Two weeks ago, for the first time in three and a half years of working in abortion care, I saw my first abortion.
In the clinic where I used to work, I was on reception on clinic days until the last patient left. So although I knew very well each step our patients took during their morning (ultrasound-payment-counseling-abortion-recovery), it just would not have been practical for me to leave my post for three hours to shadow a patient. I have no desire to ever be medical staff, so there was no need for me to learn the gritty details.
Recently (a month ago, to be exact!) I packed up my entire life and moved to a new city. I was lucky enough to get a job at an abortion clinic almost immediately, this time doing intake. It is a much bigger clinic in a much bigger city, so there are always three or four other people working with me just in the office making appointments. There are eight doctors, as opposed to the one we have at home. Things move a lot faster, but there are a lot more people to keep all the balls in the air.
As part of my training, my supervisor thought it would be of interest for me to shadow a patient through her experience. That way I would have an idea of what the patients I talked to on the phone would be going through.
My patient was a lovely woman, probably in her mid to late thirties. She had two children already, and this was her second abortion. She was very quiet, but she didn’t seem nervous; she had a calm and confident attitude throughout. She was most definitely less anxious than I was.
Our first step was payment (unlike my old clinic, where we did ultrasound first). In Ontario, abortion is covered by Medicare, so very few people have to pay out of pocket. My patient was a recent immigrant, so although she did not yet have OHIP (Ontario Health Insurance Plan) coverage, she was eligible for temporary health care coverage through the federal government. I’m glad I got to see that process, because as the staff member doing payments explained to me, we were the only clinic in town who would accept this kind of payment. Dealing with the federal government was too much of a hassle for the other clinics. The staffer had to call the hotline and enter the patient’s number to make sure she was eligible. Robot Voice told us she was not. So the staffer had to call back, speak to an operator, get put on hold many times, and finally the error was cleared up. Apparently this is just the beginning: sometimes the forms need to be submitted five or six times before the government will reimburse the clinic the whole amount.
Next stop was counseling. I was surprised with how short this stop was. The counselor was very kind but efficient: she quickly established that the patient was sure of her decision, went over her medical history, and we were done. My feeling is that some patients need a bit more time to talk things out in counseling, but the counselors get a good sense for who is doing fine. I would probably need a long time, myself. But my patient seemed very sure of her decision.
Next the patient changed into a paper gown and went in for her ultrasound. They did the finger prick blood test, and for some reason it didn’t take, so the nurse had to try multiple times. I stared at my shoes and tried not to faint. The ultrasound was no biggie; I’ve seen them printed hundreds of times. My patient was only eight weeks pregnant, so it was just a little peanut on the screen.
Then we got called up to the show. As the patient hopped up on to the operating table, I introduced myself to the doctor and two nurses and explained that I was just here to observe. Although the OR was much bigger than the one where I used to work, I had a hard time finding an appropriate place to stand. I wanted to see what was happening, but I didn’t want to be staring right up the patient’s vagina, because…well, that just seemed rude. Finally I settled into a corner with a good view of the ultrasound. That way I could be engaged in what was happening without actually having to see a lot of blood. Can you tell I am squeamish?
Well, the nurse could. After she inserted the IV into the patient’s hand she looked up at me, and I must have been paler than usual because she asked, “You aren’t a fainter, are you?”. “No,” I lied. I managed to hold out for the whole procedure. Actually, for me, the IV was the worst part: that’s when I would have passed out, had it been my abortion.
There’s only one way to describe the rest of the procedure: fast. I was just starting to understand what was going on, when it was over. I went into the next room to watch the doctor examine the parts of conception, even though I had seen that before. I felt a strange need to see the whole thing through to the end.
I have to say, I am glad that I was able to go through the process with a patient; certainly it feels more familiar now when I am reassuring potential patients on the phone. But mostly, I was struck with an overwhelming feeling of gratitude. It is amazing that in the city where I live now, I can have an abortion at any number of clinics, covered by medicare, and the staff are all very kind and professional. This is not the reality for the majority of Canadians, let alone the rest of the world! My fellow activists and I fight for this to be the standard everywhere, but we have so far to go. For me, sometimes I think working in abortion care is enough; but that won’t keep our rights secure, and it won’t make things better in other places. As my mother says, places like Toronto may be doing well for access, but “abortion still needs its champions”. And that is why, whether I work in abortion care or not, I will be an abortion gang member – proudly.