Intimate Wars

by Merle Hoffman

  THE RELENTLESS PRESSURE was compounded by the first patient death at Choices, a thirty-six-year-old Haitian woman who died of an amniotic embolism, a rare but almost always fatal phenomenon that is unforeseeable and unpreventable. Her name was Alerte Desanges.

  Even though everything that could have been done to save her had been done, and even though there was no way to prevent or to identify the possibility of the event even occurring, I had a tremendously difficult time with this fatality.

  I took many trail rides on Hollywould, my beautiful Arabian horse, trying to come to terms with the reality of her death—and the challenge of having my face and Choices smeared all over television, radio, and print media. These catastophic events happened everywhere, but this one happened at Choices, and that made all the difference. I was forced to make an excuse for something that was impossible to make an excuse for. Since I was not a medical doctor, I was dependent on my physicians’ expertise—but as the CEO of Choices, I was ultimately responsible for what happened there.

  Dr. David Gluck, who had performed the abortion, had previously had his license suspended because he’d been writing illegal prescriptions to fund his gambling habit. He was an excellent doctor, though, and an ally wholly committed to women’s reproductive freedom. Marty’s recognition of this and his willingness to hire and supervise Dr. Gluck at Choices during the five years of his probation had saved his career. Now, his past indiscretions complicated the otherwise straightforward incident of Desanges’s death, giving the press the chance to question the medical standards at Choices and our employment of Dr. Gluck.

  I told reporters that it was in the American character to give people a chance at redemption, hoping that word might strike a chord. But the media was hungry for stories about abortions gone wrong, ready to cast abortion doctors—never referred to as physicians—as the pariahs of medicine. Well-run, safe clinics like Choices were lumped together with “bargain butchers” who took advantage of poor women or undocumented immigrants who felt they couldn’t turn to a licensed facility for services. When the trial of Abu Hayat, the “Butcher of Avenue A” who botched the abortion of an eight-month-old fetus, leaving the woman hemorrhaging and her daughter with only one arm, hit the press, anti-choice groups used the opportunity to call again for a law declaring the fetus a person with constitutional rights. The pro-choice movement stayed quiet on the issue, hesitating to comment lest they dig themselves even deeper into the hole the press had put them in. We could not defend Hayat—what he did was unconscionable—but we had to make it clear that safe providers existed, too. The department of health was largely responsible for the hypocrisy and politicization of the issue; licensed facilities were held to extremely rigid standards, yet unlicensed facilities were not held to task when they “illegally” (according to a New York State law that was never enforced) performed second trimester abortions, leading to dangerous situations in which doctors were performing twenty-four-week abortions in their own offices.

  WELL-PUBLICIZED botched abortions brought second- and late-term abortion procedures, which are more physically and psychologically trying for both patients and doctors than first-term procedures, under public scrutiny. Indeed, when Choices had gone “up” in gestation in the mid-eighties by offering second-term abortions, even I found the process to be emotionally difficult. The results of choice were not diffused and amorphous, but observable and definable.

  The only second-trimester procedure offered at the time was the saline abortion, in which saline was injected into the uterine cavity to kill the fetus, after which labor was induced. Due to medical considerations, saline abortions could not be performed until the woman was sixteen or seventeen weeks pregnant. Aside from the fact that a woman who was twelve weeks pregnant (the cut off for first trimester abortions) had to go through the trauma of waiting five weeks to have an abortion, when she entered the hospital to expel the fetus she faced another special kind of hell: abortion patients were placed in the maternity ward of the hospital next to mothers who were giving birth, and many became the targets of antiabortion sentiments.

  Wanting their patients to avoid that experience, gynecologists eventually developed dilation and evacuation (D and E), a technique where the fetus was dismembered within the woman’s uterus and removed. D and E’s were much safer and psychologically easier on the patient since they could be performed at any point after twelve weeks and did not require the woman to go through a delivery. But the procedure was difficult for the doctor and staff performing it—and difficult for the public to stomach. As debates about fetal pain entered the public discussion, some physicians began routinely injecting and killing the fetus with digoxin prior to the abortion itself, eliminating the possibility that the fetus might experience pain.

  Graphic descriptions of the procedure, as well as misconceptions about how and why it was performed, added to the stigmatization of providers. These late-term procedures were done only under rare circumstances in which the mother’s life or health were at risk or it was determined to be a safer procedure by the physician. But antis focused on the difficult, traumatic procedure itself rather than on the fact that it was only performed when medically necessary. Learning that in some critical late-term cases the fetus was partially dismembered, and the skull crushed, outside the birth canal—a procedure called intact dilation and extraction (IDE)—antis renamed the procedure “partial birth abortion,” using physiological geography to further advance their claim that the procedure was no different from murder.

  The 1996 case of Amy Grossberg and Brian C. Peterson, Jr., two high school sweethearts charged with intentionally killing their newborn son and abandoning him in a dumpster, was publicly twisted by the antis into a parable with a pro-life moral. Arguing that the Peterson-Grossberg neonaticide was merely an extension of a late-term abortion was a particularly insidious style of political spin, similar to the arguments that fetuses were analogous to Jews during the Holocaust or blacks during slavery. And like “aboritoriums,” “abortion mills,” and “Hitlers,” “partial birth abortions” became a hot-button term used to manipulate the truth about the hows and whys of abortion in the eyes of the public.

  Ron Fitzsimmons, the founding executive director of the National Coalition of Abortion Providers (NCAP), publicly said that he’d lied in 1995 when he told Ted Koppel on Nightline that there were only five hundred “partial birth abortions” in the United States each year, stating the number was actually over five thousand. He implied that all abortion providers had agreed to be deliberately dishonest about how often IDEs were performed on patients. As Frank Rich wrote in the New York Times, Fitzsimmons was not himself a provider, he was a lobbyist, and the “shocking” revelation of the number of IDEs performed each year was already common knowledge. But the damage had been done, and anti-abortion activists reacted with glee, publicizing Fitzsimmons’s lie as if they’d uncovered a conspiracy.

  I was furious. He was a hired gun who had shot himself and the pro-choice movement in the foot, and I didn’t want him to get away with it. NCAP had played a very important role for providers since its inception in 1990 and I had worked closely with them to develop their organizational philosophy. It was a coalition of smaller, independent providers that acted as a balance to NAF, which was heavily loaded with Planned Parenthood leaders and interests. Planned Parenthood was quite different from the smaller facilities and clinics, and it had access to political power and money for nonprofit activities that allowed it to become a fierce competitor of smaller, but equally important, doctors’ offices and abortion clinics. Fitzsimmons had sabotaged the reputation of a very important vehicle for women’s choice. The reaction of many of the women of NCAP mirrored the “stand by your man” persona of political wives who supported their philandering or criminally involved husbands. But I pulled out of the organization, recalling a $10,000 grant I had given them. I thought he should have fallen on his sword, at least—and if he wouldn’t, someone else should have helped him to do it.

/>   Perhaps the worst effect of Fitzimmons’s debacle was its political impact. Some pro-choice leaders were willing to publicly oppose IDEs as a way to appease the antis. After a New York Times article on the issue broke, the House revisited and approved the Partial Birth Abortion Ban Act by an even larger veto-proof majority than it had the previous year. It gave some normally pro-choice, progressive Democratic senators reason to vote for legislation that placed women’s right to choose in increasing jeopardy.

  The antis had found a way to incorporate their agenda into the democratic platform, and they were being given free openings. More pro-life Democrats began demanding equal access to the Democratic platform and powerful committee positions, and in the name of the “big tent,” the Democrats handed it over. They nominated Dr. Henry Foster, Jr., a moderate physician who publicly stated that he “abhorred abortion,” for the position of surgeon general, and even invited Harold Ford, Jr., an anti-choice House representative from Tennessee, to give the keynote speech at the 2000 Democratic National Convention.

  The antis had effectively transcended the bifurcation of the Right and Left on the issue of abortion. Combining the “right to life” with other progressive causes, antis could find a home wherever they were on the political spectrum. Many people who described themselves as politically pro-choice began to feel the need to say, “I don’t like abortion, but.. .” while political leaders regularly followed President Clinton’s adage that abortion should be “safe, legal, and rare.”

  As a pro-choice president Clinton did deserve credit for his two vetoes of the “partial birth” abortion bills, but his willingness to cater to the Blue Dog Democrats, and increasingly the Republicans, was becoming a political problem. At the UN Population and Development Conference in Cairo Vice President Al Gore, bending to pressure from the Catholic Church and its fundamentalist allies, assured the attendees at the conference that “the United States has not sought, does not seek, and will not seek an international right to abortion.” He cemented the US government’s position that reproductive freedom was not a transcendent human or civil right, but merely a local privilege that could be granted, limited, or denied according to national customs and laws. This may have been situational diplomatic maneuvering, but it read as gender-specific noblesse oblige.

  And then there were the turncoats. The pro-choice movement had always had defectors—people like Dr. Bernard Nathanson (the owner and operator of CRASH, one of the nation’s first and largest abortion clinics, who went on to produce the anti-choice film classic The Silent Scream) who had a public change of mind and heart. Thanks to Clinton and Gore the numbers began to increase at an alarming pace. Norma McCorvey,24 a.k.a. Jane Roe, the original poster girl for choice, was the most famous example of this particular social and political trend. It has always amused me that people can find Jesus in the strangest of places; when news broke that McCorvey had gotten herself baptized in a Texas swimming pool by a leader of Operation Rescue, I was not surprised. Reverend Flip Benham, who did the honors, reported that Jesus Christ “had reached through the abortion mill wall and touched the heart of Norma McCorvey.” “I’ve cheated people out of money,” McCorvey told Ted Koppel in a Nightline interview on August 15. “I’ve sold drugs. I’ve done a lot against his teaching. But I think the greatest sin that I did was to be the plaintiff in Roe v. Wade.”

  Feminist Naomi Wolf argued in The New Republic that the pro-choice movement had committed three mortal sins: “hardness of heart, lying, and political failure.” She posited that by using the language of communitarianism, positioning abortion rights within a paradigm of traditional Judeo-Christian rights and responsibilities, the pro-choice movement would be able to expand its political base to include the all-encompassing middle where most Americans felt comfortable. To my thinking, this strategy would only operate as a Trojan horse to bring the enemy’s arguments into the heart of pro-choice territory, potentially tearing the movement apart.

  Wolf concluded her piece by calling for a fantasy of a world where “passionate feminists might hold candlelight vigils at abortion clinics, standing shoulder to shoulder with the doctors who work there, commemorating and saying goodbye to the dead” (the unborn, the never to be born). In the real world I lived in, passionate feminists were desperately needed to stand shoulder to shoulder with doctors and clinic workers to help protect them against the Michael Griffins, Paul Hills, and John Salvis who shot them down in cold blood. We were facing expansions of the Hyde amendment, increased clinic violence, limits on federal employee health insurance, denial of abortions to women in the military, and the reinstatement of the global gag rule. Where was her anger? Where were Thelma and Louise? I didn’t care about the rhetoric and rituals of memorials and lighting candles for the dead. I wanted the sisterhood to light the fires of resistance in the living.

  That spirit of resistance had already begun to fade, replaced by politically institutionalized actions. The anti-choice and pro-choice movements were operating as sophisticated political campaigns, using visuals, metaphors, debating points, and strategies to construct abortion narratives that would win over the masses. The media contributed by perpetuating the kind of soulless sports mentality that registered everything in neatly competitive categories: Right-to-life 2, Pro-choice 0. Cable channel New York 1 even wanted me to debate two right-to-lifers on the issue of whether or not murdering doctors was justifiable homicide. I declined. The fact that this debate was even proposed was indicative of the backslide the movement had undergone.

  The words “pro-choice” were no longer descriptive of the women’s movement on anything but a theoretical, ideological level. People felt it was necessary for the movement to cloak and soften the crushing reality of abortion in order to instill in people the knowledge that it was absolutely necessary for women’s survival and participation as full citizens in this society. But women’s rights, women’s lives, and women’s equality and autonomy wouldn’t sell in the American marketplace, no matter how appealingly they were presented. In the struggle to win the hearts and minds of the American people, the pro-choice and women’s movements had to take care not to lose their souls.

  IN A CHANGING political climate in which even the Left could not be counted on to support abortion clinics and providers, it was more important than ever for me to keep Choices functioning at its highest level. The women who came to us seeking abortions did not care about Bill Clinton’s flip-flopping or communitarianism. They just needed abortions.

  I always had to make tough choices to ensure their needs were met, but in the mid to late nineties, gut-wrenching decisions seemed to be part of my daily fare. I had been subsidizing my Mental Health Center with the surplus revenues of Choices to keep it alive while working to get it licensed, after which I assumed it would support itself. But mental health patients were always the stepchildren of the health care system. Insurance and Medicaid rates were not high enough to pay providers, and limits on the number of mental health-related visits made it hard for patients to get the care they needed. Subsidizing these expenses drained Choices, contributing to an extreme cash deficit.

  The situation was compounded further by an avalanche of economic and political attacks. Choices’ twenty-year lease was up, and it was time to negotiate a new one. But my landlord, Sam LeFrak, had ceded the management of his real estate corporation to his son Richard, who had very different politics from his father. When it came within one year of discussing the possibility of signing another lease, Richard LeFrak made it clear to me that he had no intention of having an “abortion center” continue to be a tenant in his building. If I was not out by the end of the lease, he told me, I would be forcibly evicted.

  He had already signed a contract with CompUSA to take over my lease at the end of a three-month holdover period, and he threatened to “bulldoze” my space if I remained one extra day. But it was nearly impossible to find a new building and move the entire clinic with so little warning. We petitioned the court to keep our doors open until w
e could get a new space ready, and dozens of letters of support were sent by prominent members of the community to the civil court of Queens County in 1998. “This is more than a landlord/tenant dispute—this action threatens to impact the health and safety of many Queens County residents,” wrote Geraldine Ferraro. Yet the courts ruled against me, and I was forced to liquidate my entire savings to cover the costs of speeding up the construction of the new site.

  When we finally did move into our new space (at which time it was only 70 percent finished) in October of 1997, we found that we’d simply gone from one crisis to another. Six months after I had signed the lease, the building had been sold to an owner who was anti-abortion—and committed to making my life miserable. Tim Ziss, the owner’s representative, attempted by any means possible to prevent me from moving into the new space, trying to make me change the layout from the front door to the back of the building—in essence, attempting to change our address. When I refused, Ziss did not allow the contractors to work, again jeopardizing the operation. The extent of the harassment was so severe that I had to call Attorney General Janet Reno’s office, which provided armed federal marshals to guard my space during the last few months of construction.