Guest post: Telling my patients "No"

Happy Friday! Please warmly welcome Candid Cannula, a fellow abortioneer who's graciously joined us for a guest post this morning. I loved reading about her counseling dilemma -- one that we all grapple with, I think -- and hope you will too.

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“I hope this is the right thing to do,” my patient – let’s call her Nicole – said right off the bat, instantly setting off warning bells. I asked her to elaborate, and her next sentence did nothing to alleviate my concerns: “Well, I’m basically being forced to do this.”

Those two sentences told me all I thought I needed to know, and I was sure that Nicole was not going to be seen today. But I pressed further, asking her all the standard questions to get a better picture of her situation. How had she felt when she first found out she was pregnant? Who had she told? Who was forcing her to be there, and in what way? Had she talked to anyone who was supportive? Had she considered continuing the pregnancy? How did she think she would feel after an abortion?

My role as an abortion counselor has two distinct parts: providing informed consent for abortion procedures, risks, aftercare instructions and contraceptive options; and discussing patients’ decisions to terminate their pregnancies, ensuring that they are confident it is the right choice for them and that they are not being coerced. I have the awe-inspiring right to turn patients away if I feel the latter criteria are unfulfilled, and it is that right that I struggle with when faced with patients like Nicole.

Her story came out in bits and pieces as we continued to talk: like so many of my patients, she had always considered herself to be against abortion and never imagined that she would wind up across from me in this counseling room. She did not think she would cope well after the procedure and she was struggling with whether it was the “right” thing for her to do. At twenty-one, she was a few years removed from legal childhood yet still dependent on her parents, and she said that they were the ones making her terminate the pregnancy. “My parents will kick me out if I have a baby,” she told me. “I’ll be homeless. I won’t have anywhere to go.”

What would you do if your parents were supportive of you either way?

“Honestly,” she said wearily, “I wouldn’t be sitting here right now.”

Nicole was not going to have a procedure that day. I was sure of it. But when I brought up the idea of her leaving, her tune changed.

“No,” she said urgently. “I have to do this.”

You told me you’re being forced. You told me you don’t want to have an abortion. We can’t see you when you’ve told me those things.

“I’m being forced, but I have to do this. I don’t WANT to do this, but I HAVE to. You don’t understand! It’s my decision too. I came here for an abortion, and I have to have an abortion.”

Nicole, what you’ve told me worries me. We find that women cope best after an abortion when they’ve been able to come to terms with it as their decision. Take some more time. The procedure, the cost won’t change between now and next week. Come back next week if you decide this is the right thing for you. We’ll still be here.

“NO!” she exclaimed. “I planned for this today. I can’t come back next week. Nothing’s going to change! You don’t understand, I don’t HAVE a choice. Yeah, I’m going to feel awful afterwards, and yeah, I’ll probably regret it in a way, but it’ll be worse otherwise – I have to have an abortion today!”

I spent a very long time with Nicole gathering the pieces of her story, asking the same questions, asking different questions, offering her resources to be able to continue the pregnancy, alternately trying to convince her to reschedule her appointment and feeling terribly conflicted about whether that was the right thing to do. I had little doubt that she would end up having an abortion, but maybe she could be in a better place with more time to own the decision. Or maybe another week would only create additional obstacles and difficulty, needlessly complicating her life further.

Where does the patient’s constitutional right to choose an abortion intersect with the counselor’s responsibility to screen and refuse service due to perceived ambivalence or coercion? What do ambivalence and coercion mean for women who lack the emotional or financial support to continue a pregnancy they may otherwise have welcomed? I came to feel that Nicole’s claim of being forced to be there was her way of coping with needing an abortion so that she didn’t lose her family and her home. She may have made a different decision if her family supported her either way, but the reality was that they didn’t, and she wanted to keep them in her life more than she wanted to continue the pregnancy. Many women are “forced” to have an abortion by various life circumstances; does it matter whether those circumstances are other people or faceless considerations like financial constraints, age, or health problems?

I’ve turned abortion patients away who have returned a week or two later, grateful for the extra time to think about the decision and better equipped to cope afterwards. I know that sometimes, it truly is better to wait when ambivalence is detected; patients can’t change their mind after the procedure. But I struggle with exercising my right to turn patients away when they protest. How do I know which patients will truly benefit from it? Doesn’t the patient ultimately know what’s best for her? Why should it be my right to deny a patient the service she insists on accessing?

Nicole had her procedure that day. Like many of my patients, I imagine no pregnancy outcome would have been positive for her. Many patients will never feel 100% confident or at peace with the decision to have an abortion. But no one would have subjected her to an assessment of ambivalence or coercion in order to continue the pregnancy, and that’s one thing that makes abortioneering such a uniquely challenging kind of work. In the counseling room, it’s often a delicate balancing act: trusting the patient to know what’s best for her, and stepping in when I judge that she is simply not ready to take the step that day.

A woman is a living, growing human being

In our sidebar we link to blogs of people who have had an abortion and want to write about their experience. Here's a new (to me) one: My Journey Through Abortion. The post I'm linking begins like this: "I think I am going to talk about what I have learned."

This is a wonderful, fascinating topic. How the abortion was good for me. Not just, How it sucked less than the alternative; not just, How it didn't really suck any more than getting wisdom teeth out sucks and I'm damn glad that both services exist in safe legal settings. Yes, those are interesting too. But those are already part of the public rhetoric about abortion, and the one that people who've never experienced abortion feel most comfortable joining in. It's wonderful and fascinating when a woman who's had an abortion feels able to say out loud that she is a better person after her abortion -- not in spite of it or in opposition to it or in penance for it, but thanks to it.

She is better after her abortion than she was before it. How remarkable! This exists completely outside the discourse where, no matter what else you believe, abortion must be a loss, and a taking-away -- where mathematically, and thus objectively, and thus morally, she is less than when she was pregnant. (You < You+embryo. More is more. Very baroque.) But women know this isn't true, especially when we are at our healthiest: being "good" doesn't mean saying Yes to every request; it doesn't mean taking on more than you can just-because; it does mean being true to yourself.

In the documentary "The Coat Hanger Project," interviewee Jeannie Ludlow says something remarkable that people don't discuss enough. I'll have to paraphrase: In her experience as a clinic counselor, she says, abortion can be a good thing for women; it allows some women to grow in ways that they otherwise would not have had the chance to grow. This doesn't mean, though, that no women feel wistful about their pregnancy, or that no women think of their embryo or fetus. Of course some of them don't; and some of them do but also feel joyous about returning to non-pregnancy, some of them do but also think of themselves or of their born or future children.

A friend told me about her recent experience with abortion and how it is changing her life already -- from a series of crises and dangerous disregard for self, to a new stream of moments where you face the same old decisions and this time you choose life: your life.

~

I'm willing to bet that some of our patients, if they had a blog or a diary, would express something similar to this blogger's words:

"I have learned that I am not really good at pulling the trigger on moving forward. It is like I am sitting in my car, flat tire, spare in the trunk. And I am too damn lazy to get out, open the trunk, get the jack out, and get to work. It is not because the view from the car is spectacular or because there are good tunes on the radio. It is because I am scared to move forward. I am too focused on the fact that I have a flat tire, and I have forgotten that I can FIX THE FLAT."

Especially when talk turns to second-trimester abortion, so many people seem to imagine women as two-dimensional things. If anyone ever asks you "why did she wait so long?" -- remind them of three things:
1) Health care is expensive, abortion isn't covered, and most people aren't rich.
2) Sometimes biology is sneaky and pregnancy isn't discovered quickly.
3) Women are people: sometimes they're unsure what to do, or they freeze, or panic, or they take time to weigh an important decision. Just like you.

You've got mail

Dear Patients,

Maybe I met you years ago or days ago, and maybe I'll meet you tomorrow or years in the future. I hope I made or will make a positive impact on you, but your abortion experience really wasn't or isn't or won't be about me. And that's one of the things I want to say to you. Your abortion is YOURS--your story to tell, your experience to shape. You have no obligation to justify your decision to anyone. You have a right to be informed, even when it means asking uncomfortable questions like, "What happens to the fetus afterward?" You don't need to be sad if you're not, nor do you have to be happy just because you exercised bodily autonomy. We might talk about how we'd like you to be grateful and advocate for others, but my wish is that you will make the choice for you and you will honor yourself and your choice in the best way for YOU. You have every right to be scared, and you also have every right to the safest and most caring healthcare, which is what we want to give you. You are strong enough to do this, whether "this" is having an abortion or not having one. You are allowed to dwell in as many gray areas as you'd like. We, as staff, might bristle when you ask things like, "Are your instruments clean?" but you have a right to wonder and to ask and to use your voice in whatever way you can or want. You do have a voice, but your abortion doesn't have to be a political act, either. You can be selfless or selfish or both at once. You can yell at me or hug me, and I will find some part of you, large or small, to care for. Your privacy is protected and so is your dignity, and we wish for the clinic to be a safe space for you. You might have just one abortion or just fourteen, and there is not a thing wrong with either one. There is nothing wrong with YOU.

Again, this isn't about me. But I want you to know that I don't forget you, and I am so very honored to be a part of your choice, process, justice, and life.

All the best,
Desembarazarme

All I Need to Know About Life I Learned from Working at an Abortion Clinic

Item #9:
1. It pays to be nice
When I'm taking payments, some clients are a few dollars short. If they've been a pleasure to work with at every step of the process, I comp the difference and send them on their way. But if they've been a pill, a pain, and a pest (as my grandma used to say) to everyone they encountered, I'm going to insist that they go borrow some cash from their driver or else reschedule. You better believe I'm nice to cashiers and sales associates, and I tip super-well.

2. Sometimes, the most important person to forgive and the most difficult person to forgive is yourself
Clients can forgive their ex-boyfriends for poking holes in the condom, they can forgive their sisters for not replacing their last pack of Plan B that was on reserve, and they can be at peace that God will forgive them. But when it comes to forgiving themselves, all bets are off. And when they can finally do it, good things happen.

3. Plato was right: We must "[b]e kind, for everyone you meet is fighting a hard battle."
Even the obnoxious clients mentioned above in item #1 have their stories to tell. And I don't relish the thought of counseling the woman who declares, "I don't believe in abortion, but I have to do this," but when she tells me why she "has to," it's difficult for my heart not to melt a little bit. And it makes me appreciate all the compassion I've been shown in my life.

4. Listening is a valuable skill to have
Oh, so when you made your appointment, no one told you that you couldn't drive after anesthesia, that you couldn't eat or drink anything the day of your appointment, and that we don't take payment in the form of IOUs? My co-workers and I could give those instructions in our sleep. Just admit you weren't listening. That's why I always carry around a notebook and pen.

5. Maybe we don't know what we REALLY want until we've wanted both things
A friend of mine once told me about her unplanned pregnancy. She knew right off the bat that she was going to have an abortion. Until she saw a glowing pregnant woman. It was only when she really considered both realities, she said, that she could make the most informed and honest decision. She had the abortion.

6. When you miss a period, take a pregnancy test immediately
Don't assume it's a fluke, don't assume your body's being wonky. Especially, don't take a test, see a positive result, and then believe that if you ignore it, it'll go away. That's how you end up to be 25 weeks pregnant. And that's fine, but the procedure could have been quicker and cheaper if you had just taken that first test all those months ago. My co-workers and I sure make use of the free tests at the clinic.

7. You will make a decision when you are meant to make a decision
I learned from a wise, veteran counselor that some women know what their ultimate decision will be, but they don't know how they will arrive at that decision. It can be a long process, and a painful process, but it's a process that needs to happen. I've never had to deal with an unintended pregnancy, but I sure have dealt with tough decisions, and I took my sweet time.

8. A medical history is no place for forgetfulness
nor creative writing
Oops! When you wrote, "No known allergies, no history of major health problems," it turns out that you really meant, "Allergic to every item you will use at this clinic and a history of weekly seizures since birth." Details, details! And my friends, those details are what cause those major complications. I could say, "I'm 5'9" and I've never had any mental health issues," and it sure would be fun to say those things for a change. But that doesn't make them true.

9. Wear what you love
When we schedule your appointment, we suggest wearing comfy clothing since you'll be groggy and crampy. The first time I saw a client step out of the recovery room in 4" platform heels and a mini dress, I doubted the comfort level and practicality, but she rocked it and she was proud of it, and groggy, crampiness be damned. I, on the other hand, will wear hoodies and sweatpants whenever possible, but it's just my personal jam, and no one else's.

10. Some of the best people work in abortion clinics
When clients express nervousness or when they ask if the next person they see will be nice, I sometimes tell them that I honestly work with some of my best friends. And every person in the field that I've met has been amazingly compassionate, passionate, kind, giving, determined, and an absolute champion of women.

To Zion

So I was rocking out to some Lauryn Hill the other day, and a song came on, "To Zion," that I hadn't heard in a longggggggggggggggggggggggggg time. I mean LONG. I didn't have my period the last time I listened to it. Anyway, the lyrics sort of struck me because she was obviously talking about being torn on what to do when she became pregnant unexpectedly.

Here are the lyrics:
Unsure of what the balance held
I touched my belly overwhelmed
By what I had been chosen to perform
But then an angel came one day
Told me to kneel down and pray
For unto me a man child would be born
Woe this crazy circumstance
I knew his life deserved a chance
But everybody told me to be smart
Look at your career they said,
"Lauryn, baby use your head"
But instead I chose to use my heart

Now the joy of my world is in Zion
Now the joy of my world is in Zion

How beautiful if nothing more
Than to wait at Zion's door
I've never been in love like this before
Now let me pray to keep you from
The perils that will surely come
See life for you my prince has just begun
And I thank you for choosing me
To come through unto life to be
A beautiful reflection of his grace
For I know that a gift so great
Is only one God could create
And I'm reminded every time I see your face

That the joy of my world is in Zion
Now the joy of my world is in Zion
Now the joy of my world is in Zion
Now the joy of my world is in Zion

Marching, marching, marching to Zion
Marching, marching
Marching, marching, marching to Zion
Beautiful, beautiful Zion


(Note: her son is named Zion.)

So I was reading the lyrics on my go to lyric website, songmeanings.net. A really interesting debate was sparked in the comments if the song was pro-feminist, anti-abortion, if the song should be a new "pro-life anthemn" etc.

I tried googling Lauryn Hill and her views on abortion but I couldn't really find much reliable information about it. So I'm not sure what her personal views are -- if she is pro-choice or anti-choice.

Anyway, I found a couple of the lines really interesting "... everybody told me to be smart / Look at your career they said, 'Lauryn, baby use your head' / But instead I chose to use my heart." She says that she ignored her head, which seemed to be telling her to have an abortion, and listening to her heart and kept the pregnancy. It seems the underlying statement here is that having an abortion is not "using your heart" but using your head. Abortion is smart and keeping it is loving?

She also refers to her pregancy as a life so it seems like she defines life as beginning with conception.

All that aside, I think the most important part of the song is that she struggled with the CHOICE. She got to decide what was best for her. She had the option of ending her pregnancy and she had the option of keeping it if she wished. It sounds like she definitely made the best decision for her (The joy of her world is Zion) and I think that is awesome she was able to figure that out. One thing I feel like is misconstrued about Abortioneers is that we WANT people to have abortions. I want each woman to choose what is best for her. If someone decides she wants to keep her pregnancy, great! Here are some resources on pre-natal care. If someone decides she wants to have an abortion, that's great too. Here are some clinics I'd recommend. You know? I just want everyone to be happy and do what is right for her.

Anyway... everyone should check out the song, it's very pretty!