Two Ambulances

In July 2021, five weeks after my mother died, my husband dropped me off at the emergency room of the small hospital in the Massachusetts town where my father now lived alone. I went because my primary-care doctor had ordered me to do so over the phone: I had reported to her, in language that I hoped was accurate, my severe abdominal pain. My husband left me at the hospital’s door because the children had swim lessons and someone had to take them. (If your mother dies suddenly, you start to think like this: If the children don’t learn to swim, they will drown!) I worried that the pain might be trivial—something embarrassing and unfeminine, maybe gas—even though it prevented me from breathing properly and caused sweat to bead on my forehead and drip down my chest. I was used to being dismissed or reassured by doctors. But my mother had just died of cancer—maybe stomach, maybe pancreatic, somewhere in her middle, they didn’t know where it began—so it seemed particularly foolish to disregard my doctor in this moment. I brought a book to the ER, and a snack, along with some high-quality masks.

I left several hours later, in an ambulance. This was not the exit I had envisioned. It was my second ambulance ride of that summer, the second of my life. Five weeks and four days earlier, I had ridden in one next to my mother, whose voice by that point was almost gone. She was coming home on hospice after a nightmarish few weeks in different hospitals where no one seemed to be in charge of finding out what was wrong with her, let alone fixing it. She had been okay at the beginning of this ordeal—albeit mysteriously unwell and grumpy about it—until, suddenly, she wasn’t. Overnight, as my children and I were finishing our school year, she became a very ill person. Once that happened, the doctors declared her beyond hope, untreatable. 

“Can we take her home?” my sister and I asked as soon as I arrived at the hospital from my home in Philadelphia. My mother was desperate to leave, and the hospital’s visitor policies, in the age of COVID-19, seemed capricious and terrible. 

“You’d better hurry,” the on-call nurse said quietly, looking her over. “She’s about to die.” 

“When?” I asked, blindsided, although she did look truly awful: pale, emaciated, her mouth frozen open. 

“Hopefully not until tomorrow.” Her words struck me like a fist or a wall where you don’t expect one. A car whose weight renders your own pedestrian body meaningless. 

She then told us that my mother might not even survive the ambulance ride. I braced myself. The young men who lifted her body, already corpse-like, into the back of the vehicle and carefully strapped her in were kind and achingly respectful, barely old enough to shave. “Do you think we should tell them they need a new ambulance?” my mother whispered to me as it rattled disconcertingly over the bumps of Boston’s streets. She smiled then, though it was more of a grimace. She was funny. 

A few days before that first ambulance ride, just after I learned that my mother’s middle was full of cancer, I FaceTimed her. Her voice was still strong at that point. She made a joke about whom my father should remarry. We both laughed; it was funny. She said that he didn’t think the joke was funny when she had tried it out on him. We laughed more. We both knew that she would die soon. I thought that she would weaken over the course of a summer, that I would sit next to her in her bedroom while her condition worsened. I began to imagine the things that we would talk about. My mother liked to talk. Like me, her favorite pastime was sitting on the couch in the sun, making conversation. 

I began thinking, after our call, of things that I would ask her. What did she need to tell me? What did I need to hear? 

After I had been in the emergency room alone for about an hour, the doctor came in and sat down. He said, “We ran your urine. Did you know that you are pregnant?” 

This felt like a trick question. I had told them about my IUD. I had told them about my family history of hernias. Trying to be helpful, the valedictorian of my own illness, I had asked: “Do you think it’s my appendix?” I had thought of the little French schoolgirl, in the book that I read to my son over and over again. 

Little Madeline sat in bed, 

cried and cried —her eyes were red.

And soon after Dr. Cohn 

came, he rushed out to the phone…

“Nurse,” he said, “it’s an appendix!”

This doctor was Dr. Cohen. Similar, but different. I had hoped that together we would sleuth out my ailment, and then Dr. Cohen would remove something infected or swollen within me, taking it out using sleight of hand—a knife, if absolutely necessary—and then, with a pat, send me home. 

I did not want to be pregnant, that was why I had an IUD. I started thinking of all of the reasons why I did not want to be pregnant. I began to cry very hard. 

I felt somehow foolish, careless. It is this way with pregnancy in our culture. Because abortion is precariously legal but frowned upon and shameful, there is an air of having made a mistake in getting pregnant when you wished you hadn’t. (What is more, to get pregnant accidentally, you’ve generally had sex, and nonprocreative sex is an activity you don’t strictly need to engage in. It is like having made yourself sick by eating far too many cupcakes: embarrassing and gratuitous, but much, much worse.) If you are a good and virtuous person, you will have meticulously prevented someone’s sperm from reaching your eggs. If you are less good, but not quite bad, you might allow these sperm entry into your uterus, but then you must rise above your individual desires and find it in your heart to parent—joyfully—the eventual baby. If you are bad, you have three choices: You must suffer, live out the consequences of your carelessness, rising sadly and selflessly in the middle of the night to feed an unwanted baby with your body, or from carefully sterilized bottles. Or, you can give your body over to another’s growth for nine or ten months, and then give the resulting child to someone with more money, or more enthusiasm for child-rearing. This is likely to be wrenching. Or, finally, you can attempt to secure an abortion. It will be expensive and inconvenient to do so at best—logistically and financially impossible at worst—and you must still keep in mind that you are bad. This is your penance. (“It hurt terribly,” the actress Uma Thurman writes of her own abortion, “but I didn’t complain. I had internalized so much shame that I felt I deserved the pain.”)

Never mind about the owner of the sperm, without whom none of this could have transpired. This sorrow and misfortune and the accompanying shame are yours. Never mind that the more effective the birth control, the more expensive and difficult it is to obtain. Never mind that what they told you in health class in the tenth grade was true, that there is no 100 percent reliable form of birth control, short of abstinence. 

Before my very eyes, my life fell like a tent whose poles have snapped. Dr. Cohen watched me cry. He went into the hall and looked around for something or someone. I asked him for tissues. He found some, and said he was sorry he hadn’t offered them to me right away. “Is there someone you can call?” he asked, somewhat desperately, having failed to find something in the hallway that would make me stop crying. “No!” I snapped. “My husband is with my children! My sister is with her child! My closest friend is with her baby!” All this was true. Children require a lot of supervision to ensure their survival, much less their happiness. 

I did not add “My mother is dead!” Nor did I add “I am your problem—you have to take care of me.” But I thought about it, and cried some more.

I am not sure what I would have asked my mother, had we had the summer that I’d imagined. She was wise; I wanted her wisdom. I wanted her to tell me how to live without her love and care. I wanted to know what she wished she had known about her own mother, what she wondered about my grandmother after she was no longer around. I thought of this right away, and I asked my mother about it in the hospital while we waited for her to be released to the clattering ambulance. She said it was a good question, and she thought about the answer. Then she fell asleep, because she was dying, and dying is sort of like being just born: Mostly you need to be asleep. 

I did think of one thing that I wanted to tell her a few days later. By then it was too late. She was dead. I wanted to tell her that I was so grateful for the way she greeted me every morning when she saw me, for as long as I can remember: with delight. I resolved to do the same thing for my children. They do not delight me at every turn. Sometimes they are pills. They refuse to empty the dishwasher, or to put on their fire-truck underpants in a timely fashion. But the potential for delight—theirs to inspire, mine to exude—should always be there. (And if not in the morning, when we have been apart for hours and not yet begun to annoy one another…then when?)

There was a great deal of female, or feminine, knowledge that my mother failed to impart. My mother—a second-wave feminist who had been a debutante under duress—did not teach me how to shave my legs, or apply lipstick. She did not teach me how to change a tampon, or paint my nails. She did not tell me what shapes and colors of clothing go well with others, nor did she teach me how to blow-dry my hair flatteringly and efficiently, or select the right size bra. (She did provide me with older sisters who taught me several of these skills.) 

But on one such subject she was very clear. I was feeling sick once—I think I was in college. We could discern no cause for my symptoms of nausea and exhaustion. “Do you suppose,” my mother asked, “that you could be pregnant?” 

“I’m not pregnant!” I snapped. “I’m careful.” The categories were binary: The one had nothing to do with the other. 

“You can get pregnant even if you are careful,” she said sharply. “You should know that. Careful people get pregnant.” I don’t know where the edge came from in her voice, what experience had sharpened it. She didn’t tell me. But her message was clear: It is not a moral failing to become pregnant. You don’t have as much agency as you think. 

Sure, you could always have been more careful. As in a pandemic, you could always have selected the higher level of caution, worn costlier masks, stayed home for longer. But care does not eliminate risk. She wanted me to know this. 

I will tell you the specifics of my sadness as I sat with Dr. Cohen, although I know that, to some, they will seem insufficient. My mother was newly dead, and I did not want to have a baby. I had just moved to a new state for my husband’s work, and we had bought a smaller house so that we could be more financially responsible. There wasn’t room in this house for another child to live comfortably, or at least not in the style to which I was accustomed. I had just moved, and given away every single over-laundered, meticulously selected baby item I had ever owned. And I had just moved, saying goodbye to the friends with whom I had whiled away the hours on the playground that make up much of mothering young children. I could now swim alone in the pool while my children had swimming lessons, back and forth, back and forth, and imagine that I was swimming to a place where my mother was still alive. Which is to say: My body had belonged, for a time, to my children. Now it was mine again. I detested being pregnant. I loathed the mutation of my body, the discomfort, the uncertainty and worry about what would happen to the fetus that I could not see, upon whose well-being my happiness rested. What is more, I was going to take some time off from my job as a social worker to write; anyone who has had a baby knows that you can’t write—or do much of anything—if you are watching a baby.

And I simply did not want to do the relentless work of mothering a baby again. A few weeks earlier, my sisters and I had discussed who would wake up every four hours to give my mother morphine. My sisters agreed that my father and I were poor candidates for this job—both he and I start to appear mentally ill when sleep deprived. (In the end, my oldest sister, an agreeable and resilient eldest daughter, took it on.) 

“I begin to feel like a stretch of unprotected wilderness, ringing with the shriek of chainsaws, the drill of oil wells.” This is how Rachel Cusk describes the sensation of breastfeeding around the clock. The demands of caring for a small baby are ceaseless, the potential for destruction is real. I remember when a friend visited in the early days of my son’s life and I handed her the baby. She held him, and I cried, because I was so tired. Soon he began to cry too, because he lacked other skills. It was winter and so cold, and I had not slept well in so long. Even lifting up my shirt to feed him let in drafts, reminding me that care required discomfort. To be simultaneously tired and cold is a grim fate indeed—I longed for nothing but my warm, unattainable bed. My friend was sympathetic. She made kind faces and uttered kind words. But what could she do, really? The work of tenderly keeping him whole was mine. 

“I didn’t know that you would react like this,” Dr. Cohen said, unbelievably, after what seemed to him, I suppose, like far too many tears at too high a volume. Was I myself surprised by the magnitude of my unhappiness? No, not really. I did not want to be pregnant, because I did not want another child. He cleared his throat. “There is a chance,” he said, measuredly, “that it’s ectopic. Not viable. That could be what’s causing your pain. We can do an ultrasound to see.” I think I began to cry less, although this too seemed like a terrible situation. An ectopic pregnancy is a mutually destructive arrangement: A fertilized egg growing outside the uterus—in the fallopian tubes, or the ovaries, for example—cannot become a baby. A body cannot support such a growth. In the end, one of them must give way—mostly it is the embryo, but in certain grim situations it is the mother. 

While my mother lay dying as we waited for the ambulance to take her home from the hospital, my father and my sister and I scrambled to solve the logistical problems that now accompanied our dying-mother problem: transportation for all parties, a hospital bed, visiting home health aides. Who would pick my oldest sister up from the train station? My mother, who was slipping in and out of consciousness, pulled on my arm. “There are clean sheets on the top shelf of the closet in my study,” she rasped out. “What?” I asked her. She repeated herself. My father is hard of hearing and he asked me what she had said. “I think she’s confused,” I said, turning my head away from her. “Delirious.” But then I played her words back. She was not confused. 

She had heard us say that my sister was coming and knew that we would need more beds, and therefore more clean sheets. She wanted to tell me this. It was important enough that she lifted her arm—no small feat at this stage—and pulled on my sleeve. It was important enough to repeat. Such care contains love, yes, but think too of the labor it embodies. 

I, too, care that my children have clean sheets and comfortable beds. To care—and to make the necessary arrangements to ensure that such sheets are available—might, as I say, contain love. But it should not be confused with love. “They say it is love,” Silvia Federici reminds us. “We say it is unwaged work.” It can be done alongside love, pushed along by affection. But it can be done without love too—nor does love need to contain this work (see, for example, much fathering, which is often an act of deep love absent such efforts). You can have one without the other. It is labor and, like all labor, it should be entered into with consent, not forced. 

Would I love a child if I grew it in my body and used my body to push it out and then held it in my arms, fed it with my body? Probably. Would I care for it? Probably. Would I give up wages for some months to do this care during and outside of working hours? Yes. Would I eventually pay someone to watch the baby, to do some of this care in the daytime so that I could make the money required to cover their services and the cost of living? ($1,230 a month, on average, for center-based childcare for an infant in this country, according to a 2018 study.) Sure. Would I want to do this work? No. I read later in a thick monograph about abortion in America, written by the sociologist and legal scholar Kristin Luker, that pro-life activists eschew the phrase “unwanted pregnancy,” preferring “surprise pregnancy, asserting that although a pregnancy may be momentarily unwanted, the child that results from the pregnancy almost never is” (italics in original). Surprise. Like a party, or a trip to Paris, or a large frosted cake. I have never heard of a surprise job. 

I agreed to the ultrasound that might tell Dr. Cohen whether the pregnancy was uterine or ectopic. In order to clear this next hurdle, I had to walk down many long hallways and, in a small, dark room, I had to take off my clothes. I submitted to a transvaginal ultrasound—an unpleasant, slimy procedure at best, invasive and frightening at worst. “I don’t want to see anything,” I told the technician. “I don’t want to hear anything either, if there’s a heartbeat.” I was not sure what I would feel if I saw or heard evidence of life growing in my uterus, but I was not interested in complicating my misery. Dismay and despair on their own were difficult enough to bear. Such feelings swirled with guilt would be no better. 

Some of the particulars of my miseries were, as I have said, deeply—perhaps comically—practical and mundane, such as the lack of a bedroom or crib. But some were more fundamental, though perhaps equally irrational. I did not want to have a baby that my mother would not know. I did not want to have a baby in a world that did not contain my mother. I already had two children whom I loved, whom she had loved.

I realized that there were people who would view a pregnancy after a death as a kind of miracle, a benevolent sign from the universe. I knew, with as much certainty as I knew I was alone in the gray ultrasound room (save for the technician), that I was not such a person.

Ultrasound techs reveal nothing, generally—their poker faces are admirable. They click and squeeze and wiggle things around wordlessly, devoid of expression. As with many medical professionals, your worst day is simply their Wednesday at work.

As soon as I saw my mother in the hospital, I wept. I asked her if I could sit next to her on the bed. “Better not,” she said. She was in a lot of pain. Movement hurt her. I sobbed, and sought reassurance from her, but she could not give it. She was not in a position to do so. She touched my head—that was all she could muster. She had never not been able to comfort me, or try to comfort me. This was practice for living without her, for enduring any subsequent misfortunes without her sympathy or concern. 

My mother cared deeply for her children’s pain. Sometimes her care felt blanketing, excessive even. She was compassionate, occasionally gratingly so: wincing at our sadness or discomfort, fretting to excess, telling me to stay in bed or to call my doctor. Did it hurt her, her inability to comfort me in that moment? I don’t know. I imagine it might have. But then again, she was dying of a cancer that had filled her middle, which I think hurts quite a lot.

Once, in the coffee shop down the street from my house, I overheard two women talking, their heads close together.

“But…would you say that your mother is a kind, empathic person?” one asked the other.

There was a long pause. “Weelllll…” the other answered. Her response was inaudible. But I knew, of course, that the mother was not good enough. On the one hand, what hell to be a mother, to be judged by such standards—both nebulous and high. On the other, if you chose to mother, this is your job. I am a social worker, a professional who works with children and parents. I know too well that kindness and empathy matter a great deal. I know that sometimes, with children, there is little room for error. D.W. Winnicott’s “good-enough mother” is perfectly imperfect—making just the right mistakes at the right times so that the child can grow optimally accustomed to our imperfect world. 

I received kindness and empathy in spades, until I no longer did. 

I give them to my children, not ceaselessly, but consistently. They cry, and I hold them. They are sick, and I rearrange my face, removing the irritation about the canceled meeting or trip, the looming deadline, and apply my expression of nurturing. Some days it feels genuine. Other days it feels hard, as if my performance review contains many “opportunities for growth.” It is love. And it is work. 

The culprit of my suffering was likely, but not definitely, an ectopic embryo, Dr. Cohen concluded, after conferring with the ultrasound tech. But it wasn’t really a conclusion, because he wasn’t really sure. It was hard to tell, he admitted. There was nothing in the uterus that his fairly basic equipment could detect, but there was something massive—much too big to be an ectopic pregnancy (he invoked sports balls but I do not remember if they were golf or ping-pong) in my left fallopian tube. He wasn’t sure what was going on, really. Another doctor at a bigger, better hospital would know. Probably it was ectopic, he suggested; perhaps, he added, it had something to do with my IUD. 

A high percentage of breakthrough pregnancies in patients with IUDs are ectopic. Do IUDs cause ectopic pregnancies? Probably not. The medical literature suggests that they are very good at preventing pregnancies in the uterus, but not quite as good at preventing pregnancies outside it. “So,” I ask a doctor friend later, “would I have had an ectopic pregnancy no
matter what? With or without the IUD?” 

“That’s not a question anyone can answer,” he says, with the cagey honesty of a physician. “Life finds a way, though, sometimes.” He is aware, he adds, that he is quoting Jurassic Park. He draws me some pictures that look like cocktail olives of different sizes, meant to help me understand statistics. He suggests that the breakthrough was more likely to be ectopic with an IUD than with other contraceptives, which might simply fail, resulting in a uterine pregnancy. But it’s hard to say. I squint. “Can I blame the IUD?” I ask him, pushing hard against his drawings, his equivocation. “Probably not,” he sighs. 

Bad things can happen, I have learned. Bodies are fragile. Your agency is finite, even if you exercise and eat expensive organic food and fasten your seat belt and resist the temptation to inject heroin into your veins. Your mother can get sick—that is bad. She can be dead within a week, even if you have things to ask her—that is worse. An embryo can waft through your body and land in a decidedly inappropriate place, causing pain—that is bad. Such an ailment can also cause death, if untreated—that is worse. You can use birth control—any kind, really—and become pregnant. Sometimes that is really bad. You can’t assign causation, but even if you could, the terrible things can smash your happiness to bits.

Waiting for the ambulance, I fretted: What if the pregnancy was in my uterus, after all? Dr. Cohen had offered no reassurances. I Googled Planned Parenthood and my father’s zip code. I realized with dismay, if not surprise, that I would probably have to drive an hour to Boston to have an abortion. And then I would have to get home. This wouldn’t be so difficult. My father could watch my children. My husband could drive me. It would take juggling and foresight but I could manage. We had the wherewithal, the working car. The inconvenience galled me, though, hinted at the intricate web of sticky silk encountered by many people seeking abortions, tangling them at every turn.

In large swaths of the country, the obstacles can be insurmountable. Research from the Guttmacher Institute tells us that 58 percent
of women of reproductive age live in states that are “hostile or extremely hostile to abortion rights.” The year 2021 saw states enact a record number of abortion restrictions—108 in nineteen states, the most since the Supreme Court legalized abortion nationwide in 1973. It is likely that these restrictions will increase at a frightening rate, and that the Justices will overturn Roe v. Wade. 

The effort to make abortion inaccessible seems built on the idea that my virtue rests in my ability to make do with what is thrown my way. I have always liked Alcoholics Anonymous’s Serenity Prayer: God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference. I don’t believe in God. But I do believe that one of the fundamental tasks of adulthood is just this: to reconcile yourself to the things over which you exert no control (death, the ridiculous behaviors of others, perhaps capitalism), while simultaneously changing the things that are terrible and mutable (a job you loathe, a city that depresses you, a marriage that results in bruises, a school that makes your kid cry all the time, perhaps capitalism). In my lifetime, until recently, it seemed that pregnancy fell into the latter category. It was something that could be changed, if you wanted or needed to do so. But soon we may return to the reality of my mother’s and grandmothers’ eras: Pregnancy will be something to accept, unless you are very rich. 

I was terrified, in the first ambulance, that my mother would die in front of me, suffer cardiac arrest. I remembered that singing to my children helped to reassure them, but also to reassure me, to stabilize thoughts too difficult to endure. You sing when they won’t stop crying, when they refuse to go to sleep. I found her favorite Leonard Cohen album on my phone and I placed the phone near her ear, where we could both hear it over the ambulance’s alarming ruckus. I leaned over her and sang along. She sang too, although she could barely speak. 

Walk me to the corner, our steps will always rhyme

You know my love goes with you as your love stays with me

It’s just the way it changes, like the shoreline and the sea

But let’s not talk of love or chains and things we can’t untie

Your eyes are soft with sorrow

Hey, that’s no way to say goodbye.

She smiled, occasionally. 

“I’m afraid to die,” she had whispered earlier, in the hospital. I was afraid too, but this was how I could care for her. She needed me then more than I needed her. I would work—hard—to give her last days and hours a shape that was bearable to both of us.

Death is ugly. Her body was contorted and disfigured. Her lips began to slough off; she could not close her mouth. I wanted to look away, but instead we applied Aquaphor, rubbed the dead skin away with a special brush. I did not want to see the decay, or touch it, or smell it, but this was how I could care for her. 

There was, I suppose, something sacred about accompanying her as she left us: singing to her, talking to her, touching her hands, doing the little we could to reduce her agony, but mostly it was awful. We dug up some moments of beauty—my sisters, my father, my mother’s two best friends, my oldest friend who came and talked to her frankly and warmly as my mother grunted and moaned—but I would not wish it on anyone.

We had no choice but to see her through dying. So we made something of it, huddling together and eating good brownies and drinking good wine on my father’s ill-timed birthday. The hospice workers praised us. We were doing a good job of losing her: We were kind to her and to one another, planning things collaboratively, speaking honestly and appropriately to our children, eating regular meals. There is, they
suggested, virtue in doing hard things well. 

Mothering an infant is a hard thing. There is a great deal to be said for doing it well, directing gentle kindness toward your tiny charge, and toward yourself and those around you—allowing yourself to place a sobbing baby in a crib and step away, taking deep breaths, returning a few minutes later with renewed resolve, replenished patience. 

But where is the virtue in doing it well if you don’t want to do it, and could have avoided doing it? To be a reluctant mother is hard; to be mothered under duress is, I suspect, harder still.

My grandmother—my father’s mother—raised her sister’s out-of-wedlock baby, perhaps out of a sense of obligation, perhaps under duress. Her sister gave birth in a Pennsylvania asylum in 1946, I’m told, the only evidence of lunacy being her unwed and pregnant condition. My grandmother, respectable and married to a lawyer, took the baby girl in and passed her off as her own. She had two older children already, but, everybody said, what’s one more? My grandmother was angry and miserable about this assignment, and I will politely, discreetly leave you to guess at the quality of mothering that she provided.

“Women cannot be forced to bear children they are unable to care for physically, financially, or emotionally,” Susan Wicklund, an abortion provider, writes in her memoir This Common Secret. A friend, she says, puts it this way: “The bottom line…is women have abortions because they want to be good mothers.” 

My mother was a good mother. She loved me and took care of me well. She took pleasure in me. In fact, I watched her take pleasure in many things, which was instructive. Every so often, in those last few days before she stopped being able to speak, she would look at me and whisper: “I’m still thinking about your question. About my mother.” Then she would fall back asleep. She wanted me to know that I was on her mind, that as her body’s systems shut down, my question was with her. Sometimes she would wake up, briefly, and blow me a kiss. I am thinking of you, the kiss said. You matter to me, even when there is so much that gets in the way. My love for you is bigger than this pain, than the smell of decay that surrounds us.

Now she is gone. What is left? The memory of her care, and the ways in which she taught me to care for others. There are a lot of ways to mother, infinite conflicting standards by which we can be judged. We can’t possibly all agree on what good mothering looks like, but we know that it takes care. I think, though, that I am a good mother. I take pains to try to show my children that they are loved, no matter what (while reminding them that saying please and excuse me will make them more lovable to the outside world), to teach them to scoop the yogurt into the bowl, to remind them to brush their teeth, to explain that keeping children in cages is cruel, and it is wrong for our government to do so. It takes hours, days, weeks, years to do all of this. To breastfeed an infant for a year takes, according to one mother’s estimate, 1,800 hours—just shy of the number of hours worked annually at a full-time job that offers three weeks of vacation. To find a daycare or a sitter takes hours, days, weeks. To teach a child to sleep independently is the work of weeks or months (even years, if you are unlucky). Empathy and compassion is labor; so is digging deep within yourself when it seems there is nothing left of you. The tantrum requires patience that has long ago been spent, the night waking requires wakefulness that you do not have. There will be gaps, deficits. You will outsource, or leave tasks undone—how many evenings have I observed the grime that covers my children’s cheeks or hair, and then looked away, and put them to bed dirty? 

I rode in the second ambulance alone, bound for a better hospital, one where a better doctor could decide definitively that I should be sliced open, and then perhaps do so. The men who ferried me from the one hospital to the other covered my body in stickers that would monitor my heart. This alarmed me. They were friendly, but not as startlingly courteous as the men who drove my mother home for the last time. We talked about local traffic patterns, and I breathed through pain. I had no object of care but myself on this ride, no one to sing to. Instead of soothing someone, I marveled at my bad luck. 

The better doctor did prove to be decisive, and slice she would. She wasn’t entirely sure what was going on, but she felt that I needed to be operated on, urgently. My husband arrived as she spoke. His hair seemed grayer than it had been that morning, en route to swim lessons. 

“If there’s something in my uterus,” I said, “will you make it go away?” 

“I don’t think there is, but yes,” she promised me, looking me right in the eye. This doctor spoke to me with sympathy and clarity. 

“If it’s not ectopic, can I speak to someone about terminating the pregnancy?” I had asked Dr. Cohen, in the first hospital’s gray room. He had not answered right away. He had opened his mouth, and closed it. Sensitive and polite, I saved him from himself: “Okay, okay,” I said, backtracking. “If the pregnancy is in the uterus, can I speak to a social worker?” 

“Yes!” he exclaimed, relieved. “We have social workers.”

The good doctor watched, hawkeyed, as an orderly cleaned my abdomen before the surgery, and instructed me to take off my jewelry. “You can leave your wedding ring on,” the good doctor assured me, and the orderly taped it to my finger, in a bizarre act of soldiering. She watched me shuck off my grandmother’s engagement ring, a heavy solitaire, and the delicate gold necklaces that my husband and mother gave me, opals and diamonds tangled together. Her gaze assessed the situation; she paid attention. “Her jewelry needs a locker,” she told the orderly. “Or,” she turned to me, “you can give it to your husband.” She watched me drop it all into a tiny plastic container—meant, I think, for urine—and hand it to him. He stood next to me, anxious, his head far away from mine, which rested on a gurney. The good doctor nodded approvingly. My jewelry was safe. Soon I might be safe too. 

The surgery took a long time. The ectopic pregnancy had caused a significant amount of abdominal bleeding, which is apparently a fast track to agony in both obvious and surprising places (abdomens, yes, but also shoulders, necks). She painstakingly sucked the blood out of me with a vacuum, removed the fallopian tube and the frightening, large item that had damaged it beyond repair. She sutured and stitched. 

In the early 1990s, my teenaged and twenty-something older sisters stuck “Abortion on demand, without apology” pins onto their army-surplus backpacks, the rhetoric and font leftover from the 1970s. I remember the pins, they were purple. But then the goals constricted. In 1992, Bill Clinton opined that abortion ought to be “safe, legal, and rare.” This idea seeped throughout the discourse, like a red sock in the wash. Katha Pollitt, author of Pro: Reclaiming Abortion Rights, refers to it as the “permit but deplore” attitude. Abortion is wrong, or at least a little bit wrong. It’s not quite murder, but it’s a little bit murderous. 

In the end, I didn’t have an abortion. I had a lifesaving medical procedure, to rescue my body from something that could never have become a fetus, much less a baby. Some will still express horror at my thoughts and feelings preceding the diagnosis, the plans I would have made to avoid having another baby, my Googling in the emergency department. They can accuse me, vocally or silently, of callowness, or immorality, but they cannot condemn my actual actions. Those people oppose abortion, or shake their heads and line up into the “safe, legal, and rare” camp. You should have a good reason to have an abortion, they think, not just not wanting to have a baby. 

For all of my twenties I longed for an unplanned pregnancy. I took great pains to prevent it, but I hoped for it. If I had found myself pregnant, I would have kept the baby. I wanted a child so badly at that time, but it seemed impractical, both financially and professionally. This certainty that I should not do the very thing I ached to do didn’t seem quite right—my body was strong and the desire was there. I had a willing partner, who later became my husband. When I finally had my daughter, weeks after turning thirty—still living in the juvenile world of tiny rental apartments and graduate school—it was a joy, and a relief after so many years of longing. She was beautiful. I could not stop looking at her, touching her little limbs. 

It is not strange to want a baby—biology encourages it, and they are, in many ways, lovely. Nor is it strange to not want a baby: They are, in many ways, absurdly cumbersome, even tyrannical, creatures. But if you want to have a baby, you should. The women in Kathryn Edin and Maria Kefalas’s ethnography, Promises I Can Keep: Why Poor Women Put Motherhood before Marriage—women with very little money or support who find that they derive value and satisfaction from motherhood—deserve to be able to carry pregnancies to term, and to raise the resulting children. If you are sixteen and broke, you shouldn’t have to have an abortion if you don’t want one: You should get to have a baby. The state should do its part to ensure that the circumstances into which children are born are not quite so depleted, rather than cajole parents out of pregnancy and parenting. It should provide people with money to stay home and rear their children, or subsidize high-quality care centers where children can nap, have their diapers changed, push macaroni around a plastic plate, cry, and be comforted. (The state could do either. It would be nice if it would do both, because changing diapers and wiping noses for months on end is not everyone’s cup of tea, nor does it need to be.) 

Most people who have an abortion have already had a child. Perhaps they don’t want another, knowing the reality of motherhood. But also, most people who have an abortion are poor. There are many troubling things contained within this second fact. The expense and difficulty of securing good health insurance—and, relatedly, good birth control—is one. Another, possibly more disturbing, is the expense and difficulty of raising a child in this country. If a society subsidizes neither quality childcare nor a parent’s staying home to care for a child, it declares reproduction the purview of the wealthy. This is mercenary and dystopian. 

But the inverse is true as well: If you’re thirty-eight and upper-middle class, you shouldn’t have to have a baby if you don’t want one. Even if you could buy diapers, even if your home is pleasant and roomy enough. Even if the baby will be born whole and healthy, and you will survive the pregnancy and the birth. I have read those books and essays about people who didn’t want to have an abortion but needed one anyway, when something was very wrong and it was their only option. Those stories are important and sad. But I am telling you that the sadness that I felt in the emergency department of a small Massachusetts hospital is important too. The way that I say good morning to my children is important, as is the patience and time and care that I can cook up, on demand if need be. My mothering face is calm and kind, more or less. I am motherless now. Even at thirty-eight, the absence of such care and tenderness is brutal. 

In Texas, politicians are making abortion all but illegal—Florida, Arizona, and other states are following suit with laws modeled on Mississippi’s ban on abortions after fifteen weeks of pregnancy. So far, treating an ectopic pregnancy remains precariously legal, but in March 2022, a Republican state legislator in Missouri introduced a bill that would criminalize transferring drugs or devices used to treat ectopic pregnancy. This frightening, tenuous status of basic medical procedures worries me—it is bad, perhaps sadistic—but what worries me most is the banning of regular, run-of-the-mill abortions. “[P]ro-choice advocates…in their understandable defensive posture seem to restrict themselves to discussing the most ‘sympathetic’ abortions: those performed because of rape or incest, because the life or health of the mother is in danger, or when the fetus has some devastating disease like Tay-Sachs. All those taken together account for less than a tenth of the more than one million pregnancies terminated in this country each year,” writes Laurie Abraham in her essay about her own abortions. 

You would have risen to the occasion again, some might say, of my prospective “surprise” baby. Would I? Resentment is a hell of a drug. Frustration boils close beneath the surface of my skin. I labor to tamp it down. Remember my grandmother, bringing the baby home from the asylum on the train, stone-faced. My good mothering is not guaranteed simply by my existence, by the ability of my arms to rock someone, or the capacity of my breasts.

Those passing laws that restrict access to abortion don’t seem to care about good mothering. They don’t seem to care about the difference between a gentle touch that will soothe a newborn’s mewling cries, and the rough, thumping pat of exasperation. They don’t seem to care about the baby who looks up at a mother who is crying, crying like I wept in the emergency room, because she is empty. The care has been scraped out of her. 

The night before my mother stopped responding in words—forty-eight hours before she died—I sat on one side of her. Jane, her best friend, sat on the other. I tried to tell her all the things she had taught me. I told her that she had taught me how to make a bed, and be a friend.

Jane asked me if and how my mother had taught me to have good friends. “She told me when she didn’t like my friends,” I explained. It was annoying, but she was never wrong. My mother took pride in her own friendships, cultivating them carefully, just as she cultivated the words that she wrote and the students she taught. She wanted for me friends who were kind and funny. She paid attention.

“Alice Talbot was a tick,” my mother whispered, unprompted, dredging up the name of a mediocre friend I’d had in elementary school. “But it wasn’t her fault. She had bad parents.” She didn’t say very much after that, and the next day she didn’t speak at all. I carried this last moment of lucidity with me, taking it out to admire again and again, like a found pink seashell. I felt guilty that my father and sisters had not been there; I paid them extra attention. 

We cared for my mother in her wordlessness, giving her medicine, opening and closing the window, checking her bedding, singing to her, telling her that we would love her forever, moving her head and shoulders up and down with the groaning, mechanical hospital bed.

Two days later she died between midnight and 4:00 a.m. My mother, whose name was Helen, took her last, rattling breath in the silence of a family house in which many of its members were sleeping. My oldest sister woke us, and we sang “Swing Low, Sweet Chariot” over her body. It was hard to get out the words: She was no longer there to receive our care. We poured it out of our off-key vocal cords anyway. We let it wash over one another, and over what was left of her, the only things left to absorb our tenderness. We then took on the tasks that each of us could bear to do, so that the others could be spared—calling the crematorium, the hospice nurse, her brothers, our spouses. Making coffee and, later, taking the small children for a walk, spreading jam on their toast, cutting it up into palatable triangles. 

“Loving other people is the most important thing,” my mother told me in those last days. “Even when they are very annoying.” She smiled, then. I don’t disagree. The relationships that I was given at birth and the ones that I have created give color to my days. Kristin Luker writes that “the abortion debate has become a debate about women’s contrasting obligations to themselves and others.” My obligations to others are clear to me: By virtue of my humanity, and through the connections I have inherited or created, I owe those around me a great deal. At different moments, my husband, father, children, sisters, and friends require my care, and I theirs. This care shapes my life. But the care that we provide one another is of inconsistent quality, muted and frayed by what else we must give, stretched thin by various demands, worn away by our unmet needs. Care, on its own, is not guaranteed to be good, but with the correct resources and skill, it can be done well. I resist the notion that I should offer up such care work just because my body—with the help of another’s—creates a potential object of care.

Each life already contains so much hardship—death, pain, unhappiness, discord. What is to be gained by removing access to safe abortion, except children, fear, and misery? Maybe that is the point. But I take Susan Wicklund’s view: “abortion is about life: quality of life for infants, children, and adults. Everywhere and in every sense of the word. Life, not death.”

In the end, immediately after my surgery, I was alone again. The doctor went home to her dinner. My husband went home to care for our children. A beautiful, dark-haired nurse in hot-pink scrubs watched me overnight. She told me that the scrubs were the same color as her motorcycle, which was in Florida. At least, I think that is what she said. I was so tired, and everything was so dark and so bright at the same time. I felt lonesome: The one person (besides my husband) who would care most about my having emergency surgery was dead. Through a series of unhappy mistakes, I didn’t have my phone, or my watch, or the necklaces that I always wear. I didn’t have the book I had brought to the emergency room either. My anesthetics wore off and I found myself relentlessly awake. I turned on the television, but it was nighttime, and the options were strange and dull. I turned it off again and lay alone, my limbs heavy. The thing that could have killed me in my fallopian tube was gone, but the knowledge of what it could have done had it been in my uterus was not. There was no grief for this misguided thing, only relief. My mother had died, but I would get to live. In the morning I would pull my children toward my body, whose abdomen was now stitched closed. We would carry on. I would raise my voice when the jar of applesauce tipped over, and later I would apologize for yelling. We would wipe up the mess together, because children must be taught to clean and the progress of such an education is always slow. I would call the pediatrician when their fevers spiked too high, and I would tell them to call their own doctors in a decade or two, when my care was less urgent, but no less necessary. I would try to tell them things as we went along, so that they would not wonder what they had forgotten to ask me, but there would be things I would forget. No matter how careful you are, some things are always missed.