A Day in the Life

01.22.13

Inside an Oklahoma Abortion Clinic

A husband and wife have provided abortions for 40 years in a state with tight restrictions and few providers. Allison Yarrow spends a day with them at their clinic.

Norman, Okla.—Angie is here at the office of Dr. Larry Burns for an abortion because she doesn’t want to be a mother at 21. Her sister went that route, having a son after being expelled from high school, and Angie, a pretty black psychology major who says she’s the family’s “golden child,” can’t “mess up.” She intends to be first in her family to complete college, to become a doctor treating soldiers suffering from PTSD.

Burns and his wife, Debby, who also manages the office, “rise with the chickens,” as Debby puts it, to open their abortion clinic in Norman, Okla., at 7 a.m. four days a week.

I’ve made the three-hour drive south from Wichita, Ks. on I-135, which has been traveled by many of the women Burns sees. They make the trek because there is no doctor in the metro area of more than half a million people who performs abortions. The dearth results not from restrictive laws, but from the 2009 murder, in his church’s lobby, of Dr. George Tiller, who provided abortions, including late-term abortions. Before he was fatally shot by anti-abortion protester Scott Roeder, Tiller had survived the bombing of his clinic in 1985, been besieged by protests during Operation Rescue’s 1991 “summer of mercy,” shot in both arms in 1993, and tried and acquitted in 2008 for 19 misdemeanor charges of circumventing the letter of a state law requiring a second opinion before performing an abortion. When he was murdered, the clinic closed and his name still resonates as a cautionary tale about the perils of providing abortions.

Larry and Debby Burns agreed to have me up for the day to their clinic—one of the five about 200 miles from Wichita that are now the closest remaining options for women there. I'll be the first reporter they’ve given such access to in 40 years of practice. Two other clinics who have seen an influx of Wichita women, in Kansas City and Tulsa, declined to have a reporter visit.

While I wasn’t allowed in the room for the procedure itself, Debby introduced me to patients as they arrived, and several agreed to let me spend the day with them (on the condition that their real names would not be used) from arrival and paperwork to ultrasound to medical consultation and then after the abortion was performed in recovery.

Burns sees 14 patients over the day I’m here, with the closest one coming from Oklahoma City, 45 minutes away, and the farthest coming from Oklahoma’s panhandle, some four hours away. On other days, patients arrive from as far off as Texas and Arkansas.

Angie rises from a chair in the brick waiting room, which features a skylight, a large fountain, and Oklahoma Sooner football memorabilia and fills fast with women like her who are here to end unplanned first-trimester pregnancies. She drove nearly two hours from Stillwater for her second abortion, and is relieved to see so many other women waiting, some with husbands or boyfriends or friends, and others alone like her.

“I like looking around and feeling like I’m not the only one having an abortion,” she says, stuffing her hands in the pockets of a coat with a fur hood. She knows the father, a classmate, who gave her most of the money she’ll use today, and half-heartedly offered to drive her. She lied to him that she had a driver. Angie says she has it together, unlike friends. “I write who I have sex with and the days in a calendar,” she says. “I’m not a Maury show.”

Burns, a 68-year-old father and grandfather with gray hair and kind eyes, has been practicing what’s been called both one of the safest and one of most controversial surgeries for 40 years, since 1973’s Roe. v Wade decision changed the legal abortion landscape. One of the state’s first legal clinics, in Tulsa, needed an anesthesiologist, which is what Burns was training to do, and he learned to perform the procedure while working there.

After a few months, Burns left to open his own clinic, where he performs about 2,000 procedures a year, a sizable share of the procedures in Oklahoma (nearly 6,500 total in 2009, according to the Centers for Disease Control and Prevention). It’s one of just three remaining in Oklahoma, which has in recent years passed many laws curtailing access.

Getting pregnant, or, rather, having sex is “just like driving a car,” Burns says as we sit in his office. “You don’t think you’re going to have the wreck, someone else is.”

His office feels like a quaint cabin, its walls adorned with photos of grandkids and shelves adorned with buffalo figurines. He owns a lake house and a motorcycle that he won’t drive more than 50 miles per hour. Next to his desk, which does not have computer on it, swims a frog he grew from a mail-order tadpole.

But despite the comfortable setting, the Burnses are at the frontier. Here in the country’s south prairieland, Burns and his wife are at the abortion-access frontlines, providing care where it is scarce, tightly regulated, and socially stigmatized. “Nobody plans ahead to have an abortion,” Burns says. “You can’t put a pretty face on it. It’s not table talk.”

“I like looking around and feeling like I’m not the only one having an abortion.”

That sentiment spills over to patients. “I thought there would be more cold-hearted people working here,” said Katherine, a 22-year-old mother of two, who had envisioned confronting angry protesters and doctors’ faces obscured by masks, images she says were likely rumors or came from TV. Instead, she says, “they made me feel like what I was doing wasn’t wrong.”

Katherine chose Burns, as did Angie, because of the glowing online reviews he’d received.

As patients arrive, they read and sign a pile of consent forms in the back office where Debby would sit if she had time, but she’s on her feet answering calls from prospective patients on her incessantly ringing iPhone, delivering hugs, crackers and soda cans to women recovering post-procedure, who haven’t eaten since midnight the previous evening. She also reviews patients’ medical histories, escorts them to nurses for ultrasounds and finally offers support during their operations, cooing endearments like “darling” and “sweetheart.”

"Sugar, we’re going to borrow you for a minute," says Debby to Katherine, who descends from Creeks and Choctaws and calls herself a “country girl” who favors deer hunting, fishing, and horseback riding. She slips out of a pink camouflage sweatshirt and into a backless paper gown. A nurse asks her to “scoot her bottom down” and encourages Katherine’s feet into stirrups. “You’re gonna feel the cold jelly,” she says of the lubricated ultrasound wand as Burns enters the room to read the screen. “Don’t want to be pregnant this time?” he asks. Katherine shakes her head. She is 11 weeks along, just a week shy of Burns’s 12-week cutoff, having conceived with an ex-boyfriend. Oklahoma, which bans abortions after 20 weeks, requires those wanting an abortion to wait 24 hours after making an appointment to have the procedure, and to hear about its risks, and be informed of alternatives and of the fact that the person who impregnated them would be responsible for child support. It also requires consent to operate on minors, which doesn’t apply to Katherine, but is a law abortion activists call restrictive but Burns supports.

“I’m just now getting it together with school, work, and paying bills on my own,” says Katherine. “I don’t want to be selfish and keep something I can’t take care of.” The nurse takes Katherine’s temperature and blood pressure, then leaves her to dress and “visit” with the doctor.

Cost is a concern for many women who see Dr. Burns. Oklahoma orders insurance policies not to cover procedures unless the mother’s life is endangered, or a special rider is previously purchased, though Burns points out that the service isn’t one for which people plan ahead. The procedure, anesthesia, and a checkup two weeks after total up to 550 dollars. About one in four women get financial aid from the Roe Fund run by the Oklahoma Religious Coalition for Reproductive Choice and designed to cover abortions for Oklahomans, or other sources that provide aid to pregnant women in need. But most of the clients pay cash, and about one in 10 patients don’t even cover their full bill, according to Debby.

“I’m really soft when it comes to ladies with financial trouble,” she says. “I have a big ear. We usually don’t ask for pay back, it's better to call it ‘we’re giving you a break.’” She also asks friends to donate to the Roe Fund in lieu of Christmas or birthday gifts.

The procedure itself is over in mere minutes, which surprises patients.

“You’ll be sleepy for 9 or 10 minutes, then drowsy for about 5 after,” Burns explains to Katherine in a granddad voice, quiet and raspy. “When you leave here one of three things might happen. You could bleed today, or bleed four or five days from now, or not. None of that is a period. No intercourse for up to two weeks after this procedure. It’s very easy to get pregnant while waiting for a period.”

“Nobody’s making you be here today?” Burns asks, as he must do by law. Katherine says “no.” He recites Oklahoma’s mandated counseling, which the Guttmacher Institute, a health policy organization and reproductive health advocacy group, says is intended to “discourage” women from aborting pregnancies. “I’ve never had anybody die or have brain damage, but those things can happen and I have to tell you that,” he says softly. Katherine nods, unfazed, then leaves with Debby to prep for surgery.

“No chewing gum?” Debby asks. “You pass go!”

“I do what I have to do,” Burns says when I ask about how he decided to deliver the intentionally frightening, if misleading, state-mandated information. “They can’t tell me what tone to do it in. They can go make their laws in Oklahoma City, but I’m going to run my practice the way I want.” As a medical student, Burns had “wanted to do something that mattered, not just coughs and colds,” and first worked in anesthesiology in a friend’s clinic, Oklahoma’s first to give legal abortions, which has since closed. But after about six months Burns knew he wanted his own operation, so he rented space while sketching the dream office he’d build. “I wanted to be able to control the thermostat, the attitudes, and the numbers,” he says, and got his wish.

The space, “specifically designed for first-trimester abortions,” with an exam room, operating suite and four private recovery rooms, opened in February 1974.

Burns, who carries a permitted gun, remembers the protests in the late 70s, and the picketers who chained themselves to his clinic’s gates. He scrapped the gates to solve the disruption. In the early 1990s, as the culture wars heated up, protesters picketed and many were arrested, including Aaron Joe Baker who was later convicted of assault and battery for shoving Debby into the side of a car in the clinic’s parking lot. Today, fallen acorns and holly bushes rim the grounds outside. Burns says the FACE laws, signed by President Bill Clinton, which protect clinic entrances from aggressive antiabortion protesters have helped curb conflicts.

When I arrived, two men stood on a shred of lawn, with signs propped up on the grass by them reading: ABORTION KILLS BABIES. They didn’t even look up as I left my car and walked into the clinic. Burns says two or three protesters do this daily, but that they’re quiet, barely bothering anyone.

In the operating room, Angie and Katherine are given an IV of sodium brevital to speed sleep. Burns dilates the cervix to about 6 millimeters (“the end of a pencil”) and empties the uterus with an aspirator. He then uses an instrument to remove remaining tissue along uterine walls. (Also known as as dilation and curettage, or D&C). He’ll later weigh that tissue for a more accurate pregnancy date.

In recovery, women lie, most often on their sides, knees to stomach, on beds with blue comforters in low light for half an hour or so. Angie is cramping, which she expected, but gushes to me that she loved the nurses. “I walked in and told them ‘don’t be looking at my fanny, and sorry, but I haven’t shaved in weeks.’ They said, ‘girl we haven’t shaved in weeks.’”

Angie didn’t tell her current boyfriend about the pregnancy, or where she was today. Katherine won’t tell her parents, or friends because they are “against it.” Until having her own abortion, she was too, she adds. “I will probably have to make something up about why I’m not pregnant anymore,” she says as she is lying down in recovery, arm cradling her head. She texts the father of her 1 year old and 3 year old to come fetch her, the phone's screen a spider web of cracks.

The Burnses answer calls at all hours. They don’t travel outside the United States lest a patient need immediate care, the farthest they go is Colorado. “It makes sense to stay around because what I can fix, I can do in a few minutes at no charge. With someone else it would cost thousands,” he says. They are tired and both said they had long ago thought for sure they’d have been retired by now, but face considerable pressure to stay open, as they are the only option for many women in the area.

Like many small and rural abortion operations, the future of the Burnses' clinic is uncertain. Their daughter had worked with them until giving birth to her fourth child, and left to take care of her growing family. Neither can imagine just “walking away” without a successor, and none has emerged. Burns admits that even hiring nurses he likes is difficult, let alone a replacement.   

“I’d stop if I could find somebody who does things like I do. Debby is getting tired.”

But for now, they’ll carry on. “When they need me, they need me,” Dr. Burns says of his patients.