1. Fitzgerald, Laura MSN, RN, CNM


A reminder of 'the procedure.'


Article Content

I've seen her half a dozen times in the past year. The last time was about a month or so ago, when we bumped into each other in a grocery store a few blocks away from my apartment. Maximizing my height to attract the attention of the Italian man behind the deli counter, I impatiently awaited my turn, eyeing the gourmet pizza and eggplant parmesan. A petite woman farther down the counter spoke, with an accent that might have been Eastern European: "A mozzarella sandwich, please [horizontal ellipsis] and two black-and-white cookies." Her voice jogged my memory. As I turned toward her, she met my gaze, and held it.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

"Why do I know you?" she asked. "You look so familiar."


I'd sported navy blue scrubs during our first encounter. She'd been gowned in a johnny coat, ivory underwear and a bulky maxi pad plainly visible through its open back. Even sedated, she had a remarkable face and it was hard not to look at her.


Now we were on equal footing, harried shoppers armed with baskets of produce and outstretched baguettes. I wasn't about to presume she'd welcome a reminder of her abortion or my involvement in it. The procedure, as we in the field call it, is something many women keep secret from partners, families, and friends. So I just looked at her and didn't say a word.


And then she remembered.


"I'm here with my kids," she said quickly. "I have three kids." She waved a hand toward the front of the store, where two white-haired pixies played with piles of tomatoes.


"Oh, yes, you told me about them," I said, and smiled, trying to put her at ease.


"I'm doing so much better now than I was then." There was an awkward pause. The man behind the counter handed her what she'd ordered. I let someone else take my place in line.


"Does this happen a lot?" she asked. She'd relaxed, absorbing the probability that I really would protect her confidentiality. "Running into people, I mean."


"Actually, this is the first time."


It was. Most of the women I care for, every Friday in the recovery room, do not live in my neighborhood. The clinic provides gynecologic and family planning services to uninsured and underinsured women. I take their vital signs and place hot water bottles on their cramping bellies. They're poor, often tired, sometimes abused, and I try to imagine what it's like to live without a safety net. Some days I'll see 15 or 20 patients in a row, instructing one after another to avoid tub baths and sex for two weeks and telling them that one saturated pad in an hour is deemed excessive bleeding. I dispense contraceptive pills, give Depo-Provera shots, and set up two-week follow-up appointments. "Remember, you need to take these pills at the same time every day," I warn, knowing I'll see some of them again in a few months.


This woman, now buying giant cookies for her kids, hadn't looked for sympathy or offered explanations. She'd revealed little of herself, asked informed "what if" questions, and brushed off my rote speech with, "I'm not a forgetful teenager. I'm a mother with three kids, still breastfeeding the youngest. I know how to take pills. I'm not coming back here again." I was taken aback, but I had it coming: what did I know about her circumstances?


I wanted to extend our conversation at the deli counter, taking a few moments to share bits and pieces of our daily lives. I don't remember how we said good-bye, but I am sure that she complimented me on my boots. As I watched her leave the cramped store, a child clinging to each hand and a canvas food sack slung across her back, I wanted to tell her that I was sorry for intruding on her life, for having deigned to give her advice. I wanted to tell her that sometimes I also forget-my grocery list, my pills, how easily I could be walking in my patients' shoes.