abortionclinicdays

Annie's story

Last week, Annie appeared at our door without an appointment, begging the guard to let her in.  After much discussion with the guard, and a counselor coming to the door to learn more, Annie was admitted for a counseling session and sonogram.  Annie told us she was 18 weeks pregnant, needed to have an abortion immediately, but had only a few dollars.  At 18 weeks, the cost for an abortion is more than $1000, is a 3 day process, and our state law requires a mandatory 24 hour delay.

I sat down with Annie to hear more of her story.  She told me that she did not want to be pregnant, that her boyfriend had thrown her out, she had nowhere to live and did not earn enough to even pay her rent and utilities.  So we set her up to have a sonogram to determine exactly how far into her pregnancy Annie really was.  The sono revealed that she was exactly as she said, 18 weeks, meaning that we had only one week to complete the process according to the protocols of our particular facility.  Annie told me that she wanted an abortion more than anything in her life, that she was the only person in her whole family who was not addicted to drugs and she wanted to make something of her life.  She said she was determined that she would not be like them.  She stated that no one in her family had ever had a job, no one had ever even gotten a driver's license and she wanted a different life. She had plans and had been dreaming of a different life for the past 8 years.  In fact, as she entered the clinic she immediately asked, "Do you have that five year birth control?"  I assured her that we did indeed have Mirena, that she could have it at her check up appointment and we'd take care of the necessary paperwork in the meantime.  "And", she asked, "is is possible to get a second one put in after the first five years, because I figure it will take me 10 years to get a degree, get my life on track and have a good enough job to have a baby."  Again, I assured her that she could get another Mirena inserted after the first one plus there is a 10 year IUD that we could talk about.

While Annie and I were talking, getting her medical history, and getting her consent forms signed, two other staff persons were working to find funding for her abortion since she did not even have enough money to feed herself, let alone pay for the abortion, not so uncommon these days.  By the time she left the clinic, just about everything was in place for her to return the following day for the first steps of her abortion.  Before I left for home, I thanked everyone who had worked so hard to get all that Annie needed with so little lead time.

When I arrived the next morning, the first thing I asked was, "Where's Annie?"  "Oh," another counselor reported, "Annie called and canceled.  She said that when she called her mom to tell her that she was having an abortion, her mom told her she'd never speak to her again if she had the abortion."  I was shocked.  Annie had seemed so sure, so convinced that she wanted her life to take a different path than her family.

Concerned, I called her later in the day.  "Annie", I said, "how are you?"  "Oh, Miss Lu", she said, "when my mom told me she'd try to get off crack if I had the baby and that she would never speak to me again if I had an abortion, I just had to change my mind.  Maybe this baby will help my mom to get clean. I hope you're not mad at me."  I assured her that we understood, that she was choosing what she thought was best for her.  I wished her health, happiness and success.  And I meant it.

Lu

I can't believe it happened to me!

No woman ever imagines that she will someday need an abortion.  Either because she is consistantly using birth control, or because she has a history of infertility, or because she has not gotten pregnant despite using no birth control in the past, or because her knowledge of how conception occurs is faulty, but one way or another, no one ever seems to think unintended pregnancy will happen to her.  But, of course, it does happen.  In fact, 50% of US pregnancies are unintended. 

As a counselor, I talk to many women who have chosen abortion but are still shocked that they got pregnant.  Even those using no birth control sometimes cannot believe that they are indeed pregnant. Diane was one of those women who first tried to deny to herself that she was pregnant, then hoped that her period would somehow come even though she had by then taken numerous pregnancy tests confirming the pregnancy.  Eventually, she acknowledged that she was pregnant, and decided to have the baby and put it up for adoption.  As time went on, though, she began to have doubts that she could actually go through with the adoption, and knew that she had no resources that would allow her to raise a child responsibly.  Which brings us to the point where I spoke with her.  Diane described how and why she had made the decision to have an abortion.  She described herself as "sure of her choice" but still feeling sad and lost.  "Sad" I understood but I wanted her to tell me what she meant by "lost".  Diane said that she felt adrift, was finding it difficult to reconcile her past thoughts about abortion with what she had chosen.  She said that she "never believed in abortion" yet here she was.  Eventually, as she continued to explore exactly what she was feeling, she concluded that what was lost was her own innocence.  Diane stated that life was simpler when it seemed black and white.  She concluded that she was not so much sad about having an abortion, but rather sad because never again could she imagine herself living in childlike innocence that abortion is always wrong and having the baby always right.

Many of us who have never had to face unintended pregnancy can still relate to Diane's situation.  For most of us, whether at age 18 or age 35, at some point each of us will find ourselves having to accept that life is not as simple as we would wish, that difficult choices do have to be made, but also that we can allow the sadness, accept that life is not always as we'd wish, but then move on to healing.

Lu

ps While we are sympathetic to those of you having problems with our spam blocker, we cannot seem to set it to keep out the porn spam and yet allow all of you to comment.  Sorry

homeless

Being on the front lines as we are, and talking to real women every day, counselors get to meet with and hear the stories of women and families who have been directly affected by the mortgage crisis, the closing of businesses and factories, the downturn in the economy. For them, these are not just stories in the news.  Historically, one of the major reasons women give for choosing an abortion is financial insecurity.  Now, more than ever in my many years of doing this work, I am talking to women who are essentially homeless.  I mean women who are actually living in shelters alone or with their children, or women who stay with friends a few weeks here, a few days there, hoping that they can find a job that will allow them to move out on their own before they, too, are forced into the shelters or the streets.

Myra, whom I remember from last month, was staying temporarily with her sister, but could not remain there much longer because there was no room for her.  Her boyfriend was sleeping on a friend's couch but that too could only be for a short while longer.  Her children were boarded out with family members.  Little more than sixty days earlier, her boyfriend had a good job and they rented a nice house.  When his employer suddenly closed the business, in very short order they lost their house, then their car.  Although they were both looking for work when she came for her abortion, they had not been able to find anything that would pay enough for them to again cover rent, utilities and support their kids.  Needless to say, abortion was her only option.

There have been several other similar stories in just a few months time.  Yesterday I saw a woman who lost not only her house but her kids when her husband was murdered.  She went into shock and then became so depressed her children were put into foster care.  She is again on track, but still living in a shelter.  Having found a responsible job, and now able to fend in the world again, she is on the verge of getting into an apartment, which will allow her to get her kids back.  But if she had another baby right now, she said she feared that she might not get her other kids out of "the system".  That had to be her priority, she said.

Another woman, Linda,  who lives in a rural county said that the only employer who had jobs for college educated people had recently lost their grant to operate so she had been out of work for nearly six months, is in the middle of a divorce, and cannot even sell her house because there are no buyers in her area since there is nothing to attract people to move into the area.  So although she had never imagined herself choosing abortion in the past, suddenly saw no way out since her own future is so unclear.

Our experiences with women make the stories from the newspapers and tv so much more real.  We can see how frightening it is for women to not be able to care for their kids because of economic factors.  It tears them apart, they worry every day about those kids, miss them and plot how to get them back living under the same roof.  But as the number of foreclosures increases, sadly I expect that we will see ever more women who have exhausted their welcome with friends and family and who are forced to live in the shelters.  The only option for them is abortion.

Louisa, whom I spoke with recently, told me that she works two full time jobs in order to be able to pay her rent, utilities and car payment.  She said she was looking to move to a less expensive apartment because even with the two jobs, she was just barely making ends meet.  Louisa was very sad and weepy as she told me how she would love to have a baby and wondered if the time would ever be right financially.  Her boy friend does not make enough money to live on his own so he still lives with his mom whom he helps to support.  None of them has enough room for anyone else; none makes enough to live differently and none sees any hope for things to be different.

Lest you think that all of our work is sad and depressing, it is not so!  A sizable number of women who choose abortion are actually hopeful that the future will be better for them.  They are going to school, have just gotten a promotion or are content with the family they now have.  While there may be some sadness for them, they still see life getting better.  But I want to point out to readers what may be a mini-trend in our patients' lives, so I am calling it out.  Telling their stories to us, the women we see are not just statistics.  They are real!

lu

I just kept talking and talking......

Sometimes the safety and privacy of a counseling room presents women with the opportunity to talk about things that they rarely discuss in medical settings. Whether due to lack of time, lack of trained staff or a perspective that emotional or psychological well-being are just “not a part of gynecological  or obstetrical healthcare,” it's rare for women to have the opportunity to reflect on their sexual and reproductive lives with their medical providers.  Recently, I've had the some amazing conversations with women that have led me to think about resiliency and survival in our sexual/reproductive lives.

Rayanna was quiet and almost bashful when I asked her questions about how she had come to choose to have her abortion with us today. She had given birth six times, indicating that three of the children did not live with her currently. She and her partner were caring for three of the youngest children. She was taking good care of these three, she explained, but any more, that would push them beyond their financial and emotional means. “I'm slowing it all down,” she said, 'seven pregnancies—that's too many.”  Her current pregnancy was a result of a failed tubal ligation surgery.  Complication with surgical sterilization are rare, but they do happen and sometimes you just don't know the surgery's failed until you find yourself pregnant.

Rayanna had indicated that her family did not support her having the abortion and I asked her about their relationship. “Most of them are in Mississippi,” she answered, “so I don't have to see them that often.” Her mother, however, figured large in her pregnancy history. “She does think that I'm going to hell for this,” she answered, “but I have a hard time hearing that from her. Back in Mississippi where I grew up, you know in small towns—in my family—there was a lot of incest there. Everyone just made like that was what happens. Like you go to hell for having an abortion, but not for what she's done” (referring to her mother).  Rayanna went on to describe her extended family and how the uncles were given free reign over younger female family members. “It happened to so many of us, it was almost like it wasn't any big thing. No one talked about it and when I told my mom what was happening, she didn't do anything, didn't stop it.”

As a result of the incest, Rayanna had been sexually active for most of her life—but not on her own terms, not with her consent. When Rayanna became a teenager, she said she longed for affection and attention.  But, not yet understanding how to get what she needed,  she became sexually active with partners she described as “no good, beating on me, cheating on me and never there when I needed them.”  She got pregnant twice as a teen and her mother forbid her to have an abortion. Bewildered, she went along with this and the two infants were adopted by a relative. A third pregnancy two years later came as a result of a rape. Again, her mother forbid her to have an abortion and the child was adopted by a family friend. She had borne three children by the age of 20—again, not on her own terms.

When Rayanna moved away from home, she met her current partner. “It was like moving from the projects to Beverly Hills,” she explained, describing their relationship, and they had three children together. All her other children had been boys; this time she had two daughters. Something happened to her, she said, when the girls were born. She could recognize herself in them and before she knew it, she started talking about the abuse. “I just started talking and talking,” she said, “and no one could shut me up. I talked to my mother about what it felt like when she didn't listen to me. I talked to my relatives  about what happened to me. I made sure everyone knew what those uncles had done and that all the children were aware.” This was not received well by older family members, she said, who were angry with her for stirring up “old trouble.” “Why would they think it would just stop?” she said, “They think because they're old men now that's gonna stop them? You do it to one child, you're gonna do it to another.”

Rayanna brought it into the light. Generations of incest, silence and abuse ended that day. Her children would be safe—she would see to that.  It meant sacrificing her relationship with her extended family and straining her relationship with her mother, but it was a worthy price to pay.  I didn't know what to say, other than to thank Rayanna for what she had done. “I feel like I'm sitting here with a woman of such amazing strength,” I said. “Do you realize what a big deal it was for you to speak up about that? You did it, you're keeping your family safe.”  It was a hard road, but she was staking claim to her life, her safety, her sexuality, her fertility--this time on her terms.

“I'm slowing it down,” she said. “I had three babies born and given away before I was even sure what babies were good for. Maybe if my mother had listened to me when I tried to tell her about the abuse the first time and gotten me some help, maybe then I wouldn't have needed to have all those boyfriends who treated me bad.  Maybe I wouldn't have got pregnant and maybe no rape.  But that was then. I talk about it all now and no one's going to do that to my kids.  It took years of counseling to understand what all happened and now, I'm slowing it all down. I've got my three kids and we're working on communicating better and better and I just can't handle any more kids today. That's why I'm here. I'm slowing it all back down.”

Nell

Note:  Nell (not her real name) has graciously accepted our invitation to join us on abortionclinicdays.com.   We are thrilled and honored to have her authentic voice and wisdom.

Does God know what's in your heart?

From a guest blogger:

One of the things that surprised me most when I came to work at the clinic was the level of spiritual resolution that many patients have already achieved prior to walking in the door. I expected my work with women to include a dimension of spiritual counseling. I expected the Christian women I spoke with would utilize the same black and white absolutes that they hear from the pulpit. I expected an angry Old Testament God offering punishment, women feeling cut off or cast out of God's light.

Overwhelmingly, what I found, instead was that most women had already gone to God, prayed upon their decision and felt a sense of resolution and right action. Despite whatever their religious leadership preach about abortion or sex, most of the women I counsel have found a very personal connection to God in their journey through thier pregnancy. They have gone to Him for counsel and find His love to be a sense of comfort. It's not “what does your church teach you about abortion,” that I ask women now, it's “does He know what's in your heart?”

No one typified this more than Marnie, who came into the clinic for a non-surgical abortion. She was in her thirties with three children, the adult daughter of a minister. With the support of her family, friends and therapist, she was finally moving towards separation from an abusive husband. She was trying desperately to protect herself from this man, while respecting her children's need to maintain some contact with their father. He was not abusive towards the children, she explained, but they were witness to his behavior towards her. “A man like that,” she said quietly and with conviction, “should not have any more children.”  This was how she knew that abortion was the morally right decision for her. She was doing the best with the situation she had around her, but God would not forgive her for subjecting another child to chaos and cruelty.

I asked her about growing up as a minister's kid. “When I think about church,” she said, “I think about my family, how it was a special time. I think of my dad's aftershave and getting dressed up in my best clothes. I think about the music, my mom's singing, and the big meal we'd have afterwards. Those feelings, that's what really sticks with me.” My eyes welled up listening to her. It was the love and the comfort that made an impression, preparing her best self to stand before God, to join and praise. “My mother is in the waiting room,” she said, “and this has been really hard for her, but she understands. I've had such amazing support. The man outside offered me a rosary. I told him I had already made up my mind and didn't want to talk to him, but that I could use all the prayer I could get.” 

Marnie had chosen to have a medical abortion and we discussed what that would feel like for her. “It is very important for me to take responsibility for this,” she said, “and do it myself.” She had had a prior miscarriage and felt confident that she could work through the cramping and bleeding as the pregnancy passed. This was going to be private, sacred time, she explained. She had prepared her bedroom at home, bought a new bible and had selected some scripture that she felt spoke to her situation. “I need this to be respectful,” she said, “Me and the baby are going to work through this together.” I offered some scripture I share with women about God's all-encompassing love and we hugged as she was leaving. I told her that I'd be thinking of her and thanked her for letting us care for her. The level of peace and confidence she displayed were so moving. I'm still thinking of her.

Lost

On our patient chart, as on many other abortion providers' chart, women are asked to circle all the words that describe how they are feeling.  At least thirty adjectives are on that list and women circle many or few.  Both "happy" and "sad" appear, as do "confused" and "certain"; "relieved", "strong", "scared", "peaceful", "guilty" and many more.  As a counselor, I ask women to tell me what the words that they have circled mean to them.  One word that is rarely circled, and therefore of great potential importance, is the word "lost".  It may mean to the woman that she feels lost because her partner abandoned her when he found out she was pregnant, or lost because she fears being estranged from God, or lost because she thought she was opposed to abortion but finds herself having chosen it nevertheless. She may even feel loss of her identity as mother even though she is likely to be choosing abortion specifically for those other children.

These threads are crucial for a counselor to follow, sometimes because the woman needs help in finding a pathway to support, forgiveness, or simply back to her own sense of self.  Sometimes she just needs a place to sort out her feelings in an environment that is non-judgmental.  This past week I counseled a woman whom I'll call LaTisha, aged 37.  Her description of what "lost" meant to her had more to do with denial of her husband's drug addiction, lying, stealing.  They had just had a baby this summer and that, combined with what she described as constant personal chaos as well as chaos in the home, having to go back to work almost immediately after the baby was born to cover her husband's car crashes, money thefts, had left her in a state of just mopping up one disaster after another.  Becoming pregnant again so soon made her realize that she was ruining her life and  possibly her child's too by trying to make the marriage work.  In the process, LaTisha said, she had lost herself and was losing sight of her goals. 

Life, she said, was "happening to her" rather than being under her control.  Her time and energy were usurped by trying to find out the truth (was he using or not using drugs, did he or did he not steal the money, the jewelry).  Between that and caring for her newborn and working, she said that she herself barely existed.  Because she was not paying attention to herself, she said, she sometimes missed her birth control pills, made mistakes at work and was generally not taking care of herself.  But suddenly, when she found herself pregnant again so soon after delivery, she had to stop and think about where she was, where she wanted to be, and what needed to be done.  She said that once she sat and thought about all she had been through and how caught up she was in trying to deny to herself the severity of their problems, she realized that all that she had worked for could come crashing down on her.  She could lose her home, her job, or the support of her family who had been telling her what they heard on the street about her husband.  Eventually she decided to have the abortion on Saturday and tell him to leave on Sunday. 

I commented on how calm, how at peace, she seemed as she was telling me this story.  Ah, she said, that's because I am no longer lost.  I have found myself again.

lu

Anger Management

I apologize to readers who have worried about us, who have wondered if something happened to us.  We're both ok and just needed to take care of our kids, our parents, our staff, our patients and sometimes that does not leave time to write.  I do, however, try to keep in mind that our readers do want to hear from us when we are able to post.  Working at the clinic, the women's stories are there every day and I wish I could share more of them with you.  There are also other online writings that I would like to share with you.  For example, if you are not aware of RHreality.org, do check it out.  There's a piece in response to an alternet posting on men and abortion, which is a topic that I would like to write about here some day.  Most of the men I meet at the clinic are supportive, want to help, and have been involved in the decision making.  So we try our best to honor our patients' requests to have their partners as involved as possible each step of the way.

I want to tell you about a young woman I saw today. She had been to the clinic last week but because her mother had not completed state requirements, they were re-scheduled.  Another counselor first began talking to this 16 year old but felt that they were not going to make a connection because of what seemed to be anger coming from the young woman's words, body posture and general attitude.  When the counselor asked me to start over with the young woman I immediately agreed because I enjoy talking to teens.  Many of them come into the clinic feeling as though nobody is listening to them, their feelings, their fears, their dreams.  So I just listen.  And that is exactly what I did today.  This woman, whom I'll call Jody, was exhibiting fierce anger so that is where we started.  I asked her if she was angry and she said, "I'm always angry.  I've been in anger management groups, schools, classes since I was a little kid and now I have my own therapist because I"m still angry".  So I asked her if she was mad at us, mad at her mom, mad in general or was mad because she was having an abortion or what.  She pretty much said she was mad at everyone including us because we were "taking too long" and she "just wanted to get it over with".  I apologized to her but told her that we could not move quickly on something so important.  As I told her, this is a big deal and we do not want to make a mistake.  We need to be sure that you are choosing abortion of your own free will.  I take my job very seriously.  I do not want to send you or anyone else back to surgery if there is any chance that you will wake up tomorrow and say, "Oh my God, I made a mistake".  This is too big a deal to "just get it over with".  I then asked Jody to help me out, to help me to know what she really wanted, what was just her usual anger and what was any uncertainty about going forward.  Eventually Jody began to see that I was serious about finding out more about her, whom she had in her life that she could really talk to, who really listened to her.  She does have a sister whom she trusts but says that most other people in her life have let her down, abandoned her or betrayed her.

As we continued talking, I began to believe that she was indeed telling me that abortion was her own choice.  She just did not know how to handle strong feelings without the anger to cover up her fears, her concerns about the baby.  So I answered all of her questions.  All of a sudden, I could see a change in her posture and her demeanor.  Jody started telling me that she wanted to learn to manage her anger better because she wanted to be a nurse practitioner!  She wanted to help people get well (just as she wanted to get well).  So I   accepted her request to have the abortion and we shook hands on it.  Later, I told her to  call me when she has a day off school and I would invite her to see what a nurse practitioner really does.  We would permit her to take a pledge of confidentiality and shadow the NP for a few hours.  I felt that we had made as good a contact as we could make that morning, but I realize that Jody has a long way to go on her "anger management".

Lou

Post-it

The Post-it said, "AT-TI-TUDE" all caps. The young woman was  in traditional Muslim dress, African-American, and bristling with...with something. I guessed that it was my job to find out what.

It turned out to be not so different from many women who feel like they are caught in a trap of their own making. She got pregnant, then "did the right thing and married at age 16, to a man she did not love. She had 2 more children with him, still didn't love him, but clearly did not wish him pain either. She had fallen in love with another, someone outside her culture. She knew it could never work. It was a mess, but a compelling mess.

Her self contempt, her anger at her situation and everyone around her, seemed to spring from the great divide between what she wanted and what she knew was right. Her religion guided her in everything--it was her rock. She accepted the finality of it, as a guilty person accepts a punishment.

"It's against my religion," she said defeatedly as though there could be no further discussion. I said, "Well, it may not be as clear as that. Muslims believe that the soul enters the baby at 120 days--about 16 weeks. You are about 5 weeks." Then I pulled out the Pregnancy Options Workbook (www.pregnancyoptions.info) and read her the section about Islam and abortion. It does not offer a free pass, by any means, but it does put Mohammed's proscription about killing your children in some historical context. He decried the killing of female infants, a widespread practice in his time. It also listed the acceptable reasons for abortion. It talked about atonement.

When I read the part about atonement meaning fasting for two months, an invisible veil fell from her face and there was a beautiful look of hope radiating out. "I can do that," she said. This launched us into a wonderful discussion about forgiveness, compassion, the condition of women, and other topics.

I confess that sometimes I find Muslim women unapproachable, even American Muslims. I am sure their wariness is justified, particularly in these times. There was no such feeling with this woman. We talked about life, love, sex, kids, books, culture, and of course, religion. She said, "I was raised Muslim but I know that if I lived in a Muslim country I would be stoned. How does that help you get better or learn?"

One of my favorite factoids in talking about religion is that in the original Hebrew, the word "sin" means "missing the mark" not being stoned to death. She liked it too.

--Bon

PS: I want to address the inevitable comment that I somehow made her feel "OK" about abortion, or encouraged her to have one. It was clear to me that she would have one no matter what. What I offered was a way that she could "be" with it that did not further cripple her life and the beautiful contribution she could make to life.

PPS: My apologies for being MIA on this blog. It's moving work, but there isn't always time, or the will to find time, to step back and write about it.

a moral choice

dear readers,

i sat down to share with you a story of a one patient's explanation for her abortion decision.  but then this story came my way.  my story will wait.  today this physician's tale is more moving.

lou

My Moral Choice

by docswede

Thu May 31, 2007 at 02:21:09 PM PDT

    Since I was about 8 years old I knew I wanted to be a doctor.  I have always loved science and loved people – there was no better way for me to put the two together in my mind.  All the way through the second year of medical school, I envisioned myself as a cardiothoracic surgeon, or perhaps a trauma specialist.  But these plans faded after I did my gynecology rotation in my third year. 

     I fell in love with gynecologic oncology.  The cancer patients really needed their doctors.  I could see myself helping women and their families through difficult treatments and emotionally trying times.  It felt so rewarding to be a part of the team that was helping to fight cancer.

     As a matter of fact, that is exactly how I started my residency: with a plan to go on to do an oncology fellowship.  But careers, just like life, make their own plans.

• docswede's diary ::  ::

    This is a story about the first time I realized that I was not going to be a gynecologic oncologist.  I will never forget this patient; she changed my life.  ‘Fran’ was a 30 year old, single mother of an 18 month old son.  Her partner was unfaithful and she had not seen him in over a month.  Fran had a large, cancerous tumor in her neck.  She was 10 weeks pregnant when it was diagnosed and she needed chemotherapy, radiation and possibly surgery immediately.   Even with aggressive treatment, the chances were better than 50/50 that Fran would be dead within a year.  She came to our clinic for an abortion, which I performed.

     I got a surge of emotion after I did the procedure.  I cried when I got home that night.  I wasn’t crying about doing the abortion, I was crying for her.

     She had no one to accompany her to the procedure.  She had only one friend who was willing to watch her baby, but was adamant about her prompt return to pick the child up.  The only contacts she had with her family were phone calls from her sister, and they were infrequent.  All I could think was, ‘Who is going to take her to her chemo appointments? Who will watch her baby while she recovers from surgery?  Who will take her baby when she dies?’.  I felt helpless.  There was nothing more that I could do to help her. 

     While I could not take care of Fran’s baby, or hold her hair back while she was vomiting from chemotherapy and radiation, I could prevent her from having to bring another child into this world when the time was clearly not right.  I helped her prevent a child from being born to a mother who would be dead before it was a year old.  It was such a sad situation, but I felt like I had been an important part of her care.

     After the procedure, she thanked me and with tears in her eyes said, ‘You don’t know how much you’ve helped me today’.  The gratitude she expressed took me by surprise.  This was one of my earliest personal experiences with performing an abortion and I never expected patients undergoing this procedure to be grateful.  At best I thought they would be polite and quiet, at worst I thought they would be angry at me or incredulous that I could possibly even do the procedure.  I have since learned that this is not the case at all.

     I realized shortly thereafter that I didn’t ‘only’ perform her abortion.  I provided her with a service that most doctors do not even offer.  I was able to help her in a time of unique need.  I was not fighting her cancer, but I was helping her to live out the end of her life the way she wanted to.  From that point on, I knew where my calling in medicine was: to be a provider of abortion care.

     There are very few of us willing to do these procedures.  Most obstetrician-gynecologists do not offer them to their patients.  With the history of anti-choice extremism we have witnessed in this country, it is easy to understand why a physician would decide not to offer abortion services in their office.  They may be afraid of being protested or worse.  What I do not understand is how someone could call refusing to provide abortion care, or at least provide a referral, a ‘moral choice’. 

     What is moral about telling a woman with a terminal illness that she has to continue her pregnancy?  What is moral about telling a woman who can not afford to support the children in her home to have another one?  What is moral about bringing a child into this world that will not receive the love, support and attention it needs because its mother has to work two jobs just to pay the rent and their father is long gone?  Frankly, I do not see it.

     Abortion is a moral choice.  It is about a human being’s right to determine their own destiny and the destiny of the family surrounding them here on Earth.  It is never an easy choice, but it is always moral.

     My career has led me to dedicate my life to making sure women can make that choice.  I decided that I could help more people this way than I ever could by treating cancer.  Providers of abortion care are relatively few, but we can change that.  I hope that other young doctors will be similarly inspired by the depth of the impact providing this procedure can have upon their patients.  I hope that they see abortion as part of comprehensive gynecologic care.  After all, we do over a million of them a year and 1 in 3 women will have one at some point in her lifetime.  If we do not do them, then where will our patients go?  It is physicians’ moral obligation to be sure that they can come to us for compassionate, safe abortion care.  It is one of the times when they need us the most.   

Tags: ethics, medicine, health care, abortion, women's rights, pro-choice, personal (all tags)

               

               

                Permalink                                  | 41 comments                                                                                

               

               

               

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Daily Kos Help

                               

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   Please post a tip jar if you can (12+ / 0-)  

   

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  Very important diary.

   

   

   

  This ain't no party. This ain't no disco. This ain't no foolin' around!

   

  by Snud on Thu May 31, 2007 at 02:14:19 PM PDT

     

   
   
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   thank you on so many levels (16+ / 0-)  

   

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    for your choice and your post.

  as a woman who came of age in the 60's, i remember well the back alley abortions that killed or maimed so many women.

  i remember well how abortion was NOT about "killing babies" - it was about choice - choices - to have safe access to medical procedures, to have privacy in difficult choices, to have a right to control one's own body/destiny.

  your choice to be a true doctor - a medical professional who treats the physical needs and emotional needs of your patient - makes you the truly moral one. 

  young women today do not realize what they are losing, slowly but surely losing.  from the pharmacies that refuse to fill their birth control pills to the doctors that turn their backs, women are once again being forced back into that economic box and contained.  without choice, without the RIGHT to control one's physical self, a woman has no more freedom than those helpless souls imprisoned in guantanamo.

  thank you for providing a key, a choice, dignity and physical safety. without you and the other doctors who see beyond the rhetoric, women would face obstacles that would once again lead to unimaginable and horrific consequences.

   

   

  That's the problem! That's the problem! The liberal groups are jumping around without knowing what the hell is in the bill! - dave obey

   

  by edrie on Thu May 31, 2007 at 02:15:47 PM PDT

     

   
   
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     I hope I continue to make you proud. (37+ / 0-)  

     

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    We're fighting an uphill battle against those who want to perpetuate a system of subjugation that has existed since time eternal.  What can I say... I love my job!

     

     

       

    by docswede on Thu May 31, 2007 at 02:20:15 PM PDT

     

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       offering comfort to those who face (4+ / 0-)  

       

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      difficult decisions - offering respect - offering safe medical care without judgement - docswede, you should make ALL women proud - and men, too!

       

       

      That's the problem! That's the problem! The liberal groups are jumping around without knowing what the hell is in the bill! - dave obey

       

      by edrie on Thu May 31, 2007 at 02:51:09 PM PDT

       

      [  Parent  ]

       

       
       
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       Coincidental title? (5+ / 0-)  

       

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      Dr. Maguire is a Catholic ethicist whose book, Sacred Choices - The Right to Contraception and Abortion in Ten World Religions, is also the author of a book called The Moral Choice.

      Coincidence, or are you familiar with his work? I haven't read them, they are too dense and scholarly the last time I tried, but I know him and he is a brillian man.

      Great diary, recommended.

       

       

       

      Who Dat?!

       

      by Nerdsie on Thu May 31, 2007 at 03:16:26 PM PDT

       

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         I have met Dr. Maguire (5+ / 0-)  

         

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        a couple of times.  If you're ever within a 100 mile radius of where he's speaking, be sure to get yourself there to hear him.  I've read most of his work, including Sacred Choices, and it's fantastic stuff.  He's way smarter than I'll ever be... and funnier, too.  I read his books while I was a resident in OB/GYN, and they solidified my resolve to pursue a career in family planning.  He and the other theologians who work with him are an inspiring bunch- we could use more of them from every background in our struggle.

         

         

           

        by docswede on Thu May 31, 2007 at 03:45:11 PM PDT

         

        [  Parent  ]

         

         
         
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           Dr. Maguire and his wife (1+ / 0-)  

           

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          Marjorie Reiley Maguire, have helped untold numbers of women they'll never meet by writing, "Abortion: A Guide to Making Ethical Choices."

          From the preface:

          This guide steps the reader through questions one would expect in a philosophical discussion of the issue, e.g., "Is the fetus a person?" But it is intended more precisely to help Catholic women work through the moral choices involved in abortion. The Guide identifies five beliefs which underlie its presentation:

          1. In making moral judgements about abortion, it is important to avoid rigid and negative attitudes toward sexuality itself.

          2. The decision to abort can be a moral decision justified by many circumstances; the decision can also be unjustified.

          3. Abortion must be legal for women to even begin to make a moral choice with real freedom.

          4. The abortion decision involves intrinsic values. These values include, but are not limited to, the value of a woman's life and her life plan and the value of the fetus.

          5. We all have an obligation to work actively to create a society in which women will not need to choose between the value of their own well-being and that of the fetus.

          This work has been a staple of our counseling program for many years -- an invaluable help for women in moral crisis.

           

           

           

          The TEA Fund: Practicing random acts of kindness

           

          by moiv on Thu May 31, 2007 at 05:03:35 PM PDT

           

          [  Parent  ]

           

           
           
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       Thank you (0 / 0)  

         

       

      I am so grateful for what you do, and I know it's not easy. Please know how many people are behind you.

       

       

       

      You can tell you have created God in your own image when it turns out that he or she hates all the same people you do. - Anne Lamott

       

      by javelina on Thu May 31, 2007 at 07:28:46 PM PDT

       

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     I was going to post some thoughts, but... (12+ / 0-)  

     

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    you've nicely summed up most of what I was going to say, especially this:

    young women today do not realize what they are losing, slowly but surely losing.  from the pharmacies that refuse to fill their birth control pills to the doctors that turn their backs, women are once again being forced back into that economic box and contained.  without choice, without the RIGHT to control one's physical self, a woman has no more freedom than those helpless souls imprisoned in guantanamo.

    Thank you, docswede. We need so many more doctors like you.

     

     

     

    "We are the people who run this country. We are the deciders." Molly Ivins

     

    by VetGrl on Thu May 31, 2007 at 02:24:03 PM PDT

     

    [  Parent  ]

     

     
     
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   The Right-to-Run-Everyone-Else's-Lifers (18+ / 0-)  

   

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  are the ones who are being immoral. 

  As a mother and a woman, I do, indeed, value human life and fetal life.  I do not, however, value fetal life above the life of a sentient, feeling, living, breathing woman. 

  Thank you for the kind, expert services your provide. 

   

   

     

  by AlliHi on Thu May 31, 2007 at 02:26:42 PM PDT

     

   
   
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   docswede... (12+ / 0-)  

   

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  ..you are a star, a hero, a shining example of what the vocation of medicine should be.
    Being doctor who performs abortions (listen, Alito, Roberts - NOT an "abortionist", NOT an "abortion doctor" is like choosing to live in a combat zone.  The few doctors brave enough to do this worry about opening their blinds at night, have bullet-proof glass in their clinics, wear (or should wear) Dragon Skin body armor and have a very strong support system.
    If I could give you a thousand stars for your crown, it would not be enough.  I can only say that I'm proud to share a profession with you.

   

   

   

  In a time of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

   

  by drchelo on Thu May 31, 2007 at 02:29:44 PM PDT

     

   
   
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     Thanks for your kind words, (10+ / 0-)  

     

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    Support from folks like you makes our work that much easier and rewarding- though it's hard to get much more rewarding. ;)

     

     

       

    by docswede on Thu May 31, 2007 at 02:43:22 PM PDT

     

    [  Parent  ]

     

     
     
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   I remember a woman who worked as an RN (11+ / 0-)  

   

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  at an abortion clinic.  The story she told me once, many years ago, should not be lost:

  During intake, the RN and doctor asked a thin, haggard looking woman why she wanted an abortion.  She, in response, simply rolled up her sleeves to reveal the needle tracks of a heroin addict, and then said "I have no business having a baby right now."  They performed the abortion, and never saw her again.

   

   

   

  "Fighting Fascism is Always Cool." -- Amsterdam Weekly, volume three, issue 18

   

  by Noor B on Thu May 31, 2007 at 02:32:26 PM PDT

     

   
   
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   thank you so much for what you have chosen (8+ / 0-)  

   

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  to do. 

  people need doctors like you who care.

   

   

   

  statusquomustgo...and it did...whooooops, not done yet

   

  by Statusquomustgo on Thu May 31, 2007 at 02:35:12 PM PDT

     

   
   
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   Moral choices (12+ / 0-)  

   

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  Very powerful diary, Chris.  I didn't knw you once considered doing gyn/onc.  I did a gyn/onc fellowship at the end of my residency.  Made me a much better surgeon, but not a better person.  Providing abortion care has made me a better and moral person.  In fact, I have been doing them for so many years, I should be canonized soon!  :-)  wfh

   

   

   

  A private gyn office offering full gyn services including abortion care to 18 weeks.

   

  by william f harrison on Thu May 31, 2007 at 02:37:58 PM PDT

     

   
   
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     thank you, too, for being a doctor (4+ / 0-)  

     

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      in the finest and truest sense of the word!

    you and docswede epitomise the best of medicine!  

     

     

    That's the problem! That's the problem! The liberal groups are jumping around without knowing what the hell is in the bill! - dave obey

     

    by edrie on Thu May 31, 2007 at 02:53:00 PM PDT

     

    [  Parent  ]

     

     
     
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   Thank you. (8+ / 0-)  

   

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  Thank you for posting this story and for the work that you do.  I wish those in the Pro-Lie movement could see cases like this and the many others we see on a daily basis. 

   

   

     

  by rcgrn2b on Thu May 31, 2007 at 02:41:36 PM PDT

     

   
   
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   I hope my one-year-old (6+ / 0-)  

   

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    SarahLee, annrose, moiv, Albatross, slksfca, docswede  

   

   

  daughter still has the option of having people like you around should she need it.

  Bless you (and I'm an atheist so it really means something!).

   

   

     

  by Indexer on Thu May 31, 2007 at 02:45:30 PM PDT

     

   
   
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   Excellent Diary (6+ / 0-)  

   

  Recommended by:

    SarahLee, annrose, moiv, javelina, Albatross, docswede  

   

   

  Highly recommended.  I wish I had a doctor like you when I went in for my abortion.  Although the nurse was very nice, the doctor was beastly and seemed disapproving the entire time.  Not a pleasant experience at all.

   

   

   

  There are bagels in the fridge

   

  by Sychotic1 on Thu May 31, 2007 at 02:58:27 PM PDT

     

   
   
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     I wish 'we' were always on our best (3+ / 0-)  

     

    Recommended by:

      SarahLee, moiv, javelina  

     

     

    behavior all the time.  As in all fields of medicine, some docs have great bedside manner, others have the 'manner' of a tax collector.  I try to lead by example- I teach a lot of medical students and residents, and I hope they absorb a little bit about how to be compassionate from me.  It's kind of a hard thing to teach.

     

     

       

    by docswede on Thu May 31, 2007 at 03:48:48 PM PDT

     

    [  Parent  ]

     

     
     
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   incredibly outstanding diary (5+ / 0-)  

   

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    annrose, moiv, javelina, Albatross, docswede  

   

   

  Thank you for sharing your powerful, and very moving life journey with us.

  You are right on about the morality of abortion for women and about the morality of providing compassionate, competent abortion care.

  Thank you for your work and your eloquent communication.

   

   

     

  by LisaLL on Thu May 31, 2007 at 03:02:45 PM PDT

     

   
   
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     Thanks LisaLL! (1+ / 0-)  

     

    Recommended by:

      moiv  

     

     

     

       

    by docswede on Thu May 31, 2007 at 03:49:50 PM PDT

     

    [  Parent  ]

     

     
     
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   Walking through a mall yesterday... (5+ / 0-)  

   

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    annrose, moiv, javelina, Albatross, docswede  

   

   

  In Cleveland, there's a retail court in Tower City- right off Public Square in the heart of downtown. You walk through there to get to the public transit system, the big food court, the Cavs basketball arena or Jacobs Field. Like every mall, they have small carts with specialty retailers scattered around.  Right now, one of those carts is a discreetly phrased pro-life display, complete with "authentic 3-D" images of fetuses at various stages of gestation. 

  I was simply appalled to see that as a standing exhibit in what's effectively a public place. They rented that cart and came up with the funds for the video display so that anyone coming through downtown would have to see their pro-life presentation 24-7.  Tonight, many of the people attending the Cavs playoff game will be walking by that display, just like the people attending the Indians games this season.

  So help me, I only wish I had the funds to rent another cart to provide real health care info ten feet away. It would do a lot more good than this kind of stealth propaganda.  Their cart was so cryptic, it was almost incomprehensible. Not surprisingly, the people who protest the women seeking help at the clinic a few blocks from my house get their message across in a more straighforward, more hateful way.

  Thank you for this diary and the choice you have made to provide this critical service to women.

   

   

   

  "Our attitude was- the revolution can't start until we find our hair gel."  Joe Strummer

   

  by histopresto on Thu May 31, 2007 at 03:05:18 PM PDT

     

   
   
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     The infiltration of the pro-fetus/anti-woman (2+ / 0-)  

     

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    movement in this country has been very stealthy.  I'm sure the person who owns that space that the anti's are renting thinks he or she is doing a service to preserve innocent lives.  What they don't realize is they're helping to slowly erode the rights of pregnant women in this world.  It's just sad- thanks for sharing this with us.  I haven't seen a 'Fetus Wagon' yet, but I'll keep my eyes peeled.

     

     

       

    by docswede on Thu May 31, 2007 at 03:59:36 PM PDT

     

    [  Parent  ]

     

     
     
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       The retail space is owned by a big developer (1+ / 0-)  

       

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      I'm thinking that Forest City will not enjoy reading the letter they're going to get from me about their temporary tenant. My boycott of their permanent retail tenants began yesterday when my business lunch was moved off-site. Although I live out of town, we drop a significant amount of dollars into this mall when attending events downtown. No more.

       

       

       

      "Our attitude was- the revolution can't start until we find our hair gel."  Joe Strummer

       

      by histopresto on Thu May 31, 2007 at 04:37:40 PM PDT

       

      [  Parent  ]

       

       
       
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   Thanks for the diary and (5+ / 0-)  

   

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  the service you provide.  I remember many years ago when abortion was illegal and a student at the university where I was going died from a botched abortion and another committed suicide because of a pregnancy.

  These were hard won rights to make lives better.  Sometimes we just do not remember why they fought so hard.  I appreciate that young women can be treated with respect for making a good choice for their lives. And I truly admire the doctors that will stand up to the hate mongers in doing what is needed.

   

   

   

  It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.  Charles Darwin

   

  by pioneer111 on Thu May 31, 2007 at 03:21:02 PM PDT

     

   
   
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   Thank you, you are an example (4+ / 0-)  

   

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  My daughter graduated from high school a week ago today.  Her dream is to be an obstetrician, and she's heading to college for pre-med in the fall.

  She will be faced with the situation when she begins her practice. Hopefully, she'll be able to not only meet her patients needs, but provide the care with as much compassion as you did.

  And hopefully, when she's faced with having to do what is right for her patient, the government will not have tied her hands.

   

   

     

  by mpwife on Thu May 31, 2007 at 03:34:55 PM PDT

     

   
   
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     Congratulations! (2+ / 0-)  

     

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    Tell her to go for it.  Medicine is a wonderful field.  It's stressful, hard work, but I can't imagine doing anything else. 

     

     

       

    by docswede on Thu May 31, 2007 at 04:16:09 PM PDT

     

    [  Parent  ]

     

     
     
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   grateful patients are an immediate reward (6+ / 0-)  

   

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  Thanks docswede for a great diary, and for all you do.  Just wanted to say I've talked to many other abortion providers and this is a very familiar refrain - they love what they do because of the immediate and heartfelt gratitude they get from so many patients. Doing an abortion is truly helping a woman in a very tangible way.

  Funny how anti-choice people assume that abortion providers are somehow "ashamed" of what they do - nothing could be further from the truth. Yes, most providers tend to keep a low profile, but we know it's only to protect themselves and their families from being harassed and shot at by the crazies. Thanks for speaking out docswede!

   

   

     

  by choice joyce on Thu May 31, 2007 at 03:36:21 PM PDT

     

   
   
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     You're right joyce, (2+ / 0-)  

     

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    most people don't expect that they would actually enjoy providing abortions.  I've even had residents and medical students look at me after spending time in the family planning clinic and say 'I'm not supposed to like this , am I?'.  I respond by saying 'Of course you can like this, you've helped people in a way that less than 1% of all doctors can.  Be proud, be happy and keep it up!'.

     

     

       

    by docswede on Thu May 31, 2007 at 04:22:03 PM PDT

     

    [  Parent  ]

     

     
     
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   Outstanding diary (3+ / 0-)  

   

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  Passing it on to my network and daughter.

  Thank you so much for what you do.  I've had an abortion and have served as an escort at a number of clinics, gotten to know some fabulous people who have not been afraid to openly discuss life and death and options and choices because they really loved the women they served.

  I've also lost a friend who died from a botch abortion before it was legal. 

  Good people like you, using skills to make life easier for anyone, have my undying respect.

  Thank you so much!

   

   

   

  Healthcare for ALL - We can do it NOW!

   

  by SarahLee on Thu May 31, 2007 at 04:12:22 PM PDT

     

   
   
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     Thanks for passing this along, (3+ / 0-)  

     

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    I hope they enjoy it!  I love my work and I've just begun to speak out about it.  I plan to continue to do so as much as I possibly can.

     

     

       

    by docswede on Thu May 31, 2007 at 04:17:43 PM PDT

     

    [  Parent  ]

     

     
     
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       incredibly important (2+ / 0-)  

       

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      I think it's really important that you and all of us -speak out and express our values.

      When we don't define ourselves, our values, our motivation, the antis get away with painting a very inaccurate pictures of us in order to discredit us. They've gotten away with making up stuff (like that docs are only in it for the money, they have contempt for women, only docs at the bottom of their med school classes provide abortion care, and other crazy stories). They more we speak, the more we dispel those myths.

      Keep up the good work!

       

       

         

      by LisaLL on Thu May 31, 2007 at 04:31:55 PM PDT

       

      [  Parent  ]

       

       
       
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       I'm so glad (3+ / 0-)  

       

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      that you are here speaking out about your work,docswede, along with Beket and william f harrison and blueisland. 

      As physicians providing abortion care for women, all of your voices are much needed.

      As my trainer drily said to me long years ago, "Everyone in America over age 11 has a great deal of information about abortion. Unfortunately, most of it is wrong."

      Everyone thinks they know something "about" doctors like you, so it's long past time they actually heard "from" you.

      I thank you all for caring enough about that to be here.

       

       

       

      The TEA Fund: Practicing random acts of kindness

       

      by moiv on Thu May 31, 2007 at 05:16:12 PM PDT

       

      [  Parent  ]

       

       
       
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   Bad old days of unsafe abortion (3+ / 0-)  

   

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    Dear docswede,
  Thanks so much for speaking out for providers and for those women who can't.  As one who lost a good friend from a self induced abortion before Roe; your work and words give hope that she didn't die in vain.
  Her husband and children miss her but like so many others, they just couldn't afford any more kids.  Too many mouths to feed already, too little space to live in, both parents working, too little health care for the kids that were already born, too little money to do any more than just exist- and the 'pro-lifers' say she deserved to die? Compared to you, they have no clue what true compassion is. 
  We're so very grateful for your courage and caring- it truly means the difference in life and death for some women; for others its the difference in just existing/ surviving and a life well lived.  You give us the key to a life well (or better) lived and help us preserve our ability to have pregnancies in the future, when we're better prepared. Words are inadequate to express what this truly means- keep up your wonderful and life giving/ changing work.

   

     

  by Womantrust on Thu May 31, 2007 at 04:56:52 PM PDT

     

   
   
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     I hope we never see those days again (1+ / 0-)  

     

    Recommended by:

      javelina  

     

     

    Was it Gore Vidal or Noam Chomsky who said 'we live in the United States of Amnesia'... how true.

     

     

       

    by docswede on Thu May 31, 2007 at 06:09:33 PM PDT

     

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   "Pro-life" Democrats?- Fahgeddabowdum! (2+ / 0-)  

   

  Recommended by:

    javelina, docswede  

   

   

  Docswede, since I know (more or less) who you are and what you did last summer   ;-)  , I also know that you are a mere youngster compared to me and other grayed and graying abortion-providing physicians who have been around long enough to remember the horrors that prevailed before Roe v. Wade. It is encouraging to me that through your example I can see grounds for renewed hope that competent, compassionate doctors still possess the vision and integrity to take up the mantle as we old geezers die off.

  I, too, have had experiences with many women who had compellingly dramatic, poignant reasons for terminating their pregnancies, as well as many whose reasons didn't seem as critical, but I have come to realize, as I'm sure you have, that there just aren't any reasons for a woman choosing abortion that should be regarded as trivial or frivolous.

  It is easy to judge someone else's abortion, but it is the height of cynicism and brutish callousness to do so.

  It is impossible for me to imagine a more important right of women and their families than access to fact-based, non-judgmental, compassionate family planning that includes the option of safe, legal, professional abortion care.

  And women are - what? - at least half of us? Plus their families and friends. Seems important as an aggressively pursued political issue to me, as well as one that could win if openly and honestly addressed!

   

   

   

  No matter how fervently you believe that you know what you merely believe, you merely believe it, and you might be wrong - very wrong.

   

  by Beket on Thu May 31, 2007 at 06:02:35 PM PDT

     

   
   
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     Thanks Beket! (1+ / 0-)  

     

    Recommended by:

      javelina  

     

     

    Us young bucks are here to keep you old guys kickin' 'til the day you retire... I hope I have a least a couple of years to prod you on ;).

     

     

       

    by docswede on Thu May 31, 2007 at 06:10:34 PM PDT

     

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   Thanks! (1+ / 0-)  

   

  Recommended by:

    docswede  

   

   

  We don't hear voices like yours often enough.

   

   

     

  by ib68 on Thu May 31, 2007 at 06:22:33 PM PDT

     

   
   
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   Thanks from me, too! (2+ / 0-)  

   

  Recommended by:

    javelina, docswede  

   

   

  Ditto the previous comment.

   

   

     

  by burrito on Thu May 31, 2007 at 06:23:43 PM PDT

     

   
   
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   Thank you so much. (1+ / 0-)  

   

  Recommended by:

    javelina  

   

   

  For posting this diary, but mostly for doing this work.  Your job shouldn't require bravery, but it does -- and that makes it even more noble.  It would be far easier for you to stop and take the easy way out.

  On behalf of women everywhere -- those who have had abortions, those who have never had abortions, and those who may need them in the future --  I thank you.

   

   

   

  How many now? And for what?   

   

  by edsbrooklyn on Thu May 31, 2007 at 07:27:15 PM PDT

     

   
   

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