Page 3 of 10
Ehsan, who'd also considered joining the FBI, says the two would often talk about ideas for Holly's career, and that he would advise her on the classes she'd need to take to transfer to a four-year school. He believed in her. "Holly said Ehsan treated her with respect and no one had treated her better, and he said she deserved to be treated that way," her mother remembers. "It was nice to hear them say that."
But trouble arose when Holly got pregnant this past summer at age seventeen. Although she and her mom had talked about birth control, abortion was a topic that rarely came up. "I never thought about abortion," Debbie Patterson says. "I've never been faced with it myself, or been close to anyone who confided in me about it."
Debbie did know that Holly had secretly gone to a clinic and gotten birth control pills, had later gone off them, and was in the process of getting a new prescription. She felt this kind of secrecy was normal for a teenager, even in a home where the parent had made it clear it was okay to talk about sex. "You have this idea that your daughter is going to go, 'Mom, I had my first kiss,'" Debbie says, a bit wistfully. Then her tone changes. "How many times do daughters not tell their parents they had sex or want to have sex? I know very few of my friends' daughters who did it the way we want them to."
Holly kept her pregnancy hidden from everyone but her boyfriend. She'd decided to seek out the abortion pill from the very day she found out she was pregnant, Ehsan recalls, and he promised to support her no matter what she chose. Holly knew friends who'd had abortions and she felt she wasn't ready for a baby. "It was just too early, she was just too young, and in her own words she just felt like it wasn't an abnormal thing she was doing," Ehsan says.
Together, the couple researched Mifeprex on the Internet and consulted Ehsan's aunt, a gynecological surgeon. Ehsan says he also encouraged Holly to talk to her own relatives, even offering to pay for plane tickets to fly her mom to the East Bay, but Holly refused. "She said, 'There's no reason to worry her about it. We'll get through it and I'll tell her about it later,'" he remembers. "It was obvious there was a certain amount of shame there to tell her dad or mom that this had happened, and she preferred to get it over with and put it behind her."
Holly made her appointment at the Planned Parenthood facility in Hayward shortly after her eighteenth birthday. Looking back, Debbie Patterson says her daughter must not have realized there were other alternatives, or that her family would have supported her through a pregnancy. "Instead of telling our young daughters, 'Don't get pregnant. Go get birth control pills,' the question we should ask is, 'If you found yourself pregnant, what would you do?'" Debbie says. "Because I really felt Holly didn't want to disappoint me or her father or her grandparents or her friends, and when she found herself in a predicament, I think all she heard was, 'Don't get pregnant.'"
Medical abortion, the official term for an abortion accomplished with RU-486, is best described as a regimen, not a single drug. The process used in the clinical trials and then approved by the FDA requires three separate trips to the doctor. On the first visit, the woman receives counseling, signs Danco's release form, and gets her dose of Mifeprex. The chemical blocks progesterone, a hormone that prepares the uterine lining for pregnancy -- antiabortion activists sometimes call this "starving the baby."
The mifepristone is followed two days later with a second drug called misoprostol. It is manufactured by Searle Pharmaceuticals, which marketed it as a treatment for gastric ulcers before the FDA approved it as part of the Mifeprex regimen. Misoprostol completes the process by causing the uterus to contract, expelling the fetus. In the trials, women received the second drug orally at the clinic.
A third visit is necessary about twelve days later to ensure that no fetal tissue remains. In 5 to 8 percent of cases, a continued pregnancy or incomplete expulsion of tissue requires the same type of surgical intervention doctors use in the case of natural miscarriages.
But the FDA-approved method isn't the only way to administer Mifeprex, and it wasn't the way Holly Patterson received it. As with many approved medicines, physicians developed an alternative regimen and published numerous papers in medical journals showing that it was effective and expedient. At many clinics, women now receive a lower dose of misoprostol, and are allowed to self-administer it vaginally at home. For many women, the allure of taking the second drug at home is that it allows them more control over the process, greater privacy, and a more comfortable setting.
A medical abortion mimics a natural miscarriage, in which most women experience something akin to a severe menstrual period, with up to two weeks of bleeding and cramping. Because it's a lengthy process, and because cramps and bleeding can indicate either normalcy or possible trouble, groups such as Planned Parenthood operate 24-hour hotlines for patients.