Labor

Mary Fariba Afsari is an ob-gyn physician whose memoir weaves together three strands: her career in obstetrics and gynecology across nearly two decades, the imagined story of her maternal grandmother Mehry's death following an attempted abortion in 1950s Iran, and the founding of a mobile reproductive health clinic in the years surrounding the Supreme Court's reversal of abortion rights.

The book opens in 2021 with Afsari fitting a portable gynecology table and medical supplies into the back of her small car, preparing for a future she sensed but did not yet fully understand. She reassured herself that Roe v. Wade was the law of the land but also invoked the name Mehry, connecting her instinct to prepare with a conviction shaped by family history: When women lack choices, bad things happen.

The narrative steps back to 2018, when Afsari was deep in a professional and personal crisis, questioning her career, experiencing panic attacks, and seeing two therapists. After her medical assistants dyed her hair in aqua and fuchsia streaks, she drove home and encountered a fatal motorcycle accident. She stopped, identified herself as a doctor, and performed chest compressions on a woman she recognized as already dead. Kneeling beside the body afterward, she thought of Mehry. The episode crystallized a numbness that had settled into her: She could not cry even in the privacy of her car.

Around the same time, Afsari began investigating Mehry's life. At a family wedding, she confided to her second cousin Navid that Mehry had been appearing in her thoughts uninvited. The book notes that Navid would soon be diagnosed with stage four ovarian cancer, a thread that recurs throughout the memoir. Afsari's mother had always referred to Mehry as "my angel," and Afsari sensed her grandmother had a story she needed to hear.

Parallel to this spiritual searching, the memoir recounts Afsari's care of Amelia, a pregnant preteen who arrived at her clinic in 2017 accompanied by her aunt and legal guardian. When Afsari asked who fathered the baby, Amelia began sobbing and whispered, "I don't know how this happened." Afsari reported suspected sexual abuse to the Department of Human Services (DHS), the child welfare agency, but encountered a broken system: The detective assigned told her nobody in the family would talk and that paternity tests required consent they would not give. Over subsequent weeks, Afsari learned the aunt had told Amelia that abortion would cause the baby's soul to haunt her. When Amelia delivered, she hemorrhaged severely, and Afsari worked for 45 minutes to suture catastrophic vaginal tears and save her life. In a final confrontation, Afsari suggested paternity testing to protect Amelia, but the aunt refused and walked out. Afsari never saw them again.

The experience with Amelia accelerated Afsari's unraveling. She traced her compulsive work ethic to her immigrant upbringing, recalling childhood car rides during which her father, Dr. Khosrow Afsari, an infectious disease specialist, quizzed her on economics. He devoted his career to underserved communities outside San Francisco and dreamed of his daughter becoming a doctor. In her twenties, Afsari pursued communications, karate, and life on a sailboat. On a trip to Paris, her father told her she lacked the extraordinary talent of a Picasso and that medicine would give her lifelong security. She eventually applied to medical school, but the pressure left a lasting mark.

During a visit to her parents in California, Afsari discovered she was named for Mehry. When her parents changed her birth name, Fariba, to Mary during the 1979 Iran hostage crisis to protect her from anti-Iranian bullying, they chose the name because it sounded like Mehry. She asked how her grandmother died. Her father stated it was a stroke from high blood pressure in pregnancy, but her aunt Nargess, the only family member still living in Shiraz, Iran, quietly shook her head and pressed a finger to her nose, signaling she knew something different.

From this revelation, Afsari began reconstructing Mehry's final year. In imagined scenes set in 1956 Shiraz, Mehry was 26 and pregnant for the fifth time. At the hammam, the communal bathhouse where women gathered weekly, she reconnected with Nilufar, a childhood friend who gave her a brown paper sack containing an herbal abortifacient: a tea of dried pomegranate, saffron, mugwort, and rue. Nilufar cautioned Mehry to act before 120 days, the Islamic concept of Ruh, or ensoulment, the point at which the fetus is believed to receive its soul. Late one night, Mehry boiled the tea, recited a poem from Hafiz, the revered Persian poet, and drank it.

The tea did not work. Day 120 passed without bleeding or cramping. At seven months, Mehry realized the baby had stopped moving. She told no one. Weeks passed as fever, headaches, and blurred vision set in. One evening, carrying a tray of tea to her husband's guests, she walked too close to the fire pit and her white dress caught flame. Men doused the fire and rushed her toward the hospital. Afsari's mother, four years old at the time, watched from the courtyard. Mehry never returned. The unborn baby died with her, and her youngest child, Mohsen, died within the year. Afsari connects the medical chain: The herbal tea did not expel the pregnancy; the fetus eventually stopped growing; the uterus became infected; sepsis led to a stroke; and the stroke killed Mehry.

This understanding was reinforced in 2023 when Afsari assisted Rebecca, a younger ob-gyn colleague, in operating on a 26-year-old woman who became septic after an abortion. During the exam, Afsari felt air bubbles crackling in the patient's abdomen, a sign of gas gangrene, a rare and often fatal infection caused by the bacterium Clostridium perfringens. The surgeons removed the uterus, and pathology confirmed the tissue was gangrenous. Standing in the operating room, Afsari thought of Mehry. She had also learned that her paternal grandmother, Afsar, had been institutionalized after a postpartum psychotic break and never returned to the family. Both grandmothers, lost to the dangers of pregnancy and childbirth, deepened Afsari's sense of purpose.

In 2022, Afsari launched FemForward Health, a fully functional ob-gyn practice inside a 31-foot RV in Portland, Oregon. She remodeled the interior and began serving patients failed by traditional healthcare: survivors of medical trauma, transgender individuals, and couples seeking affordable fertility help. She drove the RV to patients' homes, diagnosing one woman's uterine cancer early enough to preserve her fertility. When a patient asked why she chose this work, Afsari explained that her parents left Iran so she could have bodily autonomy, and that she had only recently learned her grandmother died from an attempted abortion, leaving four children behind.

On June 24, 2022, while on a solo road trip to Stanley, Idaho, Afsari drove out of cell service range and was flooded with messages upon reaching the town center: The Supreme Court's Dobbs decision had overturned Roe v. Wade. Driving nine hours home, she recognized that the distance she traveled was now the distance Idaho women would need to cross for an abortion. Amid her divorce from her husband, Keith, and worldwide protests following the killing of Jina Mahsa Amini by Iran's Islamic Revolutionary Guard, Afsari got "Zan, Zendegi, Azadi," meaning Woman, Life, Freedom, tattooed on her forearm.

The memoir closes with an epilogue describing a typical clinic day. Afsari unlocked a rusty gate in the rain, filled gas cans, dumped sewage water, and opened for patients. She had yet to pay herself from the clinic. But when the door opened and a patient sat down opposite her, the space felt like what it was built to be. Neither doctor nor patient knew how their stories would end, Afsari reflected, but in that space they had choices, and they had each other. For now, that was enough.