What would you do in practice?
8 MINUTE READ
On the weekend of 3-4 June 2012, I was the on-call respiratory registrar for my hospital. I received a phone call from the emergency department (ED) about a 26 year old girl who had returned from overseas travel in East Asia with a productive cough, haemoptysis and fever. I heard from ED that the girl was pregnant. The girl had just just found out about her pregnancy on the same day she presented to ED. Her last menstrual period had been 5 weeks ago. The girl had not expected that she would be pregnant. Her response was immediate. She said, “How do I kill it?”
Later, I discovered from the mother that the ED consultant had explained that termination of pregnancy cannot be performed right there and then in the ED, and that the girl needed a referral to King Edward Memorial Hospital. In her case, because the baby was still early in development, a hormonal pill could be used, rather than dilatation and curettage.
“… she had not expected that she would be pregnant, but her response was immediate. She said, ‘How do I kill it?'”
I addressed her respiratory illness. I also spoke to the girl about her newly discovered pregnancy. I did not try to avoid the “elephant in the room”.
I approached the subject by clarifying her understanding and perception. Having heard that the girl had already found out about her pregnancy in ED, I asked, “Do you understand that you’re pregnant?”
The girl replied, “Yes.”
I went on to ask, “So, how are you feeling? Is this news a shock, finding out that you’re pregnant?”
I had heard about her immediate response. Her response to me was also to-the-point, “I hate children. I never want to have children. Children disgust me. I’m going to kill this baby as soon as I get discharged from here.”
The intensity of her attitude struck me.
I gently said, “Do you know how this could have happened?”
The girl replied without hesitation, “Yes. I had sex. But I’ve had unprotected sex for 4 years, I didn’t think I would get pregnant.”
I explained to her that although she had indeed had some significant previous medical issues that reduced her fertility. However, being female, and not menopausal, if she had sex, she could get pregnant. The chance of pregnancy would still be present even if she was infertile. I ventured further, “And what are your feelings now, about this pregnancy?”
“The girl replied, ‘I’ve finally reached a place where I’m having a good time, I’m not going to let this get in the way. I won’t let a baby get in my way.’”
The girl replied, “I’ve finally reached a place where I’m having a good time, I’m not going to let this get in the way. I won’t let a baby get in my way.”
I discussed the reasons for carrying through with her baby first, particularly given her issues with fertility. I highlighted this to her, “Whilst you can and have become pregnant, your fertility has been affected. Do you realise that you may not get another chance to be a mother?”
The girl said that she was sure that she didn’t want children, that she hated them, and shrugged off the gentle observation that she was once a child herself.
I was only a couple of years older than her but she listened when I said that people sometimes feel sure about the decision they make at the time when they are young, but the lifelong implications of that decision is not known to them. In response, she shared that she had previously tried to convince doctors to give her a hysterectomy, but they had not granted her this, as they had said the same thing as me. Other doctors have also said the same thing to her, that while still young, she may feel that she would never want babies, but she may change her mind later in life.
The girl’s mother was also present and she said to me, “If you knew her, you’d know she’s extremely selfish. She’s high maintenance. She looks after herself. She wouldn’t look after anyone else.”
The girl added, “I prefer to spend my money on myself. I’d rather buy myself some clothes than spend money on a child.”
It was surprising to me to see the girl being so unashamedly and blatantly self-centred, but I kept my opinion to myself and went on to discuss reasons for not supporting termination of the pregnancy. The term, termination of pregnancy, is ironically a euphemism used by healthcare workers to make the issue less confronting. In stark contrast, the girl involved, was a lot more frank about not hiding the real issue. So, I didn’t use the euphemism with her. I spoke to the girl using her own language, “I believe you said it yourself – that it’s killing your child. Are you really sure you want to live with that on your conscience?”
The girl was not perturbed, “I just want to go back to [East Asia], and go and have fun. It’s my life. I’m not going to let the baby stop that.”
I was more nonplussed than she was, “Why so sure? How is killing your own child so easy? Does it make it easier because your baby is smaller and more vulnerable than you?”
Again, she quickly shrugged off my comments, “It doesn’t matter whether it is smaller or not. I don’t think it’s about the baby being smaller. If people try to stop me from doing things as I want, I would kill them if I could – the only thing that has stopped me is that I do not want to go to jail.”
I had to clarify, “Really, you would kill people to get what you want in life, as long as you wouldn’t go to jail?”
The girl was as hard-as-nails, “Yes. Wouldn’t you?”
I couldn’t quite believe that someone could live so selfishly and not care about the consequences, unless they impacted their own selves. Thinking on my feet, I responded to her, “No I wouldn’t. Although, there are some who kill other people and live with that, such as gangsters who make it their lifestyle, I don’t think most people would be at peace with doing that.”
In retrospect, I realised I could have replied to her question by explaining more about why I wouldn’t. I could have told her that I believe that God gives value to life and shared about who God is to me. If I had the opportunity again, I want to share with her that God has not discarded me even though I actually deserve that (Romans 5:8), and that instead of discarding me, God has adopted me as His son, and has shown me His mercy, love and care. And so I live for Him as my king, rather than just for self. and that I care for what and who God values. I would tell the girl to value the life of her baby, who is dependent on the parent for care. I would share that my belief also impacts my care of her, and that my care for her as someone who God values, motivates me to spend my time having this conversation with her, although I was sleep-deprived from being on-call all weekend. I care, because I know I have received care from God even though I don’t deserve Him. I care for her baby, who is significant to God, not just from birth, but from conception (Psalm 51:5).
“… I realised I could have replied to her question by explaining more about why I wouldn’t. I could have told her that I believe God gives value to life, and shared about who God is to me.”
I went on to discuss the pregnancy. I was so taken aback by the girl’s hardened self-absorbed attitude that I could have been stunned into silence otherwise. To keep the conversation going, I raised with the girl my (previously planned) thoughts about the pregnancy specifically. I discussed the alternatives to abortion with her, “Have you considered options besides getting rid of your baby as you’ve wanted? What about giving your baby up for adoption?”
The girl’s reply was again prompt, “But then I would have to carry this baby in my body all that time. I don’t want to have to carry a baby in my body!”
I suggested, “Perhaps that would be a comparatively short time, compared to a lifetime with the baby, or a lifetime of living with having killed your baby…”
Nevertheless, she remained undeterred and astonishingly callous, “No, I don’t want to give time out of my life to this baby. You can’t even sell your baby like you can in the US, so there’s not even that perk of keeping the baby alive.”
I was speechless, astonished at her selfishness, but I also appreciated her frankness about the only reasons that she would be motivated to not abort her baby. I tried again, “Really? That happens in the US? People are selling their babies?”
“Yes, and people are using women to be surrogate mothers to carry their babies for them,” she answered. “Anyway, I do things my own way. I don’t need anyone to tell me what to do.”
I responded, “You’re right. You have to make the decision yourself, because you will bear the responsibility for your own decision. But this is not a light decision to make, this is significant for you, as well as for your baby. I need to help you to consider what’s involved in your decision. Similar to when you had to have the high resolution CT of your chest before, and the radiologist came to inform you about the risks of being irradiated, and weighed up the reasons for and against doing the scan. You could go ahead without knowing or understanding the factors involved but if you just went ahead anyway, you might end up with consequences that you hadn’t thought about either. So it’s important to discuss things now.”
The girl nodded. This time, there was no rebuttal. She actually did seem to appreciate and agree with my point. She seemed remarkably unperturbed by her selfish motivations and frankness about her willingness to kill a life. I wondered if other girls would have questioned themselves more. She had also been remarkably cheerful about her mother’s description of her as being extremely selfish.
Her mother said, “I’m against abortion myself, but she’s an adult and has to make her own decisions.” Her mother then asked me, “Are you going to give her a referral to get an abortion?”
I said, “I’m not. Actually, I don’t even know how that gets done.”
Her mother stated, “She needs a referral to get things done at King Edward Memorial Hospital. It’s alright, we’ll go to my GP and get a referral.”
I had done what I could to counsel this girl about issues that she need to think about. I have tried to help encourage her to keep her baby alive and not kill the baby. It was remarkable to me that she was so unafraid to recognise this as killing, and call it as it is, and so upfront and sure about her selfish motivations. I prayed for her that night. I hoped that some of the things I had raised with her would stir her to rethink her planned course of action.
“I had done what I could to counsel this girl about issues she needed to think about. I have tried to encourage her to keep her baby alive and not kill the baby.”
I was grateful for the opportunity to engage in a conversation about termination of pregnancy that normally presents to the general practitioners (GPs), emergency department (ED) doctors, and obstetrician/gynaecologists, rather than to a respiratory registrar. I was also curious about what others would do in such a situation. Do other Christian / non-Christian doctors have these conversations, and what do they say? And what a significant responsibility for Christian doctors…our words could make a significant life-or-death difference.
In my own training at medical school and during my general practice and obstetrics/gynaecology terms, there had been little mention of how to approach requests for abortion, and even less about encouraging the pregnant patient to consider the issues involved and providing support through the pregnancy. Even in the local Christian healthcare student group, there had been limited preparation for this kind of conversations. Role-playing scenarios to rehearse an approach for guiding such a conversation, and planning responses to anticipated reactions from the pregnant patient wanting an abortion, may be useful.
Anonymous This article was first published in 2012, Luke's Journal Vol 17.2 - Parallel Careers after Medicine.