She is pushed in through the door of the rural Mississippi clinic where I work. Behind her is movement, the rise and fall of slurred voices. Then a cluster of people crowd in behind her. But Lulu stands where she was pushed. She looks at me. I look at her, but not for long. When I look away, I’m not sure what I’ve seen there, in those black eyes with their faintly reddened whites. I’m not sure. I’ll have to look again.

But first there’s Veldene — Veldene! She is the leader of this pulsing assembly of women and children. Relying on an innate sense of decorum, she roughly seats Lulu before turning to me.

Veldene is hard to understand; she has no teeth, and a strong Southern accent. But I can make out the salient facts: Lulu is Veldene’s child. Lulu herself is with child. Lulu already has three children. Veldene has had it with babies. She wants Lulu to get her tubes tied.

OK, I can handle this. I’m a nurse practitioner, right? So what I do is smile and say, slowly, knowing Veldene might not understand my accent, “OK, Veldene, why don’t we go to the back room with Lulu?” And, almost as an afterthought: “Do you have Medicaid? Then why don’t we give your card to Frank here, and he can do the paperwork while we talk.”

But Veldene doesn’t have time for such pleasantries. She talks to me in the hall. She talks entering the room. She talks as we sit down. She has nothing to lose and a lot to gain. I must understand: she has had it with babies. And now Lulu’s pregnant again. The problem is Lulu ain’t right in the head. And ever’ Friday night men come round to get her to go for rides with them. They just sit outside and honk their horn. Veldene tries to keep Lulu in. She tells those men to go away. But sometimes Lulu slips out anyway. Veldene can’t keep track of ever’one, what with twenty people living in her house. And the men give Lulu likker, and do what they want. And Lord if she don’t get pregnant again.

Lulu sits placidly while Veldene delivers her tirade. Lulu is wearing khaki pants and a striped T-shirt. The pants are not zipped, but are held together at the waist by a length of baling twine that can be let out to accommodate her growing belly. Lulu is interested in something on the knee of her pants. It could be a wad of pine pitch. She picks at it, absorbed.

Lulu is twenty-four, but she looks older. She is not pretty. Her hair is unkempt. The flare of her nostrils is too pronounced. Her teeth are stained from snuff, and the wad she keeps in her left cheek distorts her face. But she is neither too fat nor too thin. And she must make some attempt at beauty, judging by the tarnished chain she wears around her neck.

Beauty, however, is not the issue here. Lulu is my patient, and I must tend to her. I must study her blood, her discharges, her waste matter. She has a bladder infection. She has a one-celled parasite living in her vagina. She is anemic. Her feet are swollen. All this I can handle. I have pills. I have knowledge. I have power and connections.

I put Lulu on ampicillin. I give her iron and prenatal vitamins. I tell her to keep her feet up when she can. I measure her belly; the child is growing. She will have her baby in Pontotoc, a town thirty miles north of here. I have arranged it with the doctor. While she is there, she will have her tubes tied. The papers are in order.

But first Lulu must visit the doctor in Pontotoc. He must see her. And so I sit her down and tell her this. I tell Veldene. I draw them a map.

Friday at midnight, I am woken by the phone. It’s the emergency room at the local hospital, which does not deliver babies. The nurse tells me Lulu is there, with three men. They are drunk and going on and on about the “sick wagon.” The sick wagon, they say, must take Lulu to Pontotoc. The “doctor” has said so. See this paper? It says right here.

I ask the nurse to put Lulu on the phone. I ask Lulu how she’s doing.

“Ih pop meh,” she says. “Ih pop meh.” I am learning to speak her language. “It popped me,” she is saying. The baby is moving.

“Lulu,” I say carefully, “you are OK. The baby isn’t coming yet. Go home. Come see me Monday.”

I am touched by this midnight phone encounter. I am touched that she wanted me, that my voice calmed her. Drunk, surrounded by men, feeling her child jump, she remembered my name.

But she never does make it to her appointment in Pontotoc. Her father and her uncle are in jail for being drunk and disorderly. There is no money for gas. The car has a flat. I make her another appointment, but she misses this one, too. The doctor in Pontotoc is miffed. He says he won’t deliver Lulu’s baby.

I cannot give up so easily. Lulu is my patient. She is my project, my problem, my work. Those men who park and honk their horns must share her with me now. She takes off her dirty clothes and lies down on the examining table. I press her belly with my cool, knowing hands. I listen to her lungs and heart, their beats, swishes, and gurgles: the voice of her body. And I take her legs, her pliant legs, and put them in the stirrups. With my gloved hand, I part the heavy lips. Here is the buried treasure, the place the men honk for. Here is where life is admitted and let go. If I work hard, if I do my job, there will be no more babies after this one.


Another doctor must be found. New authorization papers must be completed and signed at least thirty days before the delivery, or they won’t be valid. How about Dr. Grimes in Eupora? He’s only fifty miles away, and he delivered Lulu’s other babies. Will he work with me?

I call. He will. He’ll do it. He won’t work with me, exactly, but if Lulu shows up in labor he’ll deliver her. And if he has the papers on file, he’ll do a tubal.

I cannot wait for Veldene and Lulu to come to the clinic to sign the papers. I must go to them. They live ten miles out of town, in a place called Dixie: The black part of town. Ten square miles of scrub pine and dirt roads, with one paved route bisecting it.

They live in a green ranch-style house built during the War on Poverty. Out back is a weathered shack, nearly covered with kudzu, its roof partly caved in. This is where Grandpa lives. Next to it is a prefab storage shed, ten by ten. One daughter lives there.

I knock tentatively on the door of the main house. It is patched with pieces of scrap wood. One of the windows is broken and has been mended with duct tape. After a few minutes, I hear the muffled sound of a human voice inside. I open the door, which is swollen and warped from heat and humidity. The first thing I see is two couches pushed together at the fronts to form a sort of trough. The trough is filled with pants, shirts, towels, and other laundry, and sitting atop the mound is a smiling baby. As I approach, the laundry begins to stir, and, quite suddenly, Lulu erupts from it, almost knocking the baby to the floor. Seeing me, Lulu ducks back into her nest.

Now Veldene comes shuffling down the hall. I explain to her that I need to have new tubal papers signed. She begins to clear off the kitchen table.

“Gey up, girl!” she yells, and Lulu flounders out of bed. This may be a universal wake-up call, for other family members in partial dress begin filing into the kitchen. I feel as if I’ve wandered onto the set of a sitcom about the old woman who lived in a shoe. From the outside, the house didn’t look very big, yet, one after another, young women and children emerge from the hall into the living room. The children have evidently learned to fend for themselves. One little boy goes over to the refrigerator, yanks it open with both hands, and rummages inside until he finds a hot dog, which he proceeds to eat cold.

Lulu is flinging herself around, mumbling, “Wah ma pi? Wah ma pi?” which I interpret, correctly, as “Where are my pills?” She finds them on the windowsill, then makes a great show of shaking them out into her palm, pouring a glass of water, and downing them. Her gestures and expressions are wonderfully exaggerated, like those of an actress in a silent movie. I grasp her shoulders, smile, pat her belly. We mime to each other across the abyss.

I put my maternity-care textbook on the table and open it to pictures of the female reproductive system. I point to the oviducts and demonstrate how they are cut. I explain that the procedure is usually not reversible. Veldene and Lulu appear unimpressed with the gravity of the decision.

Finally, I fill out three identical sheets with the pertinent names and point to the places where they are to sign. Veldene must sign, too, since Lulu is retarded. Veldene tells me she doesn’t “cipher” too well, and, indeed, her signature is illegible. Lulu does a slightly better job with her name, and I praise her. I sign as witness, fold the papers carefully, and put them in my bag. By now, a crowd has collected around my book, flipping the pages. As each picture is examined, hilarity and horror alternate on their faces. I am sorry I must take it with me. “When you come to the clinic,” I tell them, “you can look at it again. And other books. I have lots of other books.”

All women are created equal, I think as I drive home, past the collection of ramshackle trailers and small, faded clapboard houses that make up Dixie, past the old graveyards with photographs taped to the headstones, past Redonia’s juke joint with its sign depicting a nearly naked dancer, African in spirit. All women are created equal. Is that true? Were Lulu and I created equal? I try to think it through, but find it leads to a place I don’t want to go. I’ve worked to get to where it doesn’t occur to me to ask such questions. I’m not there yet. But I’m near enough to know this: you don’t get there by thinking.


Is it OK, what I’ve done? Yes, I think so. Lulu has had three children; this one will make four. And why shouldn’t she have sex? Why shouldn’t she? It feels good. The men don’t hurt her, I think. She is not beaten. She likes to drink. The burning liquid fills her limbs with tickles, puts her at ease. The air is warm and scented by the fields beside the road where they park. The insects are singing. It is all sound and heat and touching. And while his hard thing is in her, he is nice. He says nice things. And pretty soon the swell of crickets and his breathing and the car radio and the soft wind and the hard thing and the smell of earth and moonshine and gasoline become one. She rises, and is gone.


Lulu and I are friends now. Sometimes Veldene drops her off at the clinic and doesn’t come back for hours. I am not very busy. I let her sit in my office and look at books while I work on charts. The room is filled with a companionable silence. One day, Lulu takes off her shoes to study her swollen feet. I swing around in my rolling chair, take one of her feet in my lap, and press the instep, checking the extent of the edema. Then I put both hands around her foot, as though it were something I dared not drop, and say, “Poor foot. I think it’s pregnant, too.” Lulu laughs. She laughs loud, and I can see into her mouth. I think I can see far, down into her heart.