“Go have that baby!” my dermatologist said, while she was busily slicing a possibly precancerous cell off the numbed skin at the corner of my eye.

“I’m 43,” I told her.

“Go have that baby now!” she said.

This eruption was not unexpected. We’d been debating whether or not she should remove one of my xanthomas during the course of the excision she was doing. That was the plan hatched by my regular dermatologist so I could have one of these monstrosities removed from my face during a legitimate surgical procedure under my insurance company’s radar. She would cut off the small flaky cell and, before sending it off to the lab to be biopsied, whoops! her knife would slip a few centimeters to the right and bye bye beastie that’s been marring my face since my first pregnancy more than four years ago.

Our plan was foiled by a study on the use of laser surgery in the treatment of xanthelasma, brought to my attention by someone who read my blog post on the subject. I showed the doctor this study and asked if she thought it was a valid option. Turns out she thought it was a better option than the procedure we’d planned and which she subsequently called off.

“I’m trying to think what I would do if I weren’t a surgeon,” she said. She paused for a minute. “I’d do the lager surgery.”

Definitive. Final. Honest.

She said she would have done a great job with minimal scarring, but in any surgery in the eye area, there will be some amount of pulling on the skin that will remain visible even after it heals and that would be avoided if I went with the laser. She said she’d put in a call to the Boston doctor who’s The Man for this type of thing, said it would take forever to get in to see him, but maybe she would have some pull.

So why was she giving me advice about what I should do with my womb?

During the course of our discussion, she also said it would be a mistake to remove the lesions at all if I might have another baby.

“Imagine I take this thing off and you get pregnant and it comes back.”

She was right. That would suck. And of course I’d thought of that, but I’d dismissed it for two reasons:

1. It’s not everyday I have a possibly cancerous cell located practically on top of a xanthoma. This was my chance to get this fucker removed for free! (Back in the day, when I only had one lesion and it was small and manageable, I did have it removed for free, but according to my derm, nowadays xanthelasma is generally considered a cosmetic, not medical, condition and I’d likely have to pay the big bucks.)

2. Lately it’s seemed unlikely that I would have another child.

I mean, who am I kidding? I am over the hill, I am ambivalent and, mainly, I am still terrified.

But the other night I woke up in a panic.

Truth be told, I woke up because Aidan had an ear infection and was waking up every twenty minutes screaming for me. But after being awakened several times, I found myself unable to fall back to sleep and lay awake in a panic. Lots of thoughts raged through my sleep deprived noggin, but the big one was:

Oh my God, what if I blew it? What if it’s too late for me to have another baby?

And in that moment I knew that is what I wanted, what I needed: another baby.

This is something Harlan and I have debated ad nauseam. We’ve talked to a therapist. We’ve argued. We’ve cried (well, I’ve cried). I have also written and written and written about it, laboring over an essay that I desperately want to publish, but can’t seem to finish because I can’t seem to find the point under the agonizing layers of a debate that has no logical conclusion. Because ultimately it’s about taking a leap that I am terrified to take.

And so I find myself lying on an operating table, my face numb, a doctor hunched over me, being told what I already know.

“Why exactly do I have to have another baby?” I ask her, laughing at the absurdity of the moment.

“Because,” she says, “a sibling is the most beautiful gift you can give to your child.”

Pregnant with Nina, the daughter I lost. Dare I try again?