If Roe overturned, add " 'illegal abortion' to the differential diagnosis"

Regarding "Start your training now for complications of back-alley abortions" (Letters, Oct. 17): The ob-gyn's recent letter to the editor about being sued for not recognizing the complications of an illegal abortion is an addition to the discussion of the danger that Roe v. Wade might be overturned.

As a physician who had just finished her mostly Boston training in 1973 and who, therefore, had seen virtually all illegal abortion complications directly or in class, let me reassure him that the ob-gyn often will be the last doctor in the loop.

Those of us in primary care, urgent care, emergency medicine, general surgery, surgical pathology and forensic pathology will have to add "illegal abortion" to the differential diagnosis list for every female ages 9 to 60 who comes in with an acute abdomen, vaginal bleeding, vaginal discharge, fever of unknown origin, septicemia, unexplained amenorrhea, chemical burns of the vulva and vagina, odd toxic symptoms, coma, or is DOA. If the patient is well enough to talk, she will be afraid to tell us she has undergone this illegal procedure either by an abortionist or by herself, so we will have no history to go on. Some of the messiest and ugliest cases I recall were self-inflicted. (The steel or aluminum knitting needle was often the self-instrument of choice.) You will be called -- probably at some outrageous hour of the night -- to treat, repair or remove lacerated or chemically burned uteruses and/or vaginas and to help treat endometritis with retained septic products of conception.

I suspect that, given the contemporary government's tendency to become judgmentally involved in people's lives, the messy, expensive legal parts will start when the diagnosis is made. Except for the deaths, I don't remember that the police were involved in the '60s and '70s. I think that this was probably because the main concern was for getting the woman through all of this with as few residual problems as possible. We shall have to wait and see how different it will be if abortions become illegal again.

Abortion has always been with us and always will be. It has always been a private "woman's problem." The question now is whether the United States will continue to be civilized enough to offer skillful clean abortions, when desperate circumstances call for them, or whether this country will return to the bad old days when the choice was between expensive travel to a foreign country or clandestine, illegal, unskilled and unclean procedures locally.

Ann Ewalt Hamilton, MD, Riverside, Calif.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/12/12/edlt1212.htm.