The Procedure

Originally published in the Washington Post Magazine on April 5, 1998

During the 45-minute drive they try to make fun of some of the names of the small businesses they pass, all looking vacant and despondent in the midday drizzle. There is a travel agency, a nail care salon, a deli. The names aren't very good, and so don't make interesting sport. They lapse into silence until they reach the building, right across from the paint store, just as the receptionist had promised on the phone.

The office is at the back of the building, up on the second floor. The complex is open to the sky, the various offices lining the edges of the open quadrangle. As they walk up the wet cement stairs to the floor above, she almost expects to see a mob of angry protesters at the door of the clinic. Instead there is just a door, scuffed and used, many letters of the clinic's name missing, scratched down, she imagines, by angry fingernails. The only new-looking part of the entryway is a small black intercom attached to the door. 

"May I help you?"

"We have a 12:30 appointment."

"Name?"

She states it, then spells it. No one can ever get it right otherwise.

"Are you two together?"

For the first time she realizes there's a camera on them. Yes, they are together. They are allowed to push the door open and enter.

The office is tiny, packed with chairs, a slash of Plexiglas not more than four feet in front of the door separating the patients from the goings-on in the rooms behind. She is signed in through a space in the Plexiglas and asked to pay. She uses her MasterCard, vaguely wondering if she will be upset when she sees the name of the clinic and the amount of $225 on the monthly statement. It also makes her feel old, using a credit card for this. So established, so mature, so fiscally responsible. Such a person should know better than to be in this predicament. They sit in the two chairs closest to the door. There is only one other couple in the waiting room, young, maybe just friends. The girl has beautiful long hair artificially colored auburn,

Someone has painted the waiting room a shade of dusty rose, in an attempt, she guesses, to warm up the small, cramped slice of a room, although the gray carpet has been pieced together in places with duct tape, strictly, coldly, utilitarian. The walls advertise birth control methods, HIV testing and condoms. A poster of two handsome young men embracing says underneath you'll never guess what they wear to bed. There is a basket of free condoms on a counter top near the receptionist's desk. A photocopied flier on the Plexiglas tells patients that next month this clinic is consolidating with the clinic in the next town, and will be moving to, the flier promises, a bigger and better location. This new location is a lot closer to her home, she realizes. Too bad she couldn't have waited. A clock radio from a previous decade plays cloying soft rock to a pile of dogeared magazines next to her left elbow. She has an almost overpowering impulse to turn the radio off, but picks up a travel magazine

She is asked to follow a nurse, asked to pee into a cup, asked to go into a back room to have her blood pressure and temperature taken. She must also have some blood drawn to determine if she is anemic.

"Are you a bleeder?" asks the nurse after taking out the needle.

She says no, and sure enough there is barely a drop of blood to put a Band-Aid on. With her heart pounding the way it is, she is amazed the blood doesn't spurt across the room.

She is returned to the waiting area once again. A few more couples have trickled in. A young woman is buzzed in as they wait. (May I help you? Name? Are you together?) The young woman pays in cash, a wad of crumpled bills. Shakily, she tries to smooth each one before handing it to the receptionist.

A buzz. A man's voice says he wants to come in. The receptionist asks if he has an appointment. He doesn't. She says she can't let him in. He says there is a girl he wants to see. The receptionist says she's sorry but she still cannot let him enter. He asks if the receptionist can at least tell him if this certain girl is there. The receptionist tells him she cannot give him that information. Finally, he leaves.

She's prepared when they call her name again, because the woman who was there before her, the one with the dyed auburn hair that is sometimes in a bun and sometimes down, always goes right before her. First come, first served.

This time she is introduced to a counselor, who takes her into a room with a big desk and nothing on the walls. A life-size plastic uterus and vagina are on the desk, and the counselor uses them to illustrate exactly what is going to happen to her during the procedure. From now on, it is called the Procedure. That's fine with her. It's a better word than some, and right now, words have become terribly important to her. She finds herself searching almost obsessively for the right words to say and think. Doesn't want things to come back and haunt her. The counselor tells her of the risks; incomplete evacuation, infection, perforation of the uterus, hemorrhage. She is told that the Procedure is far less dangerous, statistically, than giving birth. She is also warned that the vacuum machine is very loud and alarming, and with all the advances in medical science, isn't it terrible, says the counselor, that they can't find a more humane-sounding machine for this sensitive purpose? The counselor asks if she wants some birth control pills to take home with her. She says no thank you. Didn't like the pill. Was on it once for a short time, but was uncomfortable about messing with her hormones. She'd preferred the diaphragm. Of course it had failed her miserably this time, although she'd used it religiously since the twins were born 15 months ago. She took little comfort knowing she was now a statistic herself, one of the 5 percent, give or take, for whom the diaphragm had failed.

The counselor is European, perhaps Dutch, although she can't be sure, and is very good at what she does. It helps her feel calmer. Her heart has been going like a mad thing ever since she read, in graphic detail, the required material about the Procedure. Now it quiets down to a muffled nervousness, a state where no one else could possibly guess how scared she really is. A more comfortable place to be.

The counselor informs her that the doctor who will perform the Procedure on all the women there today ("who is wonderful and very experienced and whom we are so lucky to have with us here at the clinic!") never arrives before 3 p.m. They are free to go out to the local deli for some soup, or just to wait in the waiting area. Whatever they wish. The counselor asks if there are any other questions. Why do we have to be here at 12:30 if the doctor doesn't arrive until after 3? she finds herself asking. It is patiently explained that the reason this clinic can perform the Procedure so cheaply, a third the price of other clinics, is its assembly line method. By the time the doctor gets there, everyone is prepped, counseled and waiting. He therefore has only to do Procedure after Procedure until 7, with a minimum of downtime. It seems brutal but is efficient, and the counselor has a grim, sad conviction in her explanation. So it must be. Before she leaves the room, the counselor gives her two Advil in a paper cup. For the cramping later.

She and her husband decide to leave for 45 minutes or so, and inform the receptionist, who reminds them they are No. 2, and so must return by 2:30, in case the doctor should come early. By this time, the waiting room is about two-thirds full, mostly women, some still filling out information on clipboards, some leafing absently through magazines, some just gazing ahead. She wonders if their frightened faces reflect her own, wonders how many also have children waiting for them at home. Do theirchildren consume them as hers do, leaving nothing left over? Her three boys complete her. She fears a fourth would absorb her, deplete the precious reservoir of time she has so carefully garnered to spend with each child. She fears this with such conviction that it has brought her to this place.

The two of them walk past the still-busy lunchtime traffic; the drizzle has stopped but the cars' tires still hiss through puddles and over dark gray pavement. They walk to Borders Books, a few blocks away. She thinks he wants to get something to eat, but he has another idea in mind. He leads her purposefully to the music section. After a small search and the help of an employee, he has the Beatles' White Album in his hands. She has wanted it for some time. They look admiringly at the crisp new CD and laugh when they notice a typo in the text on the back. Disc 1, Dics 2, it says. They joke that it might someday be worth a lot of money. Like the upside-down airplane in that stamp. In another moment the floor has dropped and her heart is in her throat as she thinks on what they must return to in a few minutes. It is now 2:10.

He goes and pays for the CD and a magazine while she thumbs through a book she cannot read. At the coffee counter, he gets a cookie and a drink, but although she hasn't eaten since 8 or so, she cannot manage even a bite of the cookie. They walk back toward the clinic, stopping at a pay phone to call the babysitter and find out how it's going, and to tell her they might be a little later than planned. They were suitably cryptic about what they were doing. They didn't know her views on the subject. Didn't want to offend.

Walking up the steps, they pass a couple they recognize from the waiting room. She wonders what number they are and how they can look so relaxed. She hopes she doesn't faint or throw up when it comes time.

They knock on the door and are buzzed in immediately. They are shocked to find the waiting room jammed. All the chairs are taken except those that are simply too close together for comfort. People have put their feet up on those. It is obvious that the doctor has not arrived yet. The two of them stand next to the door, in the wedge of space in front of the Plexiglas window. It is very hot and there is no discernible air current of any kind. The buzzer sounds again. (Yes? Do you have an appointment? Name? Can you please identify that package you have in your hands?) The receptionist's voice is strained and tense. The voice through the intercom, with some humor, says the box contains implements. The caller is finally buzzed in, a striking tall, slim black woman with an enormous box labeled by drawings and print as cooking implements. Asked to leave the box behind the counter, she does so. The woman's name is hard to decipher, and so a little clarifying is necessary with the receptionist. Finally, however, the woman takes a place near the door, standing. The woman smiles almost imperceptibly at her, and she returns it as they take off their heavy coats.

Some time passes, and a few waiting couples leave in search of food or air. She and her husband sit down in newly abandoned chairs, still warm from their previous occupants. She doesn't want to sit, but her legs are tired from standing and her heart is going at such a speed she thinks she'd better. The slim black woman sits next to her, filling out papers on the clipboard. She wonders what number the black woman is. Across from her is No. 1, the woman with the dyed auburn hair. Their eyes meetand they smile quickly. Next to the young woman is a black couple. He is reading the information sheet intently, and she is filling out the forms. They hold hands often and smile at each other, even laugh softly a few times. There is something reassuringin their affection, their intimacy, their obvious respect for each other in the middle of that rose-colored waiting room. She sees the woman look off into the distance occasionally, sadness in her lovely face. She cannot take her eyes off them.

No. 1 is called.

Her heart leaps out of her chest and she wants to run, but before she can, her name is called. She stands up and moves past the cramped row of chairs.

Can my husband come?

No, you are going in for the actual Procedure now. He has to wait out here.

So she hands him her coat and goes through the door.

She is asked to empty her bladder and place the sanitary napkin she was asked to bring with her in her underpants.

Another nurse comes up to her with a frank smile, introduces herself and, as they enter the small room, tells her that she'll be with her throughout the whole Procedure. She then asks her to undress from the waist down, leaving her socks on. She is to sit on the examining table with a sheet over her lap to wait for the doctor.

There is a sink, a table, a cart of instruments. Not much to look at. It is very hot. The walls are thin and she hears conversations. The nurses outside are talking about vacations, about cruises; somebody mentions the Bahamas, and there are excited gasps and a muted swell of laughter.

From next door, through the thin walls, she hears a loud machine switched on. It starts and stops a couple of times over a few minutes and then is quiet. It sounds exactly like an industrial vacuum cleaner. She thinks her heart is going to give out. She tries to think about her kids.

From outside the door there is more conversation as the nurses continue to talk about vacations. A man's deep voice joins briefly in the levity, there is a rustling of papers directly outside the door, then a brisk knock. The nurse enters first wheeling a machine, and she is followed by a thick-set doctor who introduces himself in a rich African accent. He is at once efficient and soft-spoken as he prepares.

She has been asked to recline and to shove her bottom right to the edge of the table "until it feels like you're going to fall off." The nurse stands at her right side and hands things expertly to the doctor as he seats himself on the low stool. The nurse says that she may hold her hand if she wishes, and she answers that she may take her up on that. The doctor assures her that this nurse may look petite, but that she has very strong hands indeed. He says this as his own strong hands quickly examine her uterus.

She tries to relax as the speculum is inserted. The nurse tells her what the doctor is doing so she can prepare. He gives her a shot of anesthetic in her cervix. She bucks and then apologizes when the doctor firmly tells her not to do that again. She then takes the nurse's hand and holds on tight to the protective glove. For hours afterward, her right hand will smell like latex, until she finally is able to scrub off the scent with two washings of strong soap.

Another shot in her cervix. The pain is unexpected and nauseating. She feels she's being stabbed. Apologizing for her moaning and her twitching away from the doctor, she starts to babble about her short labor before the C-section with the twins, about how she pitied the nurse who had to catheterize her without anesthetic. She had bucked and squirmed and apologized then, too, until the nurse really had to get quite sharp with her. The nurse next to her now and the doctor crouched between her legsask questions and make comments as she tries desperately to keep her mind on the story, but even she knows they are simply keeping her distracted in order that she be more pliant during the Procedure.

The third and final shot is given, and she cries out as quietly as she is able, aware of the thin walls and the other women waiting behind them. Then the doctor has to manually dilate the cervix. She cramps immediately and tries to breathe as the nurse coaches her. He goes in again with a larger tube, and she grips the latexed hand as tightly as she can. The cramping sensation is sickening, and she slips into herself for a moment until the nurse tells her the worst is over and that they're almost done now. Finish your story, she is urged.

She tries, concentrating on her memories as the vacuum is switched on and starts to gurgle and hiss.

The doctor had scheduled a C-section for Thursday but her membranes ruptured on the Saturday before, at 11 at night. She was taken by ambulance to the closest hospital (not the one they were supposed to deliver at) and rushed into Labor and Delivery. One of the babies' feet was already descending, and she was whisked off to the OR. Her doctor had arrived just in time to make a fast incision and get the loud, healthy twins into the world, two minutes apart, in a whirlwind of activity and a crowd of medical personnel. Their first cries were so beautiful as she briefly held each of them before they were taken off for observation. She was happy, stunned. She'd been unable to sleep . . .

The machine is switched off, the doctor scrapes inside her uterus with a spoon-like instrument whose name she was told but cannot remember. There is a little more vacuuming, like for crumbs, she vaguely thinks, and it is done. The nurse leaves for a few moments, and the doctor stands at the small counter, quietly filling in some forms.

She lies there on her back, the fluorescent lights in her face, her ears ringing in the silence. Her heart has slowed, but she now fears it will slow too much and just stop. At that moment she doesn't care. Her emptiness and horror are so deep she cannot think. Silently she weeps. She cannot imagine ever stopping.

The doctor finishes his paperwork and prepares to leave. He looks at her as he opens the door and tells her softly to let it out, to cry as hard as she can, that it is healing. She nods but keeps crying silently after he leaves, afraid of what might come out if she let go.

The nurse returns briskly to tidy up and to see how her patient is doing. She is allowed to sit up, then to stand if she doesn't feel too woozy. The bleeding is determined not to be excessive, and she is allowed to dress. Before she can get into her underwear with the sanitary napkin already in place, a large drop of bright red blood falls on the linoleum floor. The nurse efficiently sprays it with a massive dose of disinfectant, and wipes it away.

As she puts on her shoes, she says to the nurse that she thinks this must be one of the hardest jobs imaginable. The nurse, still busy preparing the room for the next Procedure, says it's what she believes in, what she knows to be the right thing for families, children and women. She is very worried about what the future holds for clinics like theirs. Her strength is contagious, her conviction gratifying. The nurse reminds her to go home and love her children, that over the next weeks they will be her greatest source of strength and the key to her recovery. It gives her momentary strength, this talk, to walk to the recovery room. The nurse has her sit in a reclining chair, brings her a cup of hot tea and puts a heavy blanket over her. Although

The recovery room is not lit by fluorescent tubes. There is the welcome relief of a regular desk lamp, and a small glow of recessed lighting from above the counter where refreshments are kept. Otherwise, the room is dimly lit. Out in the hallway, a large phone repairman works in a cramped utility closet full of wires and circuit breakers that she can just see from her place in the reclining chair. A nurse, after chatting with the repairman for a few moments, comes in and warns that an alarm might go off but not to worry if it does. Something to do with the phones. The nurse looks at her and asks how it's going. She just nods and tries to look like she's pulling herself together.

She is still weeping and cannot stop.

There is a horrible, unspeakable moment when she feels her whole body crying out, "Stop! Wait! Put it back! I'm sorry! I'm so, so sorry! Don't leave me, please! I don't abandon you, I don't hate you. I don't cast you out of my family!" And she thinks she will go mad then.

The tears continue. The warmth of the tea seeps into her body where the blood and tissue have left a hole. Another woman is led into the room and seated in the chair to her right, hidden, blessedly, behind the lamp. She does not want to see this other woman, and thinks she would dissolve if she did.

A nurse, who has been seated at a desk in the corner of the dim room, working busily, comes over to her and the new arrival with a paper bag for each. She takes out two bottles of pills and explains what each one is for and how to take them. There is Methergine, to help the uterus clamp down and stem the flow of blood, and there is an antibiotic to ward off infection. They are instructed to eat a yogurt a day to help prevent a yeast infection, to rest as much as possible, and to look for thesigns of trouble: infection, hemorrhage, deep depression. The nurse asks them, when they feel up to it, to go to the bathroom and check their sanitary pads. If the amount of blood is not in excess of their normal flow on the heaviest day of their period,they can leave.

In the bathroom, she is surprised not to see more blood. She feels as if there should be more. She feels as if blood has been flowing from her at the rate of knots. She also thinks she should feel faint. She does not feel faint, or lightheaded, or woozy. She thinks she should lose consciousness, faint dead away and lie there in a heap on the floor like a dead thing.

Back down the hallway, past the bathroom with the broken toilet seat, and out the door into the crowded waiting room. She feels all faces on hers, searching, trying to read her experience. She feels her face must speak volumes. Her eyes search out her husband and she motions with her head for him to follow her. At the slash of Plexiglas she makes an appointment for a follow-up visit two weeks later, and flies out of the office.

She weeps without stopping or speaking on the way home. Only when they miss their exit does the mundane chore of finding their way back to their oldest son's preschool override her misery. She waits in the car while her husband goes in to get their son, knowing the blood would overflow through her jeans if she got up. Instead she disappears behind the "After the Abortion" pamphlet, being careful to hide the name, lest she offend anyone. The school is in a church after all.

She is conscious of an anger, a rage that she cannot express her sorrow and grief to anyone, that in this tragedy she is considered a villain rather than a victim. Loneliness, guilt, bottomless sorrow fill her and the tears run down her face as she sinks into a sadness so profound she cannot fathom it.

Then there is a knock on the window. Her son is there, face full of pride, showing her a drawing of a monster and telling her all about it through the glass. She can't make out a word, but when she opens the door and hugs him, his blond curls tumble against her face and his smell of last night's shampoo and today's damp sweat fill her head, dulling for a moment the reek of disinfectant and latex.

At home the babies cling to her, both with colds, both wanting her lap, both climbing with sharp little feet onto her sore belly. She feels the blood fairly gushing into her sanitary napkin each time she stands up or even moves. She stays sitting on the floor for fear she will faint, alone with the babies, thinks she might bleed to death. She knows it might be easier that way.

She bleeds a lot, passing clots that so alarm her she calls the clinic's hot line later that evening. They reassure her, and indeed in time, a few days only, the bleeding slows to a weak spotting, occasionally getting heavier if she is especially active, but certainly fading, dying, dimming with each passing day. She never faints, never bleeds more than a normal amount, and doesn't go mad or die. In fact, she feels her body becoming her own again in a few days, her nausea and exhaustion disappearing almost without her realizing it. There are tears and darkness and fear, and, at times, her guilt weighs on her chest and makes it hard for her to breathe. She herself was, after all, the fourth child, a surprise to her parents a full five years after the supposed last child in their family.

Two weeks after the abortion, she is steady and calm. A month later she is once again so involved with the needs of her children she doesn't think much about what she has done. Five months later, she thinks occasionally on the fact that she would now be seven months pregnant, would be feeling a baby's movements and tentative kicks. The next month she reads a well-written pro-life article and bursts into tears. It is the only time a pro-life point of view has touched her. When October rolls around, the nine-month mark, it will be hard. But all she can do now is be grateful she is not pregnant. There is a closeness with the three boys, a love that is almost blinding at times. Relief floods her, and she feels a deep gratitude to the people and the clinic that made it possible for her not to have another child. No one who counts on her need be shortchanged, none of the people in her care need settle for less. Spread as thin as she now is, she still feels in control and able to divide her loveand energies equally. She will always remember this, even when grieving for her loss.