The Seven-Week Abortion

Brianna DiMonda

She opens the door to the doctor’s office hidden in a Santa Ana strip mall. Behind the desk sits a short woman with curly brown hair. She speaks Spanish to a patient on the phone. All the signs in the office, actually, are bilingual: “Mask required/Mascarilla necesaria,” “Please take a seat and we will be with you shortly/Por favor tome asiento y estaremos con usted.”  When she walks up to the desk, the nurse, Maria, hands her a stack of paperwork. She pulls out an ID, but Maria says that won’t be necessary. She’d never been to a doctor that didn’t ask for identification. In the back room, down a short hallway, Maria wraps the blood pressure monitor around her upper arm and inflates it to stop the flow in her arteries. Her blood pressure, Maria tells her, is “perfect.” She grimaces.

The first pill she takes, mifepristone, blocks the ovarian hormone progesterone, which the body secretes to grow the uterus. This pill, then, stops the pregnancy from progressing. She opts to take it in the office, ready to get the whole thing over with. Her boyfriend drives her back home, and they take a detour to the banana stand in Orange County. She eats a Balboa bar on the water, next to an imposing modern house and kids smoking on a bridge above the canal. They sit in silence for the rest of the hour-and-a-half ride home, watching the sunset over the Long Beach bonfires and the San Pedro harbor. Back in her room, she reads dozens of articles online and scours the Planned Parenthood website. She spends all evening preparing herself. She thinks this means she knows what is coming.

Have you ever had an abortion? Maybe not. But you likely know someone who has. She knows a couple of others. They don’t talk about it much, though. She knew so little, asked so little about the details—until it happened to her, too. As if abortions already happen in secret. All these people, doing something they’ve never done before, and barely acknowledging it after the fact. So many women get this procedure in the United States: one in four. Abortion bans, then, reduce bodily autonomy on a vast scale. They dismantle equal protection between people, criminalizing the decision about whether or not to bear children. Where abortion is banned, those who seek to exercise this right are rendered second-class citizens.

She has read about the symptoms to anticipate: four to six hours of severe cramps, nausea, chills, and diarrhea. She should stay home for 48 hours. Have a heating pad ready. Have lots of water. Take ibuprofen if needed, but not aspirin, as it thins the blood. Don’t wear tampons for the next month, as this could introduce infection, could lead to complications. After taking the second set of pills, she watches television on Saturday afternoon—until what feels like a bubble pushes down on her uterus, and she keels over. She curls into a ball and kicks her legs, hugs her stomach, clutches the pillow, bites the comforter.

The uterine pain is the worst part, with pressure from both sides like her lower abdomen is in some metal clamp, squeezed by an industrial compactor. The pill dissolves and takes up temporary residence in her uterus, in her stomach, in her brain, maneuvering into each of her organs to urge them to induce miscarriage. When the chills begin, she pulls up the covers and trembles, though the temperature outside is a moderate 60 degrees.

She may not be able to stop herself from throwing up, even though, as she read yesterday, she is not supposed to do so for the first hour, at the risk of her body rejecting the medicine. But that familiar sensation begins: saliva floods her mouth, a certain dizziness hits behind her eyes, and a rock forms in the bottom of her stomach. She clamps her hand over her mouth and shakes her head. “I can’t throw up,” she mutters. And for the first time since testing positive, she cries. She pukes in her mouth and swallows it. She does this six or seven times, lying in bed, sitting up in bed, still clutching her mouth. She refuses to fuck this up. She has one job, and that is to get unpregnant.

In the waiting room, she reads the fine print on the paperwork. It gives her a small feeling of control amidst the sense of derailment that has marked these last two days. She has to agree to get a second abortion if the first turns her pregnancy ectopic. She has to sign off that she understands the abortion can cause infection, may not properly complete, can lead to heavy bleeding that might not stop. She signs that she understands these risks. Even though such complications are a rarity, of course any of them could happen to her. Yet she later learns that these pills are safer for the body than acetaminophen.

There’s one other woman in the waiting room, sitting in a chair and tapping her leg. She wants to tell this stranger it will be okay, but knows that would be pointless. Maybe this woman is 11 weeks pregnant. Maybe she needs a surgical abortion and knows it’s going to hurt. She can’t do anything for her. In the examination room, she meets Dr. Azimi. He’s tall, with thick eyebrows and a calm demeanor. The whole office is a two-person operation. She wonders how many people he treats in a week. 

He doesn’t ask if she wants to keep it, which for some reason she thought would be part of the process. There are none of the hurdles or guilt trips that people in other states are forced to confront. Dr. Azimi wipes green gel on her stomach to prepare for the ultrasound. She stares at the ceiling, blinking, wondering if he’ll tell her it was a false alarm. That it was all a paranoid endeavor. That her uterus is empty. But he doesn’t say this. He says, “I’ve found it. It’s just under seven weeks,” and measures a black dot on the screen. She sits up. “That’s it?” It’s a clump of cells less than a centimeter across. How did her body know?

After she takes the first pill, her uterus stops expanding. The pregnancy will not progress. Her body will adjust to this situation, will recognize the thickened wall lining as no longer necessary, until the next set of pills induce the miscarriage. As she waits, she thinks of the bills in Missouri and Texas that are taking extreme measures against abortions: how Missouri tried to stop ectopic abortions—where the egg develops in the fallopian tube, which the abortion pill can cause in two percent of cases—even though these pregnancies threaten the life of the mother and child. She thinks of how Missouri also wants to ban out-of-state abortions, targeting a clinic in Illinois that opened with the intent of serving abortions to Missouri residents struggling for access.

She thinks of the Texas Heartbeat Ban, the first-ever successful attempt to effectively negate Roe v. Wade since the 1973 Supreme Court decision. The six-week abortion ban got around the Court by vesting private citizens to sue abortion providers and anyone who assists in the process. Idaho has now followed, allowing lawsuits to be filed against abortion providers by plaintiffs who received an abortion, or either impregnated or are related to a person who did. 

Like most others, she didn’t show signs of pregnancy until she was just over six weeks pregnant. Had she lived in one of these states, she would not have had access to a same-day abortion. She would have had to leave the state, maybe wait a month or more for an appointment. In Texas, the GOP is seeking to sentence those who seek abortions to the death penalty. 

For many, it’s as though Roe isn’t in place at all: only 10 percent of U.S. counties have clinics that offer abortions. The current abortion restrictions make it impossible for some to get treatment in time. Traveling long distances means taking off work, paying for transport, finding lodging, and, if necessary, securing childcare. The Hyde Amendment makes abortions ineligible for federal funding, and many, like her, are left to pay a minimum of $500 out of pocket for the procedure. Some clinics require two appointments: one for counseling, the second for the abortion pill. Sometimes they’ll show videos of the “precious life” inside the uterus and send the person home, where the wait in between can be up to three days. Ohio even tried to require burials and funeral rites for embryonic tissue. It’s not just financial hurdles to overcome, then, but emotional ones, too. These tactics try to guilt patients into seeing the pregnancy through. There are too many angles of attack to count.

The second set of pills, misoprostol, empty the uterus. These synthetically mimic the hormones produced in the body during a natural miscarriage. She puts four of them in her cheeks, like a chipmunk storing nuts, on Saturday afternoon. They must be taken between 24 to 48 hours after mifepristone. They must dissolve in the mouth for half an hour before swallowing. She knows this because the doctor told her so, and because she read it the night before. (Later, she learns these pills can be bought online, thanks to grassroots communities fighting to provide safe access to abortion across the country.) Once the nausea kicks in and she has to stop herself from throwing up, she begins pacing her bedroom. She is breathing deeply through her nose when she hurls again. This time she cannot stop it. She runs to the toilet and throws up. Fuck, she thinks, flushing the toilet. She made it only ten minutes past the hour.

The doctor had, actually, asked one other question. She remembers it as she’s washing the puke off her face. He asked how she knew. On the examination table, she wiped the gel off her lower abdomen with the disposable linen, her pubic hair exposed under the fluorescent lights. She told him she had been nauseous all week, and had been going to bed at 8:00 p.m. But for those five days, unable to eat in the morning, disgusted by the smell of eggs, toast, her boyfriend, anything except fruit, it didn’t occur to her she could be pregnant. That was probably hubris—it couldn’t happen to me. She also had this idea that morning sickness involved waking up and running to the toilet. A dramatic rendition of pregnancy acquired, probably, from media. But she had texted her symptoms to a friend on Friday morning. “are you pregnant? lol,” her friend asked. Her stomach dropped. She took an old test she had lying around, just to be safe. 

As she finishes washing her face, she looks in the mirror, and her lips part. She is so pale. She gets back in bed, still shaking. Even if she wanted, she couldn’t call the doctor to ask if it will still work; she is too drained. Nausea and cramps and constipation continue to come in successive waves. It’s the only pain that has ever put birth in context. She thinks of Sheila Heti’s Motherhood, that meditative novel about whether or not to have children. Like Heti, she does not want a baby, probably not ever. It is something she’s turned over in her mind for years, even before Heti’s revolutionary novel came out. She knows this marks her as different, othered. 

Just two months earlier, she’d been out at a friend’s birthday party, where the women had decided to say, going around the circle, how many kids they wanted. Everyone wanted one, four, or two kids. Except for her. Everyone gasped, real dramatic, when she said zero. No one even asked her why. They just turned to the next girl and continued talking about babies: what they would dress them in and how many girls they wanted. Maybe it was the wrong context to bring up her lack of desire for kids. But what else could she have done but lie? She thought of Heti then, she thinks of her now: “There is a kind of sadness in not wanting the things that give so many other people their life’s meaning.” But there it is: she doesn’t want it. In bed, she shakes until the pain subsides enough that she can will herself to pass out.

People keep asking how she is “emotionally.” It isn’t a very emotional experience. When the second at-home test showed up positive (something, she learned later, wasn’t necessary to check—one positive test is enough), she turned to her boyfriend and said, “I want it out.” In less than two hours they were on their way to Santa Ana.

“I can’t believe there’s a baby in me,” she said on the highway.

“It’s not a baby,” he said. “It’s a bundle of cells.” 

She doesn’t really give a shit what it’s called at this stage. 

“Frankly, we could name it and I would still want it out,” she told him.

That night, as part of her research, she looked up what seven weeks pregnant looks like. “Your baby is as big as a blueberry,” a website told her. She and her boyfriend laughed at this and clicked through to see all 40 weeks contorted into a different fruit or vegetable: onion, cucumber, then mango. Sweet potato, “large” banana, then red bell pepper. She laughed so hard she teared up. It may have been callous, but she knew it was because the countdown on the right side of the screen made her nervous. The “18 weeks to go” meter reminded her that her time was precious if she wanted this to work. It didn’t count down to a new chapter in life. It didn’t feel tender. “I think that is how childbearing feels to me: a once-necessary, now sentimental gesture,” Heti writes. She was not sentimental about having a child. She knew this now.

She wakes hours later and gets out of bed to pee, her shirt soaked with sweat. She is shaking. She passes three blood clots, each the size of a large strawberry. She calls Maria, nervous, and asks between stutters if it’s okay that she threw up. Maria says it will be fine, that they only worry if it happens in the first few minutes. Her boyfriend comes in with chicken soup, which he’d made from scratch while she rested. She had it easier than most: she’d legally accessed this procedure, gotten a same-day appointment, and had someone at home to care for her. Not everyone could say the same. She eats, and knows she is the luckiest unlucky bitch alive.

A new term is being introduced to her vocabulary: abortion refugees. Now, there are simply not enough appointments available in the regions bordering Texas, and local patients must once again leave their county to book an appointment. Roe may soon be overturned on a federal level, as the Court, with its right-wing majority, will rule on a Missouri case seeking to ban abortions after 15 weeks. Though their leaked opinion indicates that they seek to strike down Roe, no matter what happens on a federal level, her own access to abortion seems unlikely to change. She was in Los Angeles when she tested positive, and otherwise lives in New York City. These two states have codified the right to abortion into their constitutions. She will, for the time being, have access to abortion. But if the Court strikes down Roe, 33.6 million could lose that right.

There are so many scattered opinions about what the end of Roe could mean—whether it’s a strategy to preserve the white race, keep people of color in poverty, uphold spiritual notions of when life begins, or ensure the next generation of working-class Americans. But whatever the reason, the Court’s decision will be a ruling on people’s experience, a judgment on their pleasure, a diagnosis partitioning sex into what’s acceptable and unacceptable. People won’t have dominion over their bodies. The Constitution might not so explicitly “prohibit the citizens of each State from regulating or prohibiting abortion” (to quote the leaked opinion), but this is more than a question of Constitutional law. The hulking monolith of the Court threatens to dismantle fifty years of civil rights progress. They say they do this in order to save lives. She’s not so sure.

In the week that follows, she works from home and keeps a heating pad over her lower abdomen. She bleeds through three or four pads a day, diligently changing them and taking out the trash. Scrolling on her phone, she continues to read about abortion between naps. She learns that most Americans don’t even know medical abortions exist. She thinks of the knowledge she has gained in the past few weeks, and how empowering it had felt to share information and anecdotes with friends. If the laws around abortion really are about to see a 50-year reversal, it makes sense to educate each other. Keep everyone safe.

The same evening of the abortion, she and her boyfriend go to the grocery store and get Goldfish, Pirouettes, Petit Écolier cookies, and pistachios. She hobbles down the aisle, gleeful just to be walking. Then they get in bed and snack. Her purpose is clear: to get well. And, fortunately, she begins to. Her body heals, and her normal rhythm resumes in time. She returns to the doctor. Has it been two weeks already? She lies back under the second ultrasound and catches herself blinking, staring, half-expecting to wake up, sweating, from this dream. “It’s looking good so far,” Dr. Azimi tells her. She nods, and her lower lip trembles. When he’s done, she puts her hand over her still-sore abdomen, forgetting about the green gel. For her body, it is over. For so many others, it’s just beginning.♦

Brianna Di Monda is a contributing editor for Cleveland Review of Books. Her fiction and criticism have appeared in The Brooklyn Rail, Taco Bell Quarterly, Worms Magazine, and Full Stop, among others.

Cover image: Sculpture by Hannah Halpern.

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