This story, which appeared in The Truth About the Fact, focuses on the bare and unnerving reality of the inner workings of an abortion clinic. Says Dawnelle Wilkie, “To write about what I experienced and witnessed working in women’s health…required the unflinching honesty and compassion that are necessary in creative nonfiction.”
We do not talk about What Comes Out. We hold it close like a secret that has the power to undo us. When asked, we describe it in strange unphysical terms. We obfuscate. We use soft archaic language. The Contents of the Uterus. Tissue. Menstrual Products. The Products of Conception. The last one is our favorite; it’s also the accurate medical term, though we shorten it to P.O.C. in daily use.
When asked we have appropriate scripts depending on who is doing the asking. Over the phone is basic (you never know who is on the other end of the line), in person is more descriptive, in person during counseling is the most descriptive but done in the most obscure terms and with little attention to detail. The voice must be soft and slow in the last instance. In the other two instances, one can rely solely on one’s professional voice.
We stick to the script. Always.
What comes out? What do we do with it? Here is the truth. This is not the script.
There is blood, though perhaps less than you would imagine. Or perhaps not. Usually two or three cups at the most. (Imagine a Pyrex measuring cup, the four-cup size, the one you use to make brownies or to measure cut strawberries.) The amount of blood is in direct relation to how far along you are. It’s a menstrual period (plus some) that happens in the span of five minutes.
When the doctor is finished with you—when you are lying on the table and the surgical tech is applying pressure to your abdomen to help your cramps, or wiping your forehead because the Fentanyl has made you sweat, or giving you water because the stress has left you dry-mouthed, or standing quietly in the corner while you cry softly (or yell loudly) at your partner, your friend, your sister, your mother, your surgical tech—What Comes Out is taken to the lab. Maybe you see it leave, a bundle of blue surgical paper, and you imagine terrible things. Whatever you’re imagining is probably wrong. It’s mainly equipment: one speculum, one tenaculum, one ring forceps, one set of five dilators, five cotton balls, and five gauze pads. Sometimes a handheld vacuum aspirator (imagine a turkey baster), sometimes not.
In the lab, the surgical pack is unwrapped and disassembled. What Comes Out is in a small cup or a large glass jar, depending on the method of suction. Handheld suction warrants a small cup, the same kind you left your urine sample in; machine suction warrants the large glass jar. If you heard something that sounded like a small sputtering airplane or your mother’s old vacuum cleaner, you had the machine. If you heard nothing but the doctor’s voice and the sound of your own shaky breathing, you had the handheld. You may have also heard the keg delivery at the pool hall upstairs, though the surgical tech would have tried to muffle the thumps with Muzak and small talk.
The lab tech, another white-coated person, who may or may not have checked you in at the front desk or given you your pregnancy test results three days ago or ordered her coffee from you this morning at the drive-through, empties the contents of the cup or jar into a small colander. (Imagine rinsing spaghetti.) The purpose is to rinse away the blood. Much water is wasted this way. When the water starts to run clear through the bottom of the colander, she will take her hand and make a loose fist. It will be hard for her to make anything tighter because of the layers of gloves, both latex and PVC. She will rest her fist in the colander and start to grind slowly (imagine a mortar and pestle). Her first time doing this she was worried she would smash “something important” through the wire mesh (by this she meant a fetal part). The doctor assured her she would not. Most times it will be slippery. If you are far enough along she will feel small hard things bumping against her rings, which she now will remember she has forgotten to remove. These are bones.
Once What Comes Out has been rinsed, she will transfer it to a Pyrex baking dish (imagine casseroles) that sits on top of a small light board (imagine photography class). It contains nothing but a half inch of water and what has come out of your uterus. She will take a metal knitting needle and poke things around. Mostly what is there are little scraps of what was once your uterine lining, that sheddable disposable skin you had hoped to see a few weeks ago but didn’t. What she is looking for—what she is hoping to find, what she prays will be there because if it’s not you’ll have to do the whole thing over again—is the pregnancy sack.
When she finds it her shoulders will relax, she will smile slightly and her eyes will soften. It is surprisingly graceful and looks like a tiny jellyfish (imagine the seashore: the gulls, the smell of seaweed, the amoebic washed-up jellyfish undulating their way back to the sea). It is transparent and at about eight or nine weeks it grows these little hair-like cilia (or is it ganglia?) that gather nutrients from the bloodstream to feed the fetus. It’s thin and glows with a strange luminescence. On first viewing, one is struck dumb by its beauty and perfection. It’s not large, sometimes a dime or a quarter, sometimes larger if you are further along. Sometimes the doctor can feel it coming and will stop the suction to place it on a small piece of gauze. When this happens there is much oohing and aahing by the lab tech as she floats the perfect intact sea creature of your womb in light-drenched water.
There is the fetus. Or not. Sometimes it’s too small to see. Sometimes it disintegrates during suction. When it doesn’t, it usually breaks into several pieces. The lab tech looks for limbs, sometimes a rib cage, sometimes a small leathery thing that will become a skull. If a foot can be found, most times attached to a leg, it is set to one side for use later. There are small organs present: a heart, lungs, a liver; intestines uncoil and float around, getting in the way of everything (imagine the seaweed wrapping around your legs that summer at the lake when you learned to swim). Other organs are too small to see. Bones (especially ones that are encased in skin, usually in the form of a hand or foot) are important and pushed to one side of the dish. The light filters through them from below, and they glow like perfect white sticks.
After all the parts have been identified and the doctor has nodded her approval, in between asking what music the lab tech is listening to and telling a story about the deer who won’t stop eating her lettuces, What Comes Out must be assigned a number, a date, an age. This is done in one of two ways. If there is no fetus, the pregnancy sack is compared to a hand-drawn sketch on the wall above the counter (imagine the doctor, a failed painter who is forced to fall back on her medical degree to earn a living). The size of the sack corresponds to the number of weeks of the pregnancy; it is measured in centimeters or the more common familiar-object scale. A golf ball (imagine your boyfriend’s creepy father, the way he hugs too long) would equal approximately ten weeks. Larger means more; smaller, less. Due to its size, the five-week sack is the most elusive. When one is found, the lab tech will call to other clinic workers (the ones that “do the lab” and can look and won’t look away, the ones that find it all fascinating and beautiful and very seldom gross) to come and see. The five-week sack is rare and perfect—a white whale, a black pearl.
If there is a fetus the measurement is based on fetal foot length. The leg with the attached foot is held with a pair of tweezers while, in the other hand, the lab tech presses the foot against a small transparent ruler (imagine having your foot sized for new shoes). The measurement, again in centimeters, is in direct correlation to the number of weeks of the pregnancy. The lab tech, still double-gloved and sweating under layers of impermeable fabric, curses this process. She drops the leg several times in the Pyrex dish and has to tweeze it out again. Perhaps she gets hold of it at a spot where the tendon attaches to the foot and the foot flexes forward and backward and won’t hold still. Perhaps the foot falls off the limb and she has to lay it, now limbless, on a gauze pad and measure it that way. When she finally gets the measurement and announces it, the doctor, too busy with her story of the deer and the lettuces, says, “Are you sure?” and the tech must measure again.
When the measurement is complete the process is done. What was once revered by the lab tech and the doctor—protected from rushing water and placed with great care in a dish, measured, sorted, cleaned, and presented—is now dumped back in the little cup and thrown in a red biohazard bucket, where it will be joined by twelve to fourteen other What Comes Outs during the day. The bucket will be collected sometime the following week by Gerry, who chain-smokes and is planning on retiring in four months.
Unless of course you have asked to see What Comes Out. If you have—though you probably haven’t, almost no one does—you will see an abridged version. The lab tech will bring a small cup into the room after removing her layers of protective gear, and she will smile and say nothing. You will see the pregnancy sack floating in water. We will include some scraps of uterine lining. The doctor will explain to you what they are, and you will nod appreciatively and say “That’s all?” Perhaps you suspect that we haven’t shown you everything, perhaps you are smarter than we would hope you to be. If you were farther along, we will try to dissuade you from looking at fetal parts. We will explain that even most of the women who work at the clinic do not work in the lab, that they find it distasteful. We use this word: distasteful (imagine Emily Post). Most times you are pacified with looking at the ultrasound, which is grainy and indistinguishable, qualities that make us reluctant to get a new and better machine, one that would take pictures that might upset you, pictures that reveal too much.
The doctor returns to you, tells you, “Everything went just fine.” You’re not entirely sure what she means, but you say, “Thank you,” and she leaves. You get up and get dressed and go to recovery and eat stale cookies and drink apple juice (imagine afternoon snack at preschool) and then after a while the nurse tells you you’re okay and you leave. You pass the lab and see someone in a white coat reading a book and waiting for something to happen. There’s music you can’t quite make out. She’s wearing a hairnet and has a plastic face shield pulled to the top of her head like a visor (imagine a welder’s mask). She looks up at you and smiles that “I hope you’re feeling okay,” lame, pity smile you’ve seen on everyone’s face since you got here.
You go home.
Perhaps this was helpful. Perhaps not. But this is the truth; this is what we avoid saying. We hide behind our scripts and clean language; we avoid words like blood, pain, clot, and fear (imagine hesitating, even now, nauseous and cold, before typing the forbidden word: baby). We hold this truth close and don’t let it out, fearing the other side, the ones with signs, the ones with guns and websites with our names and the names of our loved ones. We cling to words like EMPOWERMENT, HEALING, and the mother of all words: choice. We shield ourselves with euphemisms and mission statements, but this is the truth we won’t even talk about among ourselves. The one we fear because there is no denying the simple truths of the body. But truth will always out, and now I have spoken its name and I am waiting for the world to crumble and our position to unravel like seaweed or intestines in a Pyrex dish. I am waiting.