This Common Secret: My Journey as an Abortion Doctor Read online

  “How are you holding up?” I ask her.

  “I’m tired. I just want this to be over,” she replies quietly.

  She reminds me of a rag doll. Pliable. Soft. Plain. No grit or fight left in her. I want to take her home and try to make everything better for her, but I know I am not being realistic. We move forward.

  “Are you absolutely sure this is what you want to do?” I ask.

  She just nods, but her head is down, and she is not looking at me. I wait for more. She nods again. Still I say nothing. Finally, she raises her head and looks at me.

  “Yes,” she says in a very soft voice.

  The staff wants me to hurry. They are justifiably afraid of the growing crowd and mounting tension outside.

  But Martina and I move at our own pace. We are together in a different realm, oddly serene. The procedure goes well, but instead of moving her to the recovery room right away, I just roll my stool up beside her and place my hand on her arm. We are both silent. We each shed tears we don’t acknowledge. I feel the weight of her life, the fatigue in her bones. I stand; our eyes meet.

  The news appeal swirling around Martina dries up and disappears in no time. Within days the charges against her are dropped, and she is released.

  Her “protectors” no longer find her useful. They claim they were tricked and misled by the clinic, as if they ever had a right to be part of Martina Greywind’s decision. Never once, before or after her abortion, do they make any genuine attempt to change the circumstances of her life. She slips back to the streets, becomes anonymous again, a cultural pariah.

  The ultimate and most threatening expression of hypocrisy comes from the segment of the “pro-life” movement that believes murdering abortion doctors is “justifiable homicide.” The biblical commandment “Thou shalt not kill” is conveniently glossed over in their ends-justify-the-means philosophy. They spout religion, they pay homage to godliness, they call themselves god-fearing, yet they find it in their hearts to commit murder, arson, and violence of every kind against doctors and clinics.

  I remember the first time I saw Sonja shrink away in horror from someone who innocently announced their devotion to Christianity. To her, Christians were the people who called me a killer and who publicly agitated for the murder of her mother.

  Until the courts ordered them to cease, the justifiable homicide crowd maintained a website listing every known abortion provider in the country, along with addresses, phone numbers, information about other family members, photos, and personal profiles. It was called the Nuremberg File, and it was nothing less than a detailed hit list. If a doctor was wounded or killed, that entry would be highlighted in a different color on the site, as if to check off a job well done.

  Seeing myself and my family listed on that website threw a dark shadow across my basic assumption of human goodness.

  FOR SALE:

  Women’s Reproductive Health Care solo

  practice. Have been providing first

  trimester abortions and general women’s

  health care including family planning and

  annual exams. Located in Bozeman,

  Montana: college town of 30,000

  surrounded by mountains and clean air.

  Call Mountain Country Women’s Clinic

  for details.

  In 2006, 87 percent of counties in the

  United States had no abortion provider.

  chapter twelve

  I was finding it hard to breathe. I flipped through the pages of the patient chart. The symptoms were all there, plain as day—hormone levels off, weak spells, headaches. Evidence stretching back more than eight years. Why hadn’t these been investigated? Why hadn’t I caught them? This patient had suffered because of my inattention, my failure.

  Worse yet, I had made a conscious decision to remain at a distance in this case. I had vowed to be a daughter, not a doctor.

  Dad sat on the exam table, swinging his legs. I had scheduled this visit from Montana to coincide with the follow-up appointment after the surgery to remove his brain tumor, a tumor that could have been identified and removed years earlier. The doctor hadn’t come in yet. I had power of attorney over Dad’s medical affairs, so I was justified in looking at his charts.

  The doctor in me was horrified at the implications of this inattention. The daughter in me kept staring at the symptoms and complaints, shaking my head, thinking of all he had suffered through and missed out on over those years.

  It had come to a head five months earlier. I had been visiting Sonja at her college in Boston when I got an urgent message to call home. “Family emergency” was all I knew when I dialed the number for my sister, Julie.

  “Julie,” I said, when she answered.

  “Sue. Dad’s in the hospital,” her voice was all business. “He had another severe headache, but this time he was completely confused and acting really strange. He was very weak, like those spells he gets out of the blue. His labs are all out of whack. Sue, they say he might die. Soon.”

  I felt myself shift into medical crisis-management mode. “What tests have they done?” I asked.

  “Well,” Julie said, “besides the blood tests, they took an MRI of his head, but it’s Friday afternoon, and there won’t be a radiologist in until Monday.”

  “You’re telling me that Dad’s dying and no one can evaluate an MRI for days?”

  “Yes. That’s exactly what I’m telling you.”

  “I’m catching the next plane. Get your hands on those films and meet me at the airport. I know someone in radiology at Abbott Hospital. We’ll get them read right away.”

  Several hours later, driving through Minneapolis traffic, I thought about a doctor visit two years earlier. Dad’s headaches and weak spells had already been going on for more than five years. He had been losing weight, acting inappropriately, experiencing memory loss. By then he was taking an alarming number of medications. I had begged the doctor to do an MRI of Dad’s head but was told it was unnecessary. I just needed to accept the fact that Dad was aging and that these symptoms were nothing more than a normal decline in an elderly man. My intuition told me otherwise, but I had acquiesced, stayed out of meddling in his medical affairs, held myself rigidly to my daughter role.

  Mom had urged me to get more involved. I wished now that I had listened to her. Now we finally had an MRI to study, but it might be too late. Dad was incoherent, incontinent, close to death in the intensive care unit of a tiny rural hospital.

  “This is a pituitary tumor,” the radiologist said, pointing to a dark, spherical anomaly on the films, just behind the optic nerve. “Pretty obvious. And it fits the medical history you’ve given me. Given its size and the duration of his symptoms, I’d say this tumor has been here a while.”

  Even to the untrained eye, the tumor was obvious, glaring. For me, it was an accusation.

  When the pituitary gland is shut down or destroyed, the rest of the endocrine system malfunctions as well. Without hormones, you die. In Dad’s case we were lucky. Within a month his condition stabilized, and he was able to have brain surgery to have the tumor removed.

  “Looking at the size of that schnoz,” the surgeon had joked, “I’d say this procedure will be a breeze. We’ll just drive right in through that nasal cavity and pluck out the tumor.”

  In fact, the surgery was a difficult but successful one. Dad’s face looked like it had been flattened by a truck, but he healed quickly.

  It was February now. I’d come back to Wisconsin to take Dad personally to his follow-up exam. No more distancing myself from his medical care. From now on, I’d be paying strict attention to the details. I would become a regular presence in my parents’ lives. I also hoped to take part in the annual family tradition of tapping trees and making maple syrup.

  Lurking in the background was the state of Mom’s health. Dad was rebounding nicely, putting weight back on. He called himself “the new, old man.” He could once again do chores, walk in the woods, play cribbage, parti
cipate in conversations. His familiar sense of humor reemerged. The most heart-wrenching part of his recovery was filling him in on the events he’d missed, things that happened over recent years that he didn’t remember, including the death of his son-in-law.

  Mom, on the other hand, had been weak and tired for several months. We took her to the Mayo Clinic, where she was diagnosed with Myelodysplastic Syndrome with sideroblastic anemia. In English, it meant that her bone marrow didn’t properly mature her red blood cells, among other things. Average life expectancy following this diagnosis is two years.

  I’d blown it with Dad. He and my family had paid a heavy price. I wasn’t about to let the same thing happen with Mom. Still, I knew exactly what that meant. In order to truly care for Mom and be there on the medical scene, I’d have to consider moving back to the Midwest.

  Like the patients who came every day to my Montana clinic, I confronted my life choice: whether to pursue my career and ambition or put that on hold, perhaps forever; how to be my own person and also be a responsible family member; how to come to a decision I could live with.

  I was still coming to grips with the failure of my second marriage. There was no terrible disagreement or ulterior motive for the divorce. Randy is a good, kind man. We’ve remained friends, and he continues to be Randad to Sonja, keeping in contact and seeing her frequently. A large part of our decision to part ways was based on our inability to reconcile our geographic separation. We had each developed our own lives. Randy was well along in his engineering career, and I had my place in the West. Once Sonja graduated from high school and went off to college, we made the divorce official.

  I had told Randy that I would never come back to Wisconsin. “Never” was a word I often told my patients to be very careful with. Many times women have told me that they would never have believed they would find themselves in an abortion clinic. Now I was faced with my own careless use of that inflexible word.

  And, like for many of my abortion patients, none of it felt black-and-white. Where they weighed the responsibilities and rewards of being a parent against life’s realities, I struggled with the closure at the other end of life, and the duty I had to help ease that transition and make what time remained as full and vital as possible for people I loved.

  For the next ten months I tried to do both. I had worked so hard to create a clinic that reflected my beliefs and convictions, to serve women the way they deserved to be served. My staff had developed into a competent, supportive, effective team. I felt somewhat responsible for their futures. Our service to women who came from as far away as Canada and the Dakotas addressed an urgent need. We had developed a reputation based on compassion and respect. I couldn’t bear to give that up.

  From February to December I flew back and forth from Montana to Wisconsin, spending several days a week operating the clinic, then returning to my family. Life was a whirl-wind of competing demands. As the weeks passed, more and more things slipped through the cracks. Try as I might, I couldn’t maintain the juggling act.

  On New Year’s Eve 1997, I was sitting alone in the hot tub on Julie’s porch in Wisconsin. Steam swirled around me. Winter woods surrounded the house. I couldn’t stop crying. My tears were a confused blend of self-pity, sadness for my parents, and guilt and anger over giving up my clinic. I was terrified of losing my autonomy, my sense of self. Above all, I knew that I had to come home and stay home, and that it meant ending my work at the clinic in Montana.

  I had been putting out feelers for someone who might buy the clinic and keep the practice open. I had some nibbles, and two serious inquiries, but the business didn’t generate enough money to finalize a deal. In the end, I had to close down Mountain Country Women’s Clinic, five years to the day from the proud morning it opened. In February 1998 I closed that door for the last time.

  At that moment an overwhelming sadness engulfed me. On some level it felt like a betrayal of Dr. Balice’s commitment to keeping the clinic open, and a betrayal of my staff. It felt as if I were turning my back on a part of myself.

  Before I left for Wisconsin, I bought a small, primitive cabin on some acreage about forty miles east of Bozeman. No running water. The only electricity came through an extension cord from the power post. Plenty of sagebrush and mountain-filled skyline. It was a quiet, windswept, austere, beautiful, lonely spot. More important, it was my deposit on a future out west, something tangible and real in a life now so full of unknowns.

  In a way, caring for Mom and Dad took me back to my time as a single parent caring for a toddler. Days melted away in a blur of tending to details, treading water, doing repetitive chores. Trips to the pharmacy, doctor appointments, keeping the house clean, doing laundry, making phone calls, keeping track of medications, and always watching for changes in Mom’s condition. It was exhausting and consuming, as well as important and satisfying, but I often felt that I’d done nothing of significance for weeks at a stretch. Julie and I became a parent-care team, and we developed a sense for when the other person was overloaded.

  I had to tamp down the ache I felt for Montana, for my clinic and my work. The Midwestern humidity gnawed at my joints, slowed me down. I kept glancing to the horizon, willing mountains to be there. But I couldn’t let myself dwell on it. I’d made my commitment.

  Although Dad had substantially recovered physically, his mental lapses didn’t disappear. Mom’s health was truly precarious, but we couldn’t afford not to keep an eye on Dad. We would send him to town with a grocery list, and he’d return an hour later with stories of the people he’d seen, but no food. When he was home alone with Mom, he would sometimes get so preoccupied with a chore in the barn that he’d completely forget she might need his help.

  Mom had weekly lab tests at the clinic. Within a year she needed frequent blood transfusions. Her disease weakened her bones to the point that she started having spontaneous fractures of her spine, then her hip and one leg. She became wheelchair-bound, had to be helped to the toilet and into bed. We moved her into the old dining room during the day so she could be close to the hub of the kitchen. The old living room became their bedroom. The upstairs rooms went vacant. Her pain became almost impossible to control. And she was angry.

  Once we were at the hospital getting a blood transfusion when one of her old schoolmates happened to walk by. He stopped and came in the room.

  “Vera,” he said. “So good to see you. How are you doing?”

  She never looked up at him, kept her head bowed. “Oh, I’m alright,” she mumbled.

  “It must be hard to see people your age who are healthy,” I said, after he left.

  “I’m so angry that this happened!” she blurted out. “My friends are out playing golf, spending time with their families, going places. Look at me. It’s not fair!” She hunched over, her muscles tight, her hands clenched into fists.

  I did look at her. The sight made me grieve. This is what had replaced the retirement my parents had looked forward to, this purgatory full of pain and dependence.

  Days marched past, weeks, years. Mom’s condition steadily worsened, but Julie and I were very attentive. Every change was monitored, medications adjusted, quirks checked out. She outlived her prognosis. We hired a compassionate, cheerful local woman to help out several days a week. Dad was cantankerous with her and resented having a stranger in the house. Fact was, we desperately needed the help. The smallest chores had become ordeals.

  Flower Grandma was still alive, suffering from Alzheimer’s disease, living in her third nursing home. She and I had never again discussed her childhood friend. I don’t know if, in her later years, she even remembered the trauma. We tried to explain Mom’s situation to her. She seemed to understand. It had been months since they’d seen each other.

  On a sunny spring day I picked up Flower Grandma and drove her to my parents’ home. The farms were green with new crops. Flocks of Canada geese flew over the fields.

  “Oh!” she exclaimed. “Big birds.”

  When we pass
ed farm silos, she’d count them off. “One, two, three silos,” she said. “One, two, three, four, five silos.” Her obsessive behavior was symptomatic of Alzheimer’s. On one level her habit was cute and endearing. On another, a chilling sign of a mind trying desperately to hang on to some thread of control.

  At the house I helped Flower Grandma from the car. She shuffled her way in through the doorway she had entered hundreds of times over the decades. Some spark of recognition lit her face. We moved farther into the house, to the old dining room. Mom lay there on her hospital bed. In that moment I saw her truly for what she’d become, a shrunken, diminished husk of herself.

  “NO!” Flower Grandma shouted at the sight of her daughter. “Not . . . not . . . oh no!”

  I pulled her into the kitchen and made coffee—my ingrained response to stress. We sat together at the table in silence, cradling the warm mugs. Crying. Eventually she was able to walk back into the room, holding her coffee cup, and sit with Mom.

  On the trip back to the nursing home, Flower Grandma counted silos, looking out across the land so familiar and yet so foreign. She died that spring, just after Easter. Bucking tradition, her six granddaughters were her pallbearers.

  I went back to work part-time for a clinic owned by a large corporation in St. Paul. The two-hour commute became my island of calm and solitude. I could listen to books on tape, play music, let my thoughts wander uninterrupted, simply be alone without demands or distractions. I loved being with patients again and got completely pulled in by their circumstances.

  At this job, however, I was no longer the boss, and I had little opportunity to have an impact on policies or protocols. Decisions about patient care, staffing, and individual concerns were dictated by a hierarchy that I often couldn’t understand and that seemed unapproachable. I was continually getting into trouble for rocking the boat, for questioning the wisdom of rules, and for putting patient requests above rigid guidelines.