There is a patient that I want to tell you about; I will call her Carla. I first met Carla when she was 14 years old, just a few weeks after she came to the United States from Togo. She had been living there with family for over ten years, while her mother was trying to get her legal status. And now she had come to Boston to live with her mom. Carla was a lovely, smart, generally healthy young woman who was low risk in terms of many of the things we think about for adolescent health.

Now flash forward three years. I was seeing Carla for a follow up on constipation. I knew her well, and she was doing fine, so it was a very quick visit. After finishing my documentation, I went to go check the results of her pregnancy test so I could put the results in the system and close the visit (we do a pregnancy test on every female patient who comes in to clinic, regardless of the reason they are there). And the pregnancy test was positive.

I went running down the hallway and caught Carla at the elevator. I asked her to come back to clinic, told her that I needed to double check one thing, and then went to re-run the pregnancy test. At three minutes—the time at which you are supposed to check the test—it was negative. At three and a half minutes, it was positive. I was confused, not quite sure what to make of the result. So I went back to talk to Carla, and asked her more about her sexual history and experiences. Carla told me that she had had sex once, a few months ago, that “it was a mistake,” and that she “doesn’t plan to have sex again.” And that her last period was two weeks ago.

Carla went to the lab for a blood pregnancy test. She went home. And I called her an hour later, to tell her that her blood pregnancy test was positive, meaning that she was pregnant. Carla started crying, “I can’t have a child. My mom can never find out.” She asked me what she was going to do.

The next day, Carla came to the clinic. We discussed all of her pregnancy options—parenting, adoption, and abortion. Carla did not want to parent right now. She wanted to have an abortion. And she was so scared of her mom finding out. We discussed judicial bypass, a way that Carla could work with a judge to consent for abortion in lieu of a parent, and that her confidentiality would be protected. But this did not reassure Carla. She made a plan to travel out of state to a place with no parental involvement laws, to pay the cost of an abortion on her own with money that she did not have. Carla was so afraid.

The weekend before her out of state travel for her abortion, Carla had a miscarriage. I don’t know what would have happened if she had not. I don’t know if she would have been able to access the abortion services that she was seeking. I don’t know if her mother would have found out. And I don’t know what I could have done differently to support her in this process. But I wonder every day…