A young woman walked in with complaints of an incomplete abortion. She had fevers for the past week and she was hypotensive on presentation. She was ambulating and conversing fine, but was likely septic from retained products.

We prepped for an evacuation.

The last time I observed a D&E, an older male doctor completed an evacuation without any pain medication. I had terrifying flashbacks to Planned Parenthood where some women can’t afford anesthesia with the procedure. The woman screamed and flailed her legs, then vomited on the floor in response to extreme pain. When I asked why the doctor hadn’t provided any pain relief, he told me that it wasn’t necessary because it is a quick procedure. Part of me wanted to twist his testicles for 2 minutes.

This time I was performing the procedure and IV analgesia was given.

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I inserted a speculum and was overwhelmed with anaerobic odors. Most of the products were sitting in the cervix, so it was easy to remove. Her cervix; however, had areas of necrosis – she had been infected for so long that her cervical tissue had started to die. I carefully evacuated the uterus, fearful that any extra force would cause a perforation through infected tissue.

“That smell”, a young doctor commented, “this is a criminal abortion”. Throughout the procedure, she and a nurse explained that elective abortion was illegal in Tanzania, and therefore, some women will seek care at less than optimal places. The procedures, as you can only image, are not performed using safe and quality measures. The young doctor was convinced that this woman had had a criminal abortion due to her extensive infection. She added that if we threatened to call the police, then the young woman would pay lots of money to avoid a criminal investigation.

I tried to remove as much dead tissue as possible without causing excessive bleeding. The young woman has no living children. We started her on antibiotics. The young doctor even put metronidazole directly into the cervix. I don’t think it works quite that way, but I was appeased to know that she would be getting IV antibiotics as well.

I went home that night and worried that she would ultimately need a hysterectomy. She went home the next day and I haven’t seen her again…