“What have I been asked to do that I haven’t done?”

“Everything you’ve been asked to do you haven’t done,” he shouted. “You haven’t helped market the practice. You haven’t helped bring in new patients. You haven’t gone to conferences to represent us. You haven’t attended seminars to expand your skill set and thus our offerings. We needed someone to take on social media and the website, and you refused. We’d like someone to look into aid work and other volunteer opportunities. I actually did the work to liaise with a clinic in Thailand, but you won’t go there, even for a brief stint. Do you know how great something like that looks for a small practice? Seattle Met might do a profile on us. Maybe even NPR. We’d get recognized by the AMA. This is how people choose doctors, Rosie. There’s a thousand big and small things that go into running a business like this, and all you’re doing is meeting with patients. Except when you can’t.”

“Howie, I can’t go to Thailand—I have patients here, not to mention a family and a life. I can’t do weekly volunteer hours—I already have a full-time job. I also already have all the skills you wanted me to go to seminars to learn. We can’t attract new patients because we’re full with the ones we already have. I can’t do social media because I’m not eighteen, and I can’t do marketing because I’m a physician, not an ad exec. However, because I’m a physician, I can treat our patients, which I do, very nearly without fail, and I’m getting no complaints. The key to a successful practice isn’t volunteer work in Thailand or a Twitter feed or a staff-appreciation breakfast which I have just taken on for the fourth year in a row; it’s happy patients, and mine are happy because I am a good doctor.”

“And I’m telling you it’s not enough. If you want it to be enough, go be a doctor elsewhere.”

“Jesus, Howie. It was three days.”

“Three days plus four years. Enough is enough. Think about it.”

*

At lunch, she called Mr. Tongo. “Everyone knows.”

“Oh shit.” It was so unlike Mr. Tongo to curse, Rosie almost laughed. Almost. “Everyone?”

“Everyone. Well, no, nearly no one. But everyone at Poppy’s school.”

“Oh my. How did that happen?”

“Who cares?”

“I suppose. How is she taking it?”

“Bad. Very bad. She shaved her head. She’s wearing sweatpants. She put away all her stuff. She won’t talk to us. She won’t come out of her room. It’s bad.”

“Oh good.” Mr. Tongo’s voice rang with relief. “Sounds perfect.”

“Really?”

“Perfecto. Great timing. Strong work. I’m so proud of her and all of you.”

Rosie was not sure she had the patience for Mr. Tongo’s idiosyncrasies today. “What are you talking about?”

“Coming out. It’s a queer right of passage. She had to do it, and the sooner the better—the closet’s no good for anyone. She’s young now, not yet in the throes of adolescence. Shaved head. Locked door. Not speaking to her parents. It’s perfect! She’s doing great!”

“She’s not … she’s not queer,” said Rosie.

“She’s not,” Mr. Tongo agreed. “And that’s the problem. You’ve so thoroughly accepted this child from the beginning. You accepted Claude as Claude. You accepted Claude as Poppy. You made this child feel so completely, entirely, unquestionably, comfortably female. You’ve deprived her of her queer.”

“You’re saying we’ve been too loving and understanding.”

“Yes.”

“Yes?”

“Yes. She’s queer. She’s a girl with a penis. That’s wonderful, but it’s not usual. It’s weird. It’s odd. It’s queer. There’s a whole community, a whole world, a whole worldview worth of queer support that makes being a girl with a penis and any number of other less than usual things not just okay but also celebrated. And we want her to be part of that world.”

“But you said don’t tell anybody.” Rosie tried and failed to keep herself from shrieking. “You said it was nobody’s business.”

“And that worked beautifully for a little while. You didn’t think that was the plan for forever, did you?” Mr. Tongo asked, maddeningly, as if his weren’t the advice they’d been following in the first place. “Six-year-old Poppy was too young to have to educate her peers, to have to stand up for herself all the time, to have to explain about sex versus sexuality or gender identity versus gender expression. In first grade, we’re still trying to teach little boys and little girls that nothing in their pants is appropriate conversation for school. But now she’s ten. She’s almost off to middle school, almost a teenager, about to start becoming a grown-up, so it’s time for her to explore and decide and be strong, to talk about who she is, to stand up for herself, and to deal with what sets her apart.”

“How does she do that?”

“Same way everyone else does,” he crowed. “Suffering! Your small town can’t accept you so you leave. Your family can’t accept you so you find a new one. Your little life of shame and wishful thinking becomes too confining, so you strike out for something larger.”