It wasn’t until that moment, when the real prospect of going back to work was laid before me, that I realized how much I’d missed the contact with patients and the rewards of my work. It had been my professional life for more than two decades. My time away from it had only fed my passion for that work. By the same token, I’d been deeply hurt and disappointed by an organization that, in my experience, often prioritized billing protocol over patient well-being. I couldn’t afford to be naïve, and I was wary about opening that door again so soon.
“I’ll be honest with you,” I said. “It’s very appealing. I love the work, and I think I’m good at what I do. But I have concerns. I can’t commit to anything before those concerns are addressed.”
“Here’s my phone number,” she said, handing me her card. “Please do call.”
The next day I did, in spite of myself. I couldn’t stand the suspense. I told her about my experiences in Minnesota and my fears of finding myself in similar situations. She forwarded me to the organization CEO and the clinical services manager. I told them straight out that I was not simply a technician paid to conduct procedures. We talked about the importance of counseling, of responding to each patient’s needs and circumstances, of putting patients ahead of strict policies and rules.
I tried to read between the lines of their responses, get an intuitive sense for their attitudes and tendencies. I put them on the spot with specific patient scenarios that might butt up against clinic regulations. What about women who don’t have the full fee? I asked. What about providing an extra service to an indigent patient to save her another trip to the clinic? What about allowing a family member or friend into the procedure room if it soothes the patient?
At the end of the phone conversations, I felt reassured enough to give it a trial run. “Let’s see how it goes for a time or two,” I said. “I can’t commit beyond that until I get a feel for how this will all work.”
Within a month I was making my first commute, a two-hour drive to Helena, Montana. The miles slipped past, full of sky and river valley scenery. I knew full well that if this experience didn’t work out, it might signal the end of my career with women’s clinics. I wanted so badly for things to go well, to return to the nurturing atmosphere I’d known in years past.
I had been to the Helena clinic before, even worked a few days there half a dozen years ago. I had memories of a place full of warmth and compassion, but that had been then. No doubt much had changed, including the administration.
I was early. I stopped for a cup of coffee, knowing it was a procrastination device. I pressed my head against the steering wheel, tried to calm myself. I was hopeful, eager, nervous, and scared stiff.
I still wasn’t ready when I pulled in to the parking lot behind the clinic, but I fought down the impulse to turn around and drive back home. I forced myself out of the car, grabbed my bag, walked to the door. Just another day of work, I told myself. Don’t make it more than it is.
Familiar faces greeted me, staff who had been there for years. I was pulled into hugs. “It’s good to see you again! Thanks so much for coming all this way.”
I took a deep breath, looked around. Very little had changed. I remembered the cubbyholes full of information and brochures on family planning, IUDs, sexually transmitted diseases, how to talk about sex, Pap smears. The furnishings were well-worn but comfortable and inviting.
I went to change into my scrubs, passing one of the staff with a patient along the way.
“Here, this will warm you up a bit,” I overheard the nurse saying in a soft voice as she wrapped a blanket around the woman’s shoulders.
My fears began to fade. Everything was so familiar—and so new. A fresh start for me, but the same decisions being made, the same fears being faced, the same questions in patients’ eyes. The same tension and fear faced by thousands of women every year. It is the farthest thing from mundane for each patient on this day, at this clinic.
As the hours passed, my confidence and optimism grew. I was back in my element. Everything I saw, and more importantly, my intuitive reading of things, gave me hope that this organization truly did its best to put patients first. The staff was efficient, cheerful, respectful. Opinions were offered and honored. When a protocol came into question, the administration and staff worked together to find a solution. I didn’t pick up any underlying tension or resentment between management and staff.
By the end of the day the job counseling I’d received, the other lines of work I’d explored, the doubts I had about continuing my clinic work had vanished. This was where I belonged. This was what I did best. This was where I felt fulfilled and valuable.
Before leaving for home, I met briefly with the staff. None of them had any idea how vulnerable and shaky I’d felt when I walked through the door that morning or how tentative I’d been about my future.
“Thank you,” I said. “Thanks to all of you.” I didn’t know how to capture my feelings. I felt tears welling up. “Thank you for caring about these women and for being here.”
“Of course we care,” one of them said. “Why else would we work here?”
“But,” I struggled to compose myself, “it’s so much more than that. This isn’t just a job for any of you. You’re all skilled and professional, but you’re more than that. You’re compassionate. You’re dedicated. I don’t think you know how much that means to every patient who comes here—and to me, especially today.” I broke off. “It is such a relief,” I finally blurted out, laughing through tears.
Over the next months I began working at several clinics around the state. These are places that are only open one day every two weeks. Just two days a month. Many patients wait two to four weeks for an appointment and then drive as many as six hours to get there. As the physician I drive up to seven hours to get to work. Montana is big country, and women come from all over the region, including Canada.
I settled into the routine, such as it was. Patients came and went, each unique, but some more memorable than others.
“Dr. Wicklund, would you please look at this ultrasound?” one of the clinic staff asked me.
“From the looks of it, the measurements put her at the edge of my limit,” I observed, after looking at the image. “Is it her first pregnancy? Maybe we should send her to Billings.”
“You might need to hear the rest of her story,” the nurse said.
We sat down.
“This patient is nineteen years old. And yes, it is her first pregnancy. It was extremely hard for her to get here today. Going to Billings in a week may as well be the moon. Worse than that, she told me she knows someone on the reservation who will do the abortion for her. She is absolutely serious. If we send her away, that’s her next option.”
These revelations never fail to stun me. I have seen the women with scarred, torn cervical tissue, with lacerations, women who have been mutilated out of desperation. But it still seems so primitive, so barbaric that I tend to bury the reality until it confronts me again. In our modern, sophisticated, medically advanced country, women are still using coat hangers and sticks and toxic concoctions to end unwanted pregnancies. No one truly knows how common it is now. There are no statistics. What is clear is that if the anti-choice forces have their way, it will become prevalent again.
“Okay,” I said. “I better go see her.”
“Hi, I’m Dr. Wicklund. You can call me Sue. How are you doing?”
“Oh, I’m fine. Really. They already warned me that you might not be willing to do the abortion today.” She was not wringing her hands. There was no pleading tone in her voice.
Perhaps she’s not so sure about her decision as we suspect, I thought. Maybe she was just exploring an option, and now she has an excuse not to do it. “Are you sure you want to end this pregnancy?” I asked her.
“Oh yes.” She looked me in the eye. “I have no intention of continuing this pregnancy. No way. But my friend can do it for me. She offered to do it in the first place. She’s done lots of them
before, on herself and other girls, but I thought it might be better to come here first. Listen, if you can’t do it, it’s okay. I know she can.” Her confidence was chilling. This young girl was so naïve, it took my breath away.
“Don’t you understand that you could die having an abortion like that?” I asked her, gently.
“Oh no, you don’t understand. My friend knows what she’s doing.”
I sighed. We talked about other things—her plans to get an education beyond high school, her siblings who had dropped out of school, her steady job. I talked about the time I spent on public assistance and how I decided to be a doctor even though I had a young child.
It was very clear, at the end of our conversation, that if she left without having her abortion, she’d have her friend perform an illegal and dangerous one.
I had her lie down so I could examine her cervix. I was reassured to find that it had already softened up, which reduced the chance for any complications. I looked at the young woman on the exam table. I thought about her life and this crossroads. I stood up.
“We’ll proceed,” I said.
Her abortion was safe and routine. I knew that she would be able to have children some day, if and when she was ready.
“Listen,” I said to her before she left. “Here’s my phone number. I want you to tell your friend to call me. I’m not trying to get her in trouble. I want to see what we can do to help women in your community. And I want to ask her how she does her abortions. Maybe I’ll be able to share some stories with her.”
“Sure,” she said. “I believe you.”
I never did hear from her friend.
Outside the clinics, the protesters gather. They hold signs; they say prayers; they call out to women coming for an appointment. Much of the time, the homegrown protesters are relatively peaceful and unthreatening. They come out of conviction, out of strongly held moral beliefs. I can respect that. As long as they don’t infringe on the rights of others, they have as much right to free speech and demonstration as any American.
Over the years I have even had conversations with several protesters. To tell the truth, I want to know where they’re coming from, what their true objectives are.
When I was working in the Midwest, one young protester followed me everywhere. Once, in a grocery store, I came around the end of an aisle, and we came face to face. We stood perfectly still. I looked hard at him.
“So, instead of following me around all the time and trying to intimidate me, why don’t you come have a cup of coffee?” I asked. I was as surprised at my words as he was.
He stared at me. “N-no, no, I don’t think so,” he stammered. But he didn’t turn to go.
“Why not?” I continued, emboldened. “I want to hear what you have to say. You can’t possibly think I’d hurt you, do you? Why follow me around if you’re afraid to even talk to me?”
He thought for a minute. I had him cornered. “Well, okay,” he said. “I’ll meet you at the coffee shop in twenty minutes.” He turned and walked quickly away.
I didn’t know whether to believe him, but twenty minutes later we faced each other across a table.
“Why do you follow me everywhere?” I asked.
“I want you to stop killing babies,” he said.
“Oh come on. You can do better than that. Why don’t you tell me what you know about abortion?”
“I know it’s dangerous,” he said. “I know women are scarred for life, physically and emotionally.”
“I wish you’d do some reading on your own rather than just believe what the other protesters tell you. Abortion is the safest minor surgery performed in the United States. Women are not scarred from it.”
I wrote down some references for him to look up, including government publications. I walked him through the procedure. “Even though it’s classified as minor surgery, there is nothing sharp, no cutting instruments, no stitches, no scalpels.”
I could tell he was shocked. He’d been immersed in the rhetoric of the antis, where knives and scalpels killed babies and maimed women. “But you are taking a human life,” he argued. “You are a murderer.”
“Would you really call me a killer?” I asked him, point blank.
“Yes, I would. It’s a human life you are taking. I don’t know what else to call you.”
I thought of the small sac and villi I remove in an abortion procedure, tissue that has no capacity to feel pain, think, or have any sense of being. To people like this young man, that tiny sac is a human being.
To me, that tissue represents potential, and the woman carrying it has to have the freedom and ability to nurture and grow that potential. Not every seed that falls from a pinecone becomes a tree. The soil has to be fertile; the climate and topography and timing have to be favorable. If those ingredients are wrong, that potential growth never takes place.
For the black-and-white protesters, women are reduced to little more than incubators. Their role is to produce babies, no matter what the circumstances. Where do their rights, their pursuit of happiness, their ambitions enter the equation? Why, like for the seed that falls, aren’t the conditions for growth considered?
We talked for more than an hour. I gained respect for his convictions and earnest beliefs. He, I think, learned a few things about the realities of abortion and the tough life dilemmas women are faced with.
Several times over the ensuing months we met and talked more. The last time we spoke was just before he was entering a seminary. At the end of the conversation, before we parted ways, he said, “You know, I can’t hate you any more.”
I don’t know what happened to him after that, but I never again saw him protesting outside of a clinic.
The professional protesters are the ones I fear. They are mostly men, and for them, protesting is a full-time obsession. They target different regions in the country or particularly vulnerable clinics. They bring their hate-filled slogans, their planes that fly over towns and cities pulling banners depicting bloody babies, their confrontational tactics. When they come to town, I wear my bulletproof vest and carry my gun. Unfortunately, their views have infiltrated the laws and policies of our country and the lives of my patients.
“Pleased to meet you, ma’am,” the young woman said, after I introduced myself.
She was a Montana resident and member of the military stationed in Germany.
“How long are you home for?” I asked.
“Just long enough to get this abortion, a note from you that I’m no longer pregnant, and then I’m on a plane headed back to Germany.”
“Are you telling me that you had to come all the way back here to have an abortion?”
She nodded. “Our government won’t allow abortions in military facilities, so this was my only option. I had to leave my unit for almost a week and pay my own way to fly from Germany to Montana so I could continue to serve my country. Seems pretty stupid, doesn’t it? Here we are, overseas, fighting for other people’s freedom, but mine is taken away.”
It isn’t only the United States military that marches to the anti-abortion drumbeat, but all recipients of our foreign aid. In Africa and Asia and throughout the developing world, humanitarian aid is cut off if family planning counseling includes any discussion of abortion, or if women are referred to clinics that provide abortion services. If the option of abortion appears anywhere on the radar, it negates aid for well-baby care, infant formula, prenatal care, HIV treatment and counseling, and a host of other critically important medical services.
Worldwide, more than five hundred thousand women die each year from complications during pregnancy and childbirth. Tens of thousands of those deaths could be prevented by reproductive health care provided in clinics, the same care often denied because of the gag rule. Clinics in the United States are also cut off from federal funding and aid if abortion appears in the repertoire of services.
Sometimes the “gags” have nothing to do with the government or political atmosphere, but are self-imposed: silence an
d hypocritical denial enforced by the fear of public exposure.
One day in Kalispell, Montana, I stood before another young woman. She had her head down, wouldn’t look at me. Staff had warned me that she seemed repressed and unresponsive. They hoped I’d be able to get her to open up.
“Ruth,” I insisted. “We’re concerned about what’s pushing you to make this decision. We need to be sure this is something you decide for yourself, not for anyone else. I need you to tell me if you really and truly want this abortion.”
“Yes, I do,” she said quietly, still not looking up. “I want to finish college.”
“I was a single mom through college and medical school,” I told her. “It’s not impossible.”
She didn’t respond.
“I’m not trying to talk you out of an abortion, but I’m getting the feeling that there is more to this than going to school. If you won’t tell me what’s going on, I can’t proceed with an abortion.”
She finally lifted her head. Her eyes met mine, held mine, seemed to assess me. She sighed.
“My parents are very religious,” she began. “My dad is a deacon at the church. If I have a baby out of wedlock, it would be a mark on them. It would say to all their friends that their daughter has sinned. Sex out of marriage. It’s a terrible sin, and it would make them look bad.”
“Okay, so you’ve sinned in their eyes, but how do they feel about abortion?” I asked.
She laughed bitterly. “Oh, abortion. That’s totally unforgivable. But it’s the lesser evil because it would be a secret. If I have an abortion, their friends in church will never know.”
“So you’re having an abortion to protect them?”
“No, I’m having an abortion so I can finish college.”
I looked at her, my face full of questions. The clock hummed on the wall.
“This is the situation,” she went on. “I live at home. My folks help pay my college tuition. Their income is high enough that I would never qualify for student grants, and they won’t cosign on a student loan. If I have this baby, they will kick me out of the house and take away any financial help. I would be banned from my family.”
This Common Secret: My Journey as an Abortion Doctor Page 19