If you’re anything like me, you may find yourself trying to plan every little detail of your life, all but eliminating the element of chance, and with it, possibility. By the time I was twenty-four, I had mapped out my entire life, in four year intervals. 1)Graduate from medical school with honors, 2)get married, 3)attend top-notch residency, 4)obtain academic professorship, 5)have babies, 6)become chairman of the department. My schedule didn’t leave much flexibility for spontaneity or for the uncertain, leaving me unprepared when my plan fell apart in my thirties.

Although everything started out just fine, nothing ended up the way I had planned. Two marriages failed, I decided not to pursue an academic career, and my beloved father died. In the wake, I found myself derailed, a train with no tracks, a skydiver with no parachute. What I discovered, through suffering and coming out the other end breathing, was the joy of wandering aimlessly and free falling. All of my life, I built extensive train tracks and safety nets, but suddenly, without a plan, I found myself adrift, floating, zig-zagging. I quit my job, wrote a book, painted, played with my daughter, and looked back at the train tracks behind me, surprising myself by finding joy in the uncertain path ahead.

Emily was lucky. She didn’t have to wait until she was almost forty to learn the lesson I learned. Her Yoni taught her the importance of being open to possibility at the ripe old age of seventeen. When Emily first came to see me, I met a studious, shy, awkward twelve-year-old who spoke in four-syllable words, with perfect grammar and impeccable manners. When she hit puberty, her wise mother wanted her to establish a candid and private relationship with a gynecologist, in case she ever needed one. Her mother always drove Emily to her appointments but stayed respectfully in the waiting room, while Emily met with me alone, year after year, for an annual exam. Because Emily wasn’t sexually active or experiencing any gynecologic problems, we usually just chatted about the economy and politics and the housing market. I tried to steer the conversation to more kid-friendly topics, but when I asked her if she had any crushes on movie stars or musicians, she said, disdainfully, “I read The New Yorker, not People magazine.” (I confessed my undying love for Rob Lowe anyway).

I always listened to her heart and lungs, palpated her small breasts, and pressed on her belly, even though her pediatrician did the same thing every year. Not until she was seventeen did I attempt to perform her first pelvic exam, only a month before Emily was about to go off to Yale for her freshman year, where she planned to study biochemistry in preparation for attending medical school. As a seventeen-year-old virgin, she still didn’t need a pap smear, but she asked for the pelvic exam anyway. “It’s time for me to be responsible about my health,” she said. I couldn’t help smiling. She reminded me so much of my nerdy little self, back when I was equally focused and serious, a grown-up dressed in little girl eyes.

So we went through the motions- heart, lungs, breast exam, belly palpation. When I pulled out the clunky metal purple-sock-covered stirrups, she pursed her lips and splayed her legs with a stoic resolve much different than the girlish resistance I displayed during my first pap smear. In anticipation of her arrival, I had already located and sterilized my special skinny Pedersen speculum, the pinky-finger-width instrument I reserve specifically for first pap smears. Because it is no bigger than a tampon, most young woman tolerate this kind of exam much better than when doctors use the mean, goose-lipped Graves speculum, which is three times wider than the skinny Pedersen and, in my opinion, should never be thrust into the vagina of a virginal teenager. I held it up to show Emily, and she inspected it curiously, opening it and closing it like a talking puppet.
“See, it’s no bigger than a Playtex tampon,” I said, hoping to sound reassuring.

Emily raised one eyebrow and sat up on the table, dropping her legs out of the stirrups. “Dr. Rankin, I don’t use tampons.”

“Why not?” I asked. “Don’t you just hate those squishy diaper maxi-pads?” I recalled my first experience with them, back when I was a gawky adolescent, walking with my legs two feet apart like I was wearing a metal chastity belt.

Emily said, “No, I hate them. But I don’t have a choice.”
I was confused. “So what do you do when you go to the pool during your period?”

She said, “I wear shorts and sit in the corner. I don’t swim.”

“Oh, honey, you’re missing out.” I shook my head. Why had this never come up before? I could have saved her years of pool wallflowerness and icky discomfort. “Have you ever asked your mother for help?”

She curled her lip at me. “Are you kidding me? That’s gross, Dr. Rankin. Like I’m gonna let my mother go down there?”

I told her about my own teenage humiliation, when my mother squatted between my legs after watching me insert my tampon in the wrong hole and finally guided me to the right one. Emily looked me like I had suddenly let her down as mentor, as if the very image of me getting tamponed by my mother shot down her whole sense of who I was.

“Dr. Rankin, I know what hole the tampon goes in. I’m not stupid.” Well, la de da. Wasn’t she all Yalie big in her britches?

I asked, “Have you tried to put a tampon inside?”

She said, “Duh.”

“So what happened?”

She shrugged. “It just wouldn’t go.”

Poor thing. I could totally relate. It’s dark and confusing down there. I knew I could help her sort it out. “Why don’t we get your pap smear out of the way, and then I’ll give you a little tampon lesson.” I’d done it many times before, teaching a teen how to use tampons. You just invite her to stand up, with one foot up on a step, while you guide her through the anatomy- the labia majora, the labia minora, the clitoris, the urethra, the rectum, and finally, the vagina. You dip the torpedo-shaped tampon into KY Jelly, and then you empower her to know her own body, to love it, rather than fear it. When she’s ready, you encourage her to insert the tampon, slowly, gently, tenderly, like it’s a sweet, drippy popsicle about to get savored on a hot, summer day. I’d teach Emily before she went off to Yale. It would be my going-away present to her.

“I’ll show you, sweetie. I know it can be confusing, but it’s not so bad.” I patted the stirrups. “First, let’s get this pap smear thing out of the way.”

Emily nodded and slid her feet back into the stirrups. Gently, I touched her inner thigh, talking my way through her exam. “First, I’m touching your leg. That’s right. Try to release the tension in these muscles right here. That’s good. Now I’m touching your labia, just opening them to the side so I can see the vagina. Here it is. I’m touching you with the speculum now. Real gentle. Now I’m going to just slide it in, nice and slow.” I probed her genitals with latex fingers and held the speculum up to her vagina, then eased it forward with careful, deliberate movements.

Usually, when I do it right, it glides right in, with no resistance. But I wasn’t getting anywhere. The speculum hit a road block, and when I pushed against the barrier, Emily cried, “No! Dr. Rankin, you’re hurting me.” I saw a tear slide down her brave face, as I yanked the speculum back, afraid, as always, that any traumatic memories of the first pap smear would erect emotional scars that might cause a life-long fear of the OB/GYN office.
“I’m sorry, honey. Let me just take a look. Just fingers now. No speculum.” I set down the speculum and inspected her vagina, pulling the lips of her labia apart so I could get a good look.

There it was. The road block. A pink, fleshy wall of tissue with tiny little seed-pearl-sized holes in it, but no vaginal opening. Usually, the vagina is a potential space, flat like a sock until you put something into it, when it expands to accommodate what enters. When you pull on the labia, you can see the space a little better, look inside a bit. But Emily’s vagina was closed off. The only space I could see was through the tiny dotted holes in the roadblock. I diagnosed a microperforate hymen, something I had only seen in books, never in real life. Usually, the hymen is a ring or a half-moon of fleshy tissue that surrounds the vaginal opening. When you pull on the labia, you can see inside it, even in a virginal woman. But Emily had no vaginal opening, only the little bullet holes. If the holes didn’t exist, she would have had an imperforate hymen, when the vagina is completely blocked from the outside world. In that case, she would have come to me earlier. With an imperforate hymen, I would have diagnosed her condition around the time of her first menses. Blood would have gathered behind her hymen, bulging out at her vagina like a veiny water balloon, while blood would have backed into her uterus and out her tubes, causing severe pain. Imperforate hymens are a piece of cake to diagnose. But with a microperforate hymen, blood seeps out like broth through a sieve, avoiding the painful consequences and delaying diagnosis.

Poor baby. I felt shitty. I could have helped her years earlier, if only I had asked. She never said anything, and we were too busy chatting about Broadway plays and Iraq to discuss tampons. I wrongly assumed she would have brought it up, if she needed my help. That day, I learned a lesson from Emily’s Yoni. Avoid making assumptions, if at all possible. It’s better to talk it through, ask questions, listen to answers. Don’t assume. What do they say about the word assume? It makes an ass out of u and me? Well, that was partly right. Certainly, if anyone was the ass here, it was me, not Emily.

Emily said, “Dr. Rankin, is everything okay down there?” Oh my God. Here I was, staring at her plugged-up vagina, not saying a word to comfort her.

I rubbed her leg. “It’s fine, honey. I’m sorry. I know I got quiet.” I stood up and reached for her hand, pulling her up to a seated position. “You’re gonna be just fine, sweetie.”

“But you didn’t do my pap smear. Aren’t you supposed to put that thing,” she pointed to the speculum sitting on my Mayo stand, “into my vagina and swab my cervix to make sure I don’t have cervical cancer?” Man, she was precocious.

I nodded. “I know. I couldn’t do your pap smear.”

“Why not? Is something wrong?”

I said, “You’re just fine, Em. Let me step out for just a second so you can get dressed, and we can talk.” I stood up and walked towards the door.

She grabbed my arm and pulled me back. “You’re scaring me, Dr. Rankin. Just spill it. I can take it.” She looked about seven, sitting there with her oversized pink half gown, crossed legged on the table, with the white paper sheet across her legs. But she sounded like she was thirty.

I sat back down on my stool. “The good news is that you’re gonna be able to wear tampons, have sex, and get pap smears.”

“And the bad news?” A tear trickled down her cheek.

“You have a very minor congenital birth defect called a microperforate hymen.” I grabbed a brochure and started drawing on the back of it. “Here’s your urethra, here’s the vagina, here’s the rectum. Right here, there’s supposed to be a hole, but instead your hymen is blocking the way. The only entrance to the vagina is these tiny little holes that are big enough to let blood out but too small to let a tampon or a speculum in.”

She wiped her eyes with the tissue I handed her and sat up tall, straightening her shoulders. “So what do we need to do?”

“Well, we don’t have to do anything right now. You haven’t had any problems with your periods and you’re not sexually active, so you don’t really need a pap smear yet. This is definitely not an emergency.”

She nodded. “Good. Good. I’m leaving for Yale on Friday.” She sat quietly for a few minutes, tapping her fingers on her knee. I could just see the wheels in her head spinning. I recognized her expression from my own, when I’m focusing, mulling, and planning. I fussed with the chart, trying to give her some space, while still being present for her. Finally, she said, “What if I meet someone at Yale? What if I do want to have sex?”

I picked up the brochure again and pointed to my drawing. Where I had drawn her microperforate hymen, I drew a cross-shaped mark. “We need to cut like this.” I drew little suture marks pinning the four pie-shaped pieces back, like the four-quadrant, puppet-like, fold-up notes we used to make in grade school, which had secrets drawn underneath each pinned back piece of paper. “We do this, and sew here, to make a new opening.” I folded up the brochure to make one of the four-quadrant notes, something I hadn’t done since I was a kid and was surprised I still remembered. Then I opened the four quadrants to the side, like a four part set of lips, to reveal the open center. I invited her to put her finger inside the note, and she complied, even though she threw me a look that said that she was too old and smart for silly fold-up notes. I clamped the note closed on her finger, catching it inside, and she laughed, before pulling her finger out and sitting up straight, wiping the grin off her face.

I opened the note with my fingers and held it out for Emily to inspect. “When we’re done, you’ll be open. Like this.” She peered quietly into the note’s mysterious depths, then looked away. I folded it back up and laid it on the counter.

Standing up, I said, “I’m going to step out now. But I do want to talk a little more about this. It’s cold in here. Why don’t you get dressed, and we can talk some more.” She nodded, and I stepped out.

When I came back, Emily looked twenty years older. No longer the fragile seven year old, she looked like a valedictorian, about to go to Yale. I wondered what life had in store for her. What dreams would come true? What goals would she achieve? What curveball would smack her in the face? What love would find her? I saw so much potential in her, wrapped up in her smart little cashmere twin set and her baby blue ballet flats. By the time I was Emily’s age, I had closed so many doors. I don’t know why. No one did it for me. I did it for myself. Why had I never ask myself what I wanted to be when I grew up, give myself choices about whether I would be a good editor or journalist or artist? Why didn’t I give myself permission to study abroad, instead of staying rooted to a man, clipping my own wings? Why did I build a box around myself when I was only seventeen years old? If only I had stayed open, leaving room for possibility, for chance, for change, for mystery. How might my life have been different?

But I am no longer seventeen. I am almost forty, and the path has been cleared open for me. I never viewed it as a choice. It seemed more like God or the universe erected a roadblock in my path to force me down the road not taken. And thank God. Had someone not intervened, I would still be trudging down a dark, narrow hole. Instead, I got lucky, and someone sewed back the four quadrants that were keeping me stuck, shining a light on me to illuminate the open road.

Finally, after smiling at her a moment too long, I said, “What do you want, Em?”

She looked confused and didn’t answer me, so I repeated my question. “What do you want, for life, for Yale, for your vagina?”

She thought about it for a minute and said, “I guess I would like to be open.”

I said, “Tell me what you mean.”

She was quiet for another moment, then she nodded her head. “I don’t want to close up my options. I don’t know what the future holds, what might happen.” She gazed out the window over the mountain range beyond. “So I’d like to be open.” She grabbed my hand and pulled me close. She whispered, “I mean, I want to have the choice, just in case.”

I whispered back, “You mean for sex?"

She said, “Well, yeah, for that. But for other things too. I’m young. I just don’t like the thought of being closed.”

Thinking back on it, I feel like Emily was the thirty-something doctor, and I was the little girl, about to go to college. When I think of her, I think of my Anything Box, the little metal sculpture with the heart inside that reminds me to let Yoni out of the box and open myself to possibility. Emily was ages ahead of me.

Emily went off to Yale that week and sent me a postcard from New Haven. When she came home for Christmas vacation, I opened her microperforate hymen with a little scalpel and taught her how to insert a tampon, so she could exercise her new vagina and make sure it stayed open, instead of scarring shut. She told her mother she needed the surgery, so she could wear tampons, and her wise mother never questioned either of us.

The next summer, Emily came in for her first pap smear, which went as smooth as silk. When I asked her if she had taken her new vagina for a test drive yet, she said, “Only with tampons. I’m still too young for sex. I don’t want to get pregnant or get some disease that might limit my potential. I’d rather stay open, just in case. But you never know what might happen.” Reaching for her purse, she said, “Want to know what got me through my first year at Yale?”

I nodded. She put her hand inside the bag and pulled out the four-quadrant fold-up note I had made the previous summer. Putting her fingers inside, she opened and closed it, then held it open, while we both peered inside.