Behind Closed Doors
Sophia Lee Ryan
I'd prepared as much as I could: I had a huge coffee, a water and every kind of snack imaginable stuffed into my bag. In my head I carried as much information about dilation and curettage as I'd been able to absorb during a study session at Starbucks the night before.
I was a third-year medical student doing my obstetrics and gynecology clerkship, and I was about to spend a day at the local family-planning clinic. The clinic offers support to women on all aspects of contraception, from education and counseling to providing various methods of birth control or carrying out terminations. I knew that this was their OR day, so I'd researched some of the cases that I would see: early pregnancy failure, repeated fetal deaths, second-trimester abortions for congenital anomalies.
But all of my culinary and intellectual preparations had done little to fortify me emotionally. Despite my full belly and head, my firm belief in a woman's right to choose and my prior confidence in my ability to handle it all, as I approached the door, I began to lose my nerve.
I thought about all of the reading and talking that I had done about abortion through the years; I thought about abortion providers murdered in the name of life; I thought about the politicization of terminations and about how much it had all seeped into the public consciousness; I thought about how painful the decision must be for some women; and I thought about what I might see in the OR that day.
"It can be difficult to be there in the operating room," my attending physician had warned. "If you feel you need to leave, everyone will understand."
"I'll be fine," I had assured her; but now I was thinking of leaving the clinic before I'd even entered it.
As I walked through the door, something changed.
I saw the patients, the busy staff, the tidy exam rooms and the readied OR. I realized that this was a day like any other: there were patients who needed care, and there were doctors, nurses and others like me on hand to provide it. My trepidation began to dissipate. I knew I would be okay.
There were seventeen procedures on the schedule, encompassing a wide range of gestational ages and a correspondingly wide range of causes.
The first patient was a woman from an orthodox religious group who needed a dilation and curettage. She had just experienced her third miscarriage at nineteen weeks' gestation. She and her husband were paying cash to avoid exposure within their community. Whether they feared the stigma of abortion, of infertility, or both, I couldn't be sure.
The woman's deep brown eyes were heavy with sadness. She took my hand and leaned in close to me.
"Why did this happen? Will you be able to tell me why this happened?" she whispered, her voice quavering.
I had no satisfactory answer to give her.
The next case was a couple who'd struggled to decide whether or not to abort their fetus with Down Syndrome. The woman's husband was clearly heartbroken, his doubt, fear and anguish written on his face with every stray tear. The patient herself kept up a brave front until the moment she lay down on the operating table, with her husband safely back in the family waiting area. Then she let the despair wash over her in waves. Eyes closed, face contorted, she cried, her sobs echoing through the sterile OR, her tears soaking the hospital sheets and her grief seeping into me through our intertwined hands.
Then came the voluntary termination by a woman on methadone maintenance. Abused by her partner, she had a young daughter at home and could not support another child at this time.
"Will it hurt the baby?" she cried as the anesthesiologist inserted the IV.
"I'm so sorry, baby," she whispered as the medicine kicked in. "I'm so sorry..."
For each of these women I had little to offer in the way of answers--and yet, because of the intensely personal nature of the situation, I felt a deep sense of connection with every one of them.
Through clasped hands, arm squeezes and kind, encouraging words, I did my best to assuage some of their fear and sadness. I can't be sure that I eased their pain, but I surely shared in it.
At day's end, I left feeling more wrung out than I'd ever felt before. I was struck by how taxing the day had been for everyone--how tired, despairing and disappointed the women had seemed, and how spent the providers seemed, too.
In the public arena, the right to choose is an emotionally charged issue. What my limited exposure to family planning has shown me is that in the privacy of a medical office, the decision to terminate a pregnancy--and the act of carrying out that termination--is similarly charged.
Behind closed doors, removed from the anger of the public debate, all of the controversy and politics fall away. They are supplanted by the very same human emotions that normally accompany the practice of medicine--fear, grief, doubt and even hope. And through compassion, cathartic emotional release, honest conversation and deep human connection, the central goal of medicine is similarly achieved: healing for the patient, the doctor, the nurse, and this medical student alike.
About the author:
Sophia Lee Ryan is a graduate of Dartmouth College and is currently a third-year medical student at Albert Einstein College of Medicine. She has loved writing all her life, beginning with a very prolific run of book publishing back in kindergarten. "Writing has always provided me with a release and has helped me weather the many emotional challenges of medical school."