#43. ALICE - "A doctor who performs abortions."

Tuesday, August 16, 2011

#43. ALICE - “A doctor who performs abortions.”

Alice

“A man in the back speaks up. ‘We have an informant that has said that you told this woman to come here today, so that you could do an abortion on her.’

‘No, that’s incorrect, ‘[I say,] ‘…She had never had a pregnancy test, or an ultrasound scan. …Because we do not have access to the ultrasound on the weekend, I told her to come back today. …She is pregnant, and the pregnancy is 16 weeks, but because she speaks [another language], I could not tell her. So I brought her to someone in our clinic who speaks [it], and he said he would tell her. I left her there with the ultrasound report, waiting for him. That was the last I saw her.’

The [hospital administrator] spoke up, looking relieved. ‘Now, you see, Doctor has explained. She did an ultrasound. Now we are settled, and we can finish this discussion.’

Everyone speaks at once, but the man in the polo shirt was loudest. ‘No, we cannot finish because she has not shown remorse!’” – ‘No Remorse,’ 5/5/2011

This is an excerpt from the blog of a passionate, young obstetrician named Alice. The blog chronicles the year she spent working at a hospital in an African country where abortion is illegal. She has asked me not to name the exact country and to give her an alias for this interview. She chose “Alice.”

Alice attended medical school and did her residency in New York City, but didn’t have a clear direction until she did three days with each specialty. When she got to “labor and childbirth,” she was so struck that a superior took one look at her beaming face and asked, “You’re going to be an obstetrician, aren’t you?”

“I remember that moment,” she says. “I really loved that we were in clinic and that we had sat there and talked to somebody so honestly about sex, and all these embarrassing topics and all these things you’re not supposed to talk about. And it was a relief, for us and for her, to be able to talk about it and to be so frank. [Women’s health and reproduction is] the most amazing thing in the world, and yet, we don’t talk about it. It’s so empowering.”

I tell her I feel like it also has the most potential to be amazing because the grown patients are so grateful for her help, but also to be devastating when something goes wrong during a birth.

“It’s 90 percent amazing and 10 percent devastating,” she says, of the birthing process. “The thing is, the amazing never stops being amazing.”

Alice, as she sits in front of me, doesn’t fit either stereotype of an OBGYN; either the creepy male gynecologist or the placenta-eating spirit mother. She says the medical stereotype of OBGYNs is that they’re “the bitches.”

“We have to be, because if you’re sitting there bleeding to death, as one of my friends used to say, ‘You don’t want someone who is going to stand around and contemplate the meaning of life.’ You want someone who is going to walk in the room and be like, ‘Move over there. Get out of my way,’ and shove their hand down,” she mimes putting her hand into a woman. “When you’re giving birth, you could die in a matter of minutes. So you don’t want someone who’s indecisive.”

I ask how she felt the first time she delivered a baby that she knew was going to die.

“I knew she wasn’t going to survive beyond a few hours, and the whole situation was not because of anything we did. It was a chromosomal thing, but that was sad. I remember it was Thanksgiving,” she says. “It was really depressing.”

But, Alice remembers, she didn’t cry. It’s not that she’s never cried in the delivery room; in fact, seeing a dad hold his newborn always gets to her, but in this truly tragic moment, she felt almost out-of-body.

“I think I was more wide‑eyed and taking it all in. The parents handled it amazing. They were so beautiful and they just held her until she died,” she pauses and then says: “I can remember so much of that episode that I usually wouldn’t remember.”

During her training, she delivered her first child, and like every trainee, performed her first abortion. Performing an abortion was not required of all students, but Alice says most in the other residents at the inner city hospital chose to learn.

“It’s a major, major part of our specialty,” Alice says. “It’s not a rare thing.” According to the reproductive health group, the Guttmacher Institute, in 2008, 1.21 million abortions were performed in the United States. Approximately, 1/3 of woman in the US will have an abortion by age 45.

“I can’t say every [OBGYN] does one later on, or maybe they do first-trimesters. And I get that,” she says. “But I’m not particularly comfortable with the fact that people go into OBGYN and don’t do them, which is a controversial thing to say. I think it’s like going into general surgery and then being like, ‘I’m not going to do amputations because diabetics did it to themselves.’”

Alice grew up in the city and was raised in a liberal, non-religious, feminist family. She says she doesn’t understand people who defensively claim they “aren’t feminist.” She grew up pro-sex education and pro-choice. But, of course, there’s a difference between believing in choice and actually being the one to do the abortion.

Alice says she compartmentalizes. She likens it to when she worked in an oncology department, delivering flowers to cancer patients. People would always ask her, ‘Isn’t it depressing?’ Alice never saw it that way. This was a struggle they had to go through, and she was helping them through that process. She feels the same way about terminating a pregnancy.

“I’m not the one making the choice. I’m the one helping her once she’s made the choice,” she says.

And for those that come to Alice undecided, she says she makes them go home and think it through. Her pre-procedure counseling, she says, is very strong and never rushed. If a woman comes in and says her boyfriend convinced her to have an abortion, Alice will parse out the real reasons.

“Sometimes you have to be really blunt, and you have to say, ‘I don’t want you to do this. I need to feel like you want to do this, because if you aren’t able to say that, then you’re going to look back on this and regret it,’” she says. “I’ve seen both how excruciating it can be and how clear the decision can be. People sit there in front of you and cry.”

This reminds me of what I told abortion protester Sarina that night at the coffee shop in New Jersey: that no one wants to be having an abortion, no one waltzes in gleeful about it. Alice agrees; it’s so rare to see someone like that, even if they’re on their 12th abortion.

Though Alice says she’s too “loud-mouthed” to friends and private to strangers to have people get confrontational about her profession, she does avoid using the word “abortion” whenever someone sits near us. I do too. When we do use it, I notice our neighbors side-eyeing us. Alice says she’s tried, like I did with Sarina, to put herself in the shoes of those who are against abortion and found she can not fathom their reasoning. She also realized she doesn’t care what they think.

“I am not in the business of persuasion and I’m not in the business of trying to convince you that it’s right or not,” she says.

The point of the issue, Alice says, is not whether or not you think it’s right to do the act. It’s about whether you think the act should be legal.

“If you don’t think that someone should do the act, don’t do it,” she says. “I don’t think someone should commit adultery, but I don’t think it should be illegal. It’s like why the National Rifle Association refuses to ban assault weapons. Nobody uses an assault weapon on deer, but they’re afraid that if they concede the point of an assault weapon, it’s going to be a ban. I think there are actually a lot of pro‑choice people who don’t agree with the act. But they recognize what it would mean if we made it illegal.”

What it would mean, according to many sources, is more abortions. In the African country Alice spent a year working in, there are actually more abortions than in the US despite abortion being illegal, according to Guttmacher. There, even counseling someone considering an abortion is banned.

“You can’t sit there and counsel them. They could be recording what you’re saying. They could go back to the police with what you said. And you wouldn’t do anything and they would implicate you [for criminal intent]. So how do you give them adequate counseling?” she says. “[In America, where abortion is legal], I can literally sit there with someone. I can say, ‘What about regret? What do you think about regret?’ You can sit there and go through every option, but you can’t do that if you make it illegal.”

Also, in the African country where Alice worked, a family member is allowed to sign medical consent forms for a woman. In one instance, after having five children and living in poverty, a woman’s husband would not sign forms for Alice to tie his wife’s tubes. Having a man sign for a woman made Alice uncomfortable.

“There were times when it just time‑wise wasn’t appropriate to insist. But if I had time, I insisted that the woman signed the form. And it was always a hullabaloo, ‘She can’t write, she can’t read, there’s no pen,’” she says. “And none of that ever guarantees that she actually has any idea what you’re talking about or is on the same page, but you do what you can do.”

I mention how most of the powerful people working to ban abortion are men. “They’re scared of…” I start. Alice finishes, “a woman having power.”

I nod. Alice says, “Why? They’re not going to abort them.”

I ask about the woman she did the ultrasound for in her blog entry. Alice didn’t perform abortions in that African country because it wasn’t her home country – if America outlawed abortions, she says she’d consider performing them. When I ask what might have become of that woman, Alice says she doesn’t like to think about it.

“She could have found someone to do it, but it would have been very dangerous at that stage, because people don’t know what they’re doing. No one can legally be trained. I encouraged her not to, and I actually told her, if she does try to get one [in that African country], she could die,” Alice says.

The most difficult part of her job, Alice says, is when the mother dies in childbirth.

“That’s much, much harder to get over,” she says. “I don’t know that you ever do. That’s what led me to [Africa] and everything, because when you realize that women die giving birth, it’s just the most infuriating injustice that exists, right? It’s supposed to be this life‑giving thing. That’s harder to put aside.”

One of the things I asked Sarina during our interview was what she would do if she was told she would die unless she got an abortion. Sarina told me she would trust in God.

I tell Alice this, adding: “If a doctor told them, ‘You have cancer. You could probably cure this,’ they would listen. But if you were like, ‘Hey, listen, the baby’s going to kill you,’ they’re like, ‘Well, I’m not sure.’”

Alice says it’s less about that, and more about taking the issue as strictly black and white.

If fetuses are always people from the moment of conception, Alice says, why when a woman has a first‑trimester miscarriage, she usually suffers alone with her partner. Where are the pro-lifers then? Or what about when abused and neglected children suffer in foster care or unfit homes, like Sarina’s would have been had she continued using drugs; what then?

Alice’s passion for medicine is evident. The people she helped, the beauty she witnessed and the difficult situations she put herself in the center of in Africa — and even in New York — is truly beyond anything I’ve personally experienced. This is never more evident than when Alice tells me about one of her first births, where the woman…um, tore particularly badly. Alice felt like she’d failed, especially with the patient yelling at her. But in the end, mother and baby were fine. My response? “Never having children ever,” I pretend to write in my notebook.

That’s not even the worst that can happen. While death during childbirth can happen in an instant, there are also lasting painful effects for women without proper reproductive and childbirth medical care. When Alice was younger, an article about the famine in Ethiopia was one of the things that made her want to be a doctor. That feeling returned one day when she read about one such condition called obstetric fistula.

Obstetric fistula happens when a woman is in labor and the fetal head puts pressure on the pelvis. Eventually the baby dies and when the woman’s tissue heals, it’s necrotic, leaving a hole between the bladder and the vagina or the vagina and the rectum.

“What it means is that she’s constantly in pain and has urine incontinence, [leaks urine and feces] for the rest of her life. It makes her a pariah. It makes her stink horribly,” Alice says.

I’m aghast (as I’m sure you are reading this). “This is common?” I say. I’ve never heard of fistula.

“The last time I read about it, which was years ago, I think it was estimated that two million women have fistula,” Alice says.

That information makes me want to cry. “You know that if there was even a remote possibility of this happening to a dude, there would be a million foundations,” I say, thinking about the number of penis pills that exist.

“Right,” Alice says simply. “It wouldn’t happen.”

The problem of fistula stayed in Alice’s mind. “It shouldn’t fucking happen,” she kept thinking. “It just shouldn’t.” She wrote her residency essay on fistula and in her fourth year went to Africa with the Global Health Initiative. After that, she was itching to do more in developing countries, which led to the scene at her hospital, where the pro-life investigators cornered her with frightening accusations of performing abortions.

“What really almost gave me a heart attack was these men sitting there saying the most vicious things, and I was thinking about episodes where I had been sitting there operating on someone who was bleeding to death in front of me. It’s just like, ‘Who the fuck are you?,’” she pauses. “And you can quote me on that. ‘Seriously, when she’s dying of hemorrhage, where the fuck are you?’”

My voice is grim, “Nowhere,” I suggest.

Alice nods, “When the kids in the malnutrition ward right now are dying because they don’t have food or they don’t have protein, where are you? That hospital, that pediatric ward is half malnutrition. Where are you? You don’t care about them.”

[Please donate to help women with obstetric fistula here.]