Karen* is my 25-year-old patient who got pregnant by accident. She had a medication abortion, for which she paid in full because she doesn’t have insurance. She came to me because she was still bleeding heavily three weeks later. Karen’s first doctor had done everything right. But instead of shrinking after the termination, Karen’s uterus remained enlarged, and she kept bleeding. Karen was frightened and pale. I wanted to do another procedure to investigate, which would require anesthesia, but she didn’t have the money. Because she was so anemic from blood loss, I was able to admit her through the emergency room to perform the procedure. Afterward, I gave her medication and sent her home to take iron. Karen is looking for a job. She’s well educated and embarrassed not to have insurance. She said her parents’ policy won’t cover her, and she can’t afford insurance until she gets a job. Now she has a hospital bill, too.

*name changed for privacy