Meanwhile, Meredith and I drifted apart. She got a serious boyfriend, and I began socializing with the “party” crowd. The night of high school graduation we got together to go to one last party. Despite my loathing for my hometown, money was tight, and I was planning to stick around for a few more years, live with my dad, work my minimum wage job as a Subway “sandwich artist,” and attend community college. Meredith was off to Purdue. She couldn’t wait to get out of there. “I fucking hate this place!” she yelled. Our car was a whizzing dot on the high school’s security cameras. I was sitting next to her smoking, silently sticking my middle finger out the passenger window.
We didn’t see each other again that summer. I got a call from her halfway through spring semester of our freshman year: “I’m pregnant. I’m coming back home.” We spent the next six months watching Felicity, eating ice cream, and being best friends again. Meredith was having the baby, unlike another friend of ours, Shannon, who was also pregnant.
I met with Shannon over a keg of beer at a party on the lake. “I had an abortion today,” she said, drinking from her foamy cup.
I stared at her. “Are you okay?”
She shrugged. “Yeah.”
I went back over to my group of friends to gossip. “And she’s here,” I told them, “drinking beer!” We looked on in horror.
Dr. B injects fentanyl and Versed into the IV on Maria’s right arm. “This will make you more comfortable and relaxed, like a few cocktails,” she explains to Maria, winking at me. I realize I should have done more research before coming into the room. On the procedure, on the meds they’re using, on the exact moments Maria might need me most.
The truth is, Lauren and I have kind of been winging it since we partnered with City Hospital last week, still not believing—after months of being shut down by other clinics—that they actually wanted abortion doulas in this room. We’ve been more focused on the logistical rush: getting time off work, meeting the clinicians and counselors, figuring out how to get from one room to the next in the hospital’s maze of corridors. (As we grew our organization, we would find that a combination of “winging it,” just jumping the hell in with both feet, and meticulously scheduling ourselves would get us through many days.)
My background is in research and development; I’ve never done anything that even hints at direct care. The design of this project has been strictly theoretical up to this point, mostly speaking at conferences about the model with bits and pieces of clinical intelligence from Lauren’s brief stint at a birth center. The closest I’ve been to an abortion was sitting in the waiting room at Planned Parenthood while a friend went behind closed doors, coming out hours later no longer pregnant. Even though I had trained as a birth doula the year before, I had yet to attend a birth. And anyway, how do you prepare for something that hasn’t existed in this exact form before, at least as far as we knew? What exactly was an abortion doula? What did I need to learn?
One thing I would learn is that the process of undergoing a procedure that is only five to seven minutes in length can become a complicated, jagged puzzle our clients have to put together, often in isolation. Each puzzle piece represented a decision our client would make along the way, sedation selection being only one of these pieces.
The “cocktail” metaphor Dr. B used described the sensation of the client becoming more relaxed and drowsy due to her anxiety level being reduced and her physical pain being alleviated by the medication. This sounded great to me. Who wouldn’t want this to be her experience of abortion? I would just as quickly see some of the drawbacks of this type of sedation, however. The client’s memory of the procedure would be negligible in many cases. For those wanting a more embodied experience of the abortion, this would be problematic. Not to mention, the more drugs used, the higher the cost in most clinics. Recovery time would also be extended and a personal escort would be required to take a client home from the abortion. Again, problematic for anyone who could not spare more time than the abortion itself required, or for people who could not or would not tell a family member or friend to meet them at the clinic after.
I wonder who Maria’s support person is, who will be taking her home from her abortion. My eyes shift back and forth between her and the foot of the bed where Dr. B is reviewing the finer points of the procedure with Dr. W, a resident who started her rotation a few weeks ago. They turn to face us. “Okay, Maria, I’m going to do a pelvic exam now. Open your legs until you feel the sides of my hands,” Dr. W says gently in Spanish.
Maria winces at the pressure of the exam. Shit, what do I do? I quickly flash back to my birth doula training, looking for guidance. “No, no, no, not like this. You want to hold her like this,” my trainer had yelled. “You need to build up the muscle in those upper arms!” Not helpful. I shake the memory from my head. I’m unsure of how I fit into this space, surrounded by “experts.” It’s one of the most common feelings for any new doula until we realize we aren’t supposed to be experts; our clients don’t need another expert in the room.
Ann grabs Maria’s hand and nods at me to do the same, sensing my panic. “Respire profundo, respire profundo,” she coaches Maria and me.
“Respire,” I whisper, smiling at Ann gratefully and reaching for Maria’s left hand with both of mine. Much of what we would learn about compassionate care would come from observing nurses and counselors.
Maria grips my hands hard and nods, inhaling and exhaling, her eyes locked into mine. I feel breathless at the intimacy of her gaze. I have typically shied away from intimacy with strangers and loved ones alike. For most of my time on earth, I may as well have been wearing a sign around my neck with the words, “You can look, but you can’t touch.”
But in this moment, looking into Maria’s eyes, something clicks, and I suddenly know what to do, as though the ability to care for another person has always been inside of me, dormant. My senses heighten as I begin to tune into my role, to be in two places at once, the head of the bed and the foot of the bed. I am acutely aware of the client’s every breath and the doctor’s every movement.
A sheet over Maria’s knees offers me only a partial view of the procedure that I would come to know by heart. Betadine, an antiseptic, is smoothed onto the vagina, vulva, the upper thighs, and abdomen with a sponge. The speculum is placed and secured, followed by an injection of lidocaine into the cervix. The tenaculum is clamped and the metal cannula is inserted in progressive sizes until the cervix is properly dilated. I find myself mesmerized by the elegance of Dr. W’s motions, her wrists and fingers moving with the grace of a pianist.
Maria is groggy. She drifts in and out of consciousness, occasionally waking with quick, sharp breaths. I continue to hold her hand in mine, trying to anticipate what she might need. Dr. W selects a flexible curette, measured for Maria’s current number of gestational weeks. She tests its size in Maria’s cervix and attaches it to the Manual Vacuum Aspirator, a tool I had once seen on a tour of Ipas—its manufacturer—in North Carolina. Dr. W presses the buttons on the side of the MVA to release the vacuum as she moves it in 180-degree angles, an in-and-out motion, feeling for the “gritty sensation” that indicates the pregnancy has been removed. Maria’s moans intensify as she shifts on the table, her uterus contracting.
“Este es el último paso,” Dr. W tells us. I look over at the clock. It’s been less than ten minutes. I brush the perspiration from Maria’s face with a tissue. Her eyes are tightly closed now as she hums through what is typically the most physically difficult part of the procedure.
“Fin,” the doctor says anticlimactically. She deftly removes the speculum and folds the instruments back into the sheet. Dr. B leaves the room with the products of conception.
Maria has opened her