The View from the Vue (21 page)

It was only during the late 1960’s that a few states began to relax some of their ultra-restrictive abortion laws, but the major change came in 1973, when the United States Supreme Court ruled that termination of a pregnancy before the seventh month should properly be a matter for private decision by a woman and her physician. This in effect created abortion on request, which in turn brought forth its own associated set of new problems. However, these have been minor in comparison to what went before and, by and large, the law seems to be working well. For instance, last year in New York, not a single maternal death was caused by an illegal abortion. That in itself is a miracle. While I was working at Bellevue, the gynecology ward usually held one or two women whose kidneys and livers had been destroyed by the poisons produced by the bacteria which had been introduced into their reproductive tracts via the filthy instruments of their abortionists. The private hospitals in the city made haste to ship these women to us. Most of them would live for a week or two, and then die of kidney or liver failure. All we could do was to try to keep them and their families as comfortable as possible.

Of course, all the patients who underwent illegal abortion didn’t die. In fact, most criminal abortions proceeded without incident. They’d have had to. Otherwise, since approximately a million illegal abortions were being performed each year, the entire female population of the United States might have been wiped out in fairly short order. During my residency, each day would bring six or ten bleeding women to Bellevue, where we would empty their uteri of residual tissue by dilatation and curettage (or dusting and cleaning, as one patient put it). Then, the next day, the patients would go home, little the worse for wear. Many would be back soon, though. And repeatedly.

Of necessity, any high-volume business runs heavily to the routine, and a good deal of this work was repetitious and not terribly interesting. But Bellevue being Bellevue, what potential existed for variation was expressed to the fullest degree.

One of the residents who trained at The Vue a few years before my time was Dr. Ralph Wynn. Dr. Wynn is presently chairman of the department of obstetrics and gynecology at Abraham Lincoln Medical School in Chicago, and is an internationally known figure in medical education circles. Dr. Wynn’s field of special expertise is the placenta. I once heard him deliver a lecture on the subject, during which he described the episode which had originally triggered his fascination for afterbirths. It seems that one night, when he was a first-year resident, an individual from the parade of incomplete abortions that passed under his care presented him with a chunk of tissue she said she had passed. Being a thorough man, Dr. Wynn examined her, and being a logical man, he was perplexed by the fact that her physical findings indicated the presence of an intact, healthy, early pregnancy. So, being a brilliant man, Dr. Wynn then put a slice of the tissue under his microscope, and with the help of some comparative anatomy textbooks, determined that the tissue was in fact cat placenta. When confronted with the findings, the patient confessed that she had saved the placenta from her cat’s litter earlier that day and had brought it to the hospital in the hope that she’d be able to trick a doctor into emptying her uterus by curettage. By such quirks is the course of history changed. Had someone other than Dr. Wynn been on duty that night, the chances are very good that the lady would have succeeded in her plan. She’d have had her abortion, and a great deal of valuable research on the structure and function of the human placenta might never have been done. Dr. Wynn didn’t say what he had done with the patient after she had confessed. I think he should have aborted her. An original and imaginative effort like that should not have gone unrewarded.

One particular patient that I treated for an incomplete abortion was a Negro woman in her mid-thirties who immediately impressed me as being an unusually cool customer. She sauntered into the GYN examining area, sat down opposite me, and smiled. Her self-assurance took me aback. The usual patient in her condition was wheeled or rolled in, screeching bloody murder. This woman, however, presumably in mid-abortion, promptly made herself at home, and calmly wished me good evening. I began to record her history; she had the usual story of cramps and bleeding during the past several hours. Then I asked her how many children she had had.

“Three,” she answered.

“And have you ever lost a pregnancy before?” I asked her.

“Oh, yes.” She smiled pleasantly. “This is my twentieth.”

I dropped my pen on the desk and stared at her. I was certain that I was in the presence of the world’s champion aborter. Either that or she was trying to fudge her way into the Guinness Book of Records. “How in the devil have you managed to have twenty miscarriages?” I asked.

“No trouble,” she smiled. “This is the first one I’ve ever had to come to the hospital for.”

I smiled smugly. Now I understood. Many women believe that if a menstrual period happens to come a few days late, this represents an early abortion (they may be right, by the way). Since very few women are perfectly regular in their menstrual patterns, I figured that I had just happened to get a compulsive calendar counter. I stopped talking to myself long enough to ask her what seemed different this time that had brought her to the hospital.

“Well, I just couldn’t get it all out.”

The hounds of uncertainty began to gnaw at my hocks. “You couldn’t get all what out?” I asked her.

Now it was her turn to look uncertain. “You
are
a female doctor, aren’t you?” she asked.

I assured her that I was indeed a gynecologist.

“Well, then you ought to know what I mean. I couldn’t get all of the baby and afterbirth out.”

At this point I decided to raise the white flag. I flashed what I hoped was a nice, confidence-inspiring smile, and asked her just how she had tried to get all the baby and the afterbirth out.

“Well, Doctor,” she said. “I used a rat-tail comb. I just stick it up inside there and swish it around and, in a little while, the whole thing comes out, just as neat as you please. But this time I kept on bleeding and having cramps, so I figured there must still be a piece up there.”

“Now come on,” I said. “Do you really expect me to believe that?”

The woman got up from her chair. I thought I had made her angry and that she was going to leave, but she walked into an examining cubicle. As she pulled the curtain, she smiled back at me, and said, “Just a minute, and I’ll show you. You can see for yourself how it works.”

A few minutes later, she bid me enter. A nurse that I had hastily rounded up went in with me. There was the patient, squatting on the floor. Between her feet she had a little round mirror on a stand, focused upward so it gave her a beautiful view of her cervix. From her pocketbook she produced a rat-tail comb and, referring to the image in her mirror, she deftly inserted the rat-tail into her uterus, gave it a couple of lighthearted twirls, and zipped it out. “Okay?” she said, with a faint but definitely observable note of triumph in her voice.

I felt dizzy. Using sterile instruments with the greatest caution, physicians sometimes perforate uteri while performing therapeutic abortions. Yet here was this crazy lady who had done twenty successful procedures on herself with a rat-tail comb, suffering as a complication only one piece of retained placenta. For this, my mother had had to send me to medical school. I lamely asked the lady how she had managed to devise her ingenious technique.

She straightened up. “Oh, I learned it from my momma. She said she must have used it on herself about fifty times. Never missed, either,” she said, and grinned at me. “Momma always said she was gonna use it when she was pregnant with me, but she changed her mind at the last minute. Bet she was sorry sometimes, too.”

I let that go by. “If you’ve got all the kids you want,” I asked her, “why don’t you get your tubes tied?”

Her eyes widened and she said, “My goodness, Doctor, I’m scared silly of having an operation.”

My knees weakened a bit more.

“Besides,” she added, “that might make me lose my nature. And I wouldn’t like that, not one bit.”

It always does my heart good to witness progress in medicine. A new technique is developed and perfected, and then it filters into general medical practice. This evolutionary process may be illustrated by the case of a young Bellevue miss who appeared one evening with an imminent miscarriage at almost the midpoint of her pregnancy. Aside from the fact that there was no way to save the baby, all was well, and the girl herself was in no danger. It was her first pregnancy, and I tried to console her by suggesting that probably things would go better next time. She smiled a little patronizingly at me, and explained that she hadn’t wanted the baby and had had the abortion induced.

I was taken aback at that, and muttered, “Oh, good.” But then it occurred to me that abortions were very difficult to perform and therefore to obtain halfway through pregnancy. So I asked her how she had done it.

She took a deep breath. “Well,” she said, “me an’ my boyfriend—he paid for the abortion—we went to this ol’ lady’s house. She does abortions, y’ know.”

I nodded my head. I knew. Or at least I thought I did. The girl drew in a fresh supply of air and went on. “Well, the ol’ lady said I wuz too far along fer her to put something up me, so she wuz gonna do whut the doctors do. So she put a teaspoon a salt from the table inna glass a water—I tell y’, Doc, I thought she wuz nuts—then she poured it all inna big hypodermic needle,” (she meant syringe) “an’ then she injected it all inna my belly.” For proof, the girl triumphantly showed me the little needle mark on her lower abdomen. “Then, when we left, she said when the pains started, I should come to the hospital. So,” she beamed up at me, “here I am.”

“How much did it cost you?” I whispered.

“Two hundred bucks.”

For a minute I just stood there, quietly gibbering. In 1965, intrauterine injections of salt solutions were just beginning to achieve medical acceptance as a means of terminating pregnancies too far advanced to permit safe dilatation and curettage. Doctors carefully measured out quantities of salt water not considered to be excessive, and with the greatest care and stringent precautions, injected the solutions into pregnant uteri. The reason for the ultra-careful behavior lay in the fact that the infusions had lethal potentialities if the salt were to reach the blood stream too rapidly or if infection happened to be introduced into the uterus. There were also a number of other non-lethal, but still serious, complications. And here, some old woman had scooped salt off her kitchen table and shot it right in—I just couldn’t stand it. “Who was the woman—what was her name?” I barked.

The girl gave me a no-no motion of her index finger. “Hain’t gonna tell yuh that,” she smirked. “You must think I’m pret-ty dumb.”

I was too mad to tell her that I thought in fact that by comparison and for many reasons, she made cretins look like Einsteins. I explained to the girl that although she had come through all right, it was terribly dangerous to inject unsterile salt water willy-nilly into someone’s uterus. I also told her that in no way would she herself be persecuted or prosecuted, but that I was only interested in preventing another girl from being mutilated or killed. No dice. All I got was, “Hain’t gonna tell yuh, so yuh might ez well quit askin’.” So finally I quit askin’.

Very likely, until the 1973 Supreme Court decision, that old midwife somewhere in the wilds of Brooklyn was still pulling in a quick couple of hundred now and then by salting out an occasional baby. The perceptive reader will at once recognize the nature of the evils related to unrestricted abortion statutes: for example, augmentation of the welfare rolls.

The Bellevue clientele utilized an endless variety of techniques in their attempts at abortion. One night, the hospital attendants raced up a three-hundred-or-so-pound woman to GYN. She was screaming like a fire siren: her wail of “Ooooooooooooooooooooooooooh” started low in the bass range, ended in mezzo-soprano, and finally was punctuated with a highly emphatic “Lawd!” Over and over. The nurses quickly stripped her and put her up for examination. One nurse ran out and called me, “Better get in fast, Dr. Karp. She’s got a positive Thom McAn sign.” This meant that the patient’s shoes and feet were covered with blood, thereby indicating the presence of brisk vaginal bleeding. So I trotted into the examining room and introduced myself. As I put in a speculum, a gigantic clot came through it and hit the floor. Now
I
had a positive Thom McAn sign. Then, when I tried to put the speculum back, the lady clamped her enormous thighs together and started her siren going again.

I quickly decided that I was not going to be of much use with my right hand pinned in the patient’s crotch while her continuing hemorrhage trickled down my sleeve into my armpit. So I requested that the lady cease and desist from her vise-like behavior.

“Oooooooooooooo-oh, Doctor—you’se gonna hurt me.”

I assured the woman that I would employ the utmost gentleness and that were she not to release my arm forthwith (a) she would bleed to death, and (b) my hand would fall off. She relaxed.

To the rising and falling of the siren’s wails, I once again tried to begin my examination. And once again a tremendous quantity of blood hit the floor, and the walls began to close in on me from both sides. I gently reminded the patient that that was a no-no, and she managed to relax again. Finally, I was able to spot the source of the bleeding. I was surprised to see it was not coming from the uterus, but from an actively spurting blood vessel at the base of a large crater at the edge of the urethra (the external opening of the urinary system). I walked up to the head of the table and asked my refugee from the Hook and Ladder Brigade what she had put into her vagina.

“Got me some purple pills fum a lady,” she gasped. “Tol’ me to put ’em way inside, in a li’l hole I’d feel.” With that, the patient leaned over the edge of the examining table and vomited on my Thom McAns.

Such was my first professional exposure to potassium permanganate, a chemical that was used fairly often in abortion attempts. Women inserted it into their vaginas, where its corrosive effect produced heavy bleeding. Some of the patients really did believe that the vaginal hemorrhage would eventuate in miscarriage. The better-informed women did it in an attempt to trick a neophyte physician into performing an abortion. They tried to make him believe that the vaginal bleeding was really of uterine origin, and that the doctor would only be completing a miscarriage already begun and fated to continue.