There were four pills, chalky white and hexagonal in shape. I held them in the palm of my hand, examining them. It was their shape that felt like the final indignity—why would the manufacturers of a medication that has to be inserted vaginally design it to have six sharp edges?
This was my fourth pregnancy, but the first whose news I had greeted with something less than elation. For context, it was the spring of 2020. You remember that spring, don’t you? Empty airports. Shuttered schools and offices. Refrigerator trucks, stacked with corpses, clogging up the streets of New York. Whole nursing homes decimated. The daily drip of fear, the strange novelty of masks, the absolute futility of trying to get my three daughters—ages five, four, and three—to participate in remote learning. And it was in this place and time—April 6, 2020, to be exact— that one of my oldest and most beloved friends, Beth, died—at home, alone, like so many others—after finally losing a long and terrible battle with addiction. There could be no wake. No funeral. No memorial. Only a Zoom call on the night of her death among her best friends. We stared into the squares of each other’s stunned faces, asking each other why, while jags of lightning lit up the Chicago skies, threatening a storm that never came.
Three weeks later, I took a positive pregnancy test. What I remember most, as I stared down unbelievingly at the pink line, was a suffocating feeling of overwhelm. I knew I had choices, and yet, as I paced the house, processing, I looked back on the births of my girls, the miracle of it all, the soft, slight heft of them, the way they gazed at me, just hours old, blinking slowly, their eye color still murky and unformed. And I found myself flooded with a feeling that was currently in very short supply: hope.
At eight weeks, when I went in for my first ultrasound, the first thing I saw on the screen was the little whirring heart, the assurance that everything was okay: new life floating and ticking inside me. I relaxed in my stirrups and smiled behind my N-95. But then the ultrasound tech asked me to repeat the date of my last period, and when I told her, she frowned.
“Do you know when you last ovulated?”
I did not. Only women who were actively trying to get pregnant, or actively trying not to, kept tabs on such things. I was neither of these. I was something else; numb, grieving, and also, apparently, careless.
“Hmm,” said the tech. “The baby’s only measuring at seven weeks.”
A nurse came in and brought me down the hall to meet with my OB.
“It’s one of two things,” she explained. “Either you just conceived later than we thought and you’re only seven weeks pregnant, or you’re eight weeks pregnant and the baby isn’t developing.”
I nodded. So this was like most things, in that there were only two possible outcomes: normalcy or catastrophe.
A week later, I returned to the doctor for a follow up ultrasound. The baby had grown, I could see that right away, a tiny snail-like thing affixed to the staticky white terrain of my womb. And its heart was beating; I could see that, too. It wasn’t really whirring, though. More like a slow, gentle pulsing.
“The baby has grown,” the ultrasound technician said, after a prolonged silence as she moved the wand around inside my body. “But its heartbeat is only eighty-six beats per minute.”
“Only?” I asked.
“I’m sorry, but at this point, we’d really like to see it over one hundred.”
I stared at the screen. My baby looked like an eye in the center of a hurricane.
“I’m sorry,” the ultrasound technician repeated.
Another week, another ultrasound. George Floyd had just been murdered, the nation simmered with a justified and longstanding rage, and Mayor Lightfoot ordered all the river bridges of downtown Chicago to be raised, the exits on the Kennedy expressway to be closed. As a result, I attempted to take Lake Shore Drive down to the hospital, a long detour from my home on the northwest side, but soon found that every entrance to LSD was also blocked off by police cars. Graffiti spackled its concrete dividers: I CAN’T BREATHE. NO JUSTICE NO PEACE. My own problems felt small and manageable in the face of pandemic and death and the deep dysfunction and rottenness and racism that marked the entire duration of Donald Trump’s presidency. But it might not be a problem at all, right? I thought. If there was no more hope, why would they bring me down for another ultrasound? If there was no more hope, I would’ve started bleeding by now.
I sped frantically through side streets, making my way, Pac-Man like, across the city. I cannot miss this appointment, I chanted silently, screeching around people in my dinged-up minivan with my children’s Cheerios sifting around the floor. I cannot miss this appointment.
I arrived to the waiting room within minutes of my ultrasound. This time, the tiny snaillike thing was no longer pulsing. It seemed to drift along my uterus like a fallen leaf on the surface of water. People say that sometimes the dead appear to be sleeping, but of course that isn’t true. There is no other kind of stillness that total. Even when the dead thing is no bigger than a grape, there was no mistaking it.
Maybe, I thought, staring up at my lost baby in the darkened room, I had killed it with my ambivalence, my lack of unabashed joy when I’d first seen that positive pregnancy test. Or maybe it was all my practical mistakes, all that wine I’d been drinking at night with my husband because we were bored and stressed and we couldn’t go anywhere or do anything but parent until we dropped to the couch, exhausted, to watch The Sopranos for the hundredth time. The occasional Xanax to quell my rushing thoughts. The countless milligrams of Excedrin to soothe my splitting headache after a day of trying to convince small children to learn in front of old, glitchy Chromebooks. The boxed hair dye, the teeth whitening pen, the fake nails in boxes applied with tiny vials of toxic glue. Or maybe it was just a result of overwhelming grief. I knew our baby was a girl; I was sure of it, I had this feeling, and I had already chosen her name: Mary Sibéal. Mary, because if you’re Catholic and you have four daughters, you’ve got to name at least one of them Mary. And Sibéal: the Irish for Beth.
“It’s very important that I say this to you clearly,” said my doctor, her gentle eyes boring into my hot, spiraling thoughts. She’d delivered my other babies; she knew me. “It is absolutely nothing you did. A woman’s body is incredibly intuitive, and miscarriage is usually its way of handling a pregnancy that isn’t viable. Most of the time, a first trimester miscarriage is caused by a chromosomal issue. And it is absolutely not your fault.”
“I thought I was supposed to bleed,” I said. “I thought that’s how you knew.”
“Every woman is different. What you’re experiencing now is sometimes called a missed miscarriage because there are no overt signs. Do you still feel pregnant?”
I’d noticed this without really clocking it. The nausea had lifted just a few days earlier. My breasts no longer felt swollen and tender. I was exhausted, sure, but the exhaustion was at a normal mom-of-three-with- no-social-outlet level, no longer actually existential. I shook my head.
“Cessation of pregnancy symptoms is often the only sign. Sometimes a woman’s body can take a while to recognize that the pregnancy is no longer viable.”
This made sense to me. My heart had a longstanding habit of holding on to things long after I’d lost them; why should my body be any different?
“I’d recommend a D & C, a simple outpatient procedure done here at the hospital.”
“Done here?” I looked around her office. There was a large bulletin board behind my doctor’s head, papered with holiday cards of her patients’ babies. I had never sent one. I didn’t even know that was a thing people did, sending a holiday greeting to their OB. Why did all these other mothers seem to know it? Why did I know so little about everything? And what would it be like to return to this hospital, the same maternity hospital where I had given birth three times, the most miraculous days of my life—what would it be like to come here and ride the elevator to the floor where there were no babies crying, to leave with my uterus scraped clean and no baby in my arms?
I asked if there were alternative options.
“Many women in your situation now use an at-home prescription medication,” she told me. “It loosens the fetal and uterine tissue, initiating cramping and the expulsion of the pregnancy.”
Expulsion. Couldn’t there be a description for it that didn’t make me sound like a hostile and incompetent landlord?
“I think I’d rather do that,” I said, “as long as it’s safe.”
“Well, there are risks that accompany it, as there are with the D & C procedure. Pregnancy is a medical condition, and it always carries risks. If you find that you’re soaking through a pad faster than once per hour, or if you’re bleeding heavily for more than three hours, you’ll need to call the office or the on-call number. But generally, yes, it’s very safe. And some women find comfort in being able to go through this privately, in their own homes. It’s going to be a bit more uncomfortable than a heavy period, but I’ll prescribe you some ibuprofen to manage the pain.”
“Okay.” I nodded woodenly. “That sounds good.”
Good? My eyes filled. This was entirely my own fault. Until the universe decided to take her away from me, I hadn’t really wanted this baby at all.
*
The prescription, a drug called misoprostol, sat for days in a white paper bag on the counter. I’d wanted to see if my body could figure this out on its own. But I couldn’t wait any longer; that would just elevate the risks. And so, on a Sunday in June 2020, here I was, alone in the upstairs bathroom with the door locked. Downstairs, my husband was making lunch for the girls, and I could hear the clink of plates and silverware, the cadence of dad-little girl conversation. I wondered if I was making a mistake. Maybe I should have just gone for the D & C. The whole reason I hadn’t wanted the procedure was because I didn’t want to taint my beautiful memories of healthy childbirth, but going through this process with the sweet piping voices of my girls coming up through the floor vent felt somehow worse. To drown them out, I turned on the shower fan. Then I took a deep, bracing breath, hunched over the toilet with my underwear pooled at my ankles, and inserted the four hexagons one by one. The unpleasant job completed; I said a one word prayer—please—to nobody in particular. God? Beth? It didn’t matter. I felt alone.
Then I waddled out of the bathroom and into bed, feeling like my crotch had been stuffed with sand. I propped my laptop on my stomach, opened Netflix, and, with a towel spread out beneath me, waited for the bleeding to begin.
An hour or so later, halfway through a new Dateline episode, I heard my husband’s heavy, familiar steps on the stairs. He paused for a moment in the doorway, then came over to hover at the edge of our bed.
“Are you okay?” He looked at me anxiously. “Anything happening?”
“Nothing.” I paused my episode of Dateline. Keith Morrison was interviewing an older woman in teenage-girl makeup whose niece had been bludgeoned to death and discarded in a ravine. “Still waiting for it to start.”
“Can I at least get you anything?”
“Maybe a Diet Coke?” I smiled up at his worried, loved face, knowing that he needed to feel useful.
“Will do.” He leaned over to kiss my forehead. I rose to meet his touch, and that’s when I first felt a warm oozing and knew the bleeding had begun. He offered to stay with me, but this felt horrid and private—I asked him to go back downstairs with the girls.
“But what if something happens?”
“Then you’re right downstairs, and I’ll call to you.”
“But—” he stood there at the side of our bed, and for a minute I remembered him as he was on our very first date, a Peruvian BYOB where we’d gone for dinner and fallen in love before the lomo saltado was even finished.
“Come up in an hour or so and it will probably already be over.”
“Okay. But text me or shout for me if you need anything sooner.”
“I will,” I said. “I promise.”
There was a lot of blood at first. A lot. When my husband came to check on me, he looked afraid. He spoke to the on-call doctor, who had trouble understanding his Irish accent and sounded impatient, even dismissive. She instructed that I drink some orange juice. I went back to bed. My husband wanted to stay with me, but I didn’t want anyone, not even him, to see me like this. Sometime later, I got out of bed and stood up. I felt a gushing, like a font, and looked down at the floor, amazed at how much blood was pouring out of me. I remembered standing there for a moment, with a detached sense of wonder, watching the puddle between my legs grow, spurting from the edges of my underwear and saturating our bedroom rug. There were clots of things, jelly-like and horrible, falling out of me too. I wondered which one of them was the beginnings of Mary Sibéal. But the rug! It was ruined. Out, damned spot! I thought with mutedly hysterical English-teacher amusement. Out, I say!
I dared look down again. It appeared as if my entire insides were draining out of me, and quickly. My blood, my organs, my little grape- sized daughter, my uterus itself. I threw up all over myself. What a mess I was making. What an embarrassment it was, reproduction, womanhood. At least we got the rug from Ikea, I thought, impressed with myself that I could still maintain logic, a cool head, at a time like this. It’s not like it’s a tragedy if we have to replace it. But then I caught a glimpse of my face in the mirror above our nightstand—it was drained entirely of color. Even my lips were a limpid shade of gray. A word, frightening in its ramifications, skulked across my mindscape: hemorrhage. I tried to call my husband’s name, just to see if he thought maybe this was a little abnormal, but little black squiggles were beginning to dance across my vision. I made it to the bathroom by crawling, my knees slipping on the warm blood that continued to pour from between my legs, but once I made it, the tiles felt so good and cool that when I rested my cheek against them, I just needed to close my eyes. I was aware that I was grinding my teeth together, even though I wasn’t feeling any pain, not anymore. I wondered, dreamily, if Beth could see me. She was always cool in a crisis; her feathers never rustled. Feathers. They touched my face, softly, and my shaking hands. The squiggles began to multiply, like fireworks, like maggots. There were so many of them now, they were all I could see.
An ambulance arrived. It was nighttime and everything was dark. When one of the EMTs pulled back the bedsheets and pressed on my belly, I saw him shudder. And then I was being lifted into the vehicle, and my husband was standing in the middle of the street, unable to come with me—Covid restrictions—and I had to let go of his hand. I remember the coolness of the IV liquids as they traveled up my veins, the alarm in the voices of the paramedics that would have been worrisome if I hadn’t been too tired to care, and then the falling into something I had to call sleep because I didn’t really have another name for exactly what it was.
There were IV drips and blood transfusions, and immense pain, and a kind doctor who told me, with her arm elbow deep inside my body, that they were going to take me to an operating room and that she might need to perform a hysterectomy “to save your life.” I shrugged. I didn’t care about my uterus anymore. In two days, my middle daughter would turn five. I didn’t want to be dead for her birthday.
The last thing I heard before the anesthesia kicked in was a soft voice speaking a language I didn’t know. I thought maybe it was an angel, but no, it was only some elderly nun praying in Polish over the intercom of the Catholic hospital nearest my home where I’d been taken. And when I woke up minutes or hours or days later, the bleeding had stopped, and I
was alive. I even got to keep my uterus.
A nurse was with me, an older woman in pale pink scrubs, wrapping a blood pressure cuff around my arm.
“What your husband needs to do when you get home,” she was saying, “is make you a big juicy hamburger. And maybe a kale salad.”
“Okay,” I managed.
“That’s all you need for now,” the nurse said firmly, removing the cuff. “A lot of iron and a lot of rest.”
“Can I ask you something?” It seemed important to measure the level of this crisis, even if it was over now.
“Of course, honey.”
“How bad was it?”
“Honey, you don’t want to know.”
“Did I almost die?”
The nurse shrugged. “I’ve been doing this a long time. If something ‘almost’ happened, but didn’t, that means it didn’t. And that’s all that matters. Okay?”
I smiled weakly. “Okay.”
“The doctor will be in to check on you in a bit, and if she gives the all- clear you’ll be free to go home.” The nurse gathered up her things. She turned back once when she reached the doorway. “I’m sorry about your baby, honey,” she said.
It was only then, as the kindly nurse closed the door, that I began to sob, alone in the little 1960’s-era room of my neighborhood hospital, a crucifix hung on the wall next to my television. But I wasn’t crying about the awful ordeal of the previous night, or even our lost baby. I was crying because the nurse had confirmed it: I had been right there, walking along the dark edge of my own life’s end, and I hadn’t felt Beth anywhere.
*
Later that summer, my mom and I went to a garden center and bought a little pear tree. My husband and daughters and I planted it in our back yard, in memory of our baby that wasn’t. And though I have managed to kill every houseplant I’ve ever owned, and though the rest of our garden is choked with overgrown weeds, this little tree has been determined to thrive. By the summer of 2021—the same summer I gave birth to a healthy baby son—it began to bear globes of hard green fruit.
Beth, too, got her memorial. My friend Katie hosted it in her yard in late August of 2020. She’d put up a framed photo of Beth—glowing, healthy, beautiful—and laid out a spread of Diet Coke and pretzels, which was Beth’s basic diet. And Katie too, had planted something for us to remember Beth by: a rose bush. At the end of the night, we gathered around our new plant, and we sifted beach sand over its deep green waxy leaves. Then we baptized it with water from Beth’s beloved Lake Michigan. I read a poem I’d written for her, and we all cried together. Surrounded by the love of my friends, in the warm glow of our shared memories, I felt a burden inside myself that had been crushing me for months carry itself high and far away. And in the morning, Katie sent a photo to the group chat: overnight, Beth’s rose bush had burst into full bloom. She’s been listening this whole time, I thought. She’s been with me all along.
As I think back now about this time, what I feel most humbled by is the grace I was given. The choices. The help, the love, and the unjudgmental support. I wasn’t surprised when Roe was overturned in the summer of 2022, and neither was a single other woman I know. But I was enraged. Reading the self-righteous, cowardly opinion of these nine people, at least two of whom were illegitimately appointed to the court, the words of my OB came back to me: pregnancy is a medical condition, and it always carries risks. Yes. Pregnancy is a medical condition, and it always carries risks. It isn’t about cute maternity clothes and balloon releases, or Babies R Us registries or religious doctrines. Pregnancy is a medical condition. And it always carries risks. For thousands of years, women have died bringing life into the world. They still do—here in the United States particularly, where our maternal mortality rate is higher than that of any other nation of similar wealth, and where the rate among Black women is shockingly, unforgivably higher: more than double that of the general population. I, who had relatively easily brought three other children into the world, had cavalierly forgotten this fact. I’d believed that I was protected from the fates of so many of my maternal forebears, being middle-class and modern and urban and—let’s be honest—White. But the simple fact is, during the course of a fairly standard first trimester miscarriage, I almost died. Would have died, in fact, had my husband not been home to call for help. All I wanted after I inserted those four pills was for it to be over quickly and privately—to suffer it alone, and then try to move on. So it horrifies me how, because of the overturning, we have seen this medical condition flung into the public arena, ripped from the hands of the women whose lives it affects and even sometimes ends, ceded to the decisions of strangers who already hate them.
I wonder what Beth would say about all this. Beth, who so firmly did not give a shit about politics, so deeply intolerant was she of liars and phonies. No matter how much I loved her, I can’t presume to speak for the dead. I can’t know what it is she would say. But I can still imagine her: long glossy hair, cigarette waving between long and expressive French- manicured fingers, Helen of Troy in an Old Navy tank top. I can hear her voice, smoke-husked and filled with all the joy and pain that makes up a history. I imagine her looking at me with those eyes of Lake Michigan blue, raising an eyebrow. She speaks very clearly. She doesn’t stutter.
She says: Jessie. Are you fucking kidding me?
Jessie Ann Foley is the Printz honor-winning author of the novels The Carnival at Bray, Neighborhood Girls, Sorry for Your Loss, You Know I’m No Good, and Breda’s Island. Her work has been named to best-of lists by Kirkus Reviews, Booklist, YALSA, Bank Street, Entertainment Weekly, and many other outlets, and has been featured on school and library recommended reading lists across the United States. Her novel, The Carnival at Bray, has been banned in at least five states. Jessie lives with her family on the northwest side of Chicago, where she was born and raised.