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Jane Armstrong ~ CLINIC

It's December and we've put a Christmas tree in the waiting room and decorated it with colored condoms in clear cellophane wrappers. One of the staff has hand-lettered a greeting, tucked it in the folds of the fleecy-white Christmas tree skirt like a gift card in tissue paper: HAVE A SAFE AND HAPPY HOLIDAY. Until you get up close, the condoms look like lollipops without sticks--cherry, orange, grape, lime and lemon. The children who come with the mothers who can't get babysitters reach for the circles of color on the tree. The mothers slap their hands away.

_____

"I need a test," the patient says.

She sets a 12-ounce Peter Pan Peanut Butter jar, half-full of cloudy urine, on the front counter. A piece of blue plastic wrap is stretched across the mouth of the jar, held in place by a fraying rubber band.

I smile, take the jar, still slightly warm--she must've come straight over from home. "We only need a few drops," I say. "You could've given us a clean catch here."

"As if I know," the patient says.

I give her a form to fill out. She sits in the waiting room. I take her specimen back to the lab. I pull off the plastic wrap and the odor nearly knocks me down. I've worked here for almost two years, but I still can't get used to the smells.

Her test is positive. Most of the tests here are positive.

I go back up front to see if she's finished the paperwork. She's set the form back on the counter. I give it a quick sweep.

PLEASE PUT A CHECK BY THE SYMPTOMS YOU ARE EXPERIENCING: Late or missed period, check; Frequency of urination, blank; Breast tenderness, check; Fatigue, check; Change in appetite, blank; Nausea or vomiting, check.

DO YOU WANT TO BE PREGNANT? Yes, blank; No, check.

At this clinic, they always check no.

I'll take her to one of the counseling rooms and say, "Well, I'm afraid I have bad news" and hand her a tissue. They usually cry, like it's a big shock. Then they'll make an appointment.

At first I was the Patient Advocate. In the procedure room, I'd stand at the head of the exam table and try to talk the woman through it, distract her from what was going on at the other end of the table. At the worst parts, the cervical dilation, then the suction curretage, I'd offer my hand and the woman would usually take it. At the end of the day, my hand would be red and bruised, sometimes cut by their fingernails. Now I assist the doctor and I don't have to talk to the patients as much.

After I'd worked here for a few weeks, Maggie, my boss, asked me if I'd had any clinic dreams. I was surprised that she asked because I had in fact been having clinic dreams. They were usually the same. In the dreams, I was covered in blood that I couldn't wash off. I hated getting those dreams because they were just the sort of stupid, cliched dreams that someone who had never worked here might imagine they'd get if they did work here. I was disappointed that the dreams weren't better.

The first fetus I ever saw was a conjoined twin. As Patient Advocate, I didn't see what went on in the lab or what was carried out of the room in the aspirator jar, covered by a paper drape, but Maggie thought I should see this one, it was such a rarity. She said, "Jill, we've got this amazing POC." POC is Products of Conception, the clinical term for everything we remove from the pregnant uterus. The POC was fascinating, like something out of those freaks-of-nature books, only right there and palpable. One set of legs with two branching torsoes, perfectly intact, the whole thing barely two inches long. The two thin, rubbery arms between then--one twin's right, the other twin's left--reached toward each other and crossed at the wrists.

I had just left the patient, the almost-mother of the two- headed baby, with the nurse in the recovery room and Maggie told me I should go back there and tell her what we found, so that she'd know she had made the right decision.

I still remember the patient. She was younger than me and already had three children. She was sitting in one of the brown Naugahyde recliners that lined the walls of the recovery room. She had a heating pad on her abdomen and was sipping ginger ale. Kara, the nurse, was taking her blood pressure. I smiled down at the patient and waited for Kara to finish. When she pulled the stethoscope away from her ears, I said, "How's she doing?"

Kara said, "Everything looks great."

I said, "Good." I patted the patient on the shoulder and waited in the hall for the next procedure.

_____

The Director of Counseling Services for Family Planning Associates, Inc. has sent us a memo regarding The Getting of Empathy. He writes, "We know how seriously you take your work and how much you care. We understand that at times you may feel that your participation in an abortion procedure is the direct result of a woman's failure to properly implement a program of effective contraception. This may lead to unfair judgementalism. But please be aware that, theoretically, the average healthy, sexually active woman could conceive as many as forty-seven to fifty-three times throughout her reproductive years. So, when you help her resolve one, or even several, unintended pregnancies, you should feel relieved that she has not reached her reproductive potential. And reassure yourself: If you weren't there to help, this same woman might be forced to become a mother. Is that a better alternative?"

It's cold out, that dull cold just before snow. Business for the free walk-in pregnancy testing is slow; bad news can wait in bad weather. I lean against the front counter and watch the shadows of the picketers moving back and forth through the slots in the window blinds. Family Planning Associates, Inc. believes in service accessibility, so our clinic is a storefront in a strip mall. We're sitting ducks.

I walk over to the window and open the blinds a little. I watch the sky, gray and darkening behind the picketers. The clouds hang heavy and thick with snow, a second-trimester sky, four fingers below the umbilicus, too late for our help.

There aren't many picketers today, just three of the regulars. I see them so often, I've given them names. The fat woman pushing the stroller is Chuckwagon. She's breast-fed at least three different infants since I've been here. The lady with the frizzy gray hair is Witch Sister. One morning as I was coming to work, she stopped me on the sidewalk and told me that she was going to put a spell on my car so that it would crash and kill me.

The guy with the sign that says "What if the Virgin Mary had Family Planning?" we call Fetusman. He carries a plastic model of a twelve week fetus in his pocket and whips it out when patients walk by. One time he shook it in my face and said, "Do you know what you're doing? Do you know what those sweet babies look like? Stop the slaughter of the innocents!" I started laughing. I had seen at least three hundred fetuses by then.

Maggie had Fetusman surveilled by one of the pro-choicers who volunteers as a patient escort. We found out that his name is Tim, that he's a member of Our Lady of Guadalupe parish, and that he used to work in the men's department at Dillard's before he was fired for putting religious tracts in the pockets of the merchandise.

I like to taunt him. One morning he dropped his plastic fetus under my car while I was parking. I got out of the car and told him that I'd call the police if he touched my car and I stood out on the sidewalk, my arms crossed, and glared at him while he circled my Mustang. His chin twitched, like a little boy about to cry. After a while, he said, "You're too pretty to do this work. Girls with nice cars shouldn't do this kind of work."

I said, "You are so stupid" and went inside, angry with myself for not saying something better.

I watch him march back and forth and try to imagine what I'd think of him if I had met him somewhere else, away from this clinic, in a college class or at a party, a place where the subject would never come up. I wonder if he plays tennis or does yard work. I wonder if I'd like him if I didn't have to hate him.

_____

Maggie says she hired the new doctor because of his butt. She's right. It's gorgeous and he's gorgeous, like a glamour-boy TV doctor. Kara calls him Dr. Ken Doll. A few of the patients have complained of his handsomeness. They're embarrassed to meet him under such circumstances, to have to show themselves to him under bright lights.

The new doctor is a big change from the last doctor. The last doctor was so old that once he reminisced about giving Marilyn Monroe a pelvic exam when he was a young resident at Cedars-Sinai. "She was a beautiful woman," he said. "Inside and out."

_____

I play Patient with the new doctor. We're setting up for clinic when he calls me back into one of the exam rooms.

"I'm having trouble adjusting these stirrups," he says. "I need you to help me out." He says this for Maggie, in case she's nearby listening. He pulls down on the roll of table paper till the paper accordions to the floor. He pats the edge of the table, smiles.

The white paper rustles as I stand at the edge of the table and pull myself up. I sit there for a moment and stare at my shoes while he fiddles with the knobs at the sides of the table.

"OK. Lie back, put your legs up."

These are surgical stirrups, the kind that cradle the back of the knees. I lift my legs, spread them, bend them over the stirrups. The doctor pushes at the insides of my knees, looks at the distance between them and nods. He moves his hands up my legs, then pushes my green scrub shirt up around my ribcage. He leans over and kisses my stomach, just above my navel. I like this. I like him. But I fold my arms across my chest and study the poster on the ceiling--The Female Reproductive Cycle--like I'm having an exam.

I'm wrapped on the table in blue paper drapes. He smoothes the paper across my hips, says, "I don't like these paper things. I won't have them in my private practice." He tells me how his patients--all upper middle class (he says "UMC"), educated, well- groomed and hygienic--will be blanketed in dusty-rose flannel ponchos and lap robes; how they'll be so cozy they'll never want to leave.

He says, "And you can be my assistant."

"Uh-huh," I say. "Great. OK."

I glance at the chart before I go into the room. The patient's name is Neal, Keesha Lee. She's fifteen and this is her first pregnancy. I look at the line on the chart that says Method of Contraception: None. We'd better get acquainted. She'll be back in six months.

Keesha Lee Neal is lying back on the table, her arms straight down along her sides. Sharon, the Patient Advocate who took my place, is talking to her, explaining the pelvic exam the doctor will do before he starts the procedure. Sharon is a facts-only kind of a girl. She doesn't make much small talk. I think she makes the patients nervous and the new doctor hates working with her, says we have more screamers here than at any clinic he's worked at.

I stand by the doctor and hand him a latex glove from the instrument table. He says, "Thank you," and snaps the glove onto his right hand. He reaches his gloved hand toward me, wiggles two fingers. I squeeze on the KY jelly and he smiles, rubs his thumb and fingers together.

Keesha Lee Neal closes her eyes during the exam. The doctor presses on her abdomen and says, "You're really early. About five or six weeks." Keesha Lee Neal doesn't say anything.

Sharon looks down and smiles at the patient. "Hold on just a minute, sweetie, while they set up." I hate the way she says "sweetie."

Keesha Lee Neal has long legs and her right foot hits the edge of the instrument tray that's at the bottom of the table. I start to wheel the tray back, but instead reach up and grab Keesha's foot. I give her toes a little tug. I say, "How're you doing up there?" I think, I need to quit this job before I start to get good at it.

Keesha opens her eyes and sits straight up on the table. She says, "I don't want to do this."

We get this sort of thing at least three times a day. Sharon strokes Keesha's arm and says, "Honey, lay back down. It'll all be over in less than five minutes."

I look at Keesha. She's so beautiful. Delicate features and smooth, dark skin, her black hair pulled back in a red bow. I've seen the expression on her face probably a hundred times, but just now recognize it. Her eyes are blank. She's moved to the center of her body, where the pain will be. I tell Sharon to be quiet. I tell the doctor to leave the room. He shakes his head, laughs handsomely, pulls the latex glove off, flicks it into the trashcan. They both leave and I slide the door closed behind them.

I sit down on the doctor's rolling stool and push it up close to Keesha. She pulls on the blue paper draped across her waist and thighs.

"Are you cold?" I say. "Do you want a blanket?"

"No."

"Tell me what you want to do."

She sits quietly on the edge of the table and crumples the blue paper in her fists. Though I know everything about conception and contraception and am surrounded by posters of reproductive organs and plastic pelvic models with movable parts, I'd forgotten about intercourse, the intricacies and complications and random fusions that bring the patients here. I stare at this beautiful Keesha and I think she's so young and wonder what she could possibly know. I hope her boyfriend was sweet to her. I know he's not in the waiting room.

I say, "Do you want to be a mother?"

"No."

"Do you want to put your baby up for adoption?"

"No."

"So you want to have the abortion?"

"No." She's crying. She says, "I didn't even want to do it. I didn't even like it."

I stand up and put my arms around her. She presses her face against mine. Her cheek is hot. "You've got some time," I say. "You can think about it some more."

"OK."

"You want to get dressed?"

Keesha's clothes--jeans, a nubby red sweater, and a pair of dull yellow underpants--are folded neatly in a chair next to the exam table. With one hand, I reach over, pick up the underpants.

"Here," I say.

"OK," she says.

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