Intimate Wars (12 page)

And yet, in his way, Marty was as radically transgressive as I was. We had a core connection that ran true and deep and would prove to be unbreakable. Our continued partnership was in part practical. Flushing Women's was often under attack from hostile forces at HIP who wanted to undermine Marty's power base and close the clinic. I was often the surrogate
target for these attacks. Marty had to be the protector, coming to my defense, sometimes to his political detriment.

But Marty's belief in Flushing Women's and the new ideas I brought to the project ultimately trumped his concerns about popularity and politics. He was my ally. It was a revolutionary time in health care and women's rights, and we were on the front lines. The romance of it all still held me fast to our relationship.

 

THE SUCCESS OF THE Women's Health Forum had left me craving a grander stage. Marty convinced the board that with the right platform I could garner a lot of positive publicity for HIP, and despite our philosophical differences, they were smart enough to see that a young, attractive, intelligent spokesperson for the fresh ideas discussed at the forum would put them on the cutting edge of health care. They set me up with Howard Rubenstein, HIP's public relations guru, with the goal to evolve the concept of Patient Power to the level of a campaign that I could present to the public.

My account representative at Rubenstein's firm wanted to start by booking me on a television talk show about breast cancer. There was just one problem: I knew absolutely nothing about it. I told him I wouldn't do it.

I did, however, begin to read about breast cancer, the rate of which was extremely high on Long Island—very close to the population of women I served at my clinic. A short time later Dr. Gene Thiessen, a well-known breast surgeon, came to see me at Flushing Women's.

This handsome man who looked as though he'd stepped out of a Ralph Lauren photo shoot swept into my office and told me he'd heard about Patient Power. He wondered if I would be interested in collaborating with him on a new program for breast cancer patients. In the seventies, when a suspicious
lump was found in a woman's breast she was asked to sign a consent form for a mastectomy before she even knew if her tumor was malignant. She was then placed under general anesthesia for the biopsy, and the questionable mass was sent to the hospital lab while the patient remained asleep on the operating room table. If a malignancy was discovered by the pathologist, the surgeon removed the offending breast. The severity of this protocol obviously frightened women away from going to the doctor for tests. Dr. Thiessen wanted to initiate a project designed to make women more aware of their treatment options and prevent unnecessary mastectomies.

I was impressed. Here was a surgeon who cared about women's psychological well-being and who was trying to find a way to ease their way through the bureaucracy of cancer. Patient Power could surely be beneficial to these women.

I consulted with Dr. Philip Strax, a well-known radiologist who pioneered the use of prophylactic mammography to screen for early breast cancer. He had recently completed his groundbreaking study on thousands of HIP women. After meeting with him to organize a workable program, I founded STOP: the Second Treatment Option Program. Flushing Women's became the first outpatient medical center to biopsy patients under local anesthesia outside of a hospital. Through our program we were able to put a stop to the practice of doing a mastectomy without the patient's consent while she was on the table under anesthesia. It would be decades before this would become routine practice.

Dr. Thiessen later founded the Self Help Action Rap Experience (SHARE), a support group for survivors of breast and ovarian cancer to which I donated meeting space at Flushing Women's. With its focus on peer option counseling, full disclosure, and separating the biopsy from the mastectomy,

SHARE fell within the paradigm of Patient Power that I created for women having abortions.

With the implementation of these programs and the expertise of the Rubenstein agency, media interest in Flushing Women's began to escalate. Everyone was talking about women's health. At first journalists were interested in SHARE and STOP, flooding Flushing Women's with positive press coverage on the tenets of Patient Power. Soon, they became interested in me. It was gratifying to see journalists encouraging people to take the concept of educating women as patients seriously—and exhilarating to find myself becoming a public figure.

 

MARTY WAS AT the height of his own career as chairman of the HIP Medical Group Council. The other New York abortion providers, male physicians who ran clinics in Manhattan, had more in common with Marty than myself, and our relationship was far too competitive to allow collegial sharing. My isolation was suddenly broken one afternoon in 1976 when I received a packet in the mail from the National Association of Abortion Facilities (NAAF). It contained a questionnaire for abortion providers and an invitation to a national meeting they'd be holding that spring. I devoured NAAF's agenda and long list of invitees. There were so many of us out there—enough to have an association!

Over three hundred representatives from abortion facilities all across the country traveled to Cleveland, Ohio, for a meeting that May. The impetus for the gathering was to adopt a NAAF constitution. Their early literature echoed my own priorities. It seemed that I had finally found my peers.

I listened attentively as the chair called the first order of business, the approval of NAAF's proposed mission statement. I was immediately put off by the first line: “The purpose
of this organization is to promote the interests of abortion facilities.”

What about the interests of women? I raised my hand and stood with what was the first objection of the organized session, stating that the purpose of the organization should be
to serve the interests of abortion patients.

It was decided that my statement should be incorporated into the founding documents of NAAF. Later that day, people approached me to say that they'd been thinking the same thing, and they were happy that I was the one who'd had the courage to say it.

After the first day, I had noticed that there appeared to be a geographical distinction among the attendees. Many of the New York and New Jersey providers had been operating since the early seventies, before
Roe
. As licensed facilities we commiserated about the difficulties of regulatory compliance. Many of the “clinics” in other states were in reality unlicensed, private doctor's offices. They tended to be headed by white, male Christians who had their own agendas.

A few months later the time came for the first election of the NAAF board of directors and officers, for which I had been nominated for vice president. But after attending a few meetings, participating in loads of discussions, and hearing the observations of others, I and my East Coast “supporters” came to feel that the organization would be better served if I were its president. A couple of nights before the election I was approached by Mel Cohen, Iggy DeBlasi, and a few others with the idea of challenging the election from the floor. I was conflicted. Of course I wanted to be president, but the notion that this coup could be unsuccessful filled me with anxiety. When they insisted our numbers were strong enough that there was a good chance I'd win, I made the decision to go forward.

I was elected president by just a few votes, but I lost some credibility and gained the resentment of a large part of NAAF. I realized there was not enough widespread support to solidify my power. The political lessons were hard. Mel Cohen had told me before the coup that he expected to be named chair of the Standards Committee if I became president. I easily agreed to the deal, focusing only on ensuring that I would get elected. But now I was forced to come to terms with the fact that the power I had gained was limited by the promises I had made to achieve it.

I shook off the negativity that trailed me after the election and moved forward aggressively, sending out meeting notices, working to form committees, and starting a NAAF publication called
January's Child.
A few months later, NAAF combined with the National Abortion Council (NAC) to become the National Abortion Federation (NAF), of which I was elected the first secretary. By this time, I knew enough to accept my place in the power structure and wait my turn.

 

MY INVOLVEMENT in these organizations was also my official entry into the world of feminism. Some of those with whom I formed political alliances would go on to become lifelong friends. But as I worked with other members of NAF to write a pamphlet titled “How To Choose an Abortion Facility” using the tenets of Patient Power as a guide, I discovered that many early feminists active in the pro-choice movement had values quite different from mine. They were medical anarchists who wanted to deinstitutionalize abortion entirely, to wrest the power from the male medical establishment into what they called the “Self-Help Movement”—essentially women's health care without doctors. Carol Downer was a leader of the movement, proselytizing self-examination and menstrual extraction (ME)
⁹
and advocating the idea that women's continuing
struggle against male oppression demanded that they find ways to help themselves.

This challenge to male medical authority resonated powerfully with me—in some ways, it aligned with Patient Power—but I ultimately viewed these feminists' thinking as separatist. It would essentially place women in ghettos. Why was it necessary for women to forgo all the clinical and technological advances that were part of the medical research and clinical establishment for protective or political purposes? Why should we adopt minimalist standards as a defense against the medical industrial complex, when we could find a way to incorporate it into our paradigms and use it to our benefit?

They were also ignoring the fact that abortion was acting as a catalyst for the development and growth of ambulatory, or outpatient, care in the United States. According to the Guttmacher Institute, first trimester abortion was and is the safest outpatient procedure that can be performed; fewer than 0.3 percent of abortion patients experience a complication requiring hospitalization. Abortion facilities were modeling a concept of service that combined basic education and informed consent with expert medical technology—treatment modalities that could be used for other surgical procedures like sterilizations, colonoscopies, breast biopsies, and orthopedic procedures. A great deal of minor surgical procedures could be done outside of hospitals at 50 percent of the cost. Abortion was changing medicine.

I did support the movement for trained nurse midwives to perform first trimester abortions, but I wasn't comfortable with the practice of menstrual extractions. Because the MEs were conducted before a woman's pregnancy could be confirmed by a blood or urine test, there was a 50 percent chance that the MEs were entirely unnecessary, potentially resulting in infections. I did not see ME as an innocuous procedure.

The most radical feminists believed that abortion, and all medical procedures, should be free of government involvement and free of cost. This struck me as wildly naive. How did they expect providers to pay for equipment, staff, and doctors? I was charging a minimal amount for the procedure, but I had to charge something. Yet the idea of making money through providing abortions was deeply antithetical to these feminists. Many had a problem with my way of operating, believing it impossible to be a feminist and a capitalist at the same time.

 

AS I BECAME more involved in defining the pro-choice movement, I grew increasingly aware of much greater challenges than these internal disagreements about how to make abortion available to women. From this vantage point I could see that the movement for women's rights had enjoyed a brief period of public popularity in the early seventies that eventually led to the legalization of abortion and granted us the temporary luxury of debating the finer points of providing abortions. But before women really had the chance to move into their power, the public discussion began to move toward the construction of simplistic, judgmental abortion narratives designed to put women back in their place.

Two sides emerged, as if they were mutually exclusive. There was either the “right to life” or the “right to choose.” Women couldn't help but internalize these narrow ways of seeing the issue and themselves accordingly. Abortion
was
a woman's right, both legally, with the passage of
Roe v. Wade
, and as a matter of biology, equality, and justice. But each woman's acceptance of her natural right was challenged and threatened by a Greek chorus screaming “murderer” at her for exercising that power.

This bifurcation was expressed eloquently by a young patient I once had. She was only nineteen years old. It was her first abortion, and she had come alone. “It was such a difficult choice for me to make,” she said softly. “The mother in me wanted so much to have it, to love it, to see it grow... The other part knew that it was impossible.”

The “other part”? For so many women, choosing abortion created this other—the one who would never have chosen this path, the good mother sitting in judgment and separating herself from the one choosing abortion. It was a formula for amplifying guilt and regret.

The growing political debate on abortion in the seventies took this reduction of women's self-identity even further by positioning the woman and fetus as adversaries. There was no way that one could advocate for both; if you believed in the right to life of the fetus, then the woman, by definition, had to come second. And if you believed in a woman's right to choose, the fetus took second place.

The pro-choice movement had to find a way to navigate these narratives. The simplest option was to negate the claims of the opposition. And so many pro-choice advocates claimed the fetus was not alive, and that abortion was not the act of terminating it. They chose to de-personalize the fetus, to see it as amorphous residue, to say that it was “only blood and tissue.”