The Anatomy of an Unsafe Abortion

5 years ago

I was in clinic when I heard the overhead STAT page to the emergency room.

As I sprinted down the stairs, I ran through the possible scenarios. I wasn't on call today, so the day-to-day gynecologic emergencies weren't my purview. I hadn't operated on anyone in the past few weeks, so it was unlikely that it was one of my own patients with a complication.

Logically there was only one conclusion.

A nurse was holding the staff entrance to the ER open. From the look on her face I surmised this was to save the minute or two it would take to punch in the numbers on the lock and inquire at the desk for patient's whereabouts.

"Down there," she pointed.

On the gurney lay a young woman the color of white marble. The red pool between her legs, ominously free of clots, offered a silent explanation.

"She arrived a few minutes ago. Not even a note." My resident was breathless with anger, adrenaline, and panic.

I had an idea who she went to. The same one the others did. The same one many more would visit. A doctor, but considering what I had seen, he could't have any formal gynecology training. The only thing he offered that the well-trained provers didn't was a cut-rate price. If you don't know to ask, well, a doctor is a doctor. That's assuming you are empowered enough to have such a discussion. I was also pretty sure his office didn't offer interpreters.

I needed equipment not available in an emergency room. I looked at the emergency room attending. "Call the OR and tell them we need a room. Now." And then I turned to my resident. I was going to tell him to physically make sure a room, any room, was ready when we arrived, but he had already sprinted towards the stairs. He knew.

We didn't wait for an orderly. A terrified medical student and I raced down the hallway with the gurney. The amorphous red pool dripped onto the floor as we rounded the corner to the elevators.

Photo by Wolfgang Hermann (Flickr).

The double doors that led to the operating rooms swung open. "The urology room. They’re between cases," my resident shouted.

I saw an anesthesiologist out of the corner of my eye. "You. Now!" Most emergencies can wait a few minutes to check in at the front desk and for the anesthesiologist and nursing staff to take stock of the situation. This was not one of them.

The urologist, whose room I appropriated, blustered and sputtered in behind me. "What the fuck are you doing barging in, I've got another case..." but as we moved my patient over to the operating table and he saw the blood, he stopped. He grabbed a tray of instruments and opened: "I'll be your scrub."

The anesthesiologist was pissed. Not really mad, more riled up than anything. No one likes to be blind-sided, no matter how well intentioned. And he probably thought I was overreacting. That is until he put in another intravenous.

"Fuck." What looked like blood-tinged water flashed back.

And now they all understood what I knew the second I laid eyes on this patient. Abortions that go horribly wrong bleed out. Quickly.

The room filled with surgeons, nurses, and students eager to help. To do something. Anything.

I opened the vagina and, by feel, clamped through the holes on either side of the uterus where I knew from experience I would find the uterine arteries, the likely site of the puncture. I didn't know which side, and at that point it didn't matter. I just needed to stop the blood flow. It took less than a minute. She would have bled to death if I had opened her belly.

The bleeding had stopped, and it was up to the anesthesiologist to fix the hematologic tempest of a vascular system so traumatized by sheer blood loss that it had run haywire and lost the ability to clot. Disseminated intravascular coagulation: this is how many young women die when an abortion goes wrong.

My hands started to shake. Everything from leaving my clinic to this point had been one crescendoing adrenaline-fueled reflex. Now that there was nothing physically for me to do the energy had to go somewhere.

I looked around. A forest of IV poles, laden with blood instead of fruit. Everyone not directly helping was running back and forth to the pharmacy or blood bank. A nurse and another surgeon started to clean the floor. We were all bonded by this nameless woman whose life we were desperately trying to save. And we were bearing witness, because we knew if she died it was unlikely anyone would read about her in the paper. It was unlikely her family would protest. A myriad of potential reasons. Shame of the abortion. Distrust of government. Fear of immigration officials.

The urologist, a grizzled older man with whom I had nothing in common except a medical degree and this patient, rested his hand on my shoulder. It was a kind, fatherly gesture. The weight was comforting.

"You done good," he said. And then he added, "those bastards."

I knew he was referring not just to the physician who did this procedure, but to everyone in society who had contributed to a disadvantaged woman finding herself in such a desperate situation.

Dr. Jen Gunter is an OB/GYN and pain medicine physician. She is the author of The Preemie Primer, a guide for the parents of premature babies. She has written for USA Today, Parents Press, and the Marin Independent Journal, among other publications. She blogs at Dr. Jen Gunter, where this post first appeared.

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