The following column is the opinion and analysis of the writer.
It was in the wee hours of a brittle winter morning in 1969, during the first year of my four-year residency in OB-GYN at a large and respected east coast hospital.
I distinctly remember standing beside the bed of a desperately ill 15-16 year-old girl. I’ll call her Mary. She had come into our emergency room in septic shock — an overwhelming systemic infection that was frequently fatal. In spite of all we did to reverse the massive bacterial infection surging through her body, she slipped away. I felt that we had failed her, that I had failed her.
Septic shock follows an ominous pattern: an infection that progresses to sepsis or system-wide disease. In overwhelming cases, this may happen in a few hours. An unnerving characteristic of septic shock is that the patient can be wide awake and aware of what is happening right up to their final breath, unlike other illnesses where the patient lapses into a coma before death. I vividly remember holding this young woman’ hand as she died of septic shock — with her eyes wide open.
There were many women who lived, but lost their ability to bear children.
And there were too many like Mary who lost their lives.
This tragedy and dozens like it have played over and over in my mind throughout my life, even now, retired at the age of 78.
It is time to tell their stories. Our society must not lose sight of what women, doctors and lawmakers faced before Roe v. Wade.
During my residency, we rotated through Philadelphia General Hospital. When we were on call, we’d be summoned to the emergency department an average of one to three times every night to attend to young women who were in the throes of abortion.
Some of these were spontaneous. Most were induced abortions, where some device had been inserted into the woman’s uterus to start the process of aborting. We’d start intravenous fluids, administer IV antibiotics and surgically complete the removal of any tissue remaining in the uterus. This was a surgery called dilation and curettage, or D&C.
One teenager told me she was trying to terminate an unwanted pregnancy. Once she was stable and on the ward, I called the Philadelphia Police Department and told them I had a patient who had just had an induced abortion. Officers came to interview the teenager while I waited outside the ward feeling uneasy about my action, but I was convinced if they could arrest the person who had violated this woman, at least some of the backstreet abortions in the city would be stopped.
When the detectives came out of the room I said, “I guess we caught one of the abortionists tonight.” The detective shook his head and said that the patient would not press charges. I was stunned. That was when I began to realize that the issue was more complex than I had understood. These women were desperate to terminate their unwanted pregnancies and, given that the law offered them no recourse, they were forced to turn to the underground.
As the years passed, those of us who took care of patients with complications from induced abortions became all too aware of this situation. It was well-known in Philadelphia that there was a woman in Baltimore who provided abortions.
Some backstreet abortionists used “slippery elm” — slivers of bark of a tree that were inserted into the cervix to open the uterus and begin the process. (“Slippery elm”, so-called because it becomes slippery when wet.) It was not sterile and was often contaminated with the clostridium perfringens bacteria, which causes gas gangrene, a common and ominous surgical finding.
The woman in Baltimore told her patients that if they ran into difficulty (fever, heavy bleeding, severe pain, etc.) they should go to the emergency department at the Hospital of the University of Pennsylvania, where they would receive excellent care. That was my hospital.
A ruse used by some women was to insert potassium permanganate in tablet form high in the vagina, where its caustic properties would cause bloody erosion of tissue. The examining doctor would get the impression that the woman was spontaneously miscarrying and perform a D&C to stop the bleeding, thereby terminating the pregnancy.
I can’t tell you how many young women I operated on, either alone or as the primary or assistant surgeon, to remove their infected reproductive organs.
In the early 1970s, a group from the Clergy Council of Philadelphia banded together to transport women wanting to terminate their pregnancy across the state line into New York, where abortion had been legalized. They hoped to decrease the number of abortion complications and deaths.
During that time, I became more and more distressed that those of us in health care, especially women’s care, were turning our backs on women who needed to abort a pregnancy, forcing them to backstreet abortions that all too often resulted in bodily harm — or death. That’s when I made the decision to learn how to safely perform termination of pregnancy. I was committed to providing access to safe abortion for women who wanted it.
Given the current anti-abortion movement in our country, I believe we must tell the story of the reality before Roe v. Wade. We cannot let the painful lessons of that time slip through our hands. It was a discouraging and difficult time for all who lived through it ... and social change back then was difficult, but I am honored to have been a part of that change.
In today’s climate, we cannot sit back silently. We need to remember these women and the harsh realities of pre-Roe times. We must work toward the permanent provision of access to safe abortion services, because choice matters.
Dr. Palmer C. Evans is a Life Fellow at the American College of Obstetricians and Gynecologists.
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