"Yes," the nurse at the medical clinic nods, "you are pregnant."
I'm in the stirrups, legs splayed open. The paper gown scrunches as I lift my head to look over at her. The last of my hopes fade as her lips settle to a firm line.
Maria's tired eyes reflect the gray screen of the ultrasound machine. I have two options, she begins: the pill or surgical abortion. There's a 15 percent chance the pill will fail, but it will be less invasive, with a smaller chance of infection. She presses a button to capture the image and rotates the small box toward me. With her index finger, she makes an invisible circle around the dark spot on the left corner of the screen. There's not much time to make a decision. The pill dramatically loses its effectiveness after six and a half weeks.
I ask if I can wait — my boyfriend won't be in NYC until Thursday. She loops a strand of disheveled, autumn-colored hair over her right ear. Her thin lips press firmly together again. Today is Saturday. It may be too late. If I choose to take the pill today, it'll cost $550. But, if I choose to come back for the pill, there will be $550 fee on top of the $250 fee for today.
"It's our policy," she shrugs when I ask her why.
I opt for the pill. She nods and leads me back to the receptionist. I sign a disclosure, pay, and then follow a nurse with baggy sky-blue scrubs that drag on the floor in to another room.
After a few minutes, a hunched-over doctor waddles into the room carrying a tiny metal tray with three cups: one plastic cup of water and two smaller Dixie cups. His hair is platinum white, and is, in fact, whiter than his lab coat, which appears to be as old as he is.
The round pills float on top of the water in my mouth before I swallow. It's no louder than any other swallow I've made in my life.
He slowly turns back around, and in his hand is a long plastic applicator with what looks like a large cotton ball at the top. "We're going to insert these four pills and that's it."
It feels no worse than a tampon inserted by someone else.
"Thirty minutes," the nurse says, giving me a three-finger okay sign. Every time she speaks, the words come out distorted, like she's sucking on a piece of candy too large for her mouth. She accidentally spits on me twice. "OK?"
I nod and she closes the door gently behind her.
The music is on low, like the music at cheap massage parlors. I'm suspended three feet above the air and naked except for the paper gown. Ten minutes in, Maria walks in with a white blanket, covers me and tucks me in. She ignores the tears running down the side of the exam table.
At checkout, I am told very little, just to call if I don't bleed. I hail a cab for the five blocks from the train to a friend's apartment, where I settle in for bed rest, cramps, and nerves — it doesn't seem possible for a body to bleed so excessively.
At my appointment the following Saturday afternoon, I tell them I spoke to my insurance provider, Consolidated Health Plans, and they will cover a portion of the abortion. Can I pay the rest after the claim is settled? The receptionist tells me their policy is that you pay before seeing the doctor. No exceptions. I sigh, too weak to argue with her, and slide over a credit card.
Waiting in the windowless room, I worry about bleeding on the slippery wax paper and the exam table. I think about my friend's ruined sheets. Maria walks in with my chart and automatically squeezes lube over the long ultrasound probe. After it's in, she frowns, flips through the chart forward and backward, and then looks back at the screen. I get a chill in the pit of my stomach that has nothing to do with the plastic instrument up my vagina.
"The pill failed." She pulls the ultrasound screen around. My eyes focus on the left corner of the sonogram; there's a blind white area where part of the fetus had been aborted. The other half is a dark, mutated edamame-bean-sized fetus, curled up and sitting tight. Hanging on. Not bled out.
I want it out.
Maria gets a surge of energy: What have I had to eat? They may be able to do the surgery today but we have to act fast. Is that what I want? She takes a look at her wristwatch.
I tell my boyfriend, who's been in the waiting room since noon, and he pays another $250. He is more confused than I am. I don't have the words or air capacity left in my lungs to explain. We wait together in our separate confusion, until the nurse comes for me.
No woman is proud to have an abortion. There's blame as soon as you put yourself in that situation. It's taboo. With personal beliefs, religion, and politics in play, it's hard to know who your allies are.
The following Saturday, I ask for an itemized receipt for all the services rendered. The receptionist glances up at me crossly, and agrees to give them to me at the end of my visit. Then she asks for $250 for the post-op visit.
Maria's tired, stoic eyes find nothing wrong with the empty walls of my uterus this time. I am so relieved all my energy seems to drain from the flats of my elevated feet.
Finally able to relax, I am dumbfounded when the receptionist refuses to give me itemized receipts. Both the women, the stocky familiar one and another receptionist I haven't seen before, tell me they spoke to their billing department, conveniently located outside of their office, and they haven't processed it yet. Why do they need to process it? I only want a receipt for what I've paid for, I tell them. I sit fuming in the waiting room while they call the billing department again.
It dawns on me as I look around the silent rectangular room with fake foliage and puffy clouds painted on the ceiling that everyone looks occupied. There are stacks of Cosmo, Bazaar, Vogue, Ellie, and People magazines to hide behind. No one makes eye contact. In my three visits, I witnessed numerous disgruntled women come and go, and instead of thinking anything was wrong with the clinic, I had also kept my gaze on the latest collar necklace trend.
After half an hour, I get three receipts: $250 for the first visit, $550 for the pill, $250 for the post-op, but none for the surgical abortion. We argue for another 15 minutes before I realize I'm wasting my breath; they have their repertoire down. I leave with the receipts clenched in a fist.
The next day, while at the laundromat near where I'm staying, I call the clinic. Outside, thick rolls of grey mask the sunny sky and wind and heavy rain come in through the propped open door. My voice rises in between cracks of thunder of a summer storm.
I gather that after receiving payment from me ($1,300 for the pill, surgical abortion and post-op), they are submitting claims to my insurance company. They will not give me the itemized receipt for the surgical abortion because if they do, then the payment would be made to me.
This clinic is one of many that provides services that give women more choices and more freedom with their body. Their "Commitment to Women's Health" motto on their website sounds lovely and supportive, except when the pile of hidden bills come crashing down afterward.
When it's piggybacking on the taboo and guilt already present in the horrific situation, women are less likely to protest unfair treatment or question medical costs; their hearts are in their throats and all they want is to have a choice. That being said, what quality of choice is it if before you are allowed to see the doctor, you have to pay a $250 flat fee? Or in the middle of a visit, while you're standing in a medical gown, you have to pull out your wallet again?
Part of it is the social acceptance, the glazed-over faces, propped behind magazines, that allow such clinics to survive and exist for the 33 years. In the midst of the pro-choice movement, aside from the constant political battle to keep our right to choose, the standard in abortion clinics is subpar medical care. Patient after patient leaves the clinic pissed and there's little that can be done about it.
I am livid; I call the insurance company who politely tell me they do not know who I can report Women Medical Center to before politely asking me if there's anything else they can help me with today. I file a complaint with the Better Business Bureau, who provide information for those looking for marketplace fraud.
I become obsessed and find reviews on Yelp.com. They have one star out of four, and the four women who have been courageous and pissed off enough to post reviews call my clinic a fraudulent clinic. After being paid in full up-front, they submit obscene, fraudulent bills to the insurance company and then slam the patients with the remaining charges the insurance won't cover.
I think about all the women who haven't posted reviews. I think about myself who didn't think about Yelp or BBB beforehand. I dismiss layers of dark thoughts; had they given me the pill correctly? Did the pill really fail?
After weeks of following up with my insurance company, I find out the clinic has filed a claim for $3,100 for emergency miscarriage charges: surgery, x-ray/lab, and miscellaneous fees. In addition, I receive three bills from the medical laboratory they sent my blood work to, for an additional total of $380. I call the clinic to discuss the insurance claim but the receptionist, a woman whose voice immediately becomes defensive when I tell her why I'm calling, informs me that she does not have the number to their billing department.
She will take a message.
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