Irresponsible and noncompliant

It's Friday morning, I went into work ready for my week to be over. It was a typical Friday, quite a few people were still scrambling to raise money for their 2 or 3 day procedure that had to start on Friday or would increase in price again, by as much as $300 or $400.

A seventeen-year-old young woman came in for the second time in hopes of getting her abortion. The first time she showed up, she was unaware of parental consent requirements and she was sent home because she didn’t have a parent with her. She was given the information about parental consent and judicial bypasses, a means of getting a court order stating a minor is mature enough to have an abortion without the consent of her parent. It is then up to her to find a way to communicate with her parents or begin the process of getting a judicial bypass.

This patient showed up with out any parent or anyone for support and was at least 13 weeks pregnant. At that point she was told, you can’t do this on your own, state law mandates that you go through extra hoops because you are a few months shy of legal adulthood. Now as she sat in the waiting room one of the clinic staff members, who had to communicate with me about financial assistance for the abortion, made a couple very disturbing comments. I talked to him about her total cost and if we should wait on the ultrasound before completing financial assistance.

“She’s really rather irresponsible.” The staff member rattled this statement as he described her first visit to the clinic alone. I was quite taken aback and told him I would talk to her once he completed the ultrasound. I planned to try and step in and help counsel her through the remaining steps to prepare for her procedure. He then told me, “well, she’s really not going to be very compliant.” I didn’t know how to respond to my colleague. I was appalled and yet in the moment there was nothing I could say. I quickly set up the financial assistance without the ultrasound and told him to let me speak directly to her if anything changes.

In my mind, this young woman is 17 and pregnant and what a mind-boggling situation to be in. Especially if she doesn’t want to stay pregnant and now she’s under time constraints to maneuver through laws, regulations, and counseling appointments. She was told, you're running out of time but you still have to talk your parent into supporting your decision or else talk to a judge.

The word "compliance" infers that the woman is weak and subservient. The idea that she needs to be compliant, or yield to those in authority is ridiculous. I realize my colleague is probably exhausted and burnt out, but patients must be treated as human beings. Patients need to be empowered to understand how to access health care that is dictated by laws and policies mandating parental consent and 24 hour waiting periods. Our patients are confused, angry, sad, relieved, broke, burnt out, tired, they are a lot of things, but noncompliant and irresponsible are not accurate descriptors.

Lila Rose

Lila Rose, the seventeen year old who goes around to Planned Parenthoods trying to get them to do and/or say something illegal, has been dubbed "the new face of the anti-choice movement." Her strategy is to show up at a clinic posing as a minor, and then telling the staff her boyfriend is several years older than her and basically try to get the staff to agree to not report her to the police. Her "evidence" is often muddled video footage that is heavily edited, which to me, makes her pretty sketch, but lots of people seem pretty jazzed about her, so here we are. Of course, the thought that a clinic could be not properly reporting abuse is very concerning and I would definitely want clinics to follow the rules. That said, does anyone find it really disturbing that someone shows up at a clinic and purposely tries to get someone to to break the law? What is edited out of those tapes? What did she say to them to make them finally agree to not report it?

Obviously, if I have to side with anyone I am going to side with clinic, but also there is a lot of footage of people at clinics definitely advising minors on how to avoid being caught by the clinic. I think this is inappropriate and not okay, but at the same time, they are trying to help the patient at the end of the day, and these young girls do need somewhere to go. Further, if Planned Parenthood or wherever is like YES WE WILL REPORT YOU that makes me nervous the creepy older dudes who are sleeping with minors will just take them to a sketchy doctor to get the procedure done which is also bad. Because the problem here is creepy older dudes who like sleeping with minors (CODWLSWM). Not the minor. If we could make CODWLSWMs go away, then we wouldn't have this problem, right? How do we make CODWLSWMs go away?

I am also bothered by much of the footage because the staffer on the phone is obviously having a hard time and isn't quite sure what to say. They are trying to do the best they can and work within the law, giving her the best advice they can. This issue is really tough, obviously, and there are a ton of gray areas where I am not sure what is the "right" thing to do. Blerg.

Alone

This past summer, I was interning at a large, urban community hospital that also provided abortion care. As a future abortion provider, my purpose for this month-long excursion was to see and experience abortion care from the perspective of a provider. I knew, on paper, how the procedure went and I knew how the counseling was supposed to go, but I had never witnessed either. It was a truly incredible experience and one from which many future blog posts will most likely be about. However, I would like to focus this posting on something unrelated to my experience, but more of a disturbing incidence that occurred overnight with one of our patients. It’s an episode that deeply disturbs me and only further drives me to seek equality for women seeking that completely legal procedure known as abortion.

In the state I interned, parental notification laws for minors seeking abortions were on the books. A 15 year old girl, let’s call her Leila, had come in seeking a second trimester procedure one afternoon. She was not in a position to tell her parents of her current unwanted pregnancy and chose the judicial bypass course instead. The judge deemed her competent to make the decision to terminate her pregnancy, and thus she showed up alone to her appointment. Upon ultrasound examination, it was determined that the gestational age of the fetus was 15 weeks and 6 days. In this particular hospital, it was standard practice to insert laminarias in a women’s cervix if she was over 14 weeks gestational age. The woman would then go home, allowing the laminarias to slowly dilate her cervix over night, and then return to the hospital the next day to complete her second trimester abortion. However, there was one problem with this system. Leila couldn’t go home. Her parents would ask questions, wonder why she had to go to the hospital the next day, wonder why she was so uncomfortable, etc. After all Leila had already been through enough to conceal this secret from her parents, and going home clearly wasn’t the best option.

So Leila called a trusted friend, who knew her situation, and asked her to pretend she was spending the night at her house if her parents called looking for her. Leila then called her own parents and told them she would be staying at her friend’s house for the night. Instead Leila would be staying in the hospital overnight…alone.

When the resident tried to find a room for Leila (and there were plenty open), nobody would take her. Nobody. The Obstetric department didn’t want a young girl aborting in their ward and the surgery team refused to have Leila stay on their end of the hospital. After the resident pleaded and negotiated with the Ob department, they finally agreed to take Leila, but it was clear they were not happy about it.

Leila settled in to her room in the Ob ward…alone. Nobody was there to stay with her and nobody came to check in on her. Yes, let me repeat that, the nurses never once came to check in on Leila. When the resident came to see her the next morning, Leila has spontaneously aborted the fetus in the middle of the night and it remained in her vaginal canal until the resident found it there the next morning. Fortunately, Leila was ok medically. Although abortions are extremely safe, they still come with risks (ie. hemorrhage, infection).

I am so enraged with I think of this story. There is no other situation where nurses and physicians would refuse to provide a hospital bed and care for a patient. There would be outrage if hospital staff refused to provide care for a patient recovering from an appendectomy, for a 55 year old woman pregnant with triplets, or maybe for a 85 year old man recovering from a penile implant.

I can’t imagine being Leila-absolutely alone, knowing that the hospital staff does not want you there because of what you are there for, not knowing what is happening to your body and afraid to ask anyone for help. What a horrible and traumatic experience. I hope I never hear of another Leila or personally witness it in whatever hospital I end up doing my training. Although, the skeptic in me thinks that is highly unlikely.

The stigma behind abortion is alive and well. Which is why we segregate it. You get abortions there , not here! Leila had made a choice, a choice she was legally allowed to make, and yet she was punished for it and her health was in danger because of it. It will take a long time to destigmatize abortion, but the time to start is now. No woman should have to go through what Leila went through…and this was in the Northeast! Imagine what it could have been like somewhere else.