This Common Secret: My Journey as an Abortion Doctor (23 page)

“Dad, you have to get dressed up and look nice.”

“For what?” he demanded.

“Dad, it’s Mom’s funeral.”

“Oh my gosh,” he turned to me. “Vera? When did she die?”

We drove in silence to the service, through the winter, rural countryside. Crows flew over the brown stubble in farm fields. At one point I looked over and caught Dad whispering to himself, counting out a row of silos as we passed.

A
fter Mom died, it took months for my head to clear. For the better part of a decade she had been my focus, my job, my preoccupation. Now she was gone, but I was reminded of her everywhere. Almost daily I caught myself thinking of a task I needed to do for her. Or I’d pick up the phone to call her about something on my mind. Then, like waking from a dream, I snapped back to reality, a life without her in it. Sonja had lived in Ecuador during the last year, and I’d felt some of the same sense of disorientation and loss, but I could call Sonja, send her a letter, imagine her living an adventure.

Mom was simply gone. All that remained was her memory, the material things that were part of her life, the family and friends she touched. Alternately, I was angry, relieved, confused, terribly sad.

I kept working in St. Paul, providing state-mandated informed consent counseling and abortions. It was my sanctuary, my escape. As always, I became completely absorbed in patients’ situations. My involvement was immediate, physical, all consuming. One at a time I engaged with them while I let the rest of the world spin in its orbit without me. The only interruptions came when some administrative snag or financial policy would divert our interaction or stop us cold.

The work was my haven, as it always has been, but the fact was, I was worn down, adrift, unable to see my way clear to a future.

Over Mother’s Day, four months after Mom died, I took a backpack trip to Arizona. I hiked alone into the dry mountains outside of Tucson. For days I pushed myself physically, wandering the austere high country while the pulses of grief and loss worked through me. There in the desert air, I started writing a letter to Mom. I let all the anger and lost years and love and mourning flow onto the scribbled pages, one after another.

Even after the trip was over, I kept reworking the letter, editing it, adding to it. Weeks later, when it was done, when I felt drained of those emotions, I burned it, one page at a time. In the rising curls of smoke I truly began the process of letting her go.

All that summer I traveled back and forth between Montana and Wisconsin. I continued to provide abortions at least six days out of every month, but my focus was on building a house out of the cabin on my property, the place I’d been drawing by Mom’s bedside. I learned to use carpentry tools—plumb bobs, levels, table saws, nail guns. I peeled logs, helped raise walls, stacked and carried endless piles of lumber.

I lived in my van, parked on a rise with panoramic views of the mountains and sky. I slept with the doors open, woke in the darkness to the star-pricked sky and the howls of coyotes. The smell of sage filled my head. I took showers at the neighbors’, sat for hours by the small stream across the field, cooked meals on a camp stove with the healing scenery for my dining room. I was coming back to life.

But then I’d return to Wisconsin, to the guilt and weight of responsibility there. Dad was steadily losing his grip negotiating life. He was becoming a challenge for Julie. At one point I decided to bring Dad back to Montana with me for two weeks, more to give Julie a break than to give Dad a vacation. He couldn’t get comfortable. He lost his bearings, never understood why he was sleeping in a neighbor’s trailer I’d pulled over to my property. Several days into his stay he announced that he was heading home, even if he had to walk all the way.

In Wisconsin he was still living on his own in the family house, but he needed daily supervision and care. He was angry much of the time, disoriented and feeble. We got him a dog, thinking he’d welcome the company, but he’d forget to feed it, get confused about whose pet it was. We finally had to take it away.

Much to the horror of some of my relatives, it was time to reckon with Dad’s collection of guns. They had been the passion of so much of his life, but they were simply too dangerous for him to be around. There were eight loaded guns in the bedroom alone, more in the kitchen, one in the bathroom. We cleaned out every gun we could find, hundreds of them, the collection of a lifetime, the legacy of the vibrant, funny, skilled, strong man who had been my father.

Would I have to spend another decade stuck in neutral?

As fall approached, I wrapped up the building project as best I could and moved back to the Midwest for the winter. Dad’s needs were a daily challenge, much as Mom’s had been. Julie and I cooked his meals, did his laundry, cleaned house, kept up his medications, took him to doctor appointments. I felt myself slide back into that caregiving mode, with all its conflicts and frustrations.

On top of that, things began to change at work.

I was being scheduled for fewer and fewer days. I suspected that it was the consequence of my outspokenness on patient care issues and bureaucratic protocols. In some cases I had appealed to my superiors. When that went nowhere, I several times contacted higher authorities. In every instance, they eventually agreed with me and overruled the lower management. My determination to be a vocal patient advocate was rubbing someone wrong. While the clinic staff were completely supportive and competent, they didn’t have any more power than I did.

About that time, several insurance companies started to deny payment for abortions that weren’t performed by a doctor with a board-certified specialty. Reproductive health is not a specialty with board certification. Suddenly I was the doctor on staff with more experience and a lower rate of complications than most, but limited by managed care rules. The accumulating stress at work began to erode the satisfaction I found with patients.

For another year I yo-yoed back and forth from Montana to Wisconsin, from one life I craved to another I felt obligated to. I knew I had to make a living, but I also knew I couldn’t keep up my fractured existence and endure the emotional tug of war. By that time we’d hired people to help take care of Dad, who was still living in his home.

I loved seeing my western home come together. I spent hours planting flower beds and trees. While I gardened, I started toying with the possibility of pursuing other work.

I spent time with a career counselor who identified what she perceived were my strengths, and encouraged me to consider new directions.

Along with a friend, I experimented with using my home and property as a retreat center for caregivers and social activists. We held several retreats, but it was very expensive and I couldn’t face the fund-raising challenge it would take to pull it off. I talked to a local veterinarian I respected about being his assistant. I looked for jobs in the medical field on the Internet, but I couldn’t get excited about a career devoted to managing high blood pressure. For a time I entered a partnership with some neighbors who ran a pottery business, making and marketing pottery funeral urns.

All the while the prospect of abandoning my profession, and the society of abortion providers, nagged at me.

One evening I spontaneously called up a colleague, the woman who had been chief resident at the hospital where I did my internship. She had been my first teacher in the practice of providing abortions. I admitted to her that I was considering other lines of work. She wasn’t surprised. She didn’t condemn me. She knew only too well how profound and personal the issues were. Perhaps I was looking for some kind of confirmation, maybe even permission, to move on, try something new, call it good. I didn’t get that either.

Instead, our conversation drifted to the other providers we knew, how they coped with the stress and danger, and to a discussion about the violence we face and the emotional price we pay.

I told her that I had been thinking lately about a memorial service in Pensacola, Florida, back in March 1994, marking the first anniversary of Dr. Gunn’s murder. Abortion doctors came to the service from all over North America, along with clinic directors, political activists, members of his family. Many of us wore bulletproof vests. A man named Paul Hill hung around the fringes. We knew him as an anti-abortion activist. I was very spooked by him, but most people thought he was harmless; some even engaged him in small talk.

As it turned out, Paul Hill murdered an abortion doctor just months after Dr. Gunn’s memorial. On July 29, 1994, Hill shot Dr. John Britton at a clinic in Florida. Hill came to the clinic before Britton’s police escort arrived. He first killed Britton’s bodyguard, retired Air Force Lt. Colonel James Barrett, with a shotgun, then shot Dr. Britton in the head.

My former chief resident and I talked about the strain of working in isolation. An occasional conference or regional meeting will pull colleagues briefly together, but for the most part, we live our lives, figure out how to survive, serve our patients, and fashion the strategies that allow us to keep going alone.

After the phone call I continued to dwell on Dr. Gunn’s memorial. It had been very clear that each doctor had coping mechanisms, had structured living situations and relationships to accommodate this profession, and had individual motivations that kept him or her working. No matter the differences in style, the lines each of us wouldn’t cross, and the reasons behind our choices, there was also an unequivocal sense of mutual respect and solidarity present in that gathering.

Early in my career, I had occasionally called my mentor, Jane Hodgson, the doctor who had taught me so much. Dr. Hodgson died in 2006 at the age of ninety-one. She was a legend in the field of women’s reproductive health and lived on the raw edge of the battle. She was also a gentle and soft-spoken woman, with clear insights and quiet authority. Whenever I had a unique case—a difficult fibroid or cyst, a woman with a systemic illness that might complicate things, a patient with an unusually tight cervix—I’d call to discuss my approach.

Inevitably, those phone conversations went beyond simple procedural advice. In the margins, we also talked through my motivations, the realities of the path I’d chosen, the impacts on my personal and emotional life. Over time, though, as I became more experienced, those calls diminished, then ceased.

Later, before she died too young of a brain tumor, I used to call Dr. Liz Karlin. I had helped train her so she could take over for me at the clinic in Appleton, Wisconsin, and she was an outspoken advocate for women’s rights. She lessened the gravity of my situation with her irreverence and humor. She was once quoted in an op-ed story as saying, “Until abortion rights in this country are assured, no penis should be allowed to enter another woman!”

The solace of phone contacts and an occasional meeting can’t overcome the reality that I am part of a far-flung culture within the medical community. We are outcasts, bonded by our commitment, valued and shunned for our services. Each of us manages our personal high-wire act. It is a solitary show. From time to time we hear about each other. Almost always, when we do, it’s bad news.

Dr. Tiller, for example, who runs a clinic in Wichita, Kansas. He endures the daily barrage of picketers, puts up with the mundane, but onerous, harassment. He and other doctors who work at his clinic are followed home by picketers. Their families are hassled, their neighborhoods leafleted.

One day in 1993, Dr. Tiller was in his car in the parking lot outside his clinic when he noticed a woman approaching. He recognized her as one of the Lambs of Christ. She strode up to his car window, pulled out a gun, and shot him. Dr. Tiller only had time to raise his arms over his head. The bullet went through both arms, but missed his skull.

The very next day, Dr. Tiller returned to his clinic and went back to work.

“I was really lucky,” he told me. “It was a small-caliber gun, and she was a lousy shot.”

Dr. Leroy Carhartt, from Nebraska, began providing abortions after retiring from surgical practice and a twenty-one-year career in the Air Force. As a young doctor, while abortions were still illegal, he had seen hundreds of women in surgical wards, many in critical condition, some dying, from botched and illegal abortions. At the end of his working life, instead of retiring, he took up clinic work out of his belief that women should be able to have safe and professional abortions.

In the fall of 1991, his home and horse barn were set on fire and completely gutted. Carhartt escaped in his car with only the clothes he was wearing. Seventeen horses, and several family pets, perished in the flames. Despite the fact that the fire was started simultaneously from seven different locations on his property, no arson charges were ever filed. The next day, Dr. Carhartt received a letter from an abortion protester who compared the death of his horses to the “murder” of babies in clinics.

In response, Dr. Carhartt increased his practice from part-time to full-time. Even now he refuses to wear a bulletproof vest. “The antis know enough by now to just shoot for the head,” he says.

Not every doctor, and not every family, can take the strain. A physician I knew in southern Wisconsin quit providing abortions in response to the anti-choice tactics directed at his family. The protesters followed his wife to the hairdresser, where they harangued her and the other clients. They picketed the garage where he had his car serviced, followed his kids to school, hung posters around town accusing him of murder. In the end, it was too much. His family couldn’t stand the pressure. Who could blame them? He made a public announcement that he would stop providing abortions.