Valerie's Story

When I saw her name on the schedule, I felt a twinge of recognition. I'd seen this patient – I'll call her Valerie – several years before. As soon as I opened her chart, Valerie's story came rushing back to me.

Seven years ago she'd been a sweet 23-year-old who arrived every year for her exam and birth control refill. But at her last visit, she'd been angry and confused. She'd missed her period, and a home pregnancy test had been positive. Pounding her fist on the exam table, she asked me how this could have happened. She'd taken the pill faithfully. Now she was "in a real bind." Her boyfriend said he was too young to think about marriage or the responsibility of a child. And I can't tell my parents, she told me. They'd kill me. I examined Valerie; her 12-week gravid uterus was round as a grapefruit. After she walked out that day, clutching the name and phone number of a nearby clinic that performed abortions, we never saw her again.

Since then, everything in our clinic had changed. We now had modern exam rooms with peach-colored curtains and a frosted glass door so no one passing by could see who was sitting in our waiting room. We'd given up old techniques for modern ones, and we'd increased our OB-GYN residents from six to 11. Seeing Valerie's name, I wondered what changes had occurred in her life.

I knocked and opened the exam room door. Huddled in a chair, her dark hair cut in ragged layers and her eyes red rimmed from crying, Valerie looked awful. My simple Hi Valerie seemed more than she could bear; as soon as she saw me, she began to sob.

All I could do was stand beside her, my arm around her shoulders. Patients often wrench me out of my private, somewhat reserved self, and Valerie was tugging at my heart without saying a word. For minutes, she mourned, and I let her cry against me. When she could talk, I sat down and waited. What Valerie told me taught me something that I will never forget about caring for women.

After her last visit, Valerie did go to that nearby clinic for a termination of her unexpected pregnancy. She never told her parents, her sister or her best friend. Her boyfriend paid for the procedure and then, a week later, told Valerie that their relationship was over.

At first, Valerie told me in between tears, I felt numb. I really loved him and thought we'd get married, if not then at least some day. But after a while I just tried to forget about him and the abortion and get on with my life. I stuffed all that away.

Valerie also started "stuffing" food, at first as a comfort measure and soon compulsively. She gained 60 pounds. When her father told her she looked disgusting – "No man will marry you if you weigh more than he does," he said – she began purging. She also began dating again. But this time she was careless about birth control and soon found herself pregnant again. Her first abortion was by then only a vague shadow in her mind. The memory of her second, she said, didn't fade so quickly. But I kept telling myself that I didn't deserve to be a mother anyway. For the next five years, Valerie bounced from boyfriend to boyfriend. When she began having nightmares, she started drinking to quiet her mind. A few months ago, drunk, she'd plowed into a tree and fractured her leg. I felt, she said, as if I had broken my life and now had broken myself. After a week in hospital, she'd entered a rehab program. There, in a small dingy office, a therapist asked Valerie about her past. I couldn't believe what I said, Valerie told me, pressing her hands to her eyes as if that might keep closed the floodgate of her tears. I wanted to talk about my father, how critical he was of me, or about my rotten love life. But what came out was the story of my abortions. How guilty I felt. How I didn't know if I could go on living with what I'd done.

Sitting in front of Valerie, I didn't know what to say. Our clinic has always been non-judgmental and non-directive about what an individual woman decides about her pregnancy. But clearly at some point the medical profession had failed Valerie. I tried to recall what I'd said to her when she sat before me, so many years ago, pregnant and desperate. Had I truly counseled her? Had I asked what her choice was, about her support system, about her religious or cultural beliefs about abortion? Had I mentioned that some women experience grief after abortion? Or had I assumed that because she was young, unmarried and afraid to tell her parents, that she had no choice?

"What did the therapist say?" I asked, and my question renewed Valerie's sobs.

"She told me that abortion was a woman's right. She said she'd asked me what trauma I'd had in my past, not what medical procedures. I said that it seemed to me as if my abortions were a trauma. When I said that, she assigned me to someone else. But no one wanted me to talk about it. Now I'm crying all the time. I can't stop thinking about what I did."

In the face of Valerie's grief, I felt clinically and emotionally unsettled and unprepared. I remembered other women I'd seen in the clinic, women whose lives also seemed to spiral downhill after they'd made what they'd felt to be, at the time, perfectly logical and necessary choices. They'd terminated pregnancies because there wasn't enough money, because it wasn't the right time, because they were too young, because they were too busy, because they couldn't tell their parents, because their boyfriends or husbands said they had to choose between them or the child. Like most caregivers in the post-feminist years, I'd been taught that abortion shouldn't cause any long term emotional effects, and so I'd never asked these women if they were experiencing any grief or sadness after pregnancy terminations – or perhaps I thought that if I didn't ask, and if they didn't tell, it would be best to leave well enough alone. It was never said, but certainly implied, that if a caregiver suggested that abortion might cause some women deep and lasting remorse or guilt, that caregiver was anti-woman and most certainly anti-women's rights.

I called our social worker and told her that Valerie was more than distraught, she was suicidal. At that moment, I didn't know any other way to help my patient.

Before Valerie's visit, I had never heard the words "post-abortion trauma," although now I know that I had witnessed its effects in other women. While the event itself, the abortion, might be put out of the conscious mind, a woman's subconscious doesn't forget. Neither does her body. Some women seem to have no long-term effects post-abortion. And yet pelvic pain, sexual dysfunction, eating disorders, promiscuity, repeated abortions, depression, intense guilt, flash backs and nightmares – all these symptoms and more might emerge in a woman who is, both mentally and physically, grieving after abortion. Often these symptoms appear soon after a pregnancy termination; for other women they can remain buried for years, only emerging when triggered by other events: marriage, especially if the partner doesn't know about the abortion; another pregnancy; holidays such as Mother's Day or Christmas; the sight of babies or pregnant women; anything that reminds a woman of the procedure itself, like the sound of a vacuum cleaner or a blob of grape jelly on a sandwich.

Our social worker helped Valerie find a therapist who was familiar with post-abortion trauma, and she also helped her find peer support. Valerie signed up for a Rachel's Vineyard retreat, a Catholic weekend program offering post-abortion healing, open to women of all religions and backgrounds. While Valerie still continues in therapy, it was this weekend, she told me later, that helped her begin to forgive herself and to accept her two pregnancies and the choices she'd made. It was Valerie's story that helped me become a better caregiver, open to any and all emotions that a woman might bring with her into the exam room.

When a woman comes in suffering from symptoms that seem to have no obvious physical cause, I've always asked about sexual or physical abuse. Now I ask about pregnancy losses too, including abortions. I've found that many women – even the most pro-choice women – have kept their remorse about their abortions secret, stuffing them down as Valerie did, and yet their guilt and sadness escape as pain, as depression, as drug abuse. When their very real grief following abortion is revealed and acknowledged, it is, for many women, as if the heavy stone that had been holding them down has finally been lifted away.

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