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“Es un milagro, señora.”

“Es un milagro, señora.”

It was getting late, and the clinic waiting room was almost empty. It was OB/GYN day, and the patients—predominantly Spanish speaking migrant agricultural workers—had all finally been seen. All except Maria, who was still in the exam room. Her six-year-old son, Joaquin, skittered around the outside corridor, under the watchful eye of the nurses preparing to close up shop.

I was in the exam room with the doctor and Maria, and my feet were starting to ache as I approached my fifth hour standing. I stole a glance at the clock on the wall—11:00 p.m. I hadn’t been home since 7:30 a.m., and with exams just two days away, all I could think about was the long night of studying ahead of me. I usually don’t mind spending time at clinic close to exams—I almost prefer it that way—but my attention span was at its breaking point.

Then, the doctor found the milagro.

My eyes shot to Maria’s eyes as hers shot to the doctor’s, wide with disbelief. Pregnant? It was incomprehensible. She was 37 years old and had used protective measures. And yet, there it was—three millimeters across, six weeks old, flickering rhythmically on the ultrasound monitor.

One-hundred and twenty beats per minute.

The doctor repeated, “Es un milagro, señora.”

Por que?” Maria asked, incredulously.

This was not good news.

The doctor, perhaps sensing Maria’s trepidation, clarified. It was a miracle insofar as it was extremely unlikely. Maria was approaching 40, had a history of PID and had an IUD—which, as it happened, had turned completely upside-down. As the doctor explained, Maria rested her head back on the exam table, her searching eyes burning into the ceiling as she rubbed her palm across her brow.

Not good news at all.

How would she feed this new baby? Take care of it while also raising her six-year old? Was she physically and psychologically ready for the demands of motherhood at the age of 37? These, among others, are just the basic questions.

Then factor in the daily challenges of life as an undocumented migrant farm worker, even in this nation of immigrants.

What kind of life would this child have?

The inverted IUD, obviously non-functional, was removed with the aid of an ultrasound. The exam was over and Maria took a seat by the desk as the doctor outlined her options. Joaquin, who had been cooped up in the clinic’s lobby for hours, couldn’t wait any longer and burst through the exam room door, hopping onto his mother’s lap.

The doctor produced a duffel-sized tote bag full of stuffed animals, which she had brought as Christmas gifts for her patients’ children. Joaquin peered into the bag, discerningly lingering over his options.

The nurse standing in the doorway fawned over him—“He’s so smart. He speaks beautifully.” She sighed and clutched her chest as he planted a thank you kiss on the doctor’s cheek.

“With one like that, I can understand why you would want another.”

The furrows in Maria’s brow softened, and the anxiety in her eyes melted away to adoration, as she watched her son bury his face into the belly of a plush Dalmatian.

I consider myself pro-choice because I think abortion is complicated, and I don’t find that most pro-life perspectives have room for complexity. The most pernicious arguments venture into horrifyingly judgmental territory, suggesting that women who get abortions are cavalier about it, that abortion is a way to evade personal responsibility and that it enables sexual promiscuity.

Maybe some women are cavalier about abortion, but I would say that most are not.

Maria certainly wasn’t—I could see the conflict in her eyes.

All of this happened over a month ago. I wonder what decision she made.

Editor’s note: The patient’s name in this article is a pseudonym and has been changed to preserve patient privacy. It originally appeared on the blog M.D. or Bust.

Ajay Koti Ajay Koti (11 Posts)

Columnist and in-Training Staff Member

Morsani College of Medicine at the University of South Florida

Ajay is a Class of 2017 medical student in the SELECT program at the University of South Florida. He is passionate about delivering primary care to underserved populations—specifically, low-income and homeless patients in urban centers. Ajay is particularly interested in the potential of patient-centered medical homes for mental health and chronic disease management.

M.D. or Bust

Numerous studies have documented that medical students lose empathy during clinical years, becoming jaded and pessimistic. This has been linked not only to diminished enjoyment of our work, but also to worse patient outcomes. My goal is to sustain the humanistic values that drive so many of us to medicine, so that, instead of being quelled by cynicism, our idealism can be refined by wisdom.