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Medically Necessary, One Throne Magazine

"Sky Full of Stars" by Barbara Florczyk.
© Please do not reproduce without artist's permission.

by Everly Anders


When I was seventeen weeks pregnant, my husband Isaac and I got the news that our unborn daughter had a severe form of Down syndrome that meant her internal organs weren’t developing. We had already suffered through one miscarriage and I wanted nothing more than to have a baby. Devastated is not a big enough, deep enough, or broad enough word to encompass the kind of pain I felt.


The doctor’s voice kept replaying in my mind: “Everly, I want you to know that ninety-five percent of women in your situation don’t keep a pregnancy like this. In my medical opinion, you cannot keep this fetus.”


Although I couldn’t process what she was saying at the moment, she knew exactly what she was doing: giving me permission to make the most horrible decision I have ever had to make.


“I made you an appointment already.”


“Why?” I asked.


“Because we find that even though this is a medically necessary procedure, a lot of women can’t bring themselves to call and actually make the appointment.”


It was Friday afternoon, and the clinic hadn’t had any openings until Tuesday morning. My husband and I had four days to sit with our decision.


We stayed inside the entire weekend, eating frozen foods and watching television. Occasionally we talked about the fact that my mother was coming to town, but nothing about the baby.


On Monday we picked up my mother at the airport. I met her at baggage claim while wearing a long, skin-tight sweater so that she could see my baby bump.


“Oh my God, look at you,” my mother said, giving me a sad smile.


“I know.” I put my hand on my stomach. “I just really wanted you to get to see me pregnant, with a little belly.”


“You are adorable with a belly.”


My mother talked incessantly the entire way to the hotel, about all the things that were going on in her life — her latest travel, her boyfriend, the birds in her backyard — anything other than what was happening to me. I was grateful. She was my replacement for TV.


We dropped her off at the hotel and drove to the clinic because they wanted us to come in a day early to sign some paperwork. It was located in a faded white office-looking building across from older Victorian homes. I don’t know why I’d assumed it would be a large hospital. This is an abortion clinic, I reminded myself.


Isaac led me into the waiting room. There were old leather chairs with slashes in the backrests. The carpet was brown and with black gummy stains and the receptionist was fortified behind a glass window. It looked like the waiting room at a DMV.


I perched awkwardly, worried that I might get a disease if I touched anything. My doctor had recommended we have the procedure done at this clinic because they do so many of them, whereas she herself only did a handful a year. I was starting to regret taking her advice.


I was a married thirty-year-old woman who’d made it through sixteen years of sexual activity without getting an STD or needing an abortion, so how the hell was I here right now?


“Do you think this place is okay?” I asked Isaac, who was seated beside me.


“It’s fine. Your doctor recommended it. They just don’t have all the money big hospitals have. I’m sure they use all their money for the actual hospital part.” He squeezed my hand and leaned over to kiss my cheek.


“Can you Yelp this place?” I asked, trying to make a joke. Isaac pulled out his phone and actually looked it up. I wanted to tell him I was kidding, but I also wanted to know if there were any horror stories, so I would have a reason to run.


“It looks like positive reviews.”


My name was called and we were escorted into an office where a smiling older Hispanic woman sat behind a desk. When we walked in she stood and introduced herself. I don’t remember what her name was or exactly what she looked like. I was busy staring at the papers on her desk and thinking, I want to get this over with as quickly as possible and get out of here.


“I’m going to have you sign a few forms here, okay?” She said everything very slowly, as though English were my second language. I lifted my head and nodded. "There is a little more paperwork here because you are past the first trimester.”


She looked down at the mess on her desk. “How many weeks are you?”


“Eighteen,” I said, realizing I was never going to get to say twenty-two, or thirty, or “my daughter is five years old.”


She put a stack of papers in front of me and handed me a cheap blue pen.


I started to cry. The woman handed me a box of Kleenex.


When I was done writing, she leaned over her desk and looked me straight in the eyes. “Now would you like me to explain what your procedure tomorrow entails?”


My heart suddenly felt like a balloon being seized in a vice grip. I hadn’t thought about what they would do. It was like someone in my mind had shut that door and told me, “Nothing to see here. Just keep moving.”


“No,” I said firmly. I liked the feeling that there was one small thing I could control. “I don’t want to know what they are going to do.”


She nodded.


“Still, today, we are going to need to prep you for tomorrow.” She pulled out a greenish gray tube the size of a cigarette. “For that, we are going to need to open your cervix, and this thing here is going to help open it slowly.”


“Wait, what?” I asked. “You need to do something to me today? No one said anything about that.” The words came out sounding angrier than I meant.


“It’s very simple. This here,” she lifted the object towards the light, “it’s just dried seaweed. Once inserted into your cervix, it slowly starts to expand. It only takes a minute to put in.”


I nodded. What else could I do, say no?


“Isaac, will you go pick up my mother and bring her here?” I asked. “I told her we would be right back.”


Isaac got up. I couldn’t let go of his hand.


“We can wait to do it until he comes back right?” I asked. “He can be in the room with me?”


“Your insurance company is asking that our chief of staff be the one to do the procedure, and so we need to wait a few minutes for him to finish with another patient anyway.”


I sat in the empty waiting room playing a game on my phone, trying to avoid eye contact with anyone else, until Isaac returned with my mother.




“Excuse me,” I heard a voice say from across the room. I raised my eyes and found a teenage girl tapping on the glass of the reception window. The receptionist slid the little glass door open.


“I was wondering if you could call me a taxi,” the girl said with an embarrassed smile. “My boyfriend says he can’t pick me up.”


The receptionist handed her a piece of paper as if this was a common occurrence. “There’s the name of three cab companies and also a bus schedule.”


The girl took the paper and stared at it as she walked out the double doors and into the parking lot. My heart sank for her. She still wore the clinic’s paper band around her wrist.


I watched her walk through the parking lot and around the corner of the building. I had to stand to see through the tall windows behind me. She headed down to the corner and crossed the street. Her long strawberry blond hair was whipping back and forth as if it was waving to me. She looked like any other high school girl walking home from school.


Where is she going? Is she looking for a payphone?


Once across the street, she sat at the bus stop sign. I turned back around and slumped down in my chair. The receptionist was studying me. I smiled, embarrassed to have been caught spying.


“They always end up taking the bus,” she said, and went back to her paperwork.


The double doors banged open then, and in walked my mom and Isaac. My mother sat next to me, pulled out her Kindle, and began reading. It was her way of offering Isaac and me some semblance of privacy if we had wanted to talk, but I didn’t. All I could think about was that girl.


How many times had I told myself I had the worst life ever? I was losing the baby I always wanted. And my marriage felt like it was cracking apart as a result. I selfishly couldn’t imagine anyone’s life being worse. And yet, here I sat in between my mother and my husband, both of whom loved me, and that teenage girl was taking a bus.


“Miss,” the receptionist called, waving me over to the window. “Would you like to pay for the procedure today? It’s probably better than tomorrow.”


I agreed.


“Your co-pay will be eighty-five dollars,” she said, taking my credit card. “Your insurance will cover the rest.”


I stood there, shocked. My insurance didn’t cover elective procedures.


As if reading my mind, the woman handed me a small piece of paper with writing on it. “Your insurance has deemed this a medically necessary procedure, so they pay for it.”


I picked up the paper, sat back down between my mother and Isaac, and stared at the printed words. It was a short explanation of my co-pay, but I kept reading the term “medically necessary” over and over again. I understood enough about insurance companies to know that if they can get out of paying for something, they will. They believed I had to have the procedure. To them, this wasn’t a choice, this was a necessity. I held the paper to my chest and silently thanked God for it.


My mother was still reading her Kindle.


“What are you reading, Mom?” I asked, trying to take my mind off what was happening.


“I’m finally checking out that Fifty Shades of Grey everyone is talking about.”


Fuck my life.




“They’re ready for you upstairs,” the receptionist said, through the glass.


A nurse led Isaac and me to a room with no windows in the back of the building. It was small and dim and didn’t seem clean enough to be a hospital room. Some women die from this procedure. Some women have complications that make it so they can’t have children again. I’ve made the wrong decision. I should have had my doctor do this in a Kaiser facility.


I changed into my gown quickly.


There was a knock at the door. “Hello,” said an older man wearing green scrubs as he entered the room. He had a warm smile. He walked over to the sink and washed his hands, scrubbing them like a surgeon. That reassured me. A nurse came in behind him, holding her gloved arms up the way they do in movies to show they can’t touch anything.


“Why don’t you lie back and put your feet in the stirrups?” she said with a singsong voice.


Isaac moved to a chair that was next to my head and squeezed my hand.


As I lay back on the table with my legs up, and Isaac holding my hand, I couldn’t help thinking, This is what it would have been like if I was giving birth. But I wasn’t giving birth, I was preparing my body to do the exact opposite. Just as I started to feel the weight of my circumstances again, the voice came back into my head saying, “Keep moving. Nothing to see here. Don’t think about things like that.”


The doctor began to talk, about nothing really, just the usual chitchat to distract you.


“Okay, you’re going to feel my hand now, and then some cold metal and a little discomfort.”


That’s code for “this is really going to hurt.”


“Oh God” was all I could get out. It felt like being stabbed from the inside. I squeezed Isaac’s hand hard and suddenly wished the woman downstairs had explained a lot more about what this prep involved.


The doctor backed up and peered at me over my legs. “You’re very tight. I’m going to have to insert another one.” I nodded once, just wanting the pain to end, and thinking if he could just finish up it would all go away.


I couldn’t see anything he was doing down there, so I closed my eyes and waited. After a moment, I felt Isaac’s hand go limp. I looked over and saw his eyes were closed and he was turning white. I squeezed.


“Isaac? Isaac, stay with me.”


He slumped over.


Seriously? Is he seriously passing out?!


He slid to the floor with a thump. Both the doctor and nurse stopped their work to go over and help him. The cutting pain had not subsided and I desperately wanted to close my legs.


How is this happening to me right now?


“Keep going,” I pleaded to the nurse and the doctor. “Get this over with.”


This got their attention. The nurse came around to my side and picked up my hand. She smiled reassuringly. “I will be here for you until he wakes up, okay?”


I wanted her to stay with me and just keep smiling at me like this was all no big deal. I didn’t want my husband to wake up, if it meant the nurse leaving.


I started to say something, but then it felt like someone was ripping me open in the place where I was stabbed earlier. The pain was so intense that when I gasped for air nothing entered my lungs.


“All done,” the doctor announced.


The pain didn’t quit, even when the doctor closed my legs. The nurse helped me sit and as I did, I noticed Isaac was still on the ground.


“What happened?” Isaac asked.


You fucking fainted. I said nothing.


The nurse helped him up and gave him some water, while the doctor handed me a prescription for pain killers. I accepted it with a shaky hand.


“No liquid after midnight tonight.” He handed me an orange medicine bottle with one white pill in it. “First thing after you wake up tomorrow morning, put this under your tongue and let it dissolve. Then be here by eight.


“And neither of you should drive just yet,” the doctor told us.


Once we’d assured him my mother was in the waiting room, he helped me into a wheelchair, then asked the nurse to get Isaac one as well.


“No, no. I’m fine,” said Isaac sheepishly, but I didn’t think it was sheepish enough.


When we got outside, my mother was already waiting with the car. I stood up to walk, and then because of the pain, immediately needed to sit down again. Then I tried to walk again and made it about three feet before I felt cold and was covered in sweat. Next thing I knew, all I could see was the sky and my mother’s lips moving. “She fainted!”


Someone picked me up and put me in the car, where I was slumped over, looking at the side of the seatbelt. People were talking all around me. I couldn’t stop shaking and sweating, and tried to sit up straight as a wave of nausea came.


Finally, I was walking into our condo. I was grateful my couch was cool and soft and I could lie down flat.


“I’m going to get the prescription filled,” Isaac said, and he headed out the door before I had time to tell him that was a good idea.




That night, as the pain killers began to work, Isaac took my mother back to her hotel room. Afterward he came back home and helped me get dressed for bed.


“I can’t believe you passed out,” I said.


I tried to make it sound like I thought it was funny, but my resentment tinged the words with a hint of honesty.


Isaac sat next to me and sighed as though he knew this conversation was coming.


He looked down at his hands. “You couldn’t see what I could see. He had this sharp metal rod.” Isaac held his hands apart, to show me it was as long as my forearm. “All I could think was, You are putting that in my wife?” He started to cry.


“I’m so sorry, Everly. I’m so, so sorry.”


I wanted to stay awake after Isaac fell asleep and have one more moment of alone time with my baby. One moment to put my hand on my belly and say goodbye, and to tell her that I loved her. But I couldn’t keep my eyes open. It’s okay, I will do it in the morning.




When I woke the pain was back. Since I wasn’t allowed to drink anything, I took the little white pill the doctor had given me and placed it under my tongue to dissolve. I put on my favorite sweatsuit and headed for the car. All I could think about was the pain.


We stopped to get my mom at the hotel and headed to the clinic.


When we got to the clinic, a nurse immediately took me back into a room with four dark wood desks. She pointed to a plastic chair by the far desk. I sat down.


There was a young girl seated by the opposite desk who was talking to a similar-looking nurse. I began to feel less like we were patients and more like we were cattle.


When my nurse took a seat and began handing me new paperwork to fill out, I asked if my husband could join me.


“You’re married?” she asked, surprised, and then scanned my paperwork.


Her eyebrows raised the moment she read the note that said this was a medically necessary procedure. This is the last place on Earth I want to be right now, I wanted to tell her. I want to be home with my husband, picking paint colors and ordering a mobile online for the baby room. Not wondering which procedure we should have to end our baby’s life.


“Sure ma’am. I’ll go get him.”


Once she’d gone, I stared at the wall in front of me, trying to pretend I wasn’t listening to the conversation between the girl and her nurse.


The girl’s nurse was going through all the drugs the girl was going to need to take after her procedure. “These are your painkillers. Take them every four to six hours as needed. These are your antibiotics.” She handed over another prescription bottle. “Take these with food. And these are your anti-anxiety meds. Just take them as needed.”


My nurse came back with Isaac and an extra chair. I was grateful to not be sitting alone. He put one hand on my back and then with his other hand held mine.


I had to sign papers and answer questions about my general health. When my nurse was done asking that, she started the same routine that I had overheard being played out for the girl: handed me Vicodin, with instructions on when to take it, and antibiotics. I waited for the third prescription but it never came. She simply returned to her paperwork.


“The other girl got anxiety medication. Why didn’t I?”


She glanced at the young girl, who was currently getting her height and weight taken, then leaned close, toward me. “We give that to women who don’t have anybody. You have your mother and your husband here to support you.”


I felt like an asshole.


After recording my height and weight, the nurse helped me lie back on one of the beds and closed the curtain around Isaac and me. I imagined we were in a spaceship’s emergency capsule, and that I could just press one little button and we would shoot safely out into space, away from this place.


Despite feeling claustrophobic, I was grateful for the privacy. I wanted us to have a moment so we could say something to the baby together.


Before we could think of anything to say, I started having sudden, sharp jabs in my pelvis.




“What’s wrong?” Isaac jumped out of his seat.


“My whole stomach’s cramping up.” I put my hand on my belly as if that could make it stop.


“Want me to call the doctor?”


“Not yet.” I was already in so much pain that I thought, what’s a little more? Besides, it quickly subsided.


But then another painful wave of cramping came. This time it was worse.


“It’s back,” I said, grabbing my stomach. I looked at Isaac; he was silent and his eyes were full of tears.


When all my muscles relaxed again, reality sunk in for me.


“I’m having contractions, aren’t I?” I stared at the popcorn ceiling. From the corner of my eye, I could see Isaac nod his head.


This must be what the little white pill did: force contractions. I had thought I would walk into the clinic, they would put me out, and do whatever it was they did. Instead, I was going to do most of the work myself, and they would only come in at the end and finish up. I was giving birth.


I lost track of time but they eventually wheeled me into another room with really bright lights. The contractions were intensifying. I didn’t make a sound because I didn’t want to admit how much pain I was in. It seemed trivial in comparison to the pain I might be causing. I told myself I deserved to feel pain. I deserved this and ten times more.


I didn’t lift my head, I couldn’t bear to see the machines they were going to use. A nurse appeared above me.


“You are going to get sleepy now. Okay, Everly?” She messed with the IV on my arm.


“I’m not asleep. Don’t do anything yet.”


The nurse laughed. “Don’t worry. Just look up. See that picture of the pretty island?”


A poster of lush vegetation surrounded by clear blue water was taped to the ceiling.


“Pretend you’re going on a trip there. What are you going to pack?”


I was too tired to play her little game.


“What are you going to pack, Everly?” she asked again, in a firm voice.


I realized this was her way of figuring out when I fell asleep, so I pushed myself to play along. “Sunscreen.”


“You’ll need that. What else?” she asked, as she put a mask on herself.


“A little white bikini.”


She laughed a second time. “I’m jealous, my husband is going to be checking you out.”


In my mind, I laughed too.


“A sarong.” Halfway through saying the word “sarong,” I realized that my head position had changed. A moment before, I had been looking straight at the poster, but now my head was leaning to the side facing the nurse. I didn’t want to let that stop me. I continued, “A towel.”


“How was your trip?” she asked.


What trip? I was confused.


“Your sarong didn’t work. My husband was still checking you out.” She winked at me. “Guess who wants to say hi to you?” she asked with a smile.


“Your husband?” I was desperately trying to follow the conversation.


“No, sweetie, your husband.” She gestured to the other side of me, where Isaac was standing.


“How are you feeling?” Isaac asked. He had a concerned look on his face.


“This lady’s husband was flirting with me,” I answered.


Isaac looked horrified and turned to the nurse. “I am so sorry, she doesn’t know what she’s saying.”


The nurse giggled behind her face mask. “It’s okay, it was an inside joke we had from earlier.”


Earlier when? I still wasn’t understanding. Am I going to pass out eventually?


They helped me sit upright.


The nurse put her face close to mine as she spoke.


“Everything went very well. Here’s a maxi pad. You need to go put it on.” She gave me the biggest pad I had ever seen. It looked like it should have come with metal attachments and a belt. Then she pointed to a small bathroom in the corner.


I shuffled slowly to the bathroom. Isaac came over to hand me my underwear. I sat down to pee but only blood came out. I didn’t worry about it. I couldn’t even focus on it if I had wanted to. Underwear, pad, blood…nothing could stay in my brain for very long.




I’m not sure how I got home. The next thing I knew I was back on my couch sitting between my mom and Isaac, watching John Carter, the Disney movie that had been a financial disaster. They were staring straight ahead at it, so I did the same. I had trouble understanding the plot, and every time my mom or Isaac made a comment, I tried to think hard about what they were saying, but couldn’t follow the conversation.


“I have to pee,” I announced, and stood.


Isaac pointed at my pants. “Oh my God!”


“Okay, okay,” my mom said and ushered me into the bathroom.


I looked down and saw that my pants were covered in blood. I began to cry.


“These are my new sweats and now they’re ruined.”


“It’s okay,” my mom said again as she pulled them down to my thighs. “We’ll get you new ones.”


But I didn’t want new ones. I wanted these ones. I didn’t want to give them up just because they had blood on them. We could wash them. We could fix them. We couldn’t just throw them away as if they were useless.


My mother pulled my pants and underwear over my feet while I stood next to the toilet like a child waiting for a clean diaper. While she ran the pants under hot water I felt something weird happening between my legs. I looked down at my half-naked body just in time to see a blood clot hit the tile floor with an audible splat.


“Holy shit!” I screamed. The fog of confusion had subsided long enough for me to comprehend what was happening. Blood clots are bad, very bad. People are not supposed to have blood clots. Mayday!


My mother stopped her scrubbing and came over to stand next to me. We regarded the clot. She turned her head sideways.


“Nope, not over the size of a nickel, you’re fine.” She bent down with a Kleenex and wiped it up, and then returned to her scrubbing. So I sat down on the toilet and finished going to the bathroom.


It wasn’t until much later that I realized how important that moment was and how much my mother was the perfect person to be there for me. My mother’s lack of emotion and inability to be overtly nurturing was just what I needed. If she had gotten emotional and held me or talked to me about my feelings, I think I would have lost it. I needed the real life embodiment of that survival voice in my head, the voice that had been speaking to me while all this was going on.


After Isaac had seen the blood on my pants, he left the house and went to work. My mother and I spent the next fourteen hours watching movies and eating junk food.


Occasionally I fell asleep and my mother would pause whatever movie we were watching and read her Kindle until I woke up again. We commented on the storyline and gossiped about the actors’ personal lives as if we were authorities on the matter. My mom disappeared every so often to get me a new handful of pills and to check my pad for clots. Other than that, it was like any other visit.


It was weeks until I was really able to process that my daughter was gone, and that I hadn’t gotten to say goodbye.


Everly Anders has essays appearing in upcoming issues of Addana, Bird’s Thumb and S/tick. She is currently finishing a memoir dealing with her divorce. She also writes short science fiction and fantasy to encourage young women to read genres.


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