dilation and evacuation

16 Jul

D & E.  a.k.a. a surgical abortion.

I have a feeling a good number of readers are not going to like this post very much–come to think of it, I don’t think any readers are going to like this post.  Pro-choice, pro-life, ambivalent–no one is pro-abortion.  It sucks.

To make myself clear, what I’m about to write is not about my political opinion, only one experience.

I scrubbed into my first dilation and evacuation last week.  It was my choice to be there, I was under no obligation and I felt no pressure–well, I suppose I did feel some obligation, but it was entirely self-imposed.  As someone who is interested in this field, I think I owe it to the patients to be educated on the medicine.

The OR was peaceful but a little sad.  Everyone was respectful and considerate to one another.  There were no frustrations or irritations, no one felt hurried.

The procedure was impeccably clean and thorough.  The removal of the contents of the uterus was more challenging than I thought it would be to watch, though I’m sure far easier than it would have been to observe the D & E from earlier that day of an anencephalic fetus (one without a brain).  At this stage in the pregnancy, the “products of conception,” as we call them, looked like unorganized soft tissue–but I didn’t look all that closely.

The physicians in the room were everything a patient would want.  They were supportive without any judgment.  They listened and acknowledged that patient’s concerns.  They showed absolutely no agenda.  They provided excellent patient-centered care.  One of them told me about an experience he had one with a patient who chose to have a criminal abortion and presented to him in severe septic shock.  He decided then that he would not let that happen to another patient of his.  He’s received death threats; he’s been physically assaulted.  He could have retired by now, but he hasn’t.

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8 Responses to “dilation and evacuation”

  1. Erica July 16, 2012 at 10:36 pm #

    Thanks so much for sharing this, Anna. It’s so sobering to read. During a procedure that I’m sure was an incredibly difficult decision, I can’t think of anybody better in the room than you. You are a brave and caring soul 🙂

    • annaojesus July 16, 2012 at 10:38 pm #

      Very kind of you, Erica–I’m blown away by your kindness, always. I think you would have really liked these physicians. They were outstanding. Love you, and many many thanks.

  2. phantomdiver July 16, 2012 at 10:40 pm #

    Even if you become an OB/GYN, you wouldn’t have to do abortions. Some don’t.

    One of my many sisters-in-law, btw, was pregnant with an anencephalic baby. Because she felt her clock was ticking, but she also didn’t want to terminate the baby’s life, she had Jeffrey delivered at 23 weeks, I think it was. Some early time at which many babies survive, anyway. He lived for 15 minutes after his birth. We were all very sad, but I was glad that she had taken that path.

    This was an elective D&E, right? No fetal anomalies or anything like that? How far had the pregnancy progressed?

    I don’t want to argue with you at all. I value reading about your experiences. So if I’m being inflammatory or something like that, let me know. That is NOT my intent.

    • annaojesus July 16, 2012 at 10:49 pm #

      First of all, I appreciate your thoughtful discussion, and I always appreciate your kindness and respectfulness. I don’t believe you are inflammatory in the slightest. I expect(ed) very mixed reactions to this post, which is why I tried to distance my own political opinion, though I doubt I completely concealed it.

      Your sister-in-law sounds like one of the bravest women in the world. I’m so sorry she had to experience that, but I’m glad she was well supported and that she found it to be the best course for her.

      Unfortunately, I can’t answer specific questions about the patient–I’m trying very hard to maintain patient confidentiality, and it’s tricky when I talk about my clinic work. I prefer to lean toward the vague end.

      I really appreciate that Ob/Gyns are not required to perform abortions. I have no idea what I’ll go into at this point, and I’m not sure how I’ll feel about opting out of a certain procedure.

      Thank you again!

  3. Jen July 16, 2012 at 10:41 pm #

    Anna, I’m so enjoying reading your thoughts on your ob/gyn clerkship – please keep writing! For what it’s worth (which I suspect is not much), I am as in love with the field at the end of my first block of internship I was when I was in your place. I’d imagine that you have many people with whom to process your thoughts about the D&E that you witnessed, but please know that this pro-choice-feminist-ob-friend of yours, who found my first (and second, and third) TABs to be far harder than I would have imagined. is always here to talk and listen. (And thank you for exposing yourself to medicine outside of your comfort zone in the service of your patients; just another sign among the many that you will be a fantastic physician.)

    • annaojesus July 16, 2012 at 10:54 pm #

      Jen! Hello! Thanks so much for the comment! I’ve been thinking of you a great deal on this rotation, wondering how you’re loving intern year thus far–I’m so glad (though not at all surprised) that your thriving 🙂 Your opinions and feelings toward the profession matter much to me.

      I would love LOVE to talk with you about our experiences–must get up to Boston! I would really like to know more about how this all went down for you, about your first impressions/reactions.

      I’m touched beyond belief by your encouraging words–thank you! Just know that you are thought of frequently in Philly. So glad you’re a physician, and very happy to have you as a friend and mentor.

  4. Linda Mills July 17, 2012 at 8:47 pm #

    Anna, I remember those days before abortions became legal and there were young women in my little home town who were raped and who had very, very dangerous back street abortions. Kind and gentle and thoughtful people like you are so important to have among the ranks of the next generation docs. Thank goodness there are still hospitals and physicians who can help any woman who is in the midst of an unwanted pregnancy. You may want to delete my comment, because it will veer toward the political in the next sentence. I hope men and women will consider which politician will help to protect a woman’s right to choose and a doctor’s right to help the patient.

    • annaojesus July 18, 2012 at 11:11 pm #

      Linda, thank you so much for your comment–scary, scary stuff. I would never delete a comment of yours. I value your opinion, and I’m glad/a little surprised that I so far haven’t managed to piss off too many readers with my political stances–or, at least, I don’t think I have…it’s been a while since I’ve gotten a really angry comment directed at me.

      I can’t believe that backstreet abortions are still going on in this country, though I suppose at a slightly lower frequency…I hope? Thank you for your encouragement. I miss and think of you often.

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