Nizhoni was a young Navajo woman I met several years ago when she was 14 or 15 years old. She was a star student in a small village in Northern Arizona and had aspirations in law or medicine. Everyone in town had high expectations for her. She started having sex at age fifteen and had come to me initially seeking birth control and had settled on “the pill.” I wrote her the initial script, gave her emergency contraception and asked her to follow up in a month or two to see how things were going and to talk about long acting methods that she was initially a bit hesitant about.

About a year had gone by without seeing her when a colleague asked me to consult on “one of your patients.” This patient turned out to be Nizhoni.  She had missed her period, had a positive pregnancy test, and was distraught. Our nurse practitioner did not know what to do.

When she came in to see me later that day, she was visibly upset and felt like she had no options. Her dream of Stanford for college now seemed unobtainable.  She couldn’t tell her family because they would insist that she keep the baby and stay home to raise it. After discussing her goals and her options, she went home to think about what to do. In the meantime, I arranged her first OB visit and scheduled her for follow up with me the following week.

At that return visit, she said she wanted to end the pregnancy but had no idea what that entailed. Unfortunately, her options were limited. In Arizona, she would need to travel with her mother to Phoenix, where she would have to spend several days. That was out of the question, as she did not want her mother to find out. We instead made arrangements in Albuquerque, New Mexico where she could go without her mother and where there was no waiting period.

The first appointment date came and went; as did the second. By the time I saw her next, she was well into her second trimester. Her mother had found out about the appointments in New Mexico and she was forbidden from traveling. By this time, she had come to terms with her pregnancy and was getting excited. She brought her mother in to speak with me—her mother was initially angry with me for the care her daughter had received without her consent, but she understood why.

In the end, Nizhoni had a beautiful baby boy, who was loved and cared for by her family and community. While Nizhoni did not go to Stanford, she did enroll in the pre-med program at a state school where she moved with her partner and her son.