Anatomy of an unsafe abortion

I was in clinic when I heard the overhead STAT page to the emergency room.

As I sprinted down the stairs, I ran through the possible scenarios. I wasn’t on call, so the day to day gynecologic emergencies weren’t my purview. I hadn’t operated on anyone in the past few weeks, so unlikely to be one of my own patients with a complication.

Logically there was only one conclusion.

A nurse was holding the staff entrance to the ER open. From the look on her face I surmised this was to save the minute or two it would take to punch in the numbers on the lock and inquire at the desk for patient’s whereabouts.

“Down there,” she pointed.

On the gurney lay a young woman the color of white marble. The red pool between her legs, ominously free of clots, offered a silent explanation.

“She arrived a few minutes ago. Not even a note.” My resident was breathless with anger, adrenaline, and panic.

I had an idea who she went to. The same one the others did. The same one many more would visit. A doctor, but considering what I had seen he could’t have any formal gynecology training. The only thing he offered that the well-trained provers didn’t was a cut-rate price. If you don’t know to ask, well, a doctor is a doctor. That’s assuming you are empowered enough to have such a discussion. I was also pretty sure his office didn’t offer interpreters.

I needed equipment not available in an emergency room. I looked at the emergency room attending. “Call the OR and tell them we need a room. Now.” And then I turned to my resident. I was going to tell him to physically make sure a room, any room, was ready when we arrived, but he had already sprinted towards the stairs. He knew.

We didn’t wait for an orderly. A terrified medical student and I raced down the hallway with the gurney. The amorphous red pool dripped onto the floor as we rounded the corner to the elevators.

The double doors that led to the operating rooms swung open. “The urology room. They’re between cases,” my resident shouted.

I saw an anesthesiologist out of the corner of my eye. “You. Now!” Most emergencies can wait a few minutes to check in at the front desk and for the anesthesiologist and nursing staff to take stock of the situation. This was not one of them.

The urologist, whose room I appropriated, blustered and sputtered in behind me. “What the fuck are you doing barging in, I’ve got another case…” but as we moved my patient over to the operating table and he saw the blood, he stopped. He grabbed a tray of instruments and opened. “I’ll be your scrub.”

The anesthesiologist was pissed. Not really mad, more riled up than anything. No one likes to be blind sided, no matter how well intentioned. And he probably thought I was over reacting. That is until he put in another intravenous.

“Fuck.” What looked like blood tinged water flashed back.

And now they all understood what I knew the second I laid eyes on this patient. Abortions that go horribly wrong bleed out. Quickly.

The room filled with surgeons, nurses, and students eager to help. To do something. Anything.

I opened the vagina and by feel clamped through the holes on either side of the uterus where I knew from experience I would find the uterine arteries, the likely site of the puncture. I didn’t know which side, and at that point it didn’t matter. I just needed to stop the blood flow. It took less than a minute. She would have bled to death if I had opened her belly.

As the bleeding had stopped, it was up to the anesthesiologist to fix the hematologic tempest. A vascular system so traumatized by sheer blood loss that it had run haywire and lost the ability to clot. Disseminated intravascular coagulation. This is how many young women die when an abortion goes wrong.

My hands started to shake. Everything from leaving my clinic to this point had been one crescendoing adrenaline-fueled reflex. Now that there was nothing physically for me to do the energy had to go somewhere.

I looked around. A forest of IV poles, laden with blood instead of fruit. Everyone not directly helping was running back and forth to the pharmacy or blood bank. A nurse and another surgeon started to clean the floor. We were all bonded by this nameless woman whose life we were desperately trying to save. And we were bearing witness, because we knew if she died it was unlikely anyone would read about her in the paper. It was unlikely her family would protest. A myriad of potential reasons. Shame of the abortion. Distrust of government. Fear of immigration officials.

The urologist, a grizzled older man with whom I had nothing in common except a medical degree and this patient, rested his hand on my shoulder. It was a kind, fatherly gesture. The weight was comforting.

“You done good.” He said. And then he added, “Those bastards.”

I knew he was referring not just to the physician who did this procedure, but to everyone in society who had contributed to a disadvantaged woman finding herself in such a desperate situation.

90 replies on “Anatomy of an unsafe abortion”

  1. Dear Dr. Gunter,

    I wish that just one of the facts that you discuss in this article — the “disseminated intravascular coagulation,” or bleeding to death as a result of damage to the uterine artery — were common knowledge. It is simply unconscionable that in the 21st century, women’s lives can be destroyed so casually by ignorance.

  2. wow… so my entire heart just broke. I have never had to go through anything like what that poor young woman did, but knowing there are “Doctors” like this out there, who really have no idea just what they could do to someone… makes me so sick to my stomach. She is really blessed for the well dedicated doctors, who saved her life. Thank you. ❤

  3. OH I HAVE AN IDEA!! how about she just use some f*cking BIRTH CONTROL IN THE DAMNED FIRST PLACE and THEN maybe she wouldn’t have been in this situation. She knew when she opened her god damned legs how babies were made.OK people?And if she didnt why the hell is she having sex?? Truth is, is that we have been given every tool and opportunity to prevent pregnancy, if you are too irresponsible or plain frigging stupid to protect yourself from it, then my God, i guess its best YOU DON’T HAVE A CHILD

    1. Dear WHOEVER,”She knew when she opened her god damned legs how babies were made”

      Years ago, a male friend of mine uttered those same-similar words. I agree. Women are only going to “keep their legs together” as he so delicately put it, when they’re educated about what pregnancy involves and how they can prevent unwanted pregnancies. I agreed with him and I agree with you now.

  4. Thank you so much for writting this. I was always a little torn on the “legalize abortion” issue. But this article convinced me. You perfectly explained, with this situation, why it has to be a choice. Becouse women deserve to make a decision. If we make abortions illegal, some women will get abortions from shady doctors anyways – they will do it anyways, becouse those decisions are VERY tough, and very dramatic for the woman. The only thing we CAN do to help women though, is to give them proper, qualified healthcare, and give them an abortion with minimalized health risk. I don’t like the idea of abortions, and I would never convince a woman to do it – but I would never want a woman to die becouse of lack of basic care from qualified doctors.

  5. How did so many commenters miss that this was a legal, “safe” abortion procedure that went wrong?

    And you sit here complaining about “right-wing conservatives” who want to make this illegal. You disgust me.

  6. I cried when I read this. It reminded me of a childhood friend…a girl I went to elementary school with who had been raped by a family member, had been taken to an illegal abortionist. More than once. Nearly died. Abortion was legal then, but it was hard to find a legal practitioner…and expensive.
    When it came out that she had been raped, her mother put her out on the street. She was 13.

    Thinking about her makes me angry (bastards) and sad. She id the reason I will always advocate for access to safe and legal abortion.

  7. This is exactly what would happen so many times each day if they ever change pro choice. It won’t stop and turn into butcher shops where the women who happen to live may not ever be able to have children again. It is a very sad situation. I wish I could help.

    1. Don’t feel sad, Mindy. According to Christian teachings, it went straight to heaven. Look at it this way: if they’re right, the mom prevented her baby from risking going to hell.


    2. No, it seems “the innocent child” (the marble-white child made pregnant) survived the near-murder of the incompetant abortion-provider.

      Yeah, I get what you’re saying, Mindy. But I reject your *religious belief* that there was another “child” involved. Children have ALREADY BEEN BORN, or else they don’t exist. That’s objective fact. Assertion that a embryo or fetus is a “child” is religion-dependent.

      Bless you, Dr Gunter, for your medical gifts to those in such need…

    3. Did you forget about the real human being in this scenario – the one that nearly bled out on an OR table? Or do you think she deserved her suffering as a “whore” or a “murderer”?

  8. I’d just like to remark to your tweet about >42,000 viewers; someone linked your post to reddit, and it made frontpage, so that probably contributed a couple of people.

  9. Reblogged this on The Ethical Villain and commented:
    I want you to read this. Even if your personal beliefs hold abortion as wrong, I still want you to read this. We must legalize abortion NOW! ASAP! PRONTO! And we must provide proper abortion-provision training to medical personnel nationwide so this doesn’t happen again. Safe abortions can result in healthy future pregnancies for the mother when she’s ready to bear children, in most cases. There is nothing — NOTHING — ethical or moral about allowing a woman, no matter her race, creed, sexual orientation, or… well, ANYTHING, to be butchered from an unsafe abortion.

  10. Reblogged this on Outspoken and commented:
    This powerful piece was written by blogger, Dr. Jen Gunter.
    Anyone who is opposed to any and all abortion might want to take a look at this and consider fully what they’re creating when they push for abortion bans.
    Sometimes, in abortion cases it’s not just “stigma” or an “unwanted baby.” Sometimes, it’s about life itself. Ironic, isn’t it?

  11. Such a moving story. So sad that women who are desperate for help and turn to someone they believe to be an ‘expert’ have to suffer this way and nearly lose their lives to someone performing nothing short of butchery. I’d imagine it’s quite hard to repeatedly roger the uterine arteries, has he been caught?
    Great blog.

  12. This brought tears to my eyes. Thank you for sharing. And in turn, I’m going to share (social networks), in the hopes of helping to draw attention to this plight.

  13. @Neosecularist: some women do not want to give birth no matter how many women are “by their side.” Bodily integrity, look into it a bit.

  14. Women need places to turn to, other women to turn to, in such times of great need. Society failed this women not because she underwent a botched abortion – that was her choosing. Society failed her because she had nowhere she could go where she could feel safe for the time she had left until she gave birth. When a woman, or young girl, becomes pregnant, regardless of the circumstances surrounding how and why she became pregnant, she needs to know there are other women who will be there by her side to care for her and her unborn child. Why do we not have more of these places in America right now?

    1. But there can be all sorts of reasons why a woman may not want to take a pregnancy to full term. So while what you say has force, it isn’t a full answer to the problem.

    2. No, actually. I don’t think she chose to undergo a botched abortion. And sometimes there is no “safe” place for women to give birth. Women that were raped, or victims of incest, or have a family to feed, or are otherwise not in any position to have a child – where should they find “safety” during the nine months that you would force them to carry a child to term, in violation of their own bodily sovereignty and good sense? Where will she go afterward, when her family abandons her or her husband leaves or the rest of her children are taken away by the state because she’s been gone for some months now? Where would the child go afterward? Some portion of healthy white babies will be adopted, but what about the non-white babies? The babies born to drug-addicted mothers, with congenital deformities, in states that don’t allow otherwise suitable parents to adopt for unseemly reasons, in situations where adoption is so expensive that families seeking an infant go to the Third World instead or where they spend hundreds of thousands on IVF instead? Your suggested “solution” is cruel, inhumane, and impractical. That’s why those places no longer exist.

      1. I agree some women will still want an abortion, for whatever reason, but there’s nothing cruel or inhumane in wishing we’d be willing to put ourselves out there and be there for women who decide to bring the baby to term. I also think a “safe place” isn’t necessarily a place a woman shamefully runs to to hide for nine months, it can be her own home with people coming by to give support – wouldn’t you do the same for a friend who just had an abortion?
        We don’t need any sort of laws for this to happen, or a formal organization. We just need to be willing to love each other, especially during the most trying times.

  15. This is the only legitimate argument for abortion.However, if you accept it ( and in many cases you have to) you are accepting that humanity and society is disgusting and we should lose all hope for our future.

      1. How does it set up a false dichotomy?
        You can’t make a claim and then not back it up you bigot

      2. @THEFARMER
        You might want to back up your reasoning as to why he’s a bigot.

        You set up a false dichotomy by saying that there are only two, mutually exclusive options.

    1. Careful there, anti-choicer. That might be your mother, sister, wife, or daughter you’re calling disgusting and damaging to the future of the country. Why don’t you keep your opinions out of other people’s uteruses?

  16. Thank you for taking care of her.
    “Those bastards” was very appropriate.
    I’m also going to include the modern day, right wing ,conservative, evangelicals who want to repeal the abortion law and are fighting to do away with birth control.

  17. Moving. There is a side that is not mentioned here, though. The doctor performing an illegal abortion. When abortion is either illegal or “legal” but with rules (either laws or social ones) that make them practically illegal, sometimes the only option is an illegal abortion. As a doctor that wants to help but also does not want risks, you give vague advice about what might be sometimes taken and it might accidentally cause an abortion (“This causes an abortion so you should never ever take it if you think you are pregnant *wink* If for some reason you take it and you think you are pregnant and heavy bleeding starts, run to the hospital. But I never recommended this!!!”). We want to help. But sometimes there is no way to help without bending rules. Placing restrictions on abortions makes it more likely for them to be dangerous, even if they are nominally legal. And, as a doctor, I know we don’t want to take responsibility over possible consequences of doing something illegal. I don’t think (or at least it is not always) it is due to “discount” rates to earn quick money… it’s mostly, wanting to help without risking your skin. Sucks, but c’est la vie. (Disclaimer: all the abortion advice I’ve given has been following current guidelines.)

    It’s also important to remind everyone that abortion restrictions only really affect those who are poor. If you have money, you can find safe ways around any anti-abortion law. It is not racist/elitist/classicist/whatever to want better birth control access for people with scarce resources. It should be free, easily available, and VOLUNTARY for everyone. If everyone can know about it, choose it and can access it when they want it they can control their reproduction however they wish to do it. “Parents have the exclusive right to determine freely and responsibly the number and spacing of their children.” Proclamation of Teheran, 1968.

  18. thanks for writing this.
    Yes, abortion is technically legal in each of the 50 states. But in most you have to pay for it yourself and then only if you can find a proper abortion provider. Good luck finding one. In some states there are only a few for the entire state.

  19. For those of us in the national media, on the front lines of the culture wars – whether we like it or not (And the overwhelming majority of us on this side don’t) – I thank you.

    In a few hundred words, you’ve made brutally clear why it doesn’t matter what so-called “side” someone is on in the stupid, ginned-up, American culture wars. Proper, affordable medical care – including women’s health issues like contraception and abortion – should be a right.

    Then, maybe, you’d never have to experience this again.

    You’re a hero, IMO. Bless you.

  20. …..they all understood what I knew the second I laid eyes on this patient…..

    Doctor Gunter, are you an iridologist too? What a precious gift anyhow, to have a sense of diseases! Right you were, and a life was saved. Well, I take it the white marble young lady made it. Thank you for the moving story.

  21. Anna, I don’t think it was illegal in the area where Dr. Gunter practices medicine. That doesn’t mean that isn’t illegal in the eyes of her family members. If she was an immigrant, she might be discouraged by her family to go to the hospital because it might attract ‘unnecessary attention’.

  22. Abortion should not simply be legal, it must also be free of charge to those who want it-otherwise its legality is a moot point for a good 30%-40% of the female population. It’s interesting to note that, where abortion is most freely available is also where the lowest per capita rates of abortion occur-& where the earliest term (& therefore safest) abortions occur. That’s a fact that some so-called “pro-life” people might want to consider!

    1. I wish there was some way to make sure poor and ill-informed didn’t get pregnant. I know that’s easy to take the wrong way but the stuff families have to go through to be foster and adoptive parents is something every person should have to fulfill. Now yes even ‘good’ people hurt kids and shouldn’t have them, including foster and adoptive. I’d like something in the way of sterilization that can safely be reversed. but that’s also putting our lives in the hands of government and that’s never wise. Maybe something like sterilizing people who after one kid are shown they can’t be trusted to have more in a healthy manner.

      1. I think your heart’s in the right place but reproductive rights vs societal health is a touchy subject. Certainly effective contraception should be free to everyone that wants it, and effectively taught in schools and taught to immigrant women in clinics like the one Margaret Sanger opened in 1916. Not being able to afford contraception is a really bad reason to conceive a child.

        There IS a fully reversible and effective form of male sterilization called RISUG that’s currently undergoing trials and appears to be close to approval in India. It’s cheap, effective, and lasts over 10 years or until a procedure is done to reverse it. I would absolutely love to see it given to all males as part of their required immunizations around the age of puberty, and for it to be culturally standard to get it renewed when needed. That would effectively vaccinate against teen pregnancy. Instead of pregnancies being accidental, one would have to make a conscious choice to have a child. Opt-in fertility instead of the current contraception model, the standard for males would be sterility.

      2. The Supreme Court has actually outlawed forced sterilization. The case was based off of the practice of sterilizing individuals in state-run institutions for the mentally handicapped, but the effect is that the government cannot force someone to undergo sterilization surgery. I really think a better (and less controversial plan) is just up the education in the public schools. No, this won’t help everyone, but having age-appropriate sex ed has been shown to decrease the instance of unwanted pregnancies, and therefore the need for abortions.

      3. I think more emphasis should be placed on education of these women, that abortion isn’t the only option available to them. Teaching like this should be in classrooms, not just once they become pregnant and begin to panic, feel hemmed in.

        People who are pro-life are not heartless; rather they see an unborn fetus with the same right to life that you and I have.

  23. Abortion didn’t become legal here until 1973. I seriously doubt that Dr. Jen waited 39 years to write about this.

    1. My understanding, based on what I read in the article, is that this woman was an immigrant, most likely illegal, and did not have the funds for a good doctor. She went to a doctor who offered a “discount” abortion and he (or she) was a hack who nearly killed her. There is no indication that this was an illegal abortion (hence, pre- 1973).

      1. But the outcome was the same – an individual who might or might not have been an actual doctor, untrained in gynecologic surgery, butchering a young woman. The only thing the woman wanted was to not bear the child she was pregnant with. How she got pregnant doesn’t matter, the rest of her life situation doesn’t matter. All that matters is that she was poor and desperate and this was the only option open to her. If the anti-choice crowd has its way, that woman will be a lot more of us.

      2. The immigrant factor brings another issue into it, which is religious beliefs and the culture in her country of origin. Many countries in Latin America are fiercely catholic and have banned abortion under any circumstances (much like Santorum wants to do in the USA). In these countries, these policies actually have a large degree of public support, because their belief in the catholic church is completely unshakeable.

        So in these countries, of course, there is a huge trade in illegal abortions and back-alley coathanger stuff that would make your stomach turn. Additionally a lot of young women somehow learn that drinking a cocktail of bleach, disinfectant, and other poisons is the way to rid yourself of an unacceptable problem.

        But it’s made much worse for the victim (I mean the pregnant mother) because their families often completely disown them if they find out an abortion has been done or attempted. It’s a bit like the ‘honor’ killings that we see in many Arab cultures – having a daughter who has had an abortion is completely unacceptable, and while murder as a result is fairly rare, they are often completely disowned and abandoned by the family.

        So if this family moves to America, the legality of abortion doesn’t matter. She still has to use an illegal doctor or procedure because the legal version means their family will know. And if she has problems and ends up very nearly bleeding out to death, she is lucky if the doctor dumps her on the footpath outside a hospital, and nobody in their family will be present during the abortion to assist in an emergency.

        It really is a tragedy, and I’d like to pile all the blame on the Catholic church. But in Latin America much of the blame belongs to the culture itself, because they take the Catholic teachings far, far too seriously in public policy and family life.

        Just so sad.

    2. Where is here? If you are speakimg about the US, abortion was legal in some states before 1973. Roe v Wade just made abortion available in all states.

      Before 1973 some women had to travel to receive the procedure. Women from where I live in Illinois usually traveled to New York for an abortion. That made it even more expensive and made it more likely a poor women would seek an unqualified person to preform the abortion. Sometimes it was not even a doctor.

      If Roe v Wade is overturned, abortions will not end. They will still take place in some states and in dingy backrooms located in the other states.

    1. Is “she” referring to the woman in the story or her baby? I’m guessing the baby did not make it.

      “And we were bearing witness, because we knew if she died it was unlikely anyone would read about her in the paper.”

      ^You’re right, no one would read about the baby who died. Mainly because you chose not to include that in the story. Very unfortunate but I am hoping the mother did make it. I’m glad we have doctors who can help these poor women. It truly is sad, but I am a little disappointed that the baby was not mentioned.

    1. They said the bleeding stopped. The way it’s written it seems recent. And mentioning immigration says a lot. that this young lady didn’t have the money to have the child let-alone money for a real doctor to perform the abortion. But even if she wasn’t an immigrant it’s still heavily frowned upon by society and is usually done back-door style by pretty much anyone. Women are scared to go to places like Planned Parenthood because they will be questioned and I.D. required.

    2. It could have been so much more than just the money, thanks to the violating restrictions that “pro-lifers” push and the dwindling number of abortion providers. Sometimes the nearest safe and legal abortion provider is hours away. And the young woman might have had to undergo some other ridiculous restriction, like wait three days after her initial appointment before she could go through with the procedure. If you were a low-income undocumented worker, and had to skip work, drive 5 or so hours to a provider, see the doctor, wait three days (paying for a hotel or driving the multi-hour drive home), and then go back (missing work again) to pay for an expensive procedure…well, you can see how illegal abortions are still very much a problem.

      1. Kayla, I’m one of those “pro-lifers” to whom you refer. Instead of the scenario you present or waiting several day, driving several hours and paying for a hotel room only to see a ‘back alley’ abortionist, I’d like to see women take a different approach to their sexuality.

        What’s that? Personal responsibility comes to mind. Women should be educated that abortion of their pregnancy is not the only answer. How about not getting into this predicament in the first place? If we legalize abortion, it’ll be centuries before we eliminate unwanted pregnancies.I defer in cases of rape incest or the life of the mother. Teach the expectant mother that she has the option of giving the child up for adoption.

  24. Thank you–for your moving story and your good work. I occasionally see infectious complications and dread the coming days when we will see more young women die from botched abortions or sepsis.

    It is incomprehensible to me that the euphemistically self-appointed “right to life” religious zealots also oppose contraceptives, which would reduce abortions, and aid for pregnant women and young children…of course it is all different when it involves their families (e.g. Mrs. Santorum’s “early induced delivery.”)

    Thanks for calling attention to this travesty.

    1. I don’t think the ‘right to life’ folks oppose contraception; they oppose having government, our taxpayer dollars pay for contraception. The Hyde Amendment is supposed to prevent taxpayer funding for abortions, but do we have legislation that prevents taxpayer dollars to fund contraception. What’s next? Taxpayer funding to mow my lawn? Where does the hand of government reach stop? This subject must be addressed; but by education and that adoption is a resource quite underutilized.

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