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Cruel to be kind
In the twilight of his career, a late-term-abortion doctor tells all

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. Thatís the one question he canít 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 partial deafness. "She is the cutest little girl you ever saw. She is not a woman; she is a child."

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, whoís been performing abortions since the practice became legal, has a right to his opinions and isnít 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 fewer than half of that number each week. After 30 years, Rashbaum still doesnít 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. Itís 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 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," says 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 womanís life or health), the risk to the patient increases, even with the preferred method for second-trimester abortions ó 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 womanís uterus, where he canít see what theyíre doing, to make sure they are as nervous as he is. "Itís 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 donít want to do second-trimester abortions. What troubles them is that as a pregnancy progresses, the fetus increasingly resembles a baby. This is also what troubled Congress, which passed a ban on "partial-birth" abortions (a term left purposefully vague but that could be interpreted to comprise all D&Es, including the rarely used dilation-and-extraction method, in which the skull is collapsed in utero and the fetus removed intact). Rashbaum, like many in his field, is furious about the law. "It is the stupidest thing I have ever heard of, outlawing a safe operation," he says. "The passage of this bill reflects the ridiculous extreme of conservatism as represented by our current administration and president." Since President Bush signed the legislation in early November, marking the first federal prohibition on abortion practice since Roe v. Wade legalized the procedure in 1973, three lawsuits filed by pro-choice organizations and physicians in San Francisco, New York City, and Nebraska have cropped up challenging the ban. All three courts granted temporary restraining orders to stop the enforcement of the law, but the Department of Justice is seeking to put it into effect as quickly as possible. Trials are expected to begin in all three cases next spring.

The procedure is gruesome, as anyone who has seen it, including Rashbaum, will attest. 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 motherís uterus, ignoring the attending staffís whispers of horror ó "Itís twins. Itís twins" ó 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 heís around to do a job they donít want. "A person who is more concerned with what people think of him than of doing the right thing wouldnít 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 wonít talk to them directly because, he explains, "I donít 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."

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Issue Date: December 5 - 11, 2003
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