Confessions of an Abortion Doctor

Ten years ago this month, John Salvi sprayed bullets into two Brookline abortion clinics, killing two people and wounding five. Since then, the number of doctors willing to perform abortions has dwindled, increasing the workload for those remaining. One local obstetrician and gynecologist, whose clinic asked that she withhold her name for safety reasons, now performs as many as 10 abortions a day, twice a week.

One morning years ago, when I was working as a resident, a nurse brought me in to talk to a pregnant girl. When I walked into the room, there was this child — an 11-year-old. She had come in for a procedure, and it soon became obvious that she had no understanding of sex — she didn't really understand that she'd even had it, or that it had any connection to her pregnancy. We literally had to teach this girl about what it means to have sex — about STDS, abstinence, and pregnancy. I remember thinking: In a world where people don't want kids to learn about these things, how can you not give them the choice to terminate a pregnancy? Even if she had chosen to continue the pregnancy and opt for adoption, what would that have done to her own childhood? How can we not provide a child with any education about sex, then force her to become a parent long before she's ready?

When I started medical school in upstate New York, I didn't want to do terminations of pregnancies at all. My mom is Catholic and my dad is Jewish, and the church we went to had a pretty strong stance on it: The message I got was that abortion was wrong. As a first-year medical student, I took an ethics class and we talked about abortion. I wrote a paper about how I believed in the right, but would never perform an abortion myself, because it was against the way I was brought up.

That all changed later on, when I had a crush on this guy who was a leader of Medical Students for Choice. At the time, I thought abortion was strictly a women's issue. But he convinced me that abortion is a civil rights issue, that if you have injustice for some members of your population, your whole population has injustice. I remember thinking that was really profound. Still, I told him that I didn't feel comfortable doing abortions, but I was pro-choice. So he gave me these two films to watch, and they changed my life. They were about different providers and patients, men and women, who talked about what life was like before abortion was legal. They really changed my views — I suddenly thought, Yeah, I have to do that.

Today, though, there are so few providers who will perform terminations that the people who do agree to provide them end up taking the bulk of procedures. It can be hard. I'm a generalist — I like a lot of different things about being an OB-GYN. But because sometimes I'm the only person around, I end up doing a lot of terminations.

Doing them over and over and over again can be really taxing. All of us who provide abortions believe in what we're doing and think it's a good thing and a right that needs to be available. But when you're in the clinic and in that group of people doing it, it can be tough, and you can get really tired. I don't think it'll ever make me stop doing terminations, but it can move people to tears. And it's not just me — it extends to the nurses and the people who help us in the operating room. It's not unusual that you'll have only a couple of nurses who will help you out with it. There are nurses that will say, “No, I won't help you take care of this patient.” I even know people who feel they can't tell their families what they do; their families think they work on labor and delivery.

It really frustrates me that there are so few providers. I've asked my friends who are doctors if they do abortions. Some women I knew were providers in residency, but they don't provide now because their current medical practice doesn't. It's upsetting that some friends don't fight harder to provide it. But I've also had friends who've stepped up and said, “I'm going to do medical abortions; would you teach me how?”

As providers, we give all options, including adoption and carrying the child to term. I always ask a patient “Are you sure about this?” I've had people change their minds, which is totally okay. We want that. Or sometimes we'll advise them that they have more time to decide what to do. I would feel worse terminating a wanted child than not being able to terminate at all. It's very important that a woman knows what she wants to do either way. I have no problem with a woman walking out. I always find those are good days — when a woman walks out and says, “No, I'm keeping it.”

I have the utmost respect for life; I appreciate that life starts early in the womb, but also believe that I'm ending it for good reasons. Often I'm saving the woman, or I'm improving the lives of the other children in the family. I also believe that women have a life they have to consider. If a woman is working full-time, has one child already, and is barely getting by, having another child that would financially push her to go on public assistance is going to lessen the quality of her life. And it's also an issue for the child, if it would not have had a good life. Life's hard enough when you're wanted and everything's prepared for. So yes, I end life, but even when it's hard, it's for a good reason.

Because of all the threats these days, doctors who have been doing this longer than I have are a lot more hesitant about things that I don't even usually think about. Things like, “Who is sponsoring this conference I've been invited to? Did this interview request come from a referral I trust?” They warn me to be more leery. I wasn't in Boston 10 years ago, during the Salvi shootings, but I recently talked with someone who had been around at that time, and she told me the incident essentially put her whole career on hold. That scares me.

What happens if something like that occurs again? Would I still be able to show up for work? It's unfair and depressing. I'm older now, but there was a time when I was going to sacrifice everything for the cause. But would I really sacrifice the well-being of my family? There are providers who have been shot at, who have been shot and still show up for work and still do their job, which is amazing.

Maybe I live in an idealistic world, but I believe in people being good and in trying to understand their opinion. I don't think I'm going to be easily swayed. Obviously, the threat of violence is something that's always in the back of my mind, that it could happen, but I feel like I'm doing something so right. How could people think it's wrong?