Dina Issa stood in a corner of the examination room, peering out through the narrow window blinds bending light across the white, sterile room. The blue medical gown lay folded in a neat square upon the exam table, untouched. She wore instead the same dark headscarf and long black skirts with which she’d first entered the clinic. Her face, framed in its tight circle of cloth, appeared bloodless. Rivka hesitated in the doorway at the sight of her patient, still dressed.

            “I feel as if someone has followed me here,” Dina said.

            Rivka went to the window. Beyond the empty parking lot and chain-link fence appeared the gray-blue Rocky Mountain ridge. Pink splinters of early morning light angled past its jagged tips. The clinic stood on the outskirts of Denver but Rivka’s patients—women from Somalia, Pakistan, Egypt, Yemen—always found their way.

            “Do you want me to call security?” she said.

            Dina shook her head. “I feel like I’ve already wasted your time. There’s nothing to be done for me. It’s too severe.”

            “Let’s at least take a look together,” Rivka said.

            Dina nodded. She gazed again at the window, her face tense with expectation.

            Of surgeons there were those who took and others who rebuilt. The years Rivka spent in Paris, studying under Dr. Foldès, had trained her in the practice of clitoroplasty and defibulation. The examination confirmed Dina’s suspicions—infibulation, the most severe kind of FGM. A Pharaonic circumcision, one that entailed a thorough eradication of the labia and clitoris, with the vaginal opening sewn, leaving but a tiny space to urinate. In ancient times, the clitoris was sacrificed to the god Hapi, who flooded the Nile at will. Wrapped in linen and anointed with sacred oil before cast off into oblivion. No matter if the practice was now illegal throughout Egypt, girls, especially those in rural areas, continued to die in the name of tradition. Today the cutters still promised the same benefits of enhanced hygiene, purification and modesty. A girl was not a woman until she became pure, clean, smooth. Untainted by desire. Fit for marriage.

            “Can you help me?” Dina said, after dislodging her feet from the stirrups, and bringing the sheet tight across her midsection.

            Rivka pulled off her plastic gloves, depositing them into a nearby medical waste bin. She’d reversed only a handful of such circumcisions during her practice. Such reconstructive surgeries came loaded with risk.

            “Yes,” she said, before explaining what so many of her patients struggled to understand—that what appeared destroyed was at most only hidden.

            Pull apart the shades again, and peer out at the surrounding lot framed in the motel window. Look once more for suspicious cars and veiled women lingering in the periphery, their shadows cast long across the asphalt. One can never be too sure in a place like this, Dina thinks. The glass is cold and dusty beneath her fingertips. She soaks in the warm, dappled light that winks from the edges of hub caps and windshields. Their voices have followed her here though Dina knows that her sisters, mother and aunts are still thousands of miles away in Egypt, oblivious of the surgery she will have today. Such distance offers no ease. She imagines them sitting together inside of her grandmother’s house in Suez, sipping shai tea as they meditate over her disgrace.

            Hushed voices snake across the mind. Her mother is the one Dina hears most. What if a boy should want to touch you that way? The pain will protect you. Purified girls grow taller, get marriage proposals. Western women are no cleaner than livestock, their uncut genitals like cattle’s.

            She is ten years old when it happens. Shame is a thief that confuses memory. The midwife comes, and others press her down against the earth. Above their heads is a wide, blue sky, dust shimmering in the heat. Palm trees rise far above the congested rows of buildings, their leaves a violet hue in summer.

            Dina closes the shade, shuts away the outside light. She massages a hand across her chest to steady her breath. Then she adjusts her hijab, fixing a loose strand of hair beneath her headscarf, and rolls out the prayer mat in the direction of Mecca. Where in the teachings of Islam does it state that a girl should be circumcised to evoke the purity of the Prophet? When Dina chants, the holy words strengthen her resolve, quiet the voice of her mother.

            Rivka sponges away the small rivulets of blood that emerge with each incision. A trail of faded scar tissue lines the small mound of flesh upon which she directs the dissecting scissors. Beneath the magnification of the surgical eye loupes, Rivka works through wet folds of tissue. She severs a few small ligaments before a small pink root appears at the edge of her scalpel.

            Antiseptic scents pierce through Rivka’s surgical mask. Dina lies inert with her legs propped up in stirrups, her consciousness locked away in an anesthetized sleep. A border of translucent plastic sheaths her lower torso, exposing only the groin and buttocks. Blue sheets create a screen that obscures the rest of her body from view. She is alone here. No one has accompanied this woman to the clinic, a requirement of new patients. This time Rivka has made an exception.

            One of the blue-smocked nurses hands Rivka a needle holder to secure the sutures in place around the fresh clitoral tissue exposed. The organ extends far underneath the pelvis, a full eight inches of erectile flesh curving around the vagina, fully intact despite the external mutilation. Only a small bit is uncovered to replace what was taken. Afterward, she will construct labia from several folds of skin near the vagina. The entire procedure takes no more than a few hours, though months of healing lie ahead.

            A cold burst of air emerges from one of the ceiling vents, and fills a space between her lungs. She remembers walking alone for hours through Brooklyn in the numb February air, a suitcase in hand. Cast out. Her mother’s shouts still raw between her ears. You have brought shame to this family. The Rebbe’s face glares from posters hung throughout the Crown Heights neighborhood. Rivka moves ahead, ignoring those who stare. A Jew among Jews, she remade her life in study.

            Inside of the bright operating room, the steady machine-led pulse of the heart monitor and ventilator travels across the background. For a moment, Rivka senses the weight of Dina’s life, and feels it as her own.

            Dina works her hands over the bandages, peeling away layers of gauze and medical tape swathed over the region of her privates. Uneven tendrils of shadow splay across the inner portions of her thighs. She sits at the edge of the tub inside the small motel bathroom. Her long, dark hair curls around her neck like a scarf. A tiny cockroach skitters along the white floor tiles, brushing past her toes, but Dina ignores it, her attention consumed with minimizing the pain spread throughout her pelvis.

            After the operation, she’d spent the first sleepless night clutching an ice pack between her legs. Even with the medication, the wrong movement promised excruciating sensations splintered across her groin. It would take months for new skin to grow atop the exposed clitoral tissue, but the discomfort was supposed to subside after a week. Until then she was not allowed to bath or forget to apply the special vitamin-enriched ointment along the incision lines. One of the nurses had called that morning to check in. Dina’s solitary presence had drawn some concern before the surgery, leading to a slew of questions—what’s the plan? Where are you going, and how are you getting back? Don’t you have anyone with you? Even the cabbie worried as Dina struggled out from the backseat upon returning from the clinic. He’d put the car in park, and came around to her door, his hand extended. She refused his assistance past the curb.

            Now Dina clutches at the sheet marked with discharge instructions, checking to see what is said about uncovering the bandages for the first time, but there is nothing. She is alone in this. Her fingers move slow as each tender patch is revealed. The phone rings again from the bedroom but it is another hour before she rises to discover her caller.

            Rivka tries again for clearer reception outside of the clinic. She follows a ridgeway of concrete bones that extends along the parking lot, offering a view of the Rockies between the shaded enclosure of Juniper and Aspens, the Bristlecone pines that spice the air in winter. Now only the musk of ragweed and cut grass fills her sinuses in the thick summer heat. Rivka massages her brow where a headache blooms. Tiny gray bars rise and disappear on the screen of her phone but soon the call goes through. A man from the front desk of the motel answers, and tries to connect Rivka to Dina’s room. Sunshine pierces through the surrounding treetops in uneven strips as the line holds and holds. A broken vein of light pools at her feet.

            She is lucky. Among her patients, complications have been few. The shadow of lawsuits and violent threats continues to elude her door. For five years she’s run this clinic for women alone with a small staff and the aid of a few fellow surgeons, an undertaking that’s demanded all of her personal resources and psychological stamina. Five years and hundreds of patients. Still, Dina worries her. Who does she think followed her that day? Someone to shoot up the clinic?

            An automated voice appears on the line, instructing Rivka to please leave a message after the tone. She hesitates; the breath sticks between her lungs before she can speak her request. Over the years, she’s tried contacting her own family in Brooklyn without response. Significant life events—her father’s death, a sister’s wedding, the birth of nieces or nephews she will never meet—still inspire the impulse. Such news reaches her through social media channels. Silence is punishment.

            Another voice interrupts, scattering Rivka’s thoughts.

            “Yes, doctor, I’m happy to come in tomorrow,” Dina says, picking up.

            Dina waits for Rivka inside of the clinic. The surgeon’s office is crowded with bookshelves lined with medical textbooks and patient photos of women, most appearing to be of African or Middle-Eastern descent. Beside a poster detailing the female anatomy hangs a world map. A sign above it reads, “The history of plastic surgery is one of innovation.” Her gaze lingers upon the smiling faces framed in glass.

            It’s difficult to sit for too long. White-hot streaks of pain knife across her groin, webbing sensations through her middle. She is desperate for some distraction. A large moth perches from the underside of the ceiling lamp, ambling closer to the bulb. Light soaks through its translucent wings, outlining a grid of black delicate veins that reach from thorax to tip. Dina studies its pattern of transverse lines, the beige and gray skin speckled over in white spots. Its feathered antennae twitch.

            In a few days she will return to Minneapolis and resume her life as a home aide through a senior care facility. Her employer is good to her; the insurance she receives has covered all treatment expenses. Work absorbs her waking hours, anchoring her to a life of routine and stability—a godsend in the few years she’s taken refuge in the States.

            Rivka enters the room with the usual pleasantries. She is warm but reserved, insisting from the start on being called by her first name. They speak of pain management and a prescription for stronger medication is written out. The surgeon warns against aggravating healing wounds, how the least bit of prodding and scratching can induce infection.

            “It’s awkward with the stitches. Especially with work coming up,” Dina says.

            “I’d like to keep them in for a bit longer to minimize the chance of scarring,” Rivka says.

            Dina nods without complaint. For years she’s tried on her dead father’s habits, his fixed attention and feigned indifference during those endless hours of selling produce in the souk, hauling baskets of guava and cucumbers to his spot in the marketplace. Beneath the white keffiyeh wrapped around his head shone a brown, wrinkled face devoid of useless emotion.

            “You said you felt you were being followed,” the doctor says.

            Dina tenses. “Yes. Since I began staying at that motel.”

            “I may have another solution,” Rivka says.

            The moth flutters out from the ceiling light and moves toward the bright sky trapped inside of a window, beating its wings against the blue.

            Headlights illuminate the trees, catching the spiny needles of white pine and spruce in a passing wash of luster. Rivka drives slowly, maneuvering each hairpin curve with care, though she’s made this trip half a dozen times before for those who needed it. Dina sits in the passenger seat, quiet and pensive, her rigid posture unchanged since leaving the motel. They speak little, each absorbed by the dim-lit road unfurling before them. Their senses remain heightened as if it could be more than ghosts that trail them.

            Rivka takes no chances—she’s called in some favors to secure a bed for Dina. Soon she makes another turn, advancing upon a hidden driveway banked by the inked formations of dense woods and unkempt shrubbery. A large fieldstone house appears around the next corner, its windows bright and inviting. Gravel crunches beneath the tires as she parks near the entrance.

            “Here we are,” she says.

            Dina opens the car door and steps outside. Rivka helps gather her suitcase from the trunk, and together they move inside of the safe house.

            Years ago, she knew shelters in Brooklyn, restarting her life through night school and government assistance. Distance failed to sever the bond, though Rivka’s family passed her in the street without recognition. She’d left them before they could fit her for a white lace veil or recite l’chaims over Slivovitz. Before she could sign a ketubah, sealing her fate with a man old enough to be her father.

            Now she waits with Dina inside of an empty beige room with soft lamps and a large plush sofa. The surrounding rooms are quiet at this hour. Dina’s stay is only for a few nights; she refuses to delay her return to Minneapolis for work, regardless of the physical discomfort she might face.

            “I hope you feel more relaxed,” Rivka says. She speaks of the twenty-four-hour security presence, along with a car service and in-house counseling—all covered by a private funder.

            “You don’t deserve to live in fear,” she says.

            A faint smile creases Dina’s face. “For years, the doctors didn’t know what to do with me. Like I was a lesser woman. An endless victim. But it was always mine to decide once I knew,” she says.

            She takes Rivka’s hand, her smile deepening. “This was the last hold they had on me,” she says.

            An attendant appears at the door, calling Dina’s name. She rises with her suitcase, leading them all from the room.