I've been on postprocedure abortion call at a reproductive health clinic for almost two years. I rotate with three other nurses, each covering one week per month. Patients call to ask about all sorts of things: sometimes they need clarification about how to take the medication they were given or advice about treating symptoms like nausea or cramping. The most common call is about pain and bleeding; many patients are surprised at how heavy bleeding can be during a medication abortion.
When I first started, I took these calls at face value. Patients were understandably scared about symptoms and wanted concrete information about how to manage them. However, after a few weeks I started noticing a pattern. While patients do seem to benefit from my clinical advice, it's the emotional support that has the greatest impact. Many of the patients mention that they are alone or haven't told anyone else about their abortion. When patients do have a partner or mother or friend with them, this support person (sometimes the one making the call) is often in distress as well. Sometimes anxiety and fear take root in the body as painful cramps, and patients call in tears. We talk, and I offer clinical guidance (take ibuprofen on a schedule, try a heating pad) as well as reassurance and-perhaps most effective-recognition of how painful and difficult the process is. Often, patients who were sobbing at the beginning of the conversation report feeling more comfortable by the end.
When the pandemic hit, much of my clinical work changed. I am no longer placing IUDs, conducting yearly exams, or running from room to room. Instead, I am refilling birth control prescriptions over the phone, often from my couch. The one part of my clinical work that hasn't changed is being on call. I've never considered it telehealth. This is probably why, when the clinic decided to transition all in-person visits to phone or video, I felt a bit resistant. I knew it would help protect staff and patients from COVID, but I was skeptical about connecting with patients virtually in the same way that I did in person. I worried that the vital part of ideal clinical visits-the personal connection-would be lost. Telehealth was a last resort effort to keep patients from being completely cut off from care.
A few weeks ago, I had a call from a patient in her teens asking for help managing pain. Her cramping was so unbearable she thought she'd have to go to the hospital. We ended up talking for 20 minutes, and she told me she was scared and sad and felt deeply alone. She felt she had made the right choice but was nevertheless mourning the loss. She was close with her mother but knew she couldn't ask her for support because her mother would disapprove and perhaps kick her out of the house. Besides listening and telling her about an abortion support hotline, I felt I had little to offer her. Although she had originally called about pain, we barely talked about it. At the end of the call I circled back to ask her how she was feeling, and she said-to my surprise and I think hers as well-that her cramping was now mild and she thought she could manage it at home. She thanked me for listening and said she felt better knowing that she could call back and talk if she needed to.
My beliefs about the clinical limits of technology were challenged by this call. I realized that I had actually been practicing telehealth for years before the pandemic and that care by phone or video can often provide patients the clinical guidance, comfort, and support they need. Telehealth may also allow for increased access to care that has been politicized, such as reproductive and sexual health care. Although I once thought of telehealth as a stopgap, I now hope that clinics continue to offer telehealth options, when appropriate, after the pandemic. Nursing calls for us to advocate for patients, "meet them where they are," and problem solve to eliminate barriers to care. For those who were isolated before COVID-19 and will continue to be in the future, telehealth may provide the connection and support they deserve.