End of the Road
In the twilight of his career, one of the oldest living late-term abortion doctors tells all.
By Rebecca Paley
September/October 2003 Issue
Dr. William Rashbaum, a New York City gynecologist and one of the pre-eminent and longest-practicing providers of second-trimester abortions in the United States, is not known as easygoing, and upon returning from a day of operations he erupts at the question of why one of his patients that afternoon, a 14-year-old rape victim, waited so long for an abortion. That's the one question he can't stand. Witness to myriad women in their most intimate and dire moments, this elderly doctor, dressed in an outfit of khaki pants, bow tie, and red-striped oxford shirt, all reminiscent of a prep-school student, is fiercely protective of those in need of his services and has absolutely no patience for those doubting their motivations. "You want to criticize her?" he barks in a loud voice made louder by a case of partial deafness. "She is the cutest little girl you ever saw. She is not a woman; she is a child."
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Sitting in his small windowless office, chockablock with civic and medical awards, the doctor resembles an absent-minded professor or perhaps a sardonic Christmas elf. His head is crowned by salt-and-pepper locks. Under unruly eyebrows, his eyes quickly vacillate from soft to stern, depending on whether he likes what he hears. At 76, Rashbaum, who's been performing abortions since the practice became legal, has a right to his opinions and isn't afraid of voicing them in stripped-down language more befitting a salty stock trader than a physician at the heart of the most controversial health concern facing women.
At an age when most doctors have long since forgone the operating room and office hours, he has kept up his work, albeit at an understandably slower pace. Where once he did upwards of 25 second-trimester abortions on Saturdays alone, the doctor now performs less than half of that number each week. After 30 years, Rashbaum still doesn't sleep well the nights before his operating days. He frets over the physical welfare of his patients. And his own; some people might want to kill him because of what he does. It's a constant fight and, he says, "I am running out of steam."
TRAINED IN AN ERA when doctors were considered gods, Rashbaum is gruff,
confrontational, and downright abrasive. He flaunts medical conventions at
will, rankling nurses and orderlies, if it serves his needs. When the
orderlies take too long in preparing his operating room between procedures,
he goes in and embarrasses them into efficiency by helping to clean up. He
boasts, "They turn my room over much faster than any other room." First- and
second-year OB/ GYN residents dread his cases. "It was always a fight about
who had to do them," relates a former intern. Cases such as his are
certainly the most technically difficult of all abortions.
As pregnancy moves closer to 24 weeks (the upper legal limit in most states,
with rare exceptions made to preserve a woman's life or health), the risk to
the patient increases, even with the preferred method for second-trimester
abortions-dilation and evacuation, or D&E for short. During the procedure,
in which both vacuum and surgical instruments are
used, the fetus is either removed in pieces or delivered more or less
intact. In the operating room, Rashbaum readily yells at the top of his
lungs at residents working with forceps inside a woman's uterus, where he
can't see what they're doing, to make sure they are as nervous as he is.
"It's not the best way to teach," he admits. "Calm, cool, collected is
better, but a tough screaming is not ineffective."
Technical difficulty, however, is not why many doctors don't want to do
second-trimester abortions. What troubles them-and the lawmakers who've been
trying to ban so-called partial-birth abortions (a term left purposefully
vague but that could be interpreted to comprise all D&Es, including the
rarely [ Rashbaum guesses he has done 21,000 D& E's since the late 1970's
out of boredom, see below*] used dilation and extraction method, in which
the skull is collapsed in utero and the fetus removed intact)-is that as a
pregnancy progresses, the fetus increasingly resembles a baby. The
procedure, as anyone who has seen it, including Rashbaum, will attest, is
gruesome.
One of his former interns remembers watching Rashbaum do a D&E on well-
developed twins one hot summer day.He intently leaned in closely and
methodically pulled piece after piece of the fetuses out of the mother's
uterus, ignoring the attending staff's whispers of horror- "It's twins. It's
twins"-to each other. The intern reacted violently, running home, throwing
up, and asking herself, "Is this right?" Rashbaum pisses people off with his
cranky, despotic ways, but the other doctors are relieved he's around to do
a job they don't want. "A person who is more concerned with what people
think of him than of doing the right thing wouldn't last," says a second-
trimester-abortion provider who trained under Rashbaum.
"He cares more about doing the right thing than what people think of his
personality."
Husbands or boyfriends have been known to barge into his office and
violently insist their baby not be aborted, to which Rashbaum replies with
an equally violent, "Fuck you, Charlie, we can abort her." He won't talk to
them directly because, he explains, "I don't treat men." But as Rashbaum
talks privately to a patient about all the circumstances that
> > brought her to him, he shows another side, one that can sympathetically
navigate highly emotional waters. An unabashed atheist, Rashbaum nonetheless
has compassion for the religious conflicts that arise when women are told by
priests not to have abortions.
Gratitude comes in the form of files that have grown thick over the years
with thank-you notes and birth announcements. Small, elaborate, hastily
scribbled, or formal, the letters have arrived in many forms but all echo a
similar sentiment: Thank you for helping us through the most difficult time
in our lives. "He gets so involved," says Maria Rodriguez, his office
manager of nearly 20 years. "He is always available. Always."
Rashbaum, who has committed himself to offering services to women from all
socioeconomic backgrounds, has seen every kind of problem. Whether it is a
woman having a late abortion because the fetus is severely deformed, or a
young girl who is a victim of incest, he treats all his patients with the
same obsessive care and refrains from judging the reasons they have come to
him. "He takes care of Park Avenue women," says Andrew Tucker, a Florida
gynecologist and former resident under Dr.
Rashbaum. "And he takes care of the Bronx prostitutes."
BORN IN NEW YORK CITY, the youngest of two sons, Rashbaum bounced around a
series of tony private schools, having developed into a smart-ass at an
early age, before shaping up in the Army and then entering New York
University as a premed student. A third- generation gynecologist, he became
a doctor to get close to his autocratic father, Maurice, with
whom he shared an obstetrical practice in New York City from 1956 until> >
his father's retirement in 1981. In their magnificent office overlooking
Central Park, they hosted an annual Macy's Thanksgiving Day Parade party for
the families of the babies they delivered.
Rashbaum trained during a time when domineering men like his father treated
residents like chattel, and in fact his main teacher was his father. While
resident Rashbaum sat conducting vaginal surgery, his father would lean on
him from behind and prompt him, a spectacle that> always drew crowds of
other residents to their operating room. Despite such close attention,
Rashbaum never got what he wanted from his father's approval. "We all need
positive reinforcement," he says, "most
importantly, from the people we care most about."
Before abortion became legal, Rashbaum remembers basement practitioners,
with "one eye on the patient and one eye on the door," who grew so rich from
under-the-table procedures that they didn't know what to do with all their
cash. (One doctor took to buying racehorses.) When New York became the first
state to legalize abortion in 1970, it coincided with Rashbaum's split from
his first wife, with whom he had two children, a son, now 43, and a
daughter, now 45. With the mounting divorce costs, including many therapy
bills, Rashbaum began performing abortions in New York City, which had
quickly become the abortion capital of the country.
The clinic where he worked was open round the clock, with three sets of
doctors and nurses each taking eight-hour shifts. He says, "You would go
home with a goddamn barrel of money."
In the beginning, Rashbaum had problems performing abortions. First, there
were his father's objections. "Growing up, the worst thing my dad could say
about another doctor was he did abortions," he says. Like the other
board-certified doctors who were suddenly doing procedures previously
relegated to back alleys, Rashbaum lacked training in the necessary medical
techniques. "None of us knew what we were doing," he says. "The only people
who knew how to do abortions were the criminals."
Rashbaum and his colleagues practically taught themselves how to perform
abortions and were limited by the crude instruments of those days-Dixie cups
attached to the suction machine by rubber bands.And although Rashbaum felt
he was performing a necessary service, it weighed heavily on his conscience.
He was troubled by a recurring dream of a fetus trying to hold onto the
walls of a uterus by its tiny fingernails. Raised that abortion was wrong,
he reasons, "What kind of dreams do you think you are going to have?"
But in what began as a way to support two households, Rashbaum discovered a
purpose and a mission.[ *]In the late 1970s, bored with his routine, he
began doing second-trimester abortions and has since performed roughly
21,000. His work in late abortions has filled an important need, not only by
providing services to desperate women but also by training other physicians.
He has trained close to 100 doctors to do D&Es, some of whom have gone on to
train others. This unlikely
champion of women's rights still insists on holding doors and slipping
coats on backs. But then a large part of what makes Rashbaum exceptional
stems from stereotypical male traits: He is a workaholic, undaunted by the
threat of violence, and focused on getting the job done.
In emergencies, he has driven patients to the hospital in his own car.Once,
while operating on a woman with severe complications, he passed out from
exhaustion, and as the other doctors were administering an EKG to make sure
he wasn't having a heart attack, he awoke, ripped off the wires, and
returned to save the woman's life. "He is good at taking someone through a
crisis in a very supportive way," says Mary, his second wife, whom he
married 30 years ago. "Bill is a Stander and a doer, not a sitter and a
thinker."
RASHBAUM HAS JUST FINISHED yelling again. This time at the hospital
administrator who is adamant that, under no circumstances whatsoever, is
Rashbaum to allow a reporter to witness a D&E. Not even if the patient has
given her consent. Not even if the hospital where he performs the procedures
is not named. "They're scared as hell," he says.
Back in his office, Rashbaum faces his next crisis: A shaky 29- year-old
mother of two, sitting next to her husband, is set the following day to
abort her 18-week fetus, which is developing without a brain. Visibly
uncomfortable, the Long Island couple begins talking about referrals and
medical history. The petite and pretty blond woman, a black T-shirt
stretched over her bulging stomach, tells Rashbaum it was hard finding a
doctor to end her pregnancy at this stage. He cuts off the measured
discussion, pops in his hearing aid, and launches in: "The first thing I
need to tell you is that you must mourn." The words, or maybe it's the
gravelly voice, act as a cathartic, and the woman begins to cry.
He reassures her that it's okay to be angry. What's happening to her isn't
right or fair. Rashbaum also encourages her to kick her husband in the groin
if at any point he tells her not to cry. Her fears quickly bubble to the
surface. "Am I a freak?" she asks, insisting that she's great at pregnancy,
even forgoing sugarless gum to ensure the health of her unborn child. She
says she knows she couldn't have prevented this abnormality but still asks
if she did something wrong. "Yeah," Rashbaum quips. "You thought bad
thoughts." The woman and her husband laugh nervously, but they're laughing.
There are other fears.
They want to have another child (they have two boys; this was a girl). He
tells them that out of 21,000 late-term abortions he has performed, only 18
women lost the ability to have children. He has also never lost a patient
and says he'll be furious with her if she's the first. Gently, he begins to
describe the procedure. Once he puts the laminaria sticks in, which soften
and dilate the cervix, the abortion will have irrevocably begun. What if I
don't dilate? the patient worries. His eyes twinkling over his reading
glasses, he answers, "I'll slit your throat."
After more nervous laughter, the woman broaches her greatest fears. She's
not sure she wants to know the details. It's difficult to relinquish her
role of protecting a fetus that has grown inside her for four and a half
months. Welling up with tears again, she asks if it will feel pain. She
doesn't want to hear much more. "I just want to make sure you get all of it
out," she pleads. "Don't leave anything in there."
IT'S TOUGH FOR A WORKAHOLIC to slow down. The impediments of age are
inevitably creeping up on Rashbaum, who had a total hip replacement two
years ago, and although he's returned to tennis, the vestiges of a limp
remain. Last spring, doctors removed a chunk of his lung that had a small
cancerous tumor, the result of smoking for 50 years. Even without the hip
and lung problems, his stamina is under assault from the physical rigors of
being an OB/GYN. Although he plans on giving up cases in a year because
"patients don't want an old man," he's hard-pressed to think of what he
enjoys other than working.
There is his garden, where he grows magnificently fragrant and full peonies,
and lettuce that he jokes costs $17 a head, tomatoes $20 a pound. There is
also his collection of antique mechanical banks. Taking after his father,
who finally retired at 88, but only after his last remaining patient died,
Rashbaum confesses that retiring "scares the bejesus out of me."
The past sticks to him. Returning home from the hospital, he finds his
dinner-crispy chicken, rice, pea pods, and salad-waiting on the stove top in
perfectly covered dishes, faithfully prepared by the same housekeeper, Lila,
now in her 80s, who began working for him when his son was six months old.
He lays his drink down on a coaster bearing the insignia of John Jay
College, where his brother Cris was a law professor. The ashes of his
brother, who died last year and was also an atheist, are still in an urn
under his desk because he hasn't yet found a plot. "I had my mother under a
table in my consulting room for about> two years," says Rashbaum with a
laugh.
Other than his wedding band, he counts a watch from a friend who died of
cancer as his most prized possession. He has a hard time letting people go.
He also has a had time letting certain sentiments go. There is a part of
Rashbaum that still needs to justify what he does. Being pro- choice, he
says, is not the same as being pro-abortion. He went into medicine to save
lives and recalls with pride one he saved 25 years ago, a baby he delivered
to a woman in cardiac arrest; both left the hospital alive three days later.
He established one of the first licensed fetal-tissue banks in the country,
collecting pancreases for research that may lead to cures for incurable
diseases. Also extremely controversial, the fetal-tissue bank was Rashbaum's
way of making some good come out of something bad.
His upbringing dictated that doctors don't do abortions, but that is what he
does day in and day out. "He is a lot of people," his wife, Mary, says. "He
is far more complicated than even he knows."
For all the bluster and authority Rashbaum displays when he barrels down a
ward or bellows over an unwieldy phone system, he is a burdened man. With
the majority of surgical abortion providers nearing retirement, and few
doctors willing to practice or even learn the procedures, who will replace
him? With conservative politicians' current assault on abortion practices,
he worries that Roe v. Wade will be overturned. He worries about a return to
the days of back-alley abortions when responsible doctors lacked the skills
to safely end pregnancies. "He has felt sad and discouraged," Mary says. "He
is saddened by things.He is not destroyed by them."
[He already stated he has trained close to 100 OB-GYN's to dismember babies
through D & E's and was quoted as saying: "The only people who knew how to
do abortions were the criminals."]
For the time being, however, he takes solace in being there for a 14-
year-old rape victim and a 29-year-old mother who have nowhere else to turn.
"As long as I can make a contribution," he says, "I enjoy what I do."
She asks if it will feel pain: "I just want to make sure you get all of it
out," she pleads. "Don't leave anything in there."
Copyright Foundation for National Progress Sep/Oct 2003