“Wait!” Joy cried, and Louie lifted his hand immediately, five fingers outstretched. “I … I didn’t shave …” she murmured.
Louie stifled a grin. If he had a dime for every time he’d heard that. He knew what it was like to be in the dentist’s chair and wonder if you had a booger in your nose; he understood what it was to be a patient, and vulnerable. Time to administer some vocal local. In Mississippi, he wasn’t allowed to give any narcotics—not even Xanax—to relax a patient.
“Now, Miz Harriet,” he said, in an exaggerated tone. “Didn’t I tell you not to bring me any more ladies who didn’t get a Brazilian before coming here?”
He saw it—the tiny crack of a grin on Joy’s face.
“You’re going to feel a little pressure.” Louie pressed the inside of the patient’s thigh. “Just like that. I’m gonna put the speculum inside now; you relax that muscle. There you go. Where you from?”
“Oxford.”
“That’s a hike.” When Louie chatted through the procedure, he wasn’t trivializing. He was normalizing the moment, putting it into context. He wanted the woman to know this abortion was a sliver of her life, and not the benchmark upon which she should judge herself.
As he yammered about the best way to get from Oxford to Jackson, Louie wrapped a ball of gauze on the tenaculum and swabbed Joy’s cervix with Betadine. Harriet, his partner in this dance, smoothly held up the lidocaine vial while he filled the syringe. “Little pinch coming. Give me a cough now.” As Joy coughed, Louie grabbed the edge of the cervix with the tenaculum and injected the lidocaine at several spots around the ring of tissue. He felt the muscles of her thighs tense. “You know people who can cough on demand can also fake things? Did you used to fake tears to get your mama not to spank you?” Louie asked.
Joy shook her head.
“Well, I used to do that. Worked every time.” He reached to his left for one of the metal dilation rods, and inserted it into the cervix and then out. Then a slightly larger one, and another after that, all the way up to 15 millimeters, as the cervix opened like the shutter of a camera. “So were you born in Oxford?”
“No, Yazoo.”
“Yazoo,” Louie said. “That’s the place with the witch.” Sometimes he thought he knew more about the states where he performed abortions than their own residents did. He had to, for moments like this.
“The what?” She flinched.
“You’re doing great, Joy. There was some swamp witch who lived in Yazoo during the eighteen hundreds. You really never heard about her?” Louie asked. “You’re gonna feel fluid now; that’s normal.” He ruptured her membranes and leaned back as a gush of blood and amniotic fluid spilled between her legs into the tray beneath. Some splattered on his sneaker. “She died in quicksand, I guess, when the police were after her? Just before she passed, she vowed she’d come back in twenty years to haunt the town and burn it to the ground.” Louie glanced up. “A little pulling now. Just breathe. All I’m doing is maneuvering around inside your uterus, and using the ultrasound to guide me.”
From the corner of his eye, he watched Joy’s fingers grasp Harriet’s more firmly. He bent his head, intent on his work, taking the fetus out with forceps. He pulled out clots of pink tissue, some recognizable, some not. At this stage of pregnancy, the calvarium was just solid enough to not collapse with suction. If it got up into the high corner of the uterus, it had a tendency to roll around like a beach ball. In with the forceps, out again. A miniature hand. A knee. In and out; in and out. The G clef of a spine. The squash-blossom calvarium.
“Anyway, twenty years later, in 1900, there was a freak fire in the town that burned a hundred buildings and two hundred homes. The townspeople went to the grave of the swamp witch, and sure enough, the tombstone was broken and the chain around her grave was all torn up. Spooky as hell, right? Now, just another minute …”
Louie knew exactly what it meant to disrupt a life process. At five weeks, he’d see nothing but a tiny sac. At six weeks, a fetal pole with cardiac activity—but no limb buds, no thorax, no calvarium. By nine weeks, there were differentiated body parts: tiny arms, tiny hands, the black spot of an emerging eye. At the fifteen-week mark, like today’s procedure, the calvarium had to be crushed to fit through a 15-millimeter cannula. As a provider, you could not unfeel that moment. And yet. Was it a person? No. It was a piece of life, but so was a sperm, an egg. If life began at conception, what about all those eggs and sperm that didn’t become babies? What about the fertilized eggs that didn’t implant? Or the ones that did, ectopically? What about the zygote that failed to thrive when implanted and was sloughed off with the uterine lining? Was that a death?
Up till twenty-two weeks of pregnancy a fetus wouldn’t survive without a host, even on a respirator. Between twenty-two and twenty-five weeks, a fetus might live briefly, with severe brain and organ damage. The American Congress of Obstetricians and Gynecologists did not recommend resuscitating babies born at twenty-three weeks. At twenty-four weeks, it was up to the parents and doctors to decide together. At twenty-five weeks, the American Medical Association suggested resuscitation, but also said that the ability to survive was not a sure thing. There were plenty of babies diagnosed late in the second trimester with anomalies that were incompatible with life. If those babies were born past twenty-nine weeks, they would feel pain when they died. In those cases, was abortion murder, or mercy? If you decided this was an exceptional case, what about if the mother was a heroin addict? What if her husband beat her so bad she broke bones several times a year? Was it ethical for that woman to carry a baby to term?
He got it, he really did. In that boggy mess of blood and tissue were recognizable parts. They were familiar enough to be upsetting. The bottom line was this: a zygote, an embryo, a fetus, a baby—they were all human. But at what point did that human deserve legal protection?
“We’re in the homestretch now.” Louie turned on the suction and swept the cannula along the uterus. “You never heard that story?”
She shook her head.
“And you call yourself a Yazooite!” Louie joked. “What do people from Yazoo call themselves?”
“Cursed,” Joy said.
He laughed. “I knew I liked you.” Louie felt for the familiar grittiness of the uterine wall that let him know he was done.
Whether or not you believed a fetus was a human being, there was no question in anyone’s mind that a grown woman was one. Even if you placed moral value on that fetus, you couldn’t give it rights unless they were stripped away from the woman carrying it. Perhaps the question wasn’t When does a fetus become a person? but When does a woman stop being one?
Louie glanced down at the tissue in the tray between his patient’s legs. The contents of the tray were swirled and amorphous, like a galaxy without stars. It was part of his job as a physician—if all the products of conception couldn’t be accounted for, then there would be infection later. It was also philosophically important to him as an abortion provider to recognize the procedure for what it was, instead of using euphemisms. He finished his silent count of limbs and landmarks. He could feel Joy’s womb starting to shrink back down.
He stood so that he could look his patient in the eye, so she would know he had seen her—not just as a patient, but as the woman she was and would be when she walked out that door. “You,” he told Joy, “are no longer pregnant.”
The woman closed her eyes. “Thank you,” she murmured.
Louie gently patted her knee. “Miz Joy,” he said simply, “you don’t have to be grateful for something that’s your right.”
—