The poem begins, "Somebody who should have been born / is gone" and this phrase is a refrain intercalated between two sets of three tercets, with a final closing tercet. Each tercet has a rhyme scheme of a, b, a. The speaker narrates a journey that takes her south to an abortionist in the mountains of Pennsylvania, and then, after the abortion, back home to the north. The situation and the speaker's perception of it are rendered in metaphors that draw on the natural environment through which the journey proceeds. At the beginning, the earth puffs buds, and the drive proceeds toward blue-green mountains -- metaphors of fecundity. The description of the mountains as "humps" might imply the sex act that initiated pregnancy.

Soon, however, there is foreboding as dark images of tearing and splitting appear: "the ground cracks evilly," "and me wondering how anything fragile survives." Then "a little man . . . took the fullness that love began" and the speaker returns north, physically and emotionally reduced as the sky grows thin and the road is "flat as a sheet of tin."