This Common Secret: My Journey as an Abortion Doctor (18 page)

Some states require that a specific script be read to the patient. The text is often laden with hyperbole and emotionally charged language, referring to an embryo as an unborn child, for instance. The required information can include inaccurate references to fetal pain, a reminder that the father will be required to provide child support, and an encouragement to review materials on other options provided on a state-sponsored website. A thorough discussion of risks associated with the procedure is also mandated by law.

After that, the patient has to take twenty-four hours to think about her decision. Only then can she legally have an abortion. The penalties for not following these laws range from significant fines to prison sentences.

I spend many hours in the evenings and early mornings calling patients to provide them the information mandated by law so that they can avoid an additional trip to the clinic and absences from school or work. Putting all the information into context and explaining the bigger picture take a tremendous amount of time.

If I tell a woman that she could die from the abortion procedure and leave it at that, it scares the bejesus out of her. If, however, I explain that there is a higher risk of complications from wisdom tooth extraction, it puts the statement into perspective.

It isn’t uncommon to play phone tag or fall prey to unforeseen problems that cause us to miss our phone session. Those patients may lose their appointments altogether or have to delay their procedures because we can’t connect.

Sunday night. Judy B. is on my call list for 8:20. She has an appointment on Wednesday. I try to call, but the number I’ve been given is incorrect. Judy waits by the phone but never hears from me. Trivial error. Unintentional, but with huge consequences.

On Monday she calls the clinic to reschedule the call, and I get the correct number. There is still time. When I call on Tuesday morning, a man answers the phone. “Judy had to go to the hospital with our three-year-old. I’m home with the other four kids. Can you call on her cell phone?” he asks.

“Of course I can,” I say, but I try three times and only get her voice mail.

The next morning Judy arrives for her appointment. We can’t do it because she has failed to comply with the law.

“I HAVE to do this today. Please!” Judy says. “Today is my only day off for the next two weeks. I’ll get fired if I miss another day.”

“I am so sorry,” I say. “The law is absolute. We really can’t do it.”

Reluctantly she reschedules. We take care of the informed consent process right there. She leaves in tears.

Several days later, Judy is finally able to have her abortion. She is angry and, as she predicted, has lost her job.

Ultimately, much of the abortion war is waged in the court-room. From county courts to the Supreme Court, cases are in constant flux, susceptible to the political tenor of the moment, changes in judicial makeup, and social pressure exerted by politicians and advocacy groups.

Roe v. Wade
gets all the attention, but off the radar, innocuous-seeming legal wrangling can change the landscape for clinics and patients in dramatic, profound ways.

In 1998 the courts found in favor of NOW and the National Women’s Health Organization, which operates eight clinics in the United States, citing the Racketeer Influenced and Corrupt Organizations (RICO) Act to prevent organized groups from crossing state lines to participate in activities that have the effect of hindering commerce. Operation Rescue and other groups routinely traveled across state lines, organized protests, and hindered the conduct of clinics.

Operation Rescue faced heavy fines, and the decision had a chilling effect on their ability to continue harassing clinics. They were essentially shut down after the court decision and a period of relative peace ensued.

In 2006 the U.S. Supreme Court revisited the case and overturned the decision. As a direct result, Operation Rescue reorganized under the banner Operation Save America and undertook a massive onslaught against the lone clinic left in Mississippi. Their express goal was shutting down the Jackson clinic.

Operation Save America’s leader, Reverend “Flip” Benham, presided over a burning of the Quran during one gathering. When asked what the Quran had to do with abortions, Benham stated that they were “different manifestations covering the same fist, the fist of the devil.”

Protesters verbally abused patients coming and going from the clinic and blatantly ignored the limitations placed on them by city ordinance. Benham said that the clinic, along with his other targets, which included Millsaps College, a high school, the Jackson police department, and the local newspaper, represented “the gates of hell.”

In April 2007 the Supreme Court upheld the Partial-Birth Abortion Ban, reversing an earlier Supreme Court decision. It was the first time that the high court has mandated what a physician can or can’t do with a patient and opened the door for more severe restrictions on abortion rights. This decision makes it illegal for doctors to perform what may be the safest medical procedure for women having second-trimester abortions. Less than five percent of all abortions fall into this category. They are often performed to save the life of the mother, in response to severe fetal anomalies, or to end a pregnancy that has been shown to be incompatible with life.

The legal and political furor focuses on the rights of embryonic tissue, not on the rights of women and young girls. All the attention is lavished on “the unborn.” The restrictions are cynically referred to as a “woman’s right to know,” when, in fact, they do everything to prevent women from exercising their legal options. If the right to know is sacrosanct, why is our foreign and domestic funding muzzled by gag laws that prevent physicians from even discussing legal health care measures available to women?

In clinics, though, it is women we are dealing with, and girls. Where is the public outcry in defense of victims of domestic abuse, rape, and incest? Who is pursuing absent fathers who walk away from responsibility? Where are the protections of confidentiality for our patients?

Every day people come through our doors coping with real-life dilemmas and traumas. I often wonder if it were men who got pregnant, men who faced these wrenching personal difficulties, whether abortion would even be on the political radar. Would men be expected to compromise their futures, give up the prospect of college, lose professional opportunities, sacrifice their ambitions . . . to fatherhood? I suspect not.

In some cases, our patients face real danger. It is our job, our duty, to serve and help them. It is up to us to recognize their plight and to provide resources. No politicians or laws help us in that process. We have to rely instead on common sense, experience, and intuition. That duty requires the ability to ferret out the shape of a situation and intervene if necessary.

“This one’s really young,” the nurse warns me one day in clinic. “Her father is here, and he’s awfully protective.”

I look at her form. Fourteen, it says. But when I see her, she looks twelve. Twelve and terrified.

“Come on back,” I beckon her down the hall. Her father follows her. A small man, unshaven, with nervous hands.

“I just want what’s best for my girl,” he says, looking right at me over his daughter’s head.

“Is your wife here?”

He shakes his head. “We don’t want to bother her mama with this. She wouldn’t take it well.

“My girl’s made a mistake, and we want to do what’s best.”

The girl stands quietly, head down.

“It will be an hour or so before your daughter’s finished,” I tell him. “You can wait up front.”

“I can comfort her,” he pleads. “I want to be with my girl.”

“She’ll be fine. Please.”

He backs away, looks hard at his daughter, who won’t look back.

I take her thin arm with my hand and lead her into the procedure room.

“Let’s talk for a minute,” I say.

She sits straight-backed, hands clasped in her lap. She looks cold.

I ask her general questions about her home, her family, how the drive was, what she likes about school. Her answers are small whispers.

I go on to tell her about the abortion, what we will be doing.

“Are you sure you want to do this?” I ask, finally coming to the point.

“I have to,” she talks to the floor.

“Why?”

No response.

“Do you want to be pregnant?”

She shakes her head.

“Do you want an abortion?”

Another shake.

Alarm bells had started going off when I saw her interaction with her father. It was time to figure some things out.

“Do you have a boyfriend?”

Silence.

“Did a boyfriend get you pregnant?”

Nothing. I can see her shivering.

I move closer. I want to hold her, make her warm and unafraid, but I know that’s the wrong move. “Listen,” I say, gently. “Sometimes things happen that aren’t easy to talk about. I need to know how you got pregnant. Did somebody do something bad to you?”

She sits mute.

“Who made you pregnant?” I insist, moving as close to the scared girl as I dare. “Who?”

Long silence, but she finally lifts her head, looks at me. Her eyes are troubled. No fourteen-year-old eyes should look that way.

“It was my daddy,” she whispers.

For a minute I don’t speak. I can’t speak. The rage exploding inside me is molten. I want that man’s neck in my hands. “I just want what’s best for my girl,” he had said. The same man who violated her, who tortured her life in service to his perversity. I start shaking, trying to control my anger.

“The man in the waiting room who you came with? Is that who you call ‘Daddy’? Is he the one who did this to you?”

“Yes,” she says. “It’s him.”

“No one else? No one else has touched you down there? Nobody has done this to you but your daddy? The man you came here with?”

“No one.”

“Does your mama know?”

She tightens up, looks down again. One question too many.

“Listen. I won’t do an abortion today. We have time to consider that. We won’t touch you or deal with your pregnancy. Our first job is to make sure you are safe.”

Her head jerks up, fear flaring in her eyes. “He’ll hurt me if I don’t. I have to! He said if I didn’t he’d beat me up again. He will! He’s done it before.”

“You are a minor,” I say. “We have to get you away from him for a while, someplace safe. You are very early in the pregnancy. We can talk again soon, but we have to make you safe.”

Her eyes plead with mine. They ask for honesty. They search for an adult to trust.

I reach out, touch her, carefully, very gently. “We’ll get you through this. I’m going to have a nurse come sit with you while I make some phone calls. We won’t let him hurt you.”

Nearly an hour had passed before I felt comfortable leaving the young girl with a nurse and could return to the main office.