I really don’t know how to thank all of you.
Each of you played an important role in
making a very scary, negative situation a
positive one that resulted in a second
chance for me. I spent a week of my life in a
trance of dread and hopelessness, full of
fear. However, after my first visit to your
clinic this feeling began to fade. Everybody
was honest, in all aspects. Never did I feel
isolated, pressured, or alone. I can now go
on with my life knowing I made the best
decision, and I plan on making it one hell
of a life!
Former Patient
chapter nine
The day begins with the pager going off as I get out of the shower at six-fifteen AM. The answering service. I pull on my bathrobe while I call in. “It’s a woman who says she has an emergency,” the operator says. “I’ll put her through.”
All I hear at first is uncontrollable sobbing. Then a voice. “I’m pregnant! I have to talk to someone. I don’t know what to do!” Words between hysterical sobs.
“Take a deep breath, and give yourself a second so we can talk. I’m sure things are going to be alright.”
“But I’m pregnant!” she wails. “It’s not alright! What am I going to do?”
“You tell me,” I reply in a quiet voice. “Tell me what you are thinking.”
“I’m thinking that I cannot stay pregnant! I have to have one of those abortions.”
“Are you sure? There are a number of options you know. Have you thought about adoption?” I speak slowly and calmly, still dripping water all over the floor.
“No. No. No. I have to have one of those abortions. I can’t be pregnant. How many days will it take?” she asks, fear creeping into her voice.
“Days? The procedure only takes a few minutes.” I am once again amazed at the misinformation out there.
“But will I bleed a lot? Will I ever be able to have children again? Could I die?” the questions fire out in quick succession.
“Just a second. Take another deep breath, and let me ask you a few questions. Okay. Now, how overdue is your period?”
“Only a week,” she sniffles.
“Good. In a pregnancy that early you are really safe having an abortion. You’d be in the clinic several hours, but most of that time is spent in counseling and recovery. The procedure actually takes only five minutes and is very safe. It is, in fact, much safer than going through a full term pregnancy and delivery. And as far as future fertility, there is absolutely no medical evidence that suggests uncomplicated first trimester abortions cause infertility or miscarriages in the future. You will be just fine.
“The most important thing is your personal choice. This has to be your choice, not someone else’s.” She has been quiet, listening. Her breathing slows. She’s calmed down a notch.
“Can my husband come, too?”
“Of course he can. We encourage you to bring someone who will support you.” There is a pause.
“Are you feeling better?”
“Yes, I guess,” she replies, an obvious change in her voice.
We talk another five minutes. She tells me about having four kids at home, about her financial situation.
“Listen, if you are absolutely sure about this, you can call in after eight and make an appointment. Or come in, and we’ll just talk about it. You are in no danger. We’ll answer any questions you have and give you referrals for other options. This is entirely your choice. Okay?”
By the time I’m off the phone I’m already behind. No time for breakfast. I down a cup of coffee while I dress, strap on the pistol, grab the backpack with the ever-present camera and tape recorder in case I need to document something. I am not in the mood for the bulletproof vest and leave it behind. I go in streaks with the vest. It is such a solid reminder of the threats I get and the diligence I have to maintain. Oddly, the pistol in the shoulder harness has become a natural part of my existence, but the vest makes me feel more like a target.
I head out the door just as Tom drives up. We both routinely check the road as we drive out, looking for unfamiliar cars, parked cars with a person inside, pedestrians. If something looks out of place, I jot down the details in my notebook: license number, descriptions of vehicles or people. As we drive to the clinic, we check the cars behind us, watch down the alleys and cross streets. All this is automatic now, part of the way I think. We drive all around the clinic block, looking for anti-abortion bumper stickers, people standing on sidewalks who look out of place.
“Let’s use the front door, Tom. We’ve gotten in the habit of always going in the back way.”
He nods. “We might want to vary our arrival time, too. It’s been pretty consistent lately. Maybe tomorrow I can pick you up ten minutes earlier.”
Tom leads the way inside, always walks ahead. He is first in and out of the elevator. Everything is quiet. The clinic is dark, undisturbed.
I punch off the security system as I open up, and Tom goes with me through every room, opening doors, turning on lights, unlocking cabinets. I make a pot of coffee, look through the appointment book. There are days that I can tell will be abnormally hectic just by glancing at the appointments, but today doesn’t look bad.
“Okay, Sue. See you tonight. Call if anything comes up,” and Tom goes out. I lock the door behind him until another staff member shows up.
The first patient of the day is a fifty-seven-year-old woman who wants a routine checkup. She has been through menopause and hasn’t had an exam in three years. We go through the usual lab work and a physical exam.
“I’m glad you are here,” she says, and her voice trails off.
“There is something else, isn’t there?” I ask. “What’s on your mind?”
“Well, there is one thing,” she says rather quietly, struggling to go on. “Sex has become painful lately. It’s gotten so I’m not very interested anymore, and I wish I could do something about it.”
I sit down, and we talk about the effects of menopause, some possible solutions. By the time she leaves she is visibly relieved. This one question is really why she came.
An abortion patient is just going in to the counseling room with one of the staff. Her lab work is finished, and I have a short break. I call two doctors about patients I’ve seen in the last few weeks. Both have been in for their follow-up exams; both are doing fine. I call another doctor about a recent patient who had an abnormal Pap smear. I think about calling home before Sonja goes to school, but realize it’s already too late. Then I overhear the receptionist taking another call. Something in her voice makes me listen.
“I’m sorry, sir, but I can’t give you that information,” she says. “I can’t answer that.” A pause. “I’m sorry you feel that way.” Her voice is increasingly firm. “I can’t help you. I’ll give the doctor your message.” By the time she hangs up I’m standing next to her.
She points to an entry in the appointment book. “That was a man calling about this person right here. He said he’s her uncle. He knows she’s coming in, and he knows when her appointment is. He kept saying to tell the doctor if he kills that baby, he’ll pay. He just kept saying, ‘You better not kill that baby. That girl’s too young.’”
The rest of the clinic staff have gathered by now, questioning, the level of anxiety rising. Then the phone rings again. The receptionist listens for several minutes, hangs up the phone, and turns to us. “That was the girl’s aunt this time. She’s on the way here. She said she forbids us to ‘kill that baby.’ She forbids us to even talk to the girl and says she is coming right now to stop us.”
Everyone looks at me. “First of all, it’s not their right to choose for her. It’s her choice, and that’s that.”
“But they said they forbid it!”
“It’s not theirs to forbid,” I add firmly.
I walk away briskly, go into my office, and close t
he door. I need to gather my thoughts. My reaction was certain, but visceral. I need to get it together. This is my call, my challenge.
“I’m sorry I walked off,” I say, when I return. “We need to be in control of this. If the patient comes in, she goes right to the back. I don’t want her sitting in the waiting room. We’ll do the lab and counseling in the back and not send her into the waiting room between times.” Everyone is nodding in agreement.
“Okay. We need to call the police. Tell them we have a potential confrontation developing and that if we call for help it won’t be just for a few hecklers out front. And erase her name from the appointment book.”
There are several patients in the waiting room. I go out to talk with them. “There’s a chance there will be some trouble with a patient’s relative today. It has nothing to do with any of you, and it probably won’t amount to anything, but if we ask you to move to another place, it will be for your safety. Please do as we ask, and do it quickly. And please, whatever happens, don’t get involved.”
“Okay, let’s not let this distract us,” I say to the staff. “No use worrying before anything happens. We have other patients to care for.” As I head back through the office, I detour to a window overlooking the street. No protesters yet. Quiet outside.
Just then I hear the door open, and my instincts tell me it is the young woman in question. I get to the front just in time to hear her give the receptionist her name. I reach across the counter and touch her hand lightly. “Come on back with me,” I say, “and bring your friend along.” She and a girlfriend have arrived more than an hour early, having driven almost 150 miles. I bring the two of them into my office and close the door.
“We need to talk.” I tell her briefly what has happened, see the weight of her dilemma settle on her. “Is your boyfriend with you?”
“No,” she says. “He stayed home and went to work so everything would look normal. He works at a sawmill with my uncle. Somehow my uncle must have made him talk. This means I can’t do it, doesn’t it?” She is crestfallen.
“That is not at all what this means,” I reassure her. “This is your decision and nobody else’s. It’s good you’re here early for the appointment. But before anything, I need to know if you’ve thought through your decision, if you’re completely sure about ending this pregnancy.”
“Are you kidding? I can’t be pregnant. I have a full scholarship to college starting this fall. There is no way. It would mean giving up everything. I’ll have kids when I can take care of them.”
Her demeanor reinforces what she says. She is unwavering, self-confident, mature. “Mark and I have talked it over a lot. This is what I have to do!”
“Do your parents know?”
She shakes her head.
“What would they say?”
“I thought about telling them. I know they would have been upset, but I think they’d probably support me. I just didn’t want to hurt them. Now my uncle has probably told them. Can he stop me? He is just such a fanatic about some things.”
“No, he can’t. He can’t decide this, and we won’t let him interfere.”
“He’s an awful man,” she says. “He could hurt someone.”
“Let us worry about him. You’re our priority patient right now, and we need to get your counseling and lab work started. Perhaps we can get you out of here before they arrive, if they really are on their way. In any case, we’ll keep you back here, out of sight.”
The staff starts working on her lab tests. Another patient has finished her counseling and is ready for her abortion. I try hard to maintain an everything-is-normal manner. Before starting the procedure I make a call to a lawyer in town who, when I first opened the clinic, made a point of offering his services. I fill him in on what’s happening. He promises to stay available, tells me to be careful. After I hang up, I readjust the shoulder harness on my pistol, feeling its heavy presence under my scrubs.
So much for an uneventful day, I think, as I go into the procedure room. All the way through that abortion I listen for the sound of the office door, for angry voices.
By the time the first patient is in recovery, we’re ready to go. Her chart is straightforward. She has gone through the informed consent form and signed off. Her vital signs are perfect, and she has no medical history to worry about. I close the chart and enter the room where she is waiting for me.
“Okay,” I start out, when I get inside. “Let’s forget all about your uncle. He has nothing to do with this. Have you had all your questions answered? Do you understand the procedure? Have you had any other surgeries or any condition we should know about?”
Given the stress she is under, she is very articulate and very steady. We review things quickly but thoroughly. She shows no doubts.
“I’m going to step out now while you undress from the waist down. When you’re undressed you can sit on the end of the table and cover with this drape.”
I close the door and walk back to the window again. Still quiet outside. I check the waiting room, give the receptionist a squeeze on the arm before I go back.
“Before we start, I want to ask you again: Are you absolutely sure you want to have this abortion? Is there anyone pushing you or telling you to be here? Is this really your decision?”
She is sure.
She lies down for the ultrasound. “That’s your uterus,” I point to the screen. “Here’s the fetal tissue. It looks normal for about five weeks gestation.” There is a small sac attached to one side of the uterine wall.
“Now I’m going to do a regular pelvic exam. I’ll touch your leg so you’ll know where I am. I’m feeling inside for your cervix.” At the same time I palpate her lower abdomen. “There is your uterus,” I push down gently. “It feels really normal, maybe tipped back just a little. Is there any tenderness there?” I move my hand and press over her ovaries.
“Now we put these sterile drapes under you.” I ready the instrument tray and sit at the end of the table. “I’ll be using a speculum. It won’t hurt, and it’s all warmed up already. It just allows me to see your cervix and create a space to work through. If you have any questions at any time, please ask.”
“I’m looking at your cervix now. Everything looks just fine. I’ll clean the cervix and take a culture with a swab.”
As I work, my assistant, a nurse, holds the bottle of lidocaine so I can draw it up into a syringe. “Most people don’t feel these shots at all. If you feel anything, it will be a little pinch. First I numb the surface of the cervix. Now I can hold your cervix with an instrument that keeps everything steady while I put in two more injections. Tell me if you feel anything at all. There. That’s that. Did you feel anything?”
She shakes her head.
“Now we’ll let that numb up a minute. You take some big, deep breaths. Try and relax.” My voice is a constant monotone. Even if there is nothing to say about the procedure, I talk about anything. The weather. How school is going. Where they work. How the drive was. Just keep talking with that soothing voice. I have changed into a new set of sterile gloves now and start explaining the next stage of the process, reinforcing what she has already heard in the counseling session. Always talking.
“These are the dilators.” I show her the instruments. “When I use them, you’ll feel a little tugging, but it won’t be painful. I insert and then remove these gently, one at a time, in increasing size, until your cervix is dilated to about the diameter of a pencil.” As I talk, I start the dilating. “When a woman delivers a baby, her cervix is dilated to ten centimeters. We’re dilating your cervix to just seven millimeters, which is less than one centimeter. Keep your bottom muscles loose. But, please, if it does feel painful, let me know. I will stop and put in more pain meds. Now, another dilator. Take a deep breath in; hold it a few seconds. Now exhale, long and slow. Keep relaxing all your muscles. Good. One more now. Keep breathing.” I find myself breathing along with her, as is the nurse.
“Any questions? Doing okay?” Always the same
steady, soothing cadence to my voice.
“I’m fine,” she says. My instruments clank softly on the tray.
“Okay, your cervix is dilated.” As I say this, the nurse hands me a small, sterile tube attached to a device that creates a gentle suction. “This will feel really weird. That’s the only way to describe it. It will be like a bubbling inside you, and you’ll feel movement from the instruments, but very little pain. We suction for thirty to forty-five seconds.” The machine always makes me think of an old refrigerator, that same deep hum.
When we finish, I rub her lower abdomen gently. “You may feel a strong deep cramp,” I tell her. She nods emphatically. “That’s good. It’s your uterus contracting down, shrinking again. It’s a good sign. Just keep breathing deep; relax.”
I check the inside of her uterus with a curette, a small looped instrument, and finish with another ten seconds of suctioning. She handles it well, and soon I am picking things up, and the nurse is checking her blood pressure and pulse.
“It’s over?” she asks. “Really, that’s it? I’m not pregnant anymore? That isn’t anything like what I heard it would be.”
“Once in a while someone has a difficult abortion,” I say. “But it is almost always someone with a fibroid growth or preexisting infection. Most are like yours.”
While the nurse escorts her to the recovery room, I take the fetal tissue to the lab. Still no sign of trouble in the office. I remove the quarter-sized sac from the jar. It is filmy with placental tissue and some of the endometrium that normally sloughs off. All normal.
I always give patients the option of seeing the tissue if they want to, and this woman wants to see it. “That’s all?” she says when I show it to her. She escapes into her own thoughts for a minute and looks at me with hesitation.
“What is it you’re thinking?” I prod.
“How can it be that my uncle believes I am less important than that tiny bit of tissue you just took out of me?”
She isn’t expecting me to respond. She is talking to herself, trying to put her world in order. I sit quietly with her for a few minutes.
This Common Secret: My Journey as an Abortion Doctor Page 11