Pregnant, then Ruptured

After an emergency operation, Joanna Petrone considers the medical advances and legal protections that allow women to survive ectopic pregnancies.

Joanna Petrone | Longreads | August 2017 | 28 minutes (7,729 words)

 

It comes on suddenly as a gas main explosion, the feeling of being grabbed tightly from within and twisted. I am standing at the front of my classroom, at one, almost, with its beige institutional carpeting and faint but pervasive smell of damp paper. I’m instructing sixth-graders — sleepy and vaguely conspiratorial-looking, the way they often are on Fridays in January just after lunch — when that blue flash of pain rips through me. I stop talking. I freeze, hand on belly, and wait to find out if I’ll vomit.

Inside me everything is lightening bolts and banshee wails and chaos. Outside, obedient, slightly bored students print in marble composition notebooks. Not one of my charges says anything — no one has noticed — so I steady my breathing and shuffle next door to find another teacher to cover for me.

On the toilet, I check my underpants. There is no new red blood — only ­ the same smear of tacky rust-colored discharge that’s been soiling my pads for weeks. The bathroom light, set to a motion-sensitive timer, blinks out into darkness while I sit stock still, afraid and in pain, replaying the highlights of the last two weeks: positive pee sticks, phone calls and doctor’s offices, a sequence of blood tests, an ultrasound confirming a mass in my right adnexa (a uterine appendage), and, last night, a duo of cheerful ER nurses sheathed in full-body, bright orange hazmat suits injecting an abortifacient into my backside.

To turn the light back on, I need to move, but I am immobilized by pain so intense I can no longer tell where in my body it is coming from. After a time, the pain quiets enough for me to think over it and will my body into action. I flail my hands to trigger the light, stand up, wash. Maybe this is cramps from the methotrexate working, I think, just very bad cramps, signaling the welcome end of a doomed, rogue pregnancy.

After talking the school secretary out of calling me an ambulance — she is alarmed by my pallor — I drive myself home across the Richmond Bridge from the Marin school where I teach to the Oakland apartment where I live, gritting my teeth at every jostle and bump, half-blind with pain. It’s a cool, sunny Friday in January, and the traffic is moving like honey, but at least it moves, over the mouth of San Pablo Bay, past the glittering sea and the oil tanker in port and the refinery on the hill belching its toxic belches. I unzip my pants to take some of the pressure off my swelling belly. At the apartment building, I crawl on hands and knees up the stairwell and steel myself to rise and unlock the front door. I shake some Vicodin into my hand and swallow with a glass of water I poured lifetimes ago, at breakfast. I push off my pants and slump by the entrance with the half-formed notion that my husband will find me there quickly if I pass out.

I’m instructing sixth-graders when that blue flash of pain rips through me. I stop talking. I freeze, hand on belly, and wait to find out if I’ll vomit.

The pills don’t kill the pain but they do make my head feel lighter, farther away from the disaster unfolding in my body. Steve arrives and ushers me into the passenger seat. In the hospital anteroom, I am brought before a ponytailed and hugely pregnant triage nurse seated in her station at the threshold of the ER, like Gabriel at the gate. She gently cuffs my arm to measure my blood pressure. She asks me to assign a number to my current level of pain.

***

Ectopic pregnancies — the term derives from the Greek word ektopos, meaning, out of place — are often called tubal pregnancies, but can happen anywhere, really, that a wayward zygote with a self-destructive streak lands. Ectopic pregnancies occur when a fertilized egg implants somewhere other than in the womb — most commonly, in or on a fallopian tube, but sometimes on the cervix, on an ovary, on the outside of the uterus or, more rarely, on the bowel or other organ. It is a relatively infrequent occurrence, affecting 2% of pregnancies. Ectopic pregnancies can manifest nonspecific symptoms such as abdominal pain and vaginal bleeding, sometimes alongside the typical pregnancy symptoms of amenorrhea, sore breasts, and morning sickness. About half the time, there are no symptoms.

An ectopic pregnancy is always a danger. As the fetus grows, pressing upon parts of the body that, unlike a uterus, are not designed to stretch and grow with it, it can and almost always will cause the tube or other structure to rupture and hemorrhage. Prior to the 1880s, when a surgeon named Robert Lawson Tait performed the first operation removing the damaged fallopian tube of a woman with a ruptured ectopic pregnancy, it was a nearly universally fatal condition.

Today, with early detection­, ectopic pregnancies are, in many cases, diagnosed and treated before they rupture. Occasionally, ectopic pregnancies are not caught in time, or, as in my case, the treatment is not effective, and a tube partially or completely ruptures and bleeds. Medical advances, such as blood transfusions and surgical techniques, have lowered mortality rates to one in 10,000. Even so, ruptured ectopic pregnancies are the leading cause of maternal mortality in the first trimester and can result in the reduction of fertility, as when a tube is damaged or removed, or, in cases where emergency hysterectomies are required, the end of fertility.

There are factors that are known to increase the incidence of ectopic pregnancy: a history of pelvic inflammatory disease, torqued or scarred fallopian tubes, a history of smoking, a history of infertility, a history, cruelly, of previous ectopic pregnancies. But most cases of ectopic pregnancy involve no risk factors. Though these factors affect the odds, ectopic pregnancies are basically a biological fluke, a result of chance, and the imperfectly designed human female reproduction system, through which fertilized eggs travel a bit more like a marble in a pinball machine and less like water through plumbing.

That is not to say I had no risk factors. I had risk factors. In fact, to understand why I did not react to my fallopian tube tearing and my abdomen filling, drip by drip, with blood, you may find it relevant to know that I had been dealing with a malfunctioning reproductive system for three years. I had become numb to it.

***

Infertility before 30 was a lonely experience. When I married at 26, I was a child bride among my peers. When, a year later, after going off the pill, I told a close friend that Steve and I were trying to have a baby, I might as well have said I was taking up the fun new hobby of intravenous drug use. She looked alarmed. She laughed nervously and asked, “Why?”

When pregnancy didn’t happen, I felt more alone still. I maintained one life in which I went around as a normal 28-year-old doing all the things normal 28-year-olds do: going to work and graduate school, running, eating brunch, pretending to enjoy yoga. At the same time, I maintained this other life, invisible and incomprehensible to my peers, where each morning I woke to an alarm and took my temperature before getting out of bed; where I had timed, procreative sex with my husband, and spent 30 minutes a day trying to visualize positive energy coursing through my ovaries. I sat in vinyl waiting rooms with fake flowers and women a decade older than me or more, dealt with weight gain and hot flashes, bent over so my husband could inject me with shots of hormones. I experienced intense, shuddering hope, doubt, closeness, and despair in monthly cycles that were entirely predictable, yet each time broke my spirit anew.

I am immobilized by pain so intense I can no longer tell where in my body it is coming from.

Our reasons for pursuing pregnancy, with increasingly drastic measures, were neither more interesting nor more important than those of anyone else fortunate enough to choose parenthood: we loved each other and felt our love was something worth sharing with a child; we thought we’d enjoy raising a child and derive meaning from the experience; we thought we could do a decent job of it, and so on. All perfectly fine reasons, yet not ones that seemed to account for the animal urge, the snarling, existential drive that I felt steering me.

On one trip to the clinic, I sat pale-faced and unsmiling after receiving some vaguely insulting information about my eggs, as a doctor, an older man with a Russian accent, said that infertility often is the first time a healthy young woman comes up against an insurmountable obstacle in life, and then, in the next breath, told me that Wellbutrin is a safe antidepressant for pregnancy. I didn’t take the antidepressant, but maybe I should have; I felt brittle and high-strung all the time, and a million innocuous things hurt me, as if I were constantly brushing up against invisible knives.

We tried to get pregnant on our own for a year and then we tried for three months with me taking the ovulation-stimulating drug Clomid, and then three times with the Clomid plus me being artificially inseminated in a doctor’s office, feet in stirrups, with a vial of my husband’s high-quality, high-count, centrifuged sperm. Our cause of infertility was not diagnosed, which, in time, became a diagnosis in itself, written like a Chinese fortune cookie across all our charts and folders: infertility, female factor, etiology unknown.


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On the Clomid, I did get pregnant, technically. Three times, I had what’s technically known as a chemical pregnancy, registering on a blood or urine test but washing out before it could be confirmed via ultrasound. I would get a positive pregnancy test and then a few days or weeks later get a heavy flow that, if I hadn’t known better, would have thought was a late period.

There was nothing wrong with my womb; a doctor shot radioactive dye in it to check. There were no immunologic signs that suggested my body was attacking healthy pregnancies as infections, which is something that can happen. Although we were young and “had time,” as we were often reminded, I grew tired of tiny, sad pregnancies I could never announce, and Steve was ready to move on from a job he stayed with in no small part because its health insurance covered a percentage­­­ — less than a hundred, better than nothing — of the cost of fertility treatments. When, after a wrenching D&C at eight weeks for a pregnancy that had failed to take form, failed to even make a fetus, instead growing an ectoplasm, an empty egg sac, inside of me, a doctor suggested IVF as the most aggressive option for us, one that could help us avoid another miscarriage by giving her the ability to identify and select the healthiest embryo out of the lot, our decision came easily: Yes.

Timing an IVF cycle is a tricky thing, an orchestration of many moving gears: my menstrual cycle, the doctor’s schedule, the clinic’s other patients, my desire to be done, one way or the other, before beginning a new job in the fall. I waited, dutifully reporting to the clinic every few days to take baseline readings of my hormones until my period, then went on birth control and marked time in little daily pills for three weeks, and then the injections began: two weeks to shut my endocrine system down; two weeks to rev it back up. I had a job teaching summer school in the mornings which was supposed to keep me distracted and occupied but only seemed to amplify the excruciatingly slow passage of time. Class was scheduled in three-hour blocks, and none of my students talked. I instituted silent reading. Every day, for 40 minutes, a dozen teenagers and I sat in thick silence, books open, staring, each of us entombed by invisible glass in a separate chamber of hell. One startled at the sound of a page turning, so rarely did it happen.

Every afternoon, I drove from the school to the clinic for a transvaginal ultrasound and blood draw. The clinic was always freezing and the nurse had trouble catching my veins, even with a butterfly needle, so I went around that summer with arms like a junkie’s, the insides of my elbows purple with loose blood. When the eggs got ripe enough, there was surgery to harvest them, the extraction performed via hollow needle through the wall of my vagina while I was under anesthesia, then fertilization in a petri dish, and the depositing via catheter, one fraught morning, of three frankly disappointing embryos into my uterus.

Ectopic pregnancies are often called tubal pregnancies, but can happen anywhere, really, that a wayward zygote with a self-destructive streak lands.

Three days later, I went in for a blood test. I was told not to use a home pregnancy test beforehand, but I did. I watched a faint pink line, barely scrutable, hover at the threshold of existence. The next day a nurse called to report the blood test results. HCG levels, in a healthy pregnancy, double every 48 hours, so the exact number is less important than the general trend. It could be 58 or 201 or 120 . . .

“Six,” said the nurse. I stopped listening.

I didn’t show up to my next appointment.

A few days later, a period.

I had been anxious and uncomfortable that whole month and had had uncontrollable crying jags of an intensity I hadn’t experienced since adolescence. I had been quietly miserable at the doctor’s office and loudly miserable at home, and when the procedure failed, Steve and I knew we would not repeat the experience. Though we still wanted to be parents, we were done with pregnancy, done with hormones, done with timed sex and medical abstinence and positive urine tests that blinked out within a few days. We were done with the nonstop medical scrutiny of my body, which eventually spun out of the doctor’s office into my own obsessive thoughts and habits and attempts to mold myself into a fertile woman using diet and exercise and the sheer anxious force of my will. We were ready to leave all that behind us and forge ahead on a different path, flexible and resilient and full of hope.

Adoption seemed to offer us the chance to bypass my unreliable and grief-producing body on our road to parenthood. If I still felt a little sadness that I would never hear a second heart beating inside of me, never feel a newborn suckle at my breast, it was small enough to fold up like an old love letter and tuck away, to forget about under a flurry of adoption books, adoption pamphlets, adoption blogs. We read, attended informational sessions, met with social workers, wrote a check to a lawyer.

***

We were well on our way down the adoption path when I noticed my body playing host to a familiar duo of symptoms — tender heaviness in my breasts and a low-grade, mocking nausea — now joined by a third: a slow drip of blood. Not like a period, just a smear of pink mucus sometimes striated with bright red. It didn’t alarm me. I was sure it was nothing.

“Paper pregnancy” is one of those cutesy phrases that gets tossed around on online support boards where women use upbeat euphemisms and little cartoons to give voice to the most grueling experiences of their lives — in this case, to an adopting parent’s obstacle course of home visits and paperwork and the undefined wait. It is a bad term, both cloying and dishonest, and it is rightly critiqued by adult adoptees for obscuring the biological fact that every adopted baby is the result of some other woman’s long pregnancy. But, I could see the appeal. I liked the idea that our family could be grown out of paper and consecrated by law — bloodless, fleshless; that a baby could be handed to us as if out of a fairytale, as if I would never have to reckon with what my body had done and what I’d done to my body and what my body had still refused to do.

When it was no longer possible to ignore my pregnancy symptoms, I bought a test and made my heart a stone. I waited with dread, not hope, on the toilet for the stick to develop. When a second pink line materialized faintly I took it to mean that another bad egg had fertilized and was headed towards demise. I felt so sure of this fact that that night, my husband’s 32nd birthday, I drank to tipsy and then kept going.

That weekend, after swimming laps at the Temescal pool, the pink spotting darkened. I put a thick pad in my underwear that night, certain my period would begin any moment. But days passed and the flow neither thickened nor ceased. I bought a three-pack of pregnancy tests and on each stick I peed on, double lines. So with the sense of doing a necessary but dreary errand, I made a doctor’s appointment.

In the exam room, I waited, nude from the waist down and covered with a paper blanket. I was cold, which was frequently the case in exam rooms. The doctor, whom I’d never met before, was a portly, middle-aged man with thinning hair and thick skin pitted with acne scars. I gave him the play-by-play of my reproductive history, which, from practice, and in order to be taken seriously, I did using clinical vocabulary and precision. No drama, no feelings.

Although we were young and ‘had time,’ I grew tired of tiny, sad pregnancies I could never announce, and Steve was ready to move on from a job he stayed with in no small part because its health insurance covered a percentage­­­ of the cost of fertility treatments.

At every ultrasound of every doomed pregnancy, always, and against my will, there had been a worm of hope that wriggled up inside me in the moments before my interior cavities became legible on the sonogram screen. I tried to smother it now with negative self-talk and cold reason to avoid the pain of disappointment, but it seemed to exist apart from even my desire, a life unto itself, if a brief one.

The doctor found nothing, no “products of conception,” inside my uterus. There were three possibilities, he explained: a pregnancy could have already ended, the HCG measured on my home pregnancy kit just the last traces of the hormone fleeing my system; an ectopic pregnancy could have implanted somewhere out of sight; or a perfectly normal, healthy pregnancy could be developing in my womb in its most nascent stages. He smiled when he presented the last possibility, a warm, practiced smile, which I resented. I would not go back to the shadowland of hope. I wanted to be done with all this. He scheduled an appointment with Radiology & Imaging to see if anything could be detected.

In the meantime, in a kind of inverse of all those months holding my breath in desperate hope to not see my period, I exercised on an empty stomach, pushing myself until I felt dizzy in the hopes of jumpstarting it. Every time I went to the bathroom I hoped to find the dark stain of blood.

I complained to my husband, not about sadness or disappointment about what seemed likely to be another loss, nor about the bald, corrosive jealousy I felt when news of friends’ pregnancies rolled in, but about the inconvenience of my body, this thing. I complained about being caught in a game of phone tag with the scheduler from Radiology & Imaging, who kept calling during class when I couldn’t pick up. I complained about having to use up a sick day I’d wanted to save up with others for the adoption that was our bright future. I carped about the way Kaiser makes it impossible to call a doctor directly. I bitched about every $10 co-pay. “They make you pay only if the baby dies,” I said bitterly. “Prenatal care is free.”

On a Wednesday afternoon I slipped out of a meeting to report to a dark, subterranean wing of the hospital for the high-resolution ultrasound. I was left in a dim room with the usual paper blanket with which to arrange myself on what was basically an enormous, reclining office chair with one of those sex ramp cushions. The technician told me to stick the cushion under my butt to elevate my pelvis, and I did. A slight and serious man, he said little and didn’t offer to show me the screen. But I knew. Over and over, he angled the probe in the same direction, pointing it towards my right hip, first from inside my vagina so hard that I worried I would pee, then from the outside, pushing down, worrying it, making micro adjustments, the wand slurping around in the puddle of lube.

The following morning, I received a voicemail from my doctor letting me know that he had seen a mass on my right adnexa and that I should call back immediately to discuss treatment options. I Googled “adnexa.” This time, when I called, I had no trouble getting him on the phone.

He explained that the scan and blood tests together suggested an ectopic pregnancy in my right fallopian tube, and I’d have to choose one of three paths. The most conservative was to wait, re-test my blood every other day, and see whether the pregnancy ended on its own. The second option was to end the pregnancy medically, with an injection of methotrexate, a cancer drug that interferes with cell division to kill rapid growths; it was designed to treat tumors but attacks early pregnancies, too. The third option was surgery. I said I needed a few hours to think about it.

Surgery would be the most decisive and lowest-risk way to end to the pregnancy, but I didn’t want it. Though I no longer wished to pursue pregnancy, it turned out I did not want the possibility being completely foreclosed upon, either. I liked the idea of adoption best when I could think of it as a choice I was making, plucking one of a wealth of divergent paths splayed in front of me; there was less pleasure in the thought the choice was one that my body had made for me.

By the time I called the doctor back, it was late in the day, and the injections lab was preparing to close, but he offered to transfer my records to the Emergency Department and have them prepare a dose of the drug.

I felt an enormous weight lift off of me. It was a pleasant time of day, the sunlight thickly yellow and goopy, bouncing off the cars that flowed in and out of the Whole Foods parking lot my kitchen window looked out on, making a resplendent stream of movement and light. No longer in any immediate rush, I cooked and sat down for dinner with my husband. I had a beer and fed the cat and gathered a stack of grading before driving over to the ER. We were immediately assigned a private room, where we were promptly ignored for hours.

Past midnight, a doctor finally entered, read my chart and sent in the nurses in their bright orange spacesuits to administer the drug. I asked about their getups. “It’s to protect us. This is toxic stuff,” said one of the nurses as she cheerfully drew up the syringe. The doctor listed off all the foods to avoid and said he would call a prescription for painkillers into the discharge pharmacy. There might be cramping. As we left, at nearly three in the morning, I said to Steve, only half-joking, “Don’t take me to the ER again unless I am dying.”

The treatment for ectopic pregnancy is termination. Ectopic pregnancies are not viable and risk cataclysmic bleeding if they rupture. Expectant management, the watch and wait approach, is sometimes appropriate, and some ectopic pregnancies do miscarry on their own. Given the high likelihood of rupture and the lethal risk involved, however, the standard of care is abortion.

We were well on our way down the adoption path when I noticed my body playing host to a familiar duo of symptoms — tender heaviness in my breasts and a low-grade, mocking nausea — now joined by a third: a slow drip of blood.

Abortion can be induced medically or surgically. A medical abortion involves one or more injections of a high dose of methotrexate, the chemotherapy drug that doubles as an abortifacient. Because ectopic pregnancies can be wily and recalcitrant, sometimes requiring additional doses, the patient is monitored for days or weeks, until her blood is free of any trace of pregnancy hormones.

Surgery involves one of two procedures. If it is early in the pregnancy and the tube is intact, the surgeon may use a procedure called a salpingostomy. In a salpingostomy, the surgeon slices open the Fallopian tube and scrapes out all products of conception before stitching the tube back together. If the tube is already damaged, the surgeon instead performs a salpingectomy, cutting off and removing the tube in its entirety, pregnancy and all. Depending on the location of the pregnancy, other excisions, such as an oophorectomy (removal of the ovary) might be needed in place of or in addition to the salpingectomy. Both salpingostomies and salpingectomies can be performed laparoscopically, using small cuts in the abdomen through which tools and a camera are inserted, except if the patient has already ruptured and is at risk of bleeding out, in which case a larger, faster wound is opened.

***

It feels vulgar, almost, that any account of terminating a pregnancy, even one that is nonviable, even one that is lethal, isn’t just the story of a hardship, something private and sad, but is necessarily political, a small rock lobbed into a foaming crowd, and grist for willful misreadings. Of all the ways that a female body can befoul the boundaries between inside and outside, it is never more striking to me than in the responses to women writing about their own bodies, an act that is both private and public. It would be ironic if it was not so barbaric that the female body is regulated by those who would not behold it, that laws are written upon it by those who lack the capacity or inclination to read what women have to say about their own experiences.

My aunt, a doctor who has worked for decades in an abortion clinic in a deeply-red rural county in Western New York State, has performed abortions on numerous women, multitudinous women, who are pro-life. As a teenager, the logic of this bothered me, and I pestered her. “How can they be pro-life? Doesn’t the experience of needing an abortion change their viewpoint?” I asked. “Not at all,” she said. They all, each of them, consider their abortion to be the exception. There’s a joke, or maybe it’s just an observation, among abortion providers that there are only three cases in which pro-lifers believe abortion should be sanctioned: rape, incest, and their own. Enter any fertility-centric internet discussion board and behold: you, too, can find women torturing themselves to circumscribe the word “abortion” so that it excludes their own terminations.

There is some debate, most of it semantic, some of it theological, about whether terminating an ectopic pregnancy is, technically, an abortion. OB-GYNs typically define abortion as the loss of a uterine pregnancy. Pro-lifers intent on making their cause palatable to those who are uncomfortable with abortion yet not on board with forcing a woman to risk her life for a nonviable pregnancy — this is not all of them, by any means — do not define the treatment of an ectopic pregnancy as abortion. They point to Ireland, where abortion is illegal but terminating ectopic pregnancies is permitted. The American Association of Pro-Life Ob-Gyns, for instance, “recognizes the unavoidable loss of human life that occurs in an ectopic pregnancy, but does not consider treatment of ectopic pregnancy by standard surgical or medical procedures to be the moral equivalent of elective abortion, or to be the wrongful taking of human life.”

The Catholic Church, on the other hand, forbids abortion absolutely. Catholic moralists oppose the administration of methotrexate as an abortifacient even in the case of ectopic pregnancy, and Catholic hospitals do not provide it as a treatment. Many Catholics also opposes the use of salpingostomy, which it considers the direct, targeted taking of a human life. “Interestingly, both procedures [methotrexate and salpingostomy] are normally presented to patients exclusive of any moral considerations. They are framed strictly as the means to assure the least damage possible to the mother’s reproductive system,” notes one Catholic bioethicist, as though minimizing a woman’s damage and pain were of no moral value.

The only morally licit treatment of an ectopic pregnancy, for a Catholic, besides watch and wait, is the salpingectomy, on the basis that the demise of the pregnancy is an indirect effect of acting to preserve the mother’s life. That the methotrexate and salpingostomy are less injurious to the patient, cause less pain, and better preserve her fertility is immaterial. Catholic-affiliated hospitals, which now account for one out of nine hospital beds and, in some regions, are the only providers of acute care, follow these religious rules regardless of the patient’s faith or preference, and receive tax dollars to do so. In 2016, the ACLU issued a report on Catholic hospitals refusing appropriate emergency care to pregnant women, and in doing so endangering women’s lives.

The treatment for ectopic pregnancy is termination. Ectopic pregnancies are not viable and risk cataclysmic bleeding if they rupture.

Terrifyingly, but perhaps not surprisingly, there are websites that make dangerously unsupportable but medical-sounding claims about ectopic pregnancies, propagating false hope that the ectopic pregnancy some hapless reader is desperately Googling after her diagnosis has a good chance of resolving on its own or even producing a baby, a miracle.

Recently, an Ohio lawmaker who supported a bill to ban abortions from six weeks — in other words, about a week or two after a woman notices she is a little overdue for a period — was asked by a reporter what he thought might make a woman want an abortion. His answer: “I don’t know. It’s not a question I ever thought about.”

In Indiana this January, a lawmaker introduced a bill known as the “Protection at Conception Act,” which would criminalize all abortions, at all stages of pregnancy, for all reasons. Similar bills are fomenting in Congress.

A “personhood amendment,” long sought by the far-right anti-abortion movement, would assign legal status to the cells that are a part of a woman’s body and also may be trying to kill her. In Indiana, where a personhood law has already gone into effect, two women have been jailed for attempting to abort their own pregnancies. No word yet if a woman facing charges of aborting an ectopic pregnancy — or a pregnancy accompanied by a uterine infection or by preeclampsia or any of the other quite ordinary complications that could kill her — could be found “Not Guilty” on a plea of self-defense.

As long as Roe v. Wade stands, many of these laws are likely to be overturned in federal court, though that is cold comfort to the many women living in regions without access to abortion providers. The current administration’s promise to its evangelical supporters is to stack the courts with conservative judges and tip the Supreme Court away from Roe, stripping away reproductive rights and putting control of a woman’s body and future into the hands of the illiterate and unimaginative, who can’t be bothered to think about, to even listen to, her story.

Vice President Pence, when he was Governor of Indiana, signed into law eight bills restricting abortion, including one which requires the burial or cremation of aborted or miscarried fetal tissue. The drips and the clots. How civilized. A world without Roe is a world where the fate of a woman’s body — its red fleshy insides, its tubes and its fluids, its unruly growths and wild transfigurations — is decided upon by cabals of men in the cold, marble halls of statehouses.

***

When I arrive at the ER this second, genuinely urgent time, loopy and pallid and every muscle clenched against the sensation, I am attended to right away by doctors and nurses who scan my insides, ask about my pain, and administer a morphine drip. If, previously, during all my fertility appointments and even last night in the ER, I’d had to steer the ship of my body, be in charge of its care — make decisions, inform professionals about my past and my medications and my preferences — now, the immediacy of my pain relieves me of all of that. I am passive, watching the comings and goings of medical personnel from behind the blurry scrim of narcotics. A small huddle of young doctors in blue scrubs gathers around the screen on the sonogram machine as though trying to make out a game on an old TV with snowy reception. They cannot see an obvious rupture. What they do see is a shadow, a spreading darkness. They are not sure. It is hard to say. It could be nothing, a mechanical glitch. But it could be, and in fact is, uncontained blood pooling behind my organs.

The ER is busy, the scanning room overbooked. Left alone and with access to the button on my morphine drip, I try to calm myself by applying the lesson I’ve learned so many times: that I cannot trust my body, that what feels serious to me is, in reality, nothing — not a heart attack but anxiety; not a real pregnancy, just a chemical one. I tell myself, this is not a rupture, this is just cramps.

By the time I am wheeled down to be scanned I have stopped trying to sort through the slurry of other people’s words. If I focus too much on what is going on, the pain comes howling back, so I let myself float with each wave of morphine. I let the technician adjust my body. I lean on Steve to take me and my IV pole to the restroom.

Back in the ER, time starts moving quickly again as a doctor comes in and explains that the scan confirms a rupture and an internal bleed and that I will be admitted to the hospital for emergency surgery, now.

It is a Friday night, the hospital a ghost town. As I am rolled across the building and into the elevator, I watch the cheerful blur of workers heading out for their evenings. Upstairs, I am parked in a little alcove off an expansive room that is all white — white walls, white floors, white partitions and sheets, white uniforms on the orderlies; so white it feels like the waiting room to the afterlife in a movie. Steve sits on the edge of my gurney, white-faced, holding my hand.

When the surgeon arrives, he explains in a calm, firm voice what will happen. He will use a laparoscopic procedure with three small incisions. He will inflate my abdomen with air pumped in through one hole while a camera threaded through another hole will guide his tools as, through a third hole, an instrument will be inserted to cut and burn off the damaged section of tube and then vacuum it out in pieces.

I feel tired. I ask if there is any possibility that my tube can be repaired rather than removed.

“As long as you have one working tube,” says the surgeon, “you can get pregnant.”

I try to explain about the three years, the IVF, about what losing that tube means for me. I beg, even.

“I’m sorry,” he says. “My job right now is to prevent you from hemorrhaging to death.” I feel a tremor in Steve’s hand.

Catholic moralists oppose the administration of methotrexate as an abortifacient even in the case of ectopic pregnancy, and Catholic hospitals do not provide it as a treatment.

Then, the surgeon leaves to scrub, and my husband kisses me, and I am wheeled away to a bright white operating theater where I am lifted onto a table. All around me nurses and assistants and the doctor whirr and hum, speaking to each other in a pleasantly inaccessible language. I lie there, heavy and useless as a baby, as my body is adjusted, measured, hooked up. I’m not scared. I think, Good. Let these men and women with their tough, impersonal competence be in charge of my body for a while. The last thing I remember is a gas mask snugly held over my mouth and nose, the strong white light shining from behind the nurses and doctors, their masked faces looking down at me like benevolent aliens.

***

Much later, I found myself looking for historical accounts of ectopic pregnancy. I hoped, maybe, to situate myself, with my lonely freakish body, in a community across time, a lineage of women whose misplaced pregnancies had almost killed them. What had women experienced in other eras? What had their doctors observed?

According to Alvin Coltar’s “Extrauterine Pregnancy: A Historical Review” in the journal Current Surgery, the earliest known record of an ectopic pregnancy appears in an account by Albucasis, an Islamic doctor writing in the 10th century, of a patient whose baby died before delivery. The visibly pregnant woman experienced intense pain, lost the feeling of fetal movement, then nothing. Weeks later, her abdominal muscles opened and putrefied fetal parts passed out. The patient recovered and lived for years, but the fistula never closed. She endured the rest of her life, cooking and eating and dressing and shitting and, who knows, maybe even raising other children, with an open hole punched through her torso.

The first known cesarean operation on a living woman, performed in 1500, was likely an ectopic in the abdomen, as the otherwise detailed record of the surgery makes no mention of opening the uterus. Though cesarean sections had been performed since antiquity on women who died in labor in an attempt to recover the baby, this was the first performed on a living woman in an attempt to save her life. The operation was performed by a swine-gelder on his wife, who he cut open like a pig after days of hard labor had failed to produce any sign of a baby. Eleven midwives refused to assist in the operation, but a healthy baby was extracted, and the swine-gelder’s wife went on to have four subsequent healthy pregnancies.

There are also records of women, autopsied or operated on years after their fruitless labors or sudden abdominal pains had ceased, whose bodies produced monsters instead of miracles, fetuses calcified into gargoyles in an attempt on the part of the mother’s body to protect her from sepsis and death. The most famous of these stone babies was the Lithopedion of Sens, which was extracted during the autopsy of Madame Chartri of Sens in 1582. Twenty-eight years earlier, in 1554, Madame Chartri had become pregnant at 40, grown large, and gone into a labor that loosed only amniotic fluid and blood. For the rest of her life, she suffered indigestion, poor appetite, and pain. During her autopsy, a calcified full-term baby, so hard that it broke the surgeons’ razors, was removed from her abdominal cavity. The woman’s baby had died inside of her and she had carried it internally, encased in stone for nearly three decades. The so-called lithopedion became a medical curiosity for decades until it was lost from the Danish Museum.

These pregnancies, both the miraculous healthy babies and the stone monsters, were able to grow to term because they were relatively unencumbered in the abdomen. Ectopic pregnancies in the fallopian tube do not have room to grow and usually rupture sometime during the 5th to 11th week.

The first description of a tubal pregnancy does not appear until 1604, when an Italian physician’s notes describe a 31-year-old woman who presented with mysterious abdominal pain, pallor, syncope, and death, all in quick succession. Autopsy revealed a partially ruptured fallopian tube, but the doctor did not understand what had rent it, probably, according to Coltar, because the function of the ovary and fallopian tube were not understood. (It was believed at the time that pregnancy arose from the mixing of male and female fluids in the womb.) Almost two more centuries would pass before doctors recognized the cause of a tubal rupture was a growing pregnancy.

If the medical accounts of ectopic pregnancies before modern times are scant, the personal stories are nonexistent. The mothers of stone babies, whatever they knew or thought or said is lost to the record. The women with tubal pregnancies — what could they say? They doubled over in pain, writhed, and dropped dead. In many cases, they never even knew they were pregnant. Women with tubal pregnancies, before very recently, in the scheme of things, simply did not survive to tell their stories.

***

I come to in a colorless room where I am aware in a hazy way of quiet words and motion. My brain feels wrapped in cotton wool. Steve is there. Across the room, another woman is sleeping. Someone, a nurse, tells me I will have to pass urine, drink water, and eat a cracker before I can be discharged. She gives Steve instructions for changing the dressing on my wounds. There are iron pills for the anemia, a stool softener for the constipating effects of the iron pills, and painkillers, two kinds. I am to take the painkillers every four hours on the dot and not wait until the pain comes back to take them. I will need to “stay ahead of the pain” or I will regret it. “Believe me,” says the nurse, an older woman with a faint accent and turquoise eyelids, “believe me. I know.” On top of the soreness from the surgery, she says, I should expect to feel weak from the blood loss and itchy all inside my abdomen.

“Blood is an irritant,” says the nurse. “Your abdomen was filled with blood up to your liver. The doctor vacuumed it out.”

“Where is my liver?” I ask.

Steve makes up the couch like a bed and I lay there for a long time, many days, dozing dreamlessly on painkillers and anodyne TV. My mother flies in to take care of me when Steve goes back to work. The irony is not lost on me that, after so long trying to become a parent, my days are now like this: I sleep and I cry and I call for my mother to walk me to the bathroom.

A week later, I return to work. My abdomen is too distended to wear any of my pants, and I can’t move nimbly enough to drive. My mother buys me elastic pants, and for another week, she stays to cook dinner and drive me to and from work in my car. “You look terrible,” a coworker says to me in the hall, “you look like a ghost.” Another colleague lends me a stool since I become faint if I stand up too long. The anemia also gives me bad headaches where it feels as if my brain is being rhythmically squeezed, blood whooshing past my ears, and the world has lost its color. I struggle with what to say when someone who didn’t know the reason for my absence asks me if I’m feeling better. Better than what? I want to ask. Most people just think I had the flu; it was a bad one that year. When I do try to explain what happened, I find myself speaking a language that no one else knows.

I struggle with what to say when someone who didn’t know the reason for my absence asks me if I’m feeling better. Better than what? I want to ask.

Then, my mother leaves. A certain degree of performance and sublimation of self is part of the nature of my job, and I am alternately grateful and resentful for every hour I have to put on a show for 13-year-olds and pretend to be fine. I am fine. I pretend to be fine, and I am fine. Fine, fine, fine. Every now and again, sadness flares up like a rash, ugly and red. I ruin a Valentine’s day dinner after a couple with a perfect toddler, babbling and curious, sits down next to us at a sushi restaurant. Steve explodes when he hears a friend’s baby daughter had been born. “Why them?” he asks, which is a far kinder way of asking, “Why us?” and “Why you?” Then, he visits his friend and her baby girl and doesn’t mention it again. There is no answer, we know. Nothing doing, he says. Life goes on. At least I am ok. I am ok, and we are both fine.

The lesson I’d been teaching my students on the day when my tube ruptured had been about finding a “So What?” — a lesson, a reason, a purpose — in the personal stories they were writing. I told them, “That’s the beauty of writing, it allows us to reexamine our experiences and learn from them.” I’m not sure how much I believe this to be true, but it’s one of those things that, as a teacher, I’ve found to be helpful to say to children.

What does one learn from an invisible disaster that almost kills you yet is unlikely to threaten you again? So my body, again and again, eluded my attempts to control it. So what? So my flesh was a brick wall in the path of my desires. So what? So the life that took hold in me would have, without intervention, killed me. So what? Often, in narratives of infertility, the redemptive lesson the teller takes from her struggle is that her losses and lacunas make her stronger, more appreciative, and better prepared for parenthood in whatever unexpected form it greets her. But my infertile yearnings, my disastrous pregnancy, did nothing to impart a sense of the sanctity of life. All I was left with was an uneasy awareness of the fragility and randomness of the whole enterprise, and with fear.

I have three scars — a raised one just inside my right hip, a flat one near my left hip, and a white line at the center of my belly button which you can really only see if you are looking. From time to time, I get phantom pains where my tube once was, probably the result of surgical adhesions, little knots of scar tissue inside of me. Except when I’m having one of those twinges or catching my reflection in a dressing room mirror, I don’t often think about what happened.

Biology isn’t a morality play. I was lucky to be in a place and time where medicine and the law gave me a good shot at self-preservation, though that enterprise, too, is fragile. What happened was this: something inside of me broke, it ruptured right open, and then life — oh, life! — just kept going on.

* * *

Joanna Petrone Joanna Petrone is a writer and teacher. Her writing has appeared in or on The Awl, The San Francisco Chronicle, and The Billfold. She lives in Berkeley with her husband and kids and is currently at work on a novel set in San Francisco.

Editor: Sari Botton