Hills like white elephants
... could have led both of these characters into a delusional sense of reality. Trepenation could have been a new way to get "high" as the effects of alcohol and other mind controlling substances have dimished in strength due to overuse. What gives the indication of trepenation instead of an abortion is in line 46 where the man says "They just let the air in and then it's perfectly natural." Abortions in earlier time were induced by pills or mechanical devices. In line 54 the girl claims how "afterwards they were all so happy." It would be hard to believe that all women would be happy after an abortion, it would be hard to believe if even half of all women would be happy for that matter. The couple seems aprehensive and nervous about the procedure, which could be attributed to either an abortion or a mind altering operation. Perhaps they thought they were releasing evil spirits from h...