Strangers Curled Together on a Bed

hand laying face up on a bed

I sanitize my stories like I wash my hands–multiple times a day, scrubbing until they pose no risk to others, until they are tolerable. This raw, bloody, visceral experience is not for the general public. Abortion is a tidy stack of legal documents in the US, a fancy printed sign for a rally, not the actual bloody, crampy, jets of diarrhea and nausea, clot-filled experience that smells of bog and moss, of iron and pennies and insides and dark mystery. Back home, childbirth is doulas and soundtracks, handwritten birth plans and endless cute outfits. Here, 14-year-olds turn their heads away from the infants that tore them apart during delivery, ten months after their own childhood was ripped from them forcefully. How deeply engrained is the horror and shame we are taught about women’s bodies, about uteruses and pregnancy, bleeding and reproduction that I hesitate to write truth, even as I witness it?

I first conceived of becoming a physician during a traumatic childbirth in Morocco. I can do better than that, I thought, watching a man unskillfully provide care. And, she deserves better. That woman’s screams and the memory of her treatment was my north star for the next thirteen years as I attended night classes to complete college credits, then toiled through medical school and residency. After a decade of squeezing international work into vacations, I finally stepped away from the crush of the US health system to volunteer for ten months with a global humanitarian aid organization. Arriving here at the border of two war-torn countries to provide obstetrics and abortion care feels like kismet, a spiral of time circling me back around to provide care to birthing people, now with the necessary training.

It’s late. I’m coming from the ToP (termination of pregnancy or “expulsion”) room. A young woman has expelled a 22 week fetus; she’s still waiting to pass the placenta. After I tied off the cord with the cuff of a torn glove and separated the expelled bit, I sat down on the bare rubber mattress next to her. She has had a long day. Opting for an in-clinic medication abortion, she started this process yesterday with a dose of mifepristone and returned this morning to start taking misoprostol every three hours. Initially, there were two women with “big” pregnancies (local terminology for second-trimester pregnancies), strangers curled together on this single bed like family, but the second woman had to leave to take care of her children. She took some medication home and will come back at sunrise to continue the process. This patient remained here, alone.

I’m grateful she came. I don’t know the details of this woman’s story, only that she is pregnant and does not want to be. Even if she told me all the details–of the circumstances around the sex that caused the pregnancy, of the man, of what her family and community think of the situation–even if she told me in her words and I wrote them down, translated from Nuer into Amharic and English, I would never understand the nuances of her life. I know this: women[i] seeking abortions after their first trimester of pregnancy are disproportionately vulnerable, often young women, survivors of violence, and women facing barriers to accessing care. They are also at highest risk for resorting to traditional, clandestine methods of ending their pregnancies. Non-medical, unsafe abortions fill our hospital with hemorrhaging, septic women. Sometimes, I touch someone’s cold, dead hand and think about the laws that people with penises make to control the reproductive systems of people with uteruses and vaginas. I get so angry I can hardly breathe. I am glad she is not coming to me dead.

Around dusk, I realized that the single lightbulb in this bare concrete room doesn’t work. As the sky and ground darkened like ink dripping into water, I scrambled to make the space feel more comfortable. I cannot leave this woman alone in a bare concrete room at night, in the dark, while having cramps and expelling a pregnancy. Two male midwives told me that the bulb has been out for a month, then shined their iPhone flashlights into the circuit breaker box as though that would solve anything. I found a torch from the night guards and taught the patient how to turn it off and on. The midwives brought a bright goosenecked light from the delivery room into a storage area adjacent to the ToP room and aimed it at the shared ceiling, creating an ambient glow. Not perfect, but better.

Also better: I found some stainless steel bowls and plastic buckets. Before tonight, women expelled onto the cement floor beside them. (When I imagine the clean, beautiful rooms at my clinics in the US, I want to cry.) Afterwards, I picked up the fetus and placenta from the concrete, wrapped them in blue sterilization paper and took them out to the placenta pit. Our hospital’s biohazard and materials waste area, tucked at the far end of the compound, is rudimentary yet tidy. Furnace, ash pits, and a deep concrete-lined well with rusted hinged covers next to a sign: “Placentas, amputated limbs, aborted fetuses, body fluids, other organic matter.” I always feel a visceral revulsion, yet intellectually understand the waste management/sanitation/infection prevention and control plan. The US medical world is a sanitized bubble, far removed from the death, gore, stench, and decay that is the biological fact of life decomposing.

I know the expulsion process can take a while, and that clinicians here customarily leave women alone to labor, or cramp and expel, but it feels wrong to leave her alone in this room in the dead of night. We sat there together in silence, unable to speak more than one or two words in each other’s language. She curled her toes and moaned softly. I gave her more ibuprofen. She yawned and laid back, feet on floor, hips at the edge of the bed, and moaned again, rubbing her lower abdomen. The mosquitos landed on her exposed belly, thighs, on my arms and neck. I waved them away from both of us and made a note to hang a mosquito net above the bed. I wasn’t sure my presence was helping until she put her head on my shoulder. I rubbed her back and soothed her in murmurs. Her hair was scratchy against my sunburned shoulder. I often wonder if anything I do matters, and then there are moments like this.

Not enough staff and a still busy maternity ward, I eventually left her to check on my other patients. When I returned at 3:30am, I saw a shock of blood (as in, I had a momentary shock of panic about her safety) on the floor as soon as I shone my headlamp into the room. I checked the bed: Her body, lying in a curl, covered by her shawl. She opened her eyes and looked at me. She had expelled the placenta. It was over. We smiled at each other. She was okay. I started out towards the waste area, but, in the darkness between buildings, I got disoriented and spooked. Even in full sunlight, lifting the heavy cover of the organics pit brings to mind grotesque visions of amputated body parts and placentas floating in putrid liquid. Alone at night, the irrational fear of a hand reaching up from this hole and grabbing my ankle was terrifying. I turned back, returning to the bare concrete room spattered with blood. I looked around for a cleaner, for a midwife, for anyone, but all was quiet. The patient was sleeping. I checked that she had her torch, hesitated, then shut off the light and left her in the room. I didn’t know what else to do. I slept fitfully for 90 minutes, then got up when the sky started lightening. Back to maternity to grab the bucket again, then on to the waste area. I gagged and leaned back from the splash as I tipped the contents in, muttering all the prayers: Back to Buddha; My Goddess, from you life is given and to you life returns; in the name of God; All shall be well and All shall be well, and All manner of things shall be well.

Later today I will deliver a breech (he survives), a compound presentation (she survives), and the result of an obstructed labor (he is dead). I will feel the prickle of tears, or maybe fatigue, with each delivery, but right now, beside the placenta pit, I stop for a moment and look up at the early morning expanse of blue sky overhead. I know that safe abortions save lives as much as–maybe even more–than the obstetrical care I provide. That woman, curled on the bare bed, has been given her life again. I take a deep breath in, let it out, and head back to maternity.


[i] In this setting, my patients identified as girls and women. Not all pregnant people identify as such and I honor the non-binary, trans-folx, men, and others with uterii who can get pregnant, carry a pregnancy, have abortions, give birth, and menstruate.

Author’s Note: Millions and millions of women, girls, and people with uteruses have abortions every year. Abortions with pills, abortion by aspiration, legal and clandestine, joyfully, sorrowfully, neutrally. Abortion is common. When I write, I want to either highlight the universality of an experience (fear, loss, love, joy) or celebrate the astonishing courage of humans. I hope this piece does both.
Julia McDonald (She/They) is a queer artist, writer, and physician from central Maine. They spent most of 2021 working in east Africa. You can follow them on IG (@drjuliamcdonald) and blog (






Share on facebook
Share on twitter
Share on linkedin
Share on email

Leave a Comment