The Omega's Dearest Baby Read online

  Noah nodded and said, “Christ, I’m a man. I’m supposed to be worried about getting someone else pregnant.”

  Rhian leant forward and tapped the scan. “The evidence says otherwise. There are three human genders, not two; male, female and intersex. About one in two thousand live births are intersex in some way. It’s either picked up at birth, or at puberty, when things don’t progress as expected. You seem to have hit the jackpot. What made you first think that something was happening to you? What changes have you noticed since ten weeks ago?”

  Vincent’s hand pressed gently against Noah’s back as he leant forward, the first time he had touched Noah that day.

  Noah blinked and said, “I’ve been impotent since then. Completely. That’s why I went to see Dr, Alden today. My back has been hurting more than usual. And I’ve felt really down, depressed even. Dr. Alden thought the lump in my belly was a tumor, but it wasn’t.” Vincent’s fingers were warm on his back, gently rubbing over the ridges of tight muscle, reminding Noah he was there.

  Rhian leant over and patted Noah’s knee. “How about I try and work out how this has happened? If we can figure that out, it might make this a bit easier to understand. I gather you’ve had no sign of anything like menstruation.”

  Noah shook his head. “I would have noticed that.”

  “What about episodes of intense unexplained abdominal pain?”

  Noah shook his head again, and Rhian said, “I want to examine you closely, do an ultrasound, have a look around so to speak.”

  “I’ve already had an ultrasound, can’t you tell from that one?”

  Rhian smiled. “Nothing at all. But that wasn’t done by me, my ultrasounds are much better than that. You know the routine by now, lose your clothes, put a robe on and hop up onto the table, and I’ll go warm the gel up.”

  As Noah pulled his T-shirt over his head and stood up, Vincent’s voice was low beside him. “Why couldn’t you tell me when I picked you up? Did you think I’m enough of a bastard to run out on you like Kaycie did?”

  Noah undid the button of his jeans, sat on the edge of the table and began to cry.

  Vincent’s arms were comforting around Noah, and he pressed his face against Vincent’s shoulder while Rhian busied herself with the ultrasound machine, keeping her back turned to them.

  Vincent stroked Noah’s hair and said, “Let’s find out what’s going on first, then we can fall to pieces.”

  Noah nodded, pushed his jeans off, pulled his legs up onto the table and leant back against the pillow.

  Rhian pulled a pair of gloves on and said, “This is going to be intrusive, Noah. Do you want Vincent to wait outside?”

  Noah shook his head. The latex gloves were strange on his skin as Rhian guided his thighs open and pulled the spotlight behind her around to shine on him.

  She looked up after a couple of minutes and said, “If you had been referred to me as an infant, I would certainly have recommended raising you male. Externally, everything is standard for a male phenotype. That means you appear unambiguously male.” She pulled his robe down for a moment and examined his nipples and chest too, and looked at his face closely.

  “Have you noticed any changes at all? Needing to shave less often? Nipple soreness?” she asked.

  Running his hand over his cheek, Noah said, “Shaving less, yes, though I haven’t thought about why at all.”

  “Penis and testicles shrinking?”

  Noah looked at the doctor blankly and said, “Ahhh. Perhaps, but I had kind of assumed that if I wasn’t impotent, it would all be normal.”

  Rhian lifted the bottle of gel and said, “Alright, let’s take a look.”

  Noah jumped when she pressed the probe against his scrotum, and Vincent’s hand tightened its grip on his shoulder.

  “Wouldn’t move around too much,” Rhian said. “Not if I was you.” She pushed keys on her keyboard with one hand, then pointed at the screen. “See that? That’s a normal testis.” She moved the probe and said, “And that is a testicular mass. Epidydimal material, fibrous structure, but no testis. Not something that would have been picked up easily.”

  She began to run the probe over his abdomen, starting at his pubic bone and sweeping upwards, pausing near his right hip bone.

  “Bingo,” she said. “Am I good, or am I good?” She pointed at the screen. “That is what is called a gonadal streak. It’s an ovary.” She pushed a little harder. “Look, there’s the remnants of the corpus luteum, the site where the egg was released from, and where the pregnancy hormones come from for the first few weeks.” She clicked the keyboard, then moved the probe again. “That is a rudimentary fallopian tube, the product of a fetal construct called the Mullerian Duct. That’s where the egg is from; now, let’s try and work out how this embryo happened. There’re two options here. The first is that it is parthenogenic, made by two egg cells that have fused. Parthenogenesis has never been seen in an animal closer to humans than the turkey, so I get a research paper out of this if it is.”

  She chuckled and pointed at the screen. “No way this is parthenogenic. Look, its neural tube is perfect, and its mouth cavity is fully formed. Parthenogenic embryos are always poorly developed. Hands and fingers are intact, feet and toes well on the way, definitely not parthenogenic. Damn, I could do with a new paper.”

  Noah watched the screen carefully for the first time. At the radiographers he had been too panicked and scared to actually understand what he was seeing. Now, Rhian was pointing out each feature as she named it, and he could clearly see the shape of the fetus. It squirmed and disappeared off the screen, and Rhian said, “Come back, stop wiggling,” to it while she readjusted the probe and the recognizable shape reappeared on the screen.

  “Christ,” Noah said. “This is real, isn’t it?” and the tears he thought had stopped started again.

  Rhian patted his leg. “Very real, sweetheart.” She moved the probe away from the fetus and went back to scanning his abdomen.

  “I can’t find anything like a uterus at all, not even a hemi-uterus. I can see that the placenta has attached to your large bowel. That in itself is not a disastrous thing, though I would avoid reading anything online that says it is if I were you. The medical literature has about a hundred cases of term pregnancies with the placenta on the bowel in it, enough of them for me to be able to give you a good idea of the percentage risks.”

  She frowned a little, then said, “I’m trying to work out how this egg got fertilized. I gather you’ve had sex with a man at about the right time?”

  Vincent gulped a little and dragged his gaze away from the screen to glance at Noah’s face, and he blinked back his own tears. “We had sex in early March, and the condom broke. Is that about the right time?”

  Rhian nodded. “Sounds right. I can’t find any indication of a rudimentary vagina. I’m afraid this ultrasound is about to get even worse.” She opened a drawer and pulled out a long thin foam shape, and pulled the end off the probe and connected the shape. “I need to look closely at your back passage, Noah. Might be less uncomfortable if I just step outside and you slip it in yourself.” She put a squeeze bottle of lube on the table next to the probe, and said, “I’ll be right outside.”

  Noah sobbed, and sat up and into Vincent’s arms. “Make this stop, please.”

  Vincent’s voice was shaky when he said, “Soon. Soon. How about I put this probe in, and we get this over with? Then I’ll take you home, and stay with you.”

  Vincent’s hands were gentle sliding the probe in, and Noah concentrated hard on the poster stuck to the ceiling above the table while Vincent opened the door and called Rhian back in.

  “You won’t feel anything,” she said, pushing buttons and staring at the screen. “There,” she said. “I can see it now. You’ve got a small vagina, but it’s not opening at your perineum. It ends in a tiny fistula in your rectum. Mystery solved. It’s not a very big opening, but sperm are tenacious little buggers and will get into all sorts of places.”
/>   She slid the probe out slowly and handed Noah a box of tissues. “Of course, if it had opened at your perineum, you would have been diagnosed as intersex at birth, and case management in the seventies was pretty brutal. Something horrendous would have been done to you to do what they politely called ‘normalize’ your genitals.”

  She turned off the screen, and washed her hands, then sat back down opposite the sofa, a clipboard in her hands, while Noah got dressed again.

  Vincent held Noah’s hand when they sat down again, and Noah said, “What happens now?”

  Rhian said, “I want to take a blood sample, and some skin scrapes from different parts of your body. Usually, for a chromosome work up, I’d just scrape the inside of your cheek, but I suspect you are what is called an XX XY mosaic, and there will different results from different locations on your body.”

  Noah nodded, and she looked at him with concern. “I want you to come back to see me again on Thursday. You need to decide whether you want to continue the pregnancy or not. The fetus looks fine to me. You need to know that that maternal mortality rate for this kind of pregnancy is about half a percent, and the fetal mortality is much higher, at about 20%. These figures mostly reflect the poor outcome when this type of pregnancy is undiagnosed until an emergency caesarean section is done. You would do well, in my opinion, because your medical team will know to give you maximum care, and to deliver you before any of the complications happen.

  “Between now and Thursday, I also want you to see Chaya, the psychotherapist who works here. Some of what you are feeling is gender dysphoria, and she can help you deal with that. That’s when the gender you actually are, male in your case, doesn’t match the reality of the body you have been born with. No matter what outcome you choose for the pregnancy, you will be offered surgery to alter your body, same as everyone else who I see that has gender dysphoria.”

  Noah gazed at Rhian in confusion, and Rhian smiled reassuringly and said, “We don’t expect you to live the rest of your life with an ovary, a fallopian tube and a rudimentary vagina that you feel don’t belong to you. And I promise you will get your sex life back. The impotence is in response to the pregnancy hormones. When the pregnancy ends, it will all come back.”

  ***

  Noah stood uncertainly at the door, Vincent’s fingers wrapped around his elbow for guidance. “Thank you, Rhian,” he said.

  Vincent added, “Yes, thank you for seeing us during your lunch break.”

  Rhian smiled and said, “When Chris Alden rang me, of course I wanted to fit you in. I owe him more than one favor. I would have failed fourth year biochem without him spending an entire weekend coaching me, and wouldn’t be a doctor at all.”

  ***

  In the car park, Vincent held the passenger door open for Noah and said, “Do you want to go to your condo, or my place?”

  Noah squeezed his eyes shut for a moment. “Your place. Kaycie has keys to my place and I can’t face her at the moment.”

  Vincent slid into the driver’s seat and started the car. “She knows?”

  Noah shrugged. “Kind of. She knows about the fetus, and that I let some guy fuck me. She doesn’t know it was you.” Noah leant his head back against the seat rest. “Do you think she’ll tell anyone?”

  Vincent shrugged too. “I think she’ll be too worried about her own image and career to say anything that might harm it. I think she’ll just hate you in silence.”

  “I can deal with that. Out of everything that has happened, Kaycie hating me just seems unimportant.”

  ***

  Noah sat at Vincent’s kitchen table, mug of tea in one hand, Vincent beside him, also holding a mug. They’d spent an hour or so on Vincent’s pc, trawling through the Google results, trying to figure out medical literature, reading personal web pages; and Noah had emailed a couple of the support organizations listed on the pamphlets Rhian had given them.

  Now, Noah felt completely overwhelmed, too tired to cry anymore, and just plain terrified witless. “What am I going to do?”

  Vincent reached out and held Noah’s free hand. “Noah,” he said. “As you told me repeatedly in the car on the way home, I did this to you. I want to tell you the same thing I told Ella when we found out she was pregnant with Ben. If you have this baby, I will stick by you, support you, and raise the child. You know, from Ben, that I’m a conscientious father. If you decide not to have this child, I’ll be there for you too, and I’ll never criticize your choice.”

  Noah squeezed Vincent’s hand. “I feel so confused. So scared. I feel like I should have this child, that it was so unlikely that I would ever conceive, that I should accept what has happened as being part of some larger plan that I can’t see.”

  Vincent nodded. “Predestination is a powerful argument. I love Ben so much; it’s hard to see him as the product of random chance.”

  “But how would I manage it? A pregnancy and a child isn’t something I can hide.”

  “Give up and then disappear for a year or so, come to Idaho, to the ranch. We’ll stay there, then say one of us adopted a baby, or used a surrogate mother or something,” Vincent said.

  Noah shook his head. “Could I just disappear?”

  “Tell everyone you are going into rehab, no one will try and stop you or argue with you,” Vincent said.

  Noah swirled the tea in his mug. “If it had been a tumor, I would have had to give up anyway.”

  Vincent nodded. “And a pregnancy is better than chemo any day.” He let go of his mug and pointed at the stack of printouts on the table. “Your being intersex does explain why you look like you do.”

  Noah looked puzzled, and Vincent said, “You read the papers we found online too. Tall, slender, gorgeous face; it all fits.” Vincent let go of Noah’s hand and slid his arm around his shoulders. “We’ll work this out, I promise.”

  CHAPTER FIVE

  Rhian was drinking coffee and eating biscuits when Noah and Vincent arrived on the Thursday, and she waved them over to the couch again. “Hey,” she said to them. “You both look a little better than on Monday. How are things?” she asked, sitting down and offering the packet of biscuits to them.

  Noah took two and said, “The shock has worn off. I saw Chaya yesterday, and talked to a couple of people online, and I think I’ve got a grip on what is happening now.”

  Rhian nodded and washed down biscuit crumbs with coffee. “Have you made any sort of decision about the pregnancy?”

  Noah could feel the happiness radiating off Vincent, just like it had been ever since Noah had decided. “I want to have this baby. We want to.”

  Rhian smiled and said, “Congratulations then, to both of you. I've already made an appointment for you to see Sandra, the obgyn that I refer my patients to. She specializes in pregnancies where at least one of the parents are intersex. Even if you had decided to terminate, you would still have had to see her to arrange that. Sandra will take over your care now, though I’ll still be involved too, for the endocrine monitoring you’ll need amongst other things. I’ll also assess your baby when it’s born, because I can guarantee, no matter how clear things are, Sandra won’t be prepared to sex your baby for you at birth, she’ll want a proper review done. She’s paranoid that way.”

  Vincent said, “Noah’s mom has asked if this means he’s a hermaphrodite. What’s the answer?”

  Rolling her eyes a little, Rhian said, “The responsible part of the medical profession no longer uses the word hermaphrodite. There’s a long and complicated history to the politics of it, but thirty years ago, Noah would have been called a ‘true hermaphrodite’. The phrasing was scrapped, partly because it was so damn insulting to the ‘false hermaphrodites’, people with Klinefelter’s Syndrome, and Androgen Insensitivity Syndrome for instance.”

  She rustled the papers on the table beside her. “Noah’s chromosome workup has shown that he is an XX XY mosaic. Cheek swab, right forearm, left flank were XY. Right flank was XX, as was left forearm. Blood typing was AB positi
ve, and without knowing your parent’s blood types, I can’t tell you what the inheritance pattern was. HCG levels were right for the age of the fetus,” she said, smiling at Noah.

  Noah finished his biscuits and said, “It’s a relief to know there’s reason I’ve been feeling so down and tired for the past few weeks. I’d still like my sex life back, though.”

  “It won’t be normal again for a while. After the baby’s been delivered, you’ll be given a drug called methotrexate to kill the placenta because it is too risky to try and surgically remove it. Once the methotrexate has worked, things should go back to how they were before. If you have the ovarian material removed at delivery, you’ll find that you’ll be more masculine than before, more facial hair, more muscle deposition, deeper voice, just more butch in general.”

  Vincent laughed quietly, and Noah looked at him briefly and said, “Shut up, Vincent.”

  Rhian said, “Expect more feminization as the pregnancy progresses though. Your voice pitch is going to change, face shape too, especially as you gain weight. Once you’re heavily pregnant, you are probably going to appear female. It’ll be disconcerting, but I’m sure, with a supportive family, you’ll be fine.”

  In the car park again, Vincent said, “Time to start telling people.”

  ***

  Ella sat on the hood of her hybrid and said, “What’s up, Vincent? Something big, you’re grinning like an idiot.”

  Vincent propped one foot on the fender and said, “I wanted to tell you before I spoke with Ben. My lover’s pregnant.”

  Ella stared at Vincent for a moment, and broke into a grin too. “No wonder you look so pleased. I didn’t even know that you had a lover. Ben usually keeps me up to date; I must tell him off for not letting me know.”

  Vincent laughed. “Don’t blame him, he doesn’t know. I’ve been casual lovers with this person for a long time, nothing intense. Contraceptive failure was not something we had expected however.” Vincent was suddenly serious. “This is where it gets complicated, Ella, so just bear with me.”