interest in family practice are asking to be trained. Think of women’s clinics, Planned Parenthood facilities, and doctors who are known to perform abortions—they have
been too easily targeted by the Right-to-Life fanatics. The essential privacy and safety of a woman’s right to choose could best be provided by her family doctor.
There is an influential group of young people called Medical Students for Choice. They have over four thousand medical students and residents on their database.
Imagine the impact on access to abortion services if even half of these students and residents became abortion providers. Even a quarter would help.
Meanwhile, a self-described Right-to-Lifer approached me in a bookstore where I was signing copies of my ninth
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novel, A Widow for One Year. She didn’t want my auto-graph. She’d come to the bookstore with her own
agenda—namely, to tell me that I misunderstood the
Right-to-Life movement. “We just want people to be responsible for their children,” she told me, giving my hand a little pat.
I patted her hand right back. I said to her what Dr. Larch says in The Cider House Rules: “If you expect people to be responsible for their children, you have to give them the right to choose whether or not to have children.”
I could see in her eyes that her resolute belief was undi-minished. She swept out of the bookstore, not pausing to look at another human face—or at a book.
The young man who stood next in line told me that
she’d cut in front of him; doubtless her zeal to impart her message was incompatible with the very idea of waiting in line.
In my opinion, it’s not that the decision to have a child or have an abortion is ever not complicated; rather, it is as morally complex (and often conflicted) a decision as any.
It’s never simple. But people who want to legislate that decision—in effect, to make that decision for someone else—are simply wrong.
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n the novel of The Cider House Rules, I transcribed more than one of my grandfather’s stories; I gave several of his Iactual patients to either Homer Wells or Dr.Larch.In the screenplay, I gave Dr. Irving’s case of the woman with the disintegrating organs to both Homer and Larch.
In real life, my grandfather’s patient was a woman hemorrhaging within her abdomen; the name Grandfather
gave her was Ellen Bean. Dr. Irving immediately operated and saw that the hemorrhage issued from a six-inch rupture in the back of her uterus. He performed a cesarean section and delivered a stillborn child. But when he tried to sew up Ellen Bean’s uterus, his stitches pulled through the tissue, which was the texture of a soft cheese. He had no choice; he had to remove her uterus.
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After multiple transfusions, the patient’s condition sta-bilized, but three days later her abdomen again filled with blood. Nor was there any evidence in her strange uterus to explain its disintegrating consistency; even the rupture was a puzzle. There was no scar from a previous cesarean section that could have given way. The placenta could not have weakened the wall of the uterus because the afterbirth had been on the other side of the uterus from the tear. There had been no tumor.
When my grandfather reopened Ellen Bean’s wound,
there was not as much blood as before, but as he sponged the blood away, he perforated the intestine, and when he lifted up the injured loop to close the hole, his fingers passed as easily through the intestine as through gelatin. His patient was, literally, disintegrating. In three days, she died.
The pathologist told my grandfather that the dead
woman had not a trace of vitamin C in her; there was widespread destruction of connective tissue and the tendency to bleed that goes with it. In short, she appeared to have died of scurvy. But Ellen Bean had been a thirty-five-year-old unmarried woman, Dr. Irving knew—not a sailor at sea, deprived of fresh fruits and vegetables.
Then, among the deceased woman’s personal effects,
Grandfather found what he was looking for. An aborticide called French Lunar Solution. In reality it was oil of tansy, which Ellen Bean had taken for so long, and in such
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amounts, that her intestines had lost their ability to absorb vitamin C.
In conclusion, my grandfather wrote of this case: “The pregnant state does not engender in all women the raptur-ous joy traditionally associated with this condition; indeed, there are some who view their future with a sour visage and a jaundiced eye. This much may be assumed from the case of Ellen Bean.”
In the novel of The Cider House Rules, I gave Ellen Bean’s cause of death to the unfortunate Mrs. Eames—“rhymes with screams.” (Mrs. Eames is the prostitute from whom Dr. Larch catches the clap.)
In Mrs. Eames’s day, oil of tansy wasn’t the only aborticide that could kill you. Turpentine was a more common household remedy to an unwanted pregnancy, and women who didn’t want babies in the 1880s and ’90s were also killing themselves with strychnine and oil of rue.
Since in the screenplay, there wasn’t time to develop Larch’s history and his relationship-ending relationship with Mrs. Eames, I gave Mrs. Eames’s disintegrating
uterus to a probable prostitute named Dorothy, and I gave to Homer Wells the correct diagnosis that Dorothy’s condition looked like scurvy.
The Dorothy scene, which inspires the aforementioned
“lengthiest and most bitter argument” between Larch and Homer on the subject of whether Homer is or isn’t a doc-
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tor, was edited out of the film. Lasse called me before I’d seen the rough cut. “Don’t be angry at me,” he said, “but Dorothy is gone.” (Lasse was doubtless correct to assume that, in the future editing of the film, a scene dedicated to solving the mystery of a disintegrating uterus was not a surefire keeper.)
In the novel, Dr. Larch performs his first abortion in South Boston on a thirteen-year-old girl. From that moment on, he is a haunted man; the demand to perform
more and more abortions follows him like a ghost. In Boston, he wouldn’t have lasted long as a hero. (“He detected the dying of conversations upon his entering a room.”) That he ends up in an orphanage hospital in the Maine wilderness means that he can last as a hero, although Larch doesn’t see himself as such. In his voice-over during the film’s opening credits, Larch says, “I think I had hoped to become a hero, but in St. Cloud’s there was no such position.” He’s wrong, of course. Dr. Larch creates the position, not only for himself but for Homer Wells.
In the novel, the description of the condition of Larch’s first abortion patient is from my grandfather’s description of an extremely small woman he called Edith Fletcher; her pelvis was only three and a half inches in diameter. (A pelvis this small is rare.) And the woman Homer Wells saves from puerperal convulsions was based on an actual patient with the fictitious name of Mrs. Mary O’Toole, a
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woman my grandfather saved from a similar eclamptic
condition in 1937.
Dr. Irving’s findings in 1942 were exactly what Dr.
Larch and Homer Wells would have found at St. Cloud’s in the same year. Syphilis, although a great source of agitation to the public-health officials of the da
y, afflicted only 2 percent of the pregnant women in Boston. The incidence of eclamptic convulsions was much higher. The disease developed in 8 percent of the country’s childbearing women.
Thus, in the novel, I felt certain that life in St. Cloud’s would not be complete without one good case of eclamptic convulsions, which would surely have tested Homer’s skills as a physician. Homer more than passes the test; he makes Larch proud of him.
As for abortion, I consulted a 1928 gynecology text-
book by Howard Kelly, the standard work at that time, and assured myself that the term D and C would have been in common use when Larch is training Homer.
The procedure itself is unchanged today. The vaginal area is prepared with an antiseptic solution. The uterus is examined to estimate its size. One hand is placed on the abdominal wall; two or three fingers of the other hand are in the vagina. A vaginal speculum, which looks like a duck’s bill, is inserted in the vagina, allowing the doctor to see the cervix. The cervix is the necklike part of the lower, constricted end of the uterus. The hole in the middle of
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the cervix is the entrance of the uterus. In pregnancy, the cervix is swollen and shiny.
With a series of metal dilators, the cervix is opened to admit entrance of the ovum forceps. These are tongs with which the doctor grabs at what’s inside the uterus. He pulls what he can out.What comes out is called “the products of conception.”
With a curette, the wall of the uterus is scraped clean.
Here is how Homer Wells felt, in the novel, when he
performed the procedure on Rose Rose.
. . . he watched the cervix open until it opened wide enough. He chose the curette of the correct size.After the first one, thought Homer Wells, this might get easier. Because he knew now that he couldn’t play God in the worst sense; if he could operate on Rose Rose, how could he refuse to help a stranger? How could he refuse anyone?
Only a god makes that kind of decision. I’ll just give them what they want, he thought. An orphan or an abortion.
Homer Wells breathed slowly and regularly; the steadi-ness of his hand surprised him. He did not even blink when he felt the curette make contact; he did not divert his eye from witnessing the miracle.
Although he scarcely knew me, I always wanted Grand-
father Irving to be proud of me. In the entirety of the novel
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The Cider House Rules, maybe that passage would have made my grandfather proud. I don’t know. Not in the book but in the movie, I tell myself that Grandfather would have appreciated how Homer Wells makes Mr. Rose be “of use”
while Homer performs the abortion on Rose Rose. (In the film, Homer makes Mr. Rose hold the ether cone over his daughter’s mouth and nose; Mr. Rose also administers the ether, drop by drop.)
You may wonder why it matters to me—namely, what
Dr. Irving might have thought of the novel and the film of The Cider House Rules. But it is not as a famous physician that I remember my grandfather; it is as a writer. Dr. Frederick C. Irving, notwithstanding his considerable medical accomplishments and his overall erudition, loved the lewd and the vulgar. And, one weekend, he gave himself over to an inspired moment of low comedy, in which he expressed that he loved not only the triumphs of obstetrics (over what he called “the relics of barbarism”) but that he also loved mankind at its crudest.
If you can’t love crudeness, how can you truly love
mankind?
With respect to crudeness, here is an interesting point.
Some of the audience who will love the movie of The Cider House Rules will be readers who didn’t love (or even finish) the novel—the principal reason being that they found the novel too crude.
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I love Lasse Hallström’s film of The Cider House Rules, but all of the novel’s crude moments are missing from the movie. And don’t you suppose that in any story about life in a Maine orphanage earlier in this century, especially a story that focuses on the life of an illegal abortionist’s apprentice, there would have been more than a few very crude moments? Somebody’s disintegrating uterus among them.
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n those years when I was writing the novel of The Cider House Rules (1981–1985), I was living in New York ICity—and in a number of rented summer homes in the
Hamptons. Concurrently I rented a house in Vermont and another in Massachusetts. I’m not exaggerating when I say that I imagined most of The Cider House Rules in my car, a white Saab.
But in 1986 I left New York, and I divested myself of the rented houses in Vermont and Massachusetts. By the time I met Janet, my second wife, I was living full-time in a house I’d bought in Sagaponack.
I must have met Phillip Borsos in New York in 1985, or early in ’86, because I already knew him the night I met Janet—she was then my Canadian publisher and she was
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wearing, unforgettably, a pink dress. (She is now my liter-ary agent, in addition to being my wife.) Phillip was at the dinner party which Janet hosted that night. Phillip and I had already begun working on the screenplay of The Cider House Rules. (At the time, I was incapable of even imagining that Phillip would be the first of four directors I would work with on the script—or that the final draft of the screenplay would bear little resemblance to the version he encouraged me to write.)
Coincidentally, Janet and Phillip were friends and had known each other for several years. Coincidences in novels are routinely deplored by book reviewers; yet it has been my observation, from so-called real life, that coinci-dences abound.
Phillip Borsos was a tall man with long, floppy hair. He spoke gently but persuasively, and his extreme kindness concealed a stubbornness of heroic proportions. I say this in admiration: Phillip may have been the most stubborn man I ever knew. His determination to make a movie of The Cider House Rules continued even as he was dying. (Phillip Borsos died of leukemia in 1995; he was forty-two.)
I wrote a dozen or more drafts of the screenplay for Phillip. The first draft was a nine-hour movie. As with any adaptation from a long, plot-driven novel, the problem was what not to keep in the film. Even minor characters come with story lines that are interconnected with the
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main story line. In losing a major minor character, like Melony, I lost part of the main story line, too.
The draft of the Cider House screenplay that Phillip and I liked best was the most radical departure from the novel I have written. Since Phillip’s death, I have revised that script beyond recognition. The screenplay Lasse Hallström and I agreed to shoot, in the fall of 1998, bears a much closer resemblance to the novel than the movie
Phillip Borsos and I wanted to make.
The way Phillip and I worked together endeared him to me, but I doubt that my work habits could have endeared me to Phillip. He would gently try to persuade me to do this or that scene a little differently from the way I had written it, or he would gently suggest that I write a scene I had not yet written; sometimes he would gently recommend losing an entire character (or two or three).
I would always respond the same way. I’d shout at him.
He was pig-headed, he was wrong, he was ruining the
story and trivializing the characters—I said this, and worse, routinely
. Then I’d go home and think about
Phillip’s suggestions. To calm myself, I would often watch a video of Phillip’s wonderful film The Grey Fox.
Eventually I’d sit down and incorporate some of his suggestions into the next draft of the screenplay. Naturally we would repeat the process; it worked the same way, every time. Phillip was pig-headed, but he was rarely wrong.
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While he changed the plot, at times rather recklessly, he never ruined the story—he occasionally made it better—
and, far from trivializing the characters, he often made them stronger.
The draft we finally liked was radical for several reasons, all of them involving choices we had made to truncate the story. By eliminating World War II, we eliminated the need for Dr. Larch to invent a heart defect for Homer Wells (to keep Homer out of the war). By eliminating the triangular love story of Homer and Candy and Wally, we eliminated the passage of time; in the movie Phillip and I wanted to make, Homer leaves the orphanage for three months, the duration of only one apple harvest, not for fifteen years.
By eliminating Candy and Wally, except as a means for Homer to leave St. Cloud’s—he hitches a ride with them after Larch gives Candy an abortion, but he never sees them again after they drive him to the coast—Phillip and I were able to focus on two stories instead of three.
The first story is Homer’s life at the orphanage and his conflict with Dr. Larch; the second is Homer’s contact with the black migrant apple pickers, and his confrontation with Mr. Rose and his pregnant daughter. Instead of Homer falling in love with Candy, Phillip and I decided to have him fall in love with Rose Rose. (What an awful idea that was.) And eliminating Melony meant that Homer
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never has a love life. (He falls in love with Rose Rose, but she never reciprocates.) Homer returns to St. Cloud’s without having had even a brief love affair.
Phillip and I called this “the bleak version.” I may have liked it the best—meaning even better than the version that Lasse Hallström shot—but I’ll never know. Because of how much I love Lasse’s version, I won’t speculate further.