Ava, p.6
Ava, page 6
“I told you already, we are just volunteering!” Aubrey huffed and slammed the door.
The health department was a square, utilitarian, red brick building with its name in large metal letters next to the entrance door. Larkin realized she had passed it hundreds of times without noticing it. Aubrey walked to the front desk. Larkin followed, pausing several feet behind her. Aubrey told the woman seated behind the reception window that she was there because she would like to start birth control.
The receptionist told Aubrey they did take walk-in appointments, but they had been busy all day. The patient care representative would have to ask the nurse practitioner if they’d be able to see her. She told Aubrey to fill out a new-patient packet while she waited.
The girls sat down in the lobby on the dark brown plastic chairs. The white linoleum floors looked freshly polished. Aubrey started filling out the pages of paperwork on a clipboard, leaving blank spaces for health information she didn’t know and couldn’t ask her parents about.
Larkin got up and looked around while she waited for her friend to finish. Even though they had been friends since day care and knew everything about each other, she didn’t want Aubrey to think she was reading over her shoulder as she answered questions about her number of sexual partners and vaginal symptoms.
The waiting room was filled mostly with women who had young children and babies in tow. A toddler with a runny nose and orange cracker crumbs around his mouth wandered over to Larkin and gently tried to grab her phone from her hand. She assumed the green cartoon dinosaurs on the case had caught his attention. His mother scooped him up and apologized.
On the pale yellow cinder block walls, posters depicted a baby smiling just before getting a vaccination in his thigh, a young couple holding hands above informational text on the availability of STD testing, and a pregnant woman in a pastel pink top—hands on her rounded belly—next to a reminder about the importance of folate for a developing baby’s brain.
Against one wall was an oak rack containing free informational brochures on HIV prevention, family planning, breastfeeding, infant and child nutrition, and dental care. Larkin was about to grab a brochure on HPV vaccination when a nurse called Aubrey’s name and told her they were able to work her into the schedule.
Larkin walked back over to Aubrey. “Do you want me to come with you?” Larkin asked.
“Nah, the fewer people looking at my ‘no-no square,’ the better. But thank you,” Aubrey replied as she stood up and gave her friend a hug.
Larkin grinned at the memory of the silly song about the “no-no square,” which they used to sing when they were little. She settled into one of the chairs in the lobby to wait for her friend.
Aubrey gave a low little wave to Larkin as she went through the door leading to the exam rooms, and Larkin held up both hands with crossed fingers.
Larkin’s phone buzzed a few minutes later when Aubrey sent a picture of a clear plastic device sitting on a silver tray and a text that said wtf??????!!!!!!!!!????? Aubrey followed up with a selfie, her face twisted in mock despair. Larkin was nervous for her friend, and she wished she could have stayed with her.
After about half an hour had passed, Aubrey came through the waiting room door. She faked a limp and held a hand to her stomach as she walked toward Larkin, who lightly punched her in the arm and told her not to scare the children who were watching her.
They walked across the street to a Mexican restaurant, where they sat in a booth, ate the free salsa and chips, and drank sodas. Aubrey also texted Lance and asked him to pick them up.
Larkin asked Aubrey about the exam while they waited.
“The lady was very nice and tried to help me calm down. It was just really weird having someone—two someones!—look that closely at me down there.”
“Just think. That will be you someday, looking at a lot of strange cooches,” Larkin teased. “I didn’t have to do any of that. I guess because I just take the pill for my periods. Did it hurt?”
“Well, she first put that plastic duck-billed thing inside me. That was weird. It’s called a speculum. It was just a little uncomfortable. And then she put in an IUD thingy that looks like a plastic letter ‘T’ with strings hanging off of it. That felt like a really bad period cramp.” Aubrey frowned. “It still feels crampy now. And she said I’ll probably have some spotting. She told me to take some ibuprofen and it should feel better. I decided to get the IUD so I don’t have to worry about remembering to take a pill or my mom finding a birth control pack.” She took a long sip of her drink.
“That was a good idea. I’m really glad you went, Aubrey. I don’t want you being a teen mom reality star.” Larkin laughed. “Did you ask her about the HPV shot?”
“No. I wanted to, but I figured if my mom finds out I went there to get birth control, it would be bad enough. If I got the HPV shot, she would completely freak out.”
“Why? I got mine a few years ago. My mom wanted me to have it.”
“She thinks it makes girls sterile and promiscuous.” Aubrey rolled her eyes. “She already thinks I’m promiscuous, so maybe she just wants to be sure I can still give her grandkids someday. Maybe I’ll just go back next year when I can drive myself.”
CHAPTER 11
January 8, 2026
The Tennessean
Tennessee legislature overturns Mature Minor Doctrine. Teens 14–17 no longer able to receive health care without parental consent.
Larkin was relieved that Aubrey’s parents had never found out about her IUD. The next year, she encouraged Aubrey to drive herself to the health department with her brand-new driver’s license to request the HPV shot. Larkin had been reading online about the safety of the HPV vaccine. She researched what Aubrey’s mom had told her about it making girls sterile and found several websites with names of organizations she didn’t recognize claiming the shot caused “premature ovarian failure,” which could lead to infertility, osteoporosis, estrogen deficiency, and heart disease, but the majority of information she read said it was safe and effective, and the rates of cervical cancer in young women had dropped significantly since the vaccine had been introduced twenty years ago. Larkin made Aubrey promise she would go.
After school a few days later, Larkin received a text from Aubrey. It contained a photo of a laminated sign taped to the health department door: “Effective January 8, 2026: Patients under 18 MUST be accompanied by an adult to receive services at ALL Tennessee Health Departments.”
this sucks, Aubrey texted.
wow. yeah. how dumb
at least I won’t be sterile like you I guess
haha
The Mature Minor Doctrine had been law in Tennessee since the 1980s, but when Tennesseans became aware of the long-forgotten legislation during the COVID-19 pandemic, Republican lawmakers demanded its repeal. They accused the health department of having an agenda and encouraging teens to defy their parents by getting vaccinated “when they don’t even know what they are putting in their bodies.” Although no one could find any wayward teens who were surreptitiously trying to get a COVID-19 shot, the law was still overturned, ending all health care services for teens under eighteen without parental consent.
The following week, Larkin had an appointment at her pediatrician’s office to receive the meningitis booster vaccines she needed before starting college in a couple of years. After the nurse gave her the vaccinations, Larkin asked if she could ask Dr. Mills a question. The doctor was on vacation, but the nurse offered to have another pediatrician talk to her.
A few minutes later, the exam room door opened. A man stepped in and introduced himself as Dr. Lyons. He was tall with a square jaw and a long, pointed nose offset by large nostrils that flared slightly when his mouth was closed. He wore a checkered short-sleeved shirt, khaki pants, and pristine white tennis shoes. His purple tie was embellished with lion heads wearing gold crowns. He kept one hand on the open door’s knob as he asked what he could do for her today.
Lyons? Lions? Larkin thought. She wondered if his choice of tie had some other meaning or was just a coincidence.
She explained to Dr. Lyons that her friend had wanted to get the HPV shot at the health department, but they had recently changed their policies. She asked if there was somewhere else her friend could go.
Without hesitating, he bluntly said her friend should talk to her parents about it.
“They told her ‘no’ already, but she would still like to get it,” Larkin replied.
“Then she’ll have to wait until she’s eighteen to make those decisions. Let her know she can decrease her risk of getting HPV to zero by abstaining from high-risk activities. Then she won’t need to worry about needing the vaccine, right?” He paused and gave Larkin a smile. He briefly took his hand off the doorknob to pull a business card from his front pocket and then handed it to Larkin.
“Have your friend go to this website. I think it would have some useful information for her. For you as well.”
Dr. Lyons left the room, and Larkin looked at the card. It was the website for Make the Right Choice, the organization that had spoken to Larkin’s seventh-grade class. Under the web address, it read, “Dan Lyons, MD – Medical Director.”
Larkin texted Aubrey later.
i asked another doctor where you can get the vaccine
and?
he lowkey slut-shamed you
CHAPTER 12
March 21, 2032
The Tennessean
Tennessee follows lead of other Southern states, bans out-of-state travel for abortions
Spencer called everyone who had just recently been so overjoyed about a new family member to let them know the devastating news. Their parents offered words of comfort and wanted to visit or help in some way, but Spencer declined. He and Larkin needed their privacy.
Larkin was now fourteen weeks pregnant, and she and Spencer had finally accepted that the ultrasound hadn’t been wrong. They both knew their baby was going to die, they just didn’t know when that time would come. They also knew that no amount of wishing or praying for a different outcome would change their baby’s fate.
Dr. Beyer was the maternal-fetal medicine specialist who took over Larkin’s care. When he repeated the ultrasound, he showed them where the brain should be—on the screen, that spot was just a dark void. He also told them she was a girl, something Dr. Parrish had not said. Larkin wondered if it had been too early to tell or if Dr. Parrish had been distracted by the unexpected and tragic news she’d had to deliver to a hopeful young couple.
“We’re having a girl,” Larkin repeated, and for a fleeting moment, she felt happy. It sounded so normal.
“Yes. Females tend to have a higher rate of anencephaly compared to males. About three to four times as high,” Dr. Beyer responded.
Larkin closed her eyes. The brief glimpse of normalcy was now gone.
“I’m going to have you meet with a genetic consultant today. They will take a family history to see if there are any genetic risk factors, and they’ll discuss the risk of possible recurrence. We would also recommend amniocentesis to look for chromosomal anomalies that may be associated with anencephaly. And we’ll need to discuss what to expect during your pregnancy. I’ll give you a minute, and we can meet in my office to discuss further.”
In his office, Dr. Beyer sat with Larkin and Spencer and showed them illustrations of a baby with anencephaly. He explained that a large portion of their baby’s brain, the cerebrum, was missing and is needed for thinking, seeing, hearing, touch, and voluntary movement. He also explained there was no bone on the back of her head.
“Her breathing, heartbeat, and body temperature will still be functional at birth because the brain stem is likely still intact. Most newborns will die within the first few hours or days of life, though about 10 percent may live up to one week. She will die from cardiorespiratory arrest.”
“I can’t do this,” Larkin stated flatly.
“I know it’s difficult to hear this, but it’s important to be informed.”
“No. I can’t do this. This pregnancy. I can’t live with the reality of growing a baby inside of me for five or six more months and then watching her slowly die. I can’t.”
“I’m sorry, Larkin. It is an incredibly difficult situation.”
“It’s too difficult. I can’t. I want an abortion.” She turned to her husband. “I want an abortion. Please. I can’t do this.”
Spencer looked at her helplessly as he saw the hurt and desperation in her eyes.
“I’m sorry, Larkin. That isn’t an option in this state,” Dr. Beyer replied.
“Yes, I know. I’ll go out of state. Where can I go? Atlanta? Somewhere in the Northeast? I’ll go anywhere. Please just tell me where.”
“It’s illegal to travel out of state for an abortion. You could have at one time, but not now. The legislation passed in the spring. If you try to do that, the state you went to would have to refuse you or they would be breaking the law. You would also be breaking the law. There will likely be more legislation passed soon. If that happens, I would have to report you to a database if I thought you might seek an abortion.”
“You’re telling me I have no choice? That I have to carry this baby to term?”
“Yes.”
“Who decided that? Who decided that for me? For Spencer? For my baby? Is this what you would want for your wife? Your daughter? Is this what you want for your patients?” Larkin said, her voice rising.
“What I would want has no bearing on this. It’s the law.”
“If I lived in another state, I could have an abortion?”
“Yes. Over half the states still allow it in this case.”
“I’m just trying to make sure I understand this. I am pregnant with a baby who has 0 percent chance of survival, and I am being forced by the legal system to carry this baby to term. Is that what you are telling me?”
“Yes.” Dr. Beyer looked away from her and stroked his chin. He cleared his throat and continued. “Now, we need to talk about potential complications for you during the pregnancy. Many women will experience polyhydramnios—”
“I can’t talk about this anymore right now, Dr. Beyer,” Larkin interrupted. “I need to go.” She stood up to leave.
“Understandable, Larkin. We can discuss more next time.”
Larkin grabbed Spencer’s hand. They walked out of Dr. Beyer’s office and into a waiting room full of expectant mothers. Spencer stopped by the receptionist’s window to schedule a follow-up appointment with Dr. Beyer and to reschedule the visit with the geneticist. Larkin scanned the waiting room crowd and wondered if any of the other women had been told they were also carrying a baby that was going to die. Searching their faces to see if she could tell, she tried to recognize any communal pain.
In the car, she told Spencer again that she couldn’t do this.
“I’m not strong enough. I can’t handle this. I can’t go to bed every night praying for a miscarriage that may never happen; I don’t want to pray for that. But I can’t handle the alternative.”
“I’m so, so sorry. It’s not fair—it’s not right. If I could somehow help you fix this, I would.”
“Can you please take me home? Susan knew I had an appointment this morning, but I didn’t tell her what it was for. I’ll text her to let her know I’m not feeling well.”
“Of course. Do you want me to stay with you?”
“No, thank you. I promise I’ll be okay. I know you need to go to work.”
Spencer took Larkin home and made her a cup of hot tea. He placed it on the nightstand beside her and helped get her comfortable in bed.
“I’ll be back in a few hours, okay?” he said as he kissed her head and pulled the comforter up for her.
She nodded and rolled over in silence.
CHAPTER 13
Spencer had decided to give his two weeks’ notice to Mr. Montgomery today. He pulled into the insurance agency’s parking lot and turned off his car. He hadn’t found another job, but he didn’t need to anymore. There was no need to save up for a baby who didn’t have a future. He held the steering wheel tightly as he started to weep.
He wiped his tears with his sleeve and looked at the building. Employees had taken down the campaign posters and replaced them with congratulatory banners. Mr. Montgomery had won the election and would be sworn in to the US Senate in January. The protesters who’d posted the video had achieved nothing other than a few days of social media outrage with angry emojis and comments for and against, but then it had been forgotten. Jack Montgomery had won by a landslide against his Democratic opponent, as had traditionally and predictably happened in their state for years.
Spencer and Larkin hadn’t voted. They hadn’t even remembered when it was Election Day. They had been too consumed with shock and grief to think of much beyond the pregnancy.
When Spencer walked into the agency, his boss was sitting in his office and shuffling through some papers. Spencer knocked on the frame of the open door and asked if he had a minute to talk.
“Why, sure, Spencer, come on in! Just organizing some things before my new gig starts in January. I’m looking forward to changing some things in this country. Keep us on the right track, you know?”
Spencer stayed in the doorframe. He said, “Not really, no. But what I wanted to talk to you about is my job. I’d like to put in my two weeks’ notice.”
“Oh, my. Did you find something better?”
“No, sir.”
“Well, I’m sorry to hear that, Spencer. I think you have great potential to be an insurance agent, and I could really use you as I travel back and forth between here and DC. I was even planning to give you a raise. Figured you could use the extra income for that little one you have coming.”
“There won’t be a little one.”
“Oh, son. Did she miscarry? That’s just terrible.”
“No, no . . . it’s worse than that. The baby has a birth defect that’s not survivable, but she may not die until after she’s born.” As the words came out of his mouth, Spencer hung his head. He couldn’t believe it was his reality. Larkin’s reality.
