Obrera
“With everything in there,” Dane says, pointing to the file folder Paul Goldberg stole from Ivelaw’s office. “I’ve never seen any of this before. I don’t know what any of it means.”
“Weren’t you told?”
“All I know is that I have cancer.”
“Cancer?” She opens the file again and works through the papers. “You don’t have cancer.”
“Yes, I do. It’s what they told me.”
“Who?”
“Everyone. My father. Dr. Porto.”
“What about other doctors?”
“I don’t have any other doctors.”
Dr. Obrera looks at him a long beat. “You do not have cancer. There is nothing in this folder indicating you have cancer now or ever had it in your life. What you have is tetragametic chimerism.”
“What’s that?”
“Nothing life-threatening. It means your genetic karyotype has two separate sets of DNA, one male and one female.”
The room’s edges swim and the blood behind Dane’s eyes began to pulse. “What?”
“Sometimes, in cases of fraternal twins in utero, one twin absorbs the other and the result is a single birth. Often we don’t even know this has happened until some unrelated blood test shows two different cell lines.
Most cases of chimerism go undetected. It’s not a disease. It’s just a flukey thing that happens.”
“I have a twin?”
“Well. You did. Once. It seems you started out with a fraternal female twin, which you then absorbed. I’m sorry, I’m making it sound like you intentionally ate her. This happens very early in pregnancy and like I said, often we don’t even know about it. But in your case…”
She opened the folder and read, “…Infant had a normal right testis and an undescended left testis, with otherwise normal male genitalia. At the age of six months, the left testis was not palpable at the inguinal ring. No further surgical exploration was recommended.”
“That’s right,” Dane says. “I only have one. My mother says my body just forgot to make the other one, but the one I had was fine.”
“So it is.”
“What about my eyes?”
Dr. Obrera smiles at him. “They’re stunning. And yes, it’s a sign of chimerism. The proper term is heterochromia iridum.”
“Not cancer?”
“No. Not cancer. It’s harmless.” Her gaze narrows. “You just lost all your color. Let me get you some water.”
She brings him a drink and patiently goes through his records with him.
At age thirteen, child was in the 10th percentile for height and weight.
No facial, axillary or pubic hair onset.
At fourteen, he presented with severe gynecomastia and intermittent abdominal pain in the left quadrant.
Mastectomy performed. Abdominal surgical exploration revealed a hernial sac, heretofore undetected, containing an abnormal gonad and vas deferens.
These structures were excised; they proved on histologic examination to be an ovary with a fallopian tube attached to a horn of uterus.
Karyotyping of peripheral-blood lymphocytes then revealed two cell lines, one 46,XX and the other 46,XY.
Dr. Obrera’s face is flushed. The more she reads, the angrier she looks.
“What is it?” Dane says. “What’s wrong with me?”
“Nothing,” she snaps. She quickly touches her mouth and takes a deep breath. “I’m sorry. I’m having a hard time keeping my composure. So much about this is unprofessional and unethical and…” Her eyes press him. “You knew nothing of your medical history?”
“No.”
“You must have been aware you were growing breasts.”
He tells her what happened.
“You woke up and the mastectomy had been performed. It was done.”
“Yes. And I had another scar. Here.” He touches his lower abdomen on the left side. “Dr. Porto says he took a cancerous tumor out.”
“He lied,” Obrera says, again with that snappish tone. “Dane, you were lied to. They had no business performing a mastectomy until you’d finished puberty. They had a dozen other treatments in the meantime. Where the hell were your parents during all of this?”
Dane shrinks back a little, feeling at fault.
“I’m sorry,” she says. “This folder has an appalling amount of malpractice, medical deceit and… Well, abuse is the only word coming to mind. I feel sick reading this.” She rubs her face, appears to come to some kind of decision.
“You’ve been treated so unprofessionally, Dane.
I don’t want to continue this discussion without you signing HIPAA forms and doctor-patient privilege in place. Do you understand?”
“Yes.”
She leans forward in her chair. “I imagine the thought of any kind of medical exam must be incredibly frightening for you.”
Dane’s eyes swim. “I… Yeah, it’s…hard.”
She gives him a tissue. “Do you think you can come back and see me tomorrow?”
“And you’ll tell me more?”
“I will tell you everything you want to know. And if I don’t know, I will find out.”
He’s fighting like hell not to cry now. “I don’t have cancer?”
“No.”
“You’re sure?”
“Positive.”
“I’ve felt shitty for so much of my life and every time I asks why, I was told I had cancer. It was the answer to every question.”
“I’m so sorry this happened to you,” Obrera says. “It’s vile. Unconscionable. I’ll be honest and say I kind of feel like throwing up right now.”
“Me too. I’ve been feeling so sick ever since I left home.”
Her brows furrow. “Dane, are you on any meds?”
“Lots.”
“What kind?” Her eyes close. “Please don’t say you don’t know.”
“I don’t know,” he says, feeling swamped with fault again. “I didn’t bring them with me. I forgot. I’m sorry.”
Her head shakes back and forth. “Me too. I’m so sorry, Dane.” She open her eyes. “Pills?”
“Yeah. And shots.”
“Shots? Injections?”
“Yeah. Once a week.”
“Subcutaneous or intramuscular?”
“I don’t know what that means. I get them in my leg or butt?”
“And you left them all at home?”
“Yeah,” Dane says. “No wait, not at my father’s house. I mean they’re home at Maisie’s house.”
“Oh thank God. All right. I want you to call me the minute you get back to your sister’s house and read me what’s on those labels.”
“I will. Should I not take the pills anymore?”
“Don’t change anything,” she says. “I don’t know what they have you on and I cannot discuss discontinuing until I know.
For your sake. I cannot stress how badly you’ve been treated by your father and your doctor.
I need as much information as possible before I start diagnosing or giving you advice. ”
“All right.”
She reaches a hand and squeezes his fingers. “We will get through this.”
“Okay.”
“Is there anything you need to ask that cannot wait until tomorrow?”
“What’s it called again? What I have?”
“Tetragametic chimerism. It’s not a disease. You are not sick.”
“Does it…make you crazy?”
“Crazy?”
“Like… I ate my twin sister, right?”
“Consumed during the embryonic stage,” Obrera says. “You weren’t you then.”
“But she stayed. With me, I mean. She stayed with me. In like, half my body literally. This side.” Dane feels all up and down the left side of his body. “The blue eye is her eye. The different skin color, that’s her. The XX DNA. That’s…her?”
“Yes.”
Dane reaches to touch the paragraph in the report. “And they thought I had a missing testicle, but they found it later. In surgery. And it was an ovary.”
“Yes.”
“I have both kinds of parts. And I started to grow breasts. So am I really both a boy and a girl? What do you call that—intersex?”
Obrera exhales. “These are all excellent questions. And if I tell you I don’t know enough to make a sound opinion right now, will you take me at my word?”
“I think so. You’re the first person who’s honestly explained all this to me.”
“And you have no idea how sorry I am to be the first.”
Later, Dane will regard returning to Obrera’s office one of the greatest acts of physical and mental courage he’s ever performed. He burns with anxiety, feeling at any moment he might throw up, pass out or weep.
Obrera examines him thoroughly but it’s nothing like Dr. Porto.
She asks about his comfort and gives him choices: Would you like to have a nurse present?
No one will come in during the exam but I can lock the door if you prefer.
Feel okay? Are you ready to start? Do you need a minute? Sip of water? You’re doing great.
Her hands are gentle and her voice friendly and conversational as she explains everything she’s doing and why. “You can ask me anything you want,” she says. “If you think of questions later, we can always chat on the phone.”
“I can call you?” Dane says, his jaw trembling a little.
“Absolutely.” She reaches for a tissue and hands it to him.
“You’ve had a terrible experience. You have no reason to trust doctors right now.
No reason to take me at my word when I say you can trust me.
So I’m going to put some more action behind the word.
You can call me. At home. With any question. ”
“I never had anyone to call.”
“I am so sorry for everything you suffered. Do you feel safe at your sister’s?”
“Yes.”
Safety is a novel concept and a tenuous one.
Hunter Academy’s attendance office was immediately on the phone to Paul Goldberg when Dane didn’t show up to school.
But Paul was oddly unreachable, so the school had to call the old man.
Within days, Ivelaw Strong’s machine had traced Dane’s flight to Maisie Montresor, but Maisie’s team was ready and waiting, with the locks changed and the security system upgraded.
“Talk to Dane’s lawyer,” Maisie says on the innumerable phone calls from her furious parent. “Speak to counsel about it. You’ll have to contact Dane’s lawyer for that information. I have nothing to say to you, Ivelaw. Talk to Dane’s lawyer. Goodbye.”