This Common Secret: My Journey as an Abortion Doctor (15 page)

The staff starts working on her lab tests. Another patient has finished her counseling and is ready for her abortion. I try hard to maintain an everything-is-normal manner. Before starting the procedure I make a call to a lawyer in town who, when I first opened the clinic, made a point of offering his services. I fill him in on what’s happening. He promises to stay available, tells me to be careful. After I hang up, I readjust the shoulder harness on my pistol, feeling its heavy presence under my scrubs.

So much for an uneventful day, I think, as I go into the procedure room. All the way through that abortion I listen for the sound of the office door, for angry voices.

By the time the first patient is in recovery, we’re ready to go. Her chart is straightforward. She has gone through the informed consent form and signed off. Her vital signs are perfect, and she has no medical history to worry about. I close the chart and enter the room where she is waiting for me.

“Okay,” I start out, when I get inside. “Let’s forget all about your uncle. He has nothing to do with this. Have you had all your questions answered? Do you understand the procedure? Have you had any other surgeries or any condition we should know about?”

Given the stress she is under, she is very articulate and very steady. We review things quickly but thoroughly. She shows no doubts.

“I’m going to step out now while you undress from the waist down. When you’re undressed you can sit on the end of the table and cover with this drape.”

I close the door and walk back to the window again. Still quiet outside. I check the waiting room, give the receptionist a squeeze on the arm before I go back.

“Before we start, I want to ask you again: Are you absolutely sure you want to have this abortion? Is there anyone pushing you or telling you to be here? Is this really your decision?”

She is sure.

She lies down for the ultrasound. “That’s your uterus,” I point to the screen. “Here’s the fetal tissue. It looks normal for about five weeks gestation.” There is a small sac attached to one side of the uterine wall.

“Now I’m going to do a regular pelvic exam. I’ll touch your leg so you’ll know where I am. I’m feeling inside for your cervix.” At the same time I palpate her lower abdomen. “There is your uterus,” I push down gently. “It feels really normal, maybe tipped back just a little. Is there any tenderness there?” I move my hand and press over her ovaries.

“Now we put these sterile drapes under you.” I ready the instrument tray and sit at the end of the table. “I’ll be using a speculum. It won’t hurt, and it’s all warmed up already. It just allows me to see your cervix and create a space to work through. If you have any questions at any time, please ask.”

“I’m looking at your cervix now. Everything looks just fine. I’ll clean the cervix and take a culture with a swab.”

As I work, my assistant, a nurse, holds the bottle of lidocaine so I can draw it up into a syringe. “Most people don’t feel these shots at all. If you feel anything, it will be a little pinch. First I numb the surface of the cervix. Now I can hold your cervix with an instrument that keeps everything steady while I put in two more injections. Tell me if you feel anything at all. There. That’s that. Did you feel anything?”

She shakes her head.

“Now we’ll let that numb up a minute. You take some big, deep breaths. Try and relax.” My voice is a constant monotone. Even if there is nothing to say about the procedure, I talk about anything. The weather. How school is going. Where they work. How the drive was. Just keep talking with that soothing voice. I have changed into a new set of sterile gloves now and start explaining the next stage of the process, reinforcing what she has already heard in the counseling session. Always talking.

“These are the dilators.” I show her the instruments. “When I use them, you’ll feel a little tugging, but it won’t be painful. I insert and then remove these gently, one at a time, in increasing size, until your cervix is dilated to about the diameter of a pencil.” As I talk, I start the dilating. “When a woman delivers a baby, her cervix is dilated to ten centimeters. We’re dilating your cervix to just seven millimeters, which is less than one centimeter. Keep your bottom muscles loose. But, please, if it does feel painful, let me know. I will stop and put in more pain meds. Now, another dilator. Take a deep breath in; hold it a few seconds. Now exhale, long and slow. Keep relaxing all your muscles. Good. One more now. Keep breathing.” I find myself breathing along with her, as is the nurse.

“Any questions? Doing okay?” Always the same steady, soothing cadence to my voice.

“I’m fine,” she says. My instruments clank softly on the tray.

“Okay, your cervix is dilated.” As I say this, the nurse hands me a small, sterile tube attached to a device that creates a gentle suction. “This will feel really weird. That’s the only way to describe it. It will be like a bubbling inside you, and you’ll feel movement from the instruments, but very little pain. We suction for thirty to forty-five seconds.” The machine always makes me think of an old refrigerator, that same deep hum.

When we finish, I rub her lower abdomen gently. “You may feel a strong deep cramp,” I tell her. She nods emphatically. “That’s good. It’s your uterus contracting down, shrinking again. It’s a good sign. Just keep breathing deep; relax.”

I check the inside of her uterus with a curette, a small looped instrument, and finish with another ten seconds of suctioning. She handles it well, and soon I am picking things up, and the nurse is checking her blood pressure and pulse.

“It’s over?” she asks. “Really, that’s it? I’m not pregnant anymore? That isn’t anything like what I heard it would be.”

“Once in a while someone has a difficult abortion,” I say. “But it is almost always someone with a fibroid growth or preexisting infection. Most are like yours.”

While the nurse escorts her to the recovery room, I take the fetal tissue to the lab. Still no sign of trouble in the office. I remove the quarter-sized sac from the jar. It is filmy with placental tissue and some of the endometrium that normally sloughs off. All normal.

I always give patients the option of seeing the tissue if they want to, and this woman wants to see it. “That’s all?” she says when I show it to her. She escapes into her own thoughts for a minute and looks at me with hesitation.

“What is it you’re thinking?” I prod.

“How can it be that my uncle believes I am less important than that tiny bit of tissue you just took out of me?”

She isn’t expecting me to respond. She is talking to herself, trying to put her world in order. I sit quietly with her for a few minutes.

We finally start talking about home care, birth control, and general recovery issues. Patients generally stay for at least thirty minutes so we can be sure they are stable. She wants to leave after just ten minutes, hoping to be gone before her uncle and aunt get there, if they really are coming. But I make her stay the full thirty minutes. Taking short cuts with her health is not an option. In the meantime I leave her with the nurse and excuse myself to go see another patient.

Finally, we are escorting her out of the clinic with her girlfriend, after having checked the corridor and elevator for signs of her relatives. I wrap my arms around her briefly as she passes through the door. The waiting room is tense. Then I let her go. The two of them hurry out of sight.

All of the staff is lined up at the window overlooking the parking lot. I hear one of them muttering urgently, “C’mon, girl, get out of here!” Finally we see them, moving quickly, getting into the van they arrived in. All of us are half-dancing with tension at the window. Finally they turn out of the parking lot, down a side street—the blinker flashes—gone.

“Yes.” I breathe. And we all turn back, grinning our relief. There are so many women who leave the office to return to their uncertain receptions, their uncertain futures. If only we could fast-forward for a glimpse to better prepare ourselves.

We are behind schedule now, and the weight of the pistol drags on my consciousness. We aren’t through this yet, I remind myself. And as I ready myself for the next patient, I hear a man’s voice at the reception desk, an ugly voice.

“Where’s that doctor?”

No time to think, just react. I suppress the momentary urge to hide, forcing myself out front.

“Where’s that doctor?” he repeats, and I can see him leaning aggressively over the counter. A heavy man, tiny sharp eyes, thick gnarled hands out in front of him.

“I’m right here,” I announce. “What can I do for you?”

“YOU?” he is thrown off. He expected a man. Now I see a woman behind him, a tall, skinny figure with gray hair. She is craning for a look at me.

“Yes. What can we do for you?”

“We know Grace is here. You can’t kill that baby. We’re here to take her home.”

The other people in the waiting room are all ears and eyes, the tension palpable. One gathers her coat in her lap. They glance at each other.

“We have no one by that name here. There is no one by that name in the appointment book at this time. You have no business disrupting this office!”

“Office!” he sneers. “This—this slaughterhouse? You’re a killer! You call yourself a doctor?”

“That’s enough!” the strength in my voice comes from somewhere I can’t fathom, overriding the fear, pushing aside the ugliness emanating from this man. Then I catch a glimpse of a young man standing just inside the door. He is shifting nervously, looking everywhere but at me. The boyfriend, I think. “That’s enough! There is no one here for you, and you have no business with my office. You’ll have to leave.”

“We know she is coming!” he tries to look around me to the back rooms. “You’re not killing that little baby!”

“You’ll have to leave. Now!” I come around to herd them out, thinking about the pistol as I approach, watching the man and woman. “There are chairs by the elevator. If you must waste your time, I can’t stop you from sitting out there.”

They are backing up. The woman’s eyes are burning with anger. The boyfriend is already out, more than willing to leave. “You’ll have some answering to do!” I hear the uncle say to him in the corridor. On their way to the chairs in the hallway the man turns to me again, shaking his fist. “And you’ll answer, too, you doctor!” he spits the words. “You’ll answer!”

I shut the door on them, lean against it briefly, and try hard to make my smile reassuring for the waiting-room audience.

“Sue,” the receptionist interrupts. “Sonja’s on the phone.”

I step into my office, pause, take a big breath. “Hi Begonia!” I use my Happy Mom voice. We chat briefly before Sonja springs the real reason for her call.

“Mom, a week from Friday is the parent/student swim meet. You know, parents against the swim team.” Silence.

“Mom,” she brings me back. “Randy doesn’t swim. Can you come home?”

I take another breath, try to get everything back in perspective. “I’ll do my best, sweetie.”

Then the call is cut short when one of the counselors knocks on the door.

“Can you come help for a minute? This one needs some comforting,” she whispers. I sigh, say good-bye to Sonja, gather myself, try to push the people in the hallway out of my mind. But I’m still flushed from the confrontation.

When I enter with the counselor, I recognize the patient. I saw her arrive earlier. She edged in through the door as if she were afraid it would slam and lock behind her. College age, jumpy, from a rural area, I expect. She confirmed her appointment without approaching the counter, sat right next to the door, never took her coat off. I see that even in the counseling room she is balanced on the edge of her chair, flinches when I close the door.

“Hi,” I say. “I’m the doctor.” She nods, gulps, looks away.

“Is everything alright?” She nods too emphatically.

“Have you been somewhere else for a pregnancy test?”

She looks surprised, makes eye contact for the first time.

“Was it the clinic that advertises abortion information in the paper?”

“How did you know?”

“You act the way most people do after they’ve been there,” I tell her. “We aren’t the same kind of place. And I doubt we’re anything like what they told you there.” I have her attention now.

“I thought I’d be able to get an abortion there,” she admits. “They looked like nurses and doctors with their white coats. They told me they were giving me a pregnancy test and put me in a room for two hours. There was a television playing an awful video in there. I couldn’t leave.”

I sit in front of her and give her all my attention, encouraging her to keep talking.

“When they told me my test was positive, they started saying there was a good chance I’d bleed to death from an abortion. That I ought to consider keeping the baby. That I’d regret this the rest of my life.”

“And,” I say as I hold her attention, “they told you you’d probably never have children after having an abortion, right?”

“How did you know?”

“And they told you there was a good chance you’d die, right? And that I am not a real doctor? That if you came here you could get AIDS from other patients?” She is open-mouthed, nodding.

“First of all, you are completely free to leave any time you want. We will answer any questions you have. This isn’t something we do to you. You can decide to have this done. If you want to talk about adoption, about social services available for mothers without money, about prenatal care, about any of that stuff, that’s fine. We have lots of information available on all the options, including accurate information about abortion.”

She is visibly relaxed, although she still looks guardedly back and forth between us, like we might be tricking her yet.

“They told me you have knives and scissors here. That you cut up babies and throw them in the garbage!”

“There are no knives, no scissors, no scalpels. If patients want to see the embryonic tissue, we give them that option. Most women are actually quite relieved when they see it. And we take great care disposing of it in a respectful, appropriate, legal manner.