Intimate Wars

by Merle Hoffman

  They approached the HIP board of directors with a proposal for adding abortion services for patients, but some members of the board—which included union representatives, teachers, politicians, and clergy—were morally and religiously uncomfortable with the radical changes wrought by abortion becoming legal.

  The HIP board’s solution was to give Marty and Orris permission to create a separate medical office to deliver abortion services to HIP subscribers. HIP doctors in all five boroughs would refer patients who wanted abortions to this new clinic, which would be responsible for hiring the doctors and running the operations. The board was satisfied because HIP was not officially offering abortion services, and those in favor of providing them were satisfied because there was an official HIP referral source to which they could send their patients.

  Marty and Orris decided to invest $12,000 each and form a professional partnership. In 1971, on the heels of legalization, they opened Flushing Women’s Medical Center, one of the first ambulatory abortion facilities in New York.

  MARTY’S NEW PROJECT became the focus of our evening talks. He wanted to find a way to get me involved in Flushing Women’s. I had proved myself a skilled assistant, and it was obvious I could be instrumental in creating the clinic. As I had fallen in love with Marty’s stories, he was also engaged with my developing narrative. “Young, ambitious classical musician leaves art behind and finds herself a healer and medical pioneer,” he said teasingly. He wanted to make me into a star. Just as importantly, the clinic would provide a way for us to keep working together, to have our own world separate from the one he had to share with his wife and family. He told me it would be our project, our space to build and to share.

  Marty’s vision for our future was exciting, and I loved the idea of continuing to work with him in a more permanent fashion. But the project was appealing on another level as well: indeed, working at the doctor’s office had become an outlet for my inchoate drives, an unexpected answer to my long search for meaning.

  Marty was a family physician. At that time specialization had not balkanized medicine, and you could have one doctor for the majority of medical issues that would arise throughout your life. As his assistant I was part of that intimate world by proxy. I was the “nurse,” the person with whom patients made their appointments, who called with their lab results, and who gave them their prescriptions. They shared their frustrations with me as I weighed them or wrote their symptoms down in their charts. I reduced their anxiety and softened the edges of their office visits. Patients’ joys and tragedies, births and deaths, were played out in the office, and I was an integral part of these milestones. I was part of their healing process, and the affiliative medical power I began to gain suited me.

  When Marty officially asked me to join him in helping him run Flushing Women’s, I didn’t have to think twice. It was the spring of 1971, I was twenty-five years old, and abortion had been legal in New York State for almost one year. It would be another two before the Supreme Court would legalize abortion nationally in Roe v. Wade. I would get to keep working with Marty and be on the front lines of an exciting, pioneering new era of medicine. Having left my childhood behind, and longing for a great stage to act upon, I was ready to throw myself into creating new worlds. Now was the time—this was my hour.

  Patient Power

  “It is the swimmer who first leaps into the frozen stream who is cut sharpest by the ice; those who follow him find it broken, and the last find it gone. It is the men or women who first tread down the path which the bulk of humanity will ultimately follow, who must find themselves at last in solitudes where the silence is deadly.”

  —OLIVE SCHREINER, WOMAN AND LABOR, 1911

  Before the legalization of abortion, before the battles, before the word became flesh and translated into thousands and thousands of women lining up for services, abortion had a particular place in hell. The word was whispered, a shared secret knowledge among women, a lurking, beckoning danger approached through necessity. The act was relegated to “back alleys,” performed by hacks posing as doctors, well-meaning friends or relatives, and often by women themselves, alone in their bedrooms with their hangers or knitting needles. A small number of fortunate women had access to one of the few “doctors of conscience” and escaped the ordeal unscathed.2 Whether the procedure ended successfully or in tragedy, illegal abortion was kept in the shadows.

  Until it wasn’t. In the early seventies what was once only whispered about was now cocktail party conversation, a political discussion point, and the subject of constant media attention.3

  Radical feminists like the Redstockings helped thrust it into the public eye by holding a speak-out on abortion in New York City. For the first time, women defied law and custom to publicly share stories about their criminal abortions. Some even spoke with paper bags over their heads. “We are the ones that have had the abortions.... This is why we’re here tonight.... We are the only experts,” said a women testifying in 1969.

  New organizations, alliances, and coalitions seemed to be forming almost daily to fight for and against it. Soon the issue morphed into a political football, a birth control problem, a population control necessity. Abortion inspired a made-for-television movie, pro-choice art exhibits, concerts, T-shirts, and poetry readings.

  Before abortion became legal on a national scale, clinics were the outposts of feminist politics, their workers grassroots missionaries who believed that the decision to have an abortion was a question of moral agency, an assertion that the power of the state must stop at one’s skin. Several underground feminist abortion providers opened for business with the goal of catapulting their theories into action by offering clean, safe, affordable abortions. Clinics such as the famous Jane Collective and the Feminist Women’s Health Center in Los Angeles were run and owned by groups of women activated by the knowledge that illegal abortion providers left women (especially poor women) vulnerable to death and butchery.

  Feminism was in the air, and I finally noticed it on the periphery of my consciousness. It was in great part thanks to the ideals and dedication of these feminist activists that abortion was legalized and Flushing Women’s was able to open in the first place. But our clinic was not founded on feminist theory or activism. In fact, I started my work in the world of abortion from a very non-theoretical place.

  MARTY WAS PROMOTED to medical director of the small HIP group in Queens with whom Flushing Women’s would share offices, so the responsibility of running the new abortion clinic fell to me almost immediately. The fact that I had almost no idea what I was doing didn’t stop me from diving in headfirst to embrace the challenge. I organized the appointments, created the charts, designed the logo and stationery, and hired the staff.

  I remember the first patient I counseled. She had come to us from New Jersey because abortion was still illegal in that state. She came without her husband, but she had a supportive friend whose face betrayed a well of empathetic anxiety.

  I was nervous. In this, as in all of my other tasks at the clinic, no one had trained me. What could I say to her? What would she say to me? All my psychology courses flooded into my brain . . . theories, theories, and more theories.

  This woman was terrified. She was pregnant and did not want to be. Coming here had required an enormous amount of courage, and now she was in my hands. I was to guide her way. I was to be her bridge, her midwife into the realms of power and responsibility that are so much a part of the abortion decision.

  I held her hand tightly in mine as I listened to her nervous staccato breath. I kept her talking to help ease the discomfort of the dilators. I locked her eyes on mine, breathed in rhythm with her, joined with her to the point of personal discomfort. In the end, I do not remember a word of what passed between us. It was strangely irrelevant. But I do remember her face. And I remember her hand, the hand that came to symbolize the intimate, personal connection of one woman helping another, the gravity of forging a natural alliance with that woman and the thousands who
followed her.

  That understanding was to come to me later—much later. That day there was only that woman, her fear, need, pain, strength, vulnerability, and hand. Every day brought new connections, new discoveries. We held sessions on Tuesdays, Fridays, and Saturday mornings. I always arrived at the clinic early to start setting up the session before the patients arrived. While my classmates spent their Friday nights on dates or at the movies, mine were spent waiting until the last patient had left the recovery room before going home, sometimes as late as eleven at night, and rising again at six o’clock on Saturday mornings to get to the clinic in time for our weekend session.

  I knew from my first week on the job that occupying the same space as the HIP doctors was going to be a challenge: they didn’t want to share. Flushing Women’s had staked out a territorial claim to the HIP group and I immediately had to defend it. The allergist who used the exam rooms during the day seemed to drag out his sessions as long as possible so that our patients had to wait until 7 p.m. for procedures that were supposed to begin at 5 or 6 p.m. Another physician stormed in during an abortion procedure and disdainfully threw the patient’s clothes on the floor, ordering us to “get these damned abortion patients out of here.” These shocking attempts to make us feel unwelcome ushered me into the world of medical politics, where, I would learn, abortion providers were always shoved to the lowest rung of the ladder. I found ways to create small pockets of care and safety in an inhospitable environment.

  After a few months, the New York City Department of Health, which had jurisdiction over all abortion providers in the city, sent in surveyors to review our facilities and practices. Our clinic was relatively small—we were only seeing five or six patients per week at that point, and charging seventy-seven dollars per procedure—but with so many patients traveling from out of state to have abortions, New York took extra care to inspect every single facility. Flushing Women’s was sterile and safe, but the inspectors took note of our meager six hundred square feet of negotiated space. I watched their faces tighten when they noticed the cots in the hallways.

  Never having experienced anyone questioning his medical or operational judgment, Marty found their presence to be an intrusion and a violation of his privacy rights as a physician. He was arrogant. He hadn’t yet realized that his doctor-as-god armor was penetrated the moment he took on abortion.

  We could have listened to the critiques of the Department of Health respectfully and asked for time to work it out, but the inspection quickly deteriorated into a power struggle between Marty and the surveyors. A week after their visit, we received a long list of deficiencies. We were informed that our clinic would be closed down until they were corrected. Marty was furious. “Who the hell are these civil servants to tell me what to do?” he ranted. He felt that the report was unfair, and that keeping the clinic open might not be worth the hassle.

  Not having a doctor’s ego to defend, I wholly disagreed. Close Flushing Women’s down? We’d just gotten started! Here was the first real challenge to the survival of this nascent project that I was beginning to call my own. I was already too invested to give up so quickly. The Department of Health’s survey was simply a report card we had failed. I was a good student; I was determined to get an A.

  I read the Department of Health’s report until I had it memorized, then made an appointment with Dr. Jean Pakter, the head of the Department of Health, to discuss solutions. I wanted to understand exactly how I was expected to correct the deficiencies. She was responsive to my earnest questions and obvious determination to fully meet the requirements.

  During the four months that Flushing Women’s was closed, Marty was again promoted to the position of medical director of a larger HIP group on Kissena Boulevard—one whose physical space, I pointed out to him, answered the environmental deficiencies in the Department of Health report. Marty would be too busy with his new responsibilities to devote much time to Flushing Women’s, but I convinced him that under my direction the clinic could rent basement space at this new medical group and work on getting appropriate staffing, beds, and medical equipment to address our programmatic weaknesses. Most importantly, we could reopen.

  After moving to Kissena Boulevard and working out a plan of correction, we were once again inspected by the Department of Health. This time, we passed.

  I WAS STILL going to school and taking classes between clinic days. I had graduated from Queens College Phi Beta Kappa and entered a graduate program in social psychology at the City University of New York Graduate Center. In college I had been distanced from my peers by my age and personality; in graduate school I was distanced from the other students due to the fact that my time outside of school was spent operating an abortion clinic. It didn’t bother me, though. I wasn’t in school to make friends.

  I encountered a hurdle early on in the program: I failed a statistics class. I went to the chair of the department requesting permission to retake it later in the curriculum, but he refused to give me any leeway. Not having any real option of another PhD program, and thinking that I was destined to fail, I decided to resign from the doctoral program. With a great deal of sadness and anxiety I carried my resignation letter with me to give to the chair of the department. When I got off the elevator on the eighth floor, Dr. Stanley Milgram, the star professor of the PhD social psychology program, was there waiting in the director’s office. Somehow he had gotten word that I was coming to see the director with my resignation, and even though he was not a professor of any of my classes, he decided to get involved. Sitting conspiratorially opposite me, he shared that he had also had difficulties with institutions, having been initially rejected from Harvard’s doctoral program. Then he leaned forward and whispered, “I have a secret to tell you: I also failed statistics.” As I laughed in amazement at his revelation he went on to say, “All the really creative people have trouble with math.” After we spoke, I tore up my resignation and decided to go to summer school to finally master statistics.

  I viewed Flushing Women’s as an extremely interesting project, a world I was creating with Marty, but I did not see it as a life’s work. It was not a profession, it was not a skill, it had no name or institutional reality, no well-worn steps of ambition. I’d always imagined a life of music, psychology, philosophy, disciplines with thousands of years of history and structure. And here I was in an untraveled medical landscape that had only just come into being.

  Yet even after Milgram’s encouragement to persevere, the theories and critical texts with which I was engaged at school were failing to hold my interest. I completed the course work for my doctorate in psychology, but I lost momentum before writing my dissertation.

  I applied to a few law schools and was accepted by Ford-ham and Adelphi. Law would be straightforward, lucrative, and impressive. I went to my uncle Louie, a lawyer, for advice. He laughed in my face, telling me that a woman could never amount to anything in the law and how he would love to have his son, also an attorney, “wipe the floor with me” in a courtroom. Of course I knew he was wrong—if I wanted to, I could be an excellent attorney—but the conversation left me disgusted. I tried to picture myself as a lawyer, but the truth was, the advocates and attorneys I met in my reading were usually tools of the state attempting to bring down my heroines. They were always on the wrong side.

  As part of my psychology studies I had done an internship at the Creedmoor State Mental Institution. I’d seen a little boy banging his head against the wall, another playing with feces. A staff member pointed to a child and told me she had never spoken a word. All I could do was observe them, my power confined to the limited interactions I could have with the children as a student.

  I contrasted that to my role at Flushing Women’s, where I would stay with each patient through her abortion, taking the rings off my hands and putting them in my lab coat pocket to avoid the pressure of their desperate, clutching fingers. I would see the patients again when they came back for their follow-up exams. I knew most of them by name.


  A fifteen-year-old patient I had recently counseled had been terrified of telling her mother she was pregnant. I’d spent almost two hours with the mother trying to help her connect to her daughter, to break through her anger, until finally she began to cry in front of me, saying, “I had her when I was fourteen. I just don’t want her to go through what I went through.”

  When it came time to pay the tuition for my first semester of law school, I realized I could not leave the clinic, not for law. Not, I knew, for anything. Flushing Women’s had become a living organism, almost a part of me. Leaving now would be tantamount to abandonment.

  AFTER THAT, I stepped into my self-appointed role as executive director of Flushing Women’s without looking back. I signed up for night classes to learn business, management, and finance skills. I learned about gynecology and abortion, set nursing schedules, met with city and state representatives, and argued with the doctors at the HIP group who harassed me with their anti-abortion sentiments.

  I was in charge of a staff that included a full-time front desk receptionist, two counselors, two doctors who worked on a case-by-case basis, and three part-time registered nurses and licensed practical nurses. To many of the employees, I was the symbol of a radically changed world. I was young, I was a woman, and I had no medical training. The idea of a person like me running a clinic turned their concept of the medical world on its head.

  By the age of twenty-six I was hiring and firing physicians. Much to their chagrin I “auditioned” my doctors, staying in the operating room while they performed abortions so I could assess their interactional skills with the patients. The doctors cared about their patients’ well-being, but they resented my position of power. They were comfortable with women as nurses, handmaids in the surgical suite, but the very idea of a young woman telling doctors how to handle patients, influencing their financial lives and time, was anathema. They could not get used to being under my jurisdiction, and when there were conflicts they would appeal to Marty. As a fellow member of that elite male club, he was able to smooth their ruffled feathers. He never allowed them to undermine me, though. He made sure they knew that my administrative directions were to be followed.