He was younger than my shift had been,

making his world debut a block from Lake Michigan

on the eighth floor

of the second tower

of the women's hospital.

Shortly after his first feeding,

his nurse spotted something that won him an instant one-way ticket,

with lights and sirens,

down Michigan Avenue,

to the children's hospital,

where I'd just arrived for my first day in the NICU.

I had yet to transfer my ID badge from the strap of my bag where it typically spent the night,

to the pocket of the scrubs I'd just changed into,

when my attending poked her head into the call room with a challenge.

Go examine the baby in room 11 and tell me what's wrong with him.

I arrived blinded at what to expect,

yet even when my eyes were given permission,

they missed it.

Everything seemed normal;

perfect even.

Open soft spot, red reflexes, symmetric palmar grasp, regular heart sounds, clear lungs, stable hips.

I was even able to count the requisite 3 vessels on the freshly clamped umbilical stump.

Everything was where it was supposed to be.

He was a textbook normal baby.

I realized this must be a trick question—

put the new intern in front of a healthy baby and make him sweat.

I ambled back into the hallway and made eye contact with the attending,

hoping a smile would unmask the prank.

There was none.

Just a curious brow raise, and then

did you find it?

Damn, there was an it.

Give me another chance.

I turned the overhead lights on this time,

and began the search anew.

Ten fingers and 10 toes.

Nostrils open.

Gluteal creases symmetric.

I had nothing.

I rocked back on my heels to pivot towards the hall when the fellow rescued me,

when she leaned in the room and whispered,

“Pssst. He has no asshole.”

I'd made it to the gluteal clefts on round 2, but hadn't gone far enough.

I leaned down and looked closer, and for the first time stared at something I'd only read about in textbooks before.

Smooth skin where the opening of the rectum should be.

Imperforate anus.

Hidden in plain sight.

All else perfectly where it was supposed to be,

the handiwork of a designer for sure,

just missing the final punctuation mark of the signature.

The dotting of the I.

Sure enough, a surgeon would complete that design a few hours later,

freeing the baby to lead a healthy

and quite literally productive life,

all before my badge returned to the strap of my bag,

on that winter day,

when 2 new assholes were formed in the hospital by the lake.