“We Were Hoping”
–Patricia J. Harman
At 4:00 p.m. Dee Telemann is fifteen minutes late for her 3:45 appointment. It gives me a chance to return a few phone calls. It’s a familiar last name, Telemann. She’s probably the daughter of my patient, Sara, who lives on a farm out on Snake Run.
At 4:45, an hour overdue, the patient arrives with a boyfriend. Dee sits on the edge of the exam table, a petite blond with the smooth tan skin and high cheekbones of a lot of Appalachian women. She’s dressed in jeans and a low-cut white blouse. Her young man slouches in the gray guest chair in a T-shirt with some kind of motorcycle logo on it. He wears tight, worn jeans, a creased baseball cap, and run-down cowboy boots.
“Hi, Dee, I’m Patsy Harman, nurse-midwife and GYN practitioner.” I reach out my hand and note the girl’s firm grip.
“This is my boyfriend, Jerry,” Dee says proudly. “My fiance.”
Jerry nods and meets my eyes. He’s a small guy, but muscular, about five feet nine with light brown hair curling over his shoulders.
I glance at the birth date on the patient’s chart. She’s sixteen. He could be eighteen. Because she was late, I’d been prepared to start off the encounter with a lecture about the importance of coming to appointments on time, but curiously I skip it. “So Dee, what brings you here today? Are you having difficulties?”
“Oh, no real problems. . . . We’re just pregnant. We did three home tests.” Her face glows and she looks at Jerry for confirmation. He grins but then quickly pulls a shade over his joy.
“So, is this a good thing that you’re pregnant? A happy thing?” From the look that has just passed between the two lovers, it’s obvious.
“Oh, yeah, we were hoping it would happen. The only problem is, we don’t have any money or a medical card. I was hoping you would take care of me until I can get one. I wish you could deliver our baby too, but the receptionist said you don’t anymore.”
“Do your parents have health insurance?”
“I don’t know, but if they do, it wouldn’t cover me. I quit school.”
I want to ask why she dropped out. She seems smart enough, but I stick to the subject. There will be time for that later. “Have you applied for medical assistance?”
“Not yet. We need my mom’s signature or a health care provider to verify that I’m pregnant. I was thinking that could be you. . . . We need a due date too, on the form.” She stops. They all stare at me.
“Does your Mom know you’re pregnant?”
“Not yet. We wanted to wait until Jerry gets his first paycheck from Taco Bell so she’ll see we can be responsible. She doesn’t even know I came to see you.”
Sara Telemann, married, thirty-four, a rural postal carrier, has eight children. I delivered the last one. Will she be happy when she finds out the news? Does she expect her daughter to get pregnant early and often? Or will she be angry seeing Dee repeat the old pattern? I glance over the new OB intake form. The girl is low risk. Like most teenagers, she hasn’t been around long enough to have many medical problems. After a quick physical and a review of the OB packet, I take them all down the hall to the ultrasound room. Standing in the dark, I point out the tiny fetus on the monitor. It’s just eight weeks, but it has arms and legs and there’s a flicker of a fetal heartbeat. Dee has tears in her eyes, and Jerry reaches over to touch her bare foot. I give them a picture of the baby.
In the end, I sign the papers for the medical card and tell the young woman to call the welfare office first thing in the morning. “And I want you to tell your mom about the pregnancy before your next appointment. Legally I can take care of you as an ‘emancipated minor,’ but I would prefer it to be out in the open.” I don’t say, “Because if your mom comes to see me, you may meet one day in the waiting room.”
Dee and Jerry will be good parents. Maybe they’ll be parents of eight like Sara. Their children will be responsible, well behaved, and loving like Sara’s and get pregnant at sixteen or seventeen and have more babies. They’ll work at Taco Bell or Wal-Mart or Select Tech, the telemarketing place downtown. Maybe one or two will stay on the farm or go to community college for nursing or computers.
Standing at the checkout desk, I watch the young couple leave with arms wrapped around each other. They have everything against them—youth, poverty, and lack of education—but they love each other and seem so solid. I think of a mountain covered with trees.
Midwife Harman explores issues about caring for patients who have different values and goals than we do. How do you remain nonjudgmental and respect your patient’s values and goals, which may be different from our own? Have you seen examples where this is done well or poorly? Share those without divulging the identities of those involved. Midwife Harman refers to an emancipated minor. Most states allow providers to provide care to teens without parental permission. What is the value of this law? Have you seen your providers use it? What are the challenges in rural areas? Midwife Harman shares one.