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A Goodreads user asked:

At one point, Vanessa and Zoe have a small fight when Zoe reveals she had a miscarriage, and she mentions that she "used to be a guy." And that was it. What was that about? It wasn't elaborated in the novel.

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Tom Sweeney It was a joke. It was a really tense situation where they were really mad at each other and like so many loving couples, one of them knows how to make the other laugh to break the anger and tension.
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by Jodi Picoult (Goodreads Author)
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