In the hallway we confront the suspicious glare of the aunt and uncle. “We’re closing up now,” I announce. “You can sit here a little longer if you want, but the building closes soon.” They say nothing as we troop past.
Tired and preoccupied as I am, I can’t afford to give in to it. I read every stranger’s face in the corridors of the building, study the cars in the lot. We drive a new route home.
“More bad letters in today’s mail?” Tom asks.
“One. But I didn’t have time to dwell on it. I hardly read it—just put it in the file.”
We idle in the driveway and make arrangements for the next morning. Then I’m done.
But I’m never really done. When I go to a movie later that evening, I see one former patient in the ticket line, another in the lobby. We make eye contact. One of them says “hi” in a whisper. I let them lead these interactions. Sometimes they give me an update on their lives; sometimes they ignore me; most often there is that moment of strong eye contact, a brief nod, our confidential bond, then on with our lives.
Very late at night the phone rings—1:30 blinks at me from the clock as I grope for the phone. “Dr. Wicklund? There is a woman on the line. She says it’s an emergency.” It is never over, I think, waiting to be put through, waiting to find out what kind of an emergency it might be. Then I realize that the day did end and that this is another, new day.
A 2006 Congressional investigation of
federally funded “Crisis Pregnancy
Centers” (CPCs) found that CPCs routinely
misinform clients about health risks
associated with abortions. CPCs are often
affiliated with anti-choice organizations and
have received more than thirty million
federal dollars between 2001 and 2005. Of
twenty-three CPCs investigated, twenty
provided false or misleading information
unsupported by scientific evidence. These
CPCs claimed that there is a link between
abortion and breast cancer, that abortion
harms a woman’s future fertility, and that
abortion increases the risk of severe mental
health problems. The Congressional report
found that CPCs are engaging in an
“inappropriate public health practice.”
chapter ten
I fired up Betty at five AM on a Thursday, aiming for the starting blocks at the Cambridge High School pool a thousand miles away. I had twenty hours. I figured that if everything went smoothly, Betty could manage a fifty-mile-an-hour average, which would put me there on Friday afternoon with about an hour to spare. Betty and I wheeled into the parking lot with more like ten minutes of cushion.
Sonja was delighted. Her hug just about erased the road fatigue, and before I was ready, I was suited up and aligned with the rest of the sacrificial parents waiting for the start pistol. That the parents lost was a foregone conclusion. That I was there for Sonja was the triumph. Randy sat poolside, cheering for both of us.
Within days I was back on the same highway, driving into the sunset. I often drive without music or news on. I let the land flow past, the miles accumulate in my wake, and my thoughts roam. This is when I do some of my best thinking, sorting things out, and occasionally, stumble across a revelation. The warmth of my visit with Sonja and Randy faded in the distance. North Dakota spread ahead for hundreds of miles. My thoughts centered more and more on the many obstacles that get in the way of my direct interaction with patients, layers and layers of obstacles.
Legal and political distractions are a constant, energy-sapping aspect of my medical life. Right from the start of my career, and on an almost daily basis, I have been interrupted, distracted, and sometimes prevented from going about my work by legal skirmishing and political meddling in patients’ lives.
A significant part of my work routine is tied up with phone calls to lawyers, appearances in court, and strategy sessions devoted to interpreting laws and coping with the latest challenge. Some of it is intensely personal and threatening, like testifying against letter-writer Michael Ross and even having to read his letters out loud to the jury. Much of it is so petty and ridiculous that it would be comical if it weren’t such a nuisance and if it didn’t have the effect of making the choice to end a pregnancy so fraught with roadblocks.
Protesters routinely take pictures of patients coming to a clinic, for example. Once, a friend of mine was visiting and decided to go outside and see how the protesters felt about her taking their pictures. The protesters called the police and the newspaper. The next day the local paper ran a story featuring the mystery woman taking pictures outside the clinic. Of course, the story never mentioned the picture-taking habit of the protesters.
While I worked in the Fargo clinic, protesters blatantly defied a court injunction banning them from being on the sidewalk in front of the doors. Once, out of frustration, the director turned on sprinklers to spray the walk. The protesters had the gall to call the police and report us. Worse yet, the police had the gall to cite us. A small thing, but unbelievably distracting and maddening.
Anti-choice politicians have enlisted in the battle. Laws and restrictive amendments are constantly being introduced. When a bill’s passage looks problematic, it gets attached at the last minute to a broader measure. The legislation may be too vital to delay, so it will pass, saddling women and clinics with the ramifications. In recent years, state and federal politicians and judges have become increasingly brazen in their efforts to outlaw abortions altogether, subpoena clinics for their records, or place restrictions on clinics and patients. The Wisconsin legislature came very close to passing a law that would have banned the University of Wisconsin Student Health Care system from discussing anything about abortion with their students seeking information on pregnancy options. Even passing on phone numbers or names of abortion providers would have been illegal.
During the summer of 2006, Congress considered several draconian measures under the headings of the Child Interstate Abortion Notification Act (CIANA) and the Child Custody Protection Act (CCPA). Among other things, these proposals would make it illegal for someone other than a parent or legal guardian to transport an abortion patient across a state line. A grandmother, boyfriend, clergy, or older sibling would be risking arrest by doing so. In addition, the patient would have to satisfy regulations such as parental notification or mandatory waiting periods for both her state of residence and the state where the procedure is performed. If the patient wanted to seek a judicial bypass, she would have to do so in both states.
On a local level, anti-choice candidates have quietly become the majority on many school boards and county commissions, where they work to pass policies outlawing sex education in schools or declaring abortions illegal in their jurisdiction.
Some of the political maneuvering sounds innocuous or even positive. Of course parents should know about a daughter’s pregnancy decision. Who would object to that? But what if that pregnancy is the result of incest, or the family has a history of domestic abuse? It also seems reasonable to consider a choice as weighty as abortion for at least a day. The fact is that the notification process burdens women with logistical, professional, and financial difficulties that in some cases make the abortion impossible.
No other medical procedure is shackled by such restrictions. Tubal ligation, vasectomy, and even open-heart surgery rely only on the discretion of a physician in consultation with his or her patient.
Much of the debate is couched in misleading and untrue statements. Embryonic tissue is referred to as an “unborn child.” Breast cancer, infertility, and mental illness are commonly, and incorrectly, associated with abortions. It isn’t uncommon for me to have to disabuse patients of the notion that they will be “scraped with a razor” during the abortion procedure.
The hyperbole can emanate from the highest levels of government. In July 2006 President Bush’s press secretary replied that
the president “doesn’t condone murder” when he was asked why Bush would not support embryonic stem-cell research using frozen, unclaimed embryos.
The result of the pitched, moralistic battle is that abortion services have become marginalized within the medical community. Insurance policies often won’t cover abortion services, although they routinely fund Viagra and similar drugs. Medical students are sent literature from anti-choice groups warning them to avoid training in abortion protocol. Many private medical practices forbid their partners to perform abortions. In the end, less than 10 percent of all abortions are performed in hospitals or in private physician’s offices.
All that aside, the logistics alone make an abortion tenuous. I had a patient once who lived on an Indian reservation in northern Montana. When I examined her, I found scarring and cuts on her cervix. She had tried repeatedly to self-abort because she had no money and no vehicle, and the nearest clinic was a three-hundred-mile trip. Her aunt found out about her condition, scraped together funds, borrowed a dilapidated vehicle, and brought her to my clinic.
Many clinics are only open one day a week or several days a month. They get booked up weeks in advance. People may have to travel four hundred miles by car. They miss work, have to borrow money. By the time they are able to put together the resources to accomplish an abortion, the pregnancy is usually several months along.
Frivolous malpractice suits or assault charges brought against escorts are almost always overturned. Judges scold the plaintiffs for wasting court resources. But that isn’t what the public remembers. The media reports the slanderous charges, blares them in headlines. That’s what lodges in the public mind. By the time charges are dropped, years later and after significant expense, it is stale news buried in the back pages.
The choice community has its share of triumphs in the war, but they hardly ever feel triumphant. Pledge-A-Picketer campaigns raise money through local citizens pledging money for each picketer who appears before a clinic. The money is set aside for indigent women. At the end of every month a newspaper ad thanks the picketers for raising so much money and helping needy women get abortions. It doesn’t take long for the picketers to evaporate.
During the summer of 1991, in Appleton, Wisconsin, Operation Rescue waged a massive and lengthy sit-in at a clinic. They chained themselves together in front of the doors, chanting, “Mommy, don’t kill me!” and pounding on the walls. Some protesters superglued their hands to the front doors. Court costs sapped the clinic budget to the point that staff could barely be paid. Local politicians took sides against abortion or remained silent.
Desperate, clinic owner Maggie Cage ran a full-page newspaper ad.
Where are you? Where are all the people we’ve helped over the years? We need you now. When you needed us we were there. We held your hand and supported you. We see you in restaurants and at the grocery store, at PTA meetings and softball games. You are the business people, the school officials, the politicians, the voters. We kept you safe. We held your secrets. But now we need help. Where are you?
The outpouring of support was overwhelming. Women wrote apologetic letters chastising themselves for being apathetic. They vowed to fight for the clinic. Financial donations revitalized the budget. The pro-choice community was revived.
The triumphs, reassuring as they are, have a bittersweet taste. Why should the fight be necessary in the first place? The time and resources squandered fighting the battle could be used to help women and provide more complete reproductive health care. And the bottom line? How many women, people who never appear in any statistical analysis, have been denied their fundamental, legal right to control their destinies because of legal restrictions or impossible circumstances imposed by the anti-choice onslaught?
I was walking from the lab to the front waiting room when I was stopped by one of the counselors. She had just finished “pre-court counseling” with a seventeen-year-old and wanted to talk to me.
“She is everything we want our daughters to be,” she said. “Top of her class, plays volleyball on the varsity, has college plans for the fall. She even teaches Sunday school. But she is really torn up about telling her parents. She had a positive pregnancy test nearly six weeks ago and knew immediately that she wanted to end the pregnancy.”
“It sounds like she comes from a solid family,” I said. “Why can’t she talk to her parents?”
“Her older sister had a baby out of wedlock two years ago. Her parents were outraged, took away all financial support, and told her that the only thing worse would have been to have an abortion. The sister moved away and is living a rough life as a single mom. This girl isn’t ready to be a mother. She doesn’t feel like she can confide in her parents. She’s decided to go for a judicial bypass.”
“What’s your concern then?” I asked.
“Her periods have been irregular. She and her boyfriend used condoms, but she still got pregnant. I’m concerned about how far along she is, and how long the court bypass procedure might take.”
“Okay, let’s do an ultrasound and find out.” I started toward the counseling room.
“Hello, Carol,” I said to the young woman. “I’m the doctor here today, and I’ve been hearing about your situation. How are you doing?”
“I just wish I could be done with this,” she sighed. “I’ve been thinking about this for more than a month, and I’m positive about my decision.”
“I know, but we have to follow the law, whether we agree with it or not. According to the law, you either have to notify both parents about your abortion, or you have to go through the courts to get a judge’s permission.”
We talked more about her life, her college prospects, her sister’s plight. Then I suggested the ultrasound so that we could know precisely what time frame we were working with.
“I have to tell you,” I said. “We only perform first trimester abortions at this clinic. If you’re farther along by the time you get the court’s permission, you’ll have to go somewhere else, spend a good deal more money, and have a more involved procedure.”
She nodded.
As soon as I saw the ultrasound image, I knew we were close to the cutoff. She was twelve weeks along. We had one week to complete the court requirement and schedule an abortion.
Carol left with the information she needed to make her court appointment, and we scheduled her in to an already busy day, a week later.
Four days later she called the clinic in tears. “The judge cancelled my court case because of a family emergency,” she said. “By the time he comes back, it’ll be too late!”
In this case, the clinic manager stepped in and called a neighboring county to arrange a court appearance. As it turned out, Carol was able to get her permission from the court and finally go through the procedure.
Afterwards, I visited her in the recovery room. She was sobbing.
“Carol,” I said, putting my hand on her arm, “Are you cramping?”
“No, no, not at all,” she wiped her face, struggled to compose herself.
“Do you feel like you made the wrong decision?” I held my breath.
“Absolutely not,” she said. “The problem is that I’ve missed two days of school last week and three days this week. I’m way behind on homework, and I know the school will let my parents know that I’ve been gone. I’ll have to tell them something. I just don’t know what.”
“Wouldn’t it be better to just tell them the truth?” I asked.
“Oh NO!” she said, shrinking away. “After what happened to my sister? Are you kidding? I could never do that.”
Without the parental consent law, Carol would have had her abortion a month earlier, missing one day of school. For young women with families they can talk to, the law is unnecessary, even insulting. In thirty-four states, however, for women like Carol, parental notification regulations only worsen an already tenuous and stressful time and perhaps complicate their lives to the point that an abortion becomes impossible.
•
Informed consent provisions specify that the doctor who will perform the abortion, or, in some cases, an agent of that doctor, has to contact the patient either face-to-face or by telephone and inform them on a variety of issues identified by politicians who have little or no knowledge of the actual procedure.
Some states require that a specific script be read to the patient. The text is often laden with hyperbole and emotionally charged language, referring to an embryo as an unborn child, for instance. The required information can include inaccurate references to fetal pain, a reminder that the father will be required to provide child support, and an encouragement to review materials on other options provided on a state-sponsored website. A thorough discussion of risks associated with the procedure is also mandated by law.
After that, the patient has to take twenty-four hours to think about her decision. Only then can she legally have an abortion. The penalties for not following these laws range from significant fines to prison sentences.
I spend many hours in the evenings and early mornings calling patients to provide them the information mandated by law so that they can avoid an additional trip to the clinic and absences from school or work. Putting all the information into context and explaining the bigger picture take a tremendous amount of time.
If I tell a woman that she could die from the abortion procedure and leave it at that, it scares the bejesus out of her. If, however, I explain that there is a higher risk of complications from wisdom tooth extraction, it puts the statement into perspective.
It isn’t uncommon to play phone tag or fall prey to unforeseen problems that cause us to miss our phone session. Those patients may lose their appointments altogether or have to delay their procedures because we can’t connect.
This Common Secret: My Journey as an Abortion Doctor Page 13