Private Ceremonies

I had only a minute while I waited for the doctor to meet my patient. I grabbed a plastic cup and a pregnancy test from the lab and slipped into the bathroom. This is one of the perks of working at an abortion clinic – all the pregnancy tests you can take. My husband Jeff and I had been trying to get pregnant with our second child. But every month when I placed those two drops of urine into the reservoir, the results had been the same. One stripe. Negative. I steeled myself for the same.

I stood at the bathroom sink, watching. The two minutes it takes for the sample to travel from reservoir to top of the test seemed like hours. Finally, faintly, a second stripe shadowed the first. A thrill shot through me.

I did not shout. I did not run into the hallway to announce to my coworkers my news. I wanted to race to the phone to call Jeff, but I knew I wouldn’t have time before the next surgery, and besides, I wanted to tell him in person. Mostly, I wanted to let the idea sink in. I pressed my hand against my lower belly, as if to give my little zygote a welcoming hug. Still, as happy as I was, I was also afraid.

I was forty. I would be forty-one by the time the baby was born. I’d worked at the abortion clinic on and off for twelve years by that point and I knew the stats. For a woman my age, the risk of having a pregnancy with Down’s syndrome is 1 in 119. Compare my risk to that of the fifteen-year-old girl I’d counseled earlier that day: 1 in 1,663. For the twenty-year-old waiting for me in the surgery room the risk for Down’s is 1 in 1,627.  If Jeff and I had waited even a year longer to get pregnant, the risks would be 1 in 91. Factor in that Jeff was also forty, and the risks increase by 50 percent.

I’d met the women my age, some younger, who had learned via amniocentesis or ultrasound that their fetus was malformed or had an anomaly that is “incompatible with life.” I’d been a counselor to these women, held their hands during their surgeries to remove their broken pregnancies, held them while they cried. I’d seen too many cases like this to be anything but cautious.

But I was hopeful, too. I thought of my friend Nancy who was forty-three when she had her baby Catherine. Jennifer was forty-two when she gave birth to her Elizabeth. Both babies were healthy. My friend Susan, a midwife, had delivered babies to women as old as forty-five.

“You have time,” she had said when I told her Jeff and I wanted another baby, “just not much.”

I cradled the test strip for a moment, staring at that tentative second stripe. I looked at myself in the mirror. I don’t look forty, I told myself, and hoped my affirmation made it all the way to my uterus. I checked my watch. I tucked the test into the trash, beneath paper towels, washed my hands, splashed cold water on my face, and walked back into the hall.

The doctor had already met my patient. That meant I had only a few minutes to get her set up and medicated before he got back to perform her procedure. I knocked softly, then opened the door.

“It’s time to get undressed,” I said, indicating the drape waiting for her on the surgery table. Her dark eyes shone with recent tears, but she seemed more relaxed than when I had first met her forty-five minutes ago in our counseling session.

I touched her shoulder.

“I’m okay,” she said.

I flipped one switch to dim the lights, another to turn on the meditative flute music, and stepped out of the room. Outside the door, I listened for the sound of crinkling paper to tell me she was sitting on the table before I reentered the room.

We chatted while I arranged the surgical instruments on the tray, her legs in the knee stirrups, and the mask for nitrous oxide on her nose, before I came to rest at the spot nearest her ear. Leaning on my elbows on the cushioned table, I began leading her into the relaxation she had chosen.

“Have you been to the ocean before?” I asked.

She nodded.

I asked her to think of her favorite time of year to be on the beach.

“Summer. No, early fall.” She smiled softly. “When everyone’s gone back to school.”

Molly, the nurse practitioner, came into the room, her small plastic basket filled with syringes and tourniquets. She introduced herself quietly before she began to administer the cocktail: 2 ccs of fentanyl, one of versed, one of atropine. She explained quietly how the woman would likely feel warm, heavy, and sleepy.

“Take a deep breath and imagine taking in the smell of the salty seaside air,” I began. “Try to feel the sensation of sand between your toes. Is it warm or cool?”

“Cool.”

I could see her features soften as the medication began to take hold.

“Is it morning, afternoon, or evening?” I asked

“Sunset,” she whispered.

As Molly left, Dr. Boyd came in. He sat in his chair at the foot of the table, touched the woman’s knees to let her know he was there, and said softly, “I will begin now.”

She nodded her acknowledgement, but otherwise did not respond.

I asked her to see the colors of the sky, make herself aware of the rhythm of the waves. Sometimes I watched her face. If she were in pain, I would have changed my tack; helped her focus on her breathing, reached for a heating pad. As it was, she was comfortable, and we could both relax. I closed my own eyes, trying to visualize what I was asking her to see – rolling waves, seagulls circling in the distance.

Looking back, it might seem odd, but I didn’t think of the irony that she, a young healthy woman, barely twenty, was choosing to abort her pregnancy, and I, a woman twice her age, was clinging to hope for mine.  I was not my patient; she was not me, although, for the moment, we walked along the beach together, felt the same the wind in our hair, the same waves lapping our feet.

 

That night I waited until Katie, our three-and-a-half-year-old, was asleep. Jeff was sitting in the den, about to turn on the TV. “We have to talk,” I said, suppressing a smile. Those were the exact words I had used before I told him I was pregnant with Katie.

Jeff looked alarmed at first, but then saw my face.

“You’re kidding!” He leapt from the beige Lazy-Boy recliner and hugged me. “How far along?”

“Maybe four weeks,” I said. I brought out the “wheel,” the device we used at the clinic to calculate weeks of gestation based on the last menstrual period. According to the wheel, the baby would be born in early February. “Six months after my birthday,” I pointed out. Katie’s birthday was almost exactly six months after Jeff’s.

“Your opposite. It’ll be a boy,” he said, half joking. It was comforting to look for signs, evidence that this was meant to be.

“Would you like that?”

“Sure. But a girl would be great, too.” Jeff paced through the den, to the kitchen, and back, his hands on his head. He does this when he’s nervous, excited or agitated. I think he got this habit from his father, a Presbyterian minister, who used to manage his stage fright by pacing outside the sanctuary door.

“I’ll be eligible for my sabbatical in February,” he said. Jeff was approaching his seventh year working at Intel. “I can time it so I can be off right when the baby’s due. We can have eight weeks at home as a family,” he said.

“Stop pacing,” I said, “so I can kiss you.”

 

The next morning we called our midwife friend, Susan. She made an appointment for me to come to her office during what would be the twelfth week of my pregnancy.

“Remember to rest when you can,” she said. “I don’t want you to get worn out.”

That would be hard to do, I thought, working part time and caring for my daughter. I thought of Katie, so full of energy, and wondered how I would ever keep up with two kids. Still, I wanted her to have a sibling, someone close to her in age. I didn’t want her to be alone. I was alone in my family until I was almost six, when my parents adopted my little brother. Having a two-week-old baby arrive out of the blue was like having an alien land in the backyard. Growing up, my brother and I were so far apart in age and personality that we were like two only children in one household. Jeff and I had considered adoption at one point, but I had balked. I didn’t want to go through what my parents did – the wait, the false hopes, the disappointments when an adoption didn’t go through, and the worry that the baby they finally received would not be healthy.

I was pregnant now, and I counted my blessings.

 

Jeff and I agreed that, with the exception of his parents and my mom, we wouldn’t tell anyone until I was at least twelve weeks along. But I had to tell Joan, the clinic director. We met in one of the counseling rooms at the end of the surgery day. We sat facing each other – Joan in one of her flowing summer dresses and thick-soled Doc Martin sandals, and I in my pleated khakis and crew-necked Tee.

“What’s up?” she asked.

I couldn’t help grinning.

“What?” she demanded. Joan was the counselor I’d shadowed the day I interviewed for this job twelve years earlier. I observed her lead a counseling session and assist during a first-trimester procedure. I remember wondering how I – someone who had never had an abortion, never knew anyone intimately who had had one, and never had a strong opinion on the issue – could handle working at a place like this. I was a not-quite successful freelance writer with no medical training. Sitting in the surgery room, waiting for the procedure to begin, I wondered if I’d cry, or run retching from the room. I didn’t know then that I could tolerate the sight of blood. I’ve had to learn to tolerate a lot more since.

In a hushed voice, I said, “I’m pregnant.”

Joan had been four months pregnant when I met her. I could still see her as she was then, her round belly straining against her red-and-white checkered shirt. I had asked her if being pregnant made her job more difficult.

She’d just shrugged. “Staying pregnant is a choice, too.”

Now she nearly jumped from her seat to congratulate me. I told her I wasn’t ready to make a general announcement, and I didn’t want to work with caustic chemicals. She said she’d find a way to ask another counselor to clean my surgery room without letting her know why.

“Anything else?” she asked. I knew what she was getting at. She wondered if I could continue to tolerate the hard cases – the fetal anomalies and demises, the second-trimester procedures.

I assured her I could handle anything.

“Just let me know,” she said. Late afternoon sun shone in stripes through the Venetian blinds, illuminating the silver in her long, dark hair. There would be silver in my hair, too, if I didn’t color it.  Her smile was warm, and tender, but I could see the hesitation in her eyes: she wouldn’t risk a pregnancy at our age.

Joan was right: some days it was harder than I expected to assist with abortions. Some of it was physiological. As the pregnancy hormones kicked in, I became more sensitive, particularly to smells. The smells of blood, amniotic fluid, bleach, the autoclave as it vented after it finished sterilizing the instruments: all conspired to turn me green.

Most troubling, I was emotionally tender. Despite my assurances to Joan, there were days when the sight of a twelve-week pregnancy dancing on the ultrasound screen would bring tears to my eyes, not because I would wish for a woman to continue a pregnancy that she didn’t want, but because life is beautiful; death is hard. In an abortion clinic, there is no getting around either one.

I had to remind myself to focus on the patient. I was her witness, her advocate, her midwife with a twist. To be any good to her, I would have to be present, not wrapped up in my own hormonal whirlwind.

Some days were exhausting, both physically and emotionally. Between 8:00 and 5:00, I could meet a twenty-one-year-old mother of three who wanted to get off welfare and go back to school; a thirty-six-year-old new into recovery for substance abuse; or a ten-year-old, the victim of a rape, wearing fuzzy blue slippers and carrying a teddy bear. I could meet an upstanding member of her church who had had an affair, a prep school student who couldn’t bear to disappoint her mother, a homeless mother who couldn’t take care of another child.

I’d seen so much in the twelve years I’d worked at the clinic that I thought I had seen it all. More importantly, I thought that I could handle it all. But I hadn’t been pregnant on the job before. And I hadn’t had a case like this one.

 

I’ll call the woman Theresa. And beyond her name, I knew from the Post-It note Joan had attached to the chart that Theresa had cancelled other appointments over the last several weeks. Under this Joan had written a single word: “Conflicted.” From Theresa’s paperwork I learned that she had a four-year-old child already, that she was twenty-three, married, and identified as Catholic. I checked the ultrasound information. Theresa was sixteen weeks into the pregnancy. Involuntarily, I made a quick calculation: Theresa had been pregnant ten weeks longer than I had.

Since Theresa was into her second trimester, an abortion would be a two-day, two-step procedure. I checked to see how she answered the question “what doubts or fears do you have regarding this abortion?” She had written, “I don’t know if I’m doing the right thing.”  I closed the chart, slipped the Post-It note into my pocket, and braced myself.

If I hadn’t already known that Theresa was twenty-three, I would have guessed she was at least thirty. Everything about her suggested exhaustion. Her shoulders slumped against the straight-backed chair. Her arms seemed too heavy for her, and her hands hung like limp gloves from her wrists. She wore ill-fitting black sweatpants speckled with what I would later learn was baby oatmeal, and a grey T-shirt with the words “BUM Equipment” arching across her chest. Blonde hair that had long ago outgrown its cut fell in front of her eyes. Around her neck she wore a gold crucifix.

“My name is Trish,” I said. “I’m a counselor here.”

“I don’t need counseling,” Theresa snapped.

I tried not to react. Sometimes when people need support the most they push it away. I know I can be like that.

“That’s fine,” I said. “You can use this time any way you like. Just let me know if you have any questions.”

Theresa looked at the floor. After a long pause, she said, “You probably think I’m a bad person.”

“Why would I think you’re a bad person?” I asked.

“I know this is wrong. But I wouldn’t be here if my baby was healthy.”

I reached for the chart. I must have missed something.

“I mean my four-year-old. He has Fragile X syndrome. He’s like a baby.”

I must have looked puzzled. I’d heard of many chromosomal birth defects, but this one new to me. I hadn’t yet begun my obsessive on-line searches to find out all I could about chromosomal abnormalities. That would come later. Then, I wondered if Fragile X were one more thing I should worry about regarding my own pregnancy.

Theresa explained that the weakened X chromosome can cause mild to severe retardation. In her son’s case, the retardation was severe.

“I’m sorry,” I said. “That must be so difficult.”

She let out a sigh that told me I didn’t know the half of it. When she spoke again her tone was angry, like I was just one in a long line of people who just didn’t understand.

“He’s four years old, okay, and he’s just now learning how to walk. He doesn’t talk yet. He’s learning to feed himself but he sure as hell isn’t very good at it.” With her thumbnail, she scraped at a dried patch of oatmeal on her pant leg. “Developmentally, he’s about eighteen-months.  Only, he’s big, and he throws these tantrums.” She showed me a pink horseshoe-shaped mark on her arm. “He bites.”

I wondered for a moment if she might bite back.

“Do you have help?” I asked.

“Not enough,” she said. Her husband was in the Air Force. The military paid for her son’s medical treatments, as well as for respite care a couple of times a month, but it had also transferred them several times, most recently to Kirtland Air Force Base in Albuquerque, hundreds of miles from their families in Oklahoma. And now, Theresa said, her marriage was on the rocks.

The conversation was taking us into areas I wasn’t trained to address and I felt uncomfortable. I had to bring us back to why she was here.

“How did you feel when you first found out you were pregnant?” I asked.

“Angry,” she said. “How could God do this to me? I shouldn’t say it like that. God only gives you what you can handle, right? Only, I can’t handle this.” She pushed her hair behind one ear, revealing a row of gold hoops that spanned from lobe to crest – evidence of a wilder time in her life.

“You have more than your share to handle,” I said.

She nodded, and for the first time I thought that maybe she was softening a little.

“When did you first consider abortion?” I asked.

“It was the first thing I thought of.” She shook her head as if disgusted. “Can you believe that? That is so against everything I’ve been taught. I grew up Catholic, okay? People who have abortions go to hell. People like you go to hell. No offense.”

“None taken,” I said and smiled. Theresa smiled wanly in return.  “Do you still believe that?” I asked.

Theresa didn’t answer. She seemed momentarily to be in another world. When she looked back at me there was fury in her eyes.

“I’m a carrier,” Theresa blurted. “Isn’t that fucked? I don’t have Fragile X, but I can pass it along to my babies. You know what? I always wanted to be a mother. I left home when I was seventeen. I wanted to get married and have babies, you know, to have the big, happy family I never had. It’s so fucked.”

She sobbed, then. I fought the urge to touch her hand or her shoulder, to offer comfort.  Instead, I held out the box of tissues. She grabbed a handful, then, one by one, she rolled each new tissue into another useless ball.

“Have you spoken to a genetic counselor?”

“Yes. I know there’s some-percentage chance that any pregnancy I have will have the syndrome. I don’t remember the numbers.”

“That means there’s some-percentage chance it wouldn’t.”

“I know.”

I waited. Theresa stared into space.

“There are tests,” I offered. If Theresa wanted to be the mother of a healthy baby, then that was what I wanted for her. “You could have an amniocentesis performed and it would tell the genetic make up of this fetus.”

I didn’t say that it would take two weeks to get the results. By that time, she would be eighteen weeks into the pregnancy, when abortion is more complicated and risky.  But if the fetus were healthy, she could continue the pregnancy with peace of mind. I felt a sudden hunger for that peace of mind for myself. It would be another eight weeks before I could have my own amnio. I tried not to think about what I would do if the results were bad. I might be sitting in Theresa’s chair.

Theresa squirmed, one leg crossing and uncrossing the other.

“I know. Okay? I had the test.” She threw her balls of tissues angrily into the trash.

“Oh. I’m sorry,” I began and felt deeply embarrassed. I still couldn’t understand why the results of Theresa’s amnio weren’t on the chart. Normally, in cases of fetal anomalies we have pages of documentation. I didn’t know where we dropped the ball.

“You don’t get it. It’s normal,” she said, beginning to sob. “There is nothing wrong with this baby.”

It was normal.

I wonder now if I hadn’t been pregnant myself if I would have reacted so strongly. I felt an almost overwhelming wave of emotions: shock, grief, sympathy, sadness, compassion, anger. I wasn’t angry with Theresa, although sometimes I felt frustrated by her. I felt rage at the cosmic cruelty of it all. If only the order of pregnancies were reversed, I thought. If the child at home had been healthy then she could have been here aborting a Fragile X fetus.  But that was not the reality. Theresa felt helpless, overwhelmed, isolated and, no doubt, depressed, caring for her developmentally delayed child. Who was I to think she should take on the burden of another child at such a stressful time in her life? But I felt uncharacteristically outraged. Theresa was about to abort the baby she always wanted. Involuntarily, my hand went to my own belly. I wanted to stop her. I wanted to say to her, you may never have another chance at a healthy baby.

Instead I asked, “If you could see into the future and knew that this would be the only healthy pregnancy you’d ever have, would that change your decision?”

Theresa looked out the window then back at me. “All I know is I can’t handle having a baby now.”

What about five or ten years from now, when you want to have a baby and you can’t because the next one has this syndrome, then what? Will you wish you would have kept this one? I didn’t say this.

“How do you think you’ll feel about this when it’s all over?” I asked.

Theresa picked again at the spot on her pant leg. “You’re probably going to think I’m a bad person,” she said.

“I won’t think you’re a bad person.” I promised, and I meant it.

With fresh tears, Theresa cried, “I think I’ll feel relieved.”

 

Theresa was stoic long enough to get through the first step in the surgical process – the insertion of laminaria into her cervix. Overnight, the thin, sterile strips of seaweed would absorb moisture from her body and expand, gradually dilating her cervix. Once this first five-minute procedure was over, Theresa seemed to crumble. As we walked to the recovery room, she asked again if I thought she was a bad person.

“Do you think you’re a bad person?” I asked.

“I think this is wrong,” she said.

Oh God, I thought. How could we have come this far if she still thought this was wrong? I must have misread her, missed something. I scrambled.

“Theresa, if you’re having second thoughts, let’s have Dr. Boyd remove the laminaria now. If you wait until the dilators have done their work, it will be too late.”

I guided her into the recovery room. It was empty of patients, but I knew that would change in a moment. I closed the door part way and showed Theresa to the couch. I sat down beside her. “Once we get to a certain point, you can’t unmake this decision,” I said. “If you’re not sure—”

She cut me off: “I’m sure I can’t handle another baby. But I’m afraid God won’t forgive me.” Church had always been her comfort, she explained. After an abortion, she was afraid she could never go to church again. God would know. Maybe the priest would know. And neither would forgive her.

This was an area I knew something about. My father’s side of the family was Catholic. My cousins by the dozens would be as likely to pray for me as damn me for the work I did. I didn’t tell Theresa that. Instead, I offered her referrals for spiritual counseling through the Religious Coalition for Reproductive Rights, Catholics for a Free Choice, The Samaritan Center. I rattled off statistics about how more than half of women who have abortions and are religiously affiliated are Catholic. I told her that the Catholic Church didn’t always condemn abortion. There was a time when they didn’t consider the fetus a life until quickening, about twenty weeks along. Then I offered her something else.

“You know, Dr. Boyd used to be a minister,” I said. She looked up at me with surprised eyes. “And he offers ceremonies for women who want them.”

Theresa stopped crying. “What kind of ceremonies?”

“Any kind you want.” In the time I’d worked at the clinic I had seen Dr. Boyd led ceremonies for Christians, Buddhists, and Native Americans.

“Could my husband be there?”

“Of course,” I said.

“Will you be with me?” she asked. She seemed so like a little girl, and my heart went out to her.

“If you want me to be,” I said. She nodded.

Theresa said she would think about it overnight.

After I walked Theresa to the door, I stood outside for a moment on the steps that lead to the back parking lot and tried to regain my own perspective. From this quiet spot on the hill I could see over the tops of Albuquerque’s tallest buildings, over the valley, to the volcanoes and Mount Taylor, a sacred site to the Navajo, in the distance. Theresa is one patient of many, I reminded myself. But I couldn’t shake her or the thought of the healthy baby she wouldn’t have. I quietly hoped she wouldn’t request me to be with her in the morning.

 

The next day, Theresa requested a ceremony. She asked me to be her counselor. I told her it would be my honor. I arranged time for Theresa and her husband to meet with Dr. Boyd to discuss their wishes before surgery. I stood in the hall, my head and back resting against the wall.

“Are you okay?” Molly asked. She was on her way to medicate another patient, but she stopped for a minute and looked hard into my eyes. “You don’t look like you feel very well.”

“I’m tired, I guess. And this case is sad.”

She nodded. “There’s something else, though. Are you really okay?”

Molly had been around enough pregnant women to know one at 20 paces. “Maybe I’ll tell you later,” I said.

“Maybe you better,” she said, as she turned to make her way down the hall, basket of medications in hand. “Go sit down for a minute. I’ll get you when he’s finished talking to your patient.”

I went around the corner and sat in the doctor’s chair in the lab. Surrounded by instruments and urine and blood samples, I dropped my head down to my chest and tried not to fall asleep.

 

Surgery was difficult for Theresa. No relaxation exercise I tried seemed to help. She couldn’t allow herself to relax, and the tighter her muscles, the more pain she felt. When it was over, we were both exhausted.

I carried the bottles and basin back to the lab, and Molly helped me gather bits of placenta and tissue for the doctor. It was hard to look, to see what might have become a perfectly normal baby in that small silver bowl. We draped it with the blue paper normally used to wrap instruments before they are sterilized in the autoclave, and taped it closed. Molly went to the waiting room to get Theresa’s husband, while I waited, bowl in hand.

I gave Theresa and her husband a few minutes alone before I returned to the surgery room. In the dim light, I could see Theresa half asleep on the table. It was the most peaceful she’d looked since I met her the day before. I placed the bowl on the freshly washed instrument tray and took my place at one side of the surgery table. I brushed Theresa’s hair from her cheek. Her eyes fluttered.

“Hey again,” I whispered. “Are you ready?”

She nodded, and I raised the head of the table slightly just as Dr. Boyd walked in. He took the small bowl from the surgery tray and held it in front of him. He guided Theresa’s right hand to the bowl, then placed her husband’s hand over hers. Over them both, Dr. Boyd rested his own large hand, like a blanket. He closed his eyes.

“We ask your blessing on this woman and her family. And we ask that we may honor her courage in making the best decision she could for herself, her family, and her future. We know this has been a difficult decision for her, and one she made with care.”

Theresa sobbed quietly.

“We ask now for your compassion and understanding. We ask that in your time and hers that she will know your deep and loving peace. Please bless Theresa, her family, her counselor, and this medical staff who witness her journey. In the spirit of love, we return this pregnancy to your care. Amen.”

Theresa and her husband held each other as Dr. Boyd and I quietly stepped out of the room. As he turned to go to another surgery room, I went to the front office.

“Joan,” I said, tears rising in my throat.

She looked up from the computer. Alarm registered on her face.

“What’s wrong?” she asked.

“Could someone else get my patient up? Room one. Her husband’s with her.”

I didn’t wait for her answer. I raced out the back door that leads to the back parking lot. I sat on the steps that overlooked the valley and cried.

 

Some days later, Molly stopped me in the hall.

“Well?” she said.

“Well,” I answered.

“Are you going to tell me or do I have to guess?

There was no point in being evasive. Even though Jeff and I had agreed not to tell anyone until after the twelfth week, I had to come clean.

“I’m pregnant,” I said.

“I knew it. I knew it. Oh my God. Congratulations!” she said.

“Sh-sh. We’re not making a public announcement yet.”

“Okay. Okay. Oh my God!” she said. She had that look she gets when she’s going to do something naughty. I could just imagine her as a teenager growing up in Santa Fe, toilet–papering her principal’s house. Now she’s the mother of teenage boys, and a caregiver to horses, rabbits, bunnies and whatever else wanders onto her East Mountain property. She pulled her long, brown hair back in a scrunchie with an air that meant business.

“Come on,” she said, conspiratorially. “Let’s take a look.” She led me to the ultrasound room, shut the door, and dimmed the lights. “Assume the position,” she said, loading the end of the probe with sono gel and K-Y.

“Lock the door,” I said then hopped on the table.

Molly fiddled with the probe for what seemed like quite a while before something small, white and flickering appeared on the screen. I’ve seen hundreds of ultrasounds, but it is different when it’s your pregnancy and you want it with all your heart. To me, the almost imperceptible pulse flashing white on a black screen might as well have been Morse code, a greeting from within.

Thus began our weekly ritual. When the clinic was quiet, we’d dash into the ultrasound room, dim the lights, and take a look. Each week, it would be different.

“There’s your grub worm,” she said, when it was around seven weeks.

“It’s a Teddy Graham,” she said late in the ninth week, when the first buds of limbs became visible. We’d watch, as the little white figure jerked and bounced on the screen.

In the tenth week of my pregnancy Molly didn’t joke during the ultrasound. She frowned at the screen.

“What?” I asked. She turned the monitor so I could look, too. “I don’t know,” she said. “It doesn’t seem to have grown much since last week.”

“Is there cardiac activity?” I asked.

“Yes, yes,” she said almost tentatively. She pointed to a pulsing spot on the screen. I could see that it wasn’t beating as fast as usual.

“Now, don’t panic, little Mama,” she said. “You know it’s too small to get a good read. Let’s take another look tomorrow.”

I could barely sleep that night. I don’t think I told Jeff there was anything to worry about. I didn’t want to think there was.

The next morning, as soon as we could get a break, Molly and I went to the ultrasound room. Lying on the table, looking up at the dark ceiling, I can’t say I prayed, but I wished. I hoped.

Molly was silent. She changed probes. She searched. Finally, she said, “I can’t find a heartbeat.”

She turned the monitor again so I could see. I watched as she moved the probe, the image appearing and disappearing with her movements. No matter what angle she chose, no matter how hard we both looked, we couldn’t make it move. We couldn’t make its heart beat.

 

That night I cried. Jeff paced. We talked. Eventually, we had to make a plan.  I knew I had a choice: I could either wait two weeks or more for nature to take its course, at which time I would bleed and cramp for as long as it would take to pass the pregnancy, or I could have a dilation and curettage procedure at the clinic, or D&C – the same procedure as a first trimester abortion, only there’s no life to abort.

Joan made the arrangements. Jeff and I came to the clinic after the last patient of the day had gone. Most of the staff had gone home as well. Only Molly and Dr. Boyd remained.

Dr. Boyd met with Jeff and me in a counseling room. He assured me I had done nothing wrong. The ultrasounds, the sleepless nights, the missed prenatal vitamins – none of these was likely to have had an effect.

“When pregnancies die around ten weeks, we generally assume the problem is chromosomal,” he explained. And chromosomal complications are more common with older mothers.

“That doesn’t mean your next pregnancy would have an anomaly,” Dr. Boyd reassured us, using words not unlike those I had used when talking with Theresa. He smiled shyly, a funny thing for a man in his line of work.  “At your age, the trick is getting pregnant in the first place, and you already proved you can do that.”

Dr. Boyd excused himself, and Jeff and I went into the first surgery room. I could tell Jeff was uncomfortable, not knowing whether to stand or sit on the chair near the wall.

“Relax,” I said. “You aren’t having surgery.”

“Yeah, well I’m not getting drugs, either,” he said. Our attempts at humor were feeble, but they helped keep me from sobbing.

I undressed from the waist down and sat on the table, as I’ve instructed other women to do. Molly entered.  She guided my legs into the knee stirrups. She put the nitrous oxide mask on my nose. She dimmed the lights, turned on the music. I knew everything she was doing, but it all felt foreign from my position on the table.

“Make a fist,” Molly instructed me, while she wrapped the tourniquet around my upper arm. Before I knew it, she had injected my veins with fentanyl, atropine and versed. All these years I’d told women what to expect from these drugs without ever having experienced them. Now, I thought, I can give them an accurate report. Within seconds of receiving the injection, I felt the warmth we all talk about, the heaviness, the sleepiness. I was dimly aware of Dr. Boyd in the room, his hands on my knees letting me know he was about to begin.

Jeff stood by my side, holding my hand, as he did when I gave birth. Molly stood on my other side. I felt a twinge, pressure, a small cramp. It was over. I felt Molly release my hand as I drifted off to sleep.

Next, I felt someone touch my cheek. I opened my eyes. Dr. Boyd was standing at the foot of the table, a stainless steel bowl wrapped in blue paper in his hand.

Someone raised the head of the table, so that I could sit up. Dr. Boyd took my hand in his then laid it over the bowl. He took Jeff’s hand and placed it over mine. Dr. Boyd’s hand–big, strong, yet soft–covered ours both.

Molly joined us as Dr. Boyd began, “We gather to honor…” Molly put one arm around me, the other around the Doctor. I held on to Jeff. We were a circle, surrounding the contents of the little silver bowl.

Dr Boyd’s voice felt smooth and soothing to my ear, though much of what he said slipped by me in my altered state. What mattered most to me was this circle, the arms around our shoulders, the hands holding ours. “Receive the spirit of this pregnancy with love,” he said. I felt the arms tighten around us.

A sob of grief mixed with gratitude rose in my chest. “Thank you,” I whispered, as the tears came. Molly kissed my forehead. Dr. Boyd held my hand. “We love you,” they said in turns, before walking quietly from the room, while I pressed my face into Jeff’s chest and cried.

 

Five days after my procedure, I returned to work. I continued to work at the clinic part time for another three years.  I did my job. But I was changed. I don’t think anyone noticed. I did not comment upon it, nor did I understand it at first, but ultimately I believe I became a better counselor.

Unlike the women we see at the clinic, I had never been pregnant unexpectedly. Every pregnancy I had – and there were only two – I wanted. Occasionally, I’d meet a patient who would ask if I had ever had an abortion. I knew she wasn’t really curious about my life experience; she just didn’t want to feel alone. My answer was always the same:  I had witnessed hundreds of abortions and I could report that it was generally simple and safe and women came through just fine.

Most women don’t talk about their abortions and miscarriages. Virtually none go through the experience with a loved one at their side. The greatest gift an abortion counselor can give is to bear witness, to be with a woman as she goes through this private journey, to witness her strength and weakness, her grief, her relief, her pain. For the first time I understood what a tremendous gift it is, because for the first and only time in my life, I had been in a position to receive. I am grateful.

And sad: we were never able to conceive again.

I was changed in another way, too. The protective shield I so carefully constructed around myself, that kept me a safe distance from my patients, was compromised. Most of the time, I could retain my professionalism, but there were those rare days when I’d meet another Theresa, or, perhaps more difficult for me, a woman my age who, for what ever compelling reason, chose to abort a health pregnancy.

My job was to support a woman in whatever decision she felt was best for her, and I did. And there were times when I would go to the back parking lot, sit on the crumbling concrete steps, stare out at the extinct volcanoes, and bear quiet witness to all that has been lost.

 

Note: This essay appeared in print in Brain, Child (2007).