Take-home Message
Listening carefully to the patient's history helps to build a good doctor-patient relationship, which promotes better understanding and acceptance of recommendations.
(Fictional narrative by the doctor)
James Fleck: Anticancerweb 01 (10), 2022
Lyla was a communicative young woman. Smart, dynamic and creative, she had just graduated in architecture. She had established an affectionate relationship with Raul, a Peruvian colleague who had come to Brazil to pursue a master's degree in urbanism. They had common goals and naturally the affinity evolved into a relationship of daily coexistence. They started to live together, despite the short period of mutual acquaintance. It was a relaxed and uncommitted relationship in which they shared expenses, expectations, frustrations and joys. They were a couple of two young people, simulating an adult married life.
Lyla thought she was living in a mature love situation and precipitated a pregnancy. Raul was surprised by the situation and immediately took the opposite stance. He was 28 years old and had other plans for his life that predated fatherhood. He criticized Lyla's impulsive attitude, which he described as irresponsible and treacherous. He was explicit in recommending an immediate abortion. Lyla, dominated by the glamour of the motherhood, had already undergone an ultrasound and was carrying a photo of the embryo, despite being the result of a non-consensual conception. What for her represented a desired child, for him was an obstacle to the full exercise of freedom and professional growth. Lyla's parents were very sensitive people. Lyla was the younger of the couple's two daughters. Upon learning of the pregnancy, they welcomed her daughter and made themselves available to support her. There was no censorship or judgment, just resigned acceptance. The position of the parents was not based on any legal, moral or religious principle. It was purely affective. Even if Lyla decided to face this pregnancy alone, she would have the approval and commitment of her parents.
Despite her family's support, Lyla felt ambivalent. She dreamed of a situation of total acceptance. In her fantasy, Raul would celebrate the conception. She rebelled against Raul's attitude, blaming him for being selfish. She began to reject him and unconsciously transferred this feeling to her offspring. She untimely decided to have an abortion. Lyla talked to Therese, her older sister, and together they looked for a clandestine abortion clinic. It was a covert environment, located on the outskirts of the city and characterized by indifference and impersonality. There, they found other young women sharing the same unpleasant feeling.
When her turn came, she was ushered into a small room and instructed to remove only the bottom of her clothing. She was placed on a gynecological table and a vein was punctured in her arm. From that point on, Lyla became unconscious as she had been given an intravenous hypnotic medication. When she woke up about one hour later, she had abdominal pain and vaginal bleeding. She never had any contact with the doctor, being guided only by a supposed nurse to get dressed, as her complaints were considered normal and would go away in a few hours.
Lyla did not communicate her decision to her parents, as she knew they would not agree to the abortion. She left the apartment she shared with Raul and moved in temporarily with Therese. They were eight years apart and Therese had always been very protective of her sister. Therese was divorced and childless, worked as an investigative journalist, and was successful in her job.
The first twenty-four hours after the procedure were marked by deep prostration, intermittent vaginal bleeding, and abdominal pain. Lyla remained lying down and drinking electrolytes. She had not received any prescribed medication or guidance on how to proceed in an emergency situation. She felt guilty and assumed the physical suffering as a punishment for her thoughtless attitude.
Therese put off all her appointments and stayed at her sister's side to comfort her. Due to physical and emotional suffering, Lyla felt sad and often cried, expressing anger and nonconformity. Teresa gave her an anxiolytic she had for personal use, as well as painkiller drops, diluted in chamomile tea.
Lyla got a few hours of sleep. The situation got worse. The pain had taken on an uncontrollable intensity and was now accompanied by distention and stiffness in the abdominal wall. Vaginal bleeding became continuous and Lyla began to develop chills after a persistent fever. She couldn't get up as she was dizzy in the upright position. What had been described as routine and transient discomfort has taken on a serious proportion.
Therese took the initiative to transfer Lyla to an emergency room. When they got there, Lyla had passed out. She had low blood pressure and received drug support to stabilize her hemodynamic condition before a more accurate diagnosis was made. Several tests were performed, revealing a uterine perforation. Lyla underwent immediate surgery, requiring the removal of her entire uterus. She received a blood transfusion and antibiotics and remained hospitalized for a week. At the time of admission, Teresa had communicated to her parents and heard severe criticism for keeping them unaware of the situation. She felt guilty, but justified that she was protecting them, as abortion was an illegal situation in Brazil. The parents were retired judges, adhering to a legal doctrine they had practiced throughout their successful professional lives. However, they were affectionate parents, who put love above their convictions, welcoming their two daughters. Lyla returned to live with her parents and Therese resumed her routine.
This whole story was buried for over two years and only came back because Lyla was now being diagnosed with breast cancer.
At that moment, the whole family was there, in front of me, for the first appointment.
To be continued in PLOT 2 (raising action) …
* Attention: The story 9 will be published sequentially from PLOT 1 to PLOT 6 and you will always see the most recent posting. To read Story 9 from the beginning, just click in the numbered links located at the bottom of the homepage.
© Copyright Anticancerweb 2022
James Fleck, MD, PhD: Full Professor of Clinical Oncology at the Federal University of Rio Grande do Sul, RS, Brazil 2021
I'm very eager to read the rest of this story. Being a brazilian woman and a medical student makes this issue even more impactant for me. It's really sad to see that a public health problem is treated as a crime, when many other Lylas are facing the same situation daily. I hope that in a near future we'll be able to help Lyla in a better way.
Unfortunately, narratives like Lyla's are common. A lot of people go through the same situation as her, and that's a big problem. Years go by and abortion, which is a very significant health problem, is never taken seriously, and knowing that is really sad. I hope that changes as soon as possible.
Stories like Lyla's are repeated daily. Talking about abortion is not always an easy task, as the topic, in addition to being delicate, involves moral, scientific, ethical, religious and philosophical issues. Therefore, it is essential to know the topic and discuss it urgently.
This story is really a portrait of the reality of many women. Abortion is often imposed by others, when it is not fraught with feelings of guilt and embarrassment. The lack of dialogue, trained professionals and medical advice makes these women at the mercy of horrible health care. These are women who are at a very delicate moment in their lives and still need to deal with the total lack of basic health conditions such as minimally qualified and empathetic care.
This is a story that repeats itself every day in the country we live in. Unfortunately, it is not given due importance by health authorities and is a public health issue. That is why it is important that there is a follow-up with health professionals in order to guide and protect the patient.
Stories with similar or even worse endings than Lyla's are increasingly observed, especially when there is no rational dialogue between those responsible. For fear of social judgment, whether from family, friends, religion, etc., they choose one of the worst choices, which is individual decision-making when it has a collective impact. Frustration about the illusions created by loving contact becomes of great impact to be transcended. Therefore, these are one of the points that should be well discussed by the health professional with the patient, with the aim of not judging him but comforting him.
Stories like her's keep happening over and over again every single day in a country like ours that make abortion look like a crime. We need to understand that some women don't have the capacitation, or even will to became a mother, and she have to have the right to choose about what is going to happend to HER OWN body, and nowbody, except her, can chose that better. No one get up wanting to get an abotion, but unwanted pregnancies happen, and the public system have to be abble to support this women because it's about public health that we're talking about. we dont need anymore unwanted child in this world, every single kid deserves love and structure, and mainly, every single woman deserve to have a safe choice.
Reading this case, i think that Medicine, at its best, is a close collaboration between doctor and patient. So it’s important find a doctor nearby – a doctor he can trust and work with to make the only life any of us have been given as good as it can be.
A história da Lyla, infelizmente, é mais uma entre milhares que se repetem no nosso país. A questão do aborto legalizado e seguro é um grande problema de saúde pública, e mesmo nas poucas situações em que as mulheres têm esse direito garantido por lei ainda há dificuldade em realizá-lo. O caso da Lyla nos leva a reflexão de que muitas e diferentes razões levam uma mulher a optar pelo aborto, e que o papel da Saúde Pública e do Estado deveria ser garantir a segurança desse procedimento.
Lyla's story, unfortunately, is one of thousands that are repeated in our country. The issue of legalized and safe abortion is a major public health problem, and even in the few situations in which women have this right guaranteed by law, it is still difficult to perform it. Lyla's case leads us to reflect that many different reasons lead a woman to opt for an abortion, and that the role of Public Health and the State should be to guarantee the safety of this procedure.
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