Obstetrix by Naomi Kritzer
TO MY DAD,
BERT KRITZER
CHAPTER 1
I HAD A NIGHTMARE again about the trial, and woke up sweaty and angry, although the “sweaty” part might have been a hot flash. I lay awake in the dark, thinking about menopause instead of the trial. Were my symptoms bad enough to merit a prescription for estrogen? I thought about the speech I gave my own patients: every treatment comes with trade-offs. Side effects or long-term risks. You’re the expert on you. What does your intuition tell you?
I finally gave up on sleeping again right away and reached for my ereader. I liked to settle my mind at bedtime by rereading an old favorite, and I had been rereading a particular favorite over and over since I got arrested. A few pages in, my eyes grew heavy again, and I set it aside and dozed.
I had to drag myself up when the alarm went off. It was a bright, cold winter day, the kind where even if there’s nowhere for a draft to get in, the cold seeps through the windows and walls. Since I had a job interview, I put on makeup and did my hair. The scent of the foundation reminded me of the trial, too—my attorney had insisted I wear makeup every day, and also a dress, the more femme the better. Even though there, my intuition said I should wear a suit—something that said “doctor,” that said “authority.” I had deferred to her instructions. And, well. I’d gotten off, after all.
I had some coffee, checked my appearance one more time, did my best to shake off the lingering anxiety from the dream or the interview or both, and headed out.
* * *
THE INTERVIEW WAS AT a new maternity practice, associated with an even newer maternity hospital, built to solve the problem of obstetricians leaving the Dakotas. If you had the money, and especially if you had any sort of high-risk pregnancy, you could temporarily move to Minnesota and give birth here. Three big, ugly apartment buildings just north of I-94 offered spare furnished apartments; the clinic and maternity hospital (“All we do is babies, and we do it well!” announced highway billboards) were just down the road, with the top-notch NICU facilities of St. Paul Children’s nearby, should anyone need them. The clinic was called MinneBaby, and to be honest, I hated this name, but fortunately I knew through the grapevine that everyone who actually worked there called it MB.
The MB clinic was in an office park, and I walked in through the main entrance, through a lobby full of heavily pregnant women, a few with toddlers in tow. A gray-haired woman in a white coat came out and waved when she spotted me. “Are you Dr. Elizabeth Gwinn?”
“Liz, please, but yes, that’s me.” I followed her back to a meeting room, where a circle of doctors waited for me.
The interview went fine, right up until someone asked why I left my last job. The first time this happened in a job interview I actually blurted out, “Didn’t you follow the news coverage?” and it still threw me every time—how are you an obstetrician who doesn’t know about this? One state over? But sometimes they knew and just wanted to hear how I framed the story, so I took a deep breath and summoned up my well-rehearsed answer.
“I spent most of my career in Minot, North Dakota. Last year I had a patient with severe treatment-resistant hyperemesis gravidarum. Her kidneys were failing, and I performed a termination, at her request. The prosecutor decided to make an example out of me and filed charges. I was acquitted after a trial, but I decided I didn’t feel comfortable working in North Dakota anymore, so I moved here.”
Light dawned. She had heard the story, but she hadn’t connected it to me. “I thought that doctor—er, I thought I heard you went to work at the big abortion clinic in Illinois.”
“They offered me a job, but I actually prefer maternity care. I just need to be able to take care of my patients to the best of my ability.” Going on trial had been terrifying. Aside from my bitterness toward my home state, I knew myself well enough to be pretty sure that my clinical judgment would be impaired by my own desperate desire not to wind up in that position again.
“Doesn’t the law provide some sort of exception for the life of the mother?”
“Well, that was kind of what the trial came down to. Whether my patient was sick enough for that to count. The prosecutor said that she had ‘morning sickness,’ like any woman with a wanted pregnancy would terminate for something they could have managed with saltine crackers or even Diclectin or ondansetron. My patient was in recovery from an eating disorder when she got pregnant, and she’d started out seriously underweight. She lost thirty-six pounds from the hyperemesis, and her labs showed her kidneys were failing. The prosecutor said the kidney damage I was seeing was from the anorexia rather than from the hyperemesis.” It was quite possible that she’d started the pregnancy with compromised kidneys and not realized it. “The course of HG can be unpredictable, and the prosecutor pointed out she might have spontaneously recovered from it the day after I performed the abortion.”
There were other reasons Maddy had wanted to end the pregnancy. This hadn’t been planned. She’d wanted to leave her husband, not have a child together. She’d clawed her way back from full-blown anorexia to a fragile recovery, and she’d immediately feared that this pregnancy was going to cause her to relapse.
She’d begged me to terminate the pregnancy.
And then she’d testified against me. I don’t know exactly what happened between the day I performed the abortion for her and the day of the trial, but I’d heard she’d reconciled with her husband, and it seemed to have something to do with pressure from her parents. My lawyer thought the prosecutor had leaned on her, threatened to charge her criminally for the abortion as well, because on the stand she blamed me for not doing something else. Anything else. What else? How would she know, she wasn’t a doctor, just a mother who would never hold her baby because I had taken it from her.