The Exchange by Kaitlin Milliken-Flohr 


I should have known when we left the town that safety was far behind us. Our trike blazed along the narrow asphalt over the estuary, while the world around us lay uncharacteristically still. The setting sun reflected in the ocean unbroken, not a breeze to ripple the water. With every kilometer, life thinned — not even birds as our witness. Music drifted to a quiet only broken by the hum of our motor.

  Ate*, is this where you want to be? the driver asked.

*Ate means “older sister,” often used as a term of respect in service interactions

Yes, we’ll get off here, she said. We’re very close to where we’re going. 

But as far as I could see, we were in the middle of nowhere. 

Months ago, I visited Lola*. Through sobs, I told her about my infertility diagnosis. With an influx of hormones by pill and injection, I conceived, just to have the process end in a miscarriage. 

*Lola means “Grandma.”

If I had had one more unsuccessful cycle, I would have been referred for IVF. The reproductive endocrinologist said I was a strong candidate. The procedure would likely work within two insurance-covered rounds. But because I had gotten pregnant without extreme intervention, my insurance denied the authorization. I could resubmit the claim after another year of failure. We had been sent back to square one, attempting the natural way with dwindling hope.

So, Lola proposed a pilgrimage. I presumed she meant the fertility festival, rites of polytheistic origin given the Catholic treatment. Devotees travel from across the Philippines to ask God for a child. They worship in mass and on the streets, dancing to petition the saints as a conduit for divine intervention. I traveled across the world to join them. Even though I had not been to a church in years, perhaps a miracle would reignite my faith.

The festivities enveloped every soul except ours. 

Lola waited until the man had receded out of our sight. Then, she beckoned me to follow her. She stepped over the heavy chain separating the paved road from the marsh. Shoes in a basket above her head, she waded through the reeds. I had never seen her break a sweat. She maintained a consistent poise. But today, she sullied her skirt in knee-high water, muddy slosh climbing up the fabric.

She untied a bangka* hidden among the stalks. We pulled out the boat, its buoyant outriggers stabilizing as we clambered aboard. With a long stick, I pushed us forward. Lola navigated us through the fleeting dusk.

*Bangka means “boat.”

  Left, right, straight, she directed. Toward that island. Pull us closer. 

If there were ground, it was shrouded by mangroves. Spiderlike, they spread until they apexed in spindly trunks, before their canopies reached toward the skies. Lola decisively grabbed onto one tree’s stilts. She hoisted herself up, then pulled toward the next foothold. I anchored us to one such crooked root, then followed.

We walked across a lattice of root crowns. Lola maneuvered with sure feet, grasping wooden stems, propelling herself forward. The deeper we traveled, the more apprehensive I became. I glanced back toward the faraway boat and thought about the even further glow of the town.

  When the last light faded, we reached the bridge at the heart of the forest. We walked along, cradled by trees. Lola lit a candle, casting crooked shadows. Dark silhouettes lingered in the corner of my eye, humanoid and sinister. The planks creaked under our weight. I huffed heavier with each step, my chest tight.

Lola turned and shone the light on me. She caressed my face with a soft, wrinkly hand.

Do you want a baby, anak*? she asked.

*Anak means “child.”

Yes, I said. More than anything else in the world.

Then, tonight we will make the exchange, she said. It will cost everything. You will need to listen to your child and give her what she wants. But, you will have a baby. Are you still sure?

She stroked a thumb over my wet cheek. I nodded.

Okay, she held out a hand for me to take. Now, follow.

We ended at a mangrove. Massive roots climbed far above our heads, creating deep hollows. Fingers interlaced, we stepped inside. 

Lola told me to kneel, so I did. My heart, a fluttering caged bird, began to pound against the bars. From her basket, she procured additional candles. She affixed them to an altar entirely of stone, heavy and rough. The surface spanned the hovel, a feat with rock so obviously quarried elsewhere and transported here.

On the mantle sat statues also carved in stone. I watched light flicker across spherical domes. Their cheeks were round and cherubic, children with only heads at different stages of development. Some had teeth, others the approximation of lips, but not one child had eyes, only sunken pits turning black with mold from the humidity.

A taller figure lorded over them. She had no head. She was just a torso with a swollen belly, pregnant far beyond any living person I had seen. Finger-like nipples extended from her grotesque chest.

Lola approached the altar, bowed. A rosary clasped in her hand, she chanted in a language that I did not recognize. She placed the beads in front of the statue, then touched its distended stomach, before heaving it off the mantle. With more force than I had ever seen her exert, she slammed the idol down on the beads. The glass crunched under its weight.

Lola took a staccato breath, then put both hands on the statue. She chanted with a voice different from her usual lilt. She continued in a low, gravely baritone even as she backed away from the altar and walked behind me.

  You need to look at her, she whispered in my ear. No matter what, you can’t look away.

I felt her lift my hair off my shoulders. I heard the scissors snip along the thick curls, all the while I stared forward. Lola placed the offering in front of the woman. She broke a hanging root and held it to the candle until a flame caught. She held the twig in the nest of my strands until the fire spread.

The warmth started at my hips and radiated across my body.  Even though my instincts screamed for me to run, I stayed paralyzed as the sensation intensified. I could feel myself ablaze, my body seizing. My shoulders convulsed. Even as I screamed and cried near boiling tears, I kept my eyes fixed. Shadows danced along her bulge, erratic and ominous, as if something inside her were trying to claw its way out.

Lola dropped to her knees, arms ascending and her head thrown back. She vocalized louder over my animalistic yowls, prolonging her last cry until she ran out of breath. 

When she stopped, the candles extinguished. The pain subsided. I fell over, exhausted.

On hands and knees, Lola crawled toward me. She placed my head in her lap.

Don’t worry, anak, she said. Rest.


Even through the soft lace curtains, the diffused morning light lit my eyelids bright orange, and I awoke in bed with no memory of coming home. Perhaps our evening on the water had been a nightmare. But, when I looked in the mirror, I noticed my locks had been lopped off. My hair, uneven and mid-length, was the only indicator that we had been to that unholy place. 

I descended the stairs to find Lola at the kitchen table. Her sister and their family had already left for mass, their yaya* in tow to tend the children. Lola waited for me, nursing her cup of three-in-one coffee.

*Yaya means “Nanny.”

Good morning, sleepy beauty, she greeted, there’s a plate for you, just add an egg.

In their bright blue kitchen, I cracked one, fresh from the chickens in the side lot. The fragile brown shell fractured with just a tap. Whites turned opaque upon contact with the pan.I focused on the yolk. A red oblong splotch interrupted its golden yellow, tendrils branching from its center.

  I called Lola over to ask if the egg was safe.

Ah, she said, it’s fertilized. A very good sign. You can eat it. You should.

So, I placed it on my plate, yolk still jiggling over rice. Though, I kept staring at the spot with its veins until I popped the pocket and ate it.

By mid-morning, the town was already lively with the Philippine brand of joyful Catholicism. Congregants from towns over donned matching tee shirts, printed custom with the year, outing, and parish. They put hands on shoulders, forming long trains so no member would be lost. Couples held hands, hope in their eyes. Many struggled like me, and yet I could hear their loud laughter. They came every year, I overheard, and they would return even after their calls had been answered.

  With Lola’s arm in mine, I stepped onto the street. I prepared to jostle shoulder-to-shoulder with other devotees. Instead, the crowd parted. People hugged the edge of the path, pushing into vendors selling sweets and religious paraphernalia.

Instead of inching forward, we strolled. As we pressed on, I heard the tinkling music. Horns played the same cheerful tune, drums signaling that the loop was set to restart.

Locals in white lace barongs* and baro’t sayas* led the group. The rest copied their dances, thoughtfully choreographed to give praise. Rolling arms with thumbs pointed inward symbolized prayers from the heart. Arms raised from womb to sky petitioned the saints, all interspersed with a flamenco-esque waltz, left to right.

*Barongs are embroidered formal shirts for men and baro’t sayas are traditional Filipino skirt and blouse combo for women

As we pulled to the front, the choreography improved. The dancers gracefully swung out of our way. Their bodies kept tempo, while heads swiveled toward us with suspicion.

  We moved through the square. In front of the church stood the town’s patroness, veiled, wooden face stoic under a halo of stars. Her anda*, ornate with fresh flowers on deep, solid wood, had already been paraded through the streets. In her final spot, she watched the celebration, head held higher than anyone else. Pilgrims grazed her float in veneration, pleading for intercession along their fertility journey. But when I approached, they pulled back, so I alone was in her presence.

*Anda means “altar.”

  I extended my hand onto the warm lacquered wood. Upon contact, a loud crack echoed. A rift ruptured beneath my fingers. The celebration paused with all eyes on me. 


Gossip festered. Even with a change of clothes and tied-back hair, I couldn’t walk the markets without wary glances. With a farewell to family, we retreated to the anonymity of Manila. Distractions always at my fingertips, I almost forgot. In either direction, dread grew. Looking back, I fixated on the rumors spreading about me. Facing forward, I anticipated the mundane melancholy of trying and waiting, futile in its lack of progress.

  I had always wanted to be a parent. The urge grew as my friends coupled off and started their families. But, I also saw the sacrifice. They had new demands on their time, a complete reordering of their priorities. Even though I wanted a baby, I exhaled at the single line. I had a few more months of complete freedom, a timeframe that turned into one year, then another. 

As time passed, want swelled to yearning, then obsession. As I waited for referrals to process, I attempted the holistic. Anything in my control, I did to the extreme. I ate low inflammation, no sugar, no alcohol. I spent hundreds on supplements and acupuncture, rooted in Eastern medicine I previously approached with skepticism.

When none of it worked, I ceded to science. The doctors took the reins with their hormone supplements and blockers. I took pills that would bind to the right receptors to force ovulation. We monitored follicles with scans. A round of Clomid failed. The attempts counted down. And, with a new approach around the corner, I conceived.

  While I finally had what I wanted, my nerves raged. Despite the precursory sacrifice, I worried that I wasn’t ready. A part of me that I tried to repress wanted to retreat to safety.

As the thought flowered, I lost the pregnancy. Instead of relieved, I was left devastated and desperate. That comfortable misery waited to welcome me home.

I kissed my husband at the airport before we resumed our lives. I expected to reach for the Provera, a progesterone supplement taken to trigger a withdrawal bleed. Natural periods were few, so I was surprised when I saw red right on time.

  From there, the cycle followed the textbook pattern taught in health class but rarely experienced. On days 10 and 12, we had sex. On day 14, the predictor strip blazed pink, my first test ever that signaled natural ovulation.

During the two-week waiting window, I could feel the tendrils of hope pulling me toward a dangerous optimism. I spent over a year detaching myself from outcomes. I modified my life and body for fertility, with the constant reminder that nothing guaranteed a baby. I could only improve my odds. I disciplined my body and distrusted my emotions. One cycle on track should not undo all my progress.

I still sprung for the nice pregnancy test at the CVS. Early results, the box promised, with an easy-to-read digital interface that would say, “pregnant” or “not pregnant.” No lines or symbols to decode. While the results processed, my heart hammered in my ears. 

I gasped, then clasped my hand over my mouth. Sobbing, I called my husband in. I could barely breathe.

What’s wrong, he asked, panicking. He had found me broken on the bathroom floor, too many times. He took my face in his hands, looking for answers in the creases. My eyes kept darting toward the bathroom counter. 

He cradled me in his arms, and we cried together.


I wanted to glow. Even though the books described a Kafkaesque metamorphosis, I dreamed of radiant smiles. During my first pregnancy, I digitally collaged women in maternity clothes. They went to work, kept the kitchen, and exercised with a modeled femininity, all while incubating life. My loss shifted everything.

I spent my first trimester consumed by worry. Dark circles appeared under my eyes from nights spent dreaming up disaster. Through a dizzying haze, I pictured my body flat on the sidewalk or crumpled over a car. I bit my lips until they were chapped. Expecting blood-soaked sheets, I’d wake in a sweat, clammy, clean, and cold. 

I waited out the weeks. The likelihood of a miscarriage decreased with time. The physical toll of my pregnancy became all-consuming. Hard comedones pulsed under my skin. Red and angry, they burst, oil weeping from the wound. New parts of my body became tender, while others bloated until the rub of fabric overwhelmed my senses.

Morning sickness persisted across every waking hour. I hunched over the toilet, heaving with no release. My mouth soured. I pursed my lips together at the pungent taste of bile. Blood leached from blistering skin. 

At the taste of copper, the churning stopped. I dug my teeth into my lip until purple welts raised. In search of release, I’d pop the wound and drink a fresh flow of blood. Eventually, deep rifts took their place, stinging with every breath. 

Only checkups brought relief. In sterile rooms, my OBGYN assured the baby was progressing as expected.

We even made it to our first ultrasound. During our time trying, I had received half a dozen grainy images from friends who left us behind. They didn’t know how often I had been scanned, childless. Instead of a baby, we looked for polyps and blockages. The doctors analyzed immature follicles and confirmed that the remaining tissue was gone. Now, I had my own sonogram of a viable pregnancy. In my hands, I held a to-be-gendered splotch with a beating heart. 

I brought a copy to lunch, excited to share the good news with my family over a lazy-Susan’s worth of dim sum. Overtaken by a particularly pungent vertigo, I leaned against the B-pillar of an open window, air whipping my face on the drive to the restaurant. I rested against my husband during the walk through the parking lot.  

Inside, the barrage of odors flooded my senses. Fatty duck crisped over a rotisserie. The smell of fry used over fish and pork alike wafted from the kitchen. A surge of queasiness clenched my stomach. With a light head, my vision blurred. Through the spots, I watched myself approach Lola and wrap my arms around her frail frame.

Then, my knees gave out. 

The day played out in flashes of consciousness. Supporting my weight, my husband and dad brought me to the car. With the seat reclined as far back as possible, I held an ice pack to my head. Any time I opened my eyes, the world streaked by with colors all too vibrant. Instead, I squeezed them shut and spun in the dark. 

Lola followed us home. A former nurse, she checked my blood pressure and cautioned that it was low. With my husband on the hunt for pillows to elevate my legs, she took my hand in hers. 

Anak, are you pregnant? she asked. 

I nodded. I gestured to my belly and flashed a weary grin. 

At the confirmation, she squealed, the loud laugh I had heard all my life bouncing off the walls. She clasped her hands together with jingling bangles, her joy musical.

I knew you could do it, she said, beaming. I wish I knew sooner. Pregnancy can be so hard, but don’t worry. Lola will help you. 

She kissed my forehead before bidding me farewell, promising to return with the remedy to my discomfort. For now, my husband was to keep me company. He held bottles of sports beverages to my mouth and presented me with a tray of plain, assorted crackers. I felt acid creeping up my throat just looking at their ridges.

  When Lola came back, she sent my husband away to unload the groceries. From there, she commandeered my care. The first order of business, she insisted, was getting me something to eat. The thought of my usual favorites made me gag. My mind conjured images of molded rot. Instead of a fully prepared dish, she returned from the kitchen with an egg and spoon.

Lola tapped the silver against the egg’s rounded bottom, peeling off the cracked bits of shell. She tipped the jagged edge against my lips, so I could lap its liquid broth. After, she used her long, manicured nails to peel back the embryo’s veiny membrane. She fed me creamy, rich yellow, before placing the mound of flesh in my mouth.

As I chewed, I crushed its still-malleable beak and bones between my teeth. They weren’t yet hard. Instead, they grizzled with cartilage-like tenacity. Soft, slimy feathers tickled as I swallowed. But most surprising, I found that I was hungry.

I asked for more. 

From that day forward, Lola brought meals to the house. Even though the fridge was stocked with whole fruits and vegetables, I tore through the plastic baon*, hearty with rich, meaty Filipino staples. On my kitchen floor, I ate dinuguan by the spoonful. I slurped the buttery marrow out of oxtail and chewed through rubbery intestines. When the broth was gone, I found myself gnawing on stock bones until every tendon was wiped clean. 

*Baon are prepackaged food. Dinuguan is a stew made of kidneys, intestines, and pig’s blood

Within me, the baby developed fingernails. Its ears poked out of a soft skull, able to hear distorted sounds through amniotic fluid. On the ultrasound, the technician looked for now-formed anatomy. He confirmed that we were having a girl.

  My body accommodated her growth. Organs found new homes, compressed into an increasingly limited space. Stretch marks extended from my spine toward my belly button, as my center protruded into the bump that signaled pending motherhood.

With a hand over taunt skin, I asked for signs of life. When I researched kicking, I read quickening described in poetic metaphors. The sensation would feel like champagne bubbles rising golden up a flute. Movement could feel like kernels popping or a goldfish swishing its tail. 

Instead, the baby rumbled with an erratic drumming. She shook in laughter-like spurts, then switched to trembling growls and screams. She rolled with a dexterity reserved for the third trimester, her limbs slamming against my insides.

It’s okay, I tried to comfort her.

When I looked down, I saw her trying to break out of my belly. Her hands, almost as big as my own, clawed and curled against my stomach. With a sharp kick, an adult-sized foot jutted forward, with an impression so clear that I could count each toe. The thrash oscillated extremities, elbows and knees, each trying to escape from within. 

Please, stop, I begged, eyes sealed shut. You’re hurting me.

I breathed deeply until the tumbling subsided. When my body calmed, I directed my gaze to my bump. An eye underneath my skin rolled until it locked with mine.

I knew that my visions were impossible. The baby’s hands and feet could be no more than a few inches long. I tried to ignore my midsection every time I felt her stir. But, the kicking had increased both in frequency and intensity. With it, the viscera became more graphic. Jagged fingers clawing from within. Limbs pressed against flesh. My innards spilled from an open womb.

My husband sped to urgent care when I woke up spasmodic in tears. With my hand in his, I told the doctor about my hallucinations. Thus began the referral chain—OBGYN, to primary care physician, to perinatal psychiatrist, and back. Each ran their own cost-benefit analysis to determine the course of care. 

I was sent home with a bottle of pills, which burned on the way down. The antipsychotics angered the baby. She shook with violent throes at my lack of hospitality. My stomach cramped, then twisted until I could feel chunks rise up my esophagus. I swallowed my vomit, hoping I could persist until the meds metabolized. Her raucous turning forced my surrender. 

Lola found me that day, doubled over the toilet. At her instruction, my husband hoisted me into bed. She cut a lock of my hair and twisted the strands around a peeled ginger root. She ground pills with a stone pestle and sprinkled the dust until the yellow surface looked chalky. Elbow deep, she shoved the talisman under my mattress. In our native tongue, she sang about banishing nightmares while I drifted into darkness. 

My bed was the only place I felt settled. There, I could escape the vivid illusions of my daughter ripping through my body, fully grown. When I left, I could feel the writhing discomfort. Unable to stand, I crawled through the house and scurried back to the relief of my bed. There I stayed, bound. The essentials of my day-to-day were positioned always within arm’s reach. The mattress sank in, cradling me in my new nest.


As the months passed, the baby hit milestones two weeks ahead of schedule. I pictured her trapped in a too-small room—a space more akin to a prison than a cozy hygge where she’d long to go back. The number on the scale offered a concrete measure of how she outpaced my body. Weighing in at nearly nine pounds, I was offered a C-section. 

After an enthusiastic yes, I jittered with possibility. I crossed out days on the calendar. Soon, my combative pregnancy would end. Motherhood fluttered at my fingertips.

  I gave my husband a last kiss. He’d be back after the doctors prepared me for my procedure.

  See you later, I said. Let my family know I’m in there.

With a prick, they administered my IV. They had me flip onto my spine. I tried to relax with deep breaths, but I knew about the needle. I could feel it slide in between my vertebrae, administering medication directly into the spinal fluid. Once removed, I felt a lingering pressure that transmuted into a warmth traveling down my legs. Pins and needles were replaced with numbness. A nothingness extended from my ribs to my toes. I struggled with deep breaths, my diaphragm fighting an unseen sludge to rise.   

The nurse moved my heavy limbs to access between my legs. If not for her calm narration of the process, I would not have known that she cleaned my labia—nor that she inserted the catheter and shaved just a bit of pubic hair that crept too close to the incision site.

  When my husband re-entered the room, he was relegated to a chair by my head. He held my hand until they restrained my arms in Velcro straps to combat shaking. A common occurrence after delivery, according to the OBGYN. This was the hospital’s policy. We were left with only words for comfort.

We opted for the clear sterile sheet instead of something opaque. We wanted to see our baby when she first entered the world. And yet, my stomach blocked the view as masterful hands sliced through my abdominal wall and again through my uterus. I could feel a muted tugging, though no pain, as the surgical team peeled back layers of tissue. 

I waited for the first glimpse of my baby beyond the horizon of my raised belly. What I first saw was a head, adult-sized. Dark hair stuck to her face, slicked back with a combination of vernix and blood. She grew larger as she crawled out of the incision. As more of her features came into view, I recognized them as my own. We were like twins, but instead of being born from the same mother, she was born from me.

The surgeon crouched down and began to dig through the gash in my uterus. I could feel her fingers wriggling through my insides until she found little limbs. She lifted the baby into her arms and tucked my child to her breast. With one hand, she grabbed onto my body for stability with a weightless touch.

She tore the curtain down and stopped when her face was just inches from mine. When we locked eyes, she smiled before depositing the baby onto my chest. I looked at my daughter, the crying, bloody manifestation of everything I had endured.

In awe, I gasped. 

At the opening, my double lunged forward, cramming her body into my mouth. I could feel my jaw stretching until it dislocated, hanging loose to make more space for the woman to shove back into my body. I could feel her inhabiting my insides. As if my organs and plasma were missing, she nestled into the vacant space until she lay just under my skin.

My will snuffed out, I could feel clouds pass over my vision. Then, I lost consciousness, falling into the black.


I viewed the hospital room like a movie. People walked by the two screens in their scrubs and surgical masks, asking how I was recovering. Did I feel my legs again? How was my body temperature? I heard myself give voice to sensations that I did not have and thoughts that were not mine. 

From the sunken place behind my eyes, I watched myself hold my daughter, though I could not feel her weight. When I saw that she had my nose and my husband’s eyes, I wanted to squeeze her. The fact that I could not overwhelmed me with sorrow. My double lived this experience while I sat as a passive viewer. 

My husband kissed her identical lips. I touched mine with cold fingers, a hollow simulation.

  He lifted the baby away from my arms and settled her in Lola’s. My grandmother’s face softened with a new love for this continuation of her lineage. She bounced and cooed while my daughter slept soundly. When she began to stir, Lola passed the baby back to my husband.

Then, she walked toward me. Leaning over my bed, she put her forehead to mine. Then, she looked at me, past the imposter and into this astral plane. For a brief moment, I could step into the light.

I’m so proud of you, Lola said. She’s beautiful.


Kaitlin Milliken-Flohr is a writer and zine maker. She previously worked as a journalist covering technology and business. Her writing has appeared in Slash Magazine and Discretionary Love. She lives in San Jose, California with her husband, dog, and cat.

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