Saturday, May 5, 2012

NO EASY ANSWERS


WARNING: Due to the controversial topic of abortion this story may not be appropriate for all. Please understand that my purpose in writing was simply to convey life, as I perceive it in my work in Cameroon. I am certainly not trying to pass judgment or stir up debate.


The chief complaint reads “irregular menses”.

As I enter our cramped consulting room, I note a young, well groomed, lady sitting on the exam table. Her hair is neatly styled back in a bun with a few extra twists to give a sassy flair. Her striped blouse and matching black leggings complement her petite figure. Her deep brown eyes with lush, curly eyelashes blink up at me. Everything in her dress and manners indicate a cultured woman with a talent for fashion. 

But, she is obviously nervous. Perhaps she is anxious about her ill health?

“Good morning!” I greet her.

She gives a small, nervous smile back.

“How are you?” I inquire.

“Fine,” she replies automatically. Her voice is soft. I can barely hear her. She lowers her eyes shyly.

“You’ve met my colleagues;” I state the obvious for lack of anything cleverer to say. “They’re going to fill me in on what you’ve talked to them regarding your problem. When they finish, you can tell me if they missed anything.”

I try to reassure her that she is in control of the information she gives and that she can be confident I won’t ignore her if she thinks of something else in addition to what she’s told the pre-med students.

Alyssa and Sarah, two pre-medical students working with me, efficiently bring me up to speed on what they have unearthed from their history.

“Eighteen year old female comes in with irregular menses. She states her menses have been irregular in the past. At that time she was prescribed an oral contraceptive. After taking the medicine for 3 weeks she stopped the medicine due to side effects. She states that the contraceptive made her breasts too large and tender. Her last period was in March. (She has missed her April period.) She denies nausea or vomiting or stomachache. Other than the menstrual problem, she has no other complaints.

Past medical history is negative for any chronic medical illnesses. Social history reveals that she is a student at the University of Buea and is currently in a dating relationship.

Ms. Deborah waits patiently on the brown, vinyl exam table with the tiny tear in the center. She doesn’t interrupt but nods in agreement. Her legs dangle from the end of the table where, underneath, her stylish sandals have been slipped off for the exam.

I move over to the table and touch her gently on the shoulder in a feeble attempt to alleviate her anxiety. I reiterate a few of the same questions Sarah and Alyssa have already asked and get a consistent response.

As I finish a short physical exam that reveals a healthy woman, I ask a few more details.

“Are you wanting to get pregnant?”

“No,” she states.

“Ok, but you didn’t like the tablets?”

“Yes,” she replies with no emotion.

“What are you doing to prevent pregnancy?” I press her to think about her situation a bit more. Birth control is underutilized among the sexually active university students. I see too many young girls risk their futures because they are ignorant about birth control or have false ideas about contraceptive use. Condoms are tricky because they require the cooperation of the partner. Most girls don’t feel empowered to demand condom use by their partners. They are financially dependent of their boyfriend. Their financial dependence cripples their safety in other regards.

Ms. Deborah looks at me with wide, anxious eyes. “Nothing,” she answers.

“But you don’t want to get pregnant,” I ask again.

She reaffirms her earlier answer with a subtle nod.

It’s the proverbial ‘monster in the room that nobody talks about’. She is afraid she is pregnant. I know she is afraid she is pregnant. I suspect she is pregnant too. Neither of us broaches the topic. I prefer to wait for definitive results.

Exam and questions complete, I send her off to our laboratory for a G-test. The G-test is simply the terminology used here in Cameroon for a urine pregnancy test. When I inform her of the test I have ordered, she is silent. I hear a tiny, sharp intake of her breath. A subtle clue my ear has become attuned to that signals anxiety or distress. She shoulders her purse bravely and heads off to the laboratory.

Time flies as I move on to seeing other patients. Before I’ve had a chance to consider Ms. Deborah again, her medical file - a flimsy, paper exam book with children’s cartoons plastered across the front - is again on my desk. In red ink, in both symbol and written form, are the results of her pregnancy test, “(+) positive”.

I call her into the consult room again. She sits herself in the chair across from me and closes the door clutching her purse on her lap. Her anxiety level has obviously not diminished.

I am not one to circle round and round in concentrically smaller circles before finally revealing bad news to patients - at least not in most situations. I know Deborah already has her suspicions.

“The lab result is positive. That means you are pregnant,” I inform her in a manner I hope is neutral. I try to give the news in a tone that implies neither joy nor grief. “You are about 7 weeks pregnant.”

 I sit back and busy myself writing a few notes in her medical book. I give her a few moments to absorb the finality of the news.

After a few moments, I lift my gaze back to meet hers. “Will your boyfriend be supportive of you?”

She simply stares at me.

“What about your family? Will they help you?”

She gives a faint shake of her head in answer and returns to staring blankly at the table. She appears to be in shock. I’m not sure how much she is hearing and comprehending now.

“Do you have any questions?” I finally inquire.

After a long pause, she nods her head yes. “I can’t have this baby. I’m in school.”

Not explicitly stated but I understand perfectly. She wants to know how to abort the pregnancy.  Her world is collapsing around her. She cannot see past this dark wall of pregnancy and all the implications it could mean in her life. They are devastating changes to one, who most of her life, has lived in relative luxury. Every privilege she enjoys now could be ripped away.  The opportunity to study at the university, earn a degree, and have a career could be gone. She can only imagine the ostracisms from her family. Families that were formally supportive but with this pregnancy might turn cut off all-financial support and ruin her reputation. Her head is swirling and she cannot think straight.

Yes, I understand her question. “I’m sorry, my dear. We do not do abortions here.” I sympathize with her fear and pain.

“In situations like yours, I recommend you talk to someone you trust – a close friend or a family member that you know well and trust. Don’t try to make any decisions today. Give yourself some time. Think about things. Talk with a trusted confidant. God can help you. I know it’s hard to think about it; it is possible to keep this pregnancy.”

She sits in her chair during my monologue. I’m not sure she understands anything. I reach across to grasp her hands in mine. “My dear, you need to talk to someone you trust. Don’t try to make any decisions on your own,” I gently counsel her.

As she continues to sit silently across from me I ask, “may I pray for you?” She doesn’t reply. I take this as an affirmative and pray aloud for God to wrap his arms around this child of His and give her courage to make the right choice. It’s not a long prayer and certainly not eloquent; it is sincere though. I am not na├»ve to reassure her everything will be fine. It will not be easy. Keeping the pregnancy will alter the course of her life forever.

I wish I could write that I had an epiphany and spoke just the right words that sent her out with peace in her heart and courage to allow God to determine the course of the pregnancy. Nothing particularly breath-taking happened though. In fact, several times I felt like I was calling her back down to earth while her thoughts floated far away. Several times I had to repeat a question before she would reply. Her face remained masked with fear and anxiety.

I gave her time to think and absorb the reality. I finished writing my counseling recommendations in her medical book.  She eventually arose with a slight shake of her head like she was coming out of a dream. She readjusted her purse on her shoulder. As she opened the door and turned to leave she gave a small, sad smile with eyes that revealed gratitude. “Thank you,” she said.

“You are welcome,” I answered. “You will be in our prayers. We will be praying for you.”

“Thank you”, she said again as she walked out the door.

A new commandment I give to you, that you love one another: just as I have loved you, you also are to love one another. By this all people will know that you are my disciples, if you have love for one another.
John 13: 34,35