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Ten minutes after the showdown in Sickbay, a much happier Karen was tucking into a thick club sandwich, French fries and coleslaw, while a half-full glass of iced tea, the remains of a garden salad, a dish of mixed fruit and a plate of cheese and crackers lay at hand, along with a yet-uneaten plate of pastries.



Thanks to her enhanced metabolism and her running habit, she'd always been able to put away an inordinate amount of food for someone her size, and even past forty, she still retained the build of a much younger woman - a trait that had alternately awed and annoyed most of the people she dealt with.



The flipside of that, of course, was a tendency to hypoglycemia, and when that happened, a headache and a case of general irritability usually weren't far behind. It had become a running joke in Sickbay, to the point that one of the surgical nurses, a battleaxe of a JG named Longchamp who'd been around almost as long as Karen had been alive, had posted a sign at the OR control desk:



"ATTENTION ALL STAFF - REVISION TO EMERGENCY CODE SYSTEM - CODE COOKIES



In case of sudden severe deterioration in Dr. Coleridge's mood:

* Notify OR Control that a Code Cookies has occurred

* Remove Dr to non-sterile area

* Administer sugar-based snack foods PRN until condition improves."



Code Cookies, indeed. I hope I didn't rip on that EMH too badly...



Her thoughts were interrupted as Captain Stryker walked in. He ordered a glass of mango juice and tossed off half the glass in one slug, staring out the transparent plate windows with a pensive expression. After a few moments' thought, he looked around the room, and began walking in her direction.



"Good afternoon, Sir. Can I help you?" Karen stood up and indicated the second chair with a wave.



"Doctor." Even in the informal atmosphere of Dot's, the captain had trouble with first names. "I have been thinking. Wondering. I finally recall that altercation that you and Alice were in, a month ago in Sickbay."



Uh-oh. The memory came back unbidden - flashes of Stryker's frozen face, Alice bursting into the ward, the other woman choking the life out of her, the shock on Alice's face. "Sir...?"



"I have attempted to read about human sexual relations, but I have found very little information that is not of either religious or pornographic nature. What does 'lesbian' mean, and why is sexuality such taboo in human society?"



Karen began to laugh softly, and Stryker regarded her with a puzzled expression. "It is a subject for humor?"



"No sir, it's just that it's a complex question to answer, and some of the answers we still don't have. The greatest of human thinkers have battled over that puzzle and they're still in the dark, yet we expect everyone past puberty to figure it out largely on their own. You might want to grab yourself a refill, because we might be here for a while."



A few moments later, they were both seated again.



"Where to begin... let's start with biology. Humans come in two sexes, male and female, which are determined at the genetic level by the presence or absence of a Y chromosome. You probably know this part. Human embryos are physiologically neuter at conception, but undergo sex differentiation in the first trimester - either a Y chromosome is present and it directs the formation of male genitalia, or it isn't and female genitalia are formed by default. Formation of the genitalia and maternal-fetal hormonal interaction results in the release of androgens or estrogens into the fetal environment, and those hormones act on the brain and the body throughout gestation. Theoretically, by the end of nine and a half months, the result is a human neonate with a determinate set of genitalia and a neurological conformation that matches the physiological sex, and when that child reaches puberty and undergoes secondary sexual differentiation, theoretically it will be oriented toward members of the opposite sex."



"Theoretically, you said. I take it the process can fail?"



"It can, and actually, derangements of the process happen a lot more often than people think. It's because of the cultural issues surrounding sexuality that many of them either aren't discussed or are thought not to exist. Humans tend not to acknowledge what's not constantly in their faces."



"Interesting, Doctor," Stryker replied. "Please continue."



"Current neuropsych theory holds that the formation of a sexual identity has four components: biological sex, neurological sex, psychological sex and environmental influence. You can have discrepancies between any of those factors. For example, you can have an individual who has female genitalia and a feminized brain, but her biological sex is male. That's called androgen insensitivity syndrome - a failure in androgen receptor formation halted the formation of male features, so the body 'defaulted' to female. Nowadays a lot of the intersex, or hermaphroditic, conditions are screened out before birth, but some we just can't do anything about short of embryonic genetic surgery in vitro, and AIS is one of them. Or in another example, you can have an individual with male genitalia, but his brain was feminized due to any one of a number of factors. He thinks of himself as a male, but finds other males attractive. That's a normal gay man. In an extreme case, where the brain is completely feminized, you get a male-to-female transsexual - someone who cannot tolerate living as a male and seeks medical and surgical assistance in living as a female. Flip the situation around, and you get either a lesbian or a female-to-male trans. Ambiguous conditions of neurological and psychological sex result in an individual who can function as a homo- or a heterosexual, and such a one is bisexual. In species where androgyny or hermaphroditism is the biological norm, the term is ambisexual.



"When you throw environmental influences, such as sex taboos and cultural norms, into the mix, it's a whole new situation. If our gay man lives in a culture where homosexuality is accepted, he will associate openly with other gay men, and he will usually have no or few problems accepting himself and his identity. If that's not the case, if either religious beliefs or secular culture teaches that homosexuality is wrong, diseased or immoral, you can see all kinds of psychological issues in many different kinds of people. For example, you can get young adults who would otherwise identify as heterosexual claiming a homosexual identity for themselves in order to seek attention or anger parents and authority figures. Once the shock value wears off, they go back to heterosexual behavior. Or, you can get a queer person who represses his or her identity and lives 'in the closet.' Such a one might live celibate and avoid the problem entirely, or deny the charge by being highly promiscuous or by marrying a heterosexual partner, but they can't deny their identity to themselves, and usually psychological problems result, anything from depressive disorders to uncontrollable rage and hatred, and in extreme cases they can pose a risk to self or others." Karen cracked a lopsided smile, but her eyes were somber. "The psych guys have a rather black joke about that situation; they call it 'suicidal/homicidal impulsive thinking,' and the joke is that you see a patient like that and say 'Oh, SHIT.'"



Stryker tilted his head to one side, thinking. "Hmm. I meant to ask you why so many medical professionals find such humor in such painful situations... but that's for another time. Go on."



"Oh, I can answer that one quickly - it's combat trauma. You see so many sick and injured people you can't help, and you have to laugh or you'd go nuts." Taking a drink of her iced tea, Karen continued speaking. "Anyway. That's the primer on human sexuality, more or less. You asked what a lesbian is, what that means. Truthfully, the answer is highly individual. For some women, it is a sexual identity and nothing more - they see themselves as just like other women in every respect, except that they find other women attractive. For others, sexuality informs their whole self-concept. Some act masculine or 'butch,' others act feminine, most fall somewhere in between. Some are very sexually aggressive, others are not. Some live entirely among others of their kind, others find a partner and have no other contact with the queer subculture - and no, that's not so much an insult anymore. Nowadays, 'queer' refers to the community comprising gay, lesbian, bi, trans, intersexual, ambisexual, hetero people with ties to any of the above, and really anyone else who doesn't see themselves as strictly straight. Some turn their identities to political ends, whether it's advocating for queer issues, women's, children's or sentient rights issues. In other words, the entire range of human diversity exists in the queer population."



"And what about you, Doctor?"



"Well, for starters, a lot of queer people describe feeling 'different' or not 'fitting in' through childhood and young adulthood. I never had that problem, because the people I lived with were already 'different' by human standards. You're probably aware that the Gethenians are biologically ambisexual - androgynous for about 26 days out of every 30, and capable of becoming either male or female in any given reproductive cycle. Then too, San Francisco has been known as a center of queer culture since the 20th century - it's little wonder so many people come out in the Academy. I've been lucky, too, in that pretty much everywhere I've gone has been pretty tolerant. It didn't always work that way; up until 2012, evidence of homosexual behavior would get you thrown out of the American armed forces, and all non-heterosexuals, even those who publicly recanted their sexuality and led heterosexual lives, were banned from military and most branches of civilian public service from the social upheavals of 2020 to the formation of the United Earth government in 2113.



"At any rate, to answer your question... it's not at the forefront of my identity, I don't run around waving the rainbow flag or chasing skirts, but it's a part of me, just like my identity as a human, or a colonist, or a physician, or a psychosomatic talent."



"Does Ensign Maxwell feel the same way?"



Karen laughed at that. "Well, for that you'd have to ask her." She glanced at the wall chrono, wincing as she noticed that almost two hours had elapsed. "Oh, no - I told my staff I'd be back in Sickbay an hour ago, so I do have to get back. Did this help at all, or did I just confuse you further?"



"No, Doctor, I found your explanation most enlightening. Thank you."