ABSTRACT
It was in the early stages of fieldwork at the hospital that a meeting was called for medical staff from different specialities to discuss the ‘case’ of a child born at the institution a few days previously. At that time, the team was still referring to the baby as ‘Carolina’s newborn’. A meeting of specialists had been called to deal with a ‘case’ of intersexuality – now known by the term disorder of sex development (DSD) in the medical sphere2 – where the precise diagnosis and attribution of male or female sex to the baby was seen as especially complicated. The meeting was attended by two paediatric surgeons, a paediatric endocrinologist, a psychiatric intern, a geneticist, a genetics intern, a paediatric intern, a neonatologist, two medical students and me. Factors considered relevant to a diagnosis were presented: data from physical examinations and tests to determine karyotype and hormone levels aimed to offer a more or less coherent picture, but at the same time indicated that other tests were required to fill in gaps concerning the diagnosis. In relation to the karyotype test, the geneticist reported that he could not ‘see’ clearly whether either the XX or the XY karyotype – considered respectively as the female and male karyotypes – were present. ‘We can’t say that it is Y’, he stated, as ‘none of the markers is indicative of Y’. The endocrinologist, contrariwise, pointed out that the ‘gonads’ were producing ‘testosterone’. The discussion continued and various opinions were offered regarding the child’s ‘biological condition’ and the ‘psychological aspects’ of the mother, until one of the doctors surprised the group with the question, ‘but why operate?’ The question was received with a degree of shock and even impatience. Laughs and mutters could also be heard. After all, the team’s concern was how best to intervene, which required the unequivocal definition of the baby’s sex. The doctor’s question sounded foolish in the context, because, the others remarked, ‘how would the child live in the world without a defined sex?’ This was precisely the decision they had come together to make. This vignette, drawn from the fieldwork, raises at least two questions. First, it shows the complex clinical/surgical and social situation in which the medical staff had found themselves. Even though more or less established practices exist in the medical field for issues related to intersexuality, this particular case shows how some decisions can be very difficult to make and that all should ideally involve professionals trained in the different specialities. Second, the vignette shows that ‘sex’ often becomes an all-encompassing category, including everything that defines a person and makes them, in a sense, recognisable.
