1. Davis, Cortney MA, NP, RN

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A young woman, whom I will call Susan, had been coming to our women's clinic for years complaining of intermittent deep pelvic ache that interfered with her sexual relationship with her husband. She'd had cultures for infection, Pap tests, ultrasounds-even an exploratory laparoscopy that discovered no adhesions, no cysts, nothing to explain her pain.

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This particular day, she slouched on the exam table. Her short hair was blond and shining, but everything else about her was dulled. When I down, she met my gaze.


"Sorry I was late," she said. "But I just wasn't sure why I should bother to come."


"The nurse says that you're having pelvic pain," I said.


"Yes, but everything always comes back negative. My husband thinks this is all in my mind."


I hesitated a moment. "Do you think all in your mind? What do you think causes your pain?"


My question-had no one asked before?-released a torrent. Susan began to cry, lifting the sheet from the examination table and pressing it to her eyes. I thought I could guess the reason -rape or abuse, and my question somehow allowed her to acknowledge the pain. But Susan's story surprised me.


Susan told me she'd gotten pregnant at 16. She didn't tell her boyfriend, but she told his mother, who paid for Susan's abortion. She kept this secret from her parents and friends. Engaged, in her early 20s, she became pregnant again. Even though she wanted to keep this pregnancy, her fiance didn't think the time was right; at his urging Susan had a second abortion, having felt forced to chose between his love and the pregnancy. Afterward, Susan became "angry and grouchy." Again, she told no one, ashamed that her fiance had been able to convince her to end the pregnancy, an action that, deep down, she believed was wrong. They soon broke up, and for several years, every time Susan saw a child around the age her child would have been, she'd weep, alone. She even calculated when she would have delivered and, every year, spent that day crying. Five years ago, she married a "wonderful" man. She wanted to tell him about her two abortions, but the time never seemed right.


"After a year or so," Susan said, "he started to talk about our getting pregnant. That's when I started getting this pain. I don't think it's in my head. I think it's in my heart. What if I become pregnant and something goes wrong? How can I be a mother, after what I did?"


I had no answer. During my 17 years in women's health, I have seen women who have chosen abortion and have no regrets. I have also seen women hounded by unresolved emotion. Some are angry at the inadequate counseling. Some complain that caregivers minimized the procedure. Others report sudden remorse about an abortion they thought was "in the past." Susan mentioned two specific fears: She felt that she didn't deserve to be a mother, and she worried that any wanted pregnancy might be jinxed.


I have seen that it's difficult for some caregivers-those who assert that abortion is an elective procedure-to acknowledge that abortion can be a secret that weighs upon a woman's life like a stone. Susan was one of those women. She didn't need more tests. But how could I best help this woman whose life had been dramatically affected by the choices she'd made?


One way was by acknowledging that her remorse was real. Many women who have questions or regrets after abortion say nothing, believing that they are not supposed to feel anything other than relief. Trying to minimize or talk women out of their grief will only, I think, deepen feelings of guilt or shame.


Susan told me that what she wanted most was to feel forgiven by God and to find a way to forgive herself. Susan was depressed and anxious, particularly about telling her husband and accepting the idea that she deserved to become pregnant. Several weeks after our visit, Susan called to tell me that she and her husband were in counseling. She had found resources on the Internet. Slowly, she said, her physical and psychic pain was dissipating.


I am now, more than ever, sensitive to women who repeatedly seek help for symptoms when all tests are negative. Although I always inquire, I don't presume to know the answer. I ask women if they have anything in their past that might contribute to depression, grief, or guilt. Then I listen closely, not just to the words that play over the surface of a story, but to the message behind them as well.