On Rejection, Abortion, and What’s Left Behind

September 14, 2022 | 8 min read

“Do you like your job?”

From one working mom to another, it’s always a loaded question. This time it was particularly fraught. The woman asking me—I’ll call her Mailea—was my patient. She was on her back, knees splayed. I was about to perform her abortion. 

“I do like my job.” I said.

“What do you like about it?”

I thought about this for a moment. “I like putting people at ease,” I said, “treating them with respect and keeping them safe, at a time when they might otherwise feel vulnerable and afraid.” 

I touched the inside of her leg, placed two gloved fingers inside her vagina and, with my other hand, pressed on her abdomen. I often talk with my patients during their abortions. Many of them want to be distracted; we’ll talk about what food they’re craving, or what movie they’ll watch with their kids that night. Some, though, go straight for the deeper topics, the harder questions. They seem to be searching for something, some kind of meaning, in the space of our 15-minute visit. I pressed the speculum into her vagina. “You’ll feel some pressure now.” She was quiet. I felt the silence between us like a gulf, or maybe a bridge—I didn’t know which.

“What do you do for work?” I said after a while. I wasn’t sure what I was doing with this question—trying to reengage Mailea, or merely distract her? Or was I trying to satisfy my own curiosity? Something about her intrigued me. She had a calm, self-assured presence, the air of someone who went for what she wanted and got it.

“I’m the editor of a magazine,” she said.

My heart rattled in my chest: an instinct, an alarm. “Oh? What magazine?” I steadied my hand, placing an instrument, aiming a needle, injecting medication around her cervix. She told me about her work for a small, online publication that she and a friend had started, an “arts-as-activism collective” centered on climate change and environmental justice. 

“I love it,” she said. “I can work part time, and from home, which is perfect for me since I had my son two years ago.” 

My heart calmed; my hands steadied. “I’m going to dilate your cervix now,” I told her. “You’ll feel strong cramps that come in waves. Just breathe through each one.”

In between breaths, she kept talking. She explained the mission behind the magazine: how she and her colleagues believed in the power of the written word to change people’s minds and bring them together, to heal not only individuals, but communities, even the planet. She told me that before today’s appointment, she’d written a letter to some of her close friends about her decision to have an abortion, asking for their support and solidarity. “It really helped me to share it with them. It helped me not to feel so alone, you know? To let go of the shame.”

There was that alarm again, a rattling inside my ribcage. Shame. I shook it off. I was almost done with her procedure now. Through a small tube, a gentle vacuum, I pulled the tiny, early pregnancy out of her uterus and deposited it into a dish. I told her I’d be back in a minute, then stepped out of the dark room into the fluorescent hallway.

In the lab I strained the material from Mailea’s uterus through a sieve. A fluff of gestational tissue flashed white against red blood: the pregnancy. I swirled it in a clear dish, watching it drift for a moment, singular and weightless, before I emptied it into its legally mandated destination: a red biomedical waste bin. Later that day, it would be incinerated. She would leave this behind.

*

When I was young, I used to tell everyone I was going to be a writer. I wrote dozens of short stories and sent them off to magazines—The New Yorker, Harpers, The Atlantic. I was twelve, thirteen years old. No editor ever wrote back.

Once my father gave me a strip from the Peanuts series, in which Snoopy sits atop his doghouse typing furiously: “Gentlemen, Enclosed please find the manuscript of my new novel.” In the next frame, Charlie Brown brings Snoopy a letter in response: “Dear Contributor, Already we hate it.” My dad watched as I read the comic. He laughed and laughed. I smiled up at him, pretending to get the joke.

My dad was an engineer with a deep creative streak. He built most of our furniture in his basement woodshop, sang Christmas carols with abandon, played the piano decently. He was an excellent and passionate cook. Although not an artist himself, he held a deep reverence for what he would call “professional” or “real” artists: those who were dedicated to their craft and who were, in turn, recognized in their field; artists and writers who were known, published, awarded, acclaimed. He held a corresponding contempt for what he called “wannabe” artists: people (particularly women) who talked about their art (the instrument they used to play in high school and might one day pick up again, the novel they planned to write), but who never followed through with their grand plans, never produced anything of real value. To believe in oneself, in one’s own worth and talent, without any external validation was, to him, the height of vanity and hubris.

I didn’t become a doctor in order to please my dad. But I did become a doctor, at least in part, so I could set my sights on something honorable, meaningful, and measurable, and achieve it. Also, I did it so I could stop telling him I was going to be a writer.

Throughout my medical training, however, I found that I couldn’t stop writing. In fact, the work I was doing and the world I inhabited with my patients was so raw, urgent, and moving, the compulsion only grew stronger. I used every precious minute of my free time to write—usually in my diary, occasionally publishing short narrative essays in medical journals. I pretended writing was just something I did on the side, a hobby. I didn’t tell anyone—including my dad, including myself—that I still wanted to be a writer: a published writer, what my dad would call a “real” writer. 

Instead, I was a doctor. And despite hating almost every minute of my training, I found some parts of the work deeply rewarding. I discovered that I loved caring for pregnant women, particularly those whose pregnancies were unexpected or unwanted. I completed my residency and went into practice. I got married, had a baby. I kept on writing, always “on the side.”

A few years ago, shortly before my dad died, I wrote a book, mostly while my infant daughter slept. It was a memoir of my training and work as an abortion doctor, framed by the story of my pregnancy. I found an agent willing to represent it. She sent the book to more than thirty publishers. It was rejected by every single one. By the time I truly understood that the book I’d written was never going to be published, I was pregnant with my second child. I should have been glowing with pride and expectation, but I could not stop crying. 

I went to see a prenatal counselor, where I sobbed and sobbed. I have no idea what other women talk about at the prenatal counselor’s office. I don’t think I uttered one word about the pregnancy, or the baby, or any of the things I was supposed to be focused on. “A disappointment,” was all I would say, through my tears. “It’s sort of a professional disappointment. Something I really thought would happen, and then it didn’t.” The counselor didn’t push me for details. 

I gave birth to our son. A few weeks later I returned to see her, still crying. Finally, after all those months, I forced myself to tell her the truth. I was so deeply ashamed I could barely get the words out. My hands trembled. I wasn’t just ashamed of the book’s failure, but of my own selfishness, that I could cry over this disappointment while nursing my beautiful, healthy baby. Look at what I had. Look at how fortunate I was. And I was dwelling on this: my stupid book, my stupid dream. That was three years ago. 

If the prenatal counselor felt out of her comfort zone, she didn’t show it. Now it occurs to me that my problem may not have been so different from the typical referrals she saw, including the many women who must have been referred after a miscarriage. Something I really thought would happen, and then it didn’t. She never offered practical suggestions, never said I should find a new agent, never said, “What about self-publishing?” as so many well-meaning friends did. (“I could never self-publish it,” was my repeated response to those friends. “That would be worse than not publishing it at all.”)

Instead the counselor looked me in the eye. “The question now is,” she said, “what meaning will you make of this great disappointment?”

*

Shame is an enormous emotion. It is so diverse and pervasive, it can be hard to recognize, even for someone who encounters it every day. For me, shame is located in my secret life as a writer, in the pain of rejection, and the sting of my dad’s derision for “wannabe writers” like me. For my patients, shame is located in their wombs, in sex, in their choices and in their bodies. It is a different shame, and, of course, it is exactly the same.

Here is another way of saying what I said to Mailea: what I like about my job is meeting a woman who is carrying shame, and giving her a chance to let it go. By talking about her abortion as a choice with which I trust her completely, by treating her with respect, by keeping her safe and comfortable, I allow her to hand some of her shame over to me. I offer to hold it for her.

Not every woman takes me up on that offer. Some cannot let go of their shame. These are the ones who shake and cry the whole time, who won’t look me in the eye, who are angry with me. But most of them can let it go, at least part of it. They seem relieved to hand it over to someone else, even just for those 15 minutes. And some of them, I believe, actually let go of their shame forever. They walk out of that room a little bit lighter—not just because of what I’ve removed from their bodies, but because of the burden they’ve left behind.

When I insisted, for those three years, that I would never self-publish the book, I was thinking, of course, of my father: what he would say about a writer who refuses to take “no” for an answer, a “wannabe” writer who insists on promoting her own work after it has been deemed undeserving of publication. But I could not shake the counselor’s question. It seemed to me I had two options: to dwell in my own failure and shame, or to move past it—across it.

Does the book deserve to be published? I guess I think it does. Sometimes, of course, I falter in that belief. I still look at the floor whenever I use the phrase “self-published.” I believe if my dad were still alive, he would look at the floor, too. In my privileged life, that is perhaps the greatest disappointment, the deepest shame I’ve ever known. But what I am trying to do—here, on this page—is to make some meaning out of it. Like my patients (at least in some ways, not quite like them in others), I am looking for someone to whom I can hand my shame. I am asking of you, reader, what Mailea asked of me. 

Do you like your job?

Back in the procedure room with Mailea, I told her that her abortion was complete. She nodded and thanked me. Then she closed her eyes, and I saw tears gathering at the edges of her lids. I paused for a moment. Then I said, “I know you told me you’re an editor, but by any chance are you also a writer?”

She opened her damp eyes. She looked at me. “Yes,” she said. “I’m a writer, too.”

“I thought you might be.” I asked her for the name of her magazine and told her I’d look it up when I got home. “I’d love to read your writing,” I said. “You have such a calm, confident presence. I bet you’re a great writer. And a wonderful mom.”

Her face crumpled and she began to cry. “I try,” she said.

is a doctor and a writer. Her essays have appeared in The New York Review of Books, The New York Times, Boston Review, The Point, Slate, and elsewhere. Her first book, Boundless: An Abortion Doctor Becomes a Mother, was published in September. She lives in California.

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