Sunday, February 05, 2012

the view from below

What I didn't tell you before because it seemed premature (poor word choice) was that during my 12 week ultrasound to measure nuchal lucency, my OB told me that he was "90% sure" that the fetus was a boy.

"Can you really tell that early?" I asked, trying to see the screen better.  I saw what he was looking at, but from my (admittedly imperfect) memory of embryology from medial school, I thought that at 12 weeks gestation the unmentionables were simply classified generically as a "genital tubercle," with no real differentiation between male and female, blah blah blah something Wolffian and Mullerian ducts, blah blah.  (I never said I didn't remember the words, I just don't remember what they mean or are.)  Anyway, the OB said that was basically right, but sometimes one can get an indication one way or the other from the angle of the genital tubercle, uh, protuberance--and in his own, anecdotal, completely not scientifically rigid experience, he has a track record of being able to call the gender from the 12 week ultrasound about 90% of the time.

At the 16 week ultrasound this last week, he looked around a bit, looked at my chart, and asked, "What did I say it was going to be the last time?"

"You said it looked like a boy."

"Huh."  He angled the probe this way, then that.  (Thing 3 was angled weirdly, legs all criss-cross applesauce).  "Well, I think I may have...hmmm.  It looks like...huh.  I think I was wrong.  I think it looks like a girl.  See that mound here?"

(I did not see the mound.)

"Usually this mound here means...oh wait.  Here's a better picture.  I think...I think I was right the first time.  I think it's a boy.  Usually I can get a better picture than this, though, at 16 weeks...Usually it's like, KABOOM, you know?"

"Kaboom," I echoed, obligingly.

"Huh.  I wish I could see better.  But I think it's a boy.  Let's say 99% sure it's a boy.  But I'll save that last 1% for next time, when we do the anatomy scan."  And then I forced him to look at the head and heart and the diaphragm and the guts to make sure they were all properly septated and in their proper areas (it's a little early to do the full anatomy scan, but major anatomical badness we could probably see, though thankfully nothing ominous presented itself at this point).

So, we are left with several possibilities.

1.) It's a boy, a fact that will become KABOOM, in your face (ew) obvious once the testes actually descend from their Spring Training Camp in the peritoneum.  (Yes, now is an appropriate time to scream the word "GUBERNACULUM,"--I for one have been waiting for years to use that word in its correct context, as opposed to just, you know, saying it randomly just because it sounds awesome.)

2.) It's a girl (unlikely, I think, which is probably good, because we were already expecting a boy and when Target had a huge sale a few weeks ago I got a bunch of boy-flavored onesies, for like, a dollar.  When Cal was first born I was determined to find only gender neutral clothing, because, like, gender role stereotyping is bad!  See also: votes for women, step in time!  But soon I realized that outside of a very limited selection of green-or-yellow newborn items, no one makes gender neutral kids clothing; everything is either, like, a screaming pink onesie with scalloped neckline and rhinestones spelling out "DADDY'S LITTLE PRINCESS" or a hyper-blue onesie reading "MOMMY'S FAVORITE QUARTERBACK," embroidered with, like, a football and a rifle or something.  Anyway, my point being, it's probably not a girl--a fact that might disappoint some but for me and Joe, at least, was admittedly something of a relief.)

3.) The final option, which crossed my mind, and which I will sum up with the following story.  Back when I was a Peds resident, we used to write notes or call consults in this little glass-walled closet known  as the Resident Work Room (the term "room" was generous--for those who similarly trained at Babies Hospital, as we were known at the time, this was back when we were still working primarily out of the old hospital building, which looked like a sanatorium and still reeked faintly of cholera and The Black Humours).  Anyway, sometimes we would stick things on the walls of the resident work room--mostly they were boring things, like schedules and reminders, but sometimes there were funny things, like notes or dictations gone awry.  One such dictation was from an abdominal and pelvic CT of an infant (maybe it was a plain film), and either the radiologist had a very heavy accent or the transcriptionist was tired that day.  The final line of the dictation was highlighted in yellow, and read, "DIAGNOSIS: UMBIGUNOUS GENITARIA."

Anyway, Thing 3 looks good.  And it's looking with increasing certainty like we're going to be living in a live-action version of Alvin and the Chipmunks.  (To be clear: Cal is Simon, Mack is Alvin.  Joe and I, of course, play the role of Dave Seville on alternating nights, please check your programs for last-minute substitutions.)

*          *          *

Usually it wouldn't have taken me that long to write the above entry, but this morning I was peeling some ginger (I am attempting an experimental new recipe for Asian-esque short ribs--if it turns out well I will post the recipe here, otherwise let's never speak of it again) when the vegetable peeler slipped and instead of taking the skin off the ginger, took the skin and 1/4th of the nail off my left index finger.  Look, usually I'm more careful in the kitchen, but ginger!  It's so bumpy!

Anyway, the good news is that it didn't ever hurt that much (strange how little it hurt, actually, juxtaposed against how disgusting it looked) and it's on my non-dominant hand.  However, the bad news is that my left hand is also my laryngoscopy hand, so I guess I'll be intubating next week with one finger sticking out, like I'm a dainty madame or something.


  1. Anonymous3:09 PM

    I recently learned that it is easier to peel ginger with a spoon. here's a video.
    thanks for the great blog,
    longtime lurker.

  2. As a former chef, I have to agree with the previous commenter. A spoon is the only way to go. All you have to do is scrape the skin with the edge of the spoon. Works SO much better than a peeler and is safer too. Your finger is going to smart in the next day or two, and your nail will grow back strange. If you cut the sides, keep an eye on the nail as it grows back to make sure it doesn't get ingrown.

  3. Anonymous4:48 PM

    3 boys! Testosterific! Michelle, how's the coopster by the way? It's been a long time since we've heard from her :)

  4. Anonymous9:55 PM

    Use a spoon to scrape the skin, no risk of mishaps.

  5. I love the rifle-embroidered onesie.
    Two boys, totally unathletic family, half their shirts say things like "Team Captain." (And I HATE that my niece's shirts all say "Star" and "Diva" on them.)

  6. "..and a rifle or something"

  7. Anuja6:59 PM

    Hmmm.. I never peel ginger, just slice/dice/sliver it up... Cant tell the difference.. Hope your ginger *oops* finger... is better:D (It rhymes!!)

  8. Anonymous6:42 AM

    Wasn't there some big debate over bagel slicers at one point and now this? Is that irony I smell?

  9. Anonymous4:01 PM

    Congratulations for your 99% boy/1% girl (ok, congratulations for your boy! :D)
    On school, we spend a week discussing a case of a boy with cryptorchidism (I´m just a first year student on a school who does PBL) and when they were explaining the descend of the testis I, too, had the urge to scream GUBERNACULUM every time it was mention (it sound like a spell from harry potter)
    Anyway, Today was my embryology exam but, because of the weird PBL, my exam was 5 questions on embryology and 45 questions on anatomy/physiology/I-expect-you--to-fail of the reproductive system. Reading your post has make me smile after a crappy day :D thank you

  10. Anonymous2:26 AM

    As a neonatologist who has seen waaay too much freaky-deaky stuff, Possibility #3 was never far from my mind, especially during my first pregnancy. After all, when the ultrasonographer says it's a girl, it's usually because they can't visualize a penis. So is it really a girl? Or is it just ambiguous genitalia (I would often say to myself in a completely reasonable tone of voice)? Unfortunately, kindly old women who would stop me on the street and ask me about the gender of the fetus invariably ended up confused by the following answer: "Well, they *think* it's a girl...but who really knows?"

  11. Victoria M5:07 PM

    I LOVE the word Gubernaculum. It was the name of the Oxford Uni med soc magazine too!

  12. Hi there, I really wished to mention, I disagree. Your current article doesn't make sense at all.

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