The avoidance of eye contact, the short responses, the quieted voices: The change in demeanor of an average patient at the Johns Hopkins Center for Family Planning was truly my biggest surprise. In no way do I mean to rob someone of their individuality; each case was unique, special and an irreplaceable lesson for someone in my position. In every clinical experience I have had until now, including outpatient gynecology, the average patient is sharing the tangential details, the jam-packed story of why they are there, without necessarily being prompted to. Health care providers tend to have to redirect the conversation in a respectful way, an art I imagine takes years to master. However, for the first time, I saw the average patient limit their responses with little desire to elaborate. Initially, I thought, it is obvious why this would be the case, but then I realized, it really is not. I had to sit and contemplate to pinpoint what these reasons might be.

Support and Assistance Programs

Although undoubtedly part of the reason, it could be more than the fact that these women are going through something terribly difficult. New life-changing diagnoses happen in several fields of medicine daily, and a patient feeling scared is unfortunately nothing new. And although keeping conditions a secret from loved ones is not unheard of, it seems to be rare in most other fields. However, this week, I saw many patients admit they are disclosing their pregnancy termination to only one other person. I’ve witnessed patients with cancer create group chats of all their friends and family for support, and certain neurodegenerative diseases have entire networks of public assistance available at their fingertips, fundraisers to pay for medical bills on social media, and so on. But the loneliness these women must feel as they keep this process a secret is a residual realization I will carry with me. Never before have I seen so many patients feel as if they’ll be judged before they even walk through the door.

Abortions are one of the most common procedures in the United States. Odds are these women know someone who has gone through this process as well, yet are unaware of it because of the lack of open communication due to harsh stigma. This can only contribute to the feelings of isolation that are already prevalent.

Creating a Safe Environment for Care

I was inspired by the way the physicians and nurses provided abortion care. From start to finish, I watched the providers offer their understanding — trusting and supporting their patients when they say they know their other options, and this is the choice they are making because it is best for them. There is no interrogation, no directive counseling, no judgment. There is only ensuring that these women are in safe relationships and are not being pressured by someone else to make this decision.

I did not go into the family planning clinic with set expectations, but I came out with a much better understanding of the work that needs to be done. I hope in the near future women feel less judged and more understood. I hope there will be greater awareness for the reality of the normalness of this process and thus fewer feelings of loneliness. I am glad the current providers in the clinic are the ones training future professionals so there will hopefully be a continuation of nonjudgmental, compassionate care.


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