When Girls are Guys, Sorta

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Last week at the world track and field championships, an 18-year-old South African woman named Caster Semenya won the 800m title. Unless you follow women’s track closely, you’ve probably never heard of her. But now she’s in the center of a bizarre controversy – not over steroids, training methods, or false starts, but over her gender.

Although Semenya competes as a woman, some details suggest otherwise. Her muscular, slim build, somewhat masculine face, and large margin of victory in the 800m have led many to believe Semenya is not a normal woman. After routine hormone tests showed her testosterone levels to be three times higher than normal for a female athlete, the International Association of Athletics Federations began an investigation into her actual gender. The final results won’t be available for weeks.

Strange as this story is, the leading theory diagnoses Semenya with a recognized medical condition called Androgen Insensitivity Syndrome, or AIS. People with AIS are genetically male but can appear to be female because their bodies do not respond normally to testosterone. All embyroes start developing as females. During the first trimester, a normal boy starts producing testosterone, which causes his boy parts to develop. A baby with AIS is coded to be a boy and starts producing testosterone normally, but his cells don’t detect it completely, if at all. The results can vary. Some people with AIS look like a combination of male and female. Many people with AIS look female externally but have internal testicles and none of the normal female sex organs. In these cases the boy is generally raised as a girl, develops breasts on time, and never knows of any problem until he reaches 15 or 16 and hasn’t started to menstruate. Once diagnosed, the boy must work through a difficult set of medical, emotional, physical, and spiritual questions. Although the medical buff in me finds this condition interesting, I ache for those who must deal with it. It’s hard enough to figure out your identity when you’re certain of your gender.

Looking back, I suspect that a good friend of mine had AIS. She looked and acted like a normal girl but never started her period. Around age 16 or 17 she finally went to the doctor, who told her she “didn’t develop right” and would never be able to have children. In a college neuroscience class I first heard about AIS and made the connection. At first I thought her doctor had withheld the whole truth from her. Imagine what it would feel like to spend 16 years thinking you were a girl and suddenly being told you were actually a boy, even though you still looked like a girl. How confusing and disturbing such news would be. But now I wonder whether her doctor didn’t tell her the truth, and my friend simply withheld the most shocking part from me. I understand if that’s how she chose to handle it. I still think of her as a woman, regardless of what the genetic tests might say.

Back to Caster Semenya…I feel terribly for her. If she has AIS, she could be banned from competing in track as a woman since she could have an unfair advantage over the normal women. Since she’s not fully male, either, she isn’t quite fast enough to compete with the men. Her countless hours of hard work would become almost worthless, her career over, due to a medical anomaly over which he had zero control. Even if she doesn’t have AIS, she’s been humilated by the gender testing and speculation, which will probably haunt her throughout her career.

Here are some links in case you’d like to read more:

AIS – University of Indiana

Time.com article on Semenya

Memory

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Over the weekend Jenny and I watched the 2004 film The Notebook, based on the book by Nicholas Sparks. Of all the books I read as a youth, The Notebook was one of the most moving, mainly because it explored a tragic situation that I hadn’t really considered by age 13 or 14: an aging couple in which one partner has Alzheimer’s Disease and has all but forgotten the other. The movie changed a few details from the book but kept a similar structure along with the emotional punch, largely due to excellent performances by the actors playing the young and old versions of the couple.

As a teenager, I remember being horrified by the idea of someone’s losing their recognition and memory of his or her spouse, especially after spending most of their lives together. To share so much with a person and then turn into just another stranger seemed so unfair. Alzheimer’s is a terrible robbery not of one’s possessions or even one’s life, but of the very things that make life so wonderful: your relationships. A few years later, I had to watch couples I knew walk down that lonely but irreversible road, matching real faces and names to the imaginary ones from the book.

Seeing the movie made both Jenny and me face the very real possibility that our own future could end in that dark, tangled forest. A day could come when I wake up and don’t remember who Jenny is, or when I come home from work and she thinks I’m a burglar. I hate that thought. The idea of forgetting Jenny, or Brenden, or anyone else in my family breaks my heart. I would rather die than live thinking that they are strangers.

One thing that consoles me about Alzheimer’s patients is my belief that if they know Jesus, they will one day receive a new body at the Resurrection. Although I don’t have any solid Biblical backing, I assume that with the new body should come a restored mind that can remember all the wonder, beauty, pain, people, and adventures gathered during their brief walk on earth.

May it be so, Lord.

Misconceptions about Foreign Health Care and Our Own

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A friend shared a fascinating article from the Washington Post about many of the misconceptions that Americans believe about health care in other countries. Due to the huge amount of incorrect information being thrown around in this country during Congress’s attempt at fixing our broken system, you’ve probably heard some of these already.

I don’t claim to be any sort of expert on health care, but I have no doubt that our system is broken. You’ve seen and experienced it yourself. We have some of the best doctors, nurses, and facilities in the world. Yet tens of millions of people inexcusably lack health insurance, the costs of health care continues to rise much quicker than inflation, and the entire system is a jumbled, confusing mess of paperwork and bureacracy.

For one example, consider Jenny’s recent gallbladder surgery. The hospital sent our insurance company a bill for over $11,000 for the surgery itself and a separate bill for $700 for the ultrasound that revealed the stones that got things rolling. (heh heh) The surgeon sent the insurance company a bill for maybe $3000. In each case, the provider was billing MORE than the actual cost of the procedure knowing that the insurance company would only cover a lower amount, which is related to whatever government-run Medicare decides is a fair price for that procedure. The provider writes off the difference, which provides them some tax benefits. Then we have to pay 10 percent of whatever amount the insurance company decides is fair. So out of a total “bill” of over $15,000 for a surgery that took less than an hour and an ultrasound that took 5 minutes, we are paying about $500. Only God and perhaps the providers know that actual cost of the care Jenny received, but it has very little to do with what we paid or what the insurance company paid.

At the same hospital, and hospitals around the country, pregnant women show up every day in labor with no insurance at all. The hospital is legally obligated to help them, so they deliver their babies and provide the same high level of care that we received when Brenden was born. The mothers’ out-of-pocket cost? $0. Reimbursement to the hospital and doctor? I assume they get something from Medicaid, but less than they got from us and our insurance company. But they probably got NO prenatal care because they didn’t have insurance, adding risk to both baby and mother.

I don’t understand why it’s so difficult for the wealthiest, most powerful, and most advanced country in the world to provide a cost-effective, efficient, and innovative health care system that makes coverage available for everyone in a fair way. As you can read in the Washington Post article, countries around the world have added great ideas to their own systems. I hope that our leaders can learn from the many examples out there and hammer out a plan that works for us.

Air Traffic Jams

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I got to work again this afternoon, this time on the Assistant desk working on some support tasks rather than dispatching flights. This desk on this day gave me a prime seat to watch but not endure one of the worst possible weather situations: a line of thunderstorms moving through the Northeast. One of my worst days ever came on a day just like this. We deal with thunderstorms all spring and summer in various parts of the country, but the Northeast is special.

  1. It’s the busiest airspace in the world. It is the launch point for hundreds of flights each day to all parts of the US plus many to Canada, Asia, Europe, and Central and South America.
  2. It’s a fairly narrow strip of land bordered by a huge ocean on one side, with a limited number of routes available, and Canada on the other with its own air traffic control system.
  3. Because it’s so busy, it has four different air traffic control “centers”, which manage traffic above a certain altitude, plus a huge number of other ATC facilities that manage traffic landing at or departing the many airports and metropolitan areas. People at all these different facilities have to work together to feed each other traffic.

Until we switch to a satellite-based ATC/navigation system, we must continue to fly generally from point to point using ground-based radio beacons that form “highways in the sky” called airways. For busy airports like many in the Northeast, ATC, the FAA, and the airport work together to design set pathways in and out. These pathways help the controllers to ensure that aircraft maintain a safe distance from each other. When a line of thunderstorms moves through an area like the Northeast, it shuts off these pathways, forcing inbound flights to hold and departing flights to sit and wait until the storms move far enough away from the pathways to make them safe to fly again. Where able, ATC moves flights from one pathway to another as the storms move through. It’s like a wreck that occurs on LBJ and shuts down a line or even the whole freeway until emergency crews can get it cleared out. Maybe there’s an alternate route, but maybe you’re stuck. It all depends.

The pilots, dispatchers, and ground personnel for an airline are trying to react to the weather and ATC’s instructions and also to predict them. Since weather is so fluid, and ATC is made of people who have their own experiences and perspectives, accurately predicting the actions of either factor is challenging.

Today, for example, the line of storms first hit Baltimore, one of our biggest airports, causing several diversions that had to sit and wait for a while at their diversion airports until the weather passed and the three Washington, D.C.-area airports got their airborne traffic cleaned up. But by then the line had moved to the northeast, hitting Philadelphia and cutting off New England from the rest of the country. The diversions finally got to land in Baltimore, but any flight trying to reach New England from Baltimore was stopped by ATC because there weren’t enough open airways to handle all the traffic. Imagine shutting down LBJ, I-30, and I-35 simultaneously. The whole area ground to a halt, and the phones started ringing more and more – pilots frustrated because ATC won’t let them launch, ground personnel who had more planes to handle than places to park them, not to mention lots of unhappy passengers.

Since we couldn’t launch many of our flights from Baltimore, we had to start holding our flights on the ground in other cities that were headed toward Baltimore because we didn’t have any available gates. Situations like this are often difficult for passengers to understand because they don’t have the big picture – the weather is great in Nashville and Baltimore, so why are we delayed for two hours?!? My hat is off to the customer service agents, pilots, and flight attendants who have to explain situations like these to our passengers.

Further complicating matters, the various ATC facilities are negotiating among themselves regarding when to open and close the available airspace as the weather moves. For example, Boston Center might tell New York TRACON that they can accept traffic spaced 15 miles apart on just one airway, but New York TRACON might only be willing to space the traffic 20 miles apart (more wiggle room around the storms) and might want to switch traffic to a different airway in 30 minutes because they think the weather will move by then. As they make decisions, the updated plans slowly feed down to the pilots and dispatchers, who then have to decide how to react. Do we need more fuel for the new route? Do we concur that it’s safe? Often the dispatcher what seems like a good route, but ATC won’t accept it because of factors that he/she cannot see. Situations like this are very complicated and frustrating all around because there is no perfect solution. We just do the best we can with the circumstances we’re given, just like you do.

I hope this post gives you some insight into both my job and your own flying experience if you ever deal with weather-related delays. I assure you that we never WANT your flight to be delayed, but for any number of reasons, it’s sometimes necessary. If the weather were always perfect, and every aircraft always worked perfectly, and the airlines collectively scheduled their flights to match the capacity of each airport, every airline could run close to 100 percent. But until those beautiful events work out, we’ll sometimes have to deal with days like today.