The movie Juno, released in 2007 and directed by Jason Reitman, enjoyed wide popular and critical acclaim despite a minuscule production budget. Like the Blair Witch Project, it became a sleeper (no pun intended) hit, eventually winning an Academy Award for best original screenplay. The show deals with teen sex and pregnancy, which obliquely involves family medicine, so I guess I have some reason to talk about it other than the fact that I did like the movie.

Juno is a 16 year old girl who gets pregnant after a tryst with her longtime best-friend and occasional boyfriend (depiction of the act is repeated, but tasteful and not gratuitously revealing). She initially chooses to have an abortion, but decides against it after a rather uncomfortable experience at the only local clinic that performs the procedure for free. Instead, she decides to put the baby up for adoption, and chooses a wealthy couple desperately seeking a child. The story dispenses with much of a dramatic climax – other than to require some very adult-like decision making by Juno. It turns out that the rich have their problems too, although their kind often crouch behind over-sized front doors, huddle in spacious breezeways or waltz softly in cellars devoted to past wishful glories. Juno’s parents weather the shock of her predicament well, with an admirable balance of reasonable judgmentalness and loving support. “I was hoping it was cocaine or shoplifting,” the step-mother confides to Juno’s Dad after they hear the news.

I can see why the screenplay beat out other brilliant scripts at the Awards. The writing credit goes to Diablo Cody – that’s a woman, not a an eternal being from the outer realms of darkness, or perhaps somewhere in Wyoming – who started her writing life as a stripper. Her imminently popular blog about the skin trade led to her contract to write Juno. Some wonderfully witty moments pepper the script, and deserve the attention they received. However, the actors rescue some lines that with lesser players would have devolved into jarring triteness. Credit the director for drumming up Ellen Page to play the title role, who herself borders on unbelievability, but is rescued in turn by moments of incisive honesty in her script. This symbiosis – script and actress relying the other – occurs regularly through the movie and probably saved the enterprise as a whole.

The depiction of the family planning clinic probably did not depart far from the reality. State-supported medical clinics tend to run heavy on the documentation and short on things like staff and, say, furniture. Given the number of teen-pregnancies my clinic deals with, I found the depiction of Juno fair and respectful. Not every teen is a bimbo with no grasp of consequences; there is nuance to many of their situations. That said, Juno exhibited a more sophisticated persona than most teenagers. Her sense of self and values was decidedly adult. In fact, we should be so lucky to have teens work through complicated issues like sex and pregnancy in such an honest and careful way. Many adults don’t rise to the level of emotional acumen we see in Juno. Frankly, much of America worships ardently at the altar of pleasure to the exclusion of anything or anyone else. Juno, like few of us at 16, and maybe even 35 or 65, spends most of her time focusing on her problems and solving them. Nary a misstep does she make after her single afternoon of what was, likely, something like 33 seconds of coital bliss in an over-stuffed red chair.

Fair or not, I enjoyed a cathartic moment when the step-mother – in the room with Juno and her best friend during her ultrasound – dresses down the tech for denigrating Juno’s situation. Chatty ultrasound techs have caused problems for more than one of my patients. In one case a tech hinted to my pregnant patient that something was wrong with the baby, “but I can’t tell you about it, you’ll have to talk to the doctor” (scan turned out to be fine but the woman had nightmares for the rest of her pregnancy). In other countries, OB ultrasounds are performed by the doctors themselves, and so can give an official read right there in the exam room. In the US, we have techs do it, who understandably become tempted after their 1000th scan to give the patient their own interpretation. Some techs are good enough that they’re usually going to be right, but legally they are required to keep their traps shut. Interpretation and commentary is NOT their job, acumen in that area be damned.

Humph! Anyway…

As a father, I watched the movie hoping I would know my daughters well enough to prevent them these kinds of dilemmas, knowing in all honesty that I won’t be the one doing any such thing. Hormones and pubic maturity arrive around 13 years of life, and from there I will be but a distant guide – one mild tenor in a chorus of influential voices. I also envisioned myself behaving quite like the father in the story – angry and protective but ultimately on-line and ready to help. God only knows if I could really manage such levelheadedness.

Politically, I knew that anti-abortion types would love the grim clinic scene and applaud the choice made by Juno to keep the baby. Many in the conservative right believe that pro-abortion forces are out to talk the rest of the planet into having the procedure – men too, if possible – and would DIE before they even discussed the alternatives to it such as adoption. My own experience with pro-abortion people suggests much more balance and pragmatism among them. Still, I did feel a sense of satisfaction on behalf of my pro-life friends in seeing a viable alternative to abortion played out step-by-step to a tenable – and preferable to all possible worlds, in this case – conclusion.

Juno glossed over the considerable emotional toll something like this must put on a young girl. The end scene is of Juno, back with her boyfriend (one assumes, also back in the sack, this time with a more proficient prophylactic). They sit idyllically in dappled sunlight on stairs leading into his front yard. Whimsically, they play guitars together and sing a melodic paean to teenage life. Consequences, perhaps lingering in soft shadows at the corners of the closing frame, hold no sway in this myth.

We should all be so lucky.