On Sunday, May 31st, 2009, in a Wichita, Kansas church, a virulent anti-abortionist walked up to Dr. Tiller and shot him in the head. Dr. Tiller was a Kansas physician who, along with two other American gynecologists, performed late abortions. These were often done into the third trimester, as late as 30+ weeks. It's been reported that "99%" of these procedures were performed for fetal anomalies, such as genetic disorders, potential birth defects, etc. I somehow doubt this is true, for I've referred several patients with normal pregnancies to these physicians. Not that this lessens the importance of such procedures for women in emotional distress. Some patients, especially young teens (and their parents), feel that their lives might be ruined by carrying a fetus to term and having a child, either raising it or giving it up for adoption. Right or wrong, undergoing one of these procedures is a difficult and traumatic personal decision.
Regardless of what one feels about late abortions, most reasonable people would agree that no one deserves to be shot for performing them. Nonetheless, several abortion providers have been killed in the last two decades, under the rationale the murders are "saving the unborn" by killing the late abortion physicians. That brings me to the point of this essay. Speech, when heard and absorbed by troubled ears, can be terribly destructive. A number of anti-abortion political and cable TV comentators have used words that might motivate borderline personality types. A well-known talk show host, even prior to Dr. Tiller's murder, called Tiller an "executioner" who had executed tens of thousandsof babies. Others suggested that Dr. Tiller deserved to be murdered, or that it was fitting that the "Tiller the Terminator" had himself been "terminated."
This vile hate speech is no different than shouting fire in a crowded theater. It incites, instigates, and provokes negative behavior and should not be tolerated in civilized societies. As I've said in previous blogs, there's nothing wrong with legal anti-abortion protest, even when offensive. But if one detests late-term abortion, the remedy is to change the law -- not shoot the doctor.
Friday, June 26, 2009
Thursday, March 5, 2009
On Abortion Protesters
We should never take the freedoms we enjoy as Americans for granted, even when we don't agree with the way some people exercise these freedoms.
One of the hallmarks of American liberty is legalized protest. Freedom of speech is guaranteed by the First Amendment to the Constitution. Though this right is not absolute, the courts give a great deal of leeway to protesters in what they may say: provided the protest is not "hate speech" or pornography, it is usually protected. This puts those of us who sometimes risk their lives to provide terminations in a quandary. Frequently, our offices or parking lots are surrounded by protesters who do their best to discourage medical staff and patients seeking termination from entering the facility. Generally (and their are rare violent exceptions), these protesters are harmless, devoutly religious senior citizens who believe they are carrying out God's will by trying to "save the unborn." But to that end, they use inflammatory rhetoric to verbally harass those coming in for care, calling them "baby killers" and proudly displaying grotesque, misleading pictures of fetuses.
It's my right to disagree with these people, and I do. Sure, I'd like them to go away. Yet as distasteful as their tactics are, provided the protesters keep their distance and don't physically interfere with anyone, it's the price we pay for living in a free society.
One of the hallmarks of American liberty is legalized protest. Freedom of speech is guaranteed by the First Amendment to the Constitution. Though this right is not absolute, the courts give a great deal of leeway to protesters in what they may say: provided the protest is not "hate speech" or pornography, it is usually protected. This puts those of us who sometimes risk their lives to provide terminations in a quandary. Frequently, our offices or parking lots are surrounded by protesters who do their best to discourage medical staff and patients seeking termination from entering the facility. Generally (and their are rare violent exceptions), these protesters are harmless, devoutly religious senior citizens who believe they are carrying out God's will by trying to "save the unborn." But to that end, they use inflammatory rhetoric to verbally harass those coming in for care, calling them "baby killers" and proudly displaying grotesque, misleading pictures of fetuses.
It's my right to disagree with these people, and I do. Sure, I'd like them to go away. Yet as distasteful as their tactics are, provided the protesters keep their distance and don't physically interfere with anyone, it's the price we pay for living in a free society.
Friday, February 27, 2009
The milk culture
In the early 1970s, we called it a "milk culture."
Taped to an IV pole at the bedside, it was a stoppered test tube filled with sterile milk into which a Q-Tip had been inserted. The Q-Tip contained vaginal or cervical secretions collected from a patient with a suspected infected criminal abortion. In such illegal abortions -- often performed by lay people with contaminated instruments, or even coat hangers -- there was a chance of contracting an infection caused by a bacterium called clostridia. If clostridia was present, it fermented and produced gas bubbles in the milk culture. Catch it, and you were in trouble.
Among germs, clostridia was a decidedly bad player, which could cause tetanus or gas gangrene. A serious infection might occur through neglect, as often happened in patients who postponed needed medical care due to guilt, denial, or misinformation. In 1970, clostridia was notoriously hard to detect and treat and could lead to a painful illness and death, caused by respiratory failure.
During my very first week of residency training, a patient died of clostridia sepsis. Another expired three months later. These deaths were both tragic and pointless, because they could have been prevented by medically safe, antiseptic, legal abortions, had the patient known of their availability. The memory of these pointless deaths will stay with me forever. These days, few people are aware of how many tens of thousands of women died from infected illegal abortions, and who still die in third world countries. So whenever an abortion opponent berates me about the unborn life I am taking, I tell them to say that to the bereaved families who have lost a loved one due to illegal abortion.
Taped to an IV pole at the bedside, it was a stoppered test tube filled with sterile milk into which a Q-Tip had been inserted. The Q-Tip contained vaginal or cervical secretions collected from a patient with a suspected infected criminal abortion. In such illegal abortions -- often performed by lay people with contaminated instruments, or even coat hangers -- there was a chance of contracting an infection caused by a bacterium called clostridia. If clostridia was present, it fermented and produced gas bubbles in the milk culture. Catch it, and you were in trouble.
Among germs, clostridia was a decidedly bad player, which could cause tetanus or gas gangrene. A serious infection might occur through neglect, as often happened in patients who postponed needed medical care due to guilt, denial, or misinformation. In 1970, clostridia was notoriously hard to detect and treat and could lead to a painful illness and death, caused by respiratory failure.
During my very first week of residency training, a patient died of clostridia sepsis. Another expired three months later. These deaths were both tragic and pointless, because they could have been prevented by medically safe, antiseptic, legal abortions, had the patient known of their availability. The memory of these pointless deaths will stay with me forever. These days, few people are aware of how many tens of thousands of women died from infected illegal abortions, and who still die in third world countries. So whenever an abortion opponent berates me about the unborn life I am taking, I tell them to say that to the bereaved families who have lost a loved one due to illegal abortion.
Sunday, December 21, 2008
Rosalina
Rosalina was 17 and a resident of the poverty-ridden Mexico City slums when she decided to come to el norte to start a new life and make money for her family. En route, she was raped by the cojote (guide) who transported her, and she was beaten nearly to death. Somehow managing to stay alive, she recuperated in the Spanish barrio of Dallas and finally got a job as a migrant worker. But after a month, she learned she was pregnant. Relatives in Farmingdale, Long Island, convinced her to come east for help, and by now she had earned enough for bus fare. Shortly after her arrival in New York, and after speaking with her relatives, she decided that she simply couldn't carry the baby of the man who had raped her. She wanted an abortion, but she had neither money, insurance, nor Medicaid. One of her relatives told her about an old woman who performed abortions for $25. Rosalina was so desperate that she agreed to the procedure. At the clandestine meeting place, she met the woman in an old abandoned room. She was given something alcoholic to drink, and a half hour later, when she was semi-conscious, she recalls something being shoved into her, and a good deal of pain. Shortly afterward, she was sent home and told to expect heavy bleeding in 2-3 days.
But she didn't bleed. What she developed, instead, was a 103 degree fever, chills, and abdominal pain. Friends who had previously been to our facility brought Rosalina to us on a day we were doing procedures. We immediately suggested that she go to a hospital, but as an illegal alien with no money, Rosalina was terrified. She begged us to examine her for free -- and we agree. During the exam, it was soon apparent that something traumatic had been shoved into her uterus -- a coat hangar? A knitting needle? -- but, insteading of causing her to abort, had left her with a trememdous infection. Our sonogram showed that her uterus contained a dead fetus and a collection of pus. Unless this was evacuated immediately, she would die.
We didn't feel we had any choice. This, after all, was what we were in business for: to help pregnany women in trouble, and maybe, in rare cases like this, to try to save the lives of pregnant women in dire straits. So we began by giving her massive doses of antibiotics intravenously, cooling down her fever, administering steroids, and giving abundant fluids. After several hours, when we felt she was as stable as she would get, we performed a suction currettage, eavcuating the dead fetus and large amounts of foul-smelling pus. This had been the easy part. The next twenty-four hours would prove critical.
One of us -- a doctor, nurse-anesthetist, or registered nurse, was with her in the recovery room in our office 24/7. After a rocky first 8 hours, Rosalina's condition stabilized, as evidenced by a dropping fever and significantly less abdominal pain. Her post-op bleeding slowed to negligible levels. After 24 hours, she felt well enough to leave, but we insisted she stay for another 12 hours, after which we were convinced she'd recovered.
Today, several years later, Rosalina has her green card, pays taxes, and is blessed with a beautiful baby girl. Although she never paid us in cash, each year she brings the baby by and gives us homemade cookies. I'd say that we've been repaid more than enough -- for after all, what more could you wish for?
But she didn't bleed. What she developed, instead, was a 103 degree fever, chills, and abdominal pain. Friends who had previously been to our facility brought Rosalina to us on a day we were doing procedures. We immediately suggested that she go to a hospital, but as an illegal alien with no money, Rosalina was terrified. She begged us to examine her for free -- and we agree. During the exam, it was soon apparent that something traumatic had been shoved into her uterus -- a coat hangar? A knitting needle? -- but, insteading of causing her to abort, had left her with a trememdous infection. Our sonogram showed that her uterus contained a dead fetus and a collection of pus. Unless this was evacuated immediately, she would die.
We didn't feel we had any choice. This, after all, was what we were in business for: to help pregnany women in trouble, and maybe, in rare cases like this, to try to save the lives of pregnant women in dire straits. So we began by giving her massive doses of antibiotics intravenously, cooling down her fever, administering steroids, and giving abundant fluids. After several hours, when we felt she was as stable as she would get, we performed a suction currettage, eavcuating the dead fetus and large amounts of foul-smelling pus. This had been the easy part. The next twenty-four hours would prove critical.
One of us -- a doctor, nurse-anesthetist, or registered nurse, was with her in the recovery room in our office 24/7. After a rocky first 8 hours, Rosalina's condition stabilized, as evidenced by a dropping fever and significantly less abdominal pain. Her post-op bleeding slowed to negligible levels. After 24 hours, she felt well enough to leave, but we insisted she stay for another 12 hours, after which we were convinced she'd recovered.
Today, several years later, Rosalina has her green card, pays taxes, and is blessed with a beautiful baby girl. Although she never paid us in cash, each year she brings the baby by and gives us homemade cookies. I'd say that we've been repaid more than enough -- for after all, what more could you wish for?
Thursday, December 18, 2008
Teen pregnancy, the good and the bad
First the good news: those of us who deal with abortion obviously deal with teenagers, both from the standpoint of procedures and contraception. The teen pregnancy rate has come down dramatically between 1991 and 2004 by 35%! The reason is not clear, because half of all teens are having intercourse. It may be that there is more widespread use of contraception, a fear of AIDS or other sexually transmitted diseases, or other factors. Still, teen pregnancies pose a tremendous problem because of the social, emotional and individual consequences that acompany them. The following paradigm may illustrate this. Social disorganization, such as lack of parents, lack of positive family influences, or poor socioeconomic status, lead to teen pregnancy, which in turn leads back to social disorganization. It's a vicious cycle. For the moms, they're very likely to lead a large portion of their lives in poverty. Of course this is not an argument in favor of abortion, but favoring contraception and a war on poverty. Hopefully, these battles will be successful and see the decrease in teen pregnancy go even further. Teen pregnancy costs all of us about 30 billion dollars a year, so the savings to society can be considerable.
Monday, December 15, 2008
The angst of abortion
Many people, especially those who oppose termination of pregnancy, think that those who choose abortion have a nonchalant, couldn't care less attitude in their decision-making. I have not found this to be true. In my three-plus decades of performing procedures, it is the extremely rare patient who requests a termination without much forethought and with total indifference. Yes, there are such patients, but they are the exceptions rather than the rule. Other rare individuals use abortion as a form of birth control and show up pregnant repeatedly, much to my chagrin and the befuddlement of the staff. We view these as failures on our part, for follow-up birth control is a large part of what we do.
For almost all others, terminating a pregnancy is an agonizing, gut-wrenching decision. Virtually every patient is aware of the pregnancy growing inside her, and as early as six weeks, many patients have begun to develop strong emotional bonds to their future child -- fantasizing about it, wondering what it will look like, guessing about its sex, etc. For the most part (except, for example, in cases of rape or nonconsensual sex) such thoughts are normal and even healthy. But, and this is a big but, they complicate what might have been an easy decision to abort. Guilt and shame often come into the picture, and they immediately complicate the decision. This is further compounded by the patient's religion, upbringing, and sense of morality. The decision goes from what might have been a snap to a tear-filled, often ambivalent mind-set.
This is a common picture. And it is these patients who require the utmost in emotional support, hand-holding, and reassurance. In my facility, we never try to force a patient in one direction or another; and it is not unusual, after counseling and discussion, that a patient opts to continue her pregnancy. If she chooses, we will happily refer her for prenatal care. It is our job to answer questions and offer advice and support, not to suggest a decision.
Bottom line: What to do with an unwanted pregnancy is an intensely personal matter, and it is rarely a decision that is made lightly.
For almost all others, terminating a pregnancy is an agonizing, gut-wrenching decision. Virtually every patient is aware of the pregnancy growing inside her, and as early as six weeks, many patients have begun to develop strong emotional bonds to their future child -- fantasizing about it, wondering what it will look like, guessing about its sex, etc. For the most part (except, for example, in cases of rape or nonconsensual sex) such thoughts are normal and even healthy. But, and this is a big but, they complicate what might have been an easy decision to abort. Guilt and shame often come into the picture, and they immediately complicate the decision. This is further compounded by the patient's religion, upbringing, and sense of morality. The decision goes from what might have been a snap to a tear-filled, often ambivalent mind-set.
This is a common picture. And it is these patients who require the utmost in emotional support, hand-holding, and reassurance. In my facility, we never try to force a patient in one direction or another; and it is not unusual, after counseling and discussion, that a patient opts to continue her pregnancy. If she chooses, we will happily refer her for prenatal care. It is our job to answer questions and offer advice and support, not to suggest a decision.
Bottom line: What to do with an unwanted pregnancy is an intensely personal matter, and it is rarely a decision that is made lightly.
Saturday, December 13, 2008
Is abortion killing?
My goal, as I began this blog, was to present medical facts, news, and controversies as they relate to abortion from the perspective of the physician who performs them. I wanted to stay away, as much as possible, from the theology, morality, philosophy, and ethics that surround such a controversial subject and simply tell it straight -- as I see it -- from the doctor's mouth. I still intend to steer clear from the muckraking, name-calling, and foul language sometimes used by those on either side of the controversy. Not that I haven't personally been on the receiving end of such language; I've been called every f-word in existence, sundry varieties of other questionable speech, and, of course, baby-killer and murderer.
Not to split hairs, but I know I'm not a murderer since murder is a legal term invoked by judges and juries, not to be found in any textbook of medicine, and this blog is devoted to medical fact. But, is it killing? Many pro-choice advocates consider an embryo or early fetus to be a lifeless blob of cells. I may have thought that before the advent and widespread use of ultrasound, but these days, beginning at around six weeks, we can see the fetal heartbeat, and later, moving fetal structures. When I wrote my New York Times fictional bestseller, THE UNBORN, I included a quote that "the brain of the human fetus exhibits recordable electrical activity as early as the eighth week." During a book tour in England, this provoked many questions from listeners and viewers about fetuses and life. A century ago, a Supreme Court Justice, when asked about pornography, said, "I know it when I see it." The same thing applies to human life: once a child of any gestational age is born and breathes and has a beating heart, I know it's alive.
But what about the pre-born? A fetus at ten weeks has a definite heartbeat and all its parts, though it's not yet breathing and can't survive independently, outside the uterus. Yet, is it alive? Certainly, it has the potential for life -- but is that dodging the question? And I must admit, as rapidly pass through middle age, that it probably is living human tissue, although not exactly a living human being. That's how I see it. The question then becomes, is destroying living human tissue killing? I've already opined that it's not murder, but is it killing? And after many years of wrestling with this question, I concede that it probably is.
Yet to me, that opinion, in and of itself, does not automatically make it wrong. And those of you who may read this, please, spare me your high-handed concept of the Hippocratic Oath. You see, we, as individuals in a society, have said that certain types of killing are, under come circumstances, permissible: punishment by execution; killing in defense of one's country, or to uphold societal laws; variations on doctor-assisted suicide, etc. In other words, types of killing are allowed in societies where the majority of that society's citizens say it's allowed. To me, the same is true of abortion: yes, it may be a type of killing, but it has been sanctioned time and time again by the will of the majority of our society's citizens.
I love my country and respect its laws. So if the day ever comes that out society completely outlaws abortion, I'll be the first to stop performing the procedure.
Not to split hairs, but I know I'm not a murderer since murder is a legal term invoked by judges and juries, not to be found in any textbook of medicine, and this blog is devoted to medical fact. But, is it killing? Many pro-choice advocates consider an embryo or early fetus to be a lifeless blob of cells. I may have thought that before the advent and widespread use of ultrasound, but these days, beginning at around six weeks, we can see the fetal heartbeat, and later, moving fetal structures. When I wrote my New York Times fictional bestseller, THE UNBORN, I included a quote that "the brain of the human fetus exhibits recordable electrical activity as early as the eighth week." During a book tour in England, this provoked many questions from listeners and viewers about fetuses and life. A century ago, a Supreme Court Justice, when asked about pornography, said, "I know it when I see it." The same thing applies to human life: once a child of any gestational age is born and breathes and has a beating heart, I know it's alive.
But what about the pre-born? A fetus at ten weeks has a definite heartbeat and all its parts, though it's not yet breathing and can't survive independently, outside the uterus. Yet, is it alive? Certainly, it has the potential for life -- but is that dodging the question? And I must admit, as rapidly pass through middle age, that it probably is living human tissue, although not exactly a living human being. That's how I see it. The question then becomes, is destroying living human tissue killing? I've already opined that it's not murder, but is it killing? And after many years of wrestling with this question, I concede that it probably is.
Yet to me, that opinion, in and of itself, does not automatically make it wrong. And those of you who may read this, please, spare me your high-handed concept of the Hippocratic Oath. You see, we, as individuals in a society, have said that certain types of killing are, under come circumstances, permissible: punishment by execution; killing in defense of one's country, or to uphold societal laws; variations on doctor-assisted suicide, etc. In other words, types of killing are allowed in societies where the majority of that society's citizens say it's allowed. To me, the same is true of abortion: yes, it may be a type of killing, but it has been sanctioned time and time again by the will of the majority of our society's citizens.
I love my country and respect its laws. So if the day ever comes that out society completely outlaws abortion, I'll be the first to stop performing the procedure.
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