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A life in the day of Dr. C.E.

Posted in Health, and Women's issues

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Image courtesy of the Daily Telegraph

I have known Dr. E for the better part of 20 years and, while I was aware he practiced abortions, we never discussed what motivated him to do it; until now. When I approached him about doing a piece on a physician’s view on abortion, the first words out of my mouth were: “I would not mention your name, nor the state where you practice.” He agreed to talk to me, mainly on the record.

To anyone reading us from outside the U.S., such precautions may make little sense but, since the Supreme Court, in the landmark Roe vs. Wade decision, legalized abortion in 1973, the conservative movement has worked hard to chip away at the legality of abortion. Although there is at least one clinic per state that offers it, some states place such limitations to make abortion virtually unobtainable.

Sofagirl and I have always been pro-choice. Meaning just that: we respect the right of every woman to decide what is best for her life, including having a baby under difficult circumstances if her beliefs consider life to begin at conception.
Being the one living in the U.S., I find it particularly troubling that more and more restrictions are placed on what I consider a right that seemed settled four decades ago.

Since 1993, 8 people have been killed for the sole reason they helped women get rid of unwanted pregnancies or worked at abortion clinics (4 doctors, 2 employees, one security guard and one clinic escort – one of the doctors, Dr. George Tiller, was killed while serving as an usher during the Sunday morning service at his church in Wichita, Kansas, in 2009).

Seventeen attempted murders have taken place since 1977, not to mention the hundreds who have been harassed and threatened.

The most fascinating part of a conversation that took place over two sessions, which I tried to condense here, is not just the medical perspective, but the male one on a fraught issue that is typically the domain of women.
Over to Dr. E.

I was still a medical resident when, one night, a doctor was wheeled into the trauma center in dire conditions. He had been shot by an anti-abortion zealot.

I have always been pro-choice. In college, I started a pro-choice group that was criticized and protested. My view is that if it were men getting pregnant, birth control and abortion would be freely available and easy to get. As a man, I can walk into a drugstore and purchase, for a few dollars, a perfectly acceptable form of birth control without being judged. I can even buy Viagra on-line, without interacting with a health care provider. But a woman, let’s say a woman without health insurance, to get access to the pill has to make an appointment at a clinic, get checked up, maybe tests are ordered and, before she knows it, she owes hundreds of dollars just for her refills. If this is not gender discrimination, what is?

The violent death of a physician I witnessed all those years ago, even if I wasn’t on the team that tried to resuscitate him, struck an emotional chord in me. Here I was, a pro-choice doctor in words only, in a community where suddenly all options for a woman had gone dark. Despite the personal dangers it presented, I decided to get trained and offer my services. And I never looked back.

The technical details of abortion are not that difficult to master. It’s more about learning to manage the complications, and that comes with time and experience, and a good mentor.

Once a week, I get picked up off-site by an off-duty police officer – I wear a mask and I am escorted into the clinic where I perform abortions. I see between a dozen to thirty women in a day, from all walks of life and income status. From inner cities women to religious girls accompanied by their mothers to suburban housewives (half of all abortions are sought by women who already have children, shattering the myth that it’s mostly young girls in trouble). Most people who are not pro-choice have two firm beliefs on who should get an abortion: victims of rape and incest – until they are confronted with their own unplanned pregnancy. Many times I have heard: “I am not pro-choice but I can’t have this baby.” You are pro-choice then.

As a physician, I don’t judge anyone and ask of my patients they do not judge anyone else in that waiting room. At the beginning I would get upset when I would see someone come in for their third abortion but, really, what do I know of her situation? Is there someone getting rid of her birth control, is violence involved? Nobody can know what circumstances lead a woman to an abortion clinic: the little girl raped by her father while her mom was in prison; the medical resident who felt she couldn’t interrupt her studies to care for an unplanned baby. No woman wants to be there, each and one of them is prey to circumstances or life or bad decisions and trying to do the best they can. What I do know is that no woman gets pregnant because she can have an abortion.

prochalk480x480As things stand in 2014, unfortunately for women in the U.S., abortion has been taken out of the primary ob-gyn venue and marginalized to clinics. Until recently, most women with an unwanted pregnancy would talk to their health care providers who, in turn, would refer them to a gynecologist within their medical group who would quietly perform abortions as part of his/her medical practice.

Today, though, what used to be a procedure that was standard in most ob-gyn offices, has been ghettoized, and most doctors intimidated into not performing it. And this is happening in a country where 1/3 of the women of reproductive age will experience an unplanned pregnancy (50% of all the pregnancies in the US are not planned).

By the time a woman walks into a clinic her mind is pretty made up and, often, the only counseling that is done is perfunctory or legally mandated. I still talk to every woman I see, to make sure this is really what they want, that they haven’t been coerced. If a woman comes in and is unsure – maybe her partner or her family are pressuring her – I will send her home pregnant every time. “Think about it and decide what is right for you” – I will tell her – “It has to be done for your reasons, and nobody else’s. If you want to keep it, there are ways you can do it.”

The procedure in itself lasts only a few minutes and it’s performed either under local anesthesia or minimal to moderate sedation (either sedation does not knock the patient unconscious). It does cause a fair bit of discomfort: a tenaculum (surgical instrument with long handles and a clamp at the end) is used to hold the cervix in place for the cervix to be dilated. When the cervix is wide enough, a cannula, which is a long plastic tube connected to a suction device, is inserted into the uterus to suction out the fetus and placenta. After the procedure, the uterus quickly returns to its pre-pregnancy condition, causing strong cramps. Most women recover in a matter of hours, and are back to their usual lives within a day or two.

I have three daughters and we talk often about the perils of unwanted pregnancy and unprotected sex. But the truth is that, should one of them find herself with a baby she wouldn’t or couldn’t have, regardless of restrictions, I would find a way to help her. But what of those girls who live in states where there is only one clinic and it may be too far for them to travel to? Or they live in a state where public funding for abortion has been banned and they can’t afford the cost?

Abortion cannot be willed away by legislation. It will always take place. In 1962, when it was still illegal, Chicago’s Cook County hospitals would admit a bleeding woman, the victim of a botched abortion, every 100 minutes. Desperate women will seek desperate measures. Why not make it safe for them? In many European countries, surgical abortion is rarely practiced anymore. The so-called abortion pill, the precursor of which was the unjustly infamous RU486, is administered at a clinic, followed by other medications taken at home to induce menstrual cramps. It can all be managed safely at home and it is effective in 98% of pregnancies up to 18 weeks. The Federal Drug Administration, however, has approved it only up to 7 weeks (a follow-up check up is required after a fortnight to ensure the fetus has been expelled in its entirety).

Why do I do it? I am certainly not in it for the money. I get paid a small fee for each procedure. If anything, the drawbacks can be considerable. I lost a teaching position at a conservative university because my outspoken support for abortion was more than frowned upon, even if it represents a tiny portion of my medical practice.

My personal belief is that there is no sentient life until there is viability, which is generally accepted to be at 24 weeks. Every time I walk into the clinic, the protesters outside scream at me “Save the babies! Use your talent to save the babies!” My standard response is I am saving the mommy today. Would these same people be willing to adopt a crack baby born at 28 weeks? Or the baby of an alcoholic? And these are the same folks who will deny children in need social services such as food stamps, early childhood education, healthcare. What are we supposed to do with these babies exactly? Are they willing to house them, school them, clothe them and feed them? There is so much passion involved in other’s people uteruses, it doesn’t make any sense.

When I tell a woman it’s all over and she did great, invariably I get a heartfelt thank you. That thank you makes me feel as if I have taken away a huge weight off her shoulders, a problem that, until the day before, maybe seemed insurmountable. As a doctor, it is my duty to try to make a difference. In the case of the women I see, I am able to help them rebalance the course of their lives. That is why I do it.

 

To read more about how individual states handle abortion and on the subject in general, you can consult Naral – Pro-choice America

For additional facts and figures, Guttmacher Institute is a wonderful resource

51ZNZTQQ1AL._SY344_BO1,204,203,200_An insightful read on the so-called “abortion wars” is the non-fiction book “Absolute Convictions by Eyal Press

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12 Comments

  1. silvia
    silvia

    Thank you Dr. E. for you respect and dedication to women who need help in a crucial time of their lives.
    He made a fundamental point if it were man who got pregnant, contraception would be as easy to get as drinking a glass of water.
    And could someone pls explain to me what does it mean to name a movement prolife? Do they think we are all insane and against it?!!!!!!!!
    Europe is slowly changing and more and more women everywhere are having troubles in getting legal assisted abortion. In my country doctors who practice it are having increasing difficulties with their job and I’m afraid it will get worse.

    May 25, 2014
    |Reply
    • It makes me sad to see even Europe is succumbing to religious rhetoric….

      May 25, 2014
      |Reply
  2. I attended Catholic schools for 12 years in the 50s and 60s. I remember a question in religion class: is a fetus a human being? The nun replied that a human being was comprised of a body and a soul and that the soul entered the body just before birth.
    She was not making this up–if was the official doctrine. So, a fetus was not a human being, despite having 10 fingers and 10 toes.
    What changed? The birth control pill. Pope Paul VI issued an encyclical denouncing birth control and things spiraled downward from there. What was right on Monday became wrong on Tuesday and, as always, the burden was on the woman — never mind where that sperm came from.
    As for the conservative politicians, they are Pro-Life from conception to birth. After that, they don’t care to offer any support for that baby–not pre-natal care, not pre-school, or school lunches. Poor mothers suddenly become leeches, sponging off of society.
    Dr. E is correct: if men had babies, we would not be having this discussion.

    May 12, 2014
    |Reply
    • Dear Kate, you bring up a very interesting point I was not aware of (what was I doing during my years of Catholic schooling? clearly not listening). I knew about Pope Paul VI’s encyclical against birth control but did not know it fudged one of their dogmas. Not surprised as Catholicism has bent itself into some unrecognizable positions.

      May 13, 2014
      |Reply
      • I only made the connection a few months ago. That religion class must have been nearly 50 years ago.

        May 13, 2014
        |Reply
  3. This is a subject I feel particularly strongly about. Way back in the bad old days of 1960s SA. contraception for women who were not married was virtually unobtainable. I was a student in my final year of uni, and became pregnant – it was not something I wanted (nor did the chap) and had happened despite our best endeavours. What to do? Abortion was illegal in SA back then.There were places you could go, but after visiting one of them I was distraught, it was filthy, the person who would conduct the procedure seemed to have been drinking; needless to say I left in a hurry.
    Thanks to a friend we were put in touch with a doctor who would do the termination in a proper clinical environment, but there were conditions. I had to pretend to be a married woman, with ring on finger etc; we had to pay a whack of money (which we borrowed); I had to visit a different doctor first who would examine me and make me bleed so that the doctor who did the procedure could justify his actions by saying I was bleeding and therefore needed the termination. Every step of the way it was impressed upon me that if the powers-that-be knew about it, I would face a criminal charge (true) and the doctor would be drummed out of his profession/livelyhood thus ruining him. It was all very very traumatic. It all went to plan thank God.
    It was something that should have been straight-forward but became a hugely expensive and complicated situation. However, I know it was the right decision, and I have never regreted it, nor felt guilty about having done it.
    Making safe medical abortion illegal will not stop abortion happening, but women will die if they have to resort to the back street abortionists…and they would do that.
    All women should be free to make the choice I made, but without the anxiety and difficulties I had to get through.
    I respect Doctor E.

    May 12, 2014
    |Reply
    • Thank you so much for sharing your story. Even at such remove, of time and space, it cannot be easy to put it black on white. But it is living proof of why safe abortions are needed.

      May 13, 2014
      |Reply
    • Thank you Many. We were a bit hesitant whether to even get close to the subject but I am glad we did.

      May 13, 2014
      |Reply
  4. Reblogged this on Womanism. and commented:
    “Why do I do it? I am certainly not in it for the money. I get paid a small fee for each procedure. If anything, the drawbacks can be considerable. I lost a teaching position at a conservative university because my outspoken support for abortion was more than frowned upon, even if it represents a tiny portion of my medical practice.

    My personal belief is that there is no sentient life until there is viability, which is generally accepted to be at 24 weeks. Every time I walk into the clinic, the protesters outside scream at me “Save the babies! Use your talent to save the babies!” My standard response is I am saving the mommy today. Would these same people be willing to adopt a crack baby born at 28 weeks? Or the baby of an alcoholic? And these are the same folks who will deny children in need social services such as food stamps, early childhood education, healthcare. What are we supposed to do with these babies exactly? Are they willing to house them, school them, clothe them and feed them? There is so much passion involved in other’s people uteruses, it doesn’t make any sense.”

    May 12, 2014
    |Reply

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