Not providing any information, just standing in the doorway watching as Grace dressed quickly and quietly, Betsy yawned and looked at her watch. Wherever they were going, Grace thought, her mother was in a hurry. Betsy examined Grace's profile in the light from the hall, trying to see if her belly was starting to stick out. It was hard to believe there was really a baby in there: her own flesh and blood, her grandchild. Nausea gripped her, and she turned away.

In the car, Betsy flipped to a new radio station and turned it up loud. Silence invited conversation, and Betsy had nothing to say to the person sitting next to her. In the few seconds it had taken for Grace to tell her parents what she had done, she had become a stranger in her mother's eyes. It was a surprise even to Betsy that she could so easily relinquish her maternal instinct. The bond between mother and child should have been much stronger than that, but Betsy had no control over what she was feeling. As much as she longed to feel loving and protective toward Grace, who was curled up in a ball in the front seat, practically glued to the pa.s.senger door, instead she felt only rage and betrayal. It was clear that the daughter was afraid of the mother, and though Betsy was sorry her daughter felt that way, she couldn't bring herself to reach across the front seat and still her daughter's shivering shoulders. It would have been like reaching across the Grand Canyon.

For three hours they drove, across the Connecticut state line and into the heart of Ma.s.sachusetts. If not for the annoyingly enthusiastic deejays on an endlessly changing stream of radio stations, Grace would have had no idea where they were, as she had not opened her eyes once since the mystery road trip had begun. The car sped along, and the only thing Grace knew was that she was being taken farther and farther away from anything familiar. Afraid that her mother was going to drop her off at some home for unwed mothers, Grace wept silently. As terrible as it was living with the disapproving stares and deafening silence at 78 Hill Road, the thought of being abandoned at some orphanage for wayward teens was much worse. She hadn't seen a suitcase, but maybe Betsy had hidden it in the trunk. And if Betsy left her someplace, she wondered if she would pick her up afterwards, if life could ever go back to the way it was before. A dozen unanswered questions raced in circles through Grace's mind.

In the midst of imagining a series of asylums her mother could be taking her to, Grace fell asleep again, the hum of the air conditioner and the engine too hypnotic to resist. Only when the car was parked did Grace wake up, slowly swimming up through her muddy brain into consciousness. When she awoke, for just a second, life was as it had been before. But then there was the jolt of her new reality, and that heavy feeling, like a cold, hard rock in her stomach, returned.

"Grace, wake up. We're here," Betsy said tersely, poking Grace's shoulder with her index finger, making as little physical contact as possible.

At her mother's touch, Grace sat bolt upright. Thus far, the top-secret mother-daughter outing had not prompted much of a thaw in family relations, but at least her mother was still talking to her.

"Where's here?" Grace sat up and stretched, looking out the car window at a large mirrored gla.s.s office building. The landscape was completely unfamiliar to her.

Ignoring Grace's question, Betsy got out, slammed the car door behind her, and marched across the parking lot toward the gla.s.s cube. Running to catch up with her mother, Grace considered the possibilities. Perhaps Betsy was taking her to a doctor before she took her to the home for unwed mothers. Or maybe there was an adoption agency in this building. It was no use asking. Betsy was clearly still not speaking to her unless absolutely necessary, and Grace would find out soon enough.

Two minutes later they were in the waiting room of a place called the Women's Health Center of Ma.s.sachusetts. Grace could understand that Betsy wanted to avoid the local obstetrician, but had it really been necessary to drive all the way to Ma.s.sachusetts to get a prenatal exam? Taking a seat at one end of a worn leather sofa, Grace picked up a parenting magazine and pretended to read. Across from her, a blond girl who looked about her age gnawed nervously on her fingernails and stared at her feet. In another chair sat a forty-something woman, clearly the biter's mother, flipping violently through an old issue of National Geographic.

"Grace Warren. We have an appointment," her mother whispered to the woman at the front desk.

"Please fill out these forms. The doctor will be with you shortly." The receptionist tried to hand Betsy a clipboard, but Betsy pushed it back across the counter.

"I'd rather not. If I'm paying cash, why do I need to give you any information?" Betsy took out her wallet and withdrew a wad of bills. "I'm not submitting anything to insurance, and I'd like to maintain my privacy."

"It doesn't matter what form of payment you use, ma'am, you still have to fill out the paperwork. Those are the rules. And you don't pay until after the doctor does the initial examination, just in case." Once again, the receptionist placed the clipboard on the counter, the attached pen dangling from a silver chain.

"Just in case what? That's outrageous." Certain that if she didn't back down, she would get her way, Betsy stared venomously at the woman in the pink and blue polka dot smock who was at that moment dreading her decision to take the extra shift that morning.

"No paperwork, no procedure," said the receptionist, glaring up at Betsy and turning back to her computer, ending the conversation, silently cursing all the spoiled, self-centered b.i.t.c.hes who were such c.r.a.ppy mothers that it was no wonder their daughters ended up pregnant.

Nostrils flaring, Betsy stuffed her wallet back into her enormous designer handbag and flounced, clipboard in hand, over to the couch where Grace cowered, wishing that whatever was going to happen next would hurry up and happen. A doctor's visit couldn't be worse than the waiting, imagining her legs splayed open, some stranger touching her, looking inside her. While she knew that she deserved whatever humiliation she was about to suffer, and she had better get used to it, as there were likely plenty of doctors' visits in her future - hopefully not all three hours away from home - she had hoped that her mother would begin to relax, but Betsy remained as cold and hard as a block of ice. As terrible as this ordeal was, it was so much worse because Grace had no shoulder to lean on. Jennifer was doing her best, but she was a kid herself, and no matter how gently she patted Grace's back, or murmured comforting words in her ear, or tried to make Grace laugh, it just wasn't enough.

A woman dressed in pale pink scrubs and holding a pink file folder opened the door to the rest of the office. "Grace?"

Betsy and Grace stood simultaneously. "Just Grace, please." The nurse smiled warmly and held the door open for Grace, while Betsy returned to the sofa, teeth clenched, shoulders up by her ears.

"Okay, Grace, take everything off and put this on, open to the front." She handed Grace a pink paper robe and left her alone in the examining room. Arctic air blew out of the ceiling vents, and Grace huddled on the paper-covered table, arms crossed, trying to keep her teeth from chattering in the chill room. The fact that everything in the office was pink did nothing to take the edge off her nerves.

The door opened again. "Hi, Grace, I'm Dr. Ryder, and I'll be taking care of you today." Thankfully, Dr. Ryder was a woman. If a man had walked in and asked her to spread her legs, she probably would have pa.s.sed out.

"So, you think you're about eight weeks or so?" Dr. Ryder asked, scanning the piece of paper in the folder.

"I think so. I only did it once, on July second." This was beyond embarra.s.sing, and Grace was grateful that the nurse hadn't allowed her mother to accompany her beyond the waiting room.

"Were you using birth control?" As sophisticated as young people were today, the myth persisted that you couldn't get pregnant the first time.

"Yes, he wore a condom, but I guess it leaked."

"And you took a pregnancy test?"

"Seven." After all that had happened, Grace couldn't believe she'd been stupid enough to believe that if she peed on enough sticks, she would eventually get the result she wanted.

"You took seven?" The doctor tried to suppress a smile. "Sometimes it's hard to accept, isn't it?" She patted Grace's knee. "Well let's take a look. Have you ever had a gynecological exam before?"

"No, ma'am."

"It's not as horrible as you think it's going to be. Just lie back on the table and scoot your b.u.m down to the edge. That's a good girl. Now put your feet in here." She guided Grace's feet into the stirrups. "Just relax your legs and let your knees come apart. I'm just going to look inside. Close your eyes, take a deep breath,

and relax."

Grace felt the doctor's latex-covered fingers, and although she tried to do as the doctor said, every muscle in her body contracted.

"I know this is scary, but you need to unclench." The doctor held up a piece of metal that looked like a cross between a duck's bill and a medieval torture device. "This is called a speculum, and I'm going to slip this part inside of you so I can see your cervix. I promise it won't hurt, as long as your muscles are relaxed."

"Okay," Grace whispered, as tears dribbled silently over her cheeks and into her ears.

"You poor thing. Don't worry. The worst part is almost over, and then we'll talk about what comes next," the doctor said softly.

Grace nodded as the cold metal slid inside her, and she could feel the metal pieces spreading apart, stretching her insides. She didn't trust her voice, afraid that if she tried to speak, she would start crying hysterically, and she wasn't sure she would ever be able to stop. It really didn't hurt much, although she couldn't imagine how a baby's head could ever fit through that part of her body. She would surely split in two if it came to that.

Dr. Ryder withdrew the speculum and placed it on the paper-covered tray next to her. "Okay, now I'm going to do an ultrasound to check the fetal heartbeat. Because you're barely eight weeks, I'm going to do it internally, but I promise it will be less uncomfortable than the exam I just did. Also, we'll need to do a blood test to check for STDs. I know this is an awful lot to take in, and the odds are low that you picked up something, but we have to make sure." As much as she hated piling on the bad news when this kid's plate was already overflowing, Dr. Ryder had no choice but to do her job, no matter how unpleasant.

Not knowing what else to say, and wondering what other indignities she would have to suffer before this ended, Grace merely murmured, "Okay." The bean was bad enough, but a s.e.xually transmitted disease would be the s.h.i.t cherry on top of her c.r.a.p sundae. If Nick had given her AIDS or herpes on top of this baby, she would definitely do herself in. Well, first she'd kill Nick, and then she'd do herself in.

As the doctor pressed b.u.t.tons on the machine, typing in Grace's vital information, she said, "Have you made a decision about the pregnancy? There's no objectively right answer, you know. It all depends on your situation."

"I just want to wake up and be me again. But my parents would never let me have an abortion - they think abortion's murder. So I guess I'm going to have it, and maybe put it up for adoption." Until that moment, Grace hadn't actually thought about what she wanted to do. She had a.s.sumed she didn't have a choice once she owned up to Betsy and Brad.

Dr. Ryder paused. "That's weird. We have you down for a D & C this morning."

"A what?" There was so much Grace didn't know, didn't want to know, but she realized she had no choice but to get educated, and fast.

"D & C stands for dilation and curettage. We insert an instrument in the uterus and sc.r.a.pe it out." Dr. Ryder spoke without emotion. She felt sorry for the poor, trembling girl lying on the table in front of her, but if she was old enough to go all the way, then she was old enough to hear all the facts.

Grace gasped. That sounded horrible - cruel and painful. Placing her hand on Grace's shoulder, Dr. Ryder said, "Don't worry, you'll be asleep, so you won't feel a thing."

Recovering slightly, Grace said, "That can't be possible. My parents would never let me have that done."

"Well, let's look into this." Dr. Ryder picked up the phone on the wall and spoke quietly into it. A minute later there was a knock at the door. "Come in."

In walked Betsy, her purse tucked tightly under her arm. "Is everything all right?" She looked suspiciously from Grace to the doctor.

"Everything's fine. Grace is definitely pregnant, based on a cursory examination of her cervix and uterus. I was about to do an ultrasound, just to confirm and make sure everything looks normal before we proceed."

Betsy nodded but said nothing.

"We have Grace down for a D & C, but she says that must be a mistake. We haven't discussed all of Grace's options yet, but it would be helpful to know if an abortion is a possible alternative. Perhaps you can help clear things up, Mrs. Warren." Turning back to Grace, she said, "Ultimately, of course, Grace, it is your choice. Have you had a frank discussion with the father? Does he have an opinion?"

At the mention of Grace's co-conspirator, Betsy found her voice. "The father is of no consequence in this. And while I am opposed to abortion in principle, I feel that under the circ.u.mstances, an exception must be made. We live in a small town, and we are very active in our church. A baby out of wedlock would destroy us." Betsy was breathing hard and her face had broken out in red splotches. "We cannot have Grace flouting our values in front of everyone."

"Mrs. Warren, while I appreciate your discomfort, I think there are many more important things to consider than whether a few people might look askance at your daughter's unfortunate situation. She is neither the first nor the last teenager to face such a decision, and whether or not the folks at your country club will judge you harshly based on the fact that your daughter engaged in premarital s.e.x and got pregnant is, I think, irrelevant at this moment." Dr. Ryder thought but did not say that having an abortion merely to save face was pretty much the ultimate in flouting one's values.

Dozens of furious mothers had pa.s.sed through the clinic, but there was a wild look in Mrs. Warren's eyes that was disturbing. Praying Mrs. Warren wasn't carrying a weapon in her oversized handbag, Dr. Ryder waited for the inevitable firestorm response, one hand resting protectively on Grace's shoulder.

"I brought my daughter to this clinic for a simple medical procedure, not a counseling session, so I would appreciate it if you would keep your words of wisdom to yourself. You know nothing about my life, and I don't need a graduate of some low-end medical school who can't be more than thirty, with no children of her own, telling me how I should deal with my daughter."

Out of all the clinics she could have chosen, Betsy wondered how she had the bad luck to choose the one occupied by a big-mouthed, know-it-all busybody. All she wanted to do was undo Grace's misstep and never speak of it again.

Willing herself to remain calm, Dr. Ryder spoke quietly but firmly. "Part of the process is to explore the patient's options, and I am merely trying to provide a neutral perspective in what I know is an emotionally charged situation. Ultimately the decision belongs to Grace, and I am simply doing my job by providing her with as much information as I can." She paused and took a breath. "By the way, for your information, I am thirty-four years old, I have a six-month-old daughter, and if you consider Harvard Medical School low end, well, so be it."

Turning to Grace, Betsy spoke through gritted teeth. "Grace, you have conducted yourself in an appalling manner. Your father and I are devastated that you would do this to us. At this point, your only concern should be to make this go away before all of our lives are ruined. There is really nothing to discuss. Do you understand me?" Betsy took a step towards the examination table and Grace recoiled, the tissue paper crackling loudly.

Genuinely afraid for Grace's safety once she and her mother left the clinic, Dr. Ryder wondered whether she should be calling social services about this woman. "Mrs. Warren, if you would please return to the waiting room. I need to finish Grace's exam, and this conversation isn't getting us anywhere."

Without a word, Betsy stormed out of the room, slamming the door so hard that the framed diplomas on the wall shook. "I'm so sorry, Dr. Ryder. She's just really mad at me, and ...."

Dr. Ryder held up one hand. "You don't need to apologize for your mother. You have no control over her behavior. I'm so sorry that you're facing all of this with no support system. Do you have anyone to talk to about this? Going through a crisis like this alone is not a good idea."

"I have a best friend, Jennifer, who knows everything, and she's been great. She told me to get an abortion without telling my family. I should have taken her advice." Grace smiled sadly. Jennifer's prediction was proving itself correct at every turn.

Sometimes this job was so difficult. The actual practice of medicine was the easy part. When she was dissecting cadavers in medical school, Emma Ryder never imagined that she would end up being a social worker as well as a doctor. "It's a big decision, one that you'll carry with you for the rest of your life, whether or not you ever choose to have children someday. Not a decision to be made lightly or out of fear, because you're the one who has to live with whatever you end up doing - not your parents, not your best friend, just you."

"I don't know what to do." The tears cascaded down her cheeks, again.

"It's not easy. There's so much to think about. You don't have any adults in your life to talk to? Right now you really need someone to take care of you, make you feel safe, whatever you decide."

Grace shook her head.

"No aunts, grandmothers?" As she spoke, Dr. Ryder turned a dial on the ultrasound machine and held up the internal probe, a plastic cuc.u.mber in a latex sheath. "Now relax, and let's take a look at you from the inside."

"n.o.body," whispered Grace as she tried to relax her pelvic muscles, silently vowing that she would never let anything or anyone inside her ever again.

"There's the baby, or the fetus," Dr. Ryder said, pointing at a spot on the computer screen. "It's about an inch across, but it starts growing pretty rapidly at this point. So if you do decide to terminate your pregnancy, it's best if you take care of it within the next few weeks. It gets harder after that, both psychologically and technically."

"That's my baby," Grace whispered, dumbfounded by the fact that she and Nick had in the course of rolling around in his Jeep actually created a human life. It shouldn't be that easy to make a baby. It should be complicated and time-consuming, like knitting a sweater or building a house. Looking at the pulsating shape on the screen, Grace could now imagine the bean as a baby, and she was scared about what that meant. It was no longer just an it.

After Dr. Ryder had finished spelunking in Grace's insides, she helped her sit up. "There you go. Your options are these. A termination, today or in the next couple of weeks, which we can perform here, or I can recommend a clinic closer to your home." When Dr. Ryder first looked at Grace's folder, she had wondered why they had come all the way to Ma.s.sachusetts from Connecticut, but now she knew all too well. "If you choose to carry the baby to term, and you decide not to keep it, there are many couples who would love to adopt your baby. And there are many different kinds of adoption, which you can learn about if you decide to go that route. I'll give you some brochures that explain the basics."

Grace still felt shaky, but something had changed. This wasn't just about her, or Nick, or her parents, anymore. There was a strawberry-sized person growing inside of her. Not exactly in a position to take a moral stance, Grace still didn't feel like abortion was murder, like those religious fanatics she sometimes saw on the news. But she did worry that if and when she ever had children on purpose, she would be unable to look at them without reliving the moment when she eradicated what would have been an older sister or brother. Could she handle that kind of what if?

Even so early on, the fetus was recognizable as a person, with sort-of fingers and toes and ears. Grace was regretting having gone to see Bodies ... The Exhibition in New York City, which had perfectly preserved fetuses at every stage of development on display. How could she get rid of what looked like a miniature baby, even if she wasn't sure that a tiny creature that had no ability to survive on its own outside of her body was actually a baby? It was way too complicated an issue to tackle, especially in her current condition, with her hormones raging and her parents fuming. But she didn't feel certain enough to take what on some level was a human life into her own hands.

"I think I've decided. I'm going to have it." Saying it out loud confirmed her feelings, at least for the moment, or until her mother returned and started screeching at her.

Dr. Ryder sighed deeply. Grateful that she had never had to make such a decision, she had no firm opinion as to what was the right thing to do in this type of situation. "Okay. I don't think your mother is going to be too happy - probably the understatement of the year - but remember, it's your life, and you have to do what's right for you. Let me give you some literature about what comes next. You don't need to decide about adoption right now, but you will need to find a doctor close to home, take prenatal vitamins, and get lots of sleep. And of course, no caffeine or alcohol. I'll leave you to get dressed while I get the brochures." Dr. Ryder hesitated and then added, "And don't forget, if you change your mind in the next few weeks, you can still terminate your pregnancy."

Slowly Grace got dressed, wondering how her mother would handle her decision. Would she hit her? Leave her by the side of the road? Although her parents had never even spanked her when she was growing up - she had never given them any reason to lay a hand on her in anger - she could imagine Betsy slapping her hard across the face. Grace's transgression had cracked the perfect veneer encasing her family, revealing a rough, primitive core that Grace could easily imagine included physical violence.

Dr. Ryder returned with a folder and handed it to Grace. "Good luck. The next year is going to be really hard, but I know you can handle it. You're a very strong person." She hugged Grace, and Grace rested her head briefly on the doctor's compa.s.sionate shoulder. "I put my card in there. If you need someone to talk to, I want you to call me. My home number and my cell are on the back. Who knows? Maybe your parents will surprise you."

Grace shrugged. "Maybe." But the possibility that Betsy and Brad would change their minds and suddenly throw their arms around her seemed less likely than Nick suddenly declaring his undying love for her and proposing on one knee.

Grace walked into the waiting room, where the nail biter had been replaced by a visibly pregnant Goth girl with racc.o.o.n-eye makeup, black motorcycle boots, and no mother hovering nearby. It had been less than an hour since she first put on the paper gown, but she felt like a completely different person.

Betsy jumped up, dropping the magazine that had been sitting unopened in her lap. "That was quick. Do you have extra pads? It's a long ride home." Now things could get back to normal. No one would ever have to know - no judgmental stares at the club, at church, at the farmers' market. Betsy made a mental note to have a little chat with Jennifer about the value of discretion. The tiny miners who had been swinging their pick axes inside her skull since Grace broke the news started to pack up their tools.

"I didn't do it." Grace's voice was loud in the library-quiet waiting room.

Grabbing Grace by the arm, her nails digging in, Betsy practically dragged her out of the office. The receptionist started to call out to Mrs. Warren, as she hadn't paid for the pelvic exam, but she thought better of it. She would sooner pay the hundred dollars out of her own pocket than risk a black eye from that crazy witch. Pounding the computer keys in frustration, she thought for the hundredth time about quitting this freak-show job with its lunatic right-to-lifers waving their picket signs dripping fake blood, and the outraged mothers who refused to believe that their teenage daughters were having s.e.x until it was too late.

"What are you talking about?" Betsy hissed at Grace as they stood in the hallway waiting for the elevator.

"I couldn't do it, and I'm the one who has to live with the decision for the rest of my life." Echoing Dr. Ryder's words, Grace sounded way braver than she felt. On the ride down, Grace pressed herself into the back corner of the elevator, as far from her mother as she could get. There was someone else in the elevator, so Betsy just stared straight ahead, white-knuckled hands clinging to her purse as if it were a life preserver.

As the gla.s.s door of the office building closed behind them, Betsy again grabbed Grace by the arm and picked up right where she'd left off. "About that you're mistaken, young lady. We all have to live with your so-called decision. What right do you have to behave this way? I don't know you anymore."

"But Mom, Reverend Halvert says every life is precious, even the lives of the unborn, and he's the leader of our church." Maybe the stress had made Betsy forget about the bigger picture.

Betsy laughed - a short, inappropriate chortle. "Reverend Halvert never had a pregnant teenage daughter."

"You always taught me that G.o.d created life. How can we destroy something that G.o.d created?" Grace was grasping at straws, trying to remember something she had learned in Sunday school that might remind Betsy what really mattered.

"An accident in the back seat of a car is not G.o.d's creation."

Grace gasped at her mother's icy tone. With thirteen little words, Betsy renounced everything she had ever taught Grace.

Letting go of Grace's arm long enough to find her keys, Betsy suddenly stopped in the middle of the parking lot, oblivious to the car that almost hit her from behind. She looked up at the sky and let out a shriek, a combination of anger, frustration, and maybe even a little fear. Grace watched, transfixed, as her mother appeared to vent her wrath at G.o.d. Then taking a deep breath, Betsy adjusted her sungla.s.ses, looked around to see if anyone had witnessed her manic moment, and marched toward the car. Before Grace was safely in her seat, Betsy had started the engine and shifted into reverse. Grace slammed the door, just missing the car parked next to theirs as Betsy lurched out of the parking s.p.a.ce and tore out of the lot. Perhaps, Grace thought, they would be in a terrible car accident on the way home, and then the only urgent decision would be left to her father: open or closed casket.

Simultaneously merging onto the highway and dialing her phone, Betsy was oblivious to the cars speeding past. "Brad, it's me."

"How did it go?"

Brad really didn't want to know any of the particulars, but he felt compelled to ask, as long as his wife was stuck with taking care of all the minutiae of this unpleasant business. He couldn't even say the word abortion out loud, and the thought of blood and scalpels and DNA belonging to some random guy who had done heaven knows what with his daughter made him physically ill. On some level, he could identify with those crazy people on the other side of the world who carried out honor killings. How did a father ever recover from something like this? It would have been so much easier if she'd been caught with a bottle of his Valium or a fifth of Jack Daniels in her locker. A blurb in the Police Blotter, with not even her name mentioned because she was underage, and that would be the end of it. But being pregnant was like wearing a sandwich board for nine months that said I'm a Teenage Tramp.

"It didn't," Betsy hissed into the phone.

"What are you talking about?" Brad asked.

"She wouldn't do it."

"Wouldn't do it? Why didn't you make her do it? You're her mother." Now Brad regretted not having gone along to make sure things were done properly. He knew a woman couldn't be depended on to take care of business when there were emotions involved.