The Vasectomy Doctor

by Dr. Andrew Rynne

  And then they all stop dead. The pheasant presumably has stopped running, the pointer goes in to her setting routine once more and Peter gets ready to take his shot. Suddenly the cock pheasant breaks out and he is up and off giving a bit of a crow out of himself, as he gets airborne. We are looking at all of this from the bottom of the field. We see the pheasant take off ten yards in front of Peter. We see him put the gun to his shoulder, see the smoke leave the end of his barrels, hear the two shots go off and see the pheasant fly on untouched. We have all missed easy birds like this before; it is part of the fun. But Peter made it even funnier. Having missed the bird he flings his shotgun onto the ground and starts jumping up and down on it. I don’t think that any of us ever laughed more than we did that winter’s afternoon down in Carlow with the Two Billys and after a good lunch in the Tobanstown Inn.

  * * *

  The summons, when it eventually arrived, demanded my presence in Naas district court on 23 December 1982. At this stage I was receiving quite a lot of ‘free’ legal aid from my good friends in the legal business and some kind of constitutional challenge along the lines of the McGee case was being mooted. If we could have established that Mr Sheridan’s constitutional rights to privacy were being violated then such a course would have the effect of my being acquitted and the law being declared unconstitutional thus killing two birds with the one stone. But since Mr Sheridan was not married at the time this seemed to weaken our case. Anyway, the upshot of the whole thing was that when 23 December came along, we asked for and received an adjournment thus winning a six-month stay of execution.

  Our next outing to Naas district court took place on Monday, 22 June 1983. By this time we had decided that an appeal to the High Court on constitutional grounds was too risky, too expensive and would be too long drawn out. We wanted the law on the sale of condoms to be changed quickly and the best way to achieve that was to run the case and embarrass the government as much as possible. The case was to be heard in front of Justice Johnston and I was to defend myself. The only danger here was that I would be found guilty but given the Probation Act. That, after all, would have been a perfectly reasonable course for Justice Johnston to take given that this was my first offence. Had that happened we would have been left dead in the water and the whole thing would have been a bit of a damp squib. Here again I had a bit of luck on my side.

  The state solicitor Mr Coonan, in the course of his cross-examination of Mr Sheridan, asked him what he wanted the condoms for. This quite extraordinary question caused a titter of laughter to go around the courthouse much to the clear annoyance of Your Honour. Things were going from bad to worse and it was my turn next. The state solicitor then asked me why I thought it necessary to break the law. This set me off on a diatribe on how ridiculous I felt the law was and how it was unworkable and so on. I was just getting into second gear when Justice Johnston abruptly interrupted me asking that I desist immediately and sit down and that he would not have ‘his court’ used by anyone to score political points. And there I was thinking that the courts belonged to the people.

  Clearly very annoyed, which was just how we needed him to be, the judge then asked Mr Coonan what the maximum fine was that he could impose. After a bit of thumb-licking through the statutes the state solicitor came back with the answer that I already knew to be the case: ‘£500, Your Honour.’

  ‘Right,’ says Justice Johnston, ‘£500 it is then or twenty-eight days in prison in default of payment.’

  I could have applauded the judge and the state solicitor right there and then only that I thought it might be churlish to do so. But this was exactly the result that I wanted and Your Honour had played a blinder.

  Outside, in front of several TV and media cameras, I said that I felt it quite extraordinary that a doctor should be fined £500 for practising medicine according to his conscience, that what happened inside the court-room just now was the natural consequences of Mr Haughey’s so-called Irish solution to the Irish problem, that I would continue to sell condoms directly to people where I thought that such action was appropriate and that I would rot in prison before I would pay one penny of a fine that I believed to be wholly unjust – all very bullish stuff.

  At this stage we had the option of leaving it at that, of not appealing against conviction or fine, not paying the fine and putting it up to the state to imprison me. This way I would have been the only doctor ever to be imprisoned for selling a package of ten condoms and embarrassment to the government would have been considerable. But there were a number of potential flaws to this approach. My wife and family were naturally hesitant and apprehensive about it, there was always the danger that some ‘third party’ would pay the fine on my behalf thus killing the whole thing off and in any event we had made our point and enough was enough. Taking all this into consideration the prevailing wisdom was to keep the thing alive and to appeal.

  My final invitation to appear at Naas district court came a few months later and on 7 December of that same year I appeared before Mr Justice Frank Roe on appeal. At this hearing I asked a colleague, Dr Derek Freedman, a consultant in sexually transmitted diseases, to give evidence on my behalf. After a lengthy hearing during which we were given every chance to make our case Judge Roe summed up the whole thing as ‘a storm in a teacup’. By this he meant that if people needed condoms in the evening or over a weekend when the local pharmacy shop might be closed then all they need do was to exercise some restraint and ‘wait until Monday’. He gave me the Probation Act on the grounds that it was my first offence, the fine was lifted and that was that. Nearly all the papers the next day bore headlines based on ‘Wait Until Monday’. Some months later Justice Frank Roe, who was himself a keen amateur jockey, named one of his horses ‘Wait Until Monday’ which showed that the man at least had some sense of humour if not a very profound grasp of human sexual behaviour. The horse did quite well too.

  I had many friends and great support throughout all of this farce. Dr Paddy Leahy and Dr Jim Loughran were both GPs who had pioneered for the kind of human rights that I was now campaigning for many years before I came on the plot. They and many other GP colleagues supported me all the way. The Irish Family Planning Association was incredibly supportive notwithstanding the fact that it would lose out financially in the event of condoms becoming more freely available. To this day I have a drawer full of letters of support from all over Ireland and indeed all over the world. I had my detractors too, of course, but they were in the minority. One lady from Birmingham sent me a package of used condoms asking if this was the kind of filth that I wanted to bring into Ireland.

  In any case what matters is that it worked. Within a few weeks of the Roe hearing the now minister for Health, Barry Desmond, asked for a meeting with us, the directors of the IFPA, to explore our views on his proposed amendments to the Family Planning Act. These were to virtually deregulate the sale of condoms making them freely available through chemists’ shops and vending machines in men’s public toilets. During this meeting I mentioned to the minister that I was on probation for selling a package of condoms. The minister replied that he was fully aware of that fact and that this gave a certain urgency to these proposed new amendments. Within a few weeks they were written into law and that was that.

  What I did through this deliberate act of civil disobedience was to bring about change to Mr Haughey’s Irish solution to an Irish problem and make condoms available to those who wanted them without the need for seeing a doctor. I have no doubt but that these changes would have come along anyway sooner or later. But knowing the nature of these things and the Irish government’s built-in resistance to grasping certain nettles it would have been later rather than sooner.

  * * *

  By this time I had a fairly good family practice built up and I had been brought into the medical card or GMS scheme. By and large I was single-handed which made the going a bit rough at times. Also I was on call for too many nights and weekends and was finding it very difficult to get away. Th
e telephone answering machine I remember was a great invention for the hard-pressed single-handed rural GP. At least now you did not need to have someone sitting by the phone all day. The mobile or cellular phone, when it eventually arrived in 1984, was to revolutionise general practice. Now with a message on the answering machine giving out a mobile number, a doctor on call was relatively free to move about.

  I still missed the hospital work and the better working and paying conditions of Canada. There were far too many demands for unnecessary house calls and it was very difficult to stop people coming to my hall door on a Sunday afternoon and enquiring if I was ‘on duty’. It may have been around this time too that I began to understand the concept of having a ‘vocation’ for general practice. My tolerance for people making unreasonable demands outside of surgery hours was not without limits and I know that I was often impatient with people and their insistence that I respond to their every whim. These stresses too I have no doubt did very little to improve my floundering marriage.

  Many of my colleagues did not share with me this tetchiness or intolerance of people’s unreasonable demands or if they did they never showed it. At some level I envied them and their enormous practices which being nice all the time can bring. At another level though I wondered about their sanity and the quality of their family and personal lives. Doctors are first and foremost fallible human beings with feelings the same as anyone else. Not allowing oneself give vent to those feelings on the basis of being the possessor of a vocation could be positively bad for one’s health.

  To compensate for all of these things of course I had my vasectomy practice within the Irish Family Planning Association and within my own general practice in Clane. The nice thing about doing a vasectomy is that there is a beginning, middle and an end. A lot of the time in general practice this is not the case. An old woman is lonely and fearsome and depressed. She worries about dying and is short of breath. At night in bed her legs feel hot and she has noticed too that she is getting dizzy spells. Her eldest son is an alcoholic, her husband passed away four years ago with lung cancer. She has a pain in her left hand and she has been out of tablets for three days. The consultation has no beginning and certainly no end. Somewhere in there there may be a middle. But this is hard going when you have no vocation.

  If someone comes into my surgery with a broken arm and a deep laceration to the forehead I am brilliant, I know exactly what to do and I will have them all fixed up in a minute. But if the same person should come in with a broken heart I am useless. Do not talk to me either about how awful your marriage is. I have a bad marriage myself and don’t know what to do about it. I must have been the worst marriage counsellor in Ireland. If your marriage were in some difficulty before you discussed it with me, it would be much worse after your visit. My idea of marriage counselling was to blame whichever party was not present during the consultation.

  I also had my writing. At first I wrote a weekly column for the Irish Medical Times and later moved over to writing for the Irish Medical News to which I still contribute regularly. Not only did this bring in an extra few shillings but also more importantly I think they allowed me to vent my feelings on a lot of topics as diverse as abortion, euthanasia, suicide and alternative medicine. Writing to a deadline is a good discipline; it forces one to assemble one’s thoughts in a logical order and demands accuracy and accountability.

  * * *

  Up in Allenwood South a young man is squatted down behind his house trying to have a bowel movement. It is a small house but a neat one. He is surrounded by mushrooms of green milky froth. He is crying and occasionally lets a roar out of him. He is going to die and I can do nothing for him. I am a doctor, he is dying and I can do nothing for him. Young men trying to help him to vomit surround him. I can smell the Paraquat all around this place; its hideous green stain is mixed up with the milk that the squatting man has managed to vomit up.

  How much of it did he take, I want to know. A young woman beside me says that she saw him drink a full cupful. One teaspoonful of Paraquat will kill you and everyone around the squatting man knows that and he knows it too and that is why he is roaring and crying and trying to have a bowel movement and vomit but it is too late. He is staring death straight in the face and death stares grimly back at him. He is already dying and he will be dead within a few days. The Paraquat has now gone into his bloodstream and is making its deadly way to his kidneys and to his liver and to his brain and every organ it touches will be completely destroyed and there will be nothing left. A vacuum. But most importantly of all the Paraquat is going to his lungs and this is where it will do its greatest damage in the shortest space of time. Tomorrow he will have gross pulmonary oedema and respiratory failure, the next day he will be on a respirator and the next day he will be dead because they will switch off the respirator as there is no point in going on.

  Why did the squatting man drink a cupful of Paraquat? He drank it because he had a row with his girlfriend and he wanted to show her. Show her what I never knew.

  * * *

  Running parallel with the condom debacle was the ‘pro-life amendment campaign’. Ever since the pope’s visit to Ireland in 1979 a certain large section of the population had been whipping itself up into a renewed religious fervour and looking for a cause. The subject of abortion seemed like an obvious one. Abortion was already illegal in Ireland at the time but the pro-life amendment people wanted more. They wanted to make it doubly illegal by enshrining – to use their word – into the Irish constitution an amendment that would make any attempt at reversing the law prohibiting abortion unconstitutional. This they told us would copper-fasten – again their word – a prohibition on abortion in Ireland for all time. Thus they said Ireland would become like a shining beacon to the rest of the world as a unique place that respected and cherished all human life from the moment of conception. Others of us pointed out that:

  • Abortion was unfortunately innate to the human species with examples of the practice going back in history for as long as history will take us.

  • That history, including recent Irish history, will show that where there is no access to legal abortion there will be illegal or so-called back-street abortion and baby abandonment.

  • That since we were currently exporting our abortion requirements to England at a rate of 5,000 per year any talk of us being a shining beacon was a tad hypocritical.

  • That there was no place on this earth that had a zero rate of abortion nor any example of any place in the world where abortion was successfully ‘stamped out’.

  The first thing that those of us opposed to the pro-life amendment learned was that if you were against them then that automatically made you anti-life and pro-abortion. It was this kind of smearing that made the whole debate so terribly divisive, vicious and unpleasant. The issues and the way that the debate was constructed were destined to divide families and friends then and for a long time afterwards. Because of my position as chairman of the Irish Family Planning Association and the attention received by my opposition to the Condom Act I was invited to many meetings all around the country to speak on the anti-amendment side.

  It was always a lost cause. People were going to vote yes ‘to save babies’ lives’, yes ‘to keep Ireland abortion free’, yes ‘to life’. The fact that a yes vote did not necessarily mean any of these things was lost and in any case the priest from the altar had asked them to vote ‘yes’ and wasn’t that good enough for anyone? The pro-life people had God on their side and they were firmly dug into the high moral ground. They won by a very comfortable majority but eventually it was to be a hollow victory.

  The eighth amendment to the constitution was passed and it read:

  The state acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.

  Nine years later the inevitable happened. A fourteen-year-old girl becam
e pregnant as a result of rape. Mr Justice Costello granted a High Court injunction preventing her from travelling to the UK for an abortion. This caused a public outcry and the case was appealed to the Supreme Court. There, three days later and by the narrowest of majorities, the injunction was lifted. The judges took the view that in this case there was a substantive risk to the life of the mother since she had threatened suicide and therefore a termination would not be unlawful and she should be allowed to travel. This became known as the X case and it totally undermined the pro-lifers’ Eighth Amendment. So much for enshrining, copper-fastening and beacons of light.

  The situation now is that by Supreme Court precedent abortion in Ireland is not illegal where there is a substantial risk to the life of the mother. But there is no matching legislation and the government has repeatedly said that they have no plans to revisit this most contentious of subjects. The matter stands in abeyance and the numbers of Irish women travelling to the UK every year for abortions has fallen slightly in the last two years. That at least is good news.

  * * *

  I cannot say for sure if this woman is beautiful or not. I suspect that she is beautiful. Her eyes are beautiful, deep brown and almond-shaped. But the rest is hidden. I cannot make out her face because it is hidden behind her boshiya. She is tall and probably slim but I am not sure. Her body is in there somewhere within the voluminous folds of her thobe, which in turn is covered by her large black cloak called an abaya. Her clinical records tell me that fourteen different general practitioners have seen her over the last sixteen months. These notes also tell me that two years ago she lost a six-month-old baby and that more recently her husband has taken a second wife. She is on Valium, 10 mg three times a day. I can feel her pain.

  I am in Saudi Arabia for two months because they will not let us build our hospital back home. The plans are drawn up; the money is in, the company incorporated. Kildare county council have granted permission but a local schoolteacher has appealed against the permission to An Bord Pleanála. This will hold us up for at least another year. It may even scuttle the whole project. The schoolteacher’s objections are ‘constitutional’. Because we foolishly mentioned female sterilisation in our articles of association this objector is now claiming that since the Irish constitution affords protection to the family and since being sterilised is somehow anti-family then the proposed hospital is ‘unconstitutional’. It matters not one bit that this objection is utterly spurious and fallacious. The quality of the objection is not the point. Any objection to An Bord Pleanála at that time had to go through due process and had the effect of delaying development for at least one year.