Saturday, September 25, 2010

Pro Life: A Physician's Perspective

I am thankful that my mother bore me. Having children is as frightening for all women as it is exciting. It's similarly life changing for the father's who take this journey with the women from beginning to end. I have no children. I have cared for hundreds of pregnant mothers, thousands of children and lived with mothers and their children. Today I'm of an age where I am mostly with grandmothers sharing in their fear and elation surrounding the announcement of grandchildren to be.

When I was an intern I thought I should learn how to do an abortion. I was in surgery then and keen to develop 'skills'. I was already doing dilatation and curettage but had not done an abortion. I asked a gynecologist I admired if he would teach me this and he agreed to have me join him one morning when he'd be doing therapeutic abortions.

There is a lot I remember about that day, perhaps a book of writing. An older woman draped and lying on a cold steel table. My senior colleague and I masked and walking in surgical greens and booties. He shows me the suction instrument, demonstrates the process. Then a new patient comes in. I do the same as he. It's the "see one, do one, teach one" days of residency. My world for this day is reduced to what I see in the speculum and what my hands and body do in this process.

When I performed this procedure I felt nauseated. I've done countless surgical procedures by this time, delivered babies, done hysterectomies with colleagues, surgically removed cancer under supervision. I've done as much as one could be expected to do with a supervisor present and am just beginning to do surgical procedures solo. I have a modicum of experience in medicine and surgery. Yet here I experienced pain at the pit of my being. It occurred after I put the suction instrument through the cervical os and heard the horrible sound of that suction machine, to me much worse than a dentist's drill. I do the curettage then ensuring that nothing is left in the uterus to cause subsequent bleeding. Another woman is brought in and I repeat the procedure. Again there is that pain at the centre of my being and the nausea as I start the suction machine and a headache comes on as I scrape the inside of the uterus to ensure that no placenta remains attached to the uterus.

After my mentor and I look at the remains. It's not recognizable as fetal even but he's careful to make sure that all of what should be present is and that the remains look normal. It's strange looking at this bit of blood and placental material by the side of the sink. The sink is a cold thing.

This wise and kind gynecologist looked at me then and in a most un surgical way asked:

"How do you feel?"

"Not good." I said.

"You look green," he said.

"I feel nauseated."

"That's good," he said. "You're a doctor and you took an oath to do no harm. If you felt good doing this you wouldn't be the man I thought you were when I offered to teach you how to do abortions."

He'd only had three women slated for the morning. In the surgeons lounge we got coffee and sat down to talk.

"I'd like to tell you a story. Those women you did abortions on weren't the average run of the mill patients. One had been raped and was pregnant as a result of it whereas the other was pregnant from adultery. Her husband is an executive, they've been married 20 years and have three children. She didn't believe he would handle it as he's had a vasectomy and she had the abortion for the sake of their other children. She wanted to keep the family together. That's the kind of story that goes with the abortions I do today. I don't do many but I have to really think about whether I'm willing to do them and I take time to know the context of the whole story. When you hear about doctors doing abortion it's mostly a factory setting. Doing abortions is one of the simplest and most lucrative procedures a doctor can do. Abortion doctors are among the richest in our profession. The money is what is so attractive."

In medicine and surgery senior doctors rarely talked like this. I hung on his every word, knowing that I was being given a rare priviledge.

"Can you tell me what you felt and thought doing those procedures?" he asked me.

I paused and said, "It wasn't what I thought I'd feel. I thought it would be like doing just another dilatation and curettage. But this time I felt this pain in my gut and I felt nauseated as I started the suction. I guess...." here I was searching for words to describe the experience, " I felt like I was killing was the same experience I felt when I kill a fish with a fish bonger when I'm fishing or the feeling I get when I shoot a partridge. I didn't expect to feel I was taking a life but that's what it felt like and that shocked me. I was surprised. I'm pro abortion and believe in women's rights but I didn't feel like I'd feel like I was killing something. I felt nauseous. I still have a headache." I looked down at my coffee cup feeling I'd blurted out too much, run on about feelings ,talked about things doctors aren't supposed to talk about. My face was probably red at the time. I know I felt shame."

"That's okay," he said. "When abortions were made legal almost all of the Obgyn's started doing them. You won't understand this till later but it was for the money mostly. It was such easy money. Most of the gynecological work we do is terribly demanding and underpaid. Delivering babies is the worst obscenity in economic terms. The amount of time and risk and effort that we put into that is not at all recompensed. It's a charity service imposed on doctors by the state and on top of that we're at greatest risk for being sued when we deliver high risk babies. That's why so many gynecologists have got right out of the obstetrics side of things. Delivering babies is the quickest route to high risk punishment a doctor can take because eventually something goes wrong for even the best of us and there's all hell to pay. But with abortion there's literally no risk in comparison. It was extraordinarily high paid for what it was and took no time at all. If you'd not been with me I'd have gone through those three women in less than half an hour. On a good day I can do dozen or more abortions in a morning and be ready for the golf course in the afternoon. I don't have to do rounds either. Mostly abortions are done in specialized offices too so there's hardly any follow up. Just money money money. Ker ching, ker ching" he laughed, making the sound of a cash machine drawer .

"But by the end of the first year we'd all stopped except a very few. The reason was it didn't feel good. We all felt like you did today. It's presented like you're just taking off a wart but none of us doctors felt that way about taking off warts or cutting out cancer. It literally makes you feel sick like you do. The ones who kept doing it had something wrong with themselves. Something that hardened them to those feelings. Maybe they liked the money more too. I just wanted you to know you're not alone. If you choose to do abortions again that feeling you gets is part of what makes you a good doctor. As gynecologists we've talked about this together. I only do them now when I agree with the cause but I assure you I understand better those that don't do them at all more than those who do them all the time, the so called abortion factory docs. I couldn't do that."

And that was my first and last encounter with abortion. I couldn't do it again after that. I hunt and fish and can justify taking a life there for myself but I just couldn't justify killing myself after that first experience. As a family physician I continued to refer people for abortion. It was like sending a person to the Market for an already killed piece of meat. Alot of people eat meat but couldn't be farmers or go hunting for their own roasts and chicken. I could do the latter but when it came to the abortions all I could do was send people off to the abortion store.

I didn't think of myself as "pro life" then either. I wasn't "anti abortion". I was somewhere in the safe middle, sitting on the fence and generally not caring to hear about either side. I'd once written a national article with a friend on abortion and proposed a middle of the road approach only to be subsequently battered and harassed by radical feminists who said a doctor should just do as women said and shouldn't have to consider their conscience or judge whether an abortion was 'ethical'. They were adament that this was 'solely' the woman's decision. They didn't care that I as the doctor or in fact any doctor was a necessary participant and literally didn't care that I as a man or citizen might have 'thoughts' on the matter.

Their salvation was the 'morning after pill' that put the whole matter into the woman and the pharmacists hands. It's a reflection on the cold business nature of the pharmacist that they're not routinely called forward for stocking or not stocking morning after pills. Doctors take the brunt of abuse while others profit the most from medicine. Frankly I was thankful to be outside of this area not liking at all dealing with the aggressive fanaticism of the pro abortionists. In the news you would see them demanding that 'pro life' folk be denied freedom of speech. In my practice I had one sad sap fellow who had been jailed for carrying a placard outside of an abortion clinic. As a male not doing abortions and only having to write prescriptions I was glad to be out of it. Mostly I'm like everyone else, just trying to make an honest living and just doing medicine is increasingly difficult. The doers in our society get the most abuse while the critics have the greatest gain.

But then I trained and studied to be a psychiatrist, psychopharmacologist and psychotherapist. During these years increasingly I was referred "intractable' 'unresponsive' depressions. All the very best medications had been used. Many times the patients had been given ECT. Still they remained depressed. I would see these people, mostly women, and go through their lives with a fine toothed comb looking for areas of loss and conflicts about loss. I would ask a whole list of loss questions and watch their reactions. Sometimes a patient had not got over the death of a parent and we'd do grief therapy around this and with medications not uncommonly already tried by colleagues before, the patients depression would 'lift' quite miraculously. People who had been bed ridden returned to work and took up active social lives again.

I enjoyed this time of my psychiatric practice given the high success that this in-depth detailed work followed by psychopharmacology and grief therapy brought. What I found though was commonly in women the questions which brought out torrential tears and sob wracked bodies were "Have you ever had a miscarriage or abortion?" It was the therapeutic abortions that they had had which were sitting like pus in their psyches causing these horrendous melancholic depressions. Once they talked about it and we did grief therapy these women would return to work and relationships quite miraculously. In all the cases the women had had no 'pre abortion" preparation. They'd just been put on the lucrative abortion factory line spewed out at the end and were rather ashamed that they didn't have a good feelings about the whole thing and once it was done there was no undoing it. They felt guilt and shame and couldn't even talk about it or when they had tried were dismissed.

At the time all the surgical procedures were being done with 'pre surgical' counselling. It was part of 'preventative medicine' and the literature was clear in showing that people who are most informed about their medical and surgical procedures had the best outcomes. It had been standard practice to show women ultrasounds of their babies and pictures of deliveries just as cardiac surgeons show videos of cardiac surgical procedures to their patients before the actual operations. It was counter intuitive in some ways to think that showing a person the removal of a kidney would help that person have less post operative infection but that was quite simply what was the case.

I consulted to the cosmetic surgeons around then and this practice was even more adamently followed in this area of 'elective' surgery. The patients had the benefits of seeing pictures of the whole procedure and knowing exactly every step of the way what was going on becuase that resulted in the best outcomes.

Yet when I asked patients if they had had an ultrasound or seen an ultrasound before they had the abortion they were told 'no', 'they said it would harm us if we knew what we were doing." This was strangely at variance with what was happening in the rest of medicine. I phoned the local abortion clinic I referred to and asked if this was the case and they frankly said, "Yes, we discourage women considering abortions from having ultrasound because it mostly causes them not to go through with the abortion."

So here was the old "we know best" what is good for you and "if the patient remains in the dark it's best" raising it's ugly head again. How can a person have 'informed' consent even if they are directly advised against being informed.

I'd worked in an early Street Clinic where we referred women for abortion however at the time we provided clear instructions about the alternatives, advising women that they could have the baby, give the baby up for adoption, have financial and educational support throughout the pregnancy, keep the baby if they chose and have financial support or whatever or alternatively have an abortion. In these latter days I'd ask the women who had an abortion if they'd been apprised of their alternatives, or if any discussion had followed into the pros and cons and repeatedly was told that no, "I told the doctor I thought I should have an abortion and before I knew it I'd had an abortion." None of the women were told of the alternatives. So here was a swing from the days when a women wasn't told about abortion to the exact opposite fanatical side where the woman wasn't told about the countless men and women who were paying tens to a hundred thousand dollars for 'surrogates' and 'adoptions'.

Meanwhile the same people who argued that a women's body was her own were denying her the right to having a child and given the child up for adoption and being paid to go through the pregnancy. The whole arena had become a snake nest of profit motivation and out worn ideologies and slogans that were really harming the very women who were supposedly the beneficiaries of these same ideologies.

I was at a meeting once where the fetus of street women had been kept without consent by the abortionists and they were actually asking for the right to sell this material for 'stem cell research' , the new billion dollar area. I said that it was a great idea but believed that the consent of the East side women,the street prostitutes and such should be in place first and that these very same women or their representatives should be paid for the fetal material. Well, talk about daggers! The women wanting to profit from the receipt of this material supposedly only for 'research' in an age where researchers are routinely patenting university and government associated research for their own personal profit were royally incensed that I should speak on behalf of the women who had had abortions and now not only suffered that inequity were going to have the 'profit' from the abortus taken by others. It seemed further victimization of women but I was most haughtily condemned and later villified.

That probably was the day I became 'pro life'. I wish I could be as passionately 'pro life' as my colleague Dr. Phillip Ney. I lack his back bone. I've watched him year after year stand up for life and fight the pro abortion camp only to be harrassed, threatened and demeaned. I've treated so many people who have taken a pro life stance and they have experienced all manner of abuse and harrassment that simply never appears in the media. The pro abortion idealogues dominate this field and the pro life contingent are really the side show. Yet the fact is that they are the ones most hassled, attacked and condemned. All the pro life doctors I know have had their licenses to practice medicine threatened and have been subjected time and again to radical and sometimes bizarre political investigation.

I'm thankful for birth control and am sorry when people don't use it and an "unplanned pregancy' occurrs. If the truth be known most of the greatest of world leaders, artists, doctors and lawyers and judges and hooligans were 'unplanned'. "Planned pregnancy is a concept that's merely decades old at most." And there is no evidence that says a child does better if 'planned' or 'unplanned'. Certainly a child born does better than a child aborted and perhaps there is value in the legal profession arguing in favour of the 'child' getting legal representation.

Abortting America, by Dr. Bernard Nathanson was a particularly significant book for me. I'd followed his arguments when I was younger and he was a major proponent of abortion. When I read his book not long ago but long after it was published and saw the change of heart that had come with experience I felt great kinship with this remarkable doctor because I'd seen my own heart change with experience.

I'd seen that when we first were in favour of abortion women were having back alley abortions and I felt good that I was apart of the mainstream that thought this horrible and took action to stop it. Today though I see that women who want to have babies can't afford to. I see that women don't 'own' their bodies and that others are even profitting from the fetus of abortion. I see the obstetricians still underpaid compared to the rich abortionists. I see the pro life people threatened and abused while the pro abortionist claim 'victimship' when mostly they actively victimize.

In my practice I see women who have no apparent harm from abortion and have adjusted well to the experience thanks to the fine counselling they received from family physicians before the abortions. These women are doing well so there clearly are those for whom abortion has no apparent negative experience. Some would say they are 'harder' and that there is a definite change in their attitude to the sanctity of life and this has strong ideological basis. I've just not seen it possibly because the instruments of assessment I use don't pick this up. In contrast the women I've seen who have been harmed by their abortions are being further harmed because they are 'politically incorrect'. They are alienated and marginalized from their fellows when they express this opinion. In contrast to other areas of medicine abortion doesn't seem to be held to the same standards in regards to complaints and patients who have had abortions and felt wronged in the process have not been compensated as other are. The abortionists continue to have far 'safer' practices than those who deliver babies creating an unfair playing ground where death is more richly rewarded than life.

I'm pro life today. Not a very good pro life person, wishy washy and middle of the road, and rather liberal in my conservative old age. But I can't personally bring myself to do an abortion unless perhaps to save the life of a mother. I still will refer a patient to an abortion doctor. In contrast to the abortion doctor I tell patients wanting to have an abortion to get an ultrasound first. I don't think the fish I kill is without life. I don't have nightmares about fishing. I've treated patients who have had years of nightmares about abortions just as I've treated patients who were ill prepared for other surgeries and had nightmares after that. I had nightmares after doing those two abortions too.

I believe patients should have access to all the information about themselves and their conditions , including ultrasounds, so that they can truly make informed decisions and provide informed consent. I think women in this country who are pregnant and don't want to have an abortion or keep the baby should have the fullest financial support allowed them so that the countless women wanting to raise children but unable to do so themselves can reward women willing to go through pregnancy and have deliveries on their behalf. I further believe that the abortus is the property of the women that had the abortion and that they should be apart of any decision as to what happens to that material.

I know in writing these views I will be punished as my colleagues have been punished for sharing any such views which may be construed in any way as 'politically incorrect'. Say that a woman should have choice and should be informed and should control what happens to her body and should be rewarded for pregnancy and delivery is politically in correct. Now isn't that ironic?

- Posted using BlogPress from my iPad


Mary said...

It's been almost a month since you posted your on your blog about abortion...I came back to check out "all" the comments I was sure would be here about this outstanding piece and am shocked to find NONE!

I reposted it on my blog and had the most hits of any piece I had posted...

It was great on so many levels and want to thank you for sharing those important points...I will continue to publish it from time to time...

Thanks again,

haykind said...

Thank you! I was personally castigated by some but kindly supported by others, Given the vehement rage I encountered at sharing my personal experience I was eerily reminded that I was not part of the 1984 Group Think.