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Subtle Shades of Difference.

September 22, 2010

An excerpt from Susan Wicklund’s “This Common Secret”

     “I have to know the subtle shades of difference between “I want,” “I need,” and “I should” for each patient on every day, no matter what else is going on to complicate or confuse the issue.
     It was one of those confusing issues, and my lack of attention, that resulted in an abortion i will always regret having done.
     The patient and her husband came together to the clinic. It was during one of the first years I was working full-time, and the clinic did not have an ultrasound. We estimated the stage of a patient’s pregnancy based on her last normal menstrual period (LMP) and by pelvic exam to determine the size of the uterus.
     When the patient and I reviewed her medical history prior to the abortion, I asked my usual question, “Are you absolutely sure of your decision to have this abortion?” She was obviously sad, but very clear in her decision and had the complete support of her husband.
     “Yes, I want to do this,” she said. “There is no way I could possibly carry this pregnancy to full term. I just cannot have this baby.”
     With hindsight, I should have asked a few more questions. “Why can’t you have this baby?” for example. I knew there were no medical reasons, but what was driving her? There were no clues in the notes from the counselor, and I didn’t probe further.
     The patient was a large woman. Due to her size, the pelvic exam was difficult and less accurate than I liked. Her history suggested she was about eight weeks since her last menstrual period. I could tell that we were within two weeks of that. She was certainly no more than ten weeks, and probably less. I continued with an uneventful abortion. The procedure took about five minutes, and she handled it well.
     We moved her to the recovery room, and the tissue we removed from the uterus was taken to the lab for evaluation. We always examine the products of conception (POC), both to confirm the stage of pregnancy and to look for any abnormal tissue. On examination of the POC, it was obvious that she was actually around ten weeks LMP, meaning she had conceived at least two weeks earlier than expected by her history. I always tell the patient if we find something unexpected.
     Upon entering the recovery room, I sat down next tot he patient and asked how she was coping.
     “Fine. Total relief, really. If I had given birth to that baby, it would have been a constant reminder of the rape. I have always been very against abortion, but in this case it was the only thing I could do.”
     I was holding my breath. This was new information to me. Was the embryo we just aborted the rapist’s or her husband’s? I stifled a gasp. Questions raced through my head. When was the rape? I had to tell her what I had found, but what if…?
     “Mrs. P., I don’t know when the rape was, but after looking at the tissue that came out of your uterus, I need to tell you that you conceived at least two weeks earlier than we had estimated.”
     The color drained out of her face. The lines around her eyes and mouth began to change and contract. She kept moving her eyes from me to the door, as if she was about to bolt.
     “What? What do you mean? When did I get pregnant? I got pregnant from the rape, right? Right?”
     I tried to stand, to go to the desk to get the wheel that we use to determine weeks of pregnancy and most likely conception dates, but my legs wouldn’t work. I broke into a sweat. The nurse sitting at the desk had figured out the situation and handed me the wheel. She and I looked at each other, trying to hide the look of horror in our faces.
     Together we went over the facts, the date of the rape, the stage of the pregnancy as evidenced by the POC. The pregnancy was clearly not the result of the rape.
     “Oh my God, what have we done?” she choked.
     Mrs. P. was inconsolable. I had another staff member get her husband from the waiting room, and I had to tell him what we had learned. In a gesture that would have horrified a malpractice lawyer, I apologized over and over. The three of us cried together. This pregnancy, this baby, would have been very welcomed and loved had they known it was theirs. But now it was ended, and I felt responsible. I was responsible.
     We spent lots of time, the three of us, trying to comfort each other. Before they left, we exchanged home phone numbers, promised to talk again soon. They never blamed me or threatened legal action against me or the clinic. We all had counseling to deal with the guilt and sadness over the event. More than anything, I learned to never assume anything, to always ask the questions in my heart, to listen to what wasn’t said, to pay attention to my intuition, and to never do an abortion without having an ultra sound first.”


I would think an event like this would scare anyone out of performing an abortion forever. I can’t imagine the guilt any of these individuals felt.

4 Comments leave one →
  1. justsnapd8 permalink
    September 22, 2010 4:53 pm

    That’s such a sad story. On one hand, I know that it really wasn’t the providers fault. On the other hand, it sounds like she continued to perform abortions even after that incident (I havn’t read the book obviously), so my sympathy is limited. The couple will always regret their decision, which could have been avoided by being completely honest.

    • September 22, 2010 4:58 pm

      She did continue performing abortions, which i suppose goes to show the limited “guilt” she felt. It truly is an amazing book though. She describes many encounters with patients, both those that she talked out of doing the abortion and those that continued through. I highly recommend the book, if nothing more than an insight into the issue from the pro-choice perspective.

      • justsnapd8 permalink
        September 22, 2010 7:20 pm

        The only guilt she had, was because it would have been a ‘wanted’ child. She had no problem with killing an unwanted one. I find more and more that prochoice has no feelings toward an unwanted child. That’s really sad, because it’s a baby, no matter who fathered it. Sounds like an awesome book btw, I’ll sure keep it in mind.

  2. Ruth permalink
    September 30, 2010 9:26 pm


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