A Spark of Light(91)
That meant Louie would start with an ultrasound. Cytotec caused sustained uterine contractions, which meant that most of the fetuses would be asystolic due to the constant squeezing. But if that wasn’t the case—if there still was a heartbeat visible on the ultrasound—it was up to Louie to use suction to bring the umbilical cord down and transect it to end cardiac activity.
Louie told the patient none of this.
He looked at Joy Perry, who was his primary concern for the next quarter of an hour. Like all his fifteen-and sixteen-week patients, she was the first and last procedure of the day. She had come early for the Cytotec—eight hundred micrograms in pill form—which were inserted by him, vaginally, to make the cervix pliable.
Now she was lying back, her pale hair in a ponytail that spilled over the edge of the procedure table, like the tassels on his grandmama’s brocade curtains. He met her gaze through the valley of her bent knees. “This is going to take about seven minutes,” Louie said. “We’re gonna get you through.”
He glanced at Harriet, his nurse du jour. He’d worked with Harriet long enough to have a shorthand with her, but truth be told, Louie flew to seven different clinics throughout the South and Plains states and he was used to working with a rotating panel of RNs and nurse practitioners. They were all exceptional, standing by the side of the women on his procedure table; providing him with a syringe of lidocaine when he needed it and a gentle whisper of support when his patient did. A flick of Louie’s eyes to the right, and Harriet took Joy’s hand in her own and squeezed.
He touched her knee.
“Wait!” Joy cried, and Louie lifted his hand immediately, five fingers outstretched. “I … I didn’t shave …” she murmured.
Louie stifled a grin. If he had a dime for every time he’d heard that. He knew what it was like to be in the dentist’s chair and wonder if you had a booger in your nose; he understood what it was to be a patient, and vulnerable. Time to administer some vocal local. In Mississippi, he wasn’t allowed to give any narcotics—not even Xanax—to relax a patient.
“Now, Miz Harriet,” he said, in an exaggerated tone. “Didn’t I tell you not to bring me any more ladies who didn’t get a Brazilian before coming here?”
He saw it—the tiny crack of a grin on Joy’s face.
“You’re going to feel a little pressure.” Louie pressed the inside of the patient’s thigh. “Just like that. I’m gonna put the speculum inside now; you relax that muscle. There you go. Where you from?”
“Oxford.”
“That’s a hike.” When Louie chatted through the procedure, he wasn’t trivializing. He was normalizing the moment, putting it into context. He wanted the woman to know this abortion was a sliver of her life, and not the benchmark upon which she should judge herself.
As he yammered about the best way to get from Oxford to Jackson, Louie wrapped a ball of gauze on the tenaculum and swabbed Joy’s cervix with Betadine. Harriet, his partner in this dance, smoothly held up the lidocaine vial while he filled the syringe. “Little pinch coming. Give me a cough now.” As Joy coughed, Louie grabbed the edge of the cervix with the tenaculum and injected the lidocaine at several spots around the ring of tissue. He felt the muscles of her thighs tense. “You know people who can cough on demand can also fake things? Did you used to fake tears to get your mama not to spank you?” Louie asked.
Joy shook her head.
“Well, I used to do that. Worked every time.” He reached to his left for one of the metal dilation rods, and inserted it into the cervix and then out. Then a slightly larger one, and another after that, all the way up to 15 millimeters, as the cervix opened like the shutter of a camera. “So were you born in Oxford?”
“No, Yazoo.”
“Yazoo,” Louie said. “That’s the place with the witch.” Sometimes he thought he knew more about the states where he performed abortions than their own residents did. He had to, for moments like this.
“The what?” She flinched.
“You’re doing great, Joy. There was some swamp witch who lived in Yazoo during the eighteen hundreds. You really never heard about her?” Louie asked. “You’re gonna feel fluid now; that’s normal.” He ruptured her membranes and leaned back as a gush of blood and amniotic fluid spilled between her legs into the tray beneath. Some splattered on his sneaker. “She died in quicksand, I guess, when the police were after her? Just before she passed, she vowed she’d come back in twenty years to haunt the town and burn it to the ground.” Louie glanced up. “A little pulling now. Just breathe. All I’m doing is maneuvering around inside your uterus, and using the ultrasound to guide me.”
From the corner of his eye, he watched Joy’s fingers grasp Harriet’s more firmly. He bent his head, intent on his work, taking the fetus out with forceps. He pulled out clots of pink tissue, some recognizable, some not. At this stage of pregnancy, the calvarium was just solid enough to not collapse with suction. If it got up into the high corner of the uterus, it had a tendency to roll around like a beach ball. In with the forceps, out again. A miniature hand. A knee. In and out; in and out. The G clef of a spine. The squash-blossom calvarium.
“Anyway, twenty years later, in 1900, there was a freak fire in the town that burned a hundred buildings and two hundred homes. The townspeople went to the grave of the swamp witch, and sure enough, the tombstone was broken and the chain around her grave was all torn up. Spooky as hell, right? Now, just another minute …”