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An Exception to the Rule

“I usually talk through the procedure as I go,” I say, pulling on a pair of blue nitrile gloves. “So you aren’t surprised by anything, so you know when to expect a sensation.”

The patient is lying on the table, eyes fixed upwards. One of the ceiling panels is illuminated with the green leafy branches of a tree—an image meant to calm and soothe, though I doubt it’s doing much for this woman.

“Or I don’t have to talk,” I tell her, arranging the instruments on my sterile tray as silently as possible. “We can be quiet or chat about other things.”

She continues her upward gaze.

“You can talk,” she whispers. “Just don’t tell me when you’re killing my baby.” Her face pinches together, tears squeezing out the corners of her eyes.

I swallow. Breathe. Notice the tension between my shoulder blades, the heat beneath my sternum.

I step towards the exam table and place my hand gently on her forearm. Her eyes are closed tightly, brow furrowed in a pained expression. I know few details of her life: first name Megan, twenty-eight years old, fifth pregnancy, four children at home. She’s never had an abortion, doesn’t believe in abortion and yet cannot continue with the pregnancy she’s carrying. Her last partner left her, and the person who caused this pregnancy is out of the picture.

“I can’t do this alone,” she’d told me after I reviewed the informed consent with her. I’d tried to reassure her by saying that most women who have abortions are already mothers, but her cold glare told me that she did not identify with these women, that I knew nothing about her situation and that although she needed an abortion, she was not thankful for the services she was going to receive.

“Are you sure you want to have an abortion today?” I try to use a voice that is both sympathetic and direct.

“Yes,” she says. “I have to.”

I nod slowly. “Okay.”

As she lies there, in a situation in which she never imagined herself, I wonder if she might start to consider what it’s like for other people in her shoes. Does she notice how her viewpoint is incongruent with the complexities of her own life? Can this inconsistency open her up to the possibility that abortion isn’t murder, but life-affirming medical care for her and her family? She’s mentioned that Child Protective Services might take her four kids away if she’s late to pick them up today. Surely she can picture other women in her situation—struggling single moms stretched to the limit, needing an abortion because they can barely keep afloat as it is.

While she’s given mostly scowls and one-word answers to staff, she’s been insistent that she cannot continue the pregnancy and needs her procedure today. She’s barely five weeks along, so medically and legally she has plenty of time in California, but the subtext is clear: She cannot psychologically, physically or emotionally bear to be pregnant one more day.

Ever since the Dobbs decision, my workdays have felt harder. It’s not just that we’ve had more protesters outside our clinic or that I’ve started seeing more patients from out of state. It’s a general feeling of unease with the human mind—its ability to judge, shame and assert power over others, even while such judgment and power cause harm. It’s the mind’s capacity to vehemently oppose something and then say, “But in my case, there should be an exception to the rule.”

When Roe was overturned, I grieved for the people in conservative states who’d be hardest hit; I grieved for the antichoice protesters who were celebrating, because I knew some of them would find themselves needing an abortion one day—that now their options would be limited, and they would suffer even more because whatever horrible thoughts they’d had about people who have abortions, they’d now be forced to entertain about themselves.

Megan’s dyed blond hair is dry and crispy, fanned out against the crinkly white exam paper. Her right arm is tattooed from shoulder to wrist; both arms are covered with small, pink bumps, some oozing with translucent yellow pus—a sign of possible substance use. When I told her about the medications we use for sedation, reviewing the risk of respiratory depression with fentanyl, she interrupted to say she’d given Narcan to a friend once.

“He thought he was shooting meth,” she’d said, “but it was laced with fent, and he stopped breathing.”

“Is he doing okay now?” I’d asked.

“He’s dead,” she’d replied flatly.

I’d swallowed. “I’m sorry for your loss.”

Megan’s eyes are still closed when I ask if she’s ready for her sedation medications. She nods, and the nurse connects a syringe to her IV, slowly pushes the clear liquid into her vein.

I wait until the meds have been given, then ask, “Is it okay if I start your exam?”

“Yeah,” she says. “Go ahead.”

The procedure only takes five minutes, but it’s the hardest one I’ve done all week. My body feels stiff; I notice I’m holding my breath, over-gripping instruments. Megan’s cervix is open from prior births, so I barely have to dilate it, and yet she cries the entire time, knees closing towards each other.

Did she ever consider having an abortion with her previous four pregnancies? Would her life be easier now if she had? Could her life be less hard if she weren’t so hard on herself?

One of the things I like about my job is that I feel like I’m helping people. I’ve served many patients who never thought they would need or want an abortion; usually I’m able to gently support them in understanding that their decision is a compassionate one; that it will allow them more time and energy to care for the family they already have, to pursue their dreams, to finish school, etc. In the best circumstances, I can help reframe their abortion decision as an empowering one that provides bodily autonomy and control over their own destiny.

During Megan’s procedure, though, I feel conflicted, like I’m not providing any real solace or relief. I’ve failed to connect with her in the brief time we’ve had; I feel the heaviness and tension of our exchange in my own body.

It is clearly painful for Megan to be here today. I assume that’s why she’s been shooting dagger eyes at me and staff—because if she doesn’t turn her anger outward, she’ll have to turn it inward. I imagine her having to reconceive her self-identity: If she’s the type of person who has an abortion, then who is she? Things must feel incredibly foggy in this moment. But she probably doesn’t have time for self-reflection—she has her four children to pick up, and work at 6 am tomorrow.

As I remove the speculum, Megan is still crying. 

”It’s okay,” I want to tell her. “Abortion is normal! Abortion is health care!”

But these slogans won’t dismantle the harsh expectations she’s placed on herself. I can’t show her that her belief system is hurting her—that if she could see things in a softer, more compassionate light, she might be able to accept herself, or perhaps even love herself, for the decision she’s made today.

Alison Hathaway is a nurse practitioner. She earned her BA from Hampshire College and her Masters from Yale University School of Nursing. She lives in California. “I write to explore the complexity of patients’ lives and to reflect on the feelings that arise in clinical practice: to delve deeper into the nuance of human experience and how to create a more trauma-informed approach to patient care.”


15 thoughts on “An Exception to the Rule”

  1. Alison,
    Thank you for the work that you do and for sharing the complexities of this experience with us. I appreciate you being with someone, without judgment, when they are in pain. Your compassion for Megan may help her have some for herself.

  2. Thank you Alison, for this moving story. It’s so important for us to humanize these experiences so we can begin to see what the people involved are really going through. What is Megan going through and what are you as the caregiver going through and where did those feelings and experiences come from? The more we can see these things that the better dialogue we can have with each other (pros and cons of abortion etc).

  3. thank you for sharing and thank you for providing this literally life saving service.
    <3 Sending lots of positive vibes your way.

  4. Alison I liked your article and appreciate your human touch & compassion towards your patient. I do have mixed emotions on abortion however I believe it should be an individual choice. Love you, uncle Dan

  5. “Abortion isn’t murder, but life-affirming medical care”? I’m shocked reading this. I don’t condemn anyone who has had an abortion, but I do not condone the practice. Yes, it absolutely is ending a life, so it’s murder. The choice should be before pregnancy happens, not after.

    1. If you don’t believe in abortion then don’t have one but do NOT force your beliefs on anyone else and denigrate providers who provide this service. This life-affirming medical care.

  6. Alison! Really great piece to read – thank you for depicting your informed perspectives and experiences! Conflicting times we are facing, so this clarity is refreshing.

    Molly Armanino

  7. Alison, what a compelling piece—and such a challenging time for you to be doing the good work you’re doing. I’m so happy your Facebook posting came across my feed today—happy to learn more about your life. I send you all the best and much love.
    Kate Winton

  8. What an evocative piece that reflects the difficulty women have about their decision to seek an abortion. Alison, your take on helping this woman to see her choice as life affirming, not just “kill my baby”, did not work for her. None the less it is a message that health care providers need to share with their patients as women struggle with their decision to have an abortion.

  9. Amazing story! I love how compassionate & empathetic you were to her & other women too. Maybe she’ll look back one day & remember your kindness.

    1. “Abortion isn’t murder, but life-affirming medical care”? I’m shocked reading this. I don’t condemn anyone who has had an abortion, but I do not condone the practice. Yes, it absolutely is ending a life, so it’s murder. The choice should be before pregnancy happens, not after.

      1. Eva, I know the author’s words challenge your beliefs and way of understanding the origins of human life being tied to conception. You speak from a position of privilege when you assert the choice should be made “before and not after”—we do not live in a society where that choice is the reality for many, many women—especially women in low-wage jobs, with non-white skin, with poor access to education about sex, pregnancy, and contraceptive options—and poor access to these when they do have education. If the people who cry out against abortion as “murder” would cry out just as loud to address the societal problems that contribute to desperate situations for women like the one in this story, it wouldn’t feel so hypocritical. An early pregnancy is not in any way an independent life—it is also, simultaneously, literally part of a woman’s body. Forcing women who have conceived a pregnancy they do not have the physical, psychological or economic capacity to carry and birth by making abortion illegal (and by not fighting hard to restore and protect the right that that care) is absolutely not the life-affirming act you think it is. And every word you wrote is condemnation—you have equated this woman’s choice and this practitioner’s care to a heinous illegal act—at least own your condemnation, rather than try to deny it.

        Alison, what a brave and poignant story to share. You are doing important and honorable work.

        1. Jessica, thank you for this excellent articulation.

          Eva, perhaps you sincerely believe that you are not condemning anyone, but Jessica is correct, you unequivocally are. Your post is devoid of compassion, but far worse, it is a gross oversimplification and naive (mis)representation of the “landscape” of this issue, and actually renders your murder accusations totally unqualified.

  10. Alison! I read the whole essay, found it evocative and moving, then scrolled down and saw it was written by an old friend! Thank you. I remember when Linda turned us into Pulse GEPN year 🙂

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