by Victor Koman
"When I was nineteen," Evelyn said, her head lowered, "I had an abortion. I was forced to make a choice no one should be forced to make-to kill a tiny little human or let one night's mistake rule my life forever. Well, I killed it. And it's ruled my life, anyway."
She took a shallow, sobbing breath. Hesitantly, David put his hand on her shoulder. If she noticed, she made no sign.
"All my life since that day I've tried to find a way out for other women. Find a way to protect that fragile, tiny human life while protecting the freedom of the full-grown woman." She gazed up at the man.
"Her life's just as fragile, you know."
David nodded. His anger had turned to wonder and con-cern. He had never seen a doctor cry. He didn't think they could.
Karen's eyes brimmed with tears. She took two tissues from the bedside box and offered one to the other woman.
Evelyn accepted it, smeared at her eyes with it. It didn't bother her-she never wore makeup. Karen dabbed at her own eyes. She wanted to reach out and hold the woman, but she was beyond her grasp.
"I made a desperate choice in helping you." Fletcher's voice lost all trace of dispassionate medical calm. "Now I have to make another choice that could undo everything we've achieved."
"I'm sorry" was all that Karen could say. They sounded like the emptiest, least helpful words in the human language.
VIII
This was the day she had hoped to avoid. She knew it would happen, she had simply hoped to put it off indefinitely. Infi-nitely.
A doctor has many difficult moments, moments she wishes would never have to occur. Regrettable moments that deal with unavoidable death or grieving relatives or angry patients. The standard, rehearsed words of comfort or confrontation can usually calm a tense situation, but even if not, the parting is generally professional and permanent.
Evelyn Fletcher, M.D., Ph.D., took a long drag on her ciga-rette, set it in the ashtray, and watched the smoke curl up past the cone of light from her desk lamp into the darkness of her office. In this situation, she was facing the end of her medical career. Words would be useless. She had endured another crisis just as severe years ago: the day she had to tell her boyfriend that she was pregnant and had decided on an abortion. Words could change nothing then, either. Ian Brunner was another premed at UCLA in the late 1950s when the world took a breather between Korea and Vietnam, between the Air Age and the Space Age. Between D-Day and Dealy Plaza.
He sported a crew cut, skinny tie, and spoke of medicine as a way to make a great living. His only regret was that he had to be around sick people all the time.
Ian and Evelyn were an odd item at the school functions. She dressed like a beatnik in black leotards, black dance shoes, and a black cashmere sweater that hung to her thighs. Her jet-black hair, pulled into a single thick ponytail, reached down to the small of her back. This did not endear her to the more staid eighteen-year-olds in premed. That she carried a copy of Gray's Anatomy instead of Sartre's Nausea set her apart from the beat crowd, too.
She liked Ian, though, with his conservative trappings that failed to disguise a rebellious streak. If their academic records had not been so superb, their notorious behavior might have gotten them sacked in their first year. Both, however, enjoyed their studies as well as their lives. That was why she never quite understood his reaction to her announcement. They had finished a chemistry class to-gether and gone for dinner to Ship's on Wilshire, a brisk walk of a few blocks in the cool winter air. She was troubled all the way, not really knowing how to broach the subject. All through the meal she had a sinking feeling that no matter what she chose, things would change between them. Finally, on their way back, she lit up two Camels, handed one to Ian, and said, "A friend of mine died today."
"Who's that?" he asked.
"A rabbit named Friedman."
She didn't have to elaborate.
He took a long drag on his cigarette. His expression was unreadable. "So what's the plan?"
"I can't have a baby," she said in an apologetic tone that surprised her. "I've got years of med school ahead. I'm seeing someone tomorrow to get"-her voice caught for a moment-"to get it fixed." They walked in silence for a long time. Finally, his voice cool and muted, he asked, "Is it mine?"
"Yes."
He flicked his cigarette into the gutter. "Are you sure?"
She stopped to stare at him. "Yes. How could you doubt me when I-" All pretensions of cool adulthood fell away from him in a blaze of anger. "I don't see how you could go ahead and just kill it. Kill it! Take a miracle like that and-"
"Ian, I-"
"Don't try to rationalize it. It's your body. Go ahead and get sliced up. Just don't pretend you're not killing our baby."
Without a glance back at her, Ian strode away into the night.
That was the last conversation they had ever shared. When Evelyn visited a Santa Monica doctor the following evening, she went alone, lonely and scared. When the deed was done, she slipped into the darkness to seek out a hotel room nearby. She spent two days there, in bed, coping with the physical and spiritual pain of her decision.
It was in that drab room with its window overlooking the bright and beautiful Pacific that Evelyn first came to realize that there had to be a way out of the horrendous morass of death and guilt that surrounded abortion.
She returned to her classes the next Monday and never slowed down. She entered medical school four years later, concentrating on reproductive endocrinology. If she found out the how and why of pregnancy, she could find a way to free women from abortion.
Studying birth and death would be her life.
"
It was twenty years later that she experienced her final, cru-cial insight. Soaking in the antique tub in her small bathroom, she read through a stack of medical journals at a swift but-for her-leisurely pace. Every fifteen minutes or so, she would drain two inches of cooling bathwater and add the same amount from the hot tap. She also added more jasmine-scented bath foam in order to maintain the heat-trapping layer of bubbles that surrounded her.
The effect of all this on her magazines elicited clucks of dis-approval from any colleagues who happened to see one of the warped, stained periodicals on her desk at the medical center. Letting a copy of the New England Journal of Medicine degen-erate to such a condition was equivalent to using the Bible as a doorstop.
Her usual riposte was that she, at least, read the bloody things.
Immersed in the issue of Microsurgery Proceedings she held inches above the surface foam, Fletcher quickly scanned through articles until one headline fairly leaped out at her face. It was not a particularly dramatic title: "Some Progress in Vas-cular Reattachment and Nerve Connection in Transplanted Rat Cerebral Tissue." The body of the article, though, outlined a delicate and egregiously complicated microsurgical laser tech-nique for attaching the minuscule blood vessels and nerve junctions of a rat brain inside the cramped environs of an-other rat's skull.
One would not expect a rat to survive such cavalier treat-ment, but the one in the article did. Not only that, it also ex-hibited a small degree of motor response and ate what the brain's previous owner had been trained to eat. The rat died a week later, succumbing to foreign tissue rejection. Such an article might not in itself have intrigued someone interested in reproductive endocrinology except that it out-lined in fairly rigorous fashion each step involved in the mi-crosurgical process. And Fletcher had just finished reading an article in Fertility Week that outlined the latest progress in nonsurgical ovum transfer in the cattle industry. Adrift in the warm, softly undulating waters of the bathtub, Evelyn laid the magazine down on the stack nearby and closed her eyes. Thoughts and images associated freely in the open frontiers of her mind. This was the time in which her wildest dreams occurred. Not in sleep, that lost, aimless time when unbidden symbols clashed pointlessly in obscure meaning. In the world between full alertness and relaxed bliss lay the realm of focused imagination.
Jasmine drifted into her nostrils. Steam
dripped from the mirror and the walls. She was once again in placental warmth, her body supported, her mind free to wander.
Non-surgical ovum transfer sounded promising for human infertility. It was no answer to abortion, though, because the fertilized ovum could only be removed before it implanted in the uterine wall. A woman would have to know she's pregnant less than five days after conception in order to have the egg lavaged out. As a treatment for infertility, it had-as the au-thors suggested-great promise. To remove an embryo that had already implanted, though, involved cutting or tearing away infinitesimal connections between the embryo and the forest of capillaries in which it nests. Connections that grow stronger, thicker, and more complex with every passing day.
By the time a woman realizes that she's pregnant, the fetus has already made itself at home. Still... She knew that late-second-trimester abortions were some-times performed in such a way that the fetus survived only to die of intentional neglect outside the womb. Such stories chilled her, just as she was warmed by the apocryphal tale of the woman who changed her mind after such an event and took the living child home with her.
A fertilized egg is viable outside the womb; it can even be frozen and stored indefinitely. A fetus is generally viable out-side the womb after the twenty-fourth week or so. But for twenty-three weeks the fetus requires a uterus in which to attach itself. To remove it at any point during those twenty-three weeks is invariably fatal.
Unless one found another uterus, she mused. She sat up in the tub. That had always been her stumbling block. Abortuses were by their nature unwanted. Who would care for them if they survived?
Yet another bloated state bureaucracy? She was well aware of the sickening abuses within the government-financed orphanages and mental hospitals. But if another woman wanted it, if non-surgical ovum transfer could solve infertility, then surgical embryo transfer could solve abortion and infertility at the same time!
The two branches of medicine that seemed so vastly and inalterably opposed fused together in her mind. She closed her eyes and slid to chin depth in the warm waters. The scent of jasmine filled her as a bold new future formed out of dark-ness. Her career choice now made total sense to her. She would no longer need to justify aborting some pregnancies while ini-tiating others as merely "giving women a full choice." She would become the conduit between the two. One woman's choice to end a pregnancy would become another woman's opportunity to begin one.
It all seemed so sensible, efficient, and-she savored the word-moral that she felt an ancient guilt floating free from her as if it were being washed away by the water in which she reposed. This was the way. She had met her destiny face to face.
"
"Totally out of the question!"
Dr. Jacob Lawrence stared at her with undisguised contempt. He was fifteen years older than Fletcher and sometimes be-haved as if he had been born a century before. As a member of the ethics committee at Bayside, though, his support was cru-cial to any future research she proposed. The man with the thinning white hair gazed at Fletcher with rheumy eyes over his horn-rims. "You can't seriously ask the board even to review a request for such a project, let alone approve it."
"I'm not asking for an actual project," she said. "Just a study of the potential ethical questions. Obviously, there has to be a groundwork in animal research before we could even contem-"
"I don't care about the research. Things such as this should not even be open to discussion." He looked at her again, frown-ing. "You think something like this is even possible?" Fletcher spoke quickly, eagerly. "The fetus does all the work in a pregnancy. It generates the hormones, it makes the deci-sions. I'm certain that microsurgical attachment to the uter-ine wall of the recipient would be sufficient to allow the fetus to gestate in the new envir-"
"All right." Lawrence waved a hand for silence. Fletcher fin-gered the pencil in her hand; she knew better than to smoke in Lawrence's presence. Bayside's assistant administrator looked down through his spectacles at the pages before him. "I'm not going to leave this up to the ethics committee alone. I'm going to send it to an outside consultant. UCLA has an expert in infertility. I read something by him in JAMA last month. Works with pregnant women a lot. Ian Brunner."
Evelyn's fingernails plunged into her hand.
Lawrence rubbed his nose. "Ever heard of him?"
"Yes." She sat back, stunned. She knew what the outcome would be. "But wouldn't there be better qualified people at USC?"
Lawrence cleared his throat. "My dear, I am a Bruin."
And that settled that. "
It took Dr. Brunner two weeks to return a twenty-page de-nunciation, which she never saw. It took an additional two years of tabling and extensions by the ethics committee before they issued their own determination. Quoting liberally from Dr. Brunner's analysis, the committee essentially stated that surgical embryo transplantation was impossible, and even if it weren't, the ethical conundrum posed by using the fetus of one woman as seed stock for another made the entire proce-dure reprehensible from any viewpoint-ethical, moral, or legal.
"Two years wasted," Fletcher muttered over her coffee.
"What do you expect?" asked the lovely woman across from her. Adrianne Dyer possessed the kind of body that filled her tight uniform in ways that caught the eye of nearly every male patient, orderly, intern, resident, and doctor. It was not her fault, and she permitted no entanglements to mar her professional conduct. Fletcher liked the taciturn young woman and sought to trans-fer her to the Reproductive Endocrinology section. Right now they drank coffee in the cafeteria and discussed the scotched project.
"Hospitals will always be conservative," Nurse Dyer said. "They have lots of money to think about."
"Yes." Fletcher nodded. "Why risk it on saving a few lives?" Dyer shrugged, tossing her head in a way that sent a cas-cade of reddish-auburn hair whipping over her shoulder. "So work without their approval and give them a fait accompli." Fletcher grinned. "That'd sear their stethoscopes." Her good humor faded almost instantly. "I've been doing theoretical work and instrument design, but if I so much as thought about try-ing, I'd lose my privileges so fast my head wouldn't have time to spin."
"Reword it and resubmit it to a different committee." Dyer took a long draught of coffee while she watched Fletcher through deep hazel eyes. "It's worth the struggle." She fin-ished off the cup. "I'd like to help."
"Thanks. You know about me. What brought you to the point of wanting to help a mad doctor?" Dyer shrugged again. "You don't need to suffer a personal crisis to determine what's right and wrong. What you said makes sense. If you have a certain perspective."
Fletcher thought quietly for a long while. Dyer said nothing more, allowing the silence to continue. That afternoon, Fletcher forced through the nurse's trans-fer to RE. For the next six years they worked together, hypoth-esized, tinkered, researched, and conspired together. Though they rarely met outside the hospital, they spent countless days in Fletcher's office in after-hours' discussions. They imagined every possible ramification of surgical embryo transfer. It was Adrianne who coined the term transoption. Evelyn considered the word transortion for "transfer birth" as an alternative to abortion, "bad birth."
"Doesn't roll off the tongue well," Dyer said. "You shouldn't make it sound anything like abortion, anyway. Raises too many images." She thought for a moment. "Make it sound more like adoption. Doesn't something like transoption sound cheerier?"
Dr. Fletcher admitted that it did. "The transfer option. Transoption." She felt as if they had created something en-tirely new, exciting, and shatteringly important just by utter-ing a word. They were trailblazers on a new path for medi-cine, a new, wider road for human rights. The future lay daz-zlingly bright ahead. "
Now all that might collapse into lawsuits, prison, or worse.
Evelyn struggled to find a way to tell Valerie Dalton that she had a daughter. She ran through possible conversational sce-narios in the theater of her mind. None of them turned out well. Why, she finally wonder
ed, after lying all this time, should I suddenly tell the truth?
She thought out the details, then telephoned.
"Hello?" said the voice on the other end.
"Hello, this is Dr. Evelyn Fletcher at-"
"Oh, hi! You have reached Ron and Valerie's place," said the recording. "We're not in right now, or maybe we are and are listening to see if we want to talk to you."
"Christ," muttered Fletcher.
"But if you wait for the tone and leave your name, phone number, the day and time you called, a brief message, and three character references, we'll consult our attorneys and astrologers and get back to you. But don't get your hopes up. Thank you for sharing."
Fletcher used the time to light up a Defiant, take a few puffs, and frown. If she disliked anything, it was flippant-and lengthy-telephone answering messages.
The phone beeped. "This is Dr. Evelyn Fletcher of Bayside University Medical Center. I'd like to speak with Valerie Dalt-"
There was a clattering noise on the line, followed by a woman's voice. "Hello?"
"Valerie Dalton?"
"Yes."
"Dr. Fletcher. You were in to see me last March."
"Yes, Doctor. I remember. How could I forget?" Her voice was hesitant, curious at a doctor's call at such a late hour.
"I know I'm calling a little late, but we have a minor crisis here that I hope you can help us with."
"What do you mean?"
Evelyn took a deep drag, letting the smoke escape with her words. "We've gone over the records of our blood tests, and yours turned up as having the right combination of factors that could help us save a very sick baby here. What we'd like is for you to come in tomorrow morning for a more thorough screen-ing with an eye toward a transfusion."
"Oh, I don't really have the time to come-"
"Miss Dalton, I don't normally call complete strangers ask-ing for blood. This really is a matter of life or death."
