On the Front Lines: Why I Am An Abortion Doctor

Lately I've been reading books about abortionists. Their personal histories are almost a genre. The titles are usually titillating: on the net there's Martin Avery's Confessions of an Abortionist, in which the author/doctor states a good case for his life -- as if St. Pete were asking -- and describes his patients, whose beauty and class he stacks for or against their pleas to end their pregnancies. Madame Restell, the 19th century's most famous abortion provider, is wantonly remembered in Scandalous Lady and The Wickedest Woman in New York. Ruth Barnett, Portland's premier provider from 1918 until 1968, is the star of The Abortionist (Macmillan, 1994), but her biographer can't quite keep her propped up on the feminist pedestal she builds into the sky. All these books were written for a world where abortion is a dirty word. They range in tone from condemnatory to heroic, but a defensive, slightly pornographic theme prevails.Remember the rejection of Dr. Henry Foster from the post of Surgeon General? Once it surfaced that he had (as is required of his profession) performed a legal procedure that poses moral problems, he was history. Now he's serving a consolation post, heading a task force on teen pregnancy. That's no shy prize, but he must be livid about the hypocrisy that prevented him from being the country's leading M.D. At least the publishing industry knows that people want to read about what goes into the making and staying of an abortion doctor, bad reputation aside.Why I am an Abortion Doctor (Prometheus Books, 1996) is Dr. Suzanne Poppema's autobiography. Dr. Poppema runs a Washington State clinic that has been on the cutting edge of research in the reproductive realm: Seattle's Aurora Medical Services was a test site for Norplant, Depo-Provera, and, most recently, the non-surgical abortives methotrexate and RU 486. Dr. Poppema is on the Board of Directors for the National Abortion Foundation. Her story was put on paper by Mike Henderson."I'm a speaker, I'm not a writer," Poppema told me recently, in her office. "My amazement is that Mike Henderson clearly heard my voice and didn't have a big agenda about what kind of opus this would be. He wrote it so that people could hear me."I couldn't tell from the book or its cover that Henderson, a journalist who teaches at the University of Washington, had actually strung the sentences, so I was surprised. Poppema's voice was not lost in the translation. When I first picked up the book I was kind of bored. Primed by a diet of juicy chat about sin's illicit ends, I expected this book to be more of the same, or at least an apology. But Poppema won't stoop to the level of rebuttal. She's too strong."I wanted to show that you could be [an abortion doctor] and also be a totally mainstream, and somewhat boring, individual," she told me, looking like my mother. Dr. Poppema is attractive and middle-aged and professional. I won't go into details. Her face doesn't appear anywhere on the book's jacket, since a tagging image might sell as many bullets as books. There is a war, after all, being waged against abortion providers. "It doesn't mean I've been a misfit since I was two years old, it doesn't mean I got a graduate degree in another county, that I couldn't find another job and so I did this because there was nothing better to do. It was a really conscious philosophical, political, and medical decision to do this work."Harvard educated, Dr. Poppema was a family doctor for 10 years before she specialized. Early on in her days at the abortion clinic, some doctors in Everett called her husband, who is also a doctor, to see if he could persuade her to stop. Her husband had a good laugh and told them that he supported her, and even if he didn't they were barking up the wrong tree. She wasn't the kind of wife to be bossed; she was a partner.Her family doctoring days convinced her of her calling; she spent much of that time helping patients fight problems related to unhappy childhoods. "If you come into this world a wanted child you have an absolute leg up on other people, socially, physically, economically. I care enough about kids to think that you deserve to be wanted when you're born, and I respect women enough to believe that they know when they're ready to be good parents. It's why I do what I do."Dr. Poppema has a few groups she'd like to reach with the book. The first are medical students she hopes to convince to follow her path. She'd like them to know that hers is a valuable, valid, and rewarding career."I am able to identify a problem when a patient comes through the door, and most of my patients have the problem solved when they leave. That is so unusual in medicine."She also hopes to reach women who might need an abortion, or those who feel guilty for having had abortions, by explaining, in a very rational way, what happens at her clinic. Aurora Medical Services seems a pleasant place to have an unpleasant procedure. The staff is friendly and engaging. The book's detailed examination of the anti-choice machine effectively strips an emotional issue down to its medical threads, without being distant and clinical.Why I am an Abortion Doctor is most engaging when Poppema rages against that machine of wounded male supremacy. I haven't seen so many questions strung together since I was in college. I love how she wonders why conspiracy wasn't suspected in the not-too-distant rash of murders performed by "pro-life" extremists. I love how she fingers what's really behind the unbabying issue: the sovereignty of women. "What would male America say," she asks, "about a political hierarchy that said men must -- or must not -- father children under given circumstances?""Haven't Pat Robertson or Pat Buchanan or Phil Gramm ever -- maybe just once -- withdrawn during intercourse to avoid pregnancies?" This is my favorite question.The book is weakest when Poppema takes politics to a personal level and describes her own mistakes. I didn't need to know she ignored a pregnancy of her own for five months, and then, realizing her condition, decided to abort. She claims in the book that this experience helped her understand the various circumstances of her current patients, but her confession inspired my doubt, not my confidence. Also, she seemed guiltily bent on making the reader know why her feminist flower bloomed so late."I always say that we in the pro-choice movement are hampered by truth," was Dr. Poppema's answer to a completely unrelated inquiry. But it works for me as an explanation for these problems I had with the book. Or maybe all books about abortion need a measure of confession, and maybe for Poppema these are the weeds of a repressed Catholicism growing back in the healthy soil of her stoutly thought-out mind.She went to Catholic school for 12 years. Until I met her (and asked) I couldn't believe she could undo that scaffolding. I couldn't believe that she could, with a clean conscience, do work forbidden by the Church. I have a once-Catholic friend who had an abortion. While sedated she begged so hard for God's forgiveness that the staff stopped and asked her if she was sure she wanted the procedure. She said yes, but kept repeating "I am sinning, I am sinning" until it was done.Poppema told me a beautiful story about how she circumnavigated her Catholic soul: When she was seven, the nun she had that year convinced her that if you weren't a Catholic you wouldn't go to heaven. This nun said that lay people could perform baptisms in an emergency, and if you were baptized right before you died, you went straight to heaven. All of Dr. Poppema's friends were Protestants, so she got very worried, and performed emergency baptisms in the swamp.When she proudly told her parents what she'd done, an explanatory dinner discussion ensued. Her parents said there were many different ways to get to God, firmly planting a subversive thought process in her impressionable mind."As I got to be an adult, I thought, I just can't support this religion anymore, I just can't do it. It's too mean to women," she said. "My parents to this day are practicing, go-to-church-every-Sunday Catholics. Very pro-choice. They totally support what I do, except they're afraid for me and my family. But they're not afraid for my soul: they just don't want it to leave my body prematurely."I asked her how afraid she was. In the book she notes that some of the doctors injured and killed were her friends."I'm not walking in fear, but I'm not that far away from it," she said, noting that it's been easier for her and her female colleagues than their male counterparts, who haven't had to fear for their lives in such a way before. "But the work I do is so important that fear is not what will ever change my mind. It's not a good tactic to use with me, because I'm so clear that what I'm doing is absolutely the right thing for me to be doing now."She has a lot of conviction. I was impressed in her book, at the faith she had in the passage of RU 486, or mifepristone. It seems to me that the fight against the "abortion pill" has been so strong so long that the FDA won't let it through their doors without a fuss. Yet that's exactly what Dr. Poppema expects this summer."The FDA is going to accept all the [research and development] work done in France, and they've agreed to accept the best studies from Europe, which is unusual. Reasonable, but unusual. There were no terrible adverse events in the study which we did on 2000 women in this country, so there is very little reason to suspect that it's not going to be recommended."I hope she's right. Use of mifepristone in this country will not only re-privatize the issue of abortion, allowing it to become more of a matter between a woman and her regular doctor and less of an identifiable situation, but FDA approval will also help worldwide distribution."Globally speaking, mifepristone is a life saver," Poppema told me. "In countries where abortions are illegal, many times the wards where women are being treated for the complications of illegal abortions are places where women get arrested. The cops come through and read the reason for admission and read the reason, botched abortion, and as soon as they're better, they're arrested."Mifepristone would help, because in the event of complications after an abortion procedure, women will be able to blame their bleeding on miscarriage. In most countries, it's still legal to miscarry.Hopefully, Why I Am an Abortion Doctor will help polish a profession's tarnished image. Dr. Poppema's been interviewed on radio shows nationwide, but only one with a baiting Christian host. Ms. even blurbed it. The first edition of 3000 copies has sold out, and a second run is in the printing. Do the free-thinking world a favor and make your local library order a copy. Then buy one for yourself.

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