The diamond chip flashed, it twinkled, it caught the light like an errant tear. Claudia asked the usual questions, but Shannon didn’t want to talk about her pregnancy. She wanted to talk about her Monroe—a gift, she said, from her new boyfriend, Kyle.
“Is he the man involved with this pregnancy?” This was how Claudia had been trained to phrase it: no assumptions, no judgment.
“None of your fuckin business,” said Shannon F.
Women in crisis were not always charming.
Did Shannon have a phone number? Did she feel safe where she was living? Had she received any prenatal care?
No, yes, no.
Claudia asked, “How often are you using?”
Shannon crossed her legs, twig-like in the black stretch pants. It was hard to believe she was pregnant. Her suede boots—battered Uggs, probably fake—seemed too large for her feet.
She said, “Whenever I can.”
Her habit, like most, had started with a prescription. At fifteen she was thrown from the back of a motorcycle and broke her shoulder. When the Vicodin ran out, heroin was stronger and cheaper. In Boston—in all of New England—it was easily found.
She found heroin and lost weight, perspective, memory, inhibitions. She lost her keys and her phone, lost minutes and hours. Her period came a few times a year, or didn’t.
She lost her keys and her phone, but what did it matter? She had no car and no apartment and no one left to call.
A janitor found her unconscious in a gas station restroom, a scenario familiar to them both: it was the janitor’s second such discovery, Shannon’s third overdose. The emergency room doctor ordered an ultrasound. Her pregnancy was dated at twenty-three weeks.
“We have until Saturday,” Claudia told her. “In Massachusetts the cutoff is twenty-four weeks. After that, we can’t help you.”
Shannon’s eyelids looked heavy.
“Shannon, do you understand?”
No response.
“Shannon?”
Her eyes clicked wide open like a doll’s. “Jesus. Yes, I understand.”
“Okay, just checking.” Claudia kept her voice even. The patients could be as rude as they wanted; they could tell her to go fuck herself, as long as they stayed awake. If they nodded off before the procedure was explained, they couldn’t give informed consent.
“Oh, for Christ’s sake! I know all this,” Shannon said. “They explained it all last time.”
She’d been pregnant twice before. The first time she gave birth to a son, now six years old and in DCF custody, her parental rights terminated. The second time, she came to Mercy Street. She explained this to Claudia matter-of-factly, without embellishment. Her narrative had a succinct, executive quality, as though she were in a hurry. As though, on the pedestrian mall at Downtown Crossing, urgent matters demanded her attention: questions of global economic collapse, impending crises of state.
Claudia explained that at twenty-three weeks, the procedure was more complicated. Shannon would need to see the doctor twice, on two consecutive days.
Shannon rolled her eyes heavenward.
The boots were definitely fake.
Informed consent, that was the standard. A lawyer might argue that it wasn’t possible at all, if the patient was high. By that measure, Shannon’s consent was unattainable. Claudia would have had to travel back in time several years—long before there was a pregnancy to terminate—to find a day when Shannon didn’t use.
For such patients—Claudia knew this—consent was a fairy tale. Shannon’s entire sexual life had happened without it. She’d lost her virginity at fourteen, an age when legal consent was impossible. By the time she reached the age of consent, she was high every day. This AB, or the last one; the haphazard intoxicated couplings that landed her, periodically, at the door of the clinic: Had she consented, legally, to any of it? Her childhood and her addiction had overlapped seamlessly. At no point, ever, had she been a sober adult.