Rivers of Babylon: The Story of a Third-Trimester Abortion

And so it came to pass that Hannah conceived and bore a son, whom she named Samuel, saying, “I have asked the Lord for him.” – 1 Samuel 1:20 Take now your son, your only son, whom you love, Isaac. Go to the land of Moriah, and offer him there as a burnt offering on one of the mountains of which I will tell you. – Genesis 22:2 And when the water in the skin was gone, she put the child under a bush. She walked away and sat down, about a bow-shot away, for she said, “I cannot watch the child die.” And as she sat there, she began to cry. – Genesis 21: 15-16 A one-day old infant, if it dies, is [thus] considered to its father and mother like a full bridegroom. – Mishnah Niddah 5:3

The first walk I took outside my house after my abortion was with my rabbi. It was a humid, hot Sunday for October in New England. I didn’t make it that far down the road. We sat down outside a Jewish day school a few blocks from my house.

She walked us through the basics of what was permitted and what was required and what she, personally, felt comfortable doing for us. We would bury my son on Tuesday; she would not say kaddish; we would sit a one-day shiva. My husband would say kaddish, once, at home, with a minyan. And then it would be done. It was a middle ground; a way to show respect to a life that almost was.

She said something to me, then, that has been a great comfort. “You had a choice,” she said, “but you did not have free will.” A choice that was no choice at all.

A standard pro-life talking point on the ethics of abortion for a terminally ill fetus insists that any life, no matter how short or painful, is better than no life at all. I hope, on my good days, that the people who repeat this mantra never have to dwell in the fullness of their ignorance.

Traditional Jewish law does not obligate the family of a child who dies at less than thirty days old to mourn. The community burial society buries and names any child lost after the fifth month of pregnancy, but the family does not attend the burial, does not sit shiva, and does not say kaddish. There is no middle space of mourning beyond that; it is simply as if the child never existed to the community. In times of high neonatal mortality this lack of public grieving was likely intended as a kindness. Shiva interrupts every aspect of your life, holding a tangible emotional space of grieving that, while therapeutic, is extraordinarily draining for the mourners.

Barring parents from grieving with the community is not so kind, though, today, and I think it may never have been. It is probably no accident that the first rabbinic opinion advocating for an interpretation of the tradition that would allow for mourning stillbirth, third-trimester abortion, and neonatal loss was written by a woman, relatively soon after women were allowed into the rabbinate of Conservative Judaism.

The lack of defined mourning rituals should not be read as evidence that Judaism is hyper-permissive on the issue of abortion. On the contrary, it is a serious matter across the ideological spectrum of modern Jewish religious thought: A fetus is “a life in the process of development” and must be treated accordingly and with greater gravity as a pregnancy proceeds.

But even the most conservative religious authorities do not grant the child full personhood until the head is delivered from the mother’s body—at that moment, two human lives exist, not before. Because of that distinction, the mother’s life always takes absolute primacy over that of the fetus, whatever the stage of development.

While the Reform Movement emphasizes the gravity of the decision but leaves the ultimate choice up to the woman and her family, a number of Orthodox rabbis and all Conservative formally allow abortion in cases where the mother’s health, mental or physical, is at risk and in cases of serious fetal illness, such as Tay-Sachs.

What ‘serious’ means is left to the individual woman and the medical and religious authorities with whom she consults.

On the second day of the four-day procedure to end my pregnancy, the sky was huge and blue after a storm the day before. There were protestors outside the clinic. The doctor washed my vagina out with Betadine to put in the first laminaria that would (in theory) dilate my cervix slowly and gently. He would announce it first in a firm voice, “I’m going to wash out with an iodine solution now!” It gave you a blackish-green discharge that smelled of hospital for the rest of the day. I used to associate iodine with hiking and my mother, who after a career in nursing always used it on my scrapes. For the rest of my life, I think I will remember it like heartbreak and the cracked ceiling tiles of the clinic’s tiny operating room.

After the appointment, my husband and I drove up into Rocky Mountain National Park. The rain had turned to snow on the Rockies and the scenic roads were all closed, but I wanted to see what we could. The mountains felt clean, something sublime thrown into the legal morass that had forced us to leave our young children with a family friend and fly from Boston to Denver for the abortion. The elk were out, lazy and napping on bare patches of grass. We stopped at one of those tiny mountain town restaurants on the way out, same as you get next to any national park. It claimed to have umpteen varieties of pie but was out of most: We had chicken pot pie and blueberry pie, on an uneven linoleum table.

Back at the hotel, my husband called the clinic to confirm they would release the body to the local, secular funeral home we had called. I could only hear his end of the conversation. “Oh,” he said. “That’s terrible,” he said. “Oh.”

He hung up and didn’t want to tell me what it was.

“No,” I insisted. “Tell me.”

“We can’t use that funeral home,” he said, “Workers at the funeral home stole remains from the clinic a few years ago, when they had a contract with them.”

“What do you mean, they stole them?” I asked, incredulous.

“They gave them to the archdiocese,” he said. “To bury. The workers cremated the bodies and the local church buried them without permission. Some of them were from women who wanted the remains back, some weren’t.”

My knees went out from under me and I sat down, hard, on the hotel room floor. All the horrifying hoops to jump through and legal tests to pass just to get here and now, this? It wasn’t enough to picket my doctor and insert yourself into my healthcare and claim to know what was best for my child, now you want to steal his body? I had been holding it together, all day, and all I remember is screaming over and over, How could someone do that? How could someone do that? This is the only thing I can do for him, to keep his body safe now. How could someone do that?

Later I found out that in 2015, two years before my abortion, workers at the funeral home went on the record as having found remains from the clinic “disturbing.” In 2005, the media caught wind that the same workers had stolen remains since at least 1999—they called it “donated”— from both the clinic and women who had miscarriages at a nearby hospital. When asked about the story, the spokesman from the archdiocese pontificated, “This discussion clarifies the distinction between people who believe in the sanctity of life and those who don’t. What is their view? To discard unborn children and then worry where they end up.”

I don’t even know where to begin, with such cruelty. It was at once something that had never occurred to me and, once it had, entirely predictable.

Fetal burial laws are increasingly a feature of Trump’s America, or more specifically, Pence’s: multiple states are either in the process of passing such laws, have recently had a law struck down or litigated, or have a law in effect. Even without a law in force, Catholic hospitals—which take federal funding dollars in the form of Medicaid and Medicare—have repeatedly pressured non-Catholic women who have miscarried before twenty weeks into fetal burial programs, berating them about the ethics of an intensely personal decision with which they have nothing, properly, to do. And Catholic churches, like the Sacred Heart of Mary in Boulder, continue to collude in unethical burial practices under the guise of universal human dignity. In the process, they violate the religious norms of other communities—neither observant Jews, nor Muslims, cremate.

Who by fire, and who by water? – Leonard Cohen, via Jewish high holiday liturgy

You get what you get and you don’t get upset.

I hate that, when we say it to children. Of course you get upset. What are we, if we can face the bareness of life stripped of any illusion of fairness, of covenantal decree, and not get upset. Tch.

We don’t get intercession. There is no-one, no conveniently human figure between us and totality, between us and the still, small voice of what we might call God, whom we can meaningfully ask to plead on our behalf. There is only the starkness of the unetanah tokef, the breath of teshuvah, tefillah, tzedakah, repeated in the desperate, human hope of anchoring the future contingent—tomorrow I will live, tomorrow he will die, tomorrow she will be cast down and he will be raised up—in the firmament of the divine.

I don’t believe it, anymore, the way a child does, if I ever did. You get what you get, el malai rahamim, fine, good, fantastic, were God not so full of mercy, there would perhaps be more mercy in the world, and not just in him. What happens to us has nothing to do with fairness, with who prays harder or does more or repents better or eats cleaner. The messianic age will not be gluten-free.

What happens to us has everything to do with who we are, to each other, with how we pick up the pieces of our brokenness and hang onto each other, with the responsibility written first in the flesh and the face of the Other. The veneer of civilization is as thin as the blood the high priest spills on the alter, as easily blown away as the ashes of his sons, as self-destructive as a society eaten alive by idolatry, by racism, by greed. Careful, we go, or we will sit on the shores of the rivers of Babylon, and weep to remember Zion.

(Zion is a metaphor. Except when it isn’t.)

I found out I was pregnant at the end of April. I was a few days late and had been feeling off. I finally bought a pregnancy test after being prodded by my husband. After I bought the brand-name kind (might as well be certain) I took the kids out for pizza and decided I might as well get the test over with so I could relax. We’d never had a real pregnancy scare, not in the ten years we’ve been married or the twenty years we’ve been together. We are, as my stepfather says, “terrifyingly responsible people.”

There’s a first time for everything.

I was surprised, to say the least, but immediately, fundamentally happy. My husband was worried: we lived in a third-floor, two-bedroom walkup with two young children and couldn’t afford to move and keep our son in the good school district. But, a few weeks later, he saw the first sonogram and that was that.

Because of a rare anatomical defect that puts me at high risk of premature labor—a duplication of the reproductive system means I have two intact uterine cavities—I had weekly growth scans. My first two children were born at term on the right side—in the oddly judgmental language obstetricians apply to female bodies, that uterus was ‘proven’ but the left one, ‘unproven,’ was new, untrusted territory.

This child was on the left. I remember thinking perhaps he would be different. Sidereal. Dark-haired, possibly quiet, where my other two children are ragingly intense redheads.

I would have so liked to have seen his face, just once.

There was a heat wave in Boston on the Monday after Rosh Hashanah. I’d gone to the dentist that morning because I read somewhere that plaque increased preterm labor risk. I remember showing up to the twenty-eight-week scan in the afternoon covered in sweat and exhausted. I reminded myself to order a bassinet for the used double stroller I had bought.

My husband was able to come with me, which was unusual. For most of my appointments, I had gone alone. But the hospital where he worked let him out early, so he came. The technician was blonde, middle-aged, and kind. She talked about the one time she had mistaken a girl for a boy on the scan and then had to correct herself. “It was so embarrassing,” she said, “Now I never say anything until I double check.”

The numbers that flashed onto the screen this time were not reassuring. I didn’t know exactly what they meant, but it wasn’t good that he was lagging behind on growth. I knew it might mean we had to deliver him prematurely; I also knew we could give him steroids before he was born and that he would almost certainly survive and go on to have a high quality of life, if not a life without long-term disability.

The doctor wasn’t there in person. We talked to her on speakerphone, huddled over the landline in the empty office. “The brain anatomy looks normal on ultrasound,” she said firmly. “I don’t think this is a genetic issue, but it’s on my list. The baby is very small and the head circumference is smaller. I want you to go to Children’s and have a fetal MRI. It will give us all the information we can get. We may need to deliver him early. I want you to talk to a specialist first.”

The period between Rosh Hashanah and Yom Kippur are called the Days of Awe, in the Jewish calendar. On Rosh Hashanah we read about Issac and Abraham, Hannah and Samuel, Hagar and Ishmael. Fathers and sons, mothers and sons, blood and knives and terrible, hard choices. Right before, we read Ecclesiastes—ashes to ashes, dust to dust, to everything there is a season. The calendar this year was either toying with me or trying to tell me something, and I wasn’t sure which or what I was meant to get out of it.

I took my children to school and back; I tried to stay off Google. I worked. I forced myself to eat more meat because one of my brief forays onto Google said that could help small babies. I vowed to eat breakfast more regularly.

Children’s called on Thursday. They wanted to schedule the tests for eight-thirty the following morning, the day before Yom Kippur.

It wasn’t just an MRI, as it turned out. It was a fetal MRI followed by an ultrasound done on a fancier machine than I had ever seen. The pediatric radiologist proudly told my husband the department had been on a waiting list for it for six months and it had cost $300,000. After the scans, a pediatric radiologist, a pediatric neurologist, and a geneticist would review the results and my previous record, call my high-risk obstetrician, and then meet with us in a conference room. We were told to show up at eight and plan on being there until three in the afternoon.

After the MRI, I asked the ultrasound technician if it was depressing to work here, in the Advanced Fetal Care Center where no pregnancy was healthy. No, she said, it was inspiring; there was so much to be done. I knew a little about this—Boston Children’s and their sister hospital, the Children’s Hospital of Philadelphia, had pioneered fetal surgery, EXIT to ECMO, neonatal cardiac care, and a list of other interventions I couldn’t begin to explain. These are the people you go to when you need a fucking miracle. These are the people that intervene when, perhaps, you shouldn’t.

“All the structures are normal!” chirped the pediatric radiologist after the ultrasound. “Maybe the head is just very small and that’s normal for this baby, but I’m a radiologist so I just say what the images say, not what they mean. You’ll talk to the neurologist later. What are you guys going to get for lunch? Just come back before your appointment time, even, I’m sure we can just see you sooner and get you home.”

We had hamburgers and fries. I had a chocolate milkshake. I hadn’t been hungry like I normally was by this point in pregnancy, but I ate anyway. Maybe it would help. We were cheerful and the radiologist seemed to think the baby was healthy, if small.

They took us out of the waiting room and back to a conference room almost immediately. We joked about the tissues on the table, little boxes of sad tissues in every sad little room. We waited for almost an hour, so long that my husband started to take calls again about his patients and eventually went to the front to ask if they had forgotten about us. They hadn’t.

The neurologist was an older man with a grey beard and a quiet demeanor; the geneticist was a younger woman with blonde hair and a firm presence. The radiologist and my high-risk obstetrician weren’t in the room; they had been in on the meeting before this meeting, along with the ultrasound tech, they explained. They all reviewed the results together.

The neurologist talked first. “Are you sure about your dates?” he asked. “If your dates are at all wrong, all of this goes away, poof.” (He made a little exploding motion with his hands.) “So, let’s be sure about your dates.” I told him I didn’t know, but I had had a six-week scan at a different hospital because I had felt terribly faint. They could pull the records from there. He nodded at the geneticist. “Make the call after we talk,” he said.

He repeated again that the problems would all go away if it were a dating error. “Okay,” I said, “say it isn’t a dating error. What are you saying is wrong?”

The two doctors kept repeating potential causes (infection, genetic, placenta), circling around the central question: What would this mean? Finally, the neurologist answered me. He cleared his throat and looked at the table.

“Right now,” he said, “you are most likely, although I cannot promise, dealing either with a baby with profound cognitive impairment that will die shortly after birth, or a baby that will live with intervention, but will never be able to swallow to clear his airway and may not be able to regulate his own breathing. He will certainly not develop language, reach for objects, be mobile in any way, and may not be able to see or hear.”

“Will he be able to live at home?” I asked, still bargaining. He gave me a strange look.

“Most babies like this can live at home now,” he said, “if they survive birth. You put a tracheostomy in their throat (he made a short jab towards his trachea) and insert a tube into their stomach, through the belly button (another jab, this time toward his side) in to feed them.”

I had been asking all the questions until that point. I had to get up and leave the room before I started sobbing. I patted the geneticist on the shoulder, to make her feel better. I don’t know why.

I pulled myself together and came back in. “What are our options?” I asked. The neurologist sighed. “Well,” he said, “we measure the baby’s head at birth and we go from there with palliative care.” “Is there any treatment?” I asked. “No,” he said. “What is the next step?” I pushed, again.

The geneticist shuffled some paperwork on the table, and said, “If you want to continue the pregnancy, we bring in a social worker to talk you through how that will work. If you don’t, we will refer you to a clinic in Colorado. Our center refers people there, when this happens, about once every other month. We can have your records there in ten minutes.”

“Why not in Massachusetts?” I asked. “The law here bans termination after twenty-four weeks,” she said. “And there is no one here experienced enough to do the procedure, in any case.” I didn’t have to ask why twenty-four weeks; I knew it was the closest the state could come to an abortion ban that would hold up in court against Roe.

It helped, when the doctors finished speaking, that my husband and I had already talked about when and if we would ask to withdraw care if we were to have a very premature baby. We had already agreed on where we thought the balance between senseless, unending suffering and the preservation of a potential life lay. I remember I looked at him, and I looked at the doctor, and then I looked over at the geneticist. “Check the dates,” I said, “and then call Colorado.”

We went home. My son was already asleep; there was no question of going to Kol Nidre now. I paid the babysitter and crawled into a bath with my two-year-old daughter. She laughed and laughed, delighted that an adult had crashed her bath-time. My husband came and sat on the floor of the bathroom with us. I tried to hold her on the couch until she fell asleep, but she asked for her father to put her to bed. She’s so big now.

Life is movement. – Aristotle, Physics

Monday was the day we had to kill the baby. It rained and rained and rained all day and snowed on the mountains. I was grateful to the rain; it felt like God agreed with me about the day. It also meant that the clinic didn’t have protestors out front like the other days we would be there.

There was a lot of paperwork and a lot of counseling, with my husband and—to be sure I wasn’t being coerced—without him. We paid $11,500, up front. There was a medical student from Arkansas who sat in on most of it. Fresh-faced, pretty, young but grave. It was the end of her two weeks at the clinic: a hard-won chance to learn from one of the four doctors left alive who will perform third-trimester abortions.

Despite the fact that they rarely did them, the clinic had agreed to do an amniocentesis for us because we didn’t know what had caused the microcephaly. They had called my hospital back home and arranged to have the sample sent back to the prenatal genetics department there. It was one of the more surreal aspects of the experience: the entire time, the clinic was in touch with my world-class obstetrics department in Boston. The law had, literally, come between us, imposing a geographic divide between doctor and patient.

They took me back into the exam room. The ultrasound was on the whole time. You have to be sure. The doctor did the amnio first. It hurt. The baby woke up afterwards; he always woke up during ultrasounds. He started moving around and I started trying so, so hard not to cry and not to move. The doctor asked if anything was wrong. I told him I would be fine and to do what he had to do. The nurse held my hand so tightly. She knew. I had whispered it to her that he had woken up. When they tried the first digoxin injection, he rolled away from them. No one in the room said a word. I think they didn’t want to upset me, but I knew. They had to prep me to try again: more lidocaine injections, another drape, more Betadine, more ultrasound. I laid a hand on the baby and I told him, please, please go to sleep. We have to do this for you now. He stopped moving, just for a moment. He could probably hear my voice, or at least the vibration of my lungs. They got the shot the second time, and he kicked, very gently, right in the lower left of my stomach. That was the last time I felt him move.

They let me go back to my husband a little while later, when they were sure I was stable. My blood pressures were high the whole week, even before they did anything. (Later, I would find out that I had developed gestational hypertension, which can happen with placental problems.) They let me go back to a private recovery room. I hung onto my husband and cried for a long time. Then we went back to the hotel.

The week I started writing this piece, a federal judge overturned a Texas law, Senate Bill 8. Among other things, the law includes a fetal burial provision, a ban on donating fetal tissue for research, a ban on elective abortions after twenty weeks, and a ban on what the bill calls “dismemberment abortions.” The bill is part of a string of similar omnibus abortion bills around the country which feature “dismemberment abortion” as the newest prong of legislative attack.

The name for a “dismemberment abortion” is properly a dilation and extraction, or D&E. It is the most commonly used abortion procedure in the first half of the second trimester of pregnancy. The law’s proponents claim it is about banning the specific procedure, not about banning abortion. The language in the Texas bill, the “unborn child,” the “dismemberment,” the “slices, crushes, grasps” of the verbs, belies that claim and insists that we are not merely talking about banning an abortion procedure, but about banning abortion itself.

I was never supposed to have a D&E. The standard of care for a third-trimester abortion is the same as for a stillbirth: ensure the fetus is dead, then induce labor. Done properly, it is safer than a live birth.

At least, that’s how it works in theory.

I came in Thursday morning nervous but unconcerned, fundamentally, with my own safety. My husband was not so sanguine; he kept asking the nurses what they would do if I needed blood. They laughed at him. Their patients lose blood measured in milliliters, always. Fewer than one percent of abortion patients suffer any kind of hemorrhage, let alone one severe enough to require a transfusion.

The doctor who performed my abortion has never lost a patient; he is obsessive, if old-fashioned, in his safety protocols. In case of a true emergency, the clinic is across the street from a hospital—a hospital today hostile to abortion patients, but a hospital. When he did the pelvic exam he seemed gruffly concerned; the second set of laminaria had fallen out overnight. He broke my water, inserted misoprostol, and did a pudendal block to help with the pain. His nurse did an IV and hooked me up to Pitocin to induce labor. Now there was nothing to do but wait.

And wait.

I sent my husband out to get lunch. When he came back protestors were standing in front of the clinic entrance. He stared at them, silently, until they moved out of the way.

The trick of inductions for late-term abortion is that you don’t have to get to ten centimeters; the fetus is still quite small, so at most one needs four. If you are a woman of childbearing age in this country, you doubtless know at least one woman who has had a cesarean for a failed induction. Most of those women will have gotten to at least four centimeters.

After four hours, two rounds of misoprostol, and a bag of Pitocin, I had made it to one. The nurse came in, again, and said the doctor wanted to see me. I told him I didn’t mind waiting longer, I didn’t mind any pain, I wanted to be able to deliver the baby’s body intact. He looked at me, sat down on a chair, frank but kind.

“Listen,” he said. “Sometimes they send me women from the Catholic hospitals, you know, when the fetus has died and they have tried to induce for days. You’ve had no pain, you’ve barely dilated. This is not going to work. We do a D&E now, or we do it later, or you wait and have a crash cesarean at the hospital. This is the safest option. I am not comfortable waiting. Okay?”

“Okay,” I sighed. “I’ll see you in there,” he said, got up, and left the room. My husband spoke quietly, from the corner.

“He’s not wrong, you know. I’ve seen the kinds of inductions he’s talking about. He’s not wrong.”

“I know he’s not wrong,” I snapped. “It’s just hard.”

That’s the thing, about the pro-life discourse. It steals my right to say without fear of legal reprisal targeted at women like me that what happened next did feel like dismemberment, it did feel like desecration, like mutilation, that I did want his body intact, that I desperately, beyond reason, wanted an intact body for burial. I wanted it viscerally, animally, the way your body wakes up in the night looking for a newborn, the way you feel a physical connection to your children even when you cannot see them, the way you want something when everything else has been taken from you. It is the same reason I buried him; I wanted to know where he had gone from me and how.

The nurse took me back to the operating room. She gave me a shot of Dilaudid, saying, “Ten shots of tequila, here we go!” with a brisk pat on my arm and left.

The medical student, the young woman, stayed with me. She said, tentatively, from the corner she had flattened herself into in the small room, “I think you are very brave.” I didn’t answer. Eventually, the rest of the team came into the room. The social worker came around to the head of the table to hold my hand and help keep me calm and still while the rest of the team worked.

“I have to get through this,” I declared, mostly to myself. “I have to get through this so I can see my kids again.” She tilted her head at me, quizzically, and said, “Yeah, that’s a positive attitude.” I turned my face away.

The world narrowed to the clicks of surgical instruments and the effort to be still against the pain. The social worker talked me through a breathing exercise; I tried to regulate my breathing and thought it was working. I heard a voice bark from the bottom of the table, between my knees, “Tara, if you don’t breathe slower you will pass out.”

I lost track of time, after that. Everyone in the room became very, very quiet and I became frightened: Surgeons, as a rule, only shut up when they’re worried. I heard the doctor order the first nurse to give me more Dilaudid, this time intravenously; sometime after, or maybe before, I moaned, trying to be quiet, and heard the nurse whisper to the social worker, “try to help her stay quiet; it’s going to terrify the other patients.” Someone asked the doctor if they should put me under, I think, and he said, “No, it’s too dangerous.” I kept breathing, in and out, in and out, I closed my eyes and tried not to think. I started to feel I would fall asleep, I was so tired.

I heard the doctor breathing heavily, at the foot of the bed, like he was running a marathon. I started to be afraid that he wouldn’t be able to get the body out, that I would have to go to the hospital, be wheeled there with my dead, mutilated baby hanging out of me like a perversely medicalized Medea. I heard the clink of the forceps on a tray and a wet plop. I refused to contemplate what part of the baby had just been dropped into the tray. Time became fuzzy around the edges.

And then, the doctor took his mask off, stood up and said, “Okay, we’re done. The nurse is going to massage your uterus now, to help the bleeding. I’ll see you in recovery.”

Recovery is patchy, white scratchy pillows over a floral blanket they use to make the place look cheery. The nurse came in to tell us how much the baby had weighed, what his head looked like, that the scans had not been a mistake. I ran a sudden fever; I started to shake. The nurses kept asking me why I was so anxious. I didn’t feel anxious at all. I felt fine, but exhausted. I asked how long I was gone; I had no idea how long the surgery had taken.

“A long time,” my husband said. “A long time.”

He got a look on his face I will never forget and kept hitting the call button, again and again.

“She’s still bleeding,” he said. “She’s still bleeding.” The nurse scolded me, waving a soaked chux pad, “This is too much blood. You need to do the fundal massage harder. This… this is too much.”

It stopped, mostly, eventually. The doctor came in again, told me that the placenta had been calcified and fibrotic, that the tissue had aged like the placenta of an overdue baby, that it had stubbornly refused to detach from the uterine wall, causing the blood loss. “I’m tired,” I said.

He laughed and said, “Well, I don’t know why; I did all the work.”

I smiled, recognizing gallows humor when I heard it. I told him thank you, thank you for your service to women. Thank you. He nodded, short and sharp, nodded at my husband, and walked out. The medical student was still standing in the corner. I was too weak to sit up. I looked at her. “You do this,” I said. “You go home, and you do this.” She looked at me, her face set and still. “Yes,” she said. “Yes, I think so.”

A standard D&E lasts thirty minutes and is done under waking sedation, sometimes under general anesthesia if done in a hospital. The patient typically loses less than five-hundred milliliters of blood.

All in all, I lost two liters of blood. The procedure lasted over an hour. I was awake the entire time.

(Do you know how much two liters of blood is? It’s one of those giant bottles of soda you buy at the store, but blood instead of Coca Cola. I saw one of those on our counter when we got home and blanked out for a minute, came to sitting on the couch a minute later.)

When we got home I tried to get back to normal, a little. I woke up the day we buried him with a fever and chills, whole-body aches like you get with the flu. The staff at the funeral home treated me like I was made of glass and I overheard my husband whispering to the rabbi, “After this, I’m taking her to the hospital.” We went from the cemetery to my obstetrician, grave-dirt still on my husband’s shoes from where he had shoveled over a stark, tiny pine box. There was a teddy bear upholstered in floral fabric with a streak of dirt over its button eyes, sitting on another grave by the bushes. The funeral director grasped my hand with a queer urgency on the way out, after we washed, clear water over each hand, a symbolic transition from death to life. “Now,” he said, “Now you have to go get better. It’s time to go, now.”

I didn’t think I was particularly sick.

The rest of the story becomes increasingly mundane: I was admitted to the hospital that day for hypertension, tachycardia, and what is called post-procedural endometritis and was there for three days, hooked up to an alarming rotation of three antibiotics with side-effects I try not to think about. They had caught the infection in time, before it turned into sepsis, and I recovered fast. By the time I left I was still anemic, still tired, but fundamentally healthy. I was very, very lucky. My survival is a privilege unearned, bought with the coin of whiteness, through the poverty we as a society have chosen to tolerate, by the nakedness of those we have not seen fit to clothe.

It took a month for my husband to stop surreptitiously checking my pulse under the guise of holding my hand. I pretended not to notice.

Because of the nature of the abortion fight in the country, let me say this plainly: what happened to me was not the clinic’s fault. It was not the doctor’s fault. It was not his staff’s fault. There was no error of medical judgment or medical practice. It is the fault of forty years of pushing abortion care out of hospitals and stigmatizing and marginalizing women and care providers to the point where only four doctors in the United States are foolish enough to risk getting shot point-blank every day on their way to work to provide late-term abortions. It is the fault of legislators terrorizing physicians with spurious investigations instead of funding abortion research and finding ways to make the procedure safer. It is the fault of giving extremist, hateful, radicalizing discourse equal airtime with scientific fact and medical expertise. What would it look like, if we truly funded women’s healthcare? I wish I knew.

A time to be born, a time to die. – Ecclesiastes, 3:2

There are multiple legends about how Sarah, Abraham’s wife, died. This is one:

Satan went to Sarah and appeared to her in the countenance of Isaac. When she saw him, she said to him: “My son, what has your father done to you?” He answered her: “Father took me and raised me up to the mountains and brought me down into the valleys. He took me up to the top of one mountain, built an altar, arranged the woodpile, and placed the logs. He bound me on the altar and took a knife to slaughter me. If God had not told him: ‘Do not raise your hand against the boy,’ I would already be slaughtered.” Satan did not finish speaking, and Sarah passed away (Tanhuma, Vayera 23).

My grandfather died on November 6, a month and a day after my son. His son, my uncle, had died not three months prior. It cracked something deep in him, something unfixable and vital. The cancer took both of them each after the other, eating them alive until, at the end, their faces, unalike in life, looked so similar that my grandmother repeated, over and over, “Doesn’t he look just like Rob? Doesn’t he look just like his son?” I held my grandfather’s hand while he died. His heart was the last thing to go, refusing to quit even when the tumors had filled his lungs. A lion of a man, right up until the end. We talk about dying as if it happens all at once and yes, there is that moment of death, when the breath leaves the body for the last time. But dying—oh, “active dying,” as they call it in hospice, takes days. It is a blessing for the family to have that time. It is not a blessing for the person doing the work of dying. And it is work—a labor not unlike childbirth, with the difference mainly in the end result. Both are crucibles, passages with a before and an after.

Some things you never get over. A teacher of mine said once, “We are redeemed into the desert. That is what it means, to be Jewish.” Perhaps, that is also what it means to be human. When Miriam sings and the seas part, we are redeemed into the desert, not into the promised land. I don’t know where the story goes from here; all I know how to do is to keep walking into it, one day at a time. I am the mother of two children and a ghost, a baby ghost who never drew breath but whose memory I will carry for the rest of my life, even as I would not carry his body. And I killed him, as surely as if I had held the needle myself. I am your Lilith, your Medea, your Sethe, your imago of monstrous maternity and the dark heart of what it can mean to love our children.

His ghost rests easy with us, full of sadness, but easy. We are beginning to put the patchwork of life back together, jumbled and beautiful, and he is part of it, always. And my conscience, such as it is, is clear.

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If you would like to donate to supporting women in need of abortion care after twenty weeks, please consider the Tiller Fund, Medical Students for Choice, and Sister Song.

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Rumpus original art by Briana Finegan.