She was nineteen and post therapeutic abortion, she had been to the abortion clinic a week ago for the procedure and was bid to see me within two weeks. She had the procedure without her mother’s knowledge. Long ago I had prescribed birth control and when I asked her what happened with that she said that she stopped taking it after her grandmother had died three months ago, that she was “really messed up” by that. Her delivery was disconnected from demonstrable grief. I wondered if I should press her on the noncompliance, if I should clearly describe the consequence of her non-compliance, but I settled for an admission that she would take the contraceptive I prescribed this time, and she asked me if this brand would help her skin.
I have referred women for therapeutic abortions, I have counselled them before and after, I think of it as a regrettable circumstance, and I do not politicize my role as physician: the truth is I would prefer there not to have to be abortions, that the necessary accommodations be made, that we all deal with our consequences, but I do not inflict my views on my patients and suffer the fallout of cognitive dissonance and hypocrisy. I remember a discussion with a visibly Christian medical student ten years ago. The student said she would decorate her waiting room with Christian messages that would signal her position on abortion, that no one would become her patient without knowing that she wouldn’t refer a patient for an abortion, and I think of this nineteen-year-old woman, I think of her asking me if her skin would be helped by a contraceptive she should have already been on, and I asked the woman if she was suffering from any negative feelings as a result of the abortion. She told me no, that it was what she had to do, that she was currently living “over a barroom” and that she didn’t want to raise the child above a bar, and I thought that it was possible to move, that finding another room to live in wasn’t a big task, that in my life I had made larger accommodations for smaller needs, and I wanted to moralize: this woman aborted a fetus, damn it if I had feelings if it were a human being or not at that seven week stage, but I did have feelings for it. I think my feelings were created by her perceived lack of feelings.
Again, I have referred several women for abortions, and in every case they were devastated by their decision, but this woman seemed unconcerned, and I wondered if it was my role to tell her that her irresponsibility had ended tragically, in a tragedy she was oblivious to, and then I wondered if this was repression, or if she just hadn’t awakened to the consequences of her decision yet, if there would be some future grief. So I told her that she might feel differently in the future, and if her feelings changed she could come and talk to me about it, but she reassured me that she was fine, that she was getting over her grandmother’s death and that she would be dutiful about taking the pill again. It felt like an emotional dead zone.
I wanted to shake her, but I did the pap and bimanual exam instead, I did the cultures, I noted that the blood was minimal, that there was no foul discharge, and I left the office that day with the feeling that the undimmed potential of the human race was often self-strangulated, that this abortion was probably needed but not fully thought through, like a medical student guessing a drug on rounds and getting the answer right but, when asked the question why, getting the reasoning all wrong, and it’s true I’m misjudging her, that there may indeed be a coming due, but I’ve referred women before and I don’t think there will be. Is it that I just demand the appropriate kind of expression of sorrow? Should abortion be a no-questions-asked social right, or should there be a requisite regret before it is granted? She had no money, no support, and she was very young. She begged me not to tell her mother. I promised her I wouldn’t, highlighting in the EMR that she had a TA and that it was confidential. I highlighted it using the style menu, and thought of my own style, my initial preparation, on finding out that she had had a TA, thinking that I would have to deal with difficult feelings, and then finding out that there was no process, no minefield. It haunts me that I wrote in the chart that her uterus had returned to a normal size.
(Read A.M. Hinton's "My Choice.")