Matters of Choice

  “You do?” Somehow, because of her rock collection, R.J. would have guessed at geology.

  “I study the television reports all the time. Some of those weather assholes are just comedians who don’t know a thing. Scientists keep learning new stuff about the weather, and I think a smart woman who works hard can go places.”

  Despite what she was feeling, R.J. found herself smiling, but only briefly. She could see clearly where the conversation was heading, but she was waiting for Sarah to take them there. “What are your plans, then?”

  “I can’t raise a baby.”

  “Are you considering adoption?”

  “I thought about it a lot. I’ll be a senior in the fall. It’s an important year. I need a scholarship to go to college, and I won’t earn one if I have to deal with a pregnancy. I want to have an abortion.”

  “You’re sure?”

  “Yes. It doesn’t take long, does it?”

  R.J. sighed. “No, it doesn’t take a lot of time, I guess. So long as there aren’t complications.”

  “Are there often complications?”

  “Not very often at all. But there can be complications with anything. It’s an invasive procedure.”

  “But you can bring me someplace good, really good, can’t you?”

  The freckles stood out in the pale face and made Sarah appear very young and so vulnerable that R.J. found it hard to speak normally. “Yes, I could bring you someplace really good, if that’s what you end up wanting to do. Why don’t we talk it over with your father?”

  “No, he’s not to know a damned thing! Not a single word, do you understand?”

  “That’s such a mistake, Sarah.”

  “You can’t tell me it’s a mistake. You think you know my father better than I do? When my mother died, he became a falling-down drunk. This could make him drink again, and I won’t risk it. Look, R. J., you’re good for my father, and I can tell he thinks a lot of you. But he loves me too, and he has … an unrealistic picture of me in his mind. I’m afraid this would really do it for him.”

  “But this is a terribly important decision, Sarah, and you shouldn’t have to make it alone.”

  “I’m not alone. I have you.”

  It forced R.J. to say four very hard words. “I’m not your mother.”

  “I don’t need a mother. I need a friend.” Sarah looked at her. “I’m going to do this with or without your help, R.J. But I really need you.”

  R.J. looked back. Then she nodded. “Very well, Sarah. I’ll be your friend.” Either her face or the words revealed her pain, and the girl took her hand.

  “Thank you, R.J. Will I have to go away overnight?”

  “From what you’ve told me, I believe you’ve entered the second trimester. An abortion in the second trimester is a two-day procedure. Afterwards, there will be bleeding. Perhaps no more than a heavy menstrual flow, but possibly more. You’ll have to plan on being away from home at least one night. But, Sarah … in Massachusetts a female under eighteen needs the written consent of her parents to have an abortion.”

  Sarah started. “You can give me the abortion, here.”

  “No.” No way, friend. R.J. took her other hand too, feeling the reassuring youthful vigor. “I’m not set up to do an abortion here. And we want you to be as safe as possible. If you’re absolutely certain you want an abortion, you have only two choices. You can go to a clinic in another state, or you can request a hearing before a judge who can grant you permission to have an abortion in this state without parental consent.”

  “Oh, God. I have to go public?”

  “No, not at all. You would see the judge in the privacy of his chambers, just the two of you.”

  “What would you do, R.J.? If you were in my place?”

  She was cornered by this direct question. No evasion was possible, and she owed the girl an answer. “I’d see the judge,” she said briskly. “I could set up the interview for you. They almost never refuse permission. And then you could go to a clinic in Boston. I used to work there, and I know that it’s very good.”

  Sarah smiled and wiped her eyes with her fingertips. “That’s what we’ll do then. But, R.J. … what will it cost?”

  “A first-trimester abortion costs three hundred and twenty dollars. A second-trimester abortion, the kind you need, is more complicated and more expensive, five hundred and fifty dollars. You don’t have that kind of money, do you?”

  “No.”

  “I’ll pay half. And you must tell Robert Henderson that he has to pay half. All right?”

  Sarah nodded. For the first time, her shoulders began to shake.

  “But right now, I have to arrange for you to have an examination.”

  Despite what she had told Sarah, she already half thought of her as … not her daughter, exactly, but at least someone with whom she had a strong personal connection. She could no more do an internal examination of Sarah Markus than if she herself had suffered the labor pains of Sarah’s birth, or been there in the department store elevator when Sarah had made water on the carpet, or brought her to the first day of school.

  She picked up the telephone and called Daniel Noyes’s office in Greenfield and made arrangements to bring Sarah in for an office visit.

  Dr. Noyes said that as near as he could tell, Sarah had been pregnant for fourteen weeks.

  Too long. The girl’s firm young stomach was barely convex, but it wouldn’t stay that way much longer. R.J. knew that with each passing day cells would multiply, the fetus would grow, and abortion would become that much more complicated.

  She arranged a judicial hearing before the Honorable Geoffrey J. Moynihan. She drove Sarah to the courthouse, kissed her before leaving her in the judge’s chambers, and sat on the hard bench of polished wood in the marble corridor, waiting.

  The purpose of the hearing was to convince Judge Moynihan that Sarah was mature enough to have an abortion. To R.J., the hearing itself was a conundrum: if Sarah wasn’t mature enough to have an abortion, how could she be mature enough to bear and raise a child?

  The interview with the judge took twelve minutes. When Sarah emerged she nodded somberly.

  R.J. put her arm around the girl’s shoulders, and they walked that way to the car.

  30

  A SMALL TRIP

  “After all, what is a lie? ’Tis but the truth in masquerade,” Byron wrote. R.J. hated the masquerade.

  “I’m taking your daughter to Boston for a couple of days, my treat, if it’s okay with you, David. Girls only.”

  “Wow. What’s in Boston?”

  “There’s a revival road company production of Les Misérables, for one. We’ll pig out and do some very serious window-shopping. I want us to get to know one another better.” She felt demeaned by the deception, yet she knew no other way.

  He was delighted, kissed her, and sent them off with his blessings, in high good humor.

  R.J. telephoned Mona Wilson at the Jamaica Plain clinic and told her she would be bringing in Sarah Markus, a seventeen-year-old patient who had entered the second trimester of pregnancy.

  “This kid means a lot to me, Mona. A whole lot.”

  “Well, R.J., we’ll offer her every amenity,” Mona said, a little less warm than she had been.

  R.J. got the message that to Mona every patient was special, but she persisted doggedly. “Is Les Ustinovich still working there?”

  “Yes, he is.”

  “Could she have Les, please?”

  “Dr. Ustinovich for Sarah Markus. She’s got him.”

  * * *

  When R.J. picked her up at the log house, Sarah was too bright, too cheerful. She was wearing a loose two-piece outfit on the advice of R.J., who had explained that she would only have to disrobe the lower part of her body.

  It was a mild summer day, the air clear as glass, and R.J. drove slowly and carefully down the Mohawk Trail and Route 2, making Boston in less than three hours.

  Outside the clinic in Jamaica Plain there were two bor
edlooking policemen R.J. didn’t recognize, and no demonstrators. Inside, the receptionist, Charlotte Mannion, took one look at her and let out a whoop. “Well, hello, stranger!” she said, and hurried from behind her desk to kiss R.J.’s cheek.

  The turnover had been high; half the staff people R.J. saw that morning were unknown to her. The other half made a fuss over seeing her again, which she found especially gratifying because it visibly gave Sarah confidence. Even Mona had gotten over her snit and hugged her long and hard. Les Ustinovich, rumpled and grumpy as always, gave her the briefest of smiles, but it was warm. “How’s life on the frontier?”

  “Very good, Les.” She introduced Sarah to him and then took him aside and told him quietly how important his patient was to her. “I’m glad you were free to take care of her.”

  “Yeah?” He was studying Sarah’s forms, noting that Daniel Noyes had done the pre-clinic physical instead of R.J. He looked at her curiously. “She something to you? Your niece? Or a cousin?”

  “Her father is something to me.”

  “Oh-ho! Lucky father.” He started to turn away but came back. “You want to assist?”

  “No, thank you.” She knew Les was being gracious, a stretch for him.

  She stayed with Sarah through several hours of first-day preliminaries, taking her through admitting and medical screening. She waited outside, reading a two-month-old Time during the counseling session, most of which would be a repeat for Sarah because R.J. had gone over every detail with her as carefully as possible.

  The last stop of the day was in a procedure room for laminaria insertion.

  R.J. stared sightlessly at Vanity Fair, knowing that in the room next door Sarah would be on the examining table, her feet in the stirrups, while BethAnn DeMarco, a nurse, inserted a two-inch twist of seaweed, like a tiny stick, into her cervix. In first-trimester abortions, R.J. had dilated the cervix with stainless steel rods, each one larger than the last. A second-trimester procedure required a larger opening to enable the use of a larger cannula. The seaweed expanded as it absorbed moisture overnight, and by the next day the patient didn’t need further dilation.

  BethAnn DeMarco accompanied them to the front door, telling R.J. the whereabouts of several people with whom they had worked. “You might just feel a little pressure,” the nurse told Sarah casually, “or the laminaria might give you some cramps tonight.”

  From the clinic they went to a suite hotel overlooking the Charles River. After they registered and went up to the room, R.J. whisked Sarah off to Chef Chang’s for dinner, thinking to razzle-dazzle her with sizzling soup and Peking duck. But razzle-dazzle was difficult because of discomfort; halfway through dessert they abandoned the ginger ice cream because the “little pressure” DeMarco had mentioned was rapidly becoming cramps.

  By the time they got back to the hotel, Sarah was pale and racked. She took the crystal heartrock from her purse and placed it on the night table where she could see it, and then she curled up like a ball on one of the beds, trying not to weep.

  R.J. gave her codeine, and finally she kicked off her shoes and lay down next to the girl. She was painfully certain she would be rebuffed, but Sarah snuffled into her shoulder when R.J. put her arms around her.

  R.J. stroked her cheek, smoothed her hair. “You know, honey, in a way I wish you hadn’t been so healthy up to now. I wish you’d needed a few fillings at the dentist’s, maybe even had your tonsils and your appendix out, so you’d understand that Dr. Ustinovich is going to take care of you and that this will pass.

  “Just tomorrow, and then it will be over,” R.J. said, patting Sarah’s back gently and even rocking her a bit. It felt right, and they lay like that for a long time.

  Next morning they arrived at the clinic early. Les Ustinovich hadn’t had his morning coffee yet and gave them a nod and a grunt. By the time he’d had his caffeine fix, DeMarco had ushered them into the treatment room, and Sarah was positioned on the table.

  She was pale, rigid with tension. R.J. held her hand as DeMarco administered the paracervical block, an injection of 20 cc of Lidocaine, and then started the IV. As luck would have it, DeMarco made a couple of false tries with the IV needle before she found the vein, and Sarah was gripping R.J.’s hand so tight it hurt. “This will make you feel better,” R.J. said as DeMarco started conscious IV sedation, 10 mcg of Fentanyl.

  Les Ustinovich came in and looked at their welded hands. “I think you’d better go to the waiting room now, Dr. Cole.”

  R.J. knew he was right. She reclaimed her hand and kissed Sarah on the cheek. “I’ll see you in just a little while.”

  In the waiting room she settled onto a hard chair between a skinny young man who was concentrating on biting off a cuticle and a middle-aged woman who was pretending to read a tattered issue of Redbook. R.J. had brought the New England Journal of Medicine but she had a hard time concentrating. She was thoroughly familiar with the timetable and knew exactly what probably was happening to Sarah. The curettage was done in two stages of suctioning. The first was called “the long session” and took about a minute and a half. Then, after a pause, the second, touch-up suctioning was briefer. She hadn’t had time to make her way through an entire article before Les Ustinovich came to the door and beckoned to her.

  He had only one clinical manner, bluntness.

  “She’s aborted, but I perforated her.”

  “Jesus Christ, Les!”

  He froze her with a glance that brought her to her senses. He undoubtedly felt bad enough without salt in the wound.

  “She jerked her body at just the wrong moment. God knows she wasn’t feeling any pain, but she was a nervous wreck. The perforation of the uterus took place where she has a fibroid tumor, so there’s some ripping and tearing. She’s bleeding a lot, but she’ll be all right. We’ve got her packed, and the ambulance is on its way.”

  From then on, everything went into very slow motion for R.J., as if suddenly she existed under deep water.

  She never had perforated a uterus during her time at the clinic, but she always had worked on women in the first trimester. Perforations happened very rarely, and they required surgical repair. Luckily, Lemuel Grace Hospital was only minutes away, and the ambulance was there almost before she had finished reassuring Sarah.

  She made the short ride with Sarah, who was taken to the operating room on arrival.

  She didn’t have to request a surgeon. Sarah was assigned a gynecologist whom R.J. knew by reputation. Sumner Harrison. He was supposed to be very good, the luck of the draw.

  The place that once had been so familiar to her was slightly out of focus. A lot of strange faces. Two familiar people smiled and said hello as they passed her in the corridor, hurrying from someplace to someplace.

  But she remembered where the telephones were located. She picked up a phone, ran her credit card through the slot, and dialed the number.

  He picked it up after two rings.

  “Hello, David? This is R.J.”

  31

  A RIDE DOWN THE MOUNTAIN

  By the time David got to Boston, Sarah was out of surgery and doing nicely. He sat by her bed and held her hand as she emerged from anesthesia. At first Sarah wept to see him and watched him warily, but R.J. thought he handled her in exactly the right way; he was tender and supportive and gave no indication he wasn’t completely in control of his thirst.

  R.J. thought it best to give them some time alone. She wanted to know details of what had happened, and she telephoned BethAnn DeMarco and asked her if they might meet for dinner. BethAnn was free, and they met in a small Mexican restaurant in Brookline, near where BethAnn lived.

  “This morning was something, wasn’t it?” DeMarco said.

  “Some morning.”

  “I can recommend the arroz con polio, very good,” BethAnn said. “Les feels bad. He doesn’t talk about it, but I know him. I’ve worked at the clinic four years, R.J., and this is only the second perforation I’ve seen.”

  “Who did the oth
er one?”

  BethAnn looked uncomfortable. “It happened to be Les. But it was so innocuous it didn’t require surgery. All we had to do was pack her and send her home for bed rest. That wasn’t Les’s fault this morning. The girl just gave an involuntary lurch, like a big twist, and the curette penetrated. That doctor who examined her out where you live …”

  “Daniel Noyes.”

  “Well, Dr. Noyes can’t be faulted either. For missing the fibroid, I mean. It wasn’t large, and it was in a little fold of tissue, impossible to see. If it had been just the perforation, or just dealing with the fibroid, it would have been easier to handle. How’s she doing?”

  “She seems to be fine.”

  “Well, all’s well that ends well. Me for the arroz con pollo. How about you?”

  R.J. didn’t care; she had the arroz con pollo too.

  It wasn’t until later that evening, when she and David were alone, that he began to formulate the hard questions that she found difficult to answer.

  “What in hell were you thinking of, R.J.? Don’t you know you should have consulted me?”

  “I wanted to, but Sarah wouldn’t hear of it. It was her decision, David.”

  “She’s a child!”

  “Sometimes pregnancy makes women out of children. She’s a seventeen-year-old woman, and she insisted on dealing with her own pregnancy. She went before a judge, who decided she was mature enough to end the pregnancy without bringing you into it.”

  “I suppose you arranged for her to see the judge?”

  “At her request. Yes.”

  “God damn you, R.J. You acted as if her father were a stranger to you.”

  “That isn’t fair.”

  When he didn’t answer, she asked if he intended to stay in Boston until Sarah was released from the hospital.

  “Of course.”

  “I have patients waiting to see me. So I’ll go back.”

  “Yes, you do that,” he said.

  It rained hard for three days in the hills, but the day Sarah came home the sun was warm, and the spicy smell of the summer woods was in the soft breeze. “What a day for riding Chaim!” Sarah said. It was good for R.J. to see her smile, but she was pale and tired-looking.