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
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
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.