Last year when I was a medical student I did an elective in a sexual health clinic that provides pre- and post- abortion care for women undergoing therapeutic abortions (TAs) at a nearby hospital. One of the patients I met was a Latin American woman in her thirties. She came to the clinic with her mother for the insertion of a laminaria tent -- a device that is used to dilate the cervix -- before her TA that afternoon. This procedure takes about fifteen minutes and usually causes moderate menstrual-like cramping.
The first thing I noticed when the doctor and I entered the treatment room was that the woman's mother was holding a bible in her lap. When we inserted the speculum the woman began experiencing a lot of discomfort. We asked if she wanted to stop the procedure, making sure she understood that she could change her mind about the laminaria insertion and TA. The woman adamantly insisted that she wanted to continue and refused extra analgesia. When the laminaria tent was inserted into the cervix, the woman began crying out in pain. Her mother opened the bible and began to pray softly under her daughter's cries. Both women became quiet when we finished the procedure and neither mother nor daughter made eye contact with us as we left the room.
I was scared. Bibles and praying during a pre-TA procedure seemed to me a short step away from Operation Rescue and abortion providers wearing bullet proof vests. There was security at the sexual health clinic, but they didn't search people for weapons. Could I be in danger right now, I thought, panicked, while the woman call out and her mother prayed and the doctor angled the speculum and inserted the laminaria.
As the day went on, I because angry. The way the woman cried out and her mother prayed and neither of them would look me in the eye made me feel guilty for hurting her, for being a small part of of something she obviously opposed. I was angry at the woman for putting me in this position, as if she planned it so that my guilt would absolve her of her own. I am strongly pro-choice, but the last thing I want to do is participate in a TA that a woman doesn't want, or worse, to feel that I forcing her into it. It is my right as a health care provider, as a person, to refuse practice medicine in a situation where I am uncomfortable.
A year later, my thinking about this episode has shifted. It was unfair of me to interpret prayer in the context of therapeutic abortion as being tied to the persecution of abortion providers by extremists. I normally welcome spirituality and religion in my practice of medicine. When I take care of terminally ill patients in hospital wards, I am happy to call the chaplain or another religious figure to the bedside. Certainly, if this had been an endometrial biopsy for the detection of uterine cancer, I would not have felt vulnerable or angry if prayer were involved. I have counseled women who have had TAs in the past. How was that for you, I ask knowing there is often pain in the answer.
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