I'm sure the doctor won't be long. In the meantime, Penny, would you like try and feed?" "I'm not hungry." "I meant would you like to try and feed your child. It says in your notes that you had a preference for breast feeding." "Is it wise to? It won't make things worse, will it?" "It won't make things worse. It will give your baby important nutrition and antibodies." The baby had already been searching for food, its small mouth moving. Penny exposed her right breast, and tried to put her baby onto it, but missed. "It's always hard the first time," said Sally moving to help. "Rest your baby against your arm and gently lift. Always move the baby to the breast, not your breast to the baby. Remember to always support the neck." After a few near misses, the baby suddenly attached and started to feed. A few minutes later, the baby came off, asleep in Penny's arms. "If only all babies were that good," smiled Sally. "Most take a lot longer to get onto the breast. They have to learn how to feed as well, as you have to learn how to feed them." There was a gentle knock on the door and two people came in. The room was getting rather crowded. One was a woman in her forties and the other was a man, wearing a white coat, who looked to be in his fifties. "Mr and Mrs Young. I'm Victoria Hammond, the midwifery sister. This is Dr Copland, a paediatric doctor. Would it be possible for us to examine your child?" Penny handed her sleeping baby to her husband, who carefully passed the precious cargo to the doctor. The little one stayed asleep, oblivious to all the attention. "Well, hello little one," he said, cradling the baby. "I'm going to open the blanket and examine your baby. That includes the genitals. Is that okay?" "Yes," said Ian, slightly uncertain. "Why don't you observe," said the doctor, laying the baby in the small Perspex baby cot. "I'll explain what I do as I go along. I'm going to start by listening to the heart and do a general check-up. I'll leave the genitals to last." The parents watched, slightly dumfounded as the doctor did his checks. He didn't rush and explained the results as he went. Victoria, the midwife sister, took notes on the baby's record sheet. "You have a very healthy child," said Dr Copland as he finished. "Do we have a boy or a girl?" asked Penny. "I'm afraid that it isn't that easy. Your child's genitalia are ambiguous. I will need to perform more tests. I also can't guarantee that urine will flow out of what looks like a penis." "Will our baby survive?" asked Penny, slightly panicking. "I don't see anything life threatening," reassured Dr Copland. "I will need to perform some tests to see what's actually going on internally. Once we see what's inside, I'll be able to make a proper judgement. I'll go and make the appointments. In the meantime, carry on as you would normally. I doubt the ultrasound will be before tomorrow at the earliest." "What names had you chosen?" asked Sally. "We'd chosen Brian for a boy and Jillian for a girl, but all that's out the window. I suppose we should choose a generic name like Sam or Alex." "Wow, Brian and Jillian are really nice names, so why don't you stick with them. There is no rush to register the name. You have forty-two days to do that." "Are you sure?" asked Ian, turning to Victoria. "Sally is correct. Since you have dealt with Sally for the birth, why don't I leave you with her," said Victoria. "Sally, if you need anything, just let me know." "What happens now?" asked Ian as Victoria disappeared out of the delivery room. "Penny needs to have a bath and so does your child," said Sally, getting back into the routine. "The bathroom is two doors down, so I'll get that going. While it is running, I'll show you how to bathe your little one. Now, Ian, your wife and child would probably like a little rest, so why don't you go home and have a rest yourself?" "But what if something happens? Shouldn't I stay, just in case?" panicked Ian. "Nothing is going to happen. Your baby has just had a thorough check-up, even more thorough than most babies get. When you've had a sleep, come back and see your wife and child. They will probably be on the main ward then." "Will you still be with us?" "Probably not," said Sally. "This week I'm delivering babies. I won't be on the ward till next week." Even though Ian had been up nearly twenty-four hours, his mind was too busy to be tired. However, this didn't help his concentration and he struggled to drive the six miles home. Once inside the privacy of home, he sat down and wept. All any parent wants is a perfect and healthy baby. His might have been healthy, but was it perfect? He'd been ordered to have some sleep, but there was so much to do and to think about. He stared at the list of relatives he had to ring and panicked slightly, not knowing what to say. "Hi Gwen," he said, having dialled the first number. "So was it a boy or a girl?" she asked, getting excited. "Er, yes." "Come on Ian, stop messing around." "I'm not," sighed Ian. Penny's mother was quite old-fashioned and he didn't know how to tell her. "The doctors don't know if our baby is a boy or girl. They are going to have to run some tests." "But apart from that, is the baby healthy?" "Yes," said Ian curiously. "Then there's nothing really much to panic about, is there. The doctors will perform the tests and help you decide what you can do now or later. Can I come down and see all three of you?" Ian just sat there, the phone held against his ear, not knowing what to think. Gwen, the person he thought wouldn't understand, was just acting as if it was an everyday thing. "Ian? Are you there?" "Oh sorry, I'm just in a bit of shock." "You didn't think I would understand, did you?" "No, sorry, I didn't." "Never judge a book by its cover." "But what nappies should I get, girls or boys?" he blurted out. "I think they are unisex at the newborn size," she laughed. "I'll be down in about six hours. How many relatives do you have to ring?" "You were the first I've rung." "Okay, well don't spend too long doing it. Once you've finished go and have a sleep. You need to be there for Penny. Oh, on second thoughts, you sound exhausted, so why don't I ring Joseph and Isabel and explain things to them. You just ring my side of the family. Knowing your mother, it will be a bit of a shock." 'My side of the family' just meant Penny's older sister, Hannah. "Hi Hannah," started Ian. "Did she have it?" said Hannah excitedly. "Yes." "Was it a boy or a girl? What weight? What colour eyes? What time? What name have you chosen?" Ian couldn't help himself, but laughed out loud. Hannah was always one to be carried away. "Okay, the answers are, unknown, eight pounds two, hazel eyes, twelve minutes past seven and unknown." "Wow, that isn't a bad size, is it? And Hazel eyes, just like you. Is it okay if I visit? I promise not to get in the way of any of the tests." "Hannah Louise Hopkins, what is going on?" demanded Ian, getting his wits about him. "First your mum acts like nothing is happening, and now you. What do you know that I don't?" "Is the baby healthy?" asked Hannah. "Yes." "And is Penny okay?" "Yes." "Then what is there to worry about. Just be thankful that mother and baby are doing well. The rest will sort itself out eventually." "Eventually?" "Well what happens if the tests are inconclusive. Will you raise the child as a boy or a girl, or will you leave things as they are and let the child decided when they are old enough." "It might take that long?" "As long as your child is safe and healthy, should it matter what is hidden under your child's clothes?" "I suppose not." "Then I will see you later. Get to bed." "Yes Mum!" Ian said, to which his sister-in-law blew a raspberry back. Surprisingly, sleep overtook Ian rather quickly. He had a lot of worries on his mind but his exhaustion after being awake all night, mixed with the stress of the birth, was a more important factor. "Hey sleepyhead," said the voice of his sister-in-law at his bedroom door. Since Hannah only lived a few miles away, she had a spare key. "Let me sleep," Ian groaned. "You've had about five hours. If you sleep much more, you'll miss the visiting hours." "Okay, okay, I'll get up. Now get out of here and let me have some privacy." When Ian came down, Hannah had toast and coffee waiting for him. She also had the look of someone who was about to burst with happiness. "You seem happy," Ian commented as he took a bite of the toast. "A baby is such a wonderful thing. The joy and miracle of new life. Now eat up, and let's go see that child of yours." "Hannah, what's ?" "Later," she said interrupting Ian. "It isn't important now. The longer we talk now, the less time with Penny and Baby." Once through the security doors and into the post-natal ward they both hurried to find Penny. She was in a small ward of six beds. Only two others were occupied and they were busy with their recent arrivals. "Oh Penny, what a lovely baby," gushed Hannah, which made Penny's face light up. "Oh you are a clever girl, making such a gorgeous baby." "You think so?" asked a blushing Penny, gently rocking her sleeping child. "Would you like to have a hold?" "Oh could I? You don't mind?" Penny passed her baby across and Hannah cradled it, just as she'd done with her own children, fifteen and sixteen years ago. "Your mum said she would be here soon," Ian said, updating his wife, while Hannah cooed at their child. "What did she say about us not being able to tell her the sex?" "The same really as Hannah, it was very strange. It was like it was an everyday thing, people giving birth to girls, boys, and unknowns." "Did the hospital bat an eyelid at it?" queried Hannah. "No, I suppose they didn't," replied Ian. Penny couldn't really remember the birth. It was like a dream. "I suppose they will have had it happen before." "What about your mum?" asked Penny, worried what she would have said. "Your mum said she would tell her. I was too exhausted to argue. Talk of the devil." "Ah, they you all are." Gwendolyn, Penny's mother, breezed in with a huge bouquet of flowers. "How are you doing, Penny? Still tired?" "I'm recovering. The little one slept quite well, so I've been able to get some rest. How did Ian's Mum take the news?" "She was fine. She said she would try and visit tomorrow night." Ian reached across and gave his wife a hug. They both knew that Ian's parents were delaying visiting as they only lived ten minutes away. She patted Ian, letting him know things would be fine. Gwen handed her grandchild to Ian, the first chance he'd had all evening to hold and admire his offspring. "Is there any news about the tests?" Ian asked after debating whether to do so. So far in the visit, the problems had not really been discussed, though it was painfully obvious to Ian and Penny how difficult it was to talk without referring to gender. "Yes, we are going down at eleven for an ultrasound. They are reluctant to do an MRI on a child so young. They will see what other information they can gather first before even thinking about an MRI." The visit was ended too soon. One of the nurses came round and reminded people gently of the visiting hours. "I'll see you tomorrow," said Ian, giving his child back to his wife, and giving both of them a kiss. When the three visitors were outside, Ian kindly asked Gwen and Hannah back to his house. "It's getting late," said Hannah, "and you know Mum is staying with me." "It sounds as if you two know far more about this medical condition than a layperson should. I want to know what's going on. If you'd rather not come to my house, I could always go to Hannah's. Perhaps George would like to join in as well." "I think a small diversion to Ian's house is called for," said Hannah dryly. "As you probably guessed, my husband doesn't know about this." The journey was a tense one. Hannah and her mother kept glancing at each other. Both seemed very nervous, and it was plainly obvious that neither of them was looking forward to the conversation that was about to take place. Ian wasn't unaffected either. His mind was on his child. What would the ultrasound show? Did he have a son, or a daughter? Why did this type of thing have to happen to them? "Does anybody want a drink?" Ian asked as they walked into the house. "Bacardi and coke," Hannah muttered. 'This must be bad,' thought Ian. 'Hannah very rarely drinks.' "Same for me, and don't go easy on the Bacardi," added Gwen. Ian didn't waste time with the drinks. He noticed his mother-in-law wasn't doing too well and he hoped the drink would help. At one point he thought about just telling them to go home, as it appeared too stressful, especially for Gwen, but he knew deep down that if they didn't have this conversation now, it would just have to happen sometime later. "There you go," said Ian putting the drinks on little coasters and settling down on one of the seats. Hannah was sitting next to her mother, trying to comfort her. After a long pause, Ian realised that nobody was going to say anything, so he decided to speak, "Look, you know I'm not going to rant and rave about things. I just want to know what's going on. I'm very worried about our baby and you two obviously know a lot more than I do." "I had a baby born with a similar condition," Gwen started in a shaky voice. "Do you want me to tell him?" asked Hannah. "NO!" almost shouted Gwen. "I should do it. I should have mentioned it to Penny years ago, but I could never bring myself to do it." "You Hannah?" Ian asked puzzled. "No and not Penny either," she smiled. "Mum had a baby between having Penny and me." "She did?" Ian sounded very surprised. "Things didn't go smoothly, and it was sort of taboo back then. It took a while before we decided to have Penny." "Since there was nearly twenty years difference between you, I always thought she was an accident," blurted out Ian, and then regretted it. "Accidents do happen," laughed Gwen. Poor Ian had gone bright red with embarrassment and was wishing the settee would swallow him. "However, Penny wasn't an accident. We had Hannah very young and after the trauma we went through with our next child, it was hard to try again." "What happened?" "We had a baby with 'ambiguous genitalia'. The doctors tried to fix things, but they didn't really have the skills and technology they do now." "Oh?" "The baby died four hours later in the operating room. I never got to hold our child, to feed our child, or even say hello. Our baby was taken directly after the birth by the doctors, with the promise they would fix everything. We were advised that it would be too traumatic to see the child later and it would be best if we just told everyone it was a still birth." Gwen threw back her glass and gulped the remainder of her drink. "I'll be back in a few minutes," she said clearly upset. "Are you going to be okay, Mum?" asked Hannah, giving Ian a dirty look. "I'll be back in a few minutes," reiterated Gwen, shaking Hannah's arms away. She got up and headed towards the bathroom. "I'm sorry," Ian said, feeling bad. "How should I have known about this? You didn't tell Penny, and therefore, she couldn't have told me." "I suppose I didn't, did I," apologised Hannah. "Well, at least you know now. It has been a topic that has been close to Mum's heart for a long time. Did you know she is part of a support team for parents with intersexed children?" "Is there such a thing?" "There sure is. Founded by Gwendolyn Hopkins." "But if she talks about this with others, why is she so upset now?" "Because you are family. She was so ashamed that she wasn't able to save her own child. However, you needed to know about this, as you are the parent of an intersexed child and you need to know what can be done." "Won't the doctors tell us?" "They might tell you some things, if you are lucky. Things are better than they were, but they aren't perfect. At least your child wasn't whisked away and butchered." "Does that still happen?" "Not in the UK, or so we believe, but it does in some other countries." "We?" "Mum can't do everything herself. She is getting older now." "Less of that young girl," said Gwen, coming into the room. "So what can be done for our child?" asked Ian, getting back to his child. "Everything or nothing," replied Gwen. "It depends what the status of your child's organs are. The doctors are doing what they now do. When they get the results, they will discuss things with you. Generally, there shouldn't be any rush to fix things. Your child is very small, and generally things can wait." "But what will people say?" "Ian, did your mum bring you up to be selfish? I don't think so!" Gwen chastised. "Your child has a medical condition. Put your child first, for goodness sake." "Yes Gwen," said Ian, hanging his head slightly. "Listen to what the doctor says and don't rush to any decision. Once the surgeons start removing things, there is generally no going back. Sometimes it is important to act quickly, for instance, in one child there was a half formed organ that was filling with urine. The surgeons repaired the urinary tract, but on the parents request didn't remove anything else. That child had some female reproductive organs and some male ones. They waited to see how the child felt when they were older and then the surgeons removed the other parts." "Did they have to?" "In some cases yes, but in some no. As long as things aren't causing issues, why go through the danger of surgery?" "There was another case where they found testicles not in the right place. If the doctors hadn't operated, they would have become useless. The doctors intervened and the child was able to get a normal supply of testosterone and not need injections. So sometimes, early intervention can be important." "Was the child fertile?" "This was a few years ago, and we don't know yet." "Why shouldn't we decide the sex of our child now?" "What if you get it wrong?" replied Hannah. "What if you decide your baby should be a girl and when she is older she tells you she wants to be a boy. How would you feel then?" "Oh, I hadn't thought of that." "Not many parents do and even less doctors tell them it's an option. Being a third sex isn't a choice for some doctors." "Don't parents have a say?" "Oh sure, but most parents just get the choice of male or female. Very rarely do they give the option of staying as is." "Well tomorrow is the start of the tests. Thanks for telling me all this," said Ian warmly. "It mustn't have been easy for you." "Well go and get a good night sleep, you have a long day tomorrow," Gwen replied, not acknowledging the amount of pain the memories still gave. The next morning, a bleary-eyed father walked with trepidation into the hospital. He hadn't slept well, trying to make sense of what Penny's mother and sister had told him. Oh how he wished they were here with him, to help him make the right choices, but they had both refused, telling him he was a grown man. They did promise to be there if the doctors started to become difficult. "I'm Ian Young, here to see Penny Young," announced Ian into the intercom. There were horror stories about people abducting newborn children, so he was so grateful for the slight inconvenience of having to be let in. "Pull the door," the crackled response replied. As he walked down the corridor, his attitude changed. He was here for his wife and child. The thought of Gwen having her baby taken away still echoed in his mind. Penny hadn't been told, so it was up to him to make sure that everything went well. When Ian went into the small ward, his wife was there breastfeeding. He stopped and watched the wonderful natural sight of mother and baby. His eyes filled slightly with moisture, which he blinked out before anybody noticed. "Hi Darling," Ian said, reaching across and giving his wife a kiss on her cheek. "How did it go last night?" "I got disturbed several times. We certainly have a greedy baby." "Several?" "Well two or three." They sat and chatted about things, while their baby fed. When finished, Ian took the baby and placed it in the cot, fast asleep. "Oh, you didn't have to cover yourself up that quickly," said Ian, putting on a wicked grin. "None of that," giggled Penny. "These are for Baby." "Spoil sport." "Too right I am," she smiled, and when she was sure nobody else in the room was looking, gave him a flash of one of her engorged breasts. "You tease," laughed Ian, giving his wife a kiss. "Isn't our baby wonderful?" "Well Baby isn't doing much other than sleep, cry, and eat at the moment, though there was a bit of time just after you'd gone when it was just sheer heaven. Baby just lay in my arms peacefully, which I'm told is rare at this age. "Any more news on the tests?" "A nurse took some blood this morning. It wasn't easy, as the veins are so small. They said this was for a whole series of tests. The only one I can remember was a chromosome test. In about thirty minutes we will be taken down for the ultrasound." "I hope the results of these tests don't take too long," sighed Ian. "I just want you both to come home and we can get on with being a family." "Be patient," said Penny calmly. "I want it too, but let's see how today's test goes, okay?" "Okay." At the allotted time, a nurse appeared with a large pram. "One special transport for a special baby," announced the nurse. "I thought we were only going for an ultrasound?" said Penny, puzzled at why a pram was needed. "You weren't planning on just carrying your child, were you?" said the nurse in a horrified voice. "What if you had fallen or something? Using the pram keeps your baby safe. By the way, I'm June, the nurse who will accompany you today." "Accompany us?" asked Ian. "Well you haven't been discharged from the ward yet, so we like to make sure that there is a nurse, just in case anything happens to either Penny or her child." "What if something happens to me?" asked Ian, facetiously. "Then I come to your rescue as well," laughed June. "Now shall we get going? Ultrasound is at the other side of the hospital complex." Ultrasound wasn't just at the other side of the hospital; it was in a different building. Instead of going outside, June went down into the basement and took them via a passage used by the hospital staff. As they waited in the ultrasound reception, the newborn child became the centre of attention. Other women cooed at the sleeping baby, and other children came up to have a peep. Ian and Penny felt so proud of their child that thoughts of its ailment vanished temporarily from their minds. "Mr and Mrs Young?" said a nurse, who'd just come into the waiting area. "Yes," said Ian and Penny together. "It's a bit small in the room, so leave the pram outside the room," the nurse requested, as Ian and Penny stood up. June followed the troop into the room. "What a well behaved baby," said the nurse as the parents laid their child onto the bed. "If only all the little ones we see would sleep through it." "I'm Duncan," said a tall man in his early forties. He was sitting by the machine and looked like he knew what he was doing. His wide smile immediately put Ian and Penny at ease. "Please will one of you remove your baby's baby-grow and nappy, as I will need to get quite low." "What happens if our baby, er, goes to the toilet?" Penny asked as she removed the nappy. She did it gently as not to wake her child. "Then I have to clean it up afterwards," said Duncan. "You?" asked his nurse in a surprised voice. "Well, us then," he laughed. "Don't worry, the bed has an absorbent layer under the paper. We put it down whenever we have a baby visiting us. I'm going to put some gel on your baby's lower tummy and look inside. If you have any questions, just ask as we go along." This baby didn't like having cold gel squirted on its stomach. It woke and started crying. "It's okay, it's okay," repeated Penny, stroking her baby's head. "Mummy is here." It helped a little, but the child still refused to lie still and began squirming and thrashing around before urinating. Penny picked up her baby while a new paper sheet was laid down over a new absorbent mat. Penny's cuddling caused her baby to calm down and after a few minutes the baby drifted off to sleep. "Let's hope your baby stays asleep," grinned Duncan, not having batted an eyelid at the activities that just occurred. Neither Duncan, nor the two nurses, made any comment about the ambiguous genitalia. Duncan explained what he was looking at as he probed at various different areas. "Is our child and boy or a girl?" Penny asked, as Duncan finished. "I'm not the best person to ask," Duncan replied. "There appears to be a little of both. There's something that might be testes in the wrong place, but the ultrasound isn't clear enough to see." "So what now?" sighed Penny. "Well, I need to send these photos off to Dr Copland. He will look at them and will probably chat with you this afternoon." "Don't stress about it," said Ian calmly as they pushed their child back towards the ward. He was a bit disappointed that the ultrasound hadn't shown anything conclusive, but he didn't want Penny to see that. "How can you say that?" fumed Penny. "Because we appear to have a healthy child, who is a wonderful baby. We want to make sure we get all the details before we even start to go forward." "You sound just like you are at work. Know the full details of the problem and then you can work out an accurate fix." "See? Being a computer nerd has its advantages." "I think you two are great," said June. "Most parents would be going nuts about the situation." "How would that help? I think I read that a stressed parent leads to a stressed baby," replied Ian. "Ian, you did read some parenting books," said Penny, looking at her husband with utmost love. "And there I was thinking I'd got away with it. Damn." At just past three that afternoon, Dr Copland appeared. "Hello, hello, and a little hello to the little one," he said giving a big grin for the child. "Hi," said Penny. "You don't mind if I continue to feed our greedy baby, do you?" "Carry on. It's great to see that everything else seems to be going well. I heard from ultrasound that urination is going well, too." "That was so embarrassing," said Ian, turning slightly red at the memory. "All part of nature. Is now okay to discuss things, or would you rather I came back when you'd finished feeding?" "Now is as good as any," said Penny. "Great, well we have had some of the blood results, but not the important ones. So far, you seem to have a very healthy child. I've looked at the ultrasound results and some of the pictures are a bit unclear to what things are. We have two choices, depending on how you both feel. We could arrange for an MRI, or we could send you to Oxford, where they have a much more powerful ultrasound scanner." "I'm still bleeding quite heavily, but I'm told it is no worse than any mother who has just given birth should expect. Which will be best for the baby?" "Did you need stitches, after giving birth?" "No. "I'll get one of the doctors on this ward to check you over, and if all is well, I'll get an appointment in Oxford." "When will it be?" "Probably sometime tomorrow. They are pretty good at fitting in requests like this. I'll provisionally book it now, and confirm when you have been checked." The ward doctor checked Penny later that day, and did a final check on her baby. "You are both well enough to go home," he smiled and produced an appointment card. "You have an appointment tomorrow, at eleven, at the John Radcliffe hospital in Oxford. Then an outpatient appointment with Dr Copland on Friday, at nine." "It looks like I might be sleeping away from hospital, but my days look like they will still continue in them." "I'm sure everything will be sorted soon enough. The surgeons are very good and nobody will ever know. All you have to do is say what sex you want for your child, and we will sort it." "There isn't any rush," interrupted Ian. "Oh, but it is best that the child doesn't know about it. It would be best to sort it very soon." "But what if you get it wrong?" asked Ian. "There isn't much chance of that. If you bring your child up properly then that will be that. If we make your child a boy, he will be bought up as a boy and he won't know anything different. The same if you choose a girl." "Wow, that was sort of creepy," said Penny, as the doctor disappeared. "I think if he could have operated now, he would of." "All I want is what's best for Baby. If that means waiting till we fully understand, then we wait," said Ian firmly. "I'm not having our child's future being rushed." "Amen," said Penny. "Did you know Mum once had a child like this? Dad told me when I found I was pregnant, but swore me to secrecy. He thought it was wise I knew, but didn't want to upset Mum." "Gwen told me on Tuesday night," confessed Ian, glad not to have to tell his wife. Bringing the child home was just like any other parent bringing their child home. The parents suddenly realised how unprepared they were. They had all the essentials, like nappies and the cot, but Ian wasn't prepared for the sudden cry from his child at two in the morning. "It's just baby letting us know its food time," laughed Penny at Ian's shocked face. "You will be driving later, so go back to sleep." "Is there anything I can do?" asked Ian, now too awake to think about sleep. "Pass me Baby? I need to rearrange my pillows." "Oh sure," said Ian, hopping out of bed. He scooped up and tried to comfort Baby, but his child had a one-track mind; food. Once ready, Ian passed Baby to Penny and went back to bed, while Penny read and their baby fed. Oxford, one of the major university cities in England, was also a regional hospital centre. If there was an issue that the local hospital couldn't deal with, the issue was passed onto a larger hospital, where they had more specialists. It also had more specialised equipment, which would be too expensive to put into local hospitals. "Has your child ever had an ultrasound before?" asked the nurse, as she took them to the room where the ultrasound would take place. "Yesterday," replied Ian. "It won't cause our child problems having an ultrasound two days running, will it?" "No, it isn't like x-rays," reassured the nurse. "I just wanted to know if you knew what to expect." The machine was nothing like either Ian or Penny expected. It must have been at least ten times larger than the one that had been used yesterday. "Wow, that is some machine," said Penny, her engineering mind becoming excited. "It sure is," said a young lady, who was sat by its controls. "By the way, my name is Sandy, and I will be making sure we scan everything we need to. Now the referral said your child has possible Reifenstein syndrome and we need to check the internal reproductive organs. Is that what you understand?" "We've never been told a medical name for our baby's issue," said Ian. "We were just told our baby had ambiguous genitals." "Well let's get started then. Lay your baby on the bed and we'll see what is happening inside." "Do you have any warm gel," asked Penny, still holding her baby. "It caused our little one to get upset yesterday." "Peed all over the bed?" asked Sandy. "Yes." "Then it's a good job we have some nice warm gel that should be at body temperature. We have the good stuff here," she said with a smile and apparent pride. All went smoothly with the gel, and the pictures of the organs where coming up a lot clearer on the monitor. Organs which were only as big as a fingernail were showing in great detail on the twenty inch screen. Sandy would occasionally say something to her nurse and she would check it off on her clipboard. They weren't only what organs were there, but making sure that the organs were structured correctly. "Can you tell us anything?" asked Ian, as Penny put a clean nappy on Baby. "Not much that you don't already know," replied Sandy. "I'm an expert with this machine and how to identify structures in the body. These results will go back to an expert who understands the impact of what we've found." "Which was?" "A slight mixture of male and female organs, some of which are more complete than others. What that means for things like fertility, is beyond my area. When are you seeing the specialist next?" "Tomorrow morning at nine." "Then I better get this data to them straight away." Ian and Penny drove home, their baby safely in the car seat behind. It wasn't far out of Oxford when Baby decided it was time for food. This was another first for them both, as there was no way they could continue with an upset child. "What do we do?" Ian asked Penny, as they pulled into a roadside eatery. "What do you think? I feed Baby here." "But this is the middle of a car park." "Yes, so go to the far end where it is quieter. I'll get in the back and feed. When Baby is to my breast, nobody will see anything." "Okay, if you're sure." Penny had always been the quiet shy type, who had never been one to show too much body, so Ian was quite surprised at the way she undid the top of her blouse and unhooked one of the cups on her nursing bra. Baby was soon having a great time. It has been said that breast milk has the taste of what the mother had recently eaten. Baby must have been having a nice Spaghetti Bolognaise. "I don't know how you did that," said Ian, as Penny burped Baby. "Baby wouldn't wait till we got home," sighed Penny. "It just seemed so natural to feed our baby when needed. Baby needed, so I fed. And no, it doesn't mean I will wear skimpier clothes." Ian just had to laugh, as that has been his exact thoughts. After a happy family evening and disturbed night, they were back at hospital. It was difficult to get anything done, such as bond as a family, which was the main reason Ian had taken two weeks off work. "Hello again," said Dr Copland, as he ushered them into his office. Well it wasn't his office, that was on the second floor, this was an outpatient office. "Any joy with yesterday?" asked Ian, getting straight down to business. "Well actually yes, we had some wonderful scans back and we have a little bit more of an idea with the material we are dealing with. We also got the blood work back. I've never known it to happen so quickly." "And?" said Ian impatiently. "Sorry, the blood work shows your child has XY sex chromosomes, which are those of a male. However, there seems to be some confusion with the internal organs as there are some female ones as well as male ones." "I think we'd gathered that bit," said Penny dryly. "Has Baby got enough reproductive organs to produce a child?" asked Ian, getting to the question he'd had in his mind. "Possibly, but we aren't sure. This is a very hard area to give a complete answer. The testes are in the wrong place and there doesn't appear to be any ovaries." "If the testes were positioned correctly, would Baby then be fertile?" Dr Copland sighed and chewed on the end of his pen. "We don't know. We hope so, but it's very rare. It looks like your child has Reifenstein syndrome. The baby got confused messages while in the womb. This can also be an inherited syndrome." "My parents had an intersex child," said Penny. "So I wonder if I inherited a gene or something." "It is very probable. Would your brother or sister be able to come in to compare the symptoms? See if they both have Reifenstein syndrome." "Unfortunately my sibling died aged four hours, as the surgeons tried to save my parents from seeing what the surgeons described as a freak. They never got chance to see their child, to hold their child or even feed him. My sibling was taken straight from the birth to the operating theatre. We have no idea if it was a boy or a girl. They wouldn't even let my parents see the child afterwards." "Oh," said Dr Copland, stopping taking notes. "That sounds like something of the past. Our surgical techniques are much better these days." "Are you saying you would like to operate on baby straight away?" asked Penny, sounding very surprised. "We could remove the female parts, remove the stray skin round the scrotum, and bring down the testes." "And when would you propose to do this?" asked Penny, starting to sound rather peeved. "We could operate on Monday morning." "You haven't even asked if we wanted to make our child a girl or a boy," said Ian. "You have just taken over and made assumptions." "Would you like your child to be made a girl then?" asked Dr Copland. "Why the rush to surgery?" asked Penny. "Well it is best to get it out of the way. You then can get on with your lives." "Isn't it harder to operate on such a small child?" "A little, but it would give you all a much higher quality of life." "Dr Copland, I take it you have dealt with intersex cases before?" "Yes, I'm very knowledgeable on the subject." "Excellent. Have you ever heard of Gwendolyn Hopkins?" asked Ian sitting back to admire the suspected change of attitude. He wasn't surprised. "Yes, though I haven't found her to be a very reliable woman," bristled Dr Copland, his face turning from absolute confidence to fury. "I wouldn't put any faith in her." "That is my mother you are talking about," snapped Penny, adding to the pressure on the doctor. "It was her baby that surgeons butchered and rushed into operating on. Now YOU want to do the same. Times really haven't changed that much, have they?" "Oh," said Dr Copland, not knowing what to say. "Er, shall we have a break for a few minutes while I just go to the toilet." "I think that sounds a great idea," fumed Penny. "Why don't you make the break a bit longer and ask your boss to join us for this meeting. I don't like your attitude on immediate surgery and potentially butchering my baby like what happened with my sibling." Ian, Penny, and Baby moved out of the room and went back to the waiting area, leaving a stunned doctor in their wake. "Calm down a bit," Ian said to his wife. "I'm in full agreement with you." "You are?" "The only surgery I would agree to, is repositioning the testes, so to give our child a chance to be a fertile male. If the female parts aren't causing any issues, then why should they be removed? It gives our child a chance to make their own choice when they are older." "Yes, but should they operate now?" "I don't think so, but we need to find out how long the testes can stay where they are without causing issues. Baby is far too young to have an operation." With an agreement between them of what they wanted, they cuddled together and waited for the doctor to reappear. So far, Baby had been good. The feed before the meeting had done the trick, but Penny worried that if the meeting dragged on too long baby would need a feed soon. Ten minutes later, Dr Copland appeared with another person and everyone was ushered back into the now cramped office. "I'd like to know why you verbally assaulted a member of my staff," demanded the unnamed man. "And you are?" asked Ian "I'm Julian Hodges, senior paediatric consultant in this hospital." "I'm not aware that we verbally assaulted your junior doctor," said Ian, causing Dr Copland to wince at being verbally demoted. "We just told him that we didn't want HIM operating on OUR child on Monday. He rushed to a judgment without proper consultation." "I see. Let me review the notes on your child and let's see what the situation is." There was silence as the file was carefully studied. Well, silence until Baby decided that it was time for food. "Do you object to me breastfeeding Baby here?" "You've called your child Baby?" inquired Julian. "Well until everything is decided, we can't choose a name." "Very true, and I have no objection. Breastfeeding is very natural and should be done wherever you and your child are comfortable. That chair looks a bit small. Why don't you have mine, it should be a bit easier." "Thank you," said Penny gratefully, accepting Julian's chair. When Julian had eventually finished studying the file, he turned and faced the family. "There is the name Gwen Hopkins at the end of the file. Is she advising you?" "She is my mother," said Penny. "Ah," Julian said and turned to Dr Copland. "Did you say things against Mrs Hopkins?" "Ah, well, I wasn't aware she was related." "Prior to the meeting you'd put in the file a note for surgery on Monday to remove female organs, bring down the testes, and cosmetically masculinise the outer genitalia. Did you discuss this with Mr and Mrs Young prior to organising that surgery?" "I thought it was the best cause of action and that the parents would agree." "Did they?" "I'm sure they would have done, if it wasn't for Mrs Hopkins." "I think it would be wise if you left this meeting and wait for me in my office." "Yes, sir," said Dr Copland. Slowly rising, he left the room without any word to the parents. "I'm sorry about that. Now, were you advised about the condition and what could be done?" "We were told it was some syndrome, I forget the name, and that Baby has XY chromosomes, so genetically is a boy." "So far so good. From the ultrasound, the testes are intact, but not in the right place. The tubes in the scrotal sac might not have developed fully to provide an outlet for sperm. It is difficult to tell from either scans and will probably need to be investigated at some stage. There are some female organs; some are more complete than others are. As you have noticed, the outer structure isn't quite right for either male or female and urine doesn't pass through the penis. Lastly, your child has some insensitivity to androgens, which is one of the reasons why there is a mixture of organs." "That is quite comprehensive, but what do you mean by being insensitive to androgens?" said Ian. "It is where the body doesn't fully respond to androgens and therefore doesn't create testosterone. There are two similar syndromes, Complete Androgen Insensitivity Syndrome and Partial Androgen Insensitivity Syndrome. In those cases, the outer genitalia would look female and it wouldn't have been questioned at birth. With Reifenstein Syndrome, it is obvious there is something wrong." "Oh." "It can be a bit confusing, so I will put everything in a letter. That way you have a complete breakdown. Now, what can be done is quite varied. What outcome are you looking for?" "It would be nice if Baby could be fertile. Is the only way to be male?" "Yes, the scan doesn't reveal any ovaries. Since the body might not react to the androgens, there have been trials where the child gets injections to help increase fertility. Those injections wouldn't need to start till they were round puberty." "Would it be possible to get the testes sorted without removing any of the female organs? Let our child make the choice when older?" "We could do that. Historically, doctors would attempt to make the child female as it is an easier operation, and there wasn't any worry about the androgen issue. However, there were a very high percentage of those that were converted to female that felt they should have been male. Surgeons now opt for the male method, just as Dr Copland suggested. If you opt to wait, how will other children react when they do PE at school and accidentally see the unique structure?" "Surgery to fix that can occur at a later time, can't it? It could be done when they are four or something?" "Yes. Just remember that if things are left as they are, there is a strong possibility that when your child hits puberty, they might start growing breasts." "When would the testes need to be done?" "You probably could wait a bit. I wouldn't recommend going past eighteen to twenty-four months." "Can the following be done?" asked Penny. "Sort out the testes in eighteen months, and leave everything else where it is. Then at a later stage, the outer regions can be sorted and roundabout the age of thirteen, they decide if they want to be male or female." "Sure," nodded Julian, taking copious notes. "Fine, then in the meantime we will bring up our child in as gender neutral way as possible, but for legal items, we will be raising a male called Brian Young." "Mr and Mrs Young, I will arrange an appointment for Brian in eighteen months. In the meantime, I wish you the best in raising your child. Boy, girl, both or neither, I think you will be wonderful parents. I've never seen someone so concerned for getting things right." Julian rose, and left Brian in the capable hands of his loving parents.