This Common Secret: My Journey as an Abortion Doctor (11 page)

Mountain Country Women’s Clinic opened its doors on February 2, 1993. From the start, counseling formed the core emphasis of patient care. I had always been at my best with one-to-one interactions, and I had hired staff who were intuitive and committed to the same style. We worked as a unit, sharing responsibilities from front desk to lab to clean up, with counseling being a focus for all of us.

No patient was turned away for financial reasons, but each staff member had complete veto power regarding the provision of services for any individual patient. Often we spent hours on a single patient before ever getting to the procedure. Sometimes we never would get to the procedure.

In counseling sessions, immersed in women’s stories and dilemmas, we heard over and over again about the real difficulties and choices they faced. With each case, each situation, we also learned about ourselves. Most important, we began to understand that above all, we simply had to listen.

As always, the patients kept me strong. Within weeks of opening our doors, there was already a handful of women whose experiences and circumstances reaffirmed my philosophy. I had a business to run, and the financial burden kept me awake some nights, but I knew I was doing everything I possibly could to keep our patients both physically and emotionally safe. It became the most important and rewarding part of my work. I knew, from my own experiences, how essential it was to be fully informed, and I could see daily, in the looks of gratitude and relief, what it meant to the women we served. That was the bottom line that mattered.

It wasn’t uncommon for a woman to return three or four times before she’d feel comfortable with her decision. In the first month of my new practice I handled one such patient: forty years old, a successful career woman, torn between her ticking biological clock and the present circumstances of her life.

“Deep down I think I’ll regret having this abortion,” she said at one point during her first visit. “I know I’m getting to an age where I have to decide about having children. But then when I think about everything else—my relationship, my work—I can’t imagine having a child.”

As soon as she said that, I knew we wouldn’t be doing an abortion, not that day anyway. But we talked nearly an hour longer. Everything about her body language communicated her indecision, her ambiguity.

“Do you think it’s the situation, your circumstances, that you’ll regret, or is it the abortion itself?”

No response. A shrug of shoulders.

“That’s a big distinction. You need to sort that out. This is not the time for a snap decision. Work it through more. Give it the time you need.”

“I feel so terribly irresponsible!” she said.

“Look,” I said, taking her by the shoulders, “it’s the people who don’t think things through, who make no plans and ignore reality until they’re really stuck and then can’t cope—they are the irresponsible ones.

“You’ve met us now. You’ve seen the clinic and how we work. Take your money and go sort this out. Come back if you need to.”

Two days later she returned.

“I just want to do it,” she said. “All this thinking is driving me crazy. Let’s just do it and be done with it.”

“No. This is irreversible. We never ‘just do it.’” I sent her on her way again.

But when she returned a third time, a week later, I could see the difference in her even before she said a word. Gone was the cocoon she had wrapped herself in earlier. Gone were the nervous, fidgety mannerisms, the hesitation before tough questions.

“I’m absolutely sure now,” she told me. “I regret my situation, but this is the right choice.” Her eyes held mine.

“Is this your head talking now, or your heart?” I asked, although I already knew the answer.

“My heart,” she said, with absolute certainty in her voice and in her manner.

I had devoted three counseling sessions to this single patient. Three unpaid sessions, from a business point of view. But there is more than one consequence in these cases. The financial one pales in comparison to the human, emotional one.

That patient expressed her gratitude when she left the clinic. “Thank you for making me wait and work through all the things I was struggling with on this choice,” she said. “I’d have been a wreck if you had done the abortion the first time I came in.”

Many times the counseling involves more than just the patient. Parents, boyfriends, or husbands are frequently very involved in the dialogue, but the decision is still ultimately the woman’s.

Another day I spent nearly an hour on the phone with the mother of a young pregnant girl. She had been calling all the clinics in the region to get a sense for which would be the best for her daughter.

They lived in a small Wyoming city. Their daughter, the way the mother described her, reminded me of Sonja. She was a responsible kid, at the top of her school class, active in sports and other activities, busy with her friends.

“She went to a movie one night,” the mother told me. “We always insisted that she walk home with friends in the neighborhood when she was out late, and she always did. But this one night her girlfriends were in a hurry, and my daughter told them not to bother. It was only a few blocks. She knew that if she called we would come and get her . . . ”

After a silence, the mother continued. “She was raped in those few blocks. On the way home my daughter was raped.

“But worse than that, she felt so terrible and so guilty, as if it were her fault! She couldn’t bring herself to tell us this awful thing. She couldn’t tell us.

“Last week I noticed that the supplies for her period hadn’t been touched for a while. I really wasn’t sure how long. When I asked her if something was wrong with her period, she broke down in tears. It was only then that she told me, and by that time she knew she was probably pregnant.”

I could hear the emotion in her voice, threatening to break through. “How overdue is your daughter?” I asked, moving us on.

We discussed in detail the process our clinic went through with each patient. By the time we finished she had decided to make an appointment. I insisted, however, that the daughter make her own appointment, stressing that we do abortions at the request of the woman, not a parent or husband. The mother understood what I was saying and put the daughter on the phone.

We had a brief discussion, long enough for me to confirm the things the mother had told me, and for me to be convinced that she indeed wanted to end this pregnancy. She had, in fact, been making calls herself, inquiring about how to get an abortion.

“Is it all right if my parents both come?”

“Of course it is. That is the way it should be,” I replied.

They arrived within days, after a six-hour drive. All three of them were well dressed, neatly groomed, polite, exuding an air of prosperity and a careful control over their emotions.

While the daughter began her counseling with one of my staff, and with her permission, I asked her parents to join me in my office.

“I know you are concerned,” I began. “And I want to fully explain the procedure your daughter will go through, if that’s her decision.” The man looked a little startled at the possibility his daughter might not elect the abortion. “It sounds, in this case, as if Ellen is pretty clear. But it’s very important that we reach a complete understanding with each patient, and that the choice is an informed one.” He nodded.

I went through the technicalities of the procedure, at one point drawing a diagram of the uterus on a notepad to illustrate the stage of her pregnancy. I could feel the father’s growing agitation as I continued. I wondered how much a part of all this he had been, whether he had fully dealt with his own feelings.

The mother had a few questions after I finished, and then we sat together in silence.

“I come from a family that never showed emotion,” the father broke the quiet. “If you had a problem, you dealt with it. You didn’t go burdening others with your trivial difficulties.”

His wife had turned to him, but he was staring off through the window.

“Now I see that my family is the same way.” His hand came to his face, ran quickly through his hair. “I feel so ashamed that my little girl couldn’t tell us that this, this criminal, hateful, violent thing had happened to her.

“She tried to take care of it all alone, thinking it would be a burden to us, that somehow this crime was her fault and that it would be better,” he pounded his hand softly on his thigh, “that it would be better if we didn’t know.”

His voice broke. His wife put her hand on his. I moved closer. “I love her so much,” he was openly crying now. All of us were. “I love her so much, and I am so terribly ashamed that she wouldn’t come to us for help, that she kept this to herself.”

He turned to his wife, and they embraced. She comforted him, cried with him. I wondered if he had ever sobbed in her arms before, if he had cried in his adult life.

“If we hadn’t discovered her pregnancy, she might have buried it from us always,” he said through tears.

When he had collected himself a bit, I left to check on their daughter.

“How are you doing?” I asked her.

“Better,” she admitted. “I finally understand that the only thing I did wrong that night was to walk home alone. It isn’t my fault I was raped. It isn’t my fault I am pregnant.”

“No, it certainly isn’t,” I said. “But you aren’t alone. Many women feel the way you did. That they are somehow responsible for being the victim of a sex crime.”

“I just wish my father could understand,” she said.

“I think he does,” I reassured her.

She shook her head.

“He’s in the other room right now, crying in your mother’s arms.” She looked at me in disbelief. “He told me how much he loves you, how terrible he feels about all this.”

“No,” she said. “I know he loves me, but he’d never say it. He’s never said that!”

“I think maybe he should come in here. I think you two need to talk.”

I left the room and returned with her parents, leading her father in first. She saw his tear-streaked face, hesitated just a moment, and then went to him. They held each other as if they hadn’t hugged since she was an infant. This man who never showed emotion, who had never told his sixteen-year-old child that he loved her—he held her now as if he would never stop, crying anew, kissing her hair, saying again and again how much he loved her, how sorry he was, and what a gift she was in his life.

All three of them came back out together, laughing their relief, looking at each other with different eyes and obviously aware of some hurdle they had just cleared as a family.

After that session, the abortion procedure was truly anticlimactic. The mother stayed with her daughter throughout, held her hand much of the time. All of them sat together in the recovery room, listening attentively to our after-care instructions.

By the time they left, they were changed people; the barriers had evaporated. I believed that no terrible secret would ever divide them again.

I walked them to the stairs to say good-bye. The young woman and her mother started down, but the father turned to me again, started to hold out his hand, then pulled me into an embrace.

“Thank you,” he whispered, his voice fierce with emotion. “Thank you for keeping my daughter safe.”

My experience with that family reaffirmed my belief in the importance of talking things through, allowing a story to unfold and paying attention to intuitive cues that so often lead to breakthroughs. The powerful experience these people shared had nothing to do with parental notification laws or twenty-four-hour waiting periods. It was the result of their commitment to each other, the opportunity to fully express their feelings, and the force of events to catalyze a revelation.

Some days women come to the clinic saying they want an abortion, but nothing they say or do convinces us that the decision is whole-hearted or genuine. Everything about them screams no, regardless of what their voices say.

Some of them are being threatened by partners or parents. Some just can’t see any other way out of a bad situation. In either case, we have to be cautious. I would rather have someone be very angry at me, even to the point of taking legal action against me, for
not
doing an abortion, than for doing an abortion she later regrets. It isn’t uncommon to get a letter or picture in the mail, as much as a year later, thanking us for our refusal.

Most women, by the time they arrive at a clinic, are very clear in their decision. They have been tormented by the dilemmas they face for days or weeks, sometimes months. They need the counseling sessions to simply clarify and solidify their convictions.

Even then, it can be a murky process. It is one thing for a woman to decide on a course of action, but sometimes quite another to truly own that decision. Some patients are very adept at pulling me in, as if they want me to recommend an abortion so they can feel more removed from that responsibility.

“I’ve been smoking and drinking alcohol while I’ve been pregnant,” they might confide in me. “Don’t you think it’s best to have an abortion rather than risk a birth defect?”

“Sure, it’s a risk,” I’ll throw back at them, “but there’s no way to predict the outcome. What if you hadn’t been smoking or drinking? Would you want to go through with your pregnancy?”

Almost always, when they are honest, they’ll admit that it wouldn’t make a difference. They simply want me to validate their decision, and perhaps assume some of their burden.

Once in a while the simple question I ask each patient just before starting the procedure will bring out startling information I hadn’t anticipated.

I had a patient once who seemed as calm and ordinary as they come. She could have been Sonja’s grade school teacher or the woman behind the counter at the grocery store. We went through her history, and she received counseling, had her lab tests, and completed all the paperwork. None of us picked up on any tension or unspoken agenda. She was sitting on the exam table, and we were about to start, when I asked the questions I always ask.