The Republic of T.

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Re-Post: Conscience & Dr. Tiller, Pt. 3

Ed. Note: Jessica Valenti’s post at The Nation alerted me that yesterday was the third anniversary of the assassination of Dr. George Tiller. Valenti asks “What Would George Tiller Do?” about the recent attacks on women’s reproductive freedom.

Today is the third anniversary of Dr. George Tiller’s assassination. On May 31, 2009, Tiller was shot and killed by Scott Roeder while he served as an usher in his Wichita church. Tiller was one of the only abortion providers in the country to provide late-term abortions. He often wore a button that said “Trust Women.”

I wonder, if Dr. Tiller were alive today, what he would think about the unwavering attack against women’s reproductive freedom and bodily integrity—if he could ever of imagined that American women would still not just be fighting for the right to abortion but for birth control. Or that there would be a national debate on whether or not it’s appropriate to call a woman who wants contraception coverage a “prostitute.” I imagine that even for a man who had seen a lot of misogyny in his life, the current climate against women would be shocking.

Three years ago, I reflected upon what George Tiller did for countless women, in a three-part series titled “Conscience & Dr. Tiller,” because, as I wrote at the time, I believed that “Dr. Tiller’s story was really one about a man of conscience.”

I still believe that today. So, in honor of Dr. George Tiller, I am re-posting that series today.

In the previous post, I wrote that neither posthumous abortion rights icon Gerri Santoro or the anonymous nine-year-old raped and impregnated by her father are representative of the women who sought Dr. Tiller’s services, or who seek late-term abortion in general. It’ safe to presume that neither of them wanted to be pregnant, each for her own reasons. Opponents of legalized abortion in all case would have both of them give birth.

There’s no way I know of to come up with exact numbers, but many of the women who sought Dr. Tiller’s services, and who seek late-term abortion in general, seem to be women who very much want to be pregnant, but found out well into their pregnancies that there were severe complications, as Dr. Tiller himself pointed out in a 1991 interview.

In September 1991, after the protests ended, Tiller granted a rare interview, saying he was tired of the rumors circulating about his practice. He said that contrary to the contentions of abortion protesters, he did not perform elective abortions up to birth.

He opened a desk drawer and pulled out a three-ring notebook.

“These are the things we do,” he said, pointing to color snapshots of aborted fetuses. “Hydrocephalus, spina bifida, fused legs, open spine, lethal chromosome abnormality. Nature makes mistakes.”

He flipped the page. “This is the brain coming out of the back of the head. This is a baby that’s allergic to itself. Look at this. There’s all water; no brain whatsoever. The skull’s just completely collapsed. This is a foot coming off the hip. You tell me that if you had one of these, you wouldn’t be devastated.”

Such news would be devastating families, but to a greater degree for some than others, because families differ in their beliefs about such circumstances and what resources — both material and inner resources — they have available
to cope with them. The assumption that every family would or should make the same choices ignores the reality that these decisions are deeply personal, made with great consideration, and based on family’s values. None of them are made lightly, especially at the later stage of pregnancy.

Judith Warner, who shared the story of the nine-year-old rape/incest victim, shares of some of the stories of women who sought Dr. Tiller’s services, along with their anguish, their reasons, and their experience.

One New York mother wrote of having been referred by an obstetrician to Tiller after learning, in her 27th week of pregnancy, that her soon-to-be son was “so very sick” that, once born, he’d have nothing more than “a brief life of respirators, dialysis, surgeries and pain.” In-state doctors refused to perform an abortion.

“The day I drove up to the clinic in Wichita, Kansas, to undergo the procedure that would end the life of my precious son, I also walked into the nightmare of abortion politics. In this world, reality rarely gets through the rhetoric,” wrote another mother, from Texas, of the shouts, graphic posters and protesters’ video camera that greeted her when she came to see Tiller.

This woman apparently arrived during the “Summer of Mercy,” and was probably greeted by scenes like these.

As activist Julie Burke pointed out, because Dr. Tiller was one of only a few doctors in the entire country. Thus many women flew to Kansas, because there were/are so few late-term options for women whose pregnancies have taken a devastating turn. The protestors certainly diligent about making sure these women saw their photographs of fetuses and yelling their slogans and accusations.

But what alternative did they offer these women and their families? What window were they willing to open. When they succeeded in shutting down a clinic, and presumably women who had appointments for procedures that they couldn’t get anywhere else were turned away, did these activists unchain themselves from clinic doors long enough

Mercy for these women and their families was in very short supply.

In 1991 and until his murder, Dr. Tiller was one of the few doctors in this country who performed late-term abortions. Despite what Operation Rescue claimed, none of his clients were ending pregnancies on a whim. None of them wanted to be there.

Each case was a tragedy — a much anticipated child discovered to have only a partially formed head, a baby that was dying in the womb and had to be delivered, a child with medical problems so profound as to be unimaginable, a diagnosis that meant a child’s life outside its mother’s body would be both brief and brutal.

Tiller’s clients often included couples who had been hoping to become parents but had their hearts broken late in pregnancy when they received horrifying medical news about their much-wanted babies.

These people got no mercy from Operation Rescue.

They were hounded and harassed, shoved and shouted at on the most heart-breaking day of their lives. In order for patients to make it to their appointments, clinic supporters had to coordinate each woman’s arrival with walkie-talkies. They shielded the patient by forming a flying wedge of bodies that rushed through the crowd to escort her into the building.

I watched one woman sobbing as she and her husband were helped into the clinic. Her tears went unnoticed by the hundreds of protestors surrounding her who shrieked and wailed and tried to trip the people escorting her to the door.

I was in college by the time the “Summer of Mercy” happened, and I volunteered for clinic defense. (I wanted to serve as an escort, but they had more than enough. So I helped keep the clinic doors from being blocked or chained-up, etc.) By then, I’d known women who’d faced this decision, and I couldn’t imagine them facing these people in the middle of an already heart-rending situation. I knew if they did, I’d want someone to be there to make sure they were safe and not turned away. So, I decided to be one of those someones.

We didn’t have nearly the number of protestors that Wichita got, but the few women who came to the clinic that day were as glad to see us as they were upset to see the protestors. We shielded them to the degree possible, and made sure they got safely through the door.

I didn’t know their individual stories, but I guess they were like many of the women whose abortions are among the 1.1% that happen after nine weeks. Some were probably facing the kind of circumstances described by a medical student who — despite an anti-choice upbringing — will likely provide abortion services.

As I continue my education, my views on abortion are still evolving. Take late-term abortions. When I first heard about them, I was horrified. I remember the flyer I saw at a pro-life event that described the procedure: It claimed that when the baby’s head emerges, the doctor jabs a pair of scissors into the back of its neck, severing the spinal cord. Even after I became pro-choice, this crossed a line for me. But later, I learned that this description was misleading and graphically politicized.

It wasn’t until I spent time in ultrasound rooms during a research job in graduate school that I began to see late-trimester abortions in a very different light. In one case, the patient’s baby had just been diagnosed with a lethal congenital anomaly. The high likelihood was that it wouldn’t survive after birth for more than a few minutes. As long as the baby remained in her mother’s womb, however, she would live. I asked the physician what this woman’s options were. The answer was, not many. She could choose to continue the pregnancy, but then she might be waiting for almost 20 more weeks to give birth to a baby that would never take more than a few breaths on its own. She was past the point where she could legally terminate the pregnancy in Alabama. If she could get an appointment in Atlanta within the next week, she might be able to have the procedure there. Beyond that, there were only a few physicians in the nation who would perform an abortion in such a case.

I could hardly wrap my mind around the agony that this woman and her husband must have been facing. They needed a caring and compassionate physician to help them through this dark moment, and if they chose not to continue the pregnancy, they also needed a physician who was both skilled enough and brave enough to provide them with the care they needed. They needed Dr. Tiller.

They may have needed Dr. Tiller, but they won’t find him now. That option has been taken away. But for some families, Dr. Tiller was there when they needed him — and when almost no one else had the courage to be.

He was there for a family whose unborn daughter had severe genetic abnormalities.

I was almost 26 weeks. I showed up for my ultrasound by myself. I was scanned for almost 2 hours. This is when my life forever changed. The scan showed that her little brain was severely calcified, parts were not symmetrical and there was fluid. The doctor took me into a room to talk to me. I told her “please just tell me the truth I need to know.” The Doctor said that she had no idea what this meant but that she felt something was terribly wrong. Within two weeks her brain had gone from “normal” to massive problems. I was sent up to Genetics. The counselor told me that the genetic doctor wanted to talk to me. I requested that they wait until my husband got there. The conversation with this doctor was the same, she felt that something was terribly wrong, but they had no idea what it was. “This looks like the tip of the iceberg” we were told.

…Friday we had to go and talk with some perinatologists. They told us that they had never seen this before and that they could not tell us what the outcome would be. We did not even get a percentage of what her life would be like. They told us that she possibly could die in utero, die shortly after birth, or be a vegetable. They told us that we could wait another two weeks and have another scan and possibly an MRI. How could I go on another day? It killed me to feel her move around inside. This was so awful.

We had another appointment with the doctor that performed the terminations. We were told that with my conditions and the lateness of the pregnancy he did not feel he could give me the care that I required. That’s when we were referred to the Women’s Clinic in Wichita, Kansas.

I was 27 weeks by this point. I was terrified. The moment I met the doctor, all of that ended. He was a wonderful and loving man. I came in on Monday and gave birth to our baby girl on Friday. We were able to hold her after, and say our goodbyes. That doctor will always be in my heart.

Thanks to Scott Roeder, Dr. Tiller won’t be there for the next family like this one. If the opponents of legal abortion have their way, families like this one won’t have anywhere else to turn, except the delivery room several more weeks after learning the sad news.

Dr. Tiller was there for another woman whose child’s brittle bones would have meant a short and painful life.

When Susan Fitzgerald went in for a routine ultrasound near the end of her pregnancy, she was expecting good news. Instead, she was stunned to learn that the fetus had a rare condition that left his bones so brittle he would live less than a day.

“It was unbelievable,” Fitzgerald said. “You think by the third trimester you’re home free. It was devastating.”

Desperate to end the pregnancy, she flew from her home in New England to Wichita, where George Tiller was one of the few doctors in the country willing to perform an abortion so late in a pregnancy.

“It was very difficult, but I knew it was the most humane thing I could do for my baby,” Fitzgerald said. “It was absolutely the right thing to do. I’m just so grateful that Dr. Tiller was there for me.”

Her story is one of dozens that have surfaced in the past week during candlelight vigils, at memorials and on blog postings since the shooting death of Tiller. An antiabortion activist has been charged in his slaying.

Thanks to Scott Roeder, Dr. Tiller won’t be there for the next family who wants to spare their child a short life mostly filled with pain — which can be seen as an act of conscience. If the opponents of legal abortion have their way, families like this one won’t have any other option except a painful delivery (that would likely break bones in the process) and watching their child suffer.

As one choice activist said, many of the women who sought Dr. Tiller’s help had “no good choices” before them.

“What made Dr. Tiller unusual was that he specialized in seeing women who found out late in very wanted pregnancies that they were carrying fetuses with anomalies that were incompatible with life,” Saporta said. “For them, there was really no good choice. They needed to terminate their pregnancies to protect their own health, and he provided both the emotional and physical care for women in that situation.”

Abortion opponents condemn the procedures, regardless of the circumstances.

Even prior to Dr. Tiller’s murder, the threat of violence (made real by the the history of violence against abortion providers and even their staff) served to narrow the options available to women whose pregnancies took devastating turns in the late-term. As one Texas women who traveled to Dr. Tiller’s clinic wrote, it can mean there’s not a doctor in a state as big as Texas who can help her or is willing to help her if it means the possibility of publicity, protests, violence, and even death.

Another woman wrote about how few options Maryland — my own state — offered.

When they told us what kind of life our baby girl had in store for her it was like a bad dream. She would most likely not survive natural labor and would have to be delivered via C-section at John Hopkins. She would be blue from lack of oxygen and would have had to be immediately hooked to life support. She would have required a minimum of three surgeries to even enable her to take her first breath. After the surgeries her lungs would have still only been at a quarter of normal capacity and she would have been brain damaged from the lack of oxygen.

They were not sure how long she would live after the surgeries. One week, one year or five years. The only thing that was certain is that she would have had a very short life that would have been spent in and out of hospitals. I did not want to put my Emilee through the torture of surgeries, constant hospital visits and (if she made it long enough to walk) to watch her sister run and play from the window because that is something she would never be able to do. I also could not put my other daughter, Kacey, through being constantly thought of second because we had a child fighting for her life only to have her taken away at a young age. So we did what we thought was the only way our baby would be at peace. We decided not to proceed with the pregnancy. I was 24 weeks when I was seen at John Hopkins.

This is when I felt that my state turned its back on my family and me. Maryland does not allow any late-term terminations for poor prenatal diagnosis. My high-risk doctor tried to have it brought before the ethics committee at John Hopkins but because this was not genetic, just a fluke of nature, they would not even consider it.

I had to fly to Kansas to have the procedure done. It was a five-day out patient procedure that cost us almost $9,000 after all was said and done. I am hurt and angry at the state of Maryland for taking away my right to allow my daughter to die in peace. I loved and wanted my baby very much. I loved her so much that I would rather her go back to God than suffer for even one day. I was appalled that Maryland did not have a quality-of-life addendum to the late-term termination law.

It can be make doctors reluctant to tell women the truth about their pregnancies, because of the unavailability of resources, and the threat of violence, as one doctor pointed out.

Many are performed in cases such as Fitzgerald’s, where a major abnormality in the fetus is discovered late, Saporta and others said.

“The latest patient was a case where the fetus had no brain at all, would never take a breath on its own. That was probably just a few weeks before delivery,” said LeRoy Carhart, a Bellevue, Neb., doctor who worked with Tiller, in an interview this week. “Her doctor knew the problem all along but just never told her.”

Another woman, who didn’t have access to Dr. Tiller’s clinic, found her options severely narrowed when, late into her pregnancy, her fetus died inside of her

I could see my baby’s amazing and perfect spine, a precise, pebbled curl of vertebrae. His little round skull. The curve of his nose. I could even see his small leg floating slowly through my uterus.

My doctor came in a moment later, slid the ultrasound sensor around my growing, round belly and put her hand on my shoulder. “It’s not alive,” she said.

She turned her back to me and started taking notes. I looked at the wall, breathing deeply, trying not to cry.

I can make it through this, I thought. I can handle this.

I didn’t know I was about to become a pariah.

As it turns out, even in her predicament — when there is no longer life in her womb — cannot find a doctor or a facility willing to remove a dead body from her womb, even though it is something utterly legal.

So much of her account is so compelling that to quote all the parts I’d like to would mean reprinting the article. But she did indeed become a pariah.

Her doctor told her that Dilation & Extraction (D&E) was all but unavailable in her community.

My doctor turned around and faced me. She told me that because dilation and evacuation is rarely offered in my community, I could opt instead to chemically induce labor over several days and then deliver the little body at my local maternity ward. “It’s up to you,” she said.

I’d been through labor and delivery three times before, with great joy as well as pain, and the notion of going through that profound experience only to deliver a dead fetus (whose skin was already starting to slough off, whose skull might be collapsing) was horrifying.

I also did some research, spoke with friends who were obstetricians and gynecologists, and quickly learned this: Study after study shows D&Es are safer than labor and delivery. Women who had D&Es were far less likely to have bleeding requiring transfusion, infection requiring intravenous antibiotics, organ injuries requiring additional surgery or cervical laceration requiring repair and hospital readmission.

A review of 300 second- trimester abortions published in 2002 in the American Journal of Obstetrics & Gynecology found that 29 percent of women who went through labor and delivery had complications, compared with just 4 percent of those who had D&Es.

The only local option was to induce labor over several days; a longer, more painful procedure.

In a labor induction, the doctor administers a feticidal agent, and the patient delivers the fetus down the birth canal. This procedure is longer, more painful, and far more emotionally taxing than a normal delivery, and it gets worse as the pregnancy progresses. While most hospitals can perform the procedure, many referred their late-term patients to Tiller because of his experience in treating the emotional and physical strain. Tiller also pioneered an outpatient induction technique.

A specialist in another county couldn’t take her for a week. So, she waited. Within a day, the bleeding started. The waiting — punctuated by worried phone calls to her doctor, and area medical centers — continued too.

On my fourth morning, with the bleeding and cramping increasing, I couldn’t wait any more. I called my doctor and was told that since I wasn’t hemorrhaging, I should not come in. Her partner, on call, pedantically explained that women can safely lose a lot of blood, even during a routine period.

I began calling labor and delivery units at the top five medical centers in my area. I told them I had been 19 weeks along. The baby is dead. I’m bleeding, I said. I’m scheduled for a D&E in a few days. If I come in right now, what could you do for me, I asked.

Don’t come in, they told me again and again. “Go to your emergency room if you are hemorrhaging to avoid bleeding to death. No one here can do a D&E today, and unless you’re really in active labor you’re safer to wait.”

The waiting continued. She was turned away from a teaching hospital, after being told to come into their emergency room. She sat shivering on an examination table, wondering “what I had done wrong,” and finally went to a hotel near the hospital (because the 45 minute drive home might be too much) to wait, and bleed, and wait.

Finally, her son was “born.”

The next few days were a blur of lumpy motel beds, telephone calls to doctors, cramps. The pre-examination for my D&E finally arrived. First, the hospital required me to sign a legal form consenting to terminate the pregnancy. Then they explained I could, at no cost, have the remains incinerated by the hospital pathology department as medical waste, or for a fee have them taken to a funeral home for burial or cremation.

They inserted sticks of seaweed into my cervix and told me to go home for the night. A few hours later — when the contractions were regular, strong and frequent — I knew we needed to get to the hospital. “The patient appeared to be in active labor,” say my charts, “and I explained this to the patient and offered her pain medication for vaginal delivery.”

According to the charts, I was “adamant” in demanding a D&E. I remember that I definitely wanted the surgical procedure that was the safest option. One hour later, just as an anesthesiologist was slipping me into unconsciousness, I had the D&E and a little body, my little boy, slipped out.

Around his neck, three times and very tight, was the umbilical cord, source of his life, cause of his death.

This woman, arguably, needed Dr. Tiller or another doctor with his courage to take a stand on conscience. That she had to go through what had to be a frightening extended wait, and could not even get a dead fetus legally removed from womb via D&E (no state, yet, requires a woman to carry a dead fetus inside of her until her body naturally tries to expel it), speaks to the absurd reality of late-term abortion and woman’s health.

No, almost no opponent of legal abortion would look at her situation and declare that the fetus inside of her must be “born,” but some of those same people — the Scott Roeders’ of the movement — and those who aide and/or support them effectively removed any other options except the most painful.

Even an array of painful choices still offers an opportunity for a woman and her family to chose the one that is right for them. One choice, and one choice only, is really no choice at all. Even when the procedure sought is utterly legal, almost no doctor is willing to risk helping many of the women whose stories are featured in this post.

Few of them want to be the next George Tiller, though recently a Nebraska doctor has announced plans to continue George Tiller’s work in Kansas. Provided he is able to do so, and for as long as he is able to do so, George Tiller’s stand on conscience will continue to mean women in desperate situations will find a window open where the opposition has sealed off nearly every exit.

That’s the other absurdity. Recently, in recent years, refusing to help women in situations like those above was elevated to the level of conscience. Refusing to help someone, and turning them away to continue suffering became an act of conscience defended by no less than the president himself, who attempted to enshrine it in law.

Not helping became the moral thing to do.

Opponents of legal abortion filled the airwaves and spilled lots of ink expressing sympathy and support for doctors who objected morally to helping women like those above. They, actually, became the victims of the abortion debate. Not women like those above, some of whom were “adamant” about getting the help they needed.

But what did they offer, and what do they offer, to these women? What option? What relief?

It’s been written that the opponents of legal abortion “lost their moral stand” with Dr. Tiller’s murder.

So far, we know little about the suspect, other than that he was driving a blue Ford when the cops stopped him outside Gardner.

However, the motive for the crime we can all surmise, given the vitriolic rhetoric aimed at Tiller these past couple of decades by anti-abortion activists.

And if we’re right about that, then we know the identities of his accomplices.

They include everyone who has ever called Tiller’s late-term abortion clinic a murder mill.

Whoever called Tiller “Tiller the Killer.”

Groups that fomented hate toward a man who, rightly or wrongly, believed he was serving a noble purpose by being one of the few doctors in the country who performed late-term abortions.

Hate. Not heated opposition. Not strong disagreement.

But blind hatred.

The kind of hate that would prompt some maniac to take a gun into a church and shoot a man to death in front of friends and family.

But perhaps they lost it long ago, failing to offer the women who came to Tiller’s clinic help, but instead a taste of the hatred directed at the man who continued his father’s work to help women in desperate circumstances, despite their belligerence, bombs, bullets, and bullhorns.

It would require another post to take into consideration that many of those so adamantly opposed to these women receiving the help Tiller offered, are the same people who will attempt to ban reality-based (read, not “abstinence-only”) sex education, restrict access to contraception, and oppose funding almost any social program that might help women who chose birth and parenthood. But suffice it to say, they will frame it all as a matter of conscience.

It’s clear who stood on conscience and who — even in death — stands taller than those cheer his death and yet don’t extend a hand to those women they continue to deny help through any means they deem necessary.

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