Originally published in The Ottawa Citizen October 2, 2001

Life is about options, the choices we make and the paths we then choose to follow. For some it can be a bittersweet experience. Yet, these decisions can alter the lives of many. Some are aware of these changes and some, regretfully, are not.

Mary (not her real name) was 16. Her mother, an alcoholic, paid little attention to her. Her father disappeared from her life when she was 5 years old. Her boyfriend abused drugs.

She came to the high school clinic twenty weeks pregnant complaining of bleeding and cramping. She expressed hope the baby was dead. The next day an ultrasound showed overlapping skull bones and a deformed chest. She was induced and the fetus delivered. She grieved after the abortion.

Three months later in March, she was 5 weeks pregnant. She said she could not afford the cost of the birth control pill. She requested a therapeutic abortion (TAB). She stated that she felt guilty and foolish about the pregnancy. She returned to the clinic in late April stating that she had slashed her wrists because she was overwhelmed by her problems and “lost it”. There was little support from her mother regarding her despondency. Her mother was unaware of the pregnancy. Mary admitted that she was burying her feelings over recent and past events and she felt depressed since the abortion. Her depression was treated. Within a month, she felt better and had no further urge to cut herself.

In early June, she returned to say she did not go for the TAB because she thought the baby had died. She said that a Doppler done two months ago did not pick up the heartbeat. She admitted she did not come back to the office sooner because she felt ashamed. She feared that if she did go for the TAB the staff at the hospital would judge her. An ultrasound showed a healthy twenty-week fetus. She decided to return to her family doctor for prenatal care.

Come September, she returned because her family doctor threatened to tell her mother about the pregnancy. She did not follow up with her family doctor because of his threat. She was at 31 weeks gestation for her first prenatal visit. Mary was initially not compliant with the required prenatal visits and tests. Our office had to constantly call her and remind her of her appointments. Her ambivalent behavior stemmed from several areas. She bore the guilt over the loss of her first baby and faced some difficult truths. Her boyfriend was unaware of her pregnancy. She feared telling him because he was not the father. She did not want her mother to know she was pregnant. She had plans for her life. These included continuing her education and attending university. She did not have the financial nor emotional capacity to raise the child in the manner she wished.

After much discussion, she decided to give the child up for adoption. A couple in my practice wanted to adopt a child. Mary spent time with them and accepted them. They were of great support to her. In many ways, they fulfilled Mary’s need for a stable family. They arranged to bring her to the hospital once labor started. They attended the birth and participated in the delivery. When she was in labor, she called her mother from the birthing room to tell her that she was staying at a friend’s house for two days.

Her pregnancy was uneventful in one respect. No one noticed! She began her pregnancy weighing about 72 kg. She gained about 11 kg. What was astonishing was that her friends did not comment nor ask her one question about the pregnancy. In fact, she hid her pregnancy so well by wearing loose clothes that no one suspected a thing. Her mother commented upon how she thought Mary was losing weight and that she looked good!

Two days after her delivery she was back in school with no one the wiser. In fact, people continued to comment about how good she looked.

During her pregnancy, Mary was treated for depression, ambivalent about her pregnancy, lacked family support and was mistrustful of those who tried to help her. She needed continuous reinforcement to attend her prenatal visits. In short, she wanted someone to care for her. She wanted a family. With all these obstacles, it is a reminder how different the outcome could have been.

Now almost 7 years later I continue to see Mary, Devon and his adoptive parents. They occasionally meet to maintain contact. Mary has no regrets about her decision especially since her son lives in a warm and caring environment. To this day, Mary’s mother does not know she has a grandson.

It is truly remarkable to witness how one person’s decision can change the lives of so many people. We all hope for happy-endings. It is especially poignant how these forks in the road determine a child’s fate. Thankfully, Devon’s life is a happy one and he is using a spoon for now. He will leave the fork for another day.