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

  “Hi, I’m Dr. Wicklund. How are you doing, Kelly?”

  “Why can’t my mom be here with me?” she asked.

  She was sixteen but looked twelve. She clutched a stuffed animal and slumped in her chair. Her eyes were pleading, young, afraid. What she needed, more than any other thing, was the comfort that her mother, and only her mother, could provide.

  I clenched up. It was so clear that a mother should be allowed to join her daughter through this process if that was what they both wanted. Yet it was counter to clinic policy. I had gone through appropriate channels and requested that, in some cases, rules be bent in response to unique circumstances. I had been consistently rebuffed. Only staff could be with a patient during an abortion: end of discussion.

  Kelly’s mom and the seventeen-year-old boyfriend sat off by themselves in the waiting room. When I went to visit with them, the mother immediately put her hand on my arm and begged to be with Kelly. Her eyes were mirrors of her daughter’s.

  “Please, Dr. Wicklund, let me come in with her. She is so young. So scared. I can help her through this.”

  “It’s against regulations,” I sighed. “But listen, I’m a mother, too. I understand your desire.” What I was really thinking of was my parents and my compelling need to be included in the decisions and procedures that affected their lives. More than that, the need to be watching them, holding their hands, reading their body language—that language only someone close would understand.

  “Listen,” I said, with sudden resolve. “In just a minute I’ll get up and walk into the surgical area. I want you to get up and follow me. Look like you know exactly what you’re doing and where you’re going. Just follow me.”

  I waited until I saw the clinic manager go into her office and close the door; then I stood and walked through the waiting room into the surgical area. Kelly’s mom was right on my heels when we entered the room where my assistant was waiting. She immediately went to her daughter and hugged her.

  “Your mom can be with you,” I told Kelly, “but please don’t mention this to any of the patients you see in the recovery room. When the abortion is over, your mom will stay in this room until we can slip her back to the waiting area.”

  The procedure went smoothly. Kelly needed lots of TLC. Her mother was a tremendous help. She pressed her face against her daughter’s, quietly sang her a song, kissed her tear-streaked face.

  At my clinic, as in many of the smaller, independent clinics I’d worked in, we made decisions like this on an individual basis. In some cases it is extremely helpful to have a partner or husband or parent with the patient. Many times it would not be the best thing. In St. Paul, we were discouraged from assessing cases on an individual basis and reprimanded for bending the rules.

  At the end of the day I was called to the manager’s office. My infraction had come to her attention. She wasn’t interested in the extenuating circumstances, the fact that a patient’s experience had been eased by having her mother with her. That wasn’t the point. The point was that I had disobeyed policy.

  I felt like a school kid in the principal’s office. I took my reprimand, but I didn’t apologize. Nor did I promise never to bend the rules. My priorities were clear. I kept remembering my own mother’s tears when she learned about my abortion and wanted so badly to be with me. My experience would have been so different had she been there. There are times when corporate guidelines and efficiency are secondary to the needs of a family going through transition. For me, ignoring individual circumstances was unacceptable.

  Resuming work at a clinic was a relief, but my true refuge was in Montana. Whenever I could carve out some time to take a break, I would drive nonstop to my cabin retreat. Each time I had to overcome the burden of guilt for leaving Julie behind to take the load.

  Once there, I might stay in pajamas for days. Hours at a time I sat on the deck and stared out at the mountains, holding an unopened novel on my lap. Time flowed past me. Dry winds stroked my face. The open space made me breathe deep, drink in the view, wallow in the long silences.

  I began to meet my neighbors on the ranches and in houses scattered across the landscape. Some of them would become my best friends. They got to know me, listened to my stories, shared their own. Every time I came back, I settled in more comfortably and quickly. More and more, it was becoming home.

  Sadly, we weren’t able to care for Mom at home to the end. She needed blood transfusions every two weeks. Transportation to the hospital had become intolerable. Putting her in an extended care facility adjacent to the hospital was our only recourse. The small hospital was very supportive of our family efforts. We were included in medical discussions and decisions. Staff welcomed our help.

  Much of the time we simply sat at her bedside, waiting for whatever might come up, just being in her company. Toward the end, she lapsed into long periods of semi-consciousness, more than sleep. As I sat through the hours, I started drawing plans for remodeling my Montana cabin.

  Mom never reconciled herself to her fate. Her bitterness, so uncharacteristic, made me ache for her. We were always on call. More than once I had to turn around on a Montana-bound trip to tend to the latest crisis. She had been terminally ill for more than five years. I had put my life on hold for half a decade already. And Dad’s Alzheimer’s symptoms were becoming undeniable.

  He would forget where he was, why he’d come someplace, who he was talking to. At least he could still play a cunning game of cribbage, but we learned not to challenge him when he bent the rules here and there. He developed an alarming habit of taking off in his car and driving aimlessly around on the rural roads. We’d get calls from people who’d seen Dad’s car twenty miles away. As Mom’s life wound down, we started Dad on a new regimen of medications specifically targeting his Alzheimer’s symptoms.

  January 2003. Mom had been in a light coma for three days. She hadn’t eaten but had roused enough to sip some liquids. These spells had been going on for the last month. Her lucid periods were rare and fleeting. Most of the time she was incoherent, confused, weak. Her pain was so intense that she required large doses of morphine. Her bones were so fractured we could no longer turn her. Her kidneys were shutting down.

  On a Monday morning, her lab day, I got a call from the doctor.

  “The only reason we would do labs is to see if she is low enough on hemoglobin to qualify for Medicaid to pay for a transfusion on Wednesday,” he said.

  “If we don’t give her blood, she’ll die,” I whispered.

  “Sue, your mom is dying right now.”

  In the end, we decided to forgo the labs and provide comfort measures only. Let her go. The words kept running in the background. It’s time. Let her go.

  Then, on Tuesday morning, Mom opened her eyes, looked around, wanted something to eat. She asked what day it was.

  “It’s Tuesday, Mom.” I knew what the next question would be, and I dreaded it.

  “Am I getting my three units of blood on Wednesday?”

  “Mom,” I said, “you’ve been completely out of it for four days. We didn’t do your labs.”

  Silence. She knew exactly what I was saying.

  “Are you just letting me die?” she accused. “I want the labs, and I want the blood, and that’s that.”

  I called the doctor, who came right over. Despite his explanation she insisted on the transfusion. Mom demanded to sit up in a wheelchair. She hadn’t been out of bed in weeks. She placed herself with her back to me while she spoke to the doctor. I felt like an abject failure.

  We did as she asked, but her lucidity lasted only a few hours. She lapsed again into a restless coma.

  Sonja was with her when she died, early one January morning. Most of the family had gathered around her the night before, telling stories, being together. Some of us hadn’t seen each other in years. Mom lay motionless, but her vital signs reacted to the sounds of our voices. I knew that on some level she was aware of us, responding to us.

  At dawn, just before dea
th, she roused, became very restless. Everyone but Sonja and one of her cousins had gone home. Mom was trying to say something. Sonja leaned close. She wanted desperately to make it out. Mom was very frustrated, repeatedly struggled to form words. She died with Sonja still bent over her, still trying to hear.

  Four days later I was with Dad at the house, getting him ready for the funeral.

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

  “For what?” he demanded.

  “Dad, it’s Mom’s funeral.”

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

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

  Between 1982 and 2000, the number of

  abortion providers in the United States

  declined from 2,900 to 1,819, a drop of

  37 percent, and the trend has continued since.

  In 2004, almost 60 percent of abortion

  providers were more than fifty years old.

  chapter thirteen

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

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

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

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

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

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

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

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

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

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

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

  Would I have to spend another decade stuck in neutral?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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