Early in my career, I had occasionally called my mentor, Jane Hodgson, the doctor who had taught me so much. Dr. Hodgson died in 2006 at the age of ninety-one. She was a legend in the field of women’s reproductive health and lived on the raw edge of the battle. She was also a gentle and soft-spoken woman, with clear insights and quiet authority. Whenever I had a unique case—a difficult fibroid or cyst, a woman with a systemic illness that might complicate things, a patient with an unusually tight cervix—I’d call to discuss my approach.
Inevitably, those phone conversations went beyond simple procedural advice. In the margins, we also talked through my motivations, the realities of the path I’d chosen, the impacts on my personal and emotional life. Over time, though, as I became more experienced, those calls diminished, then ceased.
Later, before she died too young of a brain tumor, I used to call Dr. Liz Karlin. I had helped train her so she could take over for me at the clinic in Appleton, Wisconsin, and she was an outspoken advocate for women’s rights. She lessened the gravity of my situation with her irreverence and humor. She was once quoted in an op-ed story as saying, “Until abortion rights in this country are assured, no penis should be allowed to enter another woman!”
The solace of phone contacts and an occasional meeting can’t overcome the reality that I am part of a far-flung culture within the medical community. We are outcasts, bonded by our commitment, valued and shunned for our services. Each of us manages our personal high-wire act. It is a solitary show. From time to time we hear about each other. Almost always, when we do, it’s bad news.
Dr. Tiller, for example, who runs a clinic in Wichita, Kansas. He endures the daily barrage of picketers, puts up with the mundane, but onerous, harassment. He and other doctors who work at his clinic are followed home by picketers. Their families are hassled, their neighborhoods leafleted.
One day in 1993, Dr. Tiller was in his car in the parking lot outside his clinic when he noticed a woman approaching. He recognized her as one of the Lambs of Christ. She strode up to his car window, pulled out a gun, and shot him. Dr. Tiller only had time to raise his arms over his head. The bullet went through both arms, but missed his skull.
The very next day, Dr. Tiller returned to his clinic and went back to work.
“I was really lucky,” he told me. “It was a small-caliber gun, and she was a lousy shot.”
Dr. Leroy Carhartt, from Nebraska, began providing abortions after retiring from surgical practice and a twenty-one-year career in the Air Force. As a young doctor, while abortions were still illegal, he had seen hundreds of women in surgical wards, many in critical condition, some dying, from botched and illegal abortions. At the end of his working life, instead of retiring, he took up clinic work out of his belief that women should be able to have safe and professional abortions.
In the fall of 1991, his home and horse barn were set on fire and completely gutted. Carhartt escaped in his car with only the clothes he was wearing. Seventeen horses, and several family pets, perished in the flames. Despite the fact that the fire was started simultaneously from seven different locations on his property, no arson charges were ever filed. The next day, Dr. Carhartt received a letter from an abortion protester who compared the death of his horses to the “murder” of babies in clinics.
In response, Dr. Carhartt increased his practice from part-time to full-time. Even now he refuses to wear a bulletproof vest. “The antis know enough by now to just shoot for the head,” he says.
Not every doctor, and not every family, can take the strain. A physician I knew in southern Wisconsin quit providing abortions in response to the anti-choice tactics directed at his family. The protesters followed his wife to the hairdresser, where they harangued her and the other clients. They picketed the garage where he had his car serviced, followed his kids to school, hung posters around town accusing him of murder. In the end, it was too much. His family couldn’t stand the pressure. Who could blame them? He made a public announcement that he would stop providing abortions.
Dr. Warren Hern operates a clinic in Boulder, Colorado. His clinic has been one of those targeted by Operation Rescue. Randall Terry, the national leader of that organization, publicly prayed for Hern’s death during the protest. One day five bullets were fired through the front office window.
He and I talked about the struggle to maintain balance in our lives. Dr. Hern frequently travels to South America to do research on native cultures. It is his stress release, along with his writing. He has published articles and books on many topics, including reproductive medicine.
Protesters targeted my friend Liz Karlin after she began her own clinic in Wisconsin. At one point, extremist picketers held a vigil outside her home in Madison. For hours they marched around and around her house. They believed that they could make her walls tumble down by divine intervention, like the walls of Jericho. In her case, it only galvanized neighborhood support for her work.
Every one of us knows that we are likely on a hit list, that we are watched, our families are monitored, and our personal information is circulated by enemies who wish us harm. Being the target of deranged armed fanatics comes with the territory. The fact that self-appointed vigilantes are out to get us, and that we can’t always count on protection from our legal, political, and law enforcement agencies, is the harsh, daily price all abortion providers pay to continue working.
I had accepted those terms with eyes wide open. For years I vowed never to bow to the pressure, never to miss a day of clinic due to the protesters. Part of my core resolve was fueled by a stubborn refusal to give the anti-abortion zealots any measure of satisfaction, any claim to bringing my work to a stop.
But was stubbornness enough to keep me going? For me, it no longer had anything to do with threats and intimidation. It wasn’t a battle with protesters anymore. I had lost my own clinic. I had spent years shuttling back and forth across the country for work and family. I was exhausted. I was torn. And, while I continued to provide abortions in St. Paul, it was more and more obvious that my employer didn’t value my services.
Other people, most people, make job changes. Did I have to keep providing abortions all my professional life? Why shouldn’t I explore other possibilities? Why shouldn’t I enjoy a more normal existence? I had other interests, other potential—why not?
Friday morning. A work day in St. Paul. I was heading into a room to go through the informed consent material with a young patient who did not speak English. One of the staff came with me to serve as a translator.
The patient had been driven almost two hundred miles for this face-to-face appointment necessitated by the language barrier and by the state law mandating that she receive scripted information about abortion twenty-four hours before her procedure. Her abortion was scheduled for the following day, and she would have to make a second round trip for that.
During our stilted conversation, it became clear that, because of an abnormal last menses, she could very possibly be at least a month further along than anticipated, in which case we wouldn’t be able to perform her abortion. The best way to verify her status was to do an ultrasound.
Without thinking, I reached up to turn on the ultrasound machine. A staff member in the room interrupted me. “She’ll have to pay for that today, you know. If she can’t pay, you can’t do it.”
“Look,” I said. “She has traveled almost four hours to get here. She’ll do the same tomorrow. She’ll be paying for her abortion then, and the cost of the ultrasound is included in her fee.”
“I know, but clinic policy is that she has to pay today or wait until tomorrow.”
I could feel myself heat up. This sort of bureaucratic nonsense in the face of common sense drives me nuts. I tried to stay calm. “If we wait for the ultrasound, and it turns out she is too far along for us to do the abortion, she’ll have to make another eight-hour round trip to a different clinic whenever she can make an appointment there! If we can determine her status right now, using the ultrasound th
at is a normal part of the abortion procedure, we might save her that trip, not to mention days off work, childcare expenses, and all the anxiety.”
I was talking to a wall. The staff person just shook her head.
I excused myself and went to talk to the clinic manager. She was sympathetic but said her hands were tied. Orders from administration, she said. No one was to receive services without paying for it on the spot.
I pleaded, but it got me nowhere. I went to the next level, an administrator who was involved in establishing clinic policies and who happened to be there. I recapped the story, stressed the burden it would place on the patient. “There is no real cost to the clinic to use the ultrasound,” I argued. “The machine is right there, and I get paid nothing for doing an ultrasound reading.”
“No,” she said.
I looked at her for a second; then I lost it. I needed an interpreter to talk to these people, not the patient. We had such completely opposed priorities. I couldn’t believe they didn’t understand the situation and the absurdity of their inflexibility.
“Can’t you see what this means for this patient?” I blurted out.
“We simply can’t give away services,” she repeated.
“I really don’t believe anymore that you care as much for the patients as you do for your salary!” I whirled around, slammed the door, and returned to the patient. I’ll be the first to admit that the anger I expressed was unprofessional.
Back with the patient, I proceeded to conduct a pelvic exam to help date the pregnancy. It wasn’t as good as an ultrasound, but it would give me an approximate time frame. I was tempted to ignore the administrator and do an ultrasound, but I resisted the impulse.
I hadn’t asked permission to do the pelvic exam. I knew full well that it was a service patients would normally be charged for, but I didn’t give a damn. I couldn’t imagine that they’d fire me for a procedure so clearly in the best interests of a patient.
At the end of the day I left for home in a despondent mood. Several of the staff had come up to me to express their support, but I was butting my head against a wall when it came to the management. I lamented the memory of the clinics I’d worked in fifteen years earlier. Where were people like Maggie Cage and Susan Hill? The warriors who knew that the bottom line was the women we served, not some board of directors riveted to the profit/loss spreadsheet.
I ached for my own clinic, where every staff person had a voice, where no patient was ever turned away for lack of resources, where I could face the trials of each day in solidarity with staff and patients. I drove through the city traffic, into the more rural countryside, seeing nothing, spinning with thoughts and emotions.
On Monday morning the clinic called. One of the administrators was on the line. “Your services are no longer needed,” she said, without prelude. “Your contract is terminated, effective immediately.”
At first, no one would give me a reason. “We aren’t required to give you a reason,” they said.
Eventually some vague pretense involving insurance coverage was offered. Everyone knew differently, but I had no recourse. I had worked there for sixteen years, off and on. I had an extremely low complication rate. I had been named the Physician of the Year by the parent organization just four years earlier. I had watched five clinic managers come and go. I had helped fashion clinic protocols and train new staff. Now I’d been fired for putting a patient first.
Within days I was driving west to Montana.
Sonja and I had been in the car together more than four hours. The vehicle dipped and curved along the quiet Montana highway. The spectacular, mountain-rimmed scenery of the Seeley-Swan Valley scrolled past. We talked nonstop, racing from topic to topic, only breaking the flow to exclaim at another incredible view. It was a glorious summer day to spend with my grown-up daughter.
Inevitably, the book I was writing came up. I knew we would come to this, but when we did, I felt my hands grow clammy. I gripped the steering wheel. The mountains blurred.
We had already talked a little about the project. I had told Sonja that there were things revealed that she didn’t know about, perhaps some things she would find hard, including a story about Flower Grandma.
“Of course I don’t know everything that’s gone on all these years,” she had said, “but whatever it is about Flower Grandma, I’d like you to tell me first, before I read it.”
Now it was time. Briefly, I thought about some way to escape, some way to avoid telling her. I even considered putting the book project on hold, anything to avoid confronting her with this difficult truth about the great-grandmother who had meant Swedish pancakes and fresh cookies and soft, loving hands . . . who had meant everything to Sonja.
“Mom?” Sonja brought me back.
I couldn’t get out of this. No escape. Now. I felt the warm tears start down my cheeks. I didn’t try to stop them. I knew I couldn’t. I took a deep breath, looked straight ahead. I reached over blindly, fumbled for Sonja’s hand, squeezed it tight. She squeezed back.
“Sonja. When Flower Grandma was only sixteen, her best friend got pregnant. . . .”
chapter fourteen
I took refuge in the smell of sage, in the dry winds, in the sharp ridges of the Bridger Mountains, in the home I’d built between Montana mountain ranges. I holed up, lost myself in chores and projects. Whenever my thoughts returned to the shock of losing my job, or to the decisions that would dictate my future, I headed out the door, got my work gloves on, and walked down the dirt road. For entire afternoons I occupied myself making tiles in a neighbor’s ceramic studio. Weeks went past in the flurry of distractions and in my determined state of denial. I wasn’t ready to cope.
Then, one evening, I was cleaning out a closet when I happened on a box of stuff I hadn’t looked at in years. It was jammed with old journals, scrapbooks, letters from patients, news clippings, copies of speeches I’d given. On impulse, I carried the box to the couch under my big window, turned on the lamp, and dove in.
A journal entry nearly a decade old took me back to a dance I’d gone to with a friend in Bozeman one night. We were in a funky bar, dancing to ’70s rock ’n’ roll tunes. At one point I noticed that my partner had backed away. I looked around. I was encircled by five women. They were smiling at me. Some of them looked familiar. Then the recognition kicked in. They were former patients of mine, women who had come to my clinic. They were paying tribute, dancing with me, around me, locking eyes, saying thanks. None of them said a word. We smiled at each other, danced together through the song, and then they moved off again, back to their partners, their lives.
I pulled out a fat scrapbook compiled by the staff of Mountain Country Women’s Clinic, full of patient stories, pictures of the office, news clippings from the Michael Ross trial, a photo of me sitting on the witness stand, testifying. I found myself turning the pages, alternately crying and laughing.
I went through the box but still wasn’t satiated. In another container I found my old journals. Every evening for days I returned to them, some of which went back to my medical school training. The emotions and events flowed through me again afresh. I was back with Sonja when she was a toddler, pulling her across campus in a wagon full of books. I was hiding in the guest bedroom at a friend’s house because I’d been barricaded from my home by protesters. I was marching at the front of a crowd of a million pro-choice supporters in Washington, DC. I was struggling through the palpable hatred of chanting antis at an airport, holding hands with a woman in that poignant transition after her procedure, coming home to a stranger’s muddy bootprints in my apartment, reveling in the exhilarating first days after opening my own clinic.
The immersion in memories made the pain and dislocation of the present shift into perspective. Fortified by the history held in that box, I put out feelers and started to brainstorm possibilities. I began to write again, letting it all out, confused and tangled as it was. I challenged myself to take the advice I’d given to so many patients over the year
s: it does no good to live by “what if” and “if only.”
Not only was it time to move forward, I couldn’t afford not to make a move. My finances were dwindling. Bills kept coming. I had to come up with something—and soon. Problem was, I didn’t know how.
I volunteered for some community events, gave a talk at a senior center about Alzheimer’s disease, joined a group who gave seniors rides to medical appointments, did some housekeeping, and picked up prescriptions. I wasn’t getting paid, but I was rejoining the world, meeting people, feeling useful.
I found out about a local women’s group in Livingston, Montana. They were dedicated to addressing a broad spectrum of social issues, ranging from education to tolerance. I started going to their meetings and showing up at their activities. Many of the women reinforced my own beliefs and values. I hadn’t realized how much I was craving a social and intellectual outlet.
Sometimes we met in someone’s home. Twenty or thirty of us would mill around, share a potluck meal, talk. Other times we gathered at the community library to hear a speaker. There was always spirited discussion. I drove home energized, thoughts zipping along, feeling empowered by the solidarity and compassion in the group.
At one meeting a woman came up behind me and took my arm. “Susan,” she said, “where are you working these days?” I’d known her for some time and had heard that she’d taken the job of medical director for an organization that ran a number of clinics in Montana.
“Ah, well,” I stammered. “Not really anywhere. I’m sort of between things.”
“Would you consider working for us?” she asked.
I felt my pulse pick up. I almost said yes before she fin-ished the question, but I caught myself.
“Tell me more,” I said, a guarded tone in my voice.
“Well, there’s not much to tell,” she said. “We have several clinics widely scattered across the state. We’re losing one of our providers. I was hoping you might be willing to help us out.”
This Common Secret: My Journey as an Abortion Doctor Page 18