Forced Perspectives

Eleven minutes and twenty-two seconds. That’s what the timer on my telemedicine video call indicates when my patient, Ms. P, asks whether she should have an abortion because of the pandemic.

There are a few things you need to know about the prototypical abortion counseling visit. The first is that, contrary to popular belief, it is generally pretty undramatic. Abortion is a weighty decision, to be sure, but the goal of the abortion counseling appointment is to present all the facts to the patient, so that they can make the most well-informed decision. The discussion rarely involves high-minded existential explorations of religion, politics, gender dynamics, or cultural pressures. Instead, it’s all quite mundane: what medications to take to control nausea, the out of pocket costs, how our registration process has changed during COVID-19, and even what type of clothes to wear to the procedure.

The second thing you need to know about the abortion consultation is that it largely concerns time, and timing. How many days or weeks you have to decide between a medication abortion and a surgical abortion. How long the Mifepristone pill takes to start working. How many days between beta HCG blood draws. How many weeks after the pill to wait before taking a pregnancy test? Those are the two major components of every abortion counseling visit.

Occasionally I’ll sprinkle in a few tasteful jokes if the mood lulls. My abortion counseling visit with Ms. P and her partner of 8 years is hitting all the familiar beats so far. By the specificity of the couple’s questions, it is clear they have decided to have an abortion, and are merely gathering more information about the right type for them. It’ll cost you about this much for the visit, your registration and counseling will largely take place online and over the phone, and you (based on your last menstrual period) have about thirteen days to decide between a medication and surgical abortion. I check my timer, and we are at eleven minutes and twenty-two seconds – close to wrapping up the fifteen minutes I’m allotted for this telemedicine consultation.

“So it makes sense for us to have this abortion because of COVID?” It sounds like a question, or at least a statement where her voice raises slightly at the end. There’s a lot to unpack here, and not much time. I trace back my steps with Ms. P to make sure she is making this choice based on the right information. What follows is a high-minded existential exploration of religion, politics, gender dynamics, and cultural pressures. She and her partner don’t want to have a child because they are not yet married, and the child will not be welcomed into their religion. She feels an extraordinary amount of pressure to get married by her parents, who say she is years behind where she should be in life.

“And the way this country is handling the pandemic is particularly worrisome for us.”

The way she articulates the phrase “this country” emphasizes a couple of points: that despite her living here for twenty-one years, she still doesn’t consider this her country, and that she is justifiably excoriating the U.S.’s response to the virus compared to her country of birth. I explain to her that America’s response to COVID-19 is atrocious, and that we need better coordination among hospitals, testing facilities, local and federal governments. But the small number of studies done on COVID-19 positive pregnant women do not show reliable maternal-fetal viral transfer, and thankfully, there doesn’t yet seem to be a high morbidity or mortality in newborns due to the virus.

“Would you delay starting a family because of the virus?”

I re-emphasize to Ms. P and her partner that there are no wrong reasons to get an abortion, and that my job is to make sure she has all the most accurate information about the procedure. I then take a second to think about what she is really asking. I think about her age. I think about how this pandemic doesn’t have an end in sight. I think about my own struggles to start a family with my wife. I think about how certain things like the Olympics should be delayed, but not matters of health.

“If it were me, I would not delay starting a family because of COVID. But whatever reason you choose to have an abortion or not to have an abortion, we’re here to support you.”

Ms. P and her partner glance at each other and allow themselves the slightest smiles. They thank me for my help and promise they will call back with any other questions they had. I close the telemedicine appointment at twenty-one minutes and forty-two seconds. What did that smile mean? Were they relieved at their decision to have an abortion, or pondering the idea of starting a family during the pandemic? Have I given them more time, or did I solidify their decision? Did they feel the pressure of fulfilling the Big Life Events in a specific order, or— I get a tap on my shoulder. My Health Care Assistant dangles two patient charts at my shoulder.

Both of them have been waiting for over six minutes for me. And I shouldn’t expect them to give me any more time.