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The Abortion

We have a "vag bleeder," my nurse said, rousing me at three in the morning. The differential diagnoses went through my waking mind in a split second. "Vaginal bleeding" usually meant I was about to see an early pregnancy, possibly mis-carrying; a life-threatening "ectopic" pregnancy, where the embryo was developing somewhere else besides in the normal location of the uterus; a near term pregnancy in distress; or just someone with an abnormal menstrual period.
My new patient was none of those.

"She's a twenty year old, gravida five, para one, T-AB four," my nurse succinctly said as she handed me the chart.

My patient's name was Cheryl and my nurse had described her history well, with that medical verbal shorthand that gets quickly to the nitty-gritty of a case but somewhat dehumanizes a patient. In Cheryl's young and sexually active life, she had already had five pregnancies, one child, and four therapeutic abortions. "Therapeutic" most often being a medical euphemism for the abortion of an unwanted pregnancy.

Cheryl had had her last abortion three days earlier. The bleeding had never stopped, and was now heavier, and accompanied by severe abdominal cramps. The definitive diagnosis was made by "ultrasound," a radiologic study that uses sound waves to produce visual images of internal organs. It showed that her uterus still retained some parts of the already terminated pregnancy. Her "therapeutic" abortion had been incomplete.

Cheryl just shrugged when I told her she needed to be re-hospitalized for another "d and c" - the "dilation and currettage" procedure to remove the remaining products of conception from her uterus. She was unhappy but resigned. She had been through the same procedure many times before.

I talked to her about abortion and about how this, her chosen method of terminating pregnancy, was, all ethical considerations aside, harmful to her body. "The procedure carries the risk of infection, sterility, even death," I told her. I wanted to make a strong case against abortion. Though what I said was true, I was perhaps a little heavy handed. In reality, abortion, in the hands of competent medical personnel, is a generally safe procedure.

Cheryl listened to me politely while I talked about other methods of birth control - abstinence, condoms, pills, diaphragms, spermacidals, implants. She wasn't stupid or retarded. Her speech told me she was rather intelligent. She already knew about all these other methods of birth control. She simply didn't care. "Therapeutic abortion" was obviously her preferred method of contraception, and would continue to be so.

So, having said my piece, orders were written and the patient was scheduled for her "D and C."

I am opposed to abortion. Yet, at the same time, I am for freedom of choice. I just think that that freedom ought to be "freedom of intelligent choice." I went back to sleep and wondered what was more difficult - the science of medicine or the ethics of medicine.