Choices

Bleeding so heavily that the nurses exclaimed over it from between my spread and raised knees, I didn’t feel lucky. My calm in that moment was a pacified fatalism. Everything that could be done was being done. If later there emerged ideas of could-have-done-more, they would have their day, their time. That moment of dissociation and concomitant relaxation had grown from the tip of a sterile needle taken from a syringe.

They’d searched both arms in vain, but with impressive teamwork. The ladies chattering in Malayalam fretted that there were no veins to be found, because they’d been sternly ordered to get me on fluids. They worked me over like dough – pressing, squeezing, rolling – and finally spied a possibility. With my left wrist cocked sideways, thumb pulled in line with my forearm, they moved quickly to get the IV tube into the hint of rubbery, rolling duct running under the pale skin that should have revealed every vein like an anatomy model, were those veins not collapsed upon their scant, sluggish load.

I averted my eyes, as though too modest to watch the penetration I was allowing, though I looked back as soon as the insertion was complete. I watched a long, thick needle come out of the IV feed and be replaced by the blunt end of a bag of fluids. That’s all I know – fluids. Ones I needed, ones I lacked, presumably because I misplaced them along with the fetus I was miscarrying.

A nurse, roughly my age, tore open a syringe package and I couldn’t figure out how they’d get another needle in another vein when the first had been so hard to find. She drew something from a tiny bottle in the way that was familiar to me from movies, familiarly pushed the air out, but then she removed the needle from the syringe. The blunt end went into a side receptacle in my IV feed and my arm began to lump and ache as she shoveled something into me through the little tube in my vein. She rubbed up, up, up my forearm. This pain was foreground, new and not yet relegated to the place all the other pains existed, that place for things about which I could do nothing.

My fatalistic calm would smother me, but not yet. First, I worried. About James, out there waiting with no news. About my cramping and dizziness, even while lying down. About the cost and our degraded financial situation.

The doctor came in, checking the preparations for the D&C. She looked at me, looked at the IV bag, looked at the nurse, and began to speak in a clipped monotone. If you’ve never heard the mellifluous round singing of Malayalam, you may not be impressed by this doctor’s ability to flatten those notes. I certainly was. The nurse turned to me and took the unused needle from the syringe. She pierced the bag of fluids and began massaging my arm with an ungentle hand and crooning voice. She asked me to close my eyes. She asked me to breathe.

As I realized that the doctor was concerned, I grew concerned. As I realized that the nurse was going to dump a full bag of IV fluids into me at the fastest rate she could manage, I released the concern along with every other illusion of control.

I found exactly those things that were mine. My breathing. I exercised control. My muscular tension. I exercised control. My outlook. With these two other things under my control, I found that I could alter my outlook as well. May as well get to know my nurses.

We chatted in accented English that devolved periodically into pidgin or simile. They puzzled out my American pronunciation and I puzzled out their British overlaid on Malayalam. The older nurse has a daughter who is twenty-four and works at the techno-park, something involving computers. I assured her that her daughter had chosen a career with many opportunities and agreed that an intelligent daughter was something to be proud of, no matter what others say. The younger nurse is two years older than me and has two boys who are handfuls of trouble but very dear to her. The youngest nurse has no life yet, but she hungers for a big something that will happen to her and differentiate her from the waiting monotonies of the life to which she dreads being relegated, as though her future is a mugger who will leave her without pride, possessions, or the beauty that she fears will fade all too soon.

All the while, I bled.

I’d bled before, in waves of expulsion between which I slept. After five drenched, sequential night-hours of waking, cleaning, changing, I slept and didn’t wake again for several hours. This was my first attempt at miscarrying. When the bleeding abated, or rather, when I woke to find that I hadn’t drenched the pad I’d been wearing, I thought wow. That’s it. For eight hours after that, I felt lucky.

Lucky. Yes.

I discovered I was pregnant through a complicated process of allowing myself to be aware of my body. I don’t bleed but once a year, so there was no missed period to clue me in. When I was young and distrusted the diagnosis of PCOS, I had, a dozen times, purchased a pregnancy test and then gotten my period a week later. I have no rhythm, no usual, no normal by which I can judge my hormonal state.

This time I didn’t want the test. This time, the one or two week long PMS feeling lasted for several weeks. This time, my appetite disappeared, slowly but surely, until I was eating a palm’s worth of rice and a couple ounces of curry each day.

I was told I had ovaries that wouldn’t ripen and release an egg. I was told that I would not get pregnant. For twelve years with James, I didn’t get pregnant and ignored the whole issue. It was inconceivable to me that a bedrock certainty of my life since age fifteen could come unglued, just like that.

Finally, I made an important connection. I felt, all day, for weeks, like I was seasick. It wasn’t just loss of appetite. It was seasickness. And seasickness is nausea. And nausea plus painful breasts plus fatigue plus…

So we bought two pregnancy tests. The first one was not shy – the positive line lit up within thirty seconds of the urine hitting the absorbent material. I took the second test the next morning, with the same result.

I was devastated. A surety was crumbled.

I was sure that I was lucky. I never had to worry about unintended pregnancies and the horrible choices that resulted. I didn’t want to raise a child, but I knew that, had I ever decided to be a parent, it wasn’t out of the question. Adoption would have gotten me a child without the guilt of adding the burden of more life on this overburdened planet. But I didn’t want to raise a child and wouldn’t be adopting. I was lucky because I found out I would never be pregnant when I was young enough to integrate the idea into my sense of self, into my hopes and dreams for my life. And I did.

Finding myself pregnant felt like a horrifying shifting of reality. PIV sex was to be feared, as other women fear it. But even more than that, I was stuck in that hard place I’d been so certain I’d avoid all my life.

Birth or abortion.

I can almost smile at my footprints on the road with signs like Denial, Anger, Grief. Perfectly transparent and perfectly unavoidable.

As usual, I bathed in information. I scrubbed my emotions with facts until I came to a provisional decision. I would discuss my options for abortion with the local provider and see how that went.

My first visit at the Thycaud Women and Children’s Hospital was everything I’d been led to expect of Indian hospitals through lurid, third-world views of India. I was willing, as in everything since arriving in India, to do it their way and see how it goes. So I got a piece of paper that would be my record of care, though, out of ignorance, I didn’t pay the two rupee charge. The paper identified me as Tina and as twenty-three years old. I’m thirty-three.

Passed from hand to hand, James and I flowed with the massed women toward the OB/Gyn section. From the information booth, through the security person, and into the hands of a helpful lady, we stumbled through the process. A guardian nurse stood at a door, outside of which lingered a small number of women. Many more sat in chairs or stood leaning on walls. The doctor was on her tea break.

James and I stood. Several ladies tried to give us their seats, to the polite horror of us both at the idea that we’d sit at the expense of an eight-month-pregnant woman and her grandmother (or mother – I find I consistently overestimate the age of forty-somethings and older women, but consistently underestimate that of women who haven’t reached their big forties). But this sort of attempted deference has been a sad commonplace as we’ve shoved our pale faces into locals-only type places.

And this hospital was locals only. It was started in 1814 as a medicine-dispensing center, but it grew. Here’s a newspaper quote about this hospital, one which I did not read until after all these events. “A surprise inspection of two Government hospitals in the city by the State Human Rights Commission (SHRC) has shed light on a host of malpractices and infrastructural inadequacies at the institutions which cater to the medical needs of the urban population, particularly those hailing from the lower segments of society.” Men loitered outside, as nervous and irritable as the condition of their wives inspired. The dirt drop-off area was tracked into the hospital on the bare or shod feet of the supplicants. We were all supplicants at the door of medical care that might not open if the lines were too long for that day. Remnants of my gum’s minty taste calmed my jumpy stomach in the smell of dust and rubber and rubbing alcohol. The old building resonated with voices, quiet on the scale of public spaces but louder than the hushed hospital environs I remembered from visiting my dad at work. The British Raj may have built the place, but the temporary walls creating exam rooms and plexiglass booths for information and payment were a different kind of old. The walls were old with good-enough construction that wasn’t and with the hands and feet and smooth oiled hair of a year, a decade, perhaps two or three. The plexiglass was old with unhappy exhalations that had fogged the same spot until they stained it.

Waiting for the doctor, I sat on the stool beside the desk while both chairs at the desk remained empty. A line of women, heavy with final-term babies, shifted from hip to hip or balanced on stoic, sari-brushed bare feet. The doctor asked why I was there. When I told her that I wanted an abortion, her impassive eyes didn’t react, but her lips thinned. She wanted to know why.

Why?

None of your business, not to be exhibited for your snide or smug thinned lips.

But I gave an answer, as I have been taught one does with doctors. In a room half-filled with waiting patients, another doctor, and two assistants, I tried to answer a question I hadn’t fully answered to my own satisfaction. My answer spoke to my surroundings. No home, no money, no time, not the right thing for me. Partial truths, at best.

A slippery impression of emotion altered the blank field of the doctor’s gimlet stare. It was disdain. She made a note on my paper.

Why should a white American girl complain of any lack when half the women in that makeshift exam room make less money each week than most office workers spend for lunch each day?

I refused to explain further. Discussing over-population and one’s conviction that motherhood is not a good role for most people, including oneself, seemed not only ridiculous, but hopeless, helpless, and not worth the effort.

Fast-forward to the ultrasound. Heartbeat, six weeks and four days. A brief look at the screen. Scrawled dates and no eye contact.

After another long wait, the doctor scribbled on my special two rupee paper and told me to get the blood tests listed. When I asked her where I could go, she waved an imperious hand and said, “Out there.” I left.

There is no privacy. My horrible little two rupee paper stated for all to see: Wants MTP. This paper, that was to be shown to random pharmacists, blood-testing center workers, and ultrasound techs, informed everyone that I was looking to terminate my pregnancy. I haven’t been anonymous since I arrived in India, but this was a new level of naked.

Ultrasound techs. Is that why he didn’t notice the separation of my uterus into multiple parts? Did the tech fail in my care because he felt I was failing in my duty?

This hospital visit took place on December twenty-third. I had an excuse for moving slowly on the doctor’s orders. Kerala has the highest percentage of Christians in India, and Indians celebrate everything, so there were lots of places closed down for the birthday bash. I had time.

Time was something I was counting carefully. Because of my utter and complete conviction that I could not conceive, I identified the pregnancy halfway through the first trimester. If I was going to abort, did it have to be in India, by that overworked, unhappy woman? The next day, I wrote an email to the Baltimore Planned Parenthood’s medinfo email address. I unloaded my problems, concerns, fears, and questions into the datastream connecting Trivandrum, India, with Baltimore, USA. By my math, I’d be right on the edge of the second trimester when we landed at JFK Airport on February fourth. What if I waited?

I’d have a lot more time to be sure I was doing the right thing, but I might actually starve to death in the meantime. I hadn’t had a decent meal in two weeks. Nauseous, faint, and permanently overheated, I rolled the rice and curry between my fingers, making mesas and plucking their tops off. I ate what I could and fretted over the waste. Peanut butter stayed down pretty well, but a teaspoon of peanut butter does not a well-rounded diet make.

An amazing woman traded emails with me, writing me back on Christmas Day, confirming that I was at a tricky stage as of the fourth of February. If their ultrasound confirmed my first one, agreeing on gestational age, I could get the fairly simple first-trimester D&C. If it was a week off, very possible, she would have to refer me to a facility that performs second trimester D&Cs. And the cost, while not as high as I’d thought it would be, was more than I could be happy about spending while jobless, homeless, new in town, and without resources. Cost and risk both increase as you progress further into pregnancy.

So if I was going to get an abortion (and I was, right? Had I decided or was I still just checking my options?), I would need to play nice with the Thycaud hospital’s doctor.

But what about that bad feeling? And what about the language barriers? I feared misunderstanding instructions and doing something wrong. I feared the ignorance I couldn’t broach, the unanswered questions: how often do you do this procedure, can I see the treatment room and equipment, do you hate or resent me? I drink the water, eat at little stands – I’m not afraid of a little India getting into my body. I am afraid of a lot of India getting in. And I was far more afraid of someone doing the procedure for the first time all month – if it’s not common at this hospital. What if they don’t get much practice?

Getting the blood tests took a week. The twenty-third, when I walked from the hospital with my two-rupee paper, was a Tuesday. Wednesday, I wrote Planned Parenthood; Thursday, the lady wrote me back. Friday was to be the day, but somehow James and I never left the house that day. We did nothing. I napped, ate a half of a peanut butter and jelly sandwich. The weekend! I tried to relax in the interim.

James and I talked about going ahead with the whole shebang and having a kid. We imagined our lives, the pressure to be everything I believe is good and right, because a child watches more than they listen, and it would kill me to teach my child to settle, to think nostalgically of old dreams rather than to tell stories of their realization. A baby on a boat – it’s been done, and well. I’ve liked the boat kids I’ve met. They seem far more self-possessed than their age-mates. But it’s hard to resist the calls of comfort, convenience, and maybe-next-year-when-we’ve-saved-more. How much harder would it be with a child? And traveling with a kid is like carrying yet another piece of luggage – one you can’t check at the railway station. It’s so totally not what I want to do with the next 10, 20, 50 years of my life.

Who would that person be? I am too cynical to believe that the person joining our family would be an evolutionary step forward, using James’ and my best qualities to stride into a new age, through the portals of which we would follow with glad hearts. We’re just as likely to get a paranoid-schizophrenic, ADHD, behavioral nightmare. It’s not all nurture, you know, and my family is not all sane. Or maybe nothing that bad. Maybe just a girl who loves makeup and school dances and wants to be a cheerleader. Maybe just a person I wouldn’t like.

I thought about giving birth and doing the adoption thing, but I couldn’t conceive of giving a baby, my responsibility, to anyone I didn’t know, love, and trust. Something in me shrank from the version that’s like a dating service. Sure, some couples end up married, but there are a lot more bad dates than good ones, and the baby wouldn’t be able to try again with other parents. And answering that 11 year old when s/he asked why we did it? Ugh.

On Monday, I got out of bed late and went back to bed after chai. I was spotting, but I’ve heard that’s normal early in pregnancy. I rose for lunch, which I didn’t eat, and we rode into Thampanoor. I thought in terms of errands. We needed a notebook and some Odonil, a citronella mosquito hoodwinker. I wanted to stop by a bookstore I’d spied, though I knew it would mean spending full price on a new book. I’m a used-paperback girl from way back, but I was starving for reading material. We bought Umberto Eco’s “The Mysterious Flame of Queen Loana” and Salman Rushdie’s “Shame”, one of the few of his I hadn’t read. We later stopped in Manacaud, on our way back through Kamaleswaram to Kallattumukku (our neighborhood), for the other items.

After spending more on two books than we would on plenteous, nutritious, delicious lunches for sixteen days, we rode to Statue Junction. This junction sits across from the Secretariat, one of the old British buildings of state, still housing the entire administrative machinery of the state of Kerala. Ministers, secretaries, and minions of all sorts. The junction itself is home to two industries – academic publishing and drugs. Known in North India as chemists, the pharmacies of South India are medicals shops, sometimes labeled English Medicines to differentiate themselves from the Ayurveda providers. It’s also close to the General Hospital and near many labs. We found one.

I sat on a small chair beside a low cabinet topped with formica or some such material. I absorbed my surroundings in flicking glances. I was in the lab itself! Rubber arm cuff and the reassuring rip of the sterile packaging of the needle and syringe cued me to breathe slowly and distract myself while the deep burgundy of my blood filled the collection cylinder.

Drips, drops, vials – my blood was apportioned between the four calm, chatty women and they in turn dripped other substances, set up and started the centrifuge, and studied my blood on the slide under a microscope that made me nostalgic for fifth grade. I was fascinated.

This experience was lulling my residual fears of unsanitary conditions and possible infection in the larger procedure I was approaching. Until the second bloodletting. It turned out to be a test of blot clotting time, though the guy who poked me didn’t tell me that. He placed a stopwatch on the table. Eyeing it, he took my wrist and shook my hand out, downward. He grabbed my middle finger, squeezing tightly, turned it upward in all its red glory, and stabbed it with a lancet.

He wasn’t wearing gloves, glasses, anything protective. My blood sprayed thinly across the table and onto my forearm from the small hole he’d created. Calmly and without addressing the drops of my blood on his hand (it had narrowly missed his face), he daubed the pooling blood with cotton until it stopped flowing and then until it actually clotted. Bleeding time: 1 min 04 sec. Clotting time: 4 min 46 sec. Then they kicked me out to wait with the others. I was almost getting used to being constantly nauseous, and automatically found a breeze to help me in the heat. Hemoglobin 12.9, A positive, no hepatitis b.

The hospital, when we rode up on the motorcycle, was suspiciously empty, only most of the seats taken rather than all. The information booth told me that the OB/Gyn area closed at two pm. Or something approximating that. The person behind the fogged protective plastic came into resolution when she leaned forward to push a last statement through the small hole: open eight.

So I saw the doctor again, one week after the first Tuesday visit. The nurse-guardian recognized me (never, ever anonymous) and ushered me into the exam cubicle. The doctor didn’t look at me. She waved away my papers and said wait. This time, I waited a long, long time.

She went into the back section of the exam room, partitioned from the area with her desk by more temporary walls installed in the seventies. The guard-nurse closed the door, segmenting the long line into insiders and outsiders. Slowly, the line of bursting women inched along the wall as one after another was summoned behind the partition and released with her blue chapbook. These women all had blue booklets, cheaply printed on rough paper, that chronicled their pregnancies from first visit through, hopefully, happy birth. I was the only person without a blue book. I had only the two-rupee paper. Finally, the line was gone and the doctor reappeared.

She looked at me with an air of great, insurmountable, irrecoverable fatigue. She waved her hand for my paperwork. I was irritated when she didn’t look at the blood work, merely writing something incomprehensible on the back of my two-rupee paper and telling me to go buy the pills. The pharmacy at the hospital did not sell them. I would need to go elsewhere. I asked where, fatalistically, and received a familiar “out there”. Why did I need to wait forty-five minutes for her to write two words and a number? Was I being tested? Pressured to give up?

Forty rupees later (and that’s a lot for two pills), I came back to the office and was again ushered past all other waiting women, James once again taking up station as the only man in that waiting area. He’s a brave one.

This time, the doctor looked at me. She asked me, once again, to wait. I sat on a square rubber sheet, cracked and thin on the fold-lines. Under the rubber sheet, revealed at head and foot, a metal-legged table exhibited age beyond that of the temporary walls in cracked, dry, and peeling leather over long-flattened padding. I could see nothing but grime. Nothing but the hopelessness of the cleaning staff and impecunious supplies manager.

The doctor came to me at last. She turned my two-rupee paper over and began to write. She explained that these were medicines I would need. And then she told me what to do. As she spoke, she wrote. This time, on the back of the ultrasound report. This is what she wrote.

at 11:30 PM, after washing hands
Wet the tab with a drop of boiled & cooled water
and insert inside the vagina
You may get abdml pain & bleeding
You should come at 8:45 AM at Ward 6th ward
an empty stomach
Show the OP ticket to the sister
For D&C

When I questioned the sixth ward, she waved toward the back of the hospital.

My two-rupee paper was called an OP ticket. And after a no doubt sleepless night, I was to take my cramping, bleeding self to the nuns and show them the ticket saying I wanted a D&C.

This was bad. I felt all wrong. She wasn’t going to do the procedure herself. I wouldn’t meet the doctor first; I wouldn’t see the room or equipment. It was in an area of the hospital I’d never entered. No one knew I’d be coming; I was just to show up. Sisters? Bleeding, cramping. Miscarrying due to the forty-rupee pills that would cause my body to let go. Misoprostol.

The guardian-nurse shooed me out, into the arms of another nurse. This small woman pulled me to the pharmacy of the hospital and chattered with the three pharmacists sharing a three-foot long table. By the time they’d handed me the antibiotics and B vitamins, everyone in the pharmacy and everyone in line was in awe that the white American girl was getting an abortion.

I was stripped and displayed before strangers, stared at and wondered at by people who could have no possible stake in the decisions I would make. I didn’t feel shame. I don’t think that abortion is a shameful choice, though it was one I was still wrestling with. Stoicism, however, was the best I could do.

Down the hall again with my leader-nurse, she pulled me into a small room where a baby was screaming. The poor tyke had just been poked with a needle. Vaccinations, I guess. I guess this in part because that’s what I got – a vaccination. Tetanus. India is one of the tetanus hotspots of the world, so they vaccinate every time you get any kind of medical procedure done. That’s the impression I got, anyway. You know, language difficulties.

At home, James and I avoided discussing the misoprostol. We ate dinner. I had more food than I was comfortable eating and felt especially nauseous all evening. We watched a movie. Miller’s Crossing. At the end of the gangster flick, I turned to James and picked up the pills. This was it. The moment of truth. It was eleven thirty at night.

We talked. We cried. We debated and spun hopefulhappy futures and cynicaldire futures and inbetween futures. We rehashed everything we had and hadn’t said in the nearly two weeks since the pregnancy test came up positive.

At twelve thirty, I felt sick, sad, irresolute, and angry. I was upset because it’s my body and my decision. I was upset because it’s our life and how could it be my decision? My body was hurting and sick, my brain ached, and my jaw was too tight to allow my teeth to part. It was not the right moment.

I slept, guerilla attacks by horrible dreams waking me regularly. When I woke to light rather than dark, I lay in bed in a new day. Limp, listless sheets pressed against my heated torso in the ceiling fan’s breeze. My illness took on two new aspects: vertigo and melancholy. I dozed sporadically, between trips to the kitchen for more water and more and more water, then, inevitably, trips to the bathroom again and again. Each time I got out of bed, my head dissociated from my body, floating away from the rising gorge and striving toward the void.

That night, I couldn’t sleep. I’d slept all day, on and off. James was gone – I practically begged him to accept an invitation to celebrate New Year’s Eve with some neighborhood guys. Alone, my thoughts circled, looking for fresh angles, looking for the perfect fit, the realization of rightness that has accompanied most of my big decisions in life. I couldn’t remain pregnant. It was making me miserably ill; I wasn’t meant to carry a child. I didn’t want to raise a child. But that hospital. It horrified me. The disdain, the carelessness, the nuns, the unknown doctor with unknown equipment in an unknown space. These all frightened me as much as my illness threw me to the ground. I was humbled, beaten by pregnancy and by the only option I knew for ending it.

James came home, bringing his respectfully quiet friends to hang out in the office. Finally, near morning, I slept. When I awoke the next afternoon at two, I felt better. Better felt good and I focused on the improvement, ignoring some weakness and an insurmountable lack of focus. Other than the increase in bleeding, things felt like they were going well. I washed my hair. I washed some clothes.

I sat at the computer and checked my email. I began the list of spelling conventions for James’ book, !Radio! Vol. 1. I went back to bed.

At two thirty that night, I roused to the sensation of leaking blood. I slid from the bed, trying not to rub the sheets with anything, and flipped the switch for the bathroom before entering. Sitting and checking my pad, I was not upset by the blood down my thighs and chunks of uterine lining. I was calm. I sat for a while, though, cramping and passing more blood and lining, before I cleaned myself up and adhered a new pad to a new pair of underwear.

I walked into the office, where James was writing on his manuscript. I told him that I believed I had just miscarried. It felt like the right thing. It felt like my body corroborating my feelings that the pregnancy was wrong. I babbled in relief mixed with shock. I thought I was done. I couldn’t have lost that much blood and tissue and have retained the fetus. I was close, but not correct.

I bled through a pad an hour, plus filling the toilet bowl with thick blood, for five hours. The word hemorrhaging began to circle in my mind. And then someone turned off the tap. At seven-thirty am, it just stopped. I slept for three hours – decadence! – and woke with only spotting. Cramping came and went as we rode the motorcycle to the Thycaud Women and Children’s Hospital. I thought I might need an ultrasound, but the lines outside the doors did not bode well for my chances, and I felt so much better! We left without seeing the doctor.

We stopped for food and my nausea returned somewhat during the meal. I ate very little but I was attached to the idea that I was all better. I refused to think about my continued weakness, exhaustion, and the new level of heat I radiated as I lay down for a nap. James joined me, holding my hand through the sweat. He and I both slept.

Waking to cramps, wetness, I stood and returned to the bathroom. It was five pm on Friday the second. I didn’t stop gushing blood for almost an hour. James slept and slept. I put off the moment of decision. When it seemed to slow enough for me to leave the bathroom, I got three steps away before almost fainting. I ran back and threw up bile, again and again, until I could feel the sympathetic rhythm between the cramps in my stomach and the cramps in my uterus. I sat again when I felt more likely to drench the floor with blood than vomit.

James got up at some point during this. I was unconscious of his movements until I heard the shower start. Two bathrooms: one in which he was showering, attached to the bedroom, one in which I was hemorrhaging, off the main room. Air flow slots pierced the thick concrete wall between us. When the shower stopped, I called to him.

It was more or less unreal until he looked at me. A person doesn’t have as much blood in their body as I’d lost that day and the night before. The math was wrong. But James looked at me and I knew by the look on his face that I was fucked. I could see in his reaction to me that I was haggard, pale and glassy. We both entered crisis mode.

I explained that I’d seen a hospital on our road and made a casual mental note of it. I told him where it was and he listened with every bit of attention he could bring to bear. I asked him to go to that hospital and find out whether or not they were open, when they closed, and whether or not they had an OB/Gyn-type around. He dressed and checked in on me before leaving, looking into the bathroom right as I pulled a sheet of lining from my body. It was larger than the baby wipe it sat on, larger than my palm though not longer than my palm and fingers. He blanched and asked if I was sure he should leave me alone. Though I didn’t say it, I thought it was safer than delaying.

When James returned, he told me the story of the hospital. He pulled into their parking lot and he was studying the sign out front, not seeing the magic words for which he was looking. Someone, neither of us know who, recognized him. This strange man spoke his name and asked what was wrong. James stammered that I was sick and bleeding and, before he finished, the hospital general manager was standing next to him. The manager assured James that there was a “lady doctor” on duty and that he should bring me right in.

I debated riding the motorcycle astride or side-saddle. I decided to ride astride because I would slump onto James in the case of a faint, rather than sliding off the motorcycle into the road.

And then came the laying, the bleeding, the IV and the medication, the lump in my arm and the chatting with nurses. I was dilated eight millimeters.

They couldn’t do a D&C without an ultrasound. They pulled an elastic string up my legs and tied two enormous pads to it. They slid me into three garments – a top, a mundu, and a hospital gown that hid the opening in the back of the top. They put me in a wheelchair and the smallest, oldest lady of the three pushed me down the hall and off the slight ledge onto the elevator. She couldn’t get me out of the elevator herself, but a guard helped tip me up onto the bigger ledge at the bottom floor.

The ambulance was half the size of a VW bus. The Keralan-sized stretcher I laid on fit tightly next to a small seat, on which sat the nurse with two sons. Her calm and gentle hand held mine and she hung the second bag of IV fluids from a hook in the bus’ roof. James sat in the passenger seat. We drove forever through the traffic of India, blue blinking light availing us no privilege, horn and driver bulling us through anyway. I closed my eyes, steadied my breathing, and focused on meditating through the growing waves of cramping. As the pain built, twisting or pinching my lips even through my self-hypnosis, I thought about labor and, again, strangely and distantly, felt lucky.

Devi Scans is a specialty shop. They do MRI, ultrasound, Doppler, and who knows what else. My bladder was empty and that made it hard to see my uterus, so they gave me a bottle of water and I tried to drink it. A quarter of the way down, I rolled my wheelchair to a nearby sink and, in front of a waiting room inhabited by three dozen bored, waiting people, provided a distraction by retching into the clear glass basin, molded in one piece with the floating clear glass countertop. I liked the design, though I feared to lean on it too hard and would have been better pleased if my watery stomach bile hadn’t been so thoroughly displayed for the amusement of the waiting room crowd. The water spout was dished and the water flowed from the middle off one edge of the polished steel. They pulled a tech who didn’t need my bladder to be full.

He was quite surprised by my innards. He was also quite upset that the first scan tech, at Thycaud, hadn’t noticed what he found so perfectly visible – my uterus did not form correctly when I was an embryo. It’s heart-shaped – bicornuate is the medical term – and deeply divided in the middle. The pregnancy was bound to fail.

After he’d identified the location of the remaining uterine material (there was no fetal sac), we did the reverse trip in the ambulance and returned to the hospital for the D&C. Local anesthesia and reassurances that sounded nonsensical, no stirrups, just scoot to the edge and try to keep your heels up by your butt. They shaved me and I grew upset for the first time. I am attached, emotionally, to my body hair. They held me and the doctor pulled everything out that might fester and lead to infection or irritate me and make the bleeding continue. It hurt.

They covered my lower body with a towel and allowed James to come in. We were adorable – you could see it in their eyes. We love each other so much and we wanted to reassure each other, neither focusing on anything except the fact that we would be okay. They had to shoo him out to finish cleaning me up.

They set me up in a room with air conditioning, which I refused, and a fan, which I requested be turned on low. I lay on the bed, James supporting me as I dropped to its surface, and then I begged him to go, eat, sleep, and come back the next day to take care of me. His New Year’s friends had arrived to provide moral support and one of them was in school to be a hospital administrator. He knew what didn’t occur to me or James – that I would need biscuits, bread, juice, and water – and arranged to me to have them.

It was after eleven pm. The nurse with two boys had stayed five hours past the end of her shift. The doctor had stayed three hours extra.

I should have known. I read Nyondo Nadi’s version of hospital care in India. I was in a nice hospital (and don’t think I wasn’t concerned about the cost), but it’s still India. The nurses are not there to care for anything except your health. There’s no kitchen. They don’t feed you. The extra bed – a short, narrow pallet with very little padding – was for my caregiver, a family member who was supposed to stay with me day and night. But I’d sent my family away, and I wouldn’t sentence him to that bed anyway. The older nurse adopted me. She tweaked my chin and offered to sleep in the room with me. She poured mango juice in my mouth, dribbles at a time, until I felt refreshed. She cared. She spoke only a few words of English and I spoke no Malayalam.

They woke me twice for antibiotic injections in my IV tube, but I woke on my own about an hour before the first call to prayer. I watched the sparse traffic and the sleeping nurse. I dozed. This pattern was broken by a second trip for an ultrasound to confirm the D&C’s completeness and then continued again until the afternoon, when James arrived. He hadn’t slept until five am, worrying, and then had slept too much. I was cranky and fractious when he showed up. The doctor wouldn’t talk to me alone; she wanted to wait until James was there. I felt lonely and hungry, but I had no money in the clothes I’d been wearing – not even enough for another juice. The day nurse bought one for me.

When James arrived, the pained passing of moments stopped and life began again. I cheered up immediately and demanded food. We walked with exquisite care down the stairs to the doctor’s office first, though, and she lectured us on the meaning of a bicornuate uterus. She said I would never carry a baby to term. I would miscarry every time the fetus got big enough to strain my uterus. I felt right about that. It fit my understanding of myself as someone who was unable to have children. Now, having read everything I could find on the internet, I know that some people do carry babies in bicornuate uteruses and that there are degrees of the thing. I don’t know exactly how bad mine is, but it doesn’t really matter. I won’t be going through this again.

But she didn’t understand us, our calm. James and I had, independently but with a shared understanding, refrained from mentioning to the medical staff that we’d been on the verge of aborting. This nice, supportive doctor didn’t understand why I wasn’t more depressed, more upset. I did finally explain that we’d never wanted children, but the idea did not seem to make sense to her.

At the end of the conversation, I asked again for food and James asked the doctor if he could take me to the hotel across the street. She said yes. I was floored. She’d just told us that she wanted to keep me there another night in case of further hemorrhaging, but she was willing to let me walk across an insane intersection and into a public eatery with an IV tube in my wrist. Well, there it is. This is India. Dinner was spicy, filling, and delicious. Better than any hospital food in the world.

Back in the room, James and I sat. We talked a little, but I got sleepy fast with a Valium-cousin in my veins and I sent him home. That night, I refused the nurse’s company, allowing her to sleep on the slightly more comfortable bed in the nurse’s station.

I dreamed of loss, sadness, irretrievability. I woke crying, again an hour before the first call to prayer, and I wondered at the hormonal surges that would put me in such a state. The clear part of my mind was impressed by the strength and duration of the emotional swing and my nose began to redden and chap from wiping. I settled, the flood that swept me into tears receding as floods often do, with messy detritus and eerie calm. Staring out the window, I saw motion on a sloped tin roof across the street. Then saw something again. I opened the window of my room so I could see better in the murky beginning of the blue day’s takeover.

Kittens. I watched them for hours. A mama cat sat up near the ridge, next to the old sign reading Veg/Non-Veg. Her kittens played all across the roof, piling up at the eaves behind the new sign that read AC/Non-AC. I guess the important distinctions had changed at that restaurant. The kittens, though. They buoyed me up through the growth of gold, then orange, then yellow in the sky behind them. I was fine.

James championed me when he arrived, forcing them to release me and let me go home.  I rested all day, flat on my back or sitting at the computer or sleeping. The doctor had warned me that my hemoglobin level was way too low. American averages are different from Indian averages, she said, and I was only at ten when most American women averaged sixteen or more. Somethings. I was relieved to find that the original blood work showed my original hemoglobin level at twelve, proving that I’m not an average American and that I wasn’t as bad off as she thought. I rested anyway. I didn’t have much choice.

This story resolves in calm and optimism, though these positive emotions are not unmixed with discomfort and a wary attention to time, temperature, and odor. There was, for the first few days, a danger of infection or renewed bleeding. I’m healing, though, not sickening. I haven’t felt nauseous since the D&C. I’m not overheated anymore, nor is there an infected odor to the small amount of spotting I’m doing. I cramped a little for a couple of days, but now I think I’m really done with this. I think it’s over.

The emotional outrage I felt at being trapped into the decision-tree of pregnancy hasn’t left me altogether. The excellent hospital kept me three days and two nights, performed a D&C and two ultrasounds, and pumped me full of drugs, sending me home with bunches more. They charged me, for the entire thing, 10,000 rupees, or about $200 at the current exchange rate. I no longer had to make and hold to the decision to have an abortion, but it upset me mightily that the same private clinic wouldn’t have done the D&C if I hadn’t already been miscarrying. I’m still upset about that. It’s not enough for abortion to be legal, if it’s not available. The care I got as a patient requesting abortion was despicable compared to the care I got while miscarrying. I can’t associate cause and effect directly, because the environments were so different, but I can’t help but believe that, had I gone through with the abortion, I could have been torn up by an uncaring, judgmental doctor wielding a curette. The scan tech didn’t catch my bicornuate uterus and the doctor wouldn’t have known. What would have happened to me if something had gone wrong in that environment?