When I got to the final question of the medical history portion of the appointment, our patient reluctantly replied, “well…my mom told me I have to.” I had just asked her if she was comfortable with her decision to have an abortion, and whether she was being threatened, forced or coerced. If the answer was anything other than “yes, I’m comfortable” and “no, I am not being threatened, forced or coerced”, or if a strong emotional response was provoked by the question, we hit the brakes on the appointment. Often my colleagues would pull me into the room when patient broke into sobs at the question, or mentioned someone in the waiting room insisting on the appointment. We did not perform abortion procedures on women who weren’t at our clinic of their own volition. We did not perform abortion procedures on women who weren’t in an emotionally safe place the day of their appointment. In this case the patient was a young teenager, and when I pressed for more information she told me that while she wanted to keep her pregnancy, her mom was forcing her to have an abortion. I immediately notified my colleagues to remove the patient’s name from our treatment roster, and stepped out into the lobby to bring the patient’s mother into our counseling office.

The patient’s mother was angry and defiant from the moment the three of us sat down together. She sat with her arms tightly folded across her chest, mouth pinched, eyes blazing.

Head down, staring at the floor, our patient sat silently as her mother exploded in rage at me for halting the appointment.

In the state where our clinic was located, parents essentially owned their children until they were eighteen years old, meaning anyone under eighteen had no right to privacy or decision-making about their own bodies. An abortion procedure required a parent or guardian’s signature, which obviously posed major access issues for minors seeking care without their parents’ permission. There was a loophole, called a judicial bypass, where our staff social worker would appear in front of a juvenile court judge with a prospective patient to request permission for the procedure, making a case for the minor’s future and her need for an abortion to have a future. A judge’s signature would then take the place of a parent’s, allowing us to offer care. I had grown accustomed to young women under eighteen calling and coming in to ask for help accessing abortion services because their parents wouldn’t support their decision, but this was my first encounter with a parent insisting on abortion.

Our patient’s mother was shouting, “my daughter’s life will be RUINED if she doesn’t have this procedure! How DARE you refuse to treat her! You have NO idea who you’re dealing with!” Calmly (though my blood was boiling; I believe very strongly in a woman’s right to choose, and that means I firmly support any decision a woman makes for herself when facing an unintended pregnancy) I turned to our patient, asking her, “what is your decision?” She looked up at me, saying quietly, “I want to have my baby.” Fixing my gaze on her mother I said, “I’m going to ask that you respect and support your daughter’s decision today, and that you accept the fact that we don’t do abortions on people who don’t choose them.”

I was young, only twenty-five, and in my first (and only, it turns out) year of counseling clients. In my naivete I had set up a dangerous, frustrating dynamic in this session, pitting myself against the patient’s mother, creating a win-lose situation. My deep-seated need to champion a woman’s right to choose had been inflamed, and I allowed myself (rather inappropriately) to become personally invested in taking this woman down, building a wall between her and her daughter, schooling her.

My intensity matched hers as I repeated, “Will you respect and support your daughter’s decision today?” We locked eyes, the patient no longer a factor in this sick battle of wills, the mother snarling, “no, I will NOT!” I repeated myself. She repeated herself. We went on that way for close to five minutes, neither giving an inch of ground, digging into our respective positions.

At some point I came back into myself, realizing this was one of the least client-centric sessions I’d ever had, and that I was colossally blowing it, choosing a fight over principles above our patient’s feelings and safety. Indeed using the patient’s feelings and safety as a platform to advance my own agenda. Ugh. “Ok, listen. Let’s agree to disagree. As a clinic we will not perform an abortion on a patient who hasn’t chosen it. I’m going to ask you to accept that, and to please leave,” I finished. “Fine.” the patient’s mother said, clearly as worn out as I. In a surprising gesture she asked for my business card, in case her daughter wanted to see me again for counseling. “Here, hon. Why don’t you take this and give her a call later, if you want to talk,” she said, handing my card to her daughter.

In a way, the patient’s mother and I had gotten through to each other. She was able to understand she was powerless to force the outcome of her daughter’s unintended pregnancy. And I was faced with the stark clarity that I had inserted myself, the person, into complicated, private family dynamics. However, by engaging in a battle of wills, I hadn’t gotten to the root of the issue–if abortion was so critical, how had the pregnancy occurred in the first place? Where was prevention in this equation, and what educational resources needed to be provided to both patient and mother? Had there ever been an open discussion of sex and birth control methods between the two? Well, who knew, because I hadn’t maneuvered the conversation into a productive session. I hightailed it to my supervisor’s office that afternoon, cheeks burning with anger and shame, in desperate need of consultation.

Walking into the clinic he managed, my extended colleagues took one look at my face and asked if I was ok. Pointing to my flaming cheeks I told them I was on fire with feeling, having just experienced a difficult family session. They understood. My supervisor, an extraordinarily wise, progressive, sensitive, direct and matter-of-fact man who had been counseling clients at Planned Parenthood for more than two decades took me outside for a cigarette. Puffing furiously on one of his Camels, I filled him in on the mother’s recalcitrance and my own humiliating ineptitude. It became clear that the root of the issue was my fear I had inflamed complicated family dynamics and alienated the patient, creating an unsafe space. In my need to be a hero of choice, I had inserted myself inappropriately. My supervisor had little feedback, telling me simply that next time I should create more space for discussion of choice between the patient and her mother, and that some people are so repulsive we can’t help but become personally affronted.

Next time came the next day, when the patient called to ask for a counseling appointment with me, that afternoon. It was highly unusual that I saw a patient more than once for counseling, and I viewed her request as a second chance to approach the session with more sensitivity, in a patient-centric way.

To be continued Thursday…