Stepping off the elevator on the seventh floor of the abortion hospital, I find myself in the saline unit where I am to start my research on how people involved in the performing of legal abortions feel about the work they do. Altogether there are eighteen patients here, full house for the floor. Three are fifteen years old; one, sixteen; seven, seventeen; two, eighteen; one, twenty-one; one, twenty-five; two, twenty-seven; and one, thirty-two. Their periods of gestation range from sixteen to twenty-three weeks. The one twenty-three weeks pregnant is fifteen years old.
Straight ahead of me, about six feet away, I see the television room. The regular door is open, but the slatted, swinging half-doors, common to old hospital rooms and Western saloon entrances, are closed. Below the doors I can see a pair of bare legs in pink furlike booties; another pair of bare legs in green wedgies; and farthest from the door, the bottom part of a wine-colored paisley robe. As I come closer the legs disappear from view and I can hear the television going. The seventh floor is the only one that has a television room. They need it here, because it is in this room that the girls wait, together, to be ushered by the nurse, one by one, into the treatment room for induction.
I knock and enter without waiting for an answer. Four faces look up at me. I had missed a pair of propped-up legs. “Hi,” I say. “I am Doctor Denes, I am here to. . . .” I am stuck. The wind has been knocked out of me. Abortions in my mind happen to grownups who are unwillingly pregnant but don’t look it. These are little girls far gone with child.
I gradually shift my eyes to the girl sitting nearest to me. She is the one with pink fur-like booties. She must be one of the fifteen-year-olds, although she appears much younger. She sits totally absorbed in the show, the title of which is “Hospital.” Her lips are slightly parted, and in the left corner of her mouth there is a small bubble of saliva. Her hands, folded, rest on her large belly, in the age-old posture of pregnant women. From close up, her legs are thin, vulnerable, little-girl legs, covered with long blond transparent hair.
The following day I am invited to watch one of the doctors work. He is Dr. Szenes—like me, by an odd coincidence, an emigré from Hungary. The patient, a girl of about sixteen, half-dead with fear, is helped by a nurse onto a treatment table. The nurse makes her lie down. She lifts the girl’s white hospital gown to her waist and covers her thighs and genitals with a sterile disposable towelette, leaving her round protruding belly exposed. With a small gauze pad she washes the area with alcohol. Meanwhile, Dr. Szenes scrubs his hands at a tiny sink in the corner opposite to mine. “What is your name, young lady?” he asks. “Flo. Florence Sullivan.” “Sullivan. Irish, eh? And how old are you?” “Well, my father was Irish. Sixteen and a half.” “That’s pretty young, to be going through this. When was your last period?” “June or July.” “Which?” “June, I guess.” “That makes you twenty-two weeks pregnant. Right?” “That’s what I was told.” The conversation goes on, partly to gather information, partly I suppose to reassure the obviously terrified girl.
When he is through scrubbing, Szenes stands in front of the nurse, who holds open first a left, then a right sterile rubber glove so that the doctor can slip his hands into them. “Now this whole thing should not hurt you,” he says, again addressing the girl. “It will be uncomfortable, but it should not hurt.” The nurse hands Dr. Szenes a syringe. He expels a little liquid into the air, then injects Flo, near her belly button, just under the skin, holding the syringe parallel to the girl’s abdomen. About two seconds later without removing the needle he jerks the syringe upward to make the needle plunge straight down into the abdominal cavity. At this point the needle is invisible and the syringe is completely vertical in the doctor’s hands. The injected liquid is 5 cc’s of Novocain. Flo winces and her eyes well up, but she remains silent. Szenes smiles at her. “That was the worst part, the rest is apple pie.”
The nurse sprays the area with iodine solution, tinting Flo’s skin the color of brown mustard. She takes the syringe from the doctor and hands him a needle. It looks enormous. He holds it up to show me. “It is an eighteen-gauge, three-and-a-half-inch-long spinal needle. We use this to tap the fetal sac. It works very well.” Turning back to the patient he places the needle on the exact spot of the injection and pushes it in to the hilt in one firm fluid motion resembling the choreographed movement of a dancer. Szenes’s first-rate professional competence is unmistakable. There is no reaction from Florence. The needle ends in a pink hub about half an inch long. Holding on to it, Szenes removes the stylet to permit the free flow of amniotic fluid. As he lifts the stylet, I see a little squirt of yellowish liquid shoot up through the pink hub. Szenes says: “That’s good. We’re doing very well.” The nurse hands him a short thin rubber tube, one end of which he attaches to the needle hub. To the other end of the tube he connects a large syringe. Holding it steady, he slowly pulls the plunger outward, filling the syringe with a thin liquid the color and consistency of urine. He is suctioning out the amniotic fluid. When the syringe is filled, he disconnects it from the rubber tube and squirts the liquid into the corner sink. The process is repeated three times—amounting altogether to one hundred and fifty cc’s of amniotic fluid removed from Flo’s belly.
“How do you feel, young lady?” “Fine.” Flo’s voice is barely audible. Her hands are clutched on her chest, and she is very pale. “Excellent, because we are almost finished. I am going to hook you up now to the saline to replace the fluid we took out. While that’s going on, you’ll have to tell me whether you feel anything unusual. Like if your face gets flushed or if you suddenly feel numb or very thirsty. Things like that, okay?” Flo nods. “Talking doesn’t interfere with this process, you know.” The intent is to console, the result is disaster. Flo breaks into racking sobs. Her belly heaves up and down causing the rubber tube to flop about. “Stop it at once, you will dislodge the needle.” The nurse, who until now has not uttered a sound, puts her hand on Flo’s forehead and says, “Come on, dear, it is almost over.” Flo grabs a corner of her folded-up white gown, stuffs it into her mouth and bites down on it. She looks like a broken-hearted three-year-old.
Next to the treatment table there is an intravenous stand about ten feet tall with an inverted bottle hanging from each side of its crossbar. One of the bottles has a long rubber tube attached to it. Szenes removes the short tubing from the hub of the needle in Flo’s belly and connects it to the long tube leading from the bottle. The bottle contains hypertonic solution. He checks to see that the flow is steady by lowering and raising the bottle a couple of times, before replacing it on the stand. “I want about two thousand,” he says to the nurse. It is evidently her duty now to keep an eye on the amount and the evenness of the flow.
The words of a pamphlet I had picked up weeks ago come back: “As a result of the concentrated solution of saline in the uterus the fetus will not survive more than a few hours after the injection.”
Szenes sits down at a small desk in my corner to make notes in the charts. “Look here,” he says to me, pointing to a number that exceeds nine thousand. “What is it?” “The patient’s number.” “You mean you have done this many?” “Well, not I, the five of us. Four, really, because Dr. Marcus joined us only a couple of hundred ago. I’d say it’s about two thousand apiece, give or take a few.”
“Okay,” says Dr. Szenes, getting up and checking the bottle. “I think we can remove this now.” He disconnects the bottle, retracts the needle, and the nurse puts an adhesive strip on the tiny puncture site. “Do you feel all right?” Flo nods. “You can go back to your room now. Lie down for a half-hour. Then drink two glasses of water. After that, you can walk around. Watch TV. Make phone calls, whatever you want to do. When dinner comes you must eat it all whether you like it or not. All of it. After dinner you are to stay in bed. The house doctor will come to your room and put an intravenous needle in your arm. Once that’s done you may not move at all, nor eat or drink anything. The IV contains glucose to nourish you and a medicine called Pitocin to stimulate labor. If the cramps get bad you can ask the nurse for some Demerol, a pain killer. You must ask for it if you want it, because the nurses can’t tell when your pains get really bad. Don’t believe anyone who says it retards labor. It does nothing of the sort. With any luck, you should be all done twenty-four hours after the IV is inserted.”
The process, in other words, though he does not say this to Flo, is exactly like giving birth to a child: cramps, water-break, fetus, placenta, end. Except, of course, that in this case the fetus is already dead.
The saline floor is a difficult place for lasting clarity and durable convictions. One day I speak with Debbie, twelve years old, six months pregnant by her uncle, who through the convoluted miseries of Debbie’s short life, also happens to have been her stepfather for the past ten years. “He has been messing with me for two years, but I only got my first period eight months ago,” she reports, her brown eyes full of tears behind gold-rimmed glasses. “What hurts, Debbie?” “I don’t want him to be in jail, where they put him. I love my uncle. He was like a father to me. We played games.” By now she is sobbing, bitterly mourning a vanished parent as any child will. “But Debbie, what he did with you, what about that?”
“It was wrong, but I miss my uncle,” she says, her shoulders shaking with grief.
Thanks to Debbie, the seventh floor experiences a spirit of solidarity bordering on joy. The belief that the work done here is truly in the service of humankind is manifest again in the swollen-bellied body of this little girl, whom everyone in concerted effort wants to spare and to comfort.
The attendants give her candy. Her doctor, in departure from the usual procedure, orders no IV so as to avoid confining her to bed while she waits to deliver. The nurses call her “little Debbie” and keep asking her how she feels.
There is a live child on this floor whose future people are hard at work to save.
Quantity, however, has a way of radically altering quality. When, under one roof, the number of dead fetuses mounts into the thousands, the simple fact of death gradually overshadows the significance of individual histories. It seems that none who work here can witness the extinction of a segment of the future generation without guilt and fear. In my interviews with them, the word “murder” surfaces again and again, and it sticks on the tongue like a searing coal of fire that one knows will do further damage whether it is swallowed or spat out.
Charles Bender, M.D., Age 37
“My feelings about doing abortions were very significant and it was a long period of time for me to work it out. I dare say any thinking sensitive individual can’t not realize that he is ending life or potential life, you know. I certainly don’t enjoy that. I have no conscious conflict over killing a fetus. There’s certainly nothing enjoyable in the act, except providing a necessary something to a person to make their life or burden happier, or easier, or whatever. But there’s got to be more to it. I don’t enjoy, that’s a bad word, I don’t relish delivering the fetus. Now I think the nurses have a harder job than we have. They are the ones who see the fetus. I don’t see a fetus—maybe once a week, one—so that there’s a separation of the final product and what I do. When it comes out, I don’t want to cry, and I don’t feel great remorse over this lack of life. It’s not pleasant to me by any means. But I don’t know if it is to anybody. . . .
“I’ve had the question of extramarital sex come up in my practice and I’ve spoken to girls, I mean women, about it, and I don’t feel that any girl goes into Maxwell’s Plum just because she wants to have sexual relations. She’s going in there because she’s seeking a relationship. We are not that liberated. The relationship is being sought, I feel, sadly, through a sexual contact. I think this has to reduce one’s self-respect. It takes, I feel, a significant and meaningful aspect of one’s life out of context. I think we’re certainly living in a time of decreased human respect, of decreased human relationships, and of decreased sensitivity to killing off things.
“If you lose that importance or significance in sex, you just in another way erode another means of humanistic response and we’ve lost enough.”
John Szenes, M.D., Age 36
“I think that every woman should be given the right to determine whether she wants to be pregnant or not. And if she doesn’t want to be, and it’s not two days before term, but is a reasonable time before the fetus becomes viable, she should be able to go to any gynecologist, whom she would go to for a Pap smear, or for a discharge, or whatever, and that gynecologist should not sit back and say, ‘Now let’s see what are your reasons for having this abortion.’ I don’t think that should be our decision.
“With somebody who wants to have a child, you should do your utmost to help bring that direction. And with the one who doesn’t want it, you should do your utmost to help her out of that situation.
“You have to become a bit schizophrenic. In one room you encourage the patient that the slight irregularity of the fetal heart is not important, everything is going well, she is going to have a nice baby, and then you shut the door and go into the next room and assure another patient on whom you just did a saline abortion, that it’s fine if the heart is already irregular, she has nothing to worry about, she is not going to have a live baby. I mean you definitely have to make a 180-degree turn, but somehow it evolved in my own mind gradually, and I have no trouble now making the switch. . . .
“At the beginning we were doing abortions on fetuses that were not quite as large. And the kicking and the fetal heartbeat did not manifest itself quite as obviously as it does now, in the larger cases. So I can imagine, if I had started doing twenty-four-weekers right off the bat, I would have had much greater conflict in my own mind whether this is tantamount to murder. But since we started gradually, with fifteen-, sixteen-weekers, where the overwhelming interest of the mother was so obvious, the fetus just never got consideration. It just did not enter the picture. Then, as one gained experience, the whole range of cases that we had to take care of started to become larger. All of a sudden one noticed that at the time of the saline infusion there was a lot of activity in the uterus. That’s not fluid currents. That’s obviously the fetus being distressed by swallowing the concentrated salt solution and kicking violently and that’s, to all intents and purposes, the death trauma. You can either face the method or you can turn the other way and claim it’s uterine contractions. That, however, would be essentially repressing, since as a doctor you obviously understand that it is not. Now, whether you admit this to the patient, that’s a different matter.
“The whole technique of saline abortions has come in so gradually, that there was no outstanding dramatic event which would have signaled, ‘Now, here is an issue that I have to face whether I do it, or I don’t.’ It never happened like that. The patient’s distress by unwanted pregnancy is to me the primary consideration and I am willing to put that ahead of the possible considerations for the fetus. We’ll just have to face it, that somebody has to do it. And, unfortunately, we are the executioners in this instance.
“In my view it would be unfair to say, ‘Well, I enjoy taking out fibroids but I just abhor doing abortions.’ That’s not fair. Whether this is a rationalization on my part or not, I’m not sure. But I think I have no conflict in my own mind of representing the patient’s interests all the way. . . .
“Now I think a decision of this sort is very well within the individual’s rights. Same way as somebody who wants to die. I don’t believe in medical stunts in keeping people alive when they’re hopeless. I am not prepared to defend euthanasia outright, because it has too many pitfalls, but I think that there are certain situations when at least the physician shouldn’t stand on his head to save somebody with terminal cancer, for example. Even though it’s unpleasant to turn off that last switch, by having gotten to the point where your authority may include that, you have to do it. There has to be a person where the buck stops. This joint responsibility is a lot of nonsense. I mean you didn’t become the leading member of a health team by virtue of training and what-not if you cannot assume responsibility. And being an obstetrician does propose just this sort of decision. Since you have the tools, you have the training of doing it right, and the woman has no other person to turn to. Aren’t you withholding something that she’s entitled to by refusing her? And I think somebody before going into obstetrics and gynecology should decide in his own mind is he capable of doing that. And if he’s not, then, I mean if the heat is too much in the kitchen, get the hell out.”
Mrs. X., M.D., Age 39
“When I was in training, and when we used to do some therapeutic abortions for German measles and some psychiatric reasons, I never used to like it. When I started reading more about legal abortion, and women’s privilege, and all, I think I agree with it, that up to a certain stage like twelve or fourteen weeks it’s nothing. The woman has a right to decide. I don’t know my opinion as far as after eighteen or up to twenty-four weeks, I still don’t know.
“When you are delivering a twenty-four-weeks fetus, which looks almost like a little baby, or when you hear the fetal heart tone, I don’t have any feeling of it like murderer, or like other people tell, that it is murder. Those feelings I don’t have. But somehow or other, I just feel that a woman at this stage is always involved with the baby. You know it has already been kicking for some weeks. And how can she dare give this thing up. Because it’s part of you. What we don’t realize is that these very women go home and in a quiet moment they must be thinking about it.
“I feel sad, I don’t have a guilt feeling like murder, and I hear men talking, ‘Abortion is murder.’ I still give it, it’s a woman who is going to be mother, she is the one who decides. This is my primary feeling. I’m not a Catholic, and I’m not an anti-abortionist who has a strong opinion about it as a murder. I come from an overpopulated country in Asia, and I see the great need of controlling the population. I see the load of feeding kids and also the problems of it, so I do believe that if they want it, it’s better off this way, than leaving them on the street, to the peddlers and the pushers. So I’m very scientific and very practical. It’s only inner sadness comes when I think of a baby of twenty weeks or twenty-four weeks when I see it. So I just think that this very baby, if it can move me so much has to be moving the person who has carried it so long. . . .”
Dora Greenwald, M.S.W., Age 28
“At first I was very upset by the deliveries. I’m not one to see blood and mess and things like that. But I have since gotten so excited about it that I’ve thought about going back to nursing school. When you think about it on a certain level, it’s a really interesting thing that is happening. It’s fascinating, when you can think about it clinically and not get involved in the people, or the babies. What happened when I was first working here was that I just thought about the baby and that was very upsetting. I’m very pro-abortion. I think that if women want it, and need it, they should definitely have the opportunity to get it. So I had to try to make myself keep thinking of that and the fact that these people need it. And when you hear their stories and get involved in them as people, it’s much easier to take.
“I think I must have overcompensated, you know, overreacted and tried to look, and like really get into it, And several times I saw really beautiful things happen, I mean it’s physically beautiful. . . .
“Sometimes you can see the vagina opening up and the entire thing coming out at once. Most of the times the water will break, and then the fetus will come out and then the afterbirth. You know, in sequence. But sometimes this all comes out at once, like a balloon with the fetus inside and the afterbirth just sitting on top. It’s a really interesting thing, and it got me very excited.
“Also, the fact that these patients are so grateful for whatever comfort and support you give them. It’s the first time that I’ve been in any kind of social work where people say, ‘Thank you.’ You know most of the time in therapy they are working along with you, or whatever, but there’s not the same response. Here they don’t expect to have the comfort and the support, and they are so grateful when they get it. They feel so helpless. . . .
“A lot of people say they’re killing their baby. You get a lot of that. Some people afterwards get very upset and say, ‘I killed my baby.’ They wouldn’t rather have the baby and give it up for adoption, either. If you go into that with them they will say that they could never do that because if they carry it to term they’d want to keep it. And yet they still consider it killing the baby.
“Well, they are killing a baby. I mean, they are killing something that would develop into maturity, but under the circumstances that’s necessary, and probably better for the baby. You have to realize that these children would be unwanted and a lot of times uncared for, so it’s much better that they are not brought into the world. . . .”
Susan Lindstrom, M.S.W., Age 27
“I am having a lot of difficulty with my feelings about late abortions. All the pain that seems to be there so much of the time after the baby is moving and everything. And I saw this movie of a live birth recently and it just was so terrifically painful to me, to see and feel the difference between what a live birth is and what a saline abortion is. You could just feel all the joy and excitement of seeing this live baby come out. A whole different color, like white and light and alive and moving, crying, and doing all these things, and you know, having seen a considerable number of fetuses being all dark and red and blue and dead.
“I’ll never forget the first fetus because it was the very first week I was here. This little bitty girl from, I think, Wisconsin, a black girl, very, very scared. And she was just in incredible pain, and screaming and calling to God and all kinds of things and I was holding on to her and Dr. Szenes came in and broke her water and helped her deliver right there, and it splattered all over the whole room. . . .
“And then to see, to be with somebody while they’re having the injection when they’re twenty-three, twenty-four weeks, and you see the baby, moving around, kicking around, as this needle is going down into the stomach, you know. And then one of the doctors said something he never should have said to this one girl that I’m talking about because she had just a lot of feelings about it—‘It’s a baby,’ ‘It’s a person,’ ‘I’m killing it’ kind of feelings which she had talked to me about. And at the induction he was having trouble, because the baby was moving around and blocking up the needle, and so he gets angry and he just makes the comment that the baby was putting his finger up against the needle. You know, just personalized it. . . .
“There’s such conflict because there’s so much pain in the mothers. Mixed emotional pains, conflict of what to do. And being concerned about killing something. They don’t want to kill something. . . .”
Two doors down from the nurses’ station there is a little room with several large garbage cans, each neatly marked for different types of garbage, and a medium-sized table on top of which stand paper buckets—the type in which one buys fried chicken from take-home stores. The buckets are covered with their paper lids. Attached to each lid there is a white cardboard label bearing—printed in ink—the mother’s name, the doctor’s name, the time of delivery, the sex of the “item,” the time of gestation. Inside each bucket, I have been told, there is a fetus and its placenta stored in formaldehyde. At the end of the day the buckets are transferred to the laboratory where the contents are examined for abnormalities. That done, they are collected in a large plastic bag, and a special messenger takes them to a sister hospital in possession of an incinerator. There they are burned.
One day, driven by my own need to arrive at a measure of clarity, I go into the little room, place my stuff on the floor next to the garbage cans, and pull on a pair of rubber gloves. Planting myself in front of the table, balanced, legs slightly apart, I remove with one hand the lid of a bucket. The sharp fumes of formaldehyde instantly hurt the in-sides of my nose and throat. The smell also brings with it the long-forgotten memory of fetal pigs. The association strikes me as unseemly; nevertheless I remember, with unwanted total recall, the misery of my sophomore year in college, when in Bio. I, every Wednesday from three to five, for six months, we dissected the fetal pig. On the first day of class the instructor brought in a huge container filled with formaldehyde and floating pigs. He fished out one pig for each student, tagged with the student’s last name, giving the impression that the pig was a lost, finally returned relative, in regrettable shape.
I look inside the bucket in front of me. There is a small naked person in there floating in a bloody liquid—plainly the tragic victim of a drowning accident. But then perhaps this was no accident, because the body is purple with bruises and the face has the agonized tautness of one forced to die too soon. I have seen this face before, on a Russian soldier lying on a frozen snow-covered hill, stiff with death and cold.
I take the lid off all the buckets. All of them. I reach up to the shelf above this bucket graveyard tabletop and take down a pair of forceps. With them I pull aside in each bucket the placenta, which looks like a cancerous mushroom shrouding the fetus. With the forceps I lift the fetuses, one by one. I lift them by an arm or a leg, leaving, as I return them again, an additional bruise on their purple, wrinkled, acid-soaked flesh. Finally, I lift a very large fetus whose position is such that, rather than its face, I first see its swollen testicles and abnormally large stiff penis. I look at the label. Mother’s name: Catherine Atkins; doctor’s name: Saul Marcus; sex of item: male; time of gestation: twenty-four weeks.
I remember Catherine. She is seventeen, a very pretty blond girl. Not very bright. This is Master Atkins—to be burned tomorrow—who died for his mother’s sake. But then I remember twelve-year-old Debbie, pregnant by her stepfather-uncle; and once again, like everyone else on the saline floor, I lose the lasting clarity and durable conviction which for a moment I thought I had found.