Thursday, July 20, 2006

Child of Misfortune

"Your pregnancy test is positive."

How many times have I said those words? How many different reactions have I seen? Both uncountable. Some women are unsurprised, prepared, resigned. Some are shocked into tears of happiness or fear. And everything in between.

I'm thinking today of a particular woman who was in that first group. I'll call her Sanja. Sanja was from Another Country, here for graduate school. She had fallen for a young American man. They were having sex and had slipped up with their protection. Her period was late. She was pretty sure she was pregnant and had already decided what to do. Although she cared for her lover, she wasn't sure he was It for the long term. He was an unfocused young man, a heavy pot smoker who had since dropped out of school, and she was a scientist in the making, with years of schooling yet to go. She was concerned about the effect of marijuana on the baby, but mostly she didn't want to have a child until she was in a secure, long-term relationship. She was going to terminate the pregnancy.

So, when I told her the news, she nodded, informed me of her plan, and asked for information. I gave her the name and numbers of the local pregnancy termination resources, counseled her briefly, and sent her on her way. One of the easier such sessions I've had.

Two weeks later she was back. "I couldn't do it, Dr. Spencer."

Okay. "Tell me about it."

"Well, I went to the Clinic and they put that jelly stuff on my stomach, you know? And then they did the scan thing to look. When I heard my baby's heartbeat, I just couldn't go through with it."

WHAT?! She heard the HEARTBEAT?!?!?! At a pre-termination visit?

"It surprises me that you heard that." I tried not to show my shock and outrage.

"I think it was a mistake. They turned it off right away. I don't think I was meant to hear it."

No, I don't think you were. "I'm sorry." What else could I say?

I gave her the prenatal resources this time. She carried the pregnancy to term and gave birth to a healthy girl. Because of the child, she stayed with Pothead, in spite of a deterioration in both his functioning and the relationship. He was useful. He could be home, caring for the baby, while she returned to school to finish her degree. She went back to school, determined to complete her education and become a professional, although her love for her child tugged at her constantly. A year went by. One time she came in I saw bruises on her arm. Pothead was beating her. She refused to take any action, asserting that he never hurt the baby and she needed him, and besides, he was the baby's father. Unfortunately, this wasn't the first time. Nor was it the last.

You can't report an abuser if the abused isn't willing. Unless the abused is a kid, or an elder who is non compos mentis. But an adult who is being beaten has to make the decision themselves to call the cops on the person beating them. It's one of the chronic frustrations of the medical profession.

Sanja wouldn't do it. I tried every approach. Sympathy, challenge, outrage--I even played the baby card. Who wouldn't?

Things escalated, of course, and eventually she did end up calling the cops once or twice. But when the incident cooled down, she continued to stay. She worked hard at her schooling. Baby girl blossomed into a delightful and lovely toddler. Pothead was pothead.

Sanja finished her degree, and I was excited. Now she could leave, finally. But she didn't! She thought her daughter should have a dad, so she stayed with that loser, and moved out of state to get a job. I said goodbye with an ache in my heart, for her and for the child. What kind of a home would it be for the little girl, with a father who abused the mother and no love in sight?

I figured I'd heard the last of Sanja. Then one day about a year later, out of the blue, I received a long-distance call. Over the crackling airwaves, her voice was excited, lighter and stronger than I'd ever heard. I held my breath as I listened.

"I did it, Dr. Spencer! I left! He just got worse and worse so one day I just took the baby and a few things and left when he wasn't home. He doesn't know where we are and we'll never go back. I'm so happy!"

I was thrilled to the bone. "Sanja, I'm so proud of you! Thank you so much for calling me with your happy news!" It had taken her almost five years, but she found the strength.

The first part of this story is discouragingly common. Every medical provider (and many regular folks) knows someone who stayed in an abusive relationship. It's heartbreaking.

But this time, this one glorious time, there was a happy ending.

Sanja and your lucky daughter, wherever you are, I wish you a long life and lasting happiness.


shadowfax said...

What a great story. I see that sort of thing way too often in the ER, and of course we don't have the relationship (or the time) to really work on the social side of things, though we do our best. But the cool thing is the follow-up. How neat that she remembered and took the time to call you.

Bob said...

And it almost didn't happen. If she'd gone through with the "termination" her life would undoubtedly have been much easier - she could have left Pothead, not been abused, and finished her schooling without the hassle of motherhood. But would she have had a nagging "what if?" And I wonder if she ever thinks "I almost..."

Surgeon in my dreams said...

If you're interested in reading a few more down-to-earth reasons on why women stay, my personal one is the most recent post on my blog.

This lady was fortunate, in more ways than one.

anafaran said...

This was a compelling story Dr. Peg. I know someone who went through something like this and stayed and stayed and before she knew it 20 plus years of her life were behind her. It's better late than never though for the light to shine on this sort of sorry relationship.

anafaran said...

On the other hand when there's these kinds of throw away relationships that last so long, it may be that the person involved also has spiritual and mental expansion to do themselves. I guess people are ready to make changes when they're good and ready.
I like the piece still. It does make you think about these things.

dr peg said...

shadowfax - Thanks for the visit (I love your blog!). You're right that I'm lucky to have followup, and lucky that she called me with her good news. Even for those of us with clinics and followup opportunities, too often these folks disappear.

bob - Good points. I don't know what her view of the almost-termination is through her retrospectoscope. I know that whole part of the story was disturbing to both of us.

surgeon - My pt. had some pretty down to earth reasons (babycare for one) for staying, but I look forward to reading more on your blog. Thanks for stopping by. I know, too many women leave this kind of relationship feet first. (in a body bag)

anafaran - Yep, I guess we all have our reasons for going or staying or whatever we do in relationship or in life in general. As a physician, I have to remember not to judge people for their decisions, to remember that everyone has their reasons for whatever they do. Thanks for the reminder.


medstudentitis said...

I think the first FIRST part was even more discouraging. Although I'm not suprised given the current attitudes toward abortion amongst the government of the USA and other countries, I'm still outraged that this woman did not get proper termination care. That's why there are many med students like myself out there committed to providing abortion services once we have graduated. See med students for choice ( for more info!

dr peg said...

medstudentitis - Thanks for your comment. I was surprised not to hear more like it. This story has so many difficult issues, from abortion to abuse. No easy answers.

kim said...

I have goosebumps for her!

I was under the impression here in CA, the abuser would be arrested whether the victim wanted it or not.

But that's if police are called to the home..., not if it's just reported.

Anonymous said...

I bet her daughter sure is happy that Mom "accidentally" heard her heartbeat! "Lucky Girl" indeed! Poor girl was almost killed before she even had a chance to live, then Mom was too weak to leave a dangerous situation for 5 years. She most certainly is lucky!

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