Everyone’s talking about the murder of George Tiller, the Kansas doctor assassinated because of his work providing late-term abortions to women (and, it must be said, girls). Much of the talk, on television anyway, centers on political questions: Will the Tiller murder reignite abortion as an issue at this delicate moment, just as a new justice is being considered for the Supreme Court? Will conservative pundits bear some responsibility for their characterization of the doctor as “Tiller the killer”? Does criticizing those who demonized him amount to a call for censorship?
The questions I would ask are different: Will someone else take over Tiller’s practice? How many places are left that will offer the service he did, terminating pregnancy in the second and even third trimesters? Who will take care of these mothers when they find themselves facing the worst choice ever?
Choice isn’t just a euphemism for abortion, and it’s not a political term of art either. The women who went to Dr. Tiller weren’t seeking to abort pregnancies they hadn’t chosen in the first place; they went to him because of wanted pregnancies that had gone terribly wrong, because they and their wished-for children got stuck with the worst luck ever – because they found themselves in situations they never, ever would have chosen. I know because I could have been one of them.
I hadn’t expected to be pregnant again. Our son was only eighteen months old, and at forty I wasn’t sure I was all that fertile. But my period was late and as I remembered our kid-free weekend getaway a few weeks earlier, I immediately used the last in an old boxful of pregnancy tests, left over from our days of trying to conceive our son. When it came up positive I was shocked, then thrilled – then worried, since it was an oldish test, possibly expired. My husband was out of town so I dragged the toddler off to the drugstore to buy some newer tests – these, too, showed the pale blue crosses. I called my husband’s cellphone. Out with friends, he shared the news right away; they all drank to our great good fortune.
Because we’d had a miscarriage before conceiving the toddler, and because of my age, I got an early ultrasound at eight weeks. I took the pictures – the baby looked like a child’s drawing of a teddy bear, circles etched in white, floating in a dark sack – when I traveled to my hometown for my father’s retirement party. After I returned, around eleven weeks pregnant, we heard the baby’s galloping heartbeat via the Doppler listening device.
“Nice strong heartbeat,” the doctor said. “You can relax now.” I started to take her advice. I thought, having had a miscarriage before our son, that I had already been through the worst my reproductive life had to offer, and was now getting to the good stuff. I was wrong.
A week later we had another ultrasound, this one to look at the baby’s nuchal fold measurement, an early sign, sometimes, of heightened risk for Down syndrome. Ultrasound rooms are dark and cool and quiet places. While the technician guided her wand on my tummy and looked at her monitor, my husband and I looked the other way, into a monitor set up just for us. The baby bubbled into view, yielding some obvious features – skull, spine – while others looked mysterious and hard to read, etchings in a language I don’t know. The easy thing to remember is that dark is fluid and white is tissue. At twelve weeks, the baby is just around two inches long.
The room got quieter as soon as the technician pushed and angled her wand to see the baby’s neck and spine. What should have been a tiny line of darkness looked like a deflated balloon stretching from the baby’s neck down its back to its rump. I simultaneously noticed that it looked wrong and immediately deleted the thought from my mind, asking instead about the profile, the legs, the hands. My husband asked if we could have a picture. The technician said sure, but didn’t save or print one. She removed the wand from my belly, wiped up the sticky blue jelly, and told us the doctor would be in soon.
As soon as she left the room, I began to cry.
A doctor we hadn’t yet met entered, measured in silence for what seemed like years, then crossed his arms and sighed. He told us that instead of the two millimeters they expect to see, our baby’s nuchal translucency measured 76 millimeters, off their charts. He suspected Trisomy 18, a chromosomal disorder that kills most affected children before birth, and the remainder a few days or weeks after. The rare child who survives more than a few months with Trisomy 18 will be profoundly mentally retarded and painfully physically disabled. Virtually none survive more than a year or two. We immediately scheduled another test to confirm the diagnosis, but the doctor pointed out that even if this baby didn’t have a chromosomal disorder – a vanishingly small possibility – it almost certainly had other major physical problems.
“We can’t do anything for these kids,” the doctor said, “but the best we can do is tell you early.” What he said violated the carefully drawn terms of the abortion debate – to call the fetus a kid even as you make plans for termination – but he was right on both counts.
Nobody can prepare you for how quickly things change. That morning I had been thinking about beds. Specifically, I was strategizing the family sleeping arrangements like a particularly complex word problem in math class: If we moved the toddler into a big boy bed sometime just before the new baby came, then we would not have to buy or borrow a new crib. But how to time it? Move too soon, and we might destroy our toddler’s good sleep habits, do it too late and we’d risk intense sibling rivalry as he saw a new baby move into his beloved crib. Would we move the two into a shared bedroom, and when? I looked forward to converting our current guest room into a nursery for two, and re-inventing the toddler’s room as a smaller guest room.
A few hours later I was planning for a procedure you don’t have at my age unless there’s something terribly, terribly wrong. We agreed we would almost certainly terminate the pregnancy, we would say goodbye to this very much wanted, very much loved child.
Over the next day I learned a lot of things I’d never known before. How when you cry very hard while lying on your side you can actually feel the tear make its way from one eye across the bridge of your nose into the other eye, pushing a new tear out of that one. How much hope you can pack into two inches. How 76 millimeters – it’s tiny, such a small measurement – can blow your heart open.
When I told friends what had happened, they cried with me. One sent me a link to a website where women wrote of similar bad ultrasounds and horrible options. While some of these women chose to carry to term, gestating and delivering babies born to die, or born already dead, most didn’t. The pain they faced was nearly matched by the logistical obstacles in their way. Most of them only learned of their babies’ serious problems at a second-trimester ultrasound, far too late to terminate in most places – not by law, but because the doctors and facilities simply do not exist. This is why there’s a section of the website devoted to “Kansas Stories.”
Because I grew up in Kansas, yet had never heard of Dr. Tiller, I clicked out of curiosity (even wondering, for a second, if chromosomal abnormalities could be more common in Kansas). Story after story described anguished journeys to Wichita, rushing through throngs of protestors only to emerge in a place of kindness and succor.
Reading their stories, I realized I was almost lucky; I live in a state where insurers cover the nuchal fold test, I was old enough that it was recommended. If my situation had been different, I might have found out about this baby’s condition when they did, at the 20-week ultrasound – after feeling the baby move, after weeks in maternity clothes, in the midst of shopping for cribs and bibs.
I didn’t have to go to Kansas. A week later, after cornfirming the diagnosis, I terminated this pregnancy at the hospital where my son was born. For the actual procedure, I was completely sedated. It was the first good sleep I’d had since that hushed ultrasound room.
Friends, who mean well, sometimes refer to what happened as a miscarriage. I know they’re trying to spare me the label “abortion.” I know they’re trying to be kind; they’re trying to absolve me of the implications of choice. But as much as I appreciate and depend on their kindness, I disagree with them. First, because I’ve had a miscarriage before, and this was different. When you miscarry your body is taking you on a ride your heart and mind rebel against; when you terminate a wanted pregnancy, it’s your mind against both heart and body. You do what you have to do – what the doctors caring for you tell you is right and what you know is best for you and for the baby – but your uterus keeps growing, the placenta keeps pumping your blood and nutrients into that tiny body, and there’s no way your heart can ever be ready to say goodbye.
And second, because this was a choice. When you have children, literally from the moment you realize you’re pregnant till the day they go off to college, your days are filled with choices – about birth plans, breastfeeding, diaper types, potty training, preschool curricula, sports and activities, clothing and Internet use, dating and driving, and on and on. But when your pregnancy takes the kind of turn mine did, all your mothering boils down to one choice – and I chose to spare my child the suffering of a brief, painful life. Of all the million and one things I wished I could be doing for this child, the only act of love circumstances allowed me to perform was this one. The women who went to Dr. Tiller made the same choice, under even more excruciating circumstances. Now that he’s gone, who will help women like them?