“It is the swimmer who first leaps into the frozen stream who is cut sharpest by the ice; those who follow him find it broken, and the last find it gone. It is the men or women who first tread down the path which the bulk of humanity will ultimately follow, who must find themselves at last in solitudes where the silence is deadly.”
—OLIVE SCHREINER, WOMAN AND LABOR, 1911
Before the legalization of abortion, before the battles, before the word became flesh and translated into thousands and thousands of women lining up for services, abortion had a particular place in hell. The word was whispered, a shared secret knowledge among women, a lurking, beckoning danger approached through necessity. The act was relegated to “back alleys,” performed by hacks posing as doctors, well-meaning friends or relatives, and often by women themselves, alone in their bedrooms with their hangers or knitting needles. A small number of fortunate women had access to one of the few “doctors of conscience” and escaped the ordeal unscathed.2 Whether the procedure ended successfully or in tragedy, illegal abortion was kept in the shadows.
Until it wasn’t. In the early seventies what was once only whispered about was now cocktail party conversation, a political discussion point, and the subject of constant media attention.3
Radical feminists like the Redstockings helped thrust it into the public eye by holding a speak-out on abortion in New York City. For the first time, women defied law and custom to publicly share stories about their criminal abortions. Some even spoke with paper bags over their heads. “We are the ones that have had the abortions.... This is why we’re here tonight.... We are the only experts,” said a women testifying in 1969.
New organizations, alliances, and coalitions seemed to be forming almost daily to fight for and against it. Soon the issue morphed into a political football, a birth control problem, a population control necessity. Abortion inspired a made-for-television movie, pro-choice art exhibits, concerts, T-shirts, and poetry readings.
Before abortion became legal on a national scale, clinics were the outposts of feminist politics, their workers grassroots missionaries who believed that the decision to have an abortion was a question of moral agency, an assertion that the power of the state must stop at one’s skin. Several underground feminist abortion providers opened for business with the goal of catapulting their theories into action by offering clean, safe, affordable abortions. Clinics such as the famous Jane Collective and the Feminist Women’s Health Center in Los Angeles were run and owned by groups of women activated by the knowledge that illegal abortion providers left women (especially poor women) vulnerable to death and butchery.
Feminism was in the air, and I finally noticed it on the periphery of my consciousness. It was in great part thanks to the ideals and dedication of these feminist activists that abortion was legalized and Flushing Women’s was able to open in the first place. But our clinic was not founded on feminist theory or activism. In fact, I started my work in the world of abortion from a very non-theoretical place.
MARTY WAS PROMOTED to medical director of the small HIP group in Queens with whom Flushing Women’s would share offices, so the responsibility of running the new abortion clinic fell to me almost immediately. The fact that I had almost no idea what I was doing didn’t stop me from diving in headfirst to embrace the challenge. I organized the appointments, created the charts, designed the logo and stationery, and hired the staff.
I remember the first patient I counseled. She had come to us from New Jersey because abortion was still illegal in that state. She came without her husband, but she had a supportive friend whose face betrayed a well of empathetic anxiety.
I was nervous. In this, as in all of my other tasks at the clinic, no one had trained me. What could I say to her? What would she say to me? All my psychology courses flooded into my brain . . . theories, theories, and more theories.
This woman was terrified. She was pregnant and did not want to be. Coming here had required an enormous amount of courage, and now she was in my hands. I was to guide her way. I was to be her bridge, her midwife into the realms of power and responsibility that are so much a part of the abortion decision.
I held her hand tightly in mine as I listened to her nervous staccato breath. I kept her talking to help ease the discomfort of the dilators. I locked her eyes on mine, breathed in rhythm with her, joined with her to the point of personal discomfort. In the end, I do not remember a word of what passed between us. It was strangely irrelevant. But I do remember her face. And I remember her hand, the hand that came to symbolize the intimate, personal connection of one woman helping another, the gravity of forging a natural alliance with that woman and the thousands who followed her.
That understanding was to come to me later—much later. That day there was only that woman, her fear, need, pain, strength, vulnerability, and hand. Every day brought new connections, new discoveries. We held sessions on Tuesdays, Fridays, and Saturday mornings. I always arrived at the clinic early to start setting up the session before the patients arrived. While my classmates spent their Friday nights on dates or at the movies, mine were spent waiting until the last patient had left the recovery room before going home, sometimes as late as eleven at night, and rising again at six o’clock on Saturday mornings to get to the clinic in time for our weekend session.
I knew from my first week on the job that occupying the same space as the HIP doctors was going to be a challenge: they didn’t want to share. Flushing Women’s had staked out a territorial claim to the HIP group and I immediately had to defend it. The allergist who used the exam rooms during the day seemed to drag out his sessions as long as possible so that our patients had to wait until 7 p.m. for procedures that were supposed to begin at 5 or 6 p.m. Another physician stormed in during an abortion procedure and disdainfully threw the patient’s clothes on the floor, ordering us to “get these damned abortion patients out of here.” These shocking attempts to make us feel unwelcome ushered me into the world of medical politics, where, I would learn, abortion providers were always shoved to the lowest rung of the ladder. I found ways to create small pockets of care and safety in an inhospitable environment.
After a few months, the New York City Department of Health, which had jurisdiction over all abortion providers in the city, sent in surveyors to review our facilities and practices. Our clinic was relatively small—we were only seeing five or six patients per week at that point, and charging seventy-seven dollars per procedure—but with so many patients traveling from out of state to have abortions, New York took extra care to inspect every single facility. Flushing Women’s was sterile and safe, but the inspectors took note of our meager six hundred square feet of negotiated space. I watched their faces tighten when they noticed the cots in the hallways.
Never having experienced anyone questioning his medical or operational judgment, Marty found their presence to be an intrusion and a violation of his privacy rights as a physician. He was arrogant. He hadn’t yet realized that his doctor-as-god armor was penetrated the moment he took on abortion.
We could have listened to the critiques of the Department of Health respectfully and asked for time to work it out, but the inspection quickly deteriorated into a power struggle between Marty and the surveyors. A week after their visit, we received a long list of deficiencies. We were informed that our clinic would be closed down until they were corrected. Marty was furious. “Who the hell are these civil servants to tell me what to do?” he ranted. He felt that the report was unfair, and that keeping the clinic open might not be worth the hassle.
Not having a doctor’s ego to defend, I wholly disagreed. Close Flushing Women’s down? We’d just gotten started! Here was the first real challenge to the survival of this nascent project that I was beginning to call my own. I was already too invested to give up so quickly. The Department of Health’s survey was simply a report card we had failed. I was a good student; I was determined to get an A.
I read the Department of Health’s report until I had it memorized, then made an appointment with Dr. Jean Pakter, the head of the Department of Health, to discuss solutions. I wanted to understand exactly how I was expected to correct the deficiencies. She was responsive to my earnest questions and obvious determination to fully meet the requirements.
During the four months that Flushing Women’s was closed, Marty was again promoted to the position of medical director of a larger HIP group on Kissena Boulevard—one whose physical space, I pointed out to him, answered the environmental deficiencies in the Department of Health report. Marty would be too busy with his new responsibilities to devote much time to Flushing Women’s, but I convinced him that under my direction the clinic could rent basement space at this new medical group and work on getting appropriate staffing, beds, and medical equipment to address our programmatic weaknesses. Most importantly, we could reopen.
After moving to Kissena Boulevard and working out a plan of correction, we were once again inspected by the Department of Health. This time, we passed.
I WAS STILL going to school and taking classes between clinic days. I had graduated from Queens College Phi Beta Kappa and entered a graduate program in social psychology at the City University of New York Graduate Center. In college I had been distanced from my peers by my age and personality; in graduate school I was distanced from the other students due to the fact that my time outside of school was spent operating an abortion clinic. It didn’t bother me, though. I wasn’t in school to make friends.
I encountered a hurdle early on in the program: I failed a statistics class. I went to the chair of the department requesting permission to retake it later in the curriculum, but he refused to give me any leeway. Not having any real option of another PhD program, and thinking that I was destined to fail, I decided to resign from the doctoral program. With a great deal of sadness and anxiety I carried my resignation letter with me to give to the chair of the department. When I got off the elevator on the eighth floor, Dr. Stanley Milgram, the star professor of the PhD social psychology program, was there waiting in the director’s office. Somehow he had gotten word that I was coming to see the director with my resignation, and even though he was not a professor of any of my classes, he decided to get involved. Sitting conspiratorially opposite me, he shared that he had also had difficulties with institutions, having been initially rejected from Harvard’s doctoral program. Then he leaned forward and whispered, “I have a secret to tell you: I also failed statistics.” As I laughed in amazement at his revelation he went on to say, “All the really creative people have trouble with math.” After we spoke, I tore up my resignation and decided to go to summer school to finally master statistics.
I viewed Flushing Women’s as an extremely interesting project, a world I was creating with Marty, but I did not see it as a life’s work. It was not a profession, it was not a skill, it had no name or institutional reality, no well-worn steps of ambition. I’d always imagined a life of music, psychology, philosophy, disciplines with thousands of years of history and structure. And here I was in an untraveled medical landscape that had only just come into being.
Yet even after Milgram’s encouragement to persevere, the theories and critical texts with which I was engaged at school were failing to hold my interest. I completed the course work for my doctorate in psychology, but I lost momentum before writing my dissertation.
I applied to a few law schools and was accepted by Ford-ham and Adelphi. Law would be straightforward, lucrative, and impressive. I went to my uncle Louie, a lawyer, for advice. He laughed in my face, telling me that a woman could never amount to anything in the law and how he would love to have his son, also an attorney, “wipe the floor with me” in a courtroom. Of course I knew he was wrong—if I wanted to, I could be an excellent attorney—but the conversation left me disgusted. I tried to picture myself as a lawyer, but the truth was, the advocates and attorneys I met in my reading were usually tools of the state attempting to bring down my heroines. They were always on the wrong side.
As part of my psychology studies I had done an internship at the Creedmoor State Mental Institution. I’d seen a little boy banging his head against the wall, another playing with feces. A staff member pointed to a child and told me she had never spoken a word. All I could do was observe them, my power confined to the limited interactions I could have with the children as a student.
I contrasted that to my role at Flushing Women’s, where I would stay with each patient through her abortion, taking the rings off my hands and putting them in my lab coat pocket to avoid the pressure of their desperate, clutching fingers. I would see the patients again when they came back for their follow-up exams. I knew most of them by name.
A fifteen-year-old patient I had recently counseled had been terrified of telling her mother she was pregnant. I’d spent almost two hours with the mother trying to help her connect to her daughter, to break through her anger, until finally she began to cry in front of me, saying, “I had her when I was fourteen. I just don’t want her to go through what I went through.”
When it came time to pay the tuition for my first semester of law school, I realized I could not leave the clinic, not for law. Not, I knew, for anything. Flushing Women’s had become a living organism, almost a part of me. Leaving now would be tantamount to abandonment.
AFTER THAT, I stepped into my self-appointed role as executive director of Flushing Women’s without looking back. I signed up for night classes to learn business, management, and finance skills. I learned about gynecology and abortion, set nursing schedules, met with city and state representatives, and argued with the doctors at the HIP group who harassed me with their anti-abortion sentiments.
I was in charge of a staff that included a full-time front desk receptionist, two counselors, two doctors who worked on a case-by-case basis, and three part-time registered nurses and licensed practical nurses. To many of the employees, I was the symbol of a radically changed world. I was young, I was a woman, and I had no medical training. The idea of a person like me running a clinic turned their concept of the medical world on its head.
By the age of twenty-six I was hiring and firing physicians. Much to their chagrin I “auditioned” my doctors, staying in the operating room while they performed abortions so I could assess their interactional skills with the patients. The doctors cared about their patients’ well-being, but they resented my position of power. They were comfortable with women as nurses, handmaids in the surgical suite, but the very idea of a young woman telling doctors how to handle patients, influencing their financial lives and time, was anathema. They could not get used to being under my jurisdiction, and when there were conflicts they would appeal to Marty. As a fellow member of that elite male club, he was able to smooth their ruffled feathers. He never allowed them to undermine me, though. He made sure they knew that my administrative directions were to be followed.
The nurses and counselors posed a different kind of challenge to my authority. There was no room for me to have my own office, so I set up an executive director’s desk amid the nurses’ station and recovery cots. I knew I wouldn’t be able to run the clinic efficiently unless my staff took me seriously, and since I had no physical area I could use to enforce professional boundaries, I had to firmly demonstrate that even though I was young and inexperienced, I was in charge. But some of them made it clear that they resented my position in the medical hierarchy, their lack of respect palpable with every interaction. They weren’t going to accept my authority so easily.
I’d wanted power, and now I had it, but I had no idea how to wield it effectively. I found that the very notion of women having power was difficult for many of my female staff to digest. Many had adopted the popular belief that power in and of itself was oppressive and destructive, regardless of who had it. Others thought women in positions of authority should use their power differently from men. When I conducted interviews for new employees, I asked each candidate how she felt about the concept of power. Extraordinarily, each and every one of the applicants, even those for supervisory positions, said almost the same thing: “I don’t want to have power over others, I want to empower others.” I would run up against this particular female hesitation about power for years to come.
A few of my staff, wanting to employ the egalitarian concepts of the times, told me they felt that the clinic’s atmosphere was too traditionally medical, and that the white coats might be off-putting to patients. We were all equal, so why did medical personnel have to differentiate themselves by their dress? I decided to conduct a pilot study on the issue to put their ideas to the test. I made up a questionnaire that I gave to patients asking about their attitudes on medical uniforms. The results were significantly skewed toward a preference for professional dress in white coats. Patients needed to feel safe, and the traditional white coats helped them to do so. In a world where most women were afraid that having an abortion could kill them, many had never been to a gynecologist, and there were no sexual education classes to teach people how their bodies worked, power—the power that came with knowledge, expertise, and experience—was something to embrace, not reject.
Still, my employees expected me to embody all the alternative superior qualities that women with power would ideally have: sensitivity, openness, and leniency. Wanting to be liked, I decided to try to meet their expectations. Perhaps that would earn me their respect.
I took them to dinner, listened when they confided in me about their personal relationships, helped them to analyze their dreams, and offered sympathy when they spoke of their stress levels. If people needed extra time, they got it. If someone was late, I often overlooked it. Every decision was individually negotiated. Never feeling quite satisfied, my employees began expecting more and more from me on a personal level. I felt guilty when I could not grant a specific request, and this general empathizing led to my feeling more and more responsible for their happiness.
Worse, this method of apologetic supervision put a damper on my ability to make across-the-board management decisions. When I had to give unpopular directives, I was met with passive-aggressive attempts to undermine my position of power. I would walk through the hallways and hear whispers in my wake. One day at lunch, I found a dirty speculum in my soup. I’d gotten caught up in the tension between wanting to be liked and needing to be respected, and the situation was beginning to snowball out of my control.
The HIP group with whom Flushing Women’s shared space was unionized by 1199, an extremely powerful institution whose representatives sat on the board of HIP. Mingling with the HIP employees, my staff decided they wanted to unionize, too. My office manager, a middle-aged woman who had particular difficulty with my authority, contacted 1199 as a self-appointed leader of eight people, and I soon received official notification that Flushing Women’s was in the process of being unionized. Within days of the announcement, a union meeting was held at the clinic in the room where both the patients’ beds and my desk were located.
With that, my attitude toward my employees changed. I experienced their alliance with the union leaders as a direct invasion of hostile forces. Who were these people interfering with my staff? Why was I now being censored in my interactions? How dare they interfere with the way I ran my clinic? I felt a diminution in my power, and it frustrated and enraged me. Since I was not allowed to attend the meeting, I stood outside of the room like a kid at her parents’ bedroom door and listened to the rhetoric. The leader used fiery, fighting words:
“If she does not want to give you these benefits, then we will close this place down! If you don’t like what she is doing, we will take care of it!”
It sounded like a street rally against an oppressive ruler. Regardless of my emotional reaction, it soon became clear that there was only one thing I could do to survive this challenge: submit to the process.
The union was voted in, and I was now in a position to negotiate an employment contract with union representatives. I came face to face with the philosophy of unionization and the way it was practiced at 1199. They used a boilerplate contract developed to suit a large insurance company with thousands of employees instead of one designed for a small business like ours. When Ed Bragg, the representative from 1199, advised me to terminate someone so that he could drive the salaries of others higher, I realized that the union’s philosophies did not necessarily translate into better conditions for the workers. Merit? There was no real way to address it, because all raises were built into the contract language. But this was what my staff wanted, and we all had to bear the consequences.
The workplace atmosphere became stilted and tense. These people were no longer my coworkers, but my adversaries. We had to function as a team together to deliver an extremely sensitive service to patients, yet we had no camaraderie. And because I was aware that I could be charged with union busting if I so much as discussed the unionization issues with my staff, I was relegated to dealing with them through the intermediary of a union delegate.
I developed a new strategy: I worked by the book. There were no more decisions to make concerning staff’s sick days and personal days and emotional troubles; almost every potential situation was spelled out by contract. No longer could someone appeal to my sensitivity or “feminism,” a word employees used as a tool against me when they didn’t agree with my final decisions. Staff began to feel that I was too autocratic, that I should be more collaborative. But the union contract had spelled out every part of the manager/ employee relationship, and there was little for me to do but follow these directives. Gradually, the employees found that dealing with the union and the details of the contract was impeding their ability to work with me on a personal level in our intimate setting, and that our former situation had been far more advantageous. After about a year, quietly and without my knowledge, the union was voted out.
After that experience I took on a new management style that suited me, one that combined some of my feminist attitudes with the lessons I had learned from the unionization of my employees. I thought of it as a collective autocracy. I listened to everyone’s opinions with respect and interest and promoted a good deal of feedback, but I stopped treating my staff as my surrogate family. I kept myself separate. The decision-making role was ultimately mine, because the results of those decisions fell—and still fall—most heavily on my shoulders.
I HAD ANOTHER IDENTITY besides executive director: I was the mistress of a married man, a role I had never intended to play, though I did relish it. Marty and I had successfully created the world he wanted to have together, a world that his family never entered. At Flushing Women’s his wife and son receded to hazy impressions in my mind, and it was easy to push aside the fact that his evenings and weekends were spent attending to a home life to which I had no access. My own evenings and weekends were saturated with the anticipation of seeing him at the clinic, which in itself was an enormous pleasure. Our meetings outside the clinic were hidden, riddled with obstacles that heightened the intensity of each stolen moment. I would pray for red lights to lengthen our time together when he drove me home from the office.
At times I felt I was in the Bette Davis film Now, Voyager: “Don’t let’s ask for the moon! We have the stars!” I was satisfied with the stars—content, even pleased, with our situation for the time being, even if I could not have all of him.
My mother slowly began to suspect that something was going on between Marty and me—all those late evenings and lunches on Saturdays—but she never asked me about it directly. One day I finally spoke frankly about my affair. The first thing that she said was, “You know, he will never leave his wife for you.”
I answered with earnest disdain, “Oh mother, I don’t want him to!”
Being a married woman had never entered into my fantasies; the passion and transgression of being a mistress seemed so much more alluring. After all, I was the one for whom he was risking his marriage. I was the one he wanted, the one he loved. Obstacles were the fuel to our fire, and his marriage was the constant and immobile obstacle, his wife a psychological paper cutout for me. I was too much in love, too self-involved to have empathy for someone I considered to be powerful, someone denying me happiness. It would be many years before I would come to understand the pain I had a share in causing her.
Like any new lovers, Marty and I did rather reckless things in the grip of our passion. Once, we took a few compromising Polaroid photos of me in the office. The cast-offs were stupidly left in a garbage pail and picked up by another employee, an older married woman who worked the morning sessions and had her own designs on Marty. I received a telephone call telling me that she had the pictures and would send them to his wife; she only wanted to ensure that she would get a raise and have job security.
Marty knew the Brooklyn district attorney, Eugene Gold. He contacted him for help and was advised that I should tape all my conversations with the woman as potential evidence.
As I sat in my studio apartment for hours transcribing these unpleasant discussions, I felt sick with fear that this woman would be able to use her situational power to destroy my authority over the clinic and to separate me from Marty. The issue of shame and scandal was different then. Having a child out of wedlock or an affair with a married man could affect the rest of one’s life—it was not an audition for a reality show.
One day I walked into the small waiting room we used for our patients and found her sitting there with a manila envelope on her lap. She had come to intimidate me, and to let me know that time was running out before she would do something with those photos. Our eyes met, and I felt terrified. I thought my entire life would be over. Our relationship would be unmasked, Marty would have to leave me, and I had no idea what his wife would do to us.
Playing for time, I told her I would have to get back to her. I was waiting for the New York district attorney to review my transcripts and advise me on our legal course of action. After the evidence was reviewed, it was determined that although the employee was in fact blackmailing me, the tapes could not be used in any legal fashion.
Marty fired her and warned her not to dare approach us again or she would be criminally liable. She left us alone.
Shaken but immensely relieved that the episode had finally ended, I resolved never to give an employee or coworker the chance to take me down like that again. I would have to learn to watch my back.
This was my first direct involvement with the law and its exquisite nuances. Dealing with lawsuits would come to be almost a second career for me; at times it felt like I was practicing law without a license—and thanks to Marty’s connection with Eugene Gold, it was also the first time I got to see the inner workings behind the presentation of political power, the personal strings that could be pulled to achieve a certain outcome.
THESE POWER STRUGGLES and political lessons were important for my coming-of-age as a leader. Without them I would not have been able to build and maintain a successful organization. But simultaneously, almost in spite of myself, I was undergoing a sort of awakening I’d never imagined possible. My entrance into a field that I was also creating was giving me more than a chance to exercise my ambitions. As the volume of patients steadily grew, my political strife with my employees was tempered by a growing awareness that the power and meaning of Flushing Women’s extended far beyond my own life and dreams.
Legal abortion had split the world open to the realities of women’s lives, laid bare in my counseling rooms. My patients had anxiety levels that matched their relief and dread. They were here, they had made the choice, but there was an accompanying fear of punishment and death. “Can I really do this thing and go on with my life?” they would ask. “I won’t be punished—I won’t be butchered—I won’t die?”
It was that face-to-face connection that so drew me in. After a childhood spent largely alone, my heart was expanding to embrace others. I saw that the politics, the power struggles, the hiring and firing, the hours of work that went into the clinic, were all in the service of these women, my patients. Power, my power, could be channeled to facilitate this good. I was meant to do this. And my life collided and fused with the massive force of the history behind these issues.
There were poor women of every race, many of whom had numerous children. There were patients as young as eleven years old and as old as forty-five, patients who so much wanted to keep the pregnancy but could not, Russian immigrant women with a history of multiple abortions, college students, and middle-class married women who never told their husbands. They all needed my help.
The general ignorance regarding women’s bodies, health, and sexuality was astounding. Many patients had never had a gynecological exam. Our Bodies, Ourselves—the influential women’s health book published by the pioneering feminists at the Boston Women’s Health Collective—had not yet been published. The working- and middle-class women I worked with often believed old wives’ tales about how one could become pregnant. “Can I get pregnant again after this abortion?” they would ask. “Will I still have sexual feelings?” I kept a plastic model of a uterus on my desk, and I would use real medical instruments to show them how an abortion was done. I wanted women to know what was happening, to gain control over their reproduction. As the months and years flew by, my eyes were opened to how deeply difficult a task this was for my gender.
One morning the Medical Control Board of HIP, led by Dr. Alan Guttmacher (known as the father of Planned Parenthood), made an official visit to Flushing Women’s. His mission was to review our protocols and report back to the board on whether HIP should continue to refer patients to our clinic. Marty and I had decided to have the clinic licensed, and the Medical Control Board wanted this stamp of approval. Becoming a licensed facility meant that we were regulated and inspected by both the City and State of New York, and there were pages and pages of requirements ranging from exactly how many square feet a hallway could be to how many nurses had to be in the recovery rooms.
Dr. Guttmacher was as impressive as his résumé, and I was nervous about how the day would go. But as we conversed, he said something that so shocked me I forgot my performance anxiety. After observing a couple of abortions he asked me whether or not we inserted IUDs immediately after the abortion. Thinking his question strange, I told him we did not. It was necessary to wait a couple of weeks to monitor the bleeding from the abortion itself, and to give the woman an opportunity to think about the kind of birth control she wanted to use. Immediately inserting a device that could have its own side effects and that would potentially exacerbate the side effects of the abortion was not good care, so I preferred to wait until the follow-up visit. To this, Guttmacher replied, “You already have them on the table. Why not just insert them? I would do that with all my patients.”
During counseling sessions, I got the patients’ side of the story. They told me of doctors who purposely enacted procedural delays so by the time they got to the clinic, they were beyond twelve weeks pregnant and could not have an abortion. There were women whose doctors told them it was unnecessary to refit their diaphragms after their last childbirth. I heard of doctors who refused to allow sterilization procedures on any woman unless she was at least twenty-seven years old with two children, doctors who refused to insert the IUD when patients asked for them, doctors who didn’t tell their patients that a backup method of birth control is necessary during the first two weeks a woman is on the Pill. Women came to me with pills that were too strong or too weak, diaphragms not properly sized because they were told it was unnecessary, IUDs that had been inserted incorrectly. They came with shame, anxiety, and tangles of questions someone should have answered for them long ago. “Should I go off the Pill and use foam?” they would ask. Or, “I didn’t have an orgasm, how can I be pregnant?” The trail of pregnancies caused by doctors’ misinformation, ignorance, or carelessness was endless. I began to call this phenomenon iatrogenic pregnancy.
I knew that many doctors had a deep commitment to women and their reproductive health. They had seen firsthand the results of illegal abortion. Most knew that whether abortion was legal or not, women would move heaven and earth to have one if needed, and often lose their lives in the process. Some had a political commitment to the issue and felt that abortion should be an integral part of women’s health care. Others saw it as a good way to earn extra money. The stigma that has come to haunt abortion providers had not yet fully materialized, so there was little deadly social drawback to offering abortions as part of their practice. Whatever their reason for getting involved, most doctors who did this work saw abortion services as an integral part of women’s reproductive lives.
But sometimes it was the most committed of the physicians who were the most misogynistic—though they never saw it that way themselves. They were just doing what they had been taught, and at that time being a male doctor meant being in charge, in control of the interaction and the procedure. Doctors were members of a brotherhood; their authority, power, and good intentions were never questioned by anyone, including themselves. I began to grasp that many of the good-hearted male doctors supporting the clinic didn’t see abortion in the context of a woman’s right to control her reproduction, and thus her life. It was more of a way for them to control women’s messy, complicated bodies.
Often, the problem started early. Most women were examined by a man before they had intercourse with a man. Even in that time of liberation, women held too much of the shame and fear that the previous generation had felt with regard to their bodies, especially their reproductive systems. Being a woman meant you were immediately pathologized, that control over your body was not in your hands. Menstruation, sex, pregnancy, abortion—everything had to be explained by doctors.
With her doctor, a woman had her first vaginal examination, chose a contraceptive device, was guided in her decision about whether to bear children, how to bear them, how to raise and feed them. Women were completely dependent upon the doctor’s knowledge and in a sense forced into a position of trust. All this resulted in women remaining powerless and having things done to them rather than with them.
And yet, abortion clinics were poised to be platforms for change. This new field of medicine provided the opportunity for a restructuring of power dynamics and a woman-centered approach to medical care. In the early 1970s, many minority and special interest groups were exploring their own histories and asserting their rights. Acknowledging patients as a class with rights and responsibilities seemed to me an appropriate analytical and political vehicle for combating the victimization of female patients by a generally male medical establishment. The most radical aspect of abortion—then legal in just a few states, but soon to be legal nationwide—was the potential for women to turn this situation on its head.
Clinics like Eastern Women’s Center and CRASH, the two largest for-profit New York facilities, caught onto this trend and put “chicks up front” to give the impression that their clinics were women-run even though they were actually owned and controlled by male doctors. But at Flushing Women’s I implemented policies that would truly put the patients’ interests first.
To start, I made sure patients were never left alone with the doctor. A counselor or I stayed with the women throughout the entire procedure, fielding their questions and making them comfortable. I was especially good with hostile patients who would answer a question with, “It’s none of your business,” or “Who the hell are you to tell me”—the ones who had an innate distrust of authority.
Thinking that casual humor helped relax patients, some doctors would make blatantly sexist remarks. “Come on, you knew how to spread your legs before you got here, you can spread them for the exam,” a doctor once chided. Another commanded a patient to keep still, saying, “Keep your backside on the table—you should know pretty well how to do that by now.”
These types of remarks, betrayals of the trust that I had established with the patients, infuriated me. My clinic was supposed be safe from misogyny, not another place where women were attacked at their most vulnerable. When problems occurred, I would speak privately with the doctor involved. If I witnessed an instance of disrespect, I worked to neutralize it.
I realized that restricting the roles of doctors was the realistic way to facilitate productive ties between the established male medical hierarchies and my patient-centered philosophy. Rather than expecting them to consistently provide emotional support for the patients in these intense, anxious situations, I put counselors in charge of educating and psychologically supporting the patients. The doctors had only to perform the procedure, and the support staff took care of the other equally important needs of the patients.
The necessity of these counseling sessions, these safe spaces for patients, was instantly obvious. Women didn’t know how to process what was happening to them, how to organize the confusing thoughts they faced. Because this was the first time many of them had been in a room with someone who was totally focused on them, they spilled out so much of themselves: their relationships with their parents, distress over their boyfriends, fears about the future. We helped them articulate to a stranger, something that they had never verbalized—why they did not want to be pregnant. To us, they admitted that they did not want to be mothers; that they wanted, needed, to have an abortion.
Some of my counselors felt it was necessary for an abortion counselor to have had an abortion to be able to relate to patients. In the early seventies, many feminist centers were practicing a form of peer counseling called consciousness-raising; women would meet in small groups to “rap” about their experiences under the assumption that the leader or facilitator of the group should be someone who had experience with the particular demon at hand. Women had previously been isolated from each other, and much importance was placed on being able to relate to one another as individuals who had experienced the same problems. This rationale was also operative in gender differentiation among physicians: some people requested women doctors, thinking that only females could relate to their problems.
There is of course some truth to gender generalizations; after all, a man will never know what it is to put his legs in gynecological stirrups. But to my mind this thinking is too limiting. Doing an abortion is a technical procedure. There is no difference between male and female physicians’ ability to dilate a cervix or perform an extraction. In the seventies women had become physicians in a very male-dominated field, and their behavior and attitude could be just as negative as that of men. The power lay in making sure that patients were treated by compassionate people, no matter who performed the actual procedure.
Counselors had the ability to shape each patient’s trust, which could be made or broken by the right words or the wrong information—a huge responsibility. In those early days there were no codified narratives, no context to help women process their feelings about having an abortion. It was up to the counselors and me to define new models. I developed a counseling manual to train and teach others as I learned more about what worked. We explained the abortion procedure, answered the patients’ questions about sex, pregnancy, and side effects, discussed other options besides abortion, and taught patients about birth control, centering on the three main options available to women at that time: the Pill, diaphragms, and IUDs. I eventually wrote a pamphlet to distribute at each counseling session. It introduced patients to the importance of what I called ESP—effectiveness, safety, and personality—in determining which method to use.
I knew that patients in any doctor’s office were usually too intimidated to ask the questions we answered in the counseling rooms. Women were rightly afraid of upsetting or angering their physicians, these men who had life-and-death power over them—a power they would not voluntarily surrender. As Frederick Douglass said, “Power concedes nothing without a demand”; it had to be taken back by the patients. Because I knew how very difficult this could be, I suggested they bring a friend who could be there as a witness, or a tape recorder so that nothing the doctor said would be lost on the patient in her flood of anxiety. I wanted to reduce the amount of iatrogenic pregnancies, to rescue these women from the ignorance and prejudice of their doctors, but I could not be with them for every appointment. Each one of them had to be a warrior on her own.
Immersed in the world of Flushing Women’s, balancing my drive for power with my empathic connection and compassion for my patients, I came face to face with the questions abortion forces us to ask about women’s reproductive freedom. My anger at what was happening grew. The metaphoric role of physicians as surrogate fathers and deities resulted in them communicating in a kind of code, a language that only the members of the brotherhood spoke and understood. And they were communicating about women. Making decisions for us. I viewed this as a violation of their oath “to do no harm,” a betrayal of trust, and ultimately a dangerous situation for women.
Women’s health needed a reformation, a 95 Theses to translate the language of medicine so that women would be able to make choices about their own health. By teaching women about their bodies, by sharing this sacred knowledge, it would be possible to transfer some power to the patient.
Yes, that was it: patients needed their own bill of rights. Doctors needed to know what these rights were, too—and at Flushing Women’s, they’d better learn to respect them.
Flushed with frustration after hearing yet another horror story from one of my patients in the counseling room, I arranged for one of the counselors to stay with her while I rushed to my desk and started to write, my anger spilling out into my pen.
Patients have rights:
—The right to question your doctor.
—The right to know the background, affiliation, and training of your physician.
—The right to be advised of the reasons for medicines prescribed for you.
—The right to privacy in your consultations with your doctor and the right of confidentiality of records of your treatment.
—The right to the security and knowledge that the choice of treatments and what happens to your body is up to you.
—The right not to be intimidated by the props of medical power, i.e. fancy offices, big desks, and white coats.
—The right to regard physicians and the medical establishment as a vehicle, a resource for your own health needs.
—The right to know that rarely is there a single, unchanging medical truth. The right to be informed of current medical changes.
—The right to be assertive enough to ask what tests are being performed. Why? What do they cost? What other diagnostic choices do I have?
—The right to be in touch with options that offer divergent or philosophically different theories of treatment than the one that is being offered by your physician.
—The right to see your medical records at any time and the freedom to seek another opinion.
—Above all, the knowledge that the right of choice does exist and should be exercised.
In order to help people visualize this philosophy I created a poster with the image of god (à la Michelangelo’s Sistine Chapel) shooting RX thunderbolts from the sky at patients on the ground holding placards with quotations from my Patients’ Bill of Rights. I had it replicated and sent to all the HIP medical groups throughout the city. My referral sources, the social workers in the HIP groups, were generally sympathetic to me, and they tacked my posters up in their clinics and offices.
Needless to say, it created quite a scandal. Doctors tore them off the walls.
Marty was challenged at a board meeting as to why these kinds of political propagandistic posters were being posted. Many doctors found it extremely threatening, and the idea that it was mounted by staff without asking permission from the medical administration of the groups was unheard of. It must have appeared to them to be some kind of insurrection.
Marty was bemused by the entire thing. On the one hand he was extremely proud of me, and liked being the enfant terrible by proxy, but on the other, he could not afford to alienate board members. I was allowed to hang posters at Flushing Women’s, but I could no longer distribute them to other HIP offices.
Witnessing their outrage, I was ever more certain I’d hit upon something true. The concept of women as consumers of medical care rather than passive recipients of treatment—the awareness that women’s holding to traditional relationships with physicians was ultimately destructive to them individually and as a class—led to my formulating and expanding on a philosophy that would soon become a movement. I called it Patient Power.4
IN 1973, the historic Supreme Court decision Roe v. Wade legalized abortion for the entire country. For the first time, female patients were given equal power in decision making with their physicians for a particular medical procedure.
What I had experienced with Flushing Women’s in New York became true on a national level. The legalization of abortion brought women out of the bloodstained back alleys that had been their medical habitats for hundreds of years. It thrust abortion into the traditional American medical system of health care, yet, because of its highly politicized nature, it created an entire health care system of its own—one that was to be the forerunner of new ambulatory care models.
The Supreme Court decision, in essence, initiated the women’s health movement as a defined phenomenon. It created a visible, observable, demanding reality: the reality of the female medical consumer. Millions came out to access gynecological and abortion services. The reformation had begun, and women began connecting with each other, sharing the fears, anxieties, and challenges of being a female patient. People were aware of the need for change, and others, particularly certain religious groups, became active in resisting it.
I initially called Roe v. Wade the medical Equal Rights Amendment. The law had undeified physicians and required the informed consent of the patient for surgical procedures, making Patient Power real. But as I would come to learn, implementing Roe v. Wade did not prevent abortion from being seen as a second-class medical service, or clinics and the doctors who worked in them from becoming pariahs in American society. It would be many years before I would come to see Roe as a compromise—before I would see that women still had a long way to go to truly gain control over their reproductive health.
I STILL REMEMBER when the words “patient power” first came to me. For once, I was the one on the exam table. I was having a routine gynecological exam, but I was feeling vulnerable and uncomfortable, my legs spread, the paper gown just barely covering my breasts as I breathed deeply in and out. “Just relax and be patient,” the doctor said while his gloved finger searched and poked inside me. “Be patient.”
What an unbearable request, I thought. I never had much patience as a child, woman, or patient; I never wanted to wait for anything. The word “patient” originally referred to a “sufferer or victim,” an older definition that shares meaning with the modern usage of “patience”: to “suffer and endure, bearing trials calmly without complaint,” to manifest forbearance under provocation. I was beginning to understand that women have always been the ultimate patients in this sense of the word, bearing centuries of injustice as we’ve waited for equal rights, economic parity, suffrage, freedom from violence, legal abortion. There has always been something else, one more thing to be accomplished, a war to end, an election to win, before the legal, political, and social gaze can be turned toward women.
Battles have been won only when women have refused to keep waiting to be given our turn. Was it patience that gave us the vote, rights of inheritance? If women’s freedom is like the phoenix rising from the ashes, always in the process of becoming, it is fueled by a collective and individual impatience that is expressed through righteous anger and political action.
Lying on that table in the doctor’s office, where I was expected to be physically and psychologically submissive, I realized that the definition of patient had to change. If I wanted to have mastery over my medical decisions and my reproductive health, and bestow that power to other women too, I would have to reject the notion of patient as victim. I would have to struggle against society’s attempts to keep me in my place, dependent on others to decide what was best for me and my body. It became clear to me that it might in fact be possible to have power and be a patient at the same time. Collectively and as individuals, we could attain Patient Power.
No, I was not patient, as a woman or as a patient. And after three years as director of Flushing Women’s, I didn’t believe any woman should have to be.
BY THEN my days at the clinic had begun to feel a little more routine. We were seeing fifty women a week, and at that time I was still counseling most of them.
I can’t remember how many hands I held, how many heads I caressed, how many times I whispered, “It will be all right, just breathe slowly.” I saw so much vulnerability: legs spread wide apart; the physician crouched between white, black, thin, heavy, but always trembling, thighs; the tube sucking the fetal life from their bodies. “It’ll be over soon, just take one more deep breath”—the last thrust and pull of the catheter—then the gurgle that signaled the end of the abortion. Gynecologists called it the “uterine cry.”
Over and over again I witnessed women’s invariable relief after their abortion that they were not dead, that god did not strike them down by lightning, that they could walk out of this place not pregnant any more, that their lives had been given back to them. It was the kind of born-again experience that often resulted in promises: I will never do this again. I will always make him wear condoms. I will be more careful next time.
It was the very young girls that moved me most. I felt so much rage against the males who impregnated each child— was it her father, her brother, some young boy with no thought for the consequences? The girls, the women, were duly punished for their part of the sex act. But for the boy or man there was no censure, never was.
At times I was filled with a kind of bitter resignation. I knew that I might see each patient again soon. So many of them were barely more than babies themselves when pregnancy came, unplanned and unwanted. They were innocent and often ignorant, didn’t believe they were pregnant until it was too late to deny it, too afraid to ask for help at first. “Maybe it’ll go away,” they reasoned.
I spent hours counseling husbands, lovers, sisters, and mothers whose fury at their daughters’ betrayal needed a kind of salve I couldn’t give. “Let her get local anesthesia,” they said. “Let her really feel the pain so she knows never to do it again.” The daughters’ heads lay on my shoulder as I sat on their beds, wiping tears of relief or regret or both, whispering comfort, giving absolution, channeling rage, sharing life.
“I would want to keep this pregnancy, if only . . .” I learned that it is in the “if only” that the reality of abortion resides. It’s there in the vast expanse of a lived life—the sum of experience, the pull of attachment, the pain of ambivalence. “If only” is a theme with thousands of variations.
If only I wasn’t fourteen.
If only I was married.
If only my husband had another job.
If only I didn’t give birth to a baby six months ago.
If only I didn’t just get accepted to college.
If only I didn’t have such difficult pregnancies.
If only I wasn’t in this lousy marriage.
If only I wasn’t forty-two.
If only my boyfriend wasn’t on drugs.
If only I wasn’t on drugs.
If only . . .
I bore witness to each woman’s knowledge of holding the power to decide whether or not to allow the life within her to come to term.
The act of abortion positions women at their most powerful, and that is why it is so strongly opposed by many in society. Historically viewed as and conditioned to be passive, dependent creatures, victims of biological circumstance, women often find it difficult to embrace this power over life and death. They fall prey to the assumption, the myth, that they cannot be trusted with it.
Many women came into the counseling room and said, “I’m not like all those other girls in the waiting room; they don’t seem upset about it at all; I don’t take it as lightly as they do.” Or, “I never thought it would happen to me, I never really believed in abortion.” They felt guilty about not wanting to be mothers yet, about getting pregnant even when their birth control was what failed them, guilty about not insisting that their men put on condoms—or that they neglected to put in their diaphragms. And sometimes they felt guilty about not feeling guilty. Theirs was a pervasive sense of sin, if not in the biblical sense, then in the personal one of not living up to their own self-image. They felt they should have known better.
But they found a kind of redemption at the clinic, facilitated by counselors and staff who did not devalue, but supported them. Redemption in the form of rescue from an unwanted and unplanned pregnancy, and everything that meant. Redemption in the form of demystification, neutralization, and acceptance.