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Anatomy of an unsafe abortion

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, so the day to day gynecologic emergencies weren’t my purview. I hadn’t operated on anyone in the past few weeks, so unlikely to be 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.

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 over reacting. 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.

As the bleeding had stopped, it was up to the anesthesiologist to fix the hematologic tempest. 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.


90 thoughts on “Anatomy of an unsafe abortion

  1. Thank you so much for what you do!

    Posted by mr brown | February 12, 2012, 5:35 pm
  2. Thank you so much for writting this. I was always a little torn on the “legalize abortion” issue. But this article convinced me. You perfectly explained, with this situation, why it has to be a choice. Becouse women deserve to make a decision. If we make abortions illegal, some women will get abortions from shady doctors anyways – they will do it anyways, becouse those decisions are VERY tough, and very dramatic for the woman. The only thing we CAN do to help women though, is to give them proper, qualified healthcare, and give them an abortion with minimalized health risk. I don’t like the idea of abortions, and I would never convince a woman to do it – but I would never want a woman to die becouse of lack of basic care from qualified doctors.

    Posted by Kamil Wierzbicki, UK. | February 12, 2012, 5:48 pm
  3. Would you be able to comment on which city this is in, or at least which state?

    Posted by brie | February 12, 2012, 6:25 pm
  4. Powerful story. You got mentioned in AmericaBlog which is how I found this. Thank you for all you do.

    Posted by Jeffrey Stevens (@jeff1132) | February 12, 2012, 6:34 pm
  5. OH I HAVE AN IDEA!! how about she just use some f*cking BIRTH CONTROL IN THE DAMNED FIRST PLACE and THEN maybe she wouldn’t have been in this situation. She knew when she opened her god damned legs how babies were made.OK people?And if she didnt why the hell is she having sex?? Truth is, is that we have been given every tool and opportunity to prevent pregnancy, if you are too irresponsible or plain frigging stupid to protect yourself from it, then my God, i guess its best YOU DON’T HAVE A CHILD

    Posted by whoever | February 12, 2012, 6:45 pm
    • Dear WHOEVER,”She knew when she opened her god damned legs how babies were made”

      Years ago, a male friend of mine uttered those same-similar words. I agree. Women are only going to “keep their legs together” as he so delicately put it, when they’re educated about what pregnancy involves and how they can prevent unwanted pregnancies. I agreed with him and I agree with you now.

      Posted by teamrns | February 12, 2012, 7:49 pm
  6. wow… so my entire heart just broke. I have never had to go through anything like what that poor young woman did, but knowing there are “Doctors” like this out there, who really have no idea just what they could do to someone… makes me so sick to my stomach. She is really blessed for the well dedicated doctors, who saved her life. Thank you. ❤

    Posted by ellsee | February 12, 2012, 6:54 pm
  7. Dear Dr. Gunter,

    I wish that just one of the facts that you discuss in this article — the “disseminated intravascular coagulation,” or bleeding to death as a result of damage to the uterine artery — were common knowledge. It is simply unconscionable that in the 21st century, women’s lives can be destroyed so casually by ignorance.

    Posted by thepoliticalcat | February 12, 2012, 7:00 pm

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