“Seaweed?” I ask, feeling simultaneously perplexed and defeated. “The surgeon is going to put seaweed in my vagina?”
“Yup,” says Andrew. His fingers peck away at the laptop keyboard as he reads aloud. “To open up your cervix.”
It is the summer of 2008 in New York City. I am twenty-eight, hot, barefoot and pregnant in my fiancé’s apartment. Actually, I’m approximately eighteen weeks pregnant. Second trimester. This pregnancy hadn’t been planned. The birth control pills, for some unknown reason, didn’t work.
Drone-like, Andrew sits at the table researching details of my upcoming three-day long procedure and reads them out loud while I pace.
“The seaweed serves to absorb moisture,” he says, “then swells, subsequently expanding then dilating the cervix, eventually prompting labor.”
Ten days ago, during the ultrasound that would tell us the sex of our baby, our doctor discovered that she had multiple severe birth defects (zero brain development, collapsed skull, malfunctioning heart). We were told they were random genetic flukes, that they were unpreventable, and that our baby’s life was unviable outside my womb. “Zero chance of survival,” is what they told us. This then immediately presented me with three options: terminate the pregnancy, induce and deliver in a month, or do nothing and inevitably miscarry.
I was devastated. I hated all three options. None of those choices would save our baby. But still, the choices were there and I had to choose. I chose what I thought was best for me, the one who would survive.
I walk back to the table and stare at the back of Andrew’s skull. His dark hair was beginning to turn grey along the side of his head, lining his temples like a silver Greek laurel wreath.
Several years before, back in Michigan where I’d grown up, I’d met this girl Nicole. She was seventeen, fought, smoked, dipped, drank and skipped school, went through my town like a walking middle finger. Nicole wore sandy blond cornrows that dropped to her waist and wrapped around her like seaweed. She’d sway her head side to side and fling those braids behind her shoulders, rake back the strays with two acrylic nails, then light up a Newport 100. And Nicole was exceptionally petite—at about four-feet-nine inches, she could’ve passed for an eleven-year-old. By the time she finally reached her junior year of high school, she altogether just dropped out. When she found out she was pregnant, Nicole moved out of her parents’ house, picked up a job at Arby’s, and moved in with the guy she thought might be the father of her baby.
My father was Nicole’s doctor and had been since she was a baby. He was in maybe his 28th year practicing as family physician, performing everything from wart removal to severing umbilical cords, when Nicole resurfaced, dangling her legs over a paper-wrapped table when he walked into the exam room. That was the same year Dad stopped delivering babies for good. He claims he was forced to stop because the cost of malpractice insurance had gotten so high, but, in retrospect, I believe Nicole, specifically her pregnancy, had an effect on the verdict, too. The whole thing just seemed to deflate him.
One night, when my family was shooting the breeze around the dinner table, Nicole’s name came up.
“Who’s Nicole?” I asked.
Dad put down his silverware and blew out a long trail of breath. “Oh, Nicole,” he said without looking up. “I hadn’t seen her for years until she came in for a prenatal checkup.” He went on: Nicole’s pregnancy was a rare and complicated one. She was born with something called Russell-Silver Syndrome, a rare chromosomal abnormality that causes someone to be very small and look much younger than they were. When Nicole came into my Dad’s office, all fresh-faced and pregnant, he sent her to a specialist for extra testing to see if Russell-Silver Syndrome would affect her fetus. Results proved that it would not, but something else showed up in the tests. Nicole’s baby had anencephaly, a totally unrelated birth defect.
My dad took a paper napkin off his lap, unfolded it and spread it out over the kitchen table. “Anencephaly refers to the incomplete development of a fetus’s brain and spinal cord and their protective coverings.” He pulled a pen out of his pocket and began sketching onto the cleaner side of the napkin: a line, a loop, a crescent.
“It occurs when the neural tube, which is a precursor to the baby’s central nervous system”–the pen doubled back; a tulip, a pea pod, a tunnel—“fails to close. The tube is supposed to fold and close during the third or fourth week of pregnancy. And when it doesn’t, this means a failure of the major parts of the brain, and failure of the skull and scalp to form. Infants born with anencephaly are usually blind, deaf, and unconscious. When Nicole’s baby would be born it would have already suffered serious brain damage, wouldn’t be able to eat, not even breathe for long.”
“Do they suffer, Dad?” I asked.
He put down the pen and handed me the napkin. I folded it up four times and slid it under my plate. “It’s not known to be a painful condition,” he said, not entirely answering my question, “but it is inevitably fatal.”
He went on: The specialists explained all this to Nicole and recommended that she terminate the pregnancy, but she panicked and became frightened by the thought of an abortion. She drove straight back to my father’s office, screaming and crying and causing a huge commotion in the lobby. My father pulled her into an exam room, tried to calm her down, telling her there was nothing she or anyone could do to fix things; no surgery, no medicine. The baby just wasn’t going to survive.
“I remember Nicole sitting on the exam table, weeping,” my dad said. “Then she told me, this was a spark that had no chance at life without my help, so if my child was meant to live for five minutes, it is going to live for five minutes.”
I was taken aback by Nicole’s response. I found it gallant and noble. Suddenly, Nicole was brilliant, almost saint-like.
My father agreed to ride the pregnancy out with her and continued giving Nicole care—lots of care. She’d visit his office unannounced, exclaiming that she felt movement, or that she was having a miscarriage. At the same time, the hospital was struggling with the technicalities of her delivery: the baby would die outside Nicole’s womb, and in a purely medical sense whether she delivered at twelve weeks or forty weeks, the question was moot. But because of the Silver Syndrome, because Nicole was such a tiny person, she wouldn’t be able to deliver a normal-sized baby. It wouldn’t fit through the bones of her pelvis. She would have to have a Caesarian delivery, but for a woman of her size, this was a dangerous procedure. This became a huge dilemma and production. The hospital, a Catholic hospital that did not perform abortions, formed an Ethics Committee to determine how early Nicole could be induced without it being considered unnatural, or, a termination of a pregnancy. They timed it up to the minute.
The baby inside Nicole continued to grow. Nicole learned the sex of the baby, named her baby, bought pink baby clothes, more maternity clothes, and hired the priest from the Ethics Committee to facilitate the funeral of the baby.
“And then we induced her when it was the right time.”
“And then Nicole delivered her baby, vaginally.”
“And then after five hours, the baby girl died in Nicole’s arms.”
A month or so after that, I met Nicole. I was eighteen and wanted to meet her so badly. I thought what she had chosen to do was selfless, heroic and brave. Here was this young woman, raised with little money, not very educated, who put her fears aside and gave her baby all she could. I was enchanted. I called her, told her I’d like to meet her and she agreed. A couple days later, I slid into a booth at Home Spun Family Restaurant across from Nicole and ordered a coffee while she smoked feverishly.
“Wanna see a picture of my little girl?” she asked.
“Sure!” I chirped as she slid the photo across the table, a 4 x 6 glossy with edges that were beginning to coil and curl towards the center, like a dried leaf. I continued to look straight ahead at Nicole and not down, afraid at what I might see.
“That’s her. My lil’ girl Elizabeth,” she said and as I looked down at the photo in front of me, which was upside down. Nicole leaned over and rotated it with her fingers, which were holding a cigarette, to face me.
The baby in the photo was dead. Not much different than any newborn— tiny, with a pink cap over her head, looking like an old man—but the baby in the photo was dead and I could tell. Nicole pulled a frilly scrapbook out of her purse and narrated about a few more photos: baby Elizabeth in a long white lace dress, Nicole’s parents embracing Nicole on the hospital bed while she’s holding baby Elizabeth; a cluster of nurses with close-mouthed smiles; baby Elizabeth in a tiny white casket.
“You should be proud of yourself,” I told Nicole, but saying it didn’t feel like I thought it would.
She told me she was proud. “This was just a blessin’ in disguise, I guess.”
And while she was talking and smoking, I was thinking to myself that something just didn’t seem right. She just seemed a little too happy, a little too flippant.
“Do you think you want kids?” I asked. She told me yeah, maybe. “If it happens, it happens, ya know.” That’s when my hope began to sink and I started feeling foolish. You’re smoking, I thought. You were pregnant and your baby died and now you’re smoking and you seem just fine.
“It says here that a curette is passed through the opening into the uterus cavity,” says Andrew. “‘It’s used to gently scrape the lining of the uterus and remove the tissue in the uterus.’”
“Okay, that’s enough. I don’t want to hear anymore,” I tell him. I sit down next to him, take over the keyboard and navigate to another site.
Dilation & Excavation has developed into a focal point of the abortion debate. In the United States, it is illegal in most circumstances . . .
As I read, I feel my cheeks get hot and pale at the same time. I slam the laptop shut.
The next three days were the most unkind I could ever have asked for.
Day One. Union Square. A dizzy, hot hard day. A small clinic running behind schedule. A waiting room is climbing with toddlers, women with round bellies and swollen ankles, women with flat stomachs and grey rings under their eyes, the entire room smelling like the burnt chain-store coffee next door.
Next, a small examining room with bright lights. A glass jar of Q-tips, tongue depressors and Latex gloves. A knock on the door and the remark of a medical resident— “Hey, I have that T-shirt, too!”—after the doctor introduces us and informs me that the resident will be observing my case and surgery.
There is the sight of the dried laminaria rods, the seaweed, as the doctor sets them across a paper towel atop a stainless steel tray. The rods look like the rawhide bones I’d buy for my dog. I lean back, slide my feet into stirrups, part my knees and wonder if the medical resident is wondering how this girl could’ve let her pubic hair grow so out of control. Then I scold myself, because this is a stupid thing to worry about at a time like this. Andrew asks the doctor if this is going to hurt, and there is her tepid response of “she’ll feel a little cramping, similar to menstrual cramps.” This is an understatement.
There is the emptiness of not knowing, of having no reference point and nothing to compare it to—the vacant feeling of holding my knees in the air and the pain follows. A nurse gives me a painkiller the size of an M&M, which is an insignificant amount. I take Andrew’s hand once the surgeon says here we go and feel the first pains after she begins inserting each laminaria rod into my cervix, one by one. It feels like nothing I have ever experienced. The rigid sticks scrape my insides like a switchblade, or the lip of a spade scraping cartilage off my pelvis. I have to discipline myself to breathe.
After the procedure, the pain starts to decrease. We decide to go to dinner at a new BBQ restaurant near our apartment. BBQ, like it’s a reward for enduring the pain, or an accomplishment like I had lost a tooth. I order a pulled pork sandwich and a root beer. People in the restaurant are drinking pilsners and throwing their peanuts shells onto the ground, and when I try to eat the cornbread and drink my pop, I can’t. I can barely sit. The seaweed inside me are swelling and the M&Ms aren’t dulling the pain. The laminaria sticks have been gathering moisture all afternoon, bit-by-bit, expanding and pushing the walls of my cervix apart like the Jaws of Life. And when my pulled pork sandwich finally comes, all I can do is stare at it. The meat stares back up at me and looks dead. Fleshy, flaccid and dead so I say, urgently, “Everything is going to make me throw up.” All I want to do is go home, I need to go home, so Andrew puts the money down on the table, hoists me up over his shoulder and carries me all the way to our apartment on 32nd Street, where he phones my father again and asks him to call in a prescription for Vicodin.
Day Two. 6:45 in the morning and we’re waiting in an exam room for the nurse, doctor and medical resident to arrive. We’re in the very same room at Beth Israel where, less than two weeks ago, the ultrasound was performed.
Andrew puts my underwear on his head. Despite trying to be silly, he just looks groggy and appears to be conquered. Today is his 32nd birthday. Soon, he will leave. After this appointment, I will go back to our apartment and he will go to work in Union Square and sit in his cubicle. He’ll send emails about building permits and make long-distance calls about backlogged orders from factories in China, and around 3:30 in the afternoon, Andrew’s coworkers will sneak up to his desk and surprise him with pastel-colored cupcakes. They’ll clap and sing “Happy Birthday,” which, he tells me later, made him feel just a little bit good.
But first, a knock on the door. The nurse, medical resident and surgeon enter as I yank my underwear off Andrew’s head. I recline on the table, braced for pain. After the doctor removes the first batch of seaweed sticks, she inserts the second, jabbing, one by one, this time much larger ones, much more painful. I dig my nails into Andrew’s wrist and draw blood. After the last rod is inserted, he asks, “That wasn’t so bad, right?” as I soften my grip, unable to say anything. The nurse explains to him, not me, where I have to be tomorrow and what time, when to stop eating and when I can have my last glass of water and then we are left alone.
I roll over onto my side and lay there for a second. The room is silent. The sun is pulsating from behind the shades, and when I think about going back outside, back into the fast-moving city, my heart races. Then, using my arms, I push myself, drop and dangle my legs down from the table and slide onto the floor. I hold onto Andrew’s neck as he helps me with my underpants, one foot through each loop at a time, and as he pulls them up, I glance over at the garbage can. A bunch of seaweed sticks that the resident removed and tossed into the trash are stuck to the top of the clear plastic garbage bag. Swollen rods, red and slimy like a bouquet of metacarpals.
Day Three. When I wake up, nothing makes sense. I am numb. I throw on a summer dress, slip into flip-flops and slowly walk up the stairs. Andrew is already at work. He didn’t want to take any more time off from his job; he has already gone over his limit in sick and vacation days and has decided to work at his desk until the very last possible minute then head over to the hospital.
I decide to walk to the hospital. I don’t know why I choose this—maybe because I have to move. It hurts too much to sit still, but then again, it hurts to do anything. I just want to get there on my own two feet, like I need to feel and hold and embrace and each moment of my decision.
Under the hot sun, the cobbled sidewalk feels like jelly. I pass identical delis and bodegas vending bananas, apples and cigarettes and newspapers from the U.S. and the Middle East, pharmacies with bedpans and sad wheelchairs in the display windows. Finally, nearly ten blocks later I arrive at Beth Israel and spot Andrew leaning against the wall of the entryway to the hospital, leg propped against a sallow pillar, face turned down, looking older and paler than he did that first night I met him, waiting for things to begin or end, I don’t know.
We go to the check-in room for surgery, which is packed full of the injured and their chaperones, bruised patients mummified in casts and bandages. Perfectly healthy children crawl over their mothers who couldn’t find babysitters and a chorus of coughing, sneezing, and groaning accompanies the muffled noises of others shifting in their seats with ache and irritation. This room is bland and ugly, and smells of lozenges and bleach. The receptionist motions me over then she hands me a white plastic bracelet with my name and birthday on it and I go back to my seat.
About twenty minutes later, a nurse from the previous day’s appointment enters the waiting room and powerwalks over to me. She reaches out and hands me two small white tablets. “Slip these between your teeth and your gums,” she says, “but don’t eat them.” With her hands, she folds my fingers over the chalky pills and squeezes my hand. “Good luck.”
The pills will detach the fetus from the uterine wall. I open my mouth and set the pills in, right in the back between the gum of my cheeks and my incisors, and wait for them to dissolve.
I wait. Time passes. Everyone skims through magazines. I reach over and pull one off the rack next to me. Its publication date was over four weeks ago, it’s been flipped through so many times that the edges to its pages are tattered, and the staples holding it together are coming undone. I put the magazine in my lap and it makes me think of the magazines at my father’s office, how several years ago Dad got rid of all the “cheap” literature, as he called it, and brought in healthier periodicals, “ones that are good for you.”
I open up the glossy to a two-page spread of a celebrity shopping at a grocery store. In the picture, the celebrity is wearing enormous dark sunglasses and glamorous clothing while she pushes the shopping cart down the aisle. At her side is a flock of toddlers. The cart is carelessly piled with plastic-wrapped food with primary-colored lettering, food heavy in corn syrup, salt and starches. The celebrity has maybe five or six kids, and I suspect she adopted most of them to suit her own amusement, satisfy her own publicity cravings or suppress some kind of guilty superstar feelings. Above the photo, a caption declares, “They’re Just Like Us!” and I roll my eyes. Shut up, I tell it. No. They’re not. I throw the magazine down.
When I was a kid, there was a giant big fish aquarium in my dad’s office. I remember how when my father worked late, my mom would pile the kids into her minivan and bring Dad a Tupperware container filled with food. When we’d arrive, my siblings and I would run around the hallways, chirping and scavenging the exam rooms for colorful Band-Aids to steal, and while Mom was watching Dad eat, I’d drag a vinyl-covered chair from the lobby over to the aquarium, balance on top of it with a container of fish food and drop tiny pieces of dried shrimp into the water. I’d watch the food fall to the bottom and wait for the Hermit Crab to emerge from behind the fake plastic seaweed and eat it. I always thought he looked sad and lonely, and I think I felt bad for him because he was the only creature in the aquarium that wasn’t a fish.
Twenty years later, sitting in the chair in the waiting room at Beth Israel, I begin to realize how much my understanding of the world had changed since I was a kid. My place in the world, too; my position. Nothing is just black or white anymore. Life has grown tentacles. Sitting in the waiting room at Beth Israel, I finally understand that the only truth about life is that life is complex and convoluted and confusing.
I think about Nicole. If I had never met her, would I still be sitting in this chair? Would I have made her choice? It didn’t matter. Even if I had mimicked Nicole’s decision, even then, the decision still wouldn’t be the same. Her choice was hers, not mine. Those were her moments and experiences that came before her loss, and those were her moments and experiences that would come after. I wasn’t Nicole, just like she wasn’t me. But we both had had the same desire: we wanted our child to live, but what we wanted wasn’t an option. All we could do was choose how we’d continue to go on.
In the end, everything starts happening at once. Sitting in this surgery prep room, thinking about Nicole, I suddenly begin to cramp. The pills have kicked in. The pain spreads. I press my hand over my abdomen and the throbbing builds and spreads. A burning builds and builds more and more rapidly and as it gets worse and I try and unsuccessfully to harness it, this what I finally feel about everything and everyone else in the world: indifference.
The temperature drops and suddenly it’s like I’m hanging from a hook in a meat freezer. I feel like I ate whole lot of something then drank coffee and smoked fifty cigarettes and have to go to the bathroom immediately. The seat of my chair grows spikes and the floor turns to ice, then a dark figure steps out from behind a door and calls my name. I am ready. Both Andrew and I rise, but only I can go, the nurse tells him as he kisses me goodbye and she escorts me to a new room through a set of swinging double doors.