Dr. R crosses through the doorway and places a sheet of white printer paper on my desk.  “Can you tell me about this?”  I scan the document.  It is an ultrasound report depicting an upside-down stick figure floating within a globular scribble.   The handwritten words “viable pregnancy, 13 weeks plus five days” serve as a label.     

She, the owner of the scribbled uterus and the stick figure inside, was my last patient at the clinic the previous Friday afternoon.  After we’d endured the worst of it - for me, the frank discussion about surgical complications, for her, the confirmatory pelvic exam - she sat up and dangled two plump legs over the ledge of the pink examining table.       

I tried to explain myself.  “At first I didn’t want to leave messages on your phone because you checked do not call my house on your intake form.” 

She nodded her head in understanding, stirring a crop of untamed curls, and then offered an open-mouthed smile of strained forgiveness.  She wore braces, not the metallic kind, but the kind with bits of transparent plastic and clear wire. They were new.  Her teeth were unadorned at our abortion counseling visit seven weeks earlier.  She was equally braces-less when, in the recovery room several days after that visit, she produced a sedated grin as I handed her a paper cup filled with expired ginger ale.

“And then I decided that I did have to leave messages for you, but I didn’t want to spell out what was so important.”  Several inches from my lab coat’s overflowing pocket, chubby knees peered out from beneath a blue paper-towel drape.  “You never called me back.” 

Shortly after my phoning attempts, duly documented, her chart was accidentally refiled. 

“So eventually I had to send you a letter, even though you said that you didn’t want mail from us either.”  I could feel sweat collecting at the back my neck.  I didn’t ask her when her pants started pinching.  I didn’t say, although I wanted to, “Didn’t you wonder why you didn’t bleed afterward?”  It was the letter’s urgency which finally drove her to schedule a same-day appointment.

Sometimes patients ask, “What happens to the babies?”  In my replies, I’m careful with language.  Even the word “fetus” can strike too close to the nerve.  I tell belly-baring high-schoolers, defeated and disheveled mothers, and shame-faced graduate students that the “products of conception” are sent to a lab in California.  The next week, pathology reports come back congratulating us on complete tissue samples, successful terminations.  Rarely, pathology reports are rejection letters telling us we failed wishing us, in microscopic terms, better luck next time.  Her pathology report arrived a full month before I ordered the ultrasound.  But by that time, it was no secret that her pregnancy continued and that the abortion had failed.

  Dr. R retrieves the ultrasound report from my desk and holds it, flattened, against his slender side.  I tell him, “She no-showed for her follow-up visit. I tried to reach her. I just didn’t know how pushy to be.” I pause momentarily before continuing.  “She asked not to be contacted.  I figured she’d eventually call.”

The doctor brings a wide, pale hand to his forehead and draws a pointer finger across one eyebrow.  His silence provokes a further tumble of words from me. “I already set up her re-evacuation.  She’ll have a repeat termination at Planned Parenthood tomorrow.” 

High heels clip down the hallway outside my office.  Dr. R’s eyes meet mine.  He says, “You know that this is negligence.” 

It was time to admit two truths to myself.  Firstly, this work was beginning to get to me.  Secondly, I secretly hoped that my patient hadn’t contacted me because she’d changed her mind. 



Copyright 2008- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved


Articles in this issue:


  • Masthead

    Editor-in Chief:
    Laura Fitzgerald

    Editorial Staff:
    Laura Fitzgerald
    Alison Palmer
    Kimberly McNabb
    Lisa Gordon
    Stephanie Robinson

    Creative Oversight:

    Design Director:
    Daria Dillard

    Design Firm:
    Agency San Francisco
    San Francisco, California

    Laura Fitzgerald
    Alison Palmer
    Cris Lobato
    Elisa Howard
    Susan Cramer

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