But sometimes it was the most committed of the physicians who were the most misogynistic—though they never saw it that way themselves. They were just doing what they had been taught, and at that time being a male doctor meant being in charge, in control of the interaction and the procedure. Doctors were members of a brotherhood; their authority, power, and good intentions were never questioned by anyone, including themselves. I began to grasp that many of the good-hearted male doctors supporting the clinic didn’t see abortion in the context of a woman’s right to control her reproduction, and thus her life. It was more of a way for them to control women’s messy, complicated bodies.
Often, the problem started early. Most women were examined by a man before they had intercourse with a man. Even in that time of liberation, women held too much of the shame and fear that the previous generation had felt with regard to their bodies, especially their reproductive systems. Being a woman meant you were immediately pathologized, that control over your body was not in your hands. Menstruation, sex, pregnancy, abortion—everything had to be explained by doctors.
With her doctor, a woman had her first vaginal examination, chose a contraceptive device, was guided in her decision about whether to bear children, how to bear them, how to raise and feed them. Women were completely dependent upon the doctor’s knowledge and in a sense forced into a position of trust. All this resulted in women remaining powerless and having things done to them rather than with them.
And yet, abortion clinics were poised to be platforms for change. This new field of medicine provided the opportunity for a restructuring of power dynamics and a woman-centered approach to medical care. In the early 1970s, many minority and special interest groups were exploring their own histories and asserting their rights. Acknowledging patients as a class with rights and responsibilities seemed to me an appropriate analytical and political vehicle for combating the victimization of female patients by a generally male medical establishment. The most radical aspect of abortion—then legal in just a few states, but soon to be legal nationwide—was the potential for women to turn this situation on its head.
Clinics like Eastern Women’s Center and CRASH, the two largest for-profit New York facilities, caught onto this trend and put “chicks up front” to give the impression that their clinics were women-run even though they were actually owned and controlled by male doctors. But at Flushing Women’s I implemented policies that would truly put the patients’ interests first.
To start, I made sure patients were never left alone with the doctor. A counselor or I stayed with the women throughout the entire procedure, fielding their questions and making them comfortable. I was especially good with hostile patients who would answer a question with, “It’s none of your business,” or “Who the hell are you to tell me”—the ones who had an innate distrust of authority.
Thinking that casual humor helped relax patients, some doctors would make blatantly sexist remarks. “Come on, you knew how to spread your legs before you got here, you can spread them for the exam,” a doctor once chided. Another commanded a patient to keep still, saying, “Keep your backside on the table—you should know pretty well how to do that by now.”
These types of remarks, betrayals of the trust that I had established with the patients, infuriated me. My clinic was supposed be safe from misogyny, not another place where women were attacked at their most vulnerable. When problems occurred, I would speak privately with the doctor involved. If I witnessed an instance of disrespect, I worked to neutralize it.
I realized that restricting the roles of doctors was the realistic way to facilitate productive ties between the established male medical hierarchies and my patient-centered philosophy. Rather than expecting them to consistently provide emotional support for the patients in these intense, anxious situations, I put counselors in charge of educating and psychologically supporting the patients. The doctors had only to perform the procedure, and the support staff took care of the other equally important needs of the patients.
The necessity of these counseling sessions, these safe spaces for patients, was instantly obvious. Women didn’t know how to process what was happening to them, how to organize the confusing thoughts they faced. Because this was the first time many of them had been in a room with someone who was totally focused on them, they spilled out so much of themselves: their relationships with their parents, distress over their boyfriends, fears about the future. We helped them articulate to a stranger, something that they had never verbalized—why they did not want to be pregnant. To us, they admitted that they did not want to be mothers; that they wanted, needed, to have an abortion.
Some of my counselors felt it was necessary for an abortion counselor to have had an abortion to be able to relate to patients. In the early seventies, many feminist centers were practicing a form of peer counseling called consciousness-raising; women would meet in small groups to “rap” about their experiences under the assumption that the leader or facilitator of the group should be someone who had experience with the particular demon at hand. Women had previously been isolated from each other, and much importance was placed on being able to relate to one another as individuals who had experienced the same problems. This rationale was also operative in gender differentiation among physicians: some people requested women doctors, thinking that only females could relate to their problems.
There is of course some truth to gender generalizations; after all, a man will never know what it is to put his legs in gynecological stirrups. But to my mind this thinking is too limiting. Doing an abortion is a technical procedure. There is no difference between male and female physicians’ ability to dilate a cervix or perform an extraction. In the seventies women had become physicians in a very male-dominated field, and their behavior and attitude could be just as negative as that of men. The power lay in making sure that patients were treated by compassionate people, no matter who performed the actual procedure.
Counselors had the ability to shape each patient’s trust, which could be made or broken by the right words or the wrong information—a huge responsibility. In those early days there were no codified narratives, no context to help women process their feelings about having an abortion. It was up to the counselors and me to define new models. I developed a counseling manual to train and teach others as I learned more about what worked. We explained the abortion procedure, answered the patients’ questions about sex, pregnancy, and side effects, discussed other options besides abortion, and taught patients about birth control, centering on the three main options available to women at that time: the Pill, diaphragms, and IUDs. I eventually wrote a pamphlet to distribute at each counseling session. It introduced patients to the importance of what I called ESP—effectiveness, safety, and personality—in determining which method to use.
I knew that patients in any doctor’s office were usually too intimidated to ask the questions we answered in the counseling rooms. Women were rightly afraid of upsetting or angering their physicians, these men who had life-and-death power over them—a power they would not voluntarily surrender. As Frederick Douglass said, “Power concedes nothing without a demand”; it had to be taken back by the patients. Because I knew how very difficult this could be, I suggested they bring a friend who could be there as a witness, or a tape recorder so that nothing the doctor said would be lost on the patient in her flood of anxiety. I wanted to reduce the amount of iatrogenic pregnancies, to rescue these women from the ignorance and prejudice of their doctors, but I could not be with them for every appointment. Each one of them had to be a warrior on her own.
Immersed in the world of Flushing Women’s, balancing my drive for power with my empathic connection and compassion for my patients, I came face to face with the questions abortion forces us to ask about women’s reproductive freedom. My anger at what was happening grew. The metaphoric role of physicians as surrogate fathers and deities resulted in them communicating in a kind of code, a language that only the members of the brotherhood
spoke and understood. And they were communicating about women. Making decisions for us. I viewed this as a violation of their oath “to do no harm,” a betrayal of trust, and ultimately a dangerous situation for women.
Women’s health needed a reformation, a 95 Theses to translate the language of medicine so that women would be able to make choices about their own health. By teaching women about their bodies, by sharing this sacred knowledge, it would be possible to transfer some power to the patient.
Yes, that was it: patients needed their own bill of rights. Doctors needed to know what these rights were, too—and at Flushing Women’s, they’d better learn to respect them.
Flushed with frustration after hearing yet another horror story from one of my patients in the counseling room, I arranged for one of the counselors to stay with her while I rushed to my desk and started to write, my anger spilling out into my pen.
Patients have rights:—The right to question your doctor.
—The right to know the background, affiliation, and training of your physician.
—The right to be advised of the reasons for medicines prescribed for you.
—The right to privacy in your consultations with your doctor and the right of confidentiality of records of your treatment.
—The right to the security and knowledge that the choice of treatments and what happens to your body is up to you.
—The right not to be intimidated by the props of medical power, i.e. fancy offices, big desks, and white coats.
—The right to regard physicians and the medical establishment as a vehicle, a resource for your own health needs.
—The right to know that rarely is there a single, unchanging medical truth. The right to be informed of current medical changes.
—The right to be assertive enough to ask what tests are being performed. Why? What do they cost? What other diagnostic choices do I have?
—The right to be in touch with options that offer divergent or philosophically different theories of treatment than the one that is being offered by your physician.
—The right to see your medical records at any time and the freedom to seek another opinion.
—Above all, the knowledge that the right of choice does exist and should be exercised.
In order to help people visualize this philosophy I created a poster with the image of god (à la Michelangelo’s Sistine Chapel) shooting RX thunderbolts from the sky at patients on the ground holding placards with quotations from my Patients’ Bill of Rights. I had it replicated and sent to all the HIP medical groups throughout the city. My referral sources, the social workers in the HIP groups, were generally sympathetic to me, and they tacked my posters up in their clinics and offices.
Needless to say, it created quite a scandal. Doctors tore them off the walls.
Marty was challenged at a board meeting as to why these kinds of political propagandistic posters were being posted. Many doctors found it extremely threatening, and the idea that it was mounted by staff without asking permission from the medical administration of the groups was unheard of. It must have appeared to them to be some kind of insurrection.
Marty was bemused by the entire thing. On the one hand he was extremely proud of me, and liked being the enfant terrible by proxy, but on the other, he could not afford to alienate board members. I was allowed to hang posters at Flushing Women’s, but I could no longer distribute them to other HIP offices.
Witnessing their outrage, I was ever more certain I’d hit upon something true. The concept of women as consumers of medical care rather than passive recipients of treatment—the awareness that women’s holding to traditional relationships with physicians was ultimately destructive to them individually and as a class—led to my formulating and expanding on a philosophy that would soon become a movement. I called it Patient Power.4
IN 1973, the historic Supreme Court decision Roe v. Wade legalized abortion for the entire country. For the first time, female patients were given equal power in decision making with their physicians for a particular medical procedure.
What I had experienced with Flushing Women’s in New York became true on a national level. The legalization of abortion brought women out of the bloodstained back alleys that had been their medical habitats for hundreds of years. It thrust abortion into the traditional American medical system of health care, yet, because of its highly politicized nature, it created an entire health care system of its own—one that was to be the forerunner of new ambulatory care models.
The Supreme Court decision, in essence, initiated the women’s health movement as a defined phenomenon. It created a visible, observable, demanding reality: the reality of the female medical consumer. Millions came out to access gynecological and abortion services. The reformation had begun, and women began connecting with each other, sharing the fears, anxieties, and challenges of being a female patient. People were aware of the need for change, and others, particularly certain religious groups, became active in resisting it.
I initially called Roe v. Wade the medical Equal Rights Amendment. The law had undeified physicians and required the informed consent of the patient for surgical procedures, making Patient Power real. But as I would come to learn, implementing Roe v. Wade did not prevent abortion from being seen as a second-class medical service, or clinics and the doctors who worked in them from becoming pariahs in American society. It would be many years before I would come to see Roe as a compromise—before I would see that women still had a long way to go to truly gain control over their reproductive health.
I STILL REMEMBER when the words “patient power” first came to me. For once, I was the one on the exam table. I was having a routine gynecological exam, but I was feeling vulnerable and uncomfortable, my legs spread, the paper gown just barely covering my breasts as I breathed deeply in and out. “Just relax and be patient,” the doctor said while his gloved finger searched and poked inside me. “Be patient.”
What an unbearable request, I thought. I never had much patience as a child, woman, or patient; I never wanted to wait for anything. The word “patient” originally referred to a “sufferer or victim,” an older definition that shares meaning with the modern usage of “patience”: to “suffer and endure, bearing trials calmly without complaint,” to manifest forbearance under provocation. I was beginning to understand that women have always been the ultimate patients in this sense of the word, bearing centuries of injustice as we’ve waited for equal rights, economic parity, suffrage, freedom from violence, legal abortion. There has always been something else, one more thing to be accomplished, a war to end, an election to win, before the legal, political, and social gaze can be turned toward women.
Battles have been won only when women have refused to keep waiting to be given our turn. Was it patience that gave us the vote, rights of inheritance? If women’s freedom is like the phoenix rising from the ashes, always in the process of becoming, it is fueled by a collective and individual impatience that is expressed through righteous anger and political action.
Lying on that table in the doctor’s office, where I was expected to be physically and psychologically submissive, I realized that the definition of patient had to change. If I wanted to have mastery over my medical decisions and my reproductive health, and bestow that power to other women too, I would have to reject the notion of patient as victim. I would have to struggle against society’s attempts to keep me in my place, dependent on others to decide what was best for me and my body. It became clear to me that it might in fact be possible to have power and be a patient at the same time. Collectively and as individuals, we could attain Patient Power.
No, I was not patient, as a woman or as a patient. And after three years as director of Flushing Women’s, I didn’t believe any woman should have to be.
BY THEN my days at the clinic had begun to feel a little more routine. We were seeing fifty women a week, and at that time I was still counseling most of them.
I can’t remember how many hands I held, h
ow many heads I caressed, how many times I whispered, “It will be all right, just breathe slowly.” I saw so much vulnerability: legs spread wide apart; the physician crouched between white, black, thin, heavy, but always trembling, thighs; the tube sucking the fetal life from their bodies. “It’ll be over soon, just take one more deep breath”—the last thrust and pull of the catheter—then the gurgle that signaled the end of the abortion. Gynecologists called it the “uterine cry.”
Over and over again I witnessed women’s invariable relief after their abortion that they were not dead, that god did not strike them down by lightning, that they could walk out of this place not pregnant any more, that their lives had been given back to them. It was the kind of born-again experience that often resulted in promises: I will never do this again. I will always make him wear condoms. I will be more careful next time.
It was the very young girls that moved me most. I felt so much rage against the males who impregnated each child— was it her father, her brother, some young boy with no thought for the consequences? The girls, the women, were duly punished for their part of the sex act. But for the boy or man there was no censure, never was.
At times I was filled with a kind of bitter resignation. I knew that I might see each patient again soon. So many of them were barely more than babies themselves when pregnancy came, unplanned and unwanted. They were innocent and often ignorant, didn’t believe they were pregnant until it was too late to deny it, too afraid to ask for help at first. “Maybe it’ll go away,” they reasoned.
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