“Are you here through the night? We could really use your help!”

I looked up from my phone and saw the head nurse standing in the doorway of the small hospital located in the slums of Faridabad, India where we worked. My tuk tuk had just arrived to take me home after a ten-hour workday when I looked at the nurse who could not mask her physical exhaustion with a smile. Empathy engulfed me. I was still adjusting to the eleven-and-a-half-hour time difference, and knew that I would be of more help at the hospital than staring at the ceiling in my bed that night. I turned to my driver, told him to carry on, and then proceeded up the dirt walkway through the bright yellow hospital door, eager to discover what was in store for the night ahead.

After finishing the nightly rounds with the team, I sat down in the corner of the half-occupied ICU. The exhaustion of the night began to settle in, and my eyelids became heavy while scanning the headlines of American news. In large bold letters ‘Opening arguments of Supreme Court on Roe v. Wade’ and ‘Change in Texas abortion law’ reflected off my screen. I was in the fourth year of my dual-degree, MD/MPH program, and I had recently completed the first semester of my public health degree. My clinical experience had fostered a passion for women’s health, and my public health education was centered on policymaking. The combination of the two made the scrutinization of the United States abortion laws a topic of interest.

I looked around the small ICU interior, and I began mentally replaying the abortion law debates from my classes. Suddenly, I felt an overwhelming wave of unease recalling the data I had used as evidence to support my arguments: 13.2% of maternal deaths are related to unsafe abortions, with abortion bans this percentage could increase by 21%. I shook my head, bewildered. I was mystified that policymakers were unwilling to recognize the primary and collateral damage to women’s health in their arguments. Fearful for my own and future patients’ rights, I unclenched my jaw and took a deep breath trying to exhale my angst.

Suddenly, a burst of unintelligible yelling came from the lobby. A tall, elderly gentleman carrying a young, lifeless woman emerged from the dark hallway. The young woman was wrapped in a burgundy flowered blanket with pieces of her jade salwar kameez peaking from the top. With adrenaline flooding my body, my heart began to race as I edged nearer. Red handprints stained her beautiful salwar kameez and her once blue pants, falling from the bottom of the blanket, were now purple. A trail of fresh blood followed the pair, and tears fell from his eyes. He placed the unconscious women on the bed.

The receptionist directed the gentleman, who identified himself as the young woman’s father, to the lobby and the team surrounded her. She looked to be in her early twenties and her long dark hair covered her face. On initial assessment, she was unresponsive to stimuli, hypothermic, tachycardic, and her pulse and blood pressure were barely detected. Her delicate tone had faded into a pallor due to the blood lost enroute. She was in hemorrhagic shock.

“Identify the bleed and pump fluids,” I said to the nurse. The nurse ran to a blue cardboard box located in the center of the room and hurled an IV kit with three 500 milliliter bottles of normal saline in my direction. I hesitated, unsure of my ability to gain access to the patient’s collapsed veins. The technician sterilized the field and placed the IV catheter needle in my right hand, and I responded. Within seconds, the flash of blood made its way into the chamber and I sighed relief. I began squeezing the bottle of saline with exponential force while directing my focus to the source of the bleed.

In the distance, the father’s words echoed in the empty hallway as he gave the young woman’s history to the nursing assistant. My ears picked up the English word ‘coat hanger’ and I noticed the father’s slight gesture to the patient’s legs, still wrapped in the blanket. The physician and I locked eyes, and the news headlines read only moments before flashed before me. I stood silently, uncertain on how I should proceed. Coat hanger abortions and their complications had almost become extinct in the United States since the ruling of Roe v. Wade in 1973. Access to therapeutic abortions had made uterine and gastrointestinal injuries due to unsafe measures something only studied in textbooks.

I began processing the series of events in front of me and flashed forward, growing fearful of what might return to the United States with the latest scrutinization of abortion laws. When I glanced at the nurse, however, she appeared detached, suggesting that this was not an uncommon occurrence in this country. I began mentally compiling previous conversations regarding the topic. From what I understood, abortion laws in India were highly progressive with a recent revision in 2021. The revision allowed therapeutic abortions until twenty-four weeks gestation for special categories such as survivors of rape and victims of incest. While the revision was a win for women’s rights in India, many physicians vocalized concerns regarding barriers to care. A lack of obstetricians and gynecologists in the country, in addition to a lack of abortion clinics, inadequate health care infrastructure, and unrealistic authorization requirements continued to keep treatment out of reach for many throughout the country, especially women living in poverty.

A few seconds later, the nurse’s aide emerged with the patient’s history. She was a twenty-year-old female who had been sexually assaulted several months before on a bus, an occurrence that was unfortunately common for the area. She was set to wed the following year; however, she had found out that she was pregnant the day before, and the wedding was called off. The father said they could not afford care, so the patient took terminating the pregnancy it upon herself.

I held my breath as I watched the nurse remove the blood-soaked, burgundy blanket around the patient’s legs. Once unraveled, a coat hanger with a quarter size piece of uterine tissue on the end fell onto the bed. I reached down and I looked at the small metal wire in my hand. Her blood soaked my gloves and covered my arms, and I realized that American policymakers were not ready for the negative consequences the regression of Roe v. Wade would have on women’s health.

Jesseca Pirkle is a student, patient advocate, caregiver, and travel enthusiast. Currently, a MD/MPH student at the University of Illinois-Chicago, Jesseca enjoys sharing her experiences and connecting with other individuals through writing and poetry.