Unlike the first two, the third one crept up, gray and hovering. There were no jolts of hot pain, or passing of blood and tissue, no waves of fear and nausea, no minuscule fetus forced from my body in a twisted version of labor and delivery. Instead, there was stillness, a dark bean-shaped smudge in the center of a screen, a cavernous silence where the whoosh and tick of a heartbeat once was.

For ten days this baby stayed with me in the warmth and darkness of my womb, no outward sign, not a whisper of distress.

“Are you okay? There’s something different in your face.”

How do you answer when your body is so full of emptiness?

Like a tooth extraction or an appendectomy, a D&C is a “simple, medical procedure,” Except that it’s not simple, and it’s far more than a medical procedure. I know what to expect, having been here only fourteen months earlier. I recognize the medicinal smell, the buzzes and the beeps of the monitors, the dull, colorless walls, the familiar jargon.

Naked, except for the faded blue hospital gown, I shiver and the nurse drapes a heavy, heated blanket over me. She struggles to start an I.V. and resorts to using the back of my hand. I cringe and look away.

“You have such tiny veins,” she says, “and tiny, little hands too.”

I nod and try not to think of the tiny hands and feet of the baby who refuses to leave the warmth of my body on his own.

The ambulatory surgery wing is two floors below the maternity ward, two floors separating high-risk pregnancies and multiple miscarriages from the lusty cries of healthy newborns.

When they wheel me into the freezing O.R. everything around me is eclipsed by the blinding white light of the enormous fixture directly above me. The anesthesiologist is at my head, his voice a steady drone in my ear and then a second later a nurse is calling my name. Like my pregnancy, the D&C seems to be over before it began. Tender and groggy, I am on my way home less than three hours after I arrive.

I return to work two days later and move through my tasks with sluggish determination. A weight blankets everything, making a pencil or a coffee mug an effort to lift.

When the large manila envelope arrives in the mail, I open it with trembling hands. My doctor already informed me of the lab results, but the visual confirmation is harrowing. I study the strange, caterpillar-like marks of the karyotype. Their story written in a single word: abnormal. Searching the unfamiliar image for the intangible, I will the black symbols to rearrange themselves into something less foreign, less removed from the son I’ll never know. Trisomy 13, the least common and the most severe of the viable trisomies. We name him Jonah.

The second piece of mail is a standard white envelope from my insurance company. The numerous doctor and hospital charges are all covered, except for one. The anesthesia fee is listed in full under “patient responsibility.” Assuming it’s a mistake, I dial the customer service number.

“Thank you for holding Ma’am. The billing statement is correct. We don’t cover anesthesia for abortions.” He’s young, a kid. I struggle to control the bile rising in my throat.

“I didn’t have an abortion. It was a miscarriage.”

“Well, Ma’am, the computer says you had an abortion, and we don’t pay for abortions.”

“It wasn’t an abortion! It was my third miscarriage! We wanted this baby so much.” Hyperventilating, tears streaming, all attempts to remain composed are gone while the kid stays steady, almost mechanical.

“Ma’am, it is coded as a spontaneous abortion. As I told you before, we don’t pay for abortions.”

I’m screaming now. “Spontaneous abortion is the medical term for miscarriage!”

“I’m sorry Ma’am, we don’t pay for abortions”

The paper in my hand is rattling, adding to my own violent cacophony. I hang up and slide down the wall until I’m curled and crumpled on the floor. Abortion. The word assaults me, cutting, slicing, taking my only solace. If only money could wipe this away. But paying the bill will not erase the accusation, the belief that my baby was not wanted, that his death was a choice. I look down at the statement in my hand and two words scream back at me. St. Charles. An abortion was never even a possibility. It was a Catholic hospital.