Living and Dying in Brick City

by Sampson Davis

  I sensed that she felt somehow to blame, and so I assured her she had not done anything wrong and that, in fact, from what I read in her journal, I could tell she’d been one of the most careful and deliberate pregnant women I’d seen. But Mrs. Givens seemed to be devolving right in front of me, suddenly becoming withdrawn, wrapping her arms around herself, and slowly rocking back and forth.

  I glanced down at my watch and realized I had to move things along. Calling for a nurse to assist me, I wheeled my stool over so I could perform a pelvic exam. Once I placed the speculum, I could see a steady flow of maroon blood rushing out of Mrs. Givens’s cervix. Not good. The bleeding likely meant she was shedding her uterine lining, fetus included. Probing with my hands, I could tell the cervix was closed. At least that was a good sign. An open cervix would have certainly signified an impending miscarriage. Perhaps bed rest could save the baby. A small chance, but a chance nonetheless.

  Now I needed a more detailed look inside. I called for an orderly to take Mrs. Givens for an ultrasound. I could have performed the test myself but decided to spare her the indignity of possibly having to undergo the same test twice in one day: If she had indeed miscarried, hospital rules required her to have an ultrasound in the radiology suite. Since the Givenses would be busy for a while, I left to continue my rounds.

  I picked up the chart for my next patient and knocked on A4’s door, waited for a positive response, then stepped inside. A twenty-one-year-old woman, Ms. Harris, was pacing the small exam room. She was wearing a hospital gown, and I could easily see her behind, as she had failed to tie the gown in back. She was not happy; that much was plain.

  “About time,” she said, by way of introduction.

  “Hi, I’m Dr. Davis,” I said, pointing to my identification badge.

  “I know who you are. I saw you running around the department last time I was here. I got a female doctor then. Is there one here today?”

  I informed her that the female physician on staff would not be in until later. “At midnight—just another four hours, if you’re willing to wait,” I said, pretty sure what her response would be.

  She made a hissing sound. “I guess you’ll have to do. I was here a week ago. That doctor, she told me I was miscarrying.”

  I glanced down at the nurse’s triage sheet and saw that the patient indeed was pregnant. An ultrasound performed a week earlier showed her at about seven weeks.

  “She said I had a fifty-fifty chance of miscarrying,” Ms. Harris continued. “That my ultrasound was abnormal, and then something about me having a threatened pregnancy. She told me to stay in bed and follow up with the clinic across the street from me.”

  “Well, have you made an appointment there?” I asked.

  “No,” she quipped. “I don’t have time to show up at nobody’s clinic.”

  She explained that she was too busy for a full doctor’s appointment. “This is my sixth pregnancy,” she said. She had three children at home and had undergone two abortions. “I only decided to come back today because I didn’t miscarry. That doctor, she told me the baby would be gone by now.”

  She couldn’t afford an abortion, she said, so she’d come back to the emergency room to get the procedure done. “After all, you guys told me it would happen, and it didn’t,” she added belligerently. “This is malpractice to me, and I want you to be the first to know that you guys lied to me and if I have to, I will get a lawyer.”

  I could barely believe her; I just hoped my facial expression didn’t give away my thoughts. The memory of what had just happened next door was too fresh in my mind. It certainly affected my reaction to Ms. Harris—she was almost too much to take. My many encounters with young women like her sometimes left me feeling defeated, frustrated, as it seems impossible to stamp out all the reproductive ignorance and sexual carelessness in the world.

  Looking back, I wish I’d taken a deep breath, ignored her rant, and talked to her about responsible methods of birth control to prevent unwanted pregnancies. I also wish I hadn’t made any knee-jerk assumptions. I think we doctors sometimes assume too much. We assume that young women know what to do for their bodies and are just behaving irresponsibly. Unfortunately, I’m too often reminded that, in fact, they don’t have the information they need to make responsible choices, and that their sexual decisions are sometimes not just spontaneous but also based on myths and half-truths.

  “Ms. Harris, I’m sorry to hear what happened, and I assure you we will find out what’s going on,” I said. “Now, to make sure I understand: You were hoping to lose this pregnancy and were under the impression that was going to happen.”

  “You got it,” she said. “But since the bleeding stopped and I didn’t see any clots, I’m sure it is still inside of me … Doc, I need this thing to happen, like, yesterday. I didn’t want to come back here.”

  She continued: “You got to understand, I love my man, and he doesn’t want any more kids.” He already had six, she said, including her three, and they definitely didn’t need any more mouths to feed.

  I rubbed my suddenly tired eyes. “Ms. Harris, let’s first see if you’re still pregnant. You may have already miscarried, and the stopping of the vaginal bleeding may simply be a sign that the fetus has passed. I’ll need to perform a full examination, which includes a pelvic. A nurse will be in the room with me.”

  “Oh, no, Dr. Davis, they did that exam last week. You don’t have to repeat it. Besides, my man isn’t going to allow no dude to look up inside of me.”

  As crazy as it sounds, this kind of response isn’t rare. I’ve had patients demand to be examined only by a female doctor, and I’ve seen boyfriends and husbands act out, as though I was invading their personal Fort Knox. Usually, I can calm the situation by remaining professional, assuring the couple that I’ve performed thousands of pelvic exams and that a nurse (most assuredly a woman in these circumstances) would be present the entire time. Still, I’d seen grown men storm out of the room, slamming the door behind them.

  “Ms. Harris, you’re here for help. Let me do my job. The nurse will be in the room. You will be safe,” I said more sharply than I’d intended.

  “Okay, but if he comes in here and sees you doing this thing, he’s going to get you,” she threatened. I wanted to laugh out loud, even though it was obvious she was dead serious. Instead, I said calmly: “Let me worry about that, Ms. Harris.”

  I had her climb on the exam table and moved to listen to her lungs, which were clear. Her heart rate was regular, with no murmur. Her abdomen was soft, she had regular bowel sounds, there were no abnormal masses and no tenderness. “Okay, Ms. Harris, your exam thus far is fine. I’ll go grab a nurse and be right back.”

  As I made my way to the door, she said, “Hey, Doctor, if you can’t perform the abortion, do you have a department that’ll do it for me? I really want to get it done today.”

  “Let’s just get through the exam,” I said, opening the door. “I’ll also bring back the ultrasound machine.”

  As soon as I shut the door behind me, I couldn’t contain my disbelief. Linda, one of my favorite nurses, was standing near the door. Her expression told me she could tell something was wrong.

  “I’m going to need you as a chaperone in A4,” I explained. “You won’t believe what’s going on in there. I’ve got an irate patient blaming us because she didn’t miscarry.”

  Rolling the ultrasound machine toward the room, I explained the two stories unfolding simultaneously. “What’s crazy is that the couple in A3 would kill for the opportunity to have a baby, and here we have Ms. Harris, who can’t wait to abort her fetus.”

  I wasn’t judging either family, I told Linda. Ms. Harris had every right to get an abortion, just not in the emergency room. I wished these young couples thought more about birth control before it came to this. And I wished I had the power to grant both parties their desires: If only I could take Ms. Harris’s unwanted pregnancy and give it to Mr. and Mrs. Givens.

  “That would be a mi
racle,” Linda said.

  Well, it was definitely pure fantasy. And this here was as real as life got. I completed Ms. Harris’s ultrasound, which showed that she was indeed still pregnant. There was even fetal heart activity.

  “Ms. Harris, the fetus is still present. As you can see from the image on the ultrasound machine, the heart is beating.”

  “I don’t want to see it. I want it out of me.”

  “Ms. Harris, we don’t perform abortions in the emergency department. You’ll have to follow up with the obstetrics clinic.”

  There wasn’t much left for me to say to her, although silently a million thoughts were spinning in my mind. I usually wouldn’t have gotten so worked up, but the side-by-side contrast was just so stark. Though I was taken aback by Ms. Harris’s irritation, part of me understood. To her, this fetus represented one thing: more struggle in a young life already heaped with so much of it. I got it. I really did. I just wanted her to see the other side, and before I could bite it back, a non-medical opinion slipped out of my mouth: “You know, there are people out there who wish they were in your position.”

  “What do you mean?” she snapped.

  I chose my words carefully. “Well, some women can’t have kids and want more than anything else to be a mom.”

  Immediately, I wished I’d kept my mouth shut. She looked shocked at first, and then her face contorted to anger: “Dr. Davis, you have some nerve. You are not the judge of me. It’s none of your business what I decide to do.”

  I apologized right away. I hadn’t intended to offend her. I’m not sure she heard me, though, because by then her voice had reached a full screech: “I’m going to sue this hospital! I hope it burns to the ground!”

  I left the room, stood outside for a moment, and took a deep breath. The Givenses were waiting to hear the results of the ultrasound, so I retrieved their chart and headed back to A3. The hour it had taken for me to get the ultrasound results had given the couple some good time together, apparently. Mrs. Givens seemed more at peace. Her husband sat on the bed beside her and held her hand. I felt like a judge about to render a disappointing verdict. My words would redefine their lives somehow and determine the road they would take from here.

  Sweat began beading on my forehead. I had removed my white coat earlier so that I would look less formal, less callous. I only hoped my scrubs didn’t smell, since I hadn’t had time to wash them the night before.

  “Mr. and Mrs. Givens, the ultrasound results show a low-lying fetus close to the cervix,” I began.

  “What does that mean?” Mrs. Givens asked.

  I knew beforehand that they wouldn’t understand the medical terminology. I guess I was just trying to buy more time. I didn’t want to steal their dreams. This part of my job sucked.

  “Mrs. Givens, you are miscarrying. The fetus is moving toward the vagina, and eventually you will pass it.”

  The husband and wife reached for each other, crying. For me, it was bad enough being the bearer of bad news, but I especially hated that this couple’s strong faith had not been rewarded—at least, not yet. I searched my brain for comforting words.

  “I read your journal,” I told them. “The two of you are believers and an inspiration to me. Please don’t blame yourselves. All the right steps were taken. Your journal tells it all, from your battle with morning sickness to the fact that Mr. Givens slept in the guest room when he had the flu so that you wouldn’t get sick. So many sacrifices. You are going to be great parents, even if you have to adopt.”

  I had no idea whether Mr. and Mrs. Givens had ever even considered adoption or would in the future, but I hoped so. I’d seen far too many children come into the world unwanted, and—as far as I could see—this husband and wife were a loving couple who wanted nothing more than to become parents.

  For many couples, the desire for a blood connection to a child, to create someone who carries part of their unique genetic makeup, is so strong that they don’t even want to hear about adoption. Many are afraid. They wonder: Can I love a child who has no biological part of me? How will I know for sure what the child is like? What if I end up with a problem child? Those fears are real, and unfortunately a few highly visible stories about adoptions gone wrong contribute to broad misperceptions. But adoption, much like having a child the natural way, is full of wonder and mystery. There is no 100 percent guarantee that a family who adopts will wind up with a perfect child and a perfect life, just as there is no guarantee that a natural birth will result in these things. But the 2007 National Survey of Adoptive Parents, the first large national survey of families across all adoption types—the foster care system, private domestic adoptions, and international adoptions—offers some assurance.

  Conducted by the U.S. Department of Health and Human Services, the study—which included interviews with more than 2,000 families—shows that the overwhelming majority of adoptive families are happy with their choice: 93 percent of those who adopted through private agencies reported that they would definitely make the same decision again; 87 percent of those who had adopted internationally also said they would do so again; and 81 percent of those who had gone through the foster care system would repeat their decision as well.

  Likewise, a large majority—85 percent—of the adopted children were reported by their parents to have been in excellent or very good health. Eighty-eight percent of the school-aged children demonstrated positive social behaviors. Only a small minority had been diagnosed with disorders such as attachment disorder, depression, attention deficit disorder, attention deficit/hyperactivity disorder, conduct disorder, Fetal Alcohol Syndrome, or drug issues. That’s the happy side of the adoption coin, the side that the public rarely sees.

  The need for more African American families to adopt is tremendous, given the disproportionate numbers of our children in the nation’s foster care system waiting to find a permanent family. As of the end of September 2010, there were a total of 107,011 children in foster care available for adoption—30,812 of whom were African American and another 6,771 of mixed race.

  The process for becoming an adoptive parent varies, depending on the type of adoption. But all adoptions generally require some type of home study, in which an investigator, usually a social worker, conducts a series of home visits and interviews with family members and collects pertinent data to determine a family’s fitness to become adoptive parents. Of the three adoption types, the foster care system is the most affordable, with fees that generally don’t exceed $2,500. A private adoption can cost upward from $5,000 to $40,000, and an international adoption from $15,000 to $30,000. The push in recent decades to increase the number of African American adoptive families has spawned an industry of agencies and programs dedicated to that purpose. Since faith plays such an important role in the lives of many black families, one of the most visible programs is connected to the Catholic Church. One Church One Child dates back to the 1980s, when Father George Clements, a civil rights activist and African American Roman Catholic priest, adopted a boy and formed the organization to encourage churches to help find stable homes for black children. Dozens of state and local chapters of the organization have since been formed throughout the country. For families of faith, like Mr. and Mrs. Givens, the support of their church in adopting a child would add an extra layer of comfort.

  I’ve always heard that God works in mysterious ways. I couldn’t give Mr. and Mrs. Givens the news they wanted in the emergency room that day. But maybe my role was broader: to plant the seed of possibility.

  Birth Control Methods

  CONTINUOUS ABSTINENCE

  This means not having sex (vaginal, anal, or oral) at any time. It is the only sure way to prevent pregnancy and protect against sexually transmitted infections (STIs), including HIV.

  NATURAL FAMILY PLANNING/RHYTHM METHOD

  This method means either you do not have sex or you use a barrier method on the days you are most fertile (most likely to become pregnant). It also involves checking your cervical mucus
and recording your body temperature each day. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. Use a basal thermometer to take your temperature and record it on a chart: Your temperature will rise 0.4 to 0.8°F on the first day of ovulation. You can talk with your doctor or a natural family planning instructor to learn how to record and understand this information.

  BARRIER METHODS—PUT UP A BLOCK, OR BARRIER, TO KEEP SPERM FROM REACHING THE EGG

  Contraceptive sponge

  This barrier method is a soft, disk-shaped device with a loop for removal. It is made out of polyurethane foam and contains nonoxynol-9, which kills sperm (spermicide). Before having sex, wet the sponge and place it, loop side down, inside your vagina to cover the cervix. The sponge is effective for up to twenty-four hours, including more than one act of intercourse. It needs to be left in for at least six hours after having sex to prevent pregnancy. It must then be taken out within thirty hours after it is inserted.

  Only one kind of contraceptive sponge is sold in the United States: the Today Sponge. Women who are sensitive to the spermicide nonoxynol-9 should not use the sponge.

  Diaphragm, cervical cap, and cervical shield

  These barrier methods block the sperm from entering the cervix (the opening to your womb) and reaching the egg. Before having sex, add spermicide (to block or kill sperm) to the device. (You can buy spermicide gel or foam at a drugstore.) Then place it inside your vagina to cover your cervix. All three of these barrier methods must be left in place for six to eight hours after having sex to prevent pregnancy. The diaphragm should be taken out within twenty-four hours. The cap and shield should be taken out within forty-eight hours.

  Female condom

  This condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, man-made rubber and is packaged with a lubricant. It can be inserted up to eight hours before having sex. Use a new condom each time you have intercourse. And don’t use it and a male condom at the same time. Condoms, both male and female, are the only methods listed here that also offer protection from STIs.