Why do Abortion

The procedure is disarmingly simple. Women are surprised as though the mystery of contraception, a dark and hidden genesis, requires an elaborate finale. In the first trimester of pregnancy, it's a mere few minutes of vacuuming, a neat tidy up. I give a woman a small yellow Valium, and when it has begun to relax her, I lead her into the back, into bareness, into the stirrups. The doctor reaches in her, opening the narrow tunnel to the uterus with a succession of slim, smooth bars of steel. He inserts a plastic tube and hooks it to a hose on the machine. The woman is framed against white paper that crackles as she moves, the light bright in her eyes. Then the machine rumbles low and loud in the small windowless room; the doctor moves the tube back and forth with an efficient rhythm, and the long tail of it filled with blood that spurts and stumbles along into a jar. He is usually finished in a few minutes. They are long minutes for the woman. Her uterus frequently reacts to its abrupt emptying with a powerful, unceasing cramp, which cuts off the blood vessels and enfolds the bleeding tissue.

I am learning to recognize the shadows that cross the faces of the woman I hold. While the doctor works between her spread legs, the paper drape hiding his intent expression, I stand beside the table. I hold the woman's hands in mine, resting them just below her ribs. I watch her eyes, finger her necklace, stroke her hair. I ask about her job, her family; in a haze she answers me; we chatter, faces close, eyes meeting and sliding apart.

A sleepy-eyed girl, just fourteen, watched me with a slight smile all through her abortion. "Does it have little feet and little fingers and all?" she'd asked earlier. When the suction was over she sat up woozily at the end of the table and murmured, "Can I see it?" I shook my head firmly.

This city has several "Crisis pregnancy centers" advertised in the Yellow Pages. They are small offices staffed by volunteers, and they offer free pregnancy testing, glossy photos of dead fetuses, and movies. I had a client recently whose mother is active in the anti-abortion movement. The young woman went to the local crisis center and was told that the doctor would make her touch her dismembered baby, that the pain would be the most horrible she could imagine, and that she might, after an abortion, never be able to have children. All lies. They called her at home and at work, over and over and over, but she had been wise enough to give a false name. She came to us a fugitive. We who do abortions are marked by some as impure. It's dirty work.

We do ultrasounds, a sound-wave test that paints a faint, gray picture of the fetus, whenever we're uncertain of gestation. Age is measured by the width of the skull and confirmed by the length of the femur or thighbone; we speak of pregnancy as being a certain "femur length" in weeks. The usual concern is whether a pregnancy is within the legal limit for an abortion. Women this far along have bellies which swell out round and tight like trim muscles. When they lie flat, the mound rises softly about the hips, pressing the umbilicus upward.

It takes practice to read an ultrasound picture, which is grainy and etched as though in strokes of charcoal. But suddenly a rapid rhythmic motion appears—the beating heart. Nearby is a soft oval, scratched with lines—the skull. The leg is harder to find, and then suddenly the fetus moves, bobbing in the surf. The skull turns away, an arm slides across the screen, the torso rolls. I know the weight of a baby's head on my shoulder, the whisper of lips on ears, the delicate curve of a fragile spine in my hand. I know how heavy and correct a newborn cradled feels. The creature I watch in secret requires nothing from me but to be left alone, and that is precisely what won't be done.

I have fetus dreams, we all do here: dreams of abortions one after the other; of buckets of blood splashed on the walls; trees full of crawling fetuses. I dreamed that two men grabbed me and began to drag me away. "Let's do an abortion," they said with a sickening leer, and I began to scream, plunged into a vision of sucking, scraping pain, of being spread and torn by impartial instruments that do only what they are bidden. I woke from this dream barely able to breathe and thought of kitchen tables and coat hangers, knitting needles striped with blood, and women all alone clutching a pillow in their teeth to keep the screams from piercing the apartment-house walls. Abortion is the narrowest edge between kindness and cruelty. Done as well as it can be, it is still violence—merciful violence, like putting a suffering animal to death.

Maggie, one of the nurses, received a call at midnight not long ago. It was a woman in her twentieth week of pregnancy; the necessarily gradual process of cervical dilation begun the day before had stimulated labor, as it sometimes does. Maggie and one of the doctors met the woman at the office in the night. Maggie helped her onto the table, and as she lay down the fetus was delivered into Maggie's hands. When Maggie told me about it the next day, she cupped her hands into a small bowl—"it was just like a little kitten," she said softly, wonderingly. "Everything was still attached."

At the end of the day I clean out the suction jars, poring bloods into the sink, splashing the sides with flecks of tissue. From the sink rises a rich and humid smell, hot, earthy, and moldering; it is the smell of something recently alive beginning to decay. I take care of the plastic tub on the floor, filled with pieces too big to be trusted to the trash. The law defines the contents of the bucket I hold protectively against my chest as "tissue." Some would say my complicity in filling that bucket gives me no right to call it anything else. I slip the tissue gently into a bag and place it in the freezer, to be burned at another time. Abortion requires of me an entirely new set of assumptions. It requires a willingness to live with conflict, fearlessness, and grief. As I close the freezer door, I imagine a world where this won't be necessary, and then return to the world where it is.