"I feel bad..." Amy whispered, then paused.
I'm a family-medicine resident, and I was doing my gynecology rotation, which involved spending a few days at a Planned Parenthood facility. This was my first day. I'd been assigned a patient to shadow: a young woman named Amy, who was here to have a first-trimester abortion.
I'm a fan of Planned Parenthood's work providing high-quality, affordable contraceptive and gynecological care. In college, when I lost my health insurance, I'd gone to Planned Parenthood for birth control. Now, as a doctor in training, I was curious to see how the clinic worked from the inside.
I'd found Amy sitting with a young man in the waiting room. She was twenty-seven, with large, expressive eyes.
After she'd had an ultrasound, we crossed the hall to the laboratory. Amy squeezed her eyes shut and giggled nervously as the nurse found her vein and filled a tube with her blood. Then we went to the counselor's office, where Amy was asked a myriad of questions.
She had been pregnant once before and had a four-year-old son. She and her current partner had been together for three years and had been using an intrauterine device (IUD) for birth control. Unfortunately, this had been expelled, resulting in Amy's current pregnancy.
During this lengthy interview, my mind wandered back to a conversation with my grandmother a few months prior. I'd been sitting at her kitchen table, stirring a cup of herbal tea.
"Where do they have you working now?" she asked as she handed me a bowl of honey and a spoon with her gnarled, arthritic hands.
"Obstetrics. I'm delivering babies," I replied, spooning honey into my tea.
"That's nice. You know, when I had your aunt and your mother, back in the Soviet Union, there was none of these fancy pain-medicine shots they put in your back nowadays."
"I know, babushka, I know," I said, rolling my eyes. I'd heard this so many times.
Sipping my tea, I wondered aloud: "So you had my aunt, and then my mom eight years later. Why did you wait so long to have another baby?"
"We couldn't afford it," she replied simply, settling down across from me with her teacup.
I thought she would leave it at that, but after a moment she said, "I did get pregnant once. When your aunt was about a year and a half old."
I replaced my teacup in the saucer, surprised. This was news. I'd thought I knew everything about my grandma.
"What happened?" I asked.
"I had an abortion," she said matter-of-factly, spreading raspberry jam on a roll. "We were poor. All three of us lived in one room in a communal apartment, sharing the bathroom and kitchen with three other families. Your grandfather and I earned pennies at the factory. I worked the day shift, and he worked nights, so we could take turns staying home with your aunt. We couldn't afford day care. We would all have starved if I went through with the pregnancy and had to stop working."
"So what did you do?"
"Well, abortions were illegal--Stalin wanted to increase the population. But I heard there was a woman in my neighborhood who knew what to do." She absentmindedly took a bite out of the roll and looked off into the distance.
"I went to her house, and she put a catheter into my womb. Then I went home. I was worried, because for hours nothing happened. I just walked around with a catheter between my legs. Finally, the blood started to come. And that was that."
I pictured my grandmother lying on a couch in a dim room as an older woman inserted a nonsterile catheter through her cervix. As much as I respected this woman for helping other women in need, I also felt horrified: my grandmother could have died of an infection or had some awful complication. I had heard of things like that happening in the US in the days when abortions were illegal.
"Why haven't you ever told me about this?" I asked.
"It never came up," she shrugged. "I haven't thought about it in a long time."
"Okay, we're all finished here." The Planned Parenthood counselor's voice brought me back to the present.
A nurse whisked us away to another waiting area, thronged with women of various ages, races, ethnicities, shapes and sizes.
I tried to picture my grandma here and wondered if she would have preferred this place to a stranger's living room.
Before long, the charge nurse called Amy's name, then led us to his office.
"You've been medically cleared for a manual vacuum-aspiration procedure," he told Amy. He gave her an ibuprofen tablet. "Take this; it will help with cramping during the procedure."
When the charge nurse stepped out of the room, I asked Amy a few questions. She told me about her job, her family and her boyfriend, the young man in the waiting room.
"He's going to take me back to my job," she said. "It's not far, so I'm not missing too much work."
Whenever Amy mentioned her boyfriend, she looked uncomfortable. The counselor had asked her if her partner was abusive or threatening, and she'd firmly responded, "No." But I wondered if there was more.
"You seem nervous," I observed.
"I feel bad..." she whispered, then paused. Her eyes were bright with tears. Before she could say more, the charge nurse returned and led us into the procedure room, where another nurse, a physician and a doula were waiting.
What does Amy mean? I wondered. Does she feel bad about her pregnancy? Does she regret choosing to get a termination?
The nurse got Amy a cool compress for her forehead, and the doula held her hand and distracted her with conversation as the family-medicine physician quickly performed the procedure, then inserted an IUD. The whole thing took no more than five minutes, and Amy did not seem terribly uncomfortable.
Soon Amy was reclining in a soft recovery-room chair, warm packs soothing her back and abdomen. She looked relieved.
"What did you mean before, that you feel bad?" I asked.
"I think he's mad," she said vaguely, her eyes growing sad.
She nodded. "I think he wanted the baby, to keep me around."
"What do you mean?"
"We haven't been doing so well," she said. "He's an actor; he's always off performing. He gets a lot of attention from other women, but he's very jealous whenever I talk to any man. We've been fighting a lot."
"Ah," I said. Understanding began to dawn. "Are you thinking of leaving him?"
"Yes, and I have my son to think about. I can't have another baby right now," she said firmly.
Ah. I got it. Amy was already a single mom to her son. She didn't want to be in the same situation with a second child.
My heart filled, thinking about this decision she'd had to make. I felt honored that she'd confided in me. And I wondered how my grandma had felt, making this decision a half-century earlier. Looking ahead, I hoped that I would be able to help women like them in my future practice.
I squeezed Amy's hand.
"Thank you for letting me shadow you," I said, then stood to go.
Amy smiled and waved goodbye.
Leaving the room, I glanced back one last time. Amy's eyes were closed. She seemed at peace.
I thought I'd go home and call my grandma.
About the author:
Maria ("Masha") Gervits is a family-medicine resident in the Residency Program in Social Medicine at Montefiore Medical Center in the Bronx. She grew up in the Bronx and attended Albert Einstein College of Medicine. "There, during the transition ceremony marking the start of clinical rotations, a professor read a story about one of his patients and encouraged us to keep a journal to honor and remember our patients and reflect upon our experiences on the wards. I took this advice to heart and have been writing ever since."