For more than thirty years, I’ve practiced general pediatrics and adolescent medicine with a private group practice in New Rochelle, just north of New York City.
Today I saw an adolescent girl for a checkup. Before this, I had seen her for a sick visit or two, but I didn’t know her all that well. She was accompanied by her father, whom I was meeting for the first time.
I started the checkup, as I always do, by asking if they had any special concerns.
Looking a little shy, Bella shook her head. Her father didn’t respond.
“Is there anything you want to discuss?” I asked.
Bella glanced at her father as though to say, Dad, you tell.
So he shared the big news: “Bella’s not a girl anymore.”
They couldn’t see much of my reaction, because most of my face was covered by my KN95 mask.
The rest of our visit unfolded as follows:
Me: When did you first discover this, Bella?
Bella: Last year.
Me: Did you tell anyone?
Bella: I told my mother.
Me: And your dad?
Bella: No, I was embarrassed, so I asked my mother to tell him.
Me: Have you told people at school?
Bella: No.
Me: Why not?
Bella: This is very private.
Me: Did you tell anyone else?
Bella: I told a few of my friends.
Me: Are you going to be called Bella?
Bella: Of course.
Me: But Bella is a girl’s name.
Bella: I’m still a girl!
Me: But I thought your dad said you weren’t a girl anymore.
Bella: Dad!
Dad: She’s not a girl anymore; she’s a woman. I was trying to say that she’d had her first period!
A light bulb went on over my head, and we all laughed.
“I wasn’t sure how to talk about it, because I grew up in a house with brothers,” Bella’s dad continued, a bit embarrassed. “This is my first time having a daughter, and needing to talk about periods.”
“That’s very understandable,” I said, relieved that I wasn’t the only one feeling awkward. Now it was my turn to explain.
“I’m sorry that I misunderstood,” I said. “You see, every few months or so in the last few years, I’ve had patients coming out to me about their desire to transition. I’m sorry, but it just didn’t occur to me to think that you could be talking about periods.”
Afterwards, I reflected on how tempting it is for parents to fall back on euphemisms when they talk with their children about sensitive personal subjects.
Parents aren’t the only ones, an inner voice quickly reminded me. I began to think of the phrases that I use when asking my patients about things usually considered, in Bella’s words, “very private.” There’s no doubt that my stock of genteel but vague expressions helps me to feel more comfortable—especially when inquiring into sexual matters.
One favorite euphemism that I use with patients is the question “Are you sexually active?” I feel comfortable with this wording—and, as I tell my residents and medical students, I like its openness and lack of pronouns.
But patients don’t always understand it right away. I’ve gotten several funny answers in response.
One girl replied, “No, I just lie there; he does all the work.”
Another young woman seemed confused and said, “Not really.” When I clarified that it’s a yes-or-no question, she said, “Oh, I thought that ‘active’ meant, like, doing it all the time.”
And though I do like phrasing this question that way, I have to admit that sometimes I’m just as liable as my patients to get things confused in the ensuing conversation.
Once, while examining a student who needed sports clearance for college basketball, I asked if she was sexually active.
“Yes,” she said.
“What do you use for protection?”
“I don’t need protection,” she replied.
Feeling compelled to make a point, I employed my usual follow-up: “Do you want to get pregnant?”
“I can’t get pregnant,” she answered, regarding me quizzically.
“Why not?”
“Because I’m a lesbian,” she said matter-of-factly.
Taking my foot out of my mouth, I apologized.
It was another light-bulb moment—one of many in my career as a pediatrician. And I’m sure it won’t be the last.
I’m glad that the young woman felt comfortable enough to tell me the truth and clear up my misunderstanding. And I came away from our encounter feeling just as I had after Bella’s visit: humbled, and reflecting on two vital lessons.
First, I need to make sure that the questions I ask my patients are clear, so that they understand exactly what I need to know.
And second, when questioning them, I need to keep an open ear, an open mind and an open heart—so that I can hear and fully understand everything they need to tell me.
5 thoughts on “Bella’s Not a Girl Anymore”
Wonderful story and as others have said, a most welcome happy ending/theme and beautiful humor as well as thoughtful reflection. Thank you for sending this.
I once asked a patient if she’d had multiple sexual partners. She thought for a moment before replying, “Well, not at the same time!”
I actually laughed out loud at your sentence “One girl replied, “No, I just lie there; he does all the work.””
It’s not often that I laugh out loud to the stories here, but this was quite an enjoyable read! Thank you for bringing some humor back to the profession, there are so many funny moments and we don’t often write about them.
Dr. Wager, I really enjoyed reading your piece tonight, and I absolutely could relate to the situations you described. I once recall asking an older male patient if he had an intimate partner, to which he quickly replied, “Hell no, Doc, I’m married”.
You can’t make this stuff up…
I can identify with those euphemisms. I was office nurse in an OB/G practice readying a patient for a pelvic exam. She mentioned she would have been in sooner, but she fell off the roof. I was about to ask if she had been hurt, when it dawned on me that she meant she had begun to menstruate. I had never heard that one before and not since.
I should mention that incident occurred nearly 70 years ago.