The Choices

Methotrexate may be a new alternative to surgical abortion. I was the second person to try it.

January 29

Woke up sick again this morning. I feel like I've been poisoned. Still, I can't afford to miss another day of work. I dress and stumble to my car, double-checking to make sure that I haven't forgotten any vital article of clothing. By the time I get to the office, people are lined up at my desk. Their voices sit like sour milk in the pit of my stomach. I bite my lips to control the rising waves of nausea. My mind drifts off. Slowly, as if from a long distance, I watch as the final piece of a puzzle drops into place. And I get the picture. It all fits. The pinching cramps, the back pain, the ominous absence of blood. I'm dry as a bone. I'm pregnant.

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The rest of the day seems interminable. After work, I fly to the nearest Pay Less Drug Store. The array of home pregnancy tests bewilders me. I read each package word-for-word, as if choosing the right product will determine the final outcome. In the end I bring home the box that seems prettiest to me.

With trembling hands I extract its contents and set up my laboratory on the bathtub rim. I mix, shake, and count the seconds. As I put the little white palette into the final vial, I begin to bargain with God. If you let me off just this once I promise I'll never have sex without condoms again. In fact I'll never have sex again, period. I watch with rapt attention as the palette begins to turn color, hoping it's nothing more than a trick of the light, a reflection of the glass. By the end of ten minutes a bright blue square glimmers cheerfully back at me. I pause and take note of how my first thoughts automatically fly to abortion. But in my case, I'm afraid it might not be so simple. The opening of my womb is crusted with scar tissue.

January 30

The counselor at Planned Parenthood sounds apologetic. Because of the scars on my cervix, an ordinary surgical abortion could be difficult. The suction curettage, in which the cervix is dilated and suction is used to remove the fetal tissue, could be more painful than usual, and might present a risk of perforation and infection. Complications could produce further scarring, which might impair my future fertility.

"The perfect solution for you," she tells me, "would be RU 486, but of course it's not available in this country." RU 486, the abortion pill now commonly used in France and Great Britain, is 95 percent effective, with no known long-term side effects and very few short-term risks. It's safer and has the potential to be cheaper than the typical suction abortion. And it's still unavailable in this country because of pressure put on the French manufacturing company, Roussel-Uclaf, by American antiabortion forces.

"You might be able to find it in Canada or Mexico, or maybe through the black market here," she says, "but I would have no idea how to go about doing that." Well, neither would I, and that would mean taking it without a doctor's supervision.

Bouncing from one referral to the next, I end up conducting an extensive investigation into what is not available to women in this country. I call every women's hot line and clinic within a fifty-mile radius, along with scores of gynecologists, Chinese herbalists, and hospitals both public and private. People's responses run from evasive to downright insulting. Worst are those who say, "You're forty years old--do you really think you're ever going to have children?" I begin to feel ashamed of my age, my childlessness, my foolish desire to hang on to my fertility. "Yes," I want to shout, "I'm forty, but I'm not yet willing to give up my body's capacity to embrace life!" Instead I just cry.

After hours of fruitless and painful phone calls, I've lost all pretense of composure. I dial the last of my numbers, the family-planning clinic at San Francisco General Hospital. A cheerful-sounding Latina woman answers. When I've finished my story, she says, "We might have something just right for you here." She tells me they're doing a study on a nonsurgical procedure similar to RU 486. She gives me the name of the doctor in charge.

February 2

Dr. Creinin is surprisingly young. I can still see the traces of childhood in his curly blond hair and winsome smile. An unlikely face to be on the cutting edge of abortion technology. We go into a small examining room, and he explains the procedure to me.

The first step, after establishing that there is in fact a living fetus, would be to administer a shot of methotrexate, a drug that's been used in cancer treatment for forty years. This would end the growth of the fetal tissue. Methotrexate has already been used as a substitute for surgery in ectopic pregnancy, when the fertilized egg lodges in the fallopian tubes instead of descending into the uterus. After being treated with methotrexate the fetal tissue of a tubal pregnancy is automatically reabsorbed into the body. In the case of a normal pregnancy like mine, the fetal tissue would need to be expelled in some other way. Several days after the methotrexate, I would be given misoprostol, which would hopefully produce uterine contractions and eject the pregnancy. I ask about potential side effects. In the higher doses given for cancer treatment, methotrexate can irritate the stomach, and with long-term use it can suppress the production of bone marrow and permanently damage the liver and kidneys. But when methotrexate has been used on tubal pregnancies, they've recorded no major side effects.

I ask about the success rate of the procedure. "Well, you're only the second woman we will have tried this with," Dr. Creinin answers earnestly. "And it didn't really work with the first woman. We ended up having to perform a suction curettage when the misoprostol didn't expel all of the pregnancy. We're still experimenting with timing and dosages." I ask if anyone anywhere else is working on this.

"Not to my knowledge," he says.

In other words, I would be the second woman on earth to undergo what has so far been an unsuccessful procedure. If I agree to participate in this experiment, I will have to sign a paper stipulating that if I am injured as a result of the study I will forgo any monetary compensation. The hospital's responsibility will end at trying to repair whatever damage has been done.

"Let's go ahead with the preliminary exams," I say. "But I've really got to think about this."

Dr. Creinin draws blood to do the official pregnancy test. He also does an ultrasound, inserting a long probe, covered with a rubber glove, into my vagina. The fingers seem to be waving at me. He apologizes. The clinic has run out of condoms. He turns the monitor on, and we examine my womb like a couple of deep-sea divers in an underwater cave. The pregnancy appears as a solid patch in the milky background of my uterus.

We won't be able to start the procedure until we see evidence of a heartbeat. For the purposes of data collection, there has to be proof that the fetal tissue is normal before it can be eliminated.

February 3

I feel like I should get a second opinion and call Lisa, an obstetrics doctor at one of the women's clinics. "This is very exciting!" she bursts out, as I'm describing the procedure. "We've never heard of it. All we have to offer is surgery." We talk about the escalating assaults on clinics and the diminishing availability of abortion, especially for poor women. "This would make abortion much more accessible. You'll be doing a wonderful thing for all women if you participate." I hang up the phone feeling almost heroic.

February 8

A mustardy fog has settled over me. All day I'm exhausted, then at night I'm too agitated to sleep. I'm tormented by a cacophony of voices inside my head, berating me for not having made it to the elusive plateau called "security," from which one does things like having children. Raising a baby in my cramped and noisy apartment, on this street known for its junkies and drive-by shootings, would seem like doing a stint in prison. A life sentence in two tiny rooms, festooned with half-finished crackers and discarded toys. My time consumed by the tedious, daily activities that I've always done my best to avoid. Three meals a day. Unwashed laundry, untied shoes, unwiped noses.

The father of this pregnancy is young, lives out of state. He's not ready to be a parent. And I barely make enough to cover my own expenses. How can I dream of taking responsibility for this fragile being whose entire existence would depend on me?

My mind wallows in images of what my own childhood in the fifties was supposed to be, and never was. Mothers in gingham aprons spooning out Jell-O. Little girls playing hopscotch; little boys saluting the flag. I'm drowning in an ocean of voices. I can't distinguish my own from June Cleaver's, or Jesse Helms's.

And I'm haunted by the vision of a small face that I love beyond imagining. A heart entwined with mine, as no other heart would ever be. An immutable, undissolvable relationship. Almost as a bystander I watch as my body and psyche do what they are programmed to do, honing down to the single focus of sheltering this new being. I find myself scrupulously avoiding alcohol. Am I eating enough vegetables?

February 9

In the morning, I pass an elaborate construction of cardboard boxes and upturned shopping carts. Inside, a woman and her three children are eating potato chips. I feel like a voyeur, intruding on the space they've so carefully constructed to separate themselves from life on the street.

There are no easy answers to this question of whether or not to have children. I've been sucked into a swamp of self-doubt and regret, and have stopped telling people that I'm pregnant. Their responses only confuse me.

My friend Judith was sterilized in her early twenties. Now thirty-five, she's been trying to adopt. "Let me have the baby," she pleads. "You could visit her anytime, and if you ever wanted her back, I promise I would let her go."

Other friends, single women dancing on the edges of poverty, have postponed pregnancy, hoping time would bring greater prosperity. But time brought only menopause, and, for better or worse, the decision was made. For my friend Alice, her womb grew a cancer like mine is growing a baby. Still, to bring another child into a world full of unwanted children is no answer. Why have I been given this gift, one I can't imagine accepting?

February 12

Today's the day. I still have this life inside of me. Last night Dr. Creinin and I saw a heartbeat on the monitor, like the fluttering of a butterfly's wing. I have a four o'clock appointment for the methotrexate shot. I still don't know what I'm going to do.

On my way to the hospital, I suddenly realize that I need a haircut. I wander into a Mexican beauty salon. I can't stop fidgeting in the chair. The stylist is cutting too much, I'm sure of it. "Poco, poco," I keep repeating nervously. I know that the hair will grow back. This baby won't. "Bonita," she says. She must think I'm nuts.

I arrive at the hospital, completely numb, and watch myself as one foot moves after the other, until I'm in Dr. Creinin's examining room. I notice that he also got a haircut. He looks tender and unprotected, like a sheep shorn for summer. I have him go over the specifics of the procedure in minute detail, grasping on to every extra second.

Eventually he falls silent. As if from a distance, I watch myself. I'm rolling up my sleeve. My arm stretches out. "Pressure and a little sting," he says. And it's done. The shot of methotrexate. The immutable act.

"How long will it take for the, uh, process to work?" We both laugh nervously. "Two days," he says. "More or less. By Sunday you won't see on the monitor what we call the heartbeat."

As we walk down the stairs I notice the shoelace to his sneaker is hanging loose, like that of a boy running home from playing baseball. "You should tie your shoe," I say, feeling a sudden surge of affection. "Yeah," he smiles bashfully.

In the elevator I'm surprised by my overwhelming and buoyant sense of relief. For better or worse, the decision is made. There's no going back.

February 15

The delicate pulse of the fetal heartbeat has vanished. Sitting in Dr. Creinin's office at the hospital, I can hear women in labor crying out down the hall. I notice that I don't feel any desire to change places with them.

Dr. Creinin has given me the misoprostol, which is supposed to evict the now-inert material from my womb, but nothing seems to be happening. When I ask him when the drug might kick in, he says, "It could happen today, or anytime in the next couple of weeks. We just don't know."

February 16

Had a couple of hours of intense pain yesterday, after leaving the hospital. I watched soap operas, a time-honored women's anesthetic. Became heavily drowsy and slept through the afternoon.

February 17

The bleeding has stopped. It's too soon. The emptying of my uterus is not yet complete. Maybe I should have gone to Europe for the RU 486. Why did I let them use my body as a laboratory when something already exists that's known to work? We're barbarians in this country. We let everything important be decided by religious fanatics and big business.

March 8

Women's Day. This is one demonstration I wasn't about to miss. "Our bodies, our lives, our right to decide." I feel awash with joy, a tiny drop in a river of boisterous, shouting, unruly women. We will not be polite and we will not disappear.

I lose my balance suddenly and grab my friend Nancy's arm. Waves of dizziness pass over me. I'm bleeding. At last, the blood I've been praying for. I look at the women around me and think how beautiful we are in our rebellion, in all our glorious variety. Women who bring children through our bodies and entrust them to this capricious world. Women who forgo parenthood and love the world's children as our own. I stand with my sisters, a woman without children. A barren field perhaps, or an orchard that will produce a different fruit. My life feels luxuriant with possibility. For one precious moment, I believe that we have the power to dismantle this system. I finish the march, borne along by the women, feeling as if I've come home after a long journey.

D. Redman is a Bay Area writer.

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