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A decision she hated to make but has never since doubted

NCR Staff

When Sophie Horak learned she was pregnant in October of 1992, she and her husband, Bob, were elated.

The Horaks had one child, 7-year-old Steven Andrew Horak, and had long wished for another. They announced the good news to their extended families at Thanksgiving.

The following spring, the couple, both active Catholics, made a painful decision to end the pregnancy. Sophie Horak has spoken publicly about their loss, supporting the legality of the controversial procedure known as intact dilation and evacuation or partial-birth abortion. The developments she relates illustrate the complexities of medical situations removed from the sloganeering that so often marks the public abortion debate.

Horak's public discussion of her situation has brought her into conflict with her parish. Recently, she and Bob were asked to discontinue teaching in the parish School of Religion at Holy Cross Catholic Church in Batavia, Ill. -- a volunteer job she had accepted for the second year.

Here is her story, as she told it in an interview with NCR:

When Horak was four months into her pregnancy, her physicians recommended a routine ultrasound, partly because of her age. She was 35. The ultrasound produced two findings: that their second child would also be a boy and that there were potential complications with the fetus.

The couple had already picked a name: Joseph Peter Horak -- Joey. "In my heart I was really hoping for another boy," Sophie Horak said.

But the technician's sudden silence as he scanned her womb worried her. The problem, she later learned was the position of the baby's heart. It appeared to be on the right side of the chest cavity. More tests followed. The problem was a diaphragmatic hernia, a hole that allowed abdominal organs to push against the heart.

Horak's physician sent her to a specialist, an obstetrician specializing in high-risk pregnancies. She made an appointment with Dr. James Keller at Lutheran General Perinatal Center in Park Ridge, Ill., not far from Batavia, the Chicago suburb where the Horaks live.

Keller ordered further tests. Horak said he told her that, barring problems with the baby's liver (extremely fragile and hard to deal with in neonatal surgery), the hernia might be repairable in surgery after birth. She could deliver Joey around her due date, in June or July. As she recalls it, his chances for survival were estimated at 25-30 percent.

Horak had already been warned that delivery would be by cesarean section. A previous emergency C-section when Steven was born had left her unable to deliver vaginally, she said.

Keller mentioned other options, Horak said, including fetal surgery at the University of California at San Francisco, where Dr. Michael Harrison has pioneered the procedure. The fetus would be removed from her womb while remaining connected through the umbilical cord. An operation would be performed, and the fetus would be put back in the womb. Horak would then remain at the medical center until delivery, many weeks away, receiving medication to prevent premature labor.

The Horaks were interested and agreed to more tests. "I was very frightened at this point, for Joey, Bob, our son Steven and finally for myself. I would have done anything to save our child, even if it meant giving my own life," Horak said.

When test results showed that Joey appeared otherwise healthy, the Horaks prepared to travel to San Francisco. Friends were recruited to care for Steven during their long stay. "Once people heard the news of Joey's troubles, they came from everywhere to help us," Sophie Horak said.

At that point, "Bob and I were all smiles," she said. "We were going to San Francisco to save Joey. I called everyone I knew."

But the surgery was not to be. In San Francisco, there were more tests, and the results were not good. Joey's stomach, his intestines and his entire liver were in his chest, smashing his tiny heart and lungs, Horak said. Further, she said, doctors had detected a ventricular septal defect, a tiny hole in Joey's heart. Harrison told her the baby was very weak and she would probably lose him soon. Surgery was out of the question.

Horak said she felt "alone, completely alone. I wanted to be so close to Joey, but I couldn't," she said. "Would he ever know how much I wanted to hold and touch him?"

Based on medical advice she had received up to that point, Horak, now in her 28th week, decided she had little choice but to terminate her pregnancy. She had been warned of possible serious medical complications at delivery, now exacerbated because of Joey's deteriorating condition. While Horak had been willing to go to any length to save her child, she didn't want to risk her life or health for a child who could not be saved.

The couple went to Los Angeles to have the fetus removed by intact dilation and evacuation. It was performed by Dr. James McMahon, a man Horak said they immediately trusted. They asked him some pressing emotional questions: Would it be possible to see Joey after the procedure, and would Dr. McMahon, a Catholic, agree to baptize their child. The answers were affirmative.

Not only could they see Joey, McMahon said. They could hold him and bathe him, and the staff would take pictures. McMahon said he would be honored to baptize their child, giving him the name they had chosen.

The first stage of the procedure is dilation of the uterus, a process that takes several days. Meanwhile, the Horaks went shopping. They bought a baby blue sleeper embroidered with a small Peter Rabbit. They bought a small stuffed Peter Rabbit to match.

"We knew these would be little Joey's only possessions," Sophie Horak said. "We were preparing for his funeral."

McMahon met the couple at the clinic, Eve Surgical Center in Los Angeles, on May 1, shortly after her water broke, and Joey was removed from the womb. But first, as is usual with the intact D and E procedure, a catheter was inserted into his head through a hole the size of a drinking straw, Horak said, and fluid and tissue were extracted to reduce the size of his head. Horak said McMahon told her that Joey was in an anesthesia-induced coma when the catheter was inserted, so that he felt no pain.

When the procedure was over, Horak said both she and McMahon were crying. Nevertheless, she said, she has never doubted that she made the right decision.

Soon the staff brought Joey, swaddled in a blanket, to the recovery room. The Horaks bathed him, dressed him in his little blue outfit and took turns holding and rocking him. Except for a small hole, his head appeared normal, Sophie Horak said.

The Horaks and the center's staff took pictures -- "pictures of proud daddy and mommy holding their baby boy," Horak said. The next day, the couple took their son home, holding him close in a small box. Back in Illinois they chose a white casket lined in satin. Next they selected a headstone, one engraved with a tiny lamb.

Joey was buried in a Catholic cemetery near Sophie's father's grave following a graveside service conducted by their pastor, Fr. Stephen St. Jules of Holy Cross Catholic Church. Two weeks later, scores of family and friends attended a memorial service at the church for Joey, Horak said. At that service, "we celebrated his life," Horak said. "Though it was short, Joey's life had meaning."

When it was all over, like many who mourn, Horak wanted to tell her story. She wanted to tell it for herself, to aid her grieving process, but also for McMahon, who died of a brain tumor months after Joey's death. Her story was published in November 1994 as an op-ed piece she submitted to the Chicago Tribune.

Horak was asked by Planned Parenthood and by the National Abortion Federation if she would talk publicly about her experience. She did. She addressed legislators in Maryland and Washington, did a cable television program and gave a series of talks in Illinois.

Her appearances generated news reports, which were faxed to Fr. St. Jules. A few days before classes were to begin this fall in the parish School of Religion, a conversation with the priest and a youth minister at the parish prompted her decision to resign.

Horak said she was made to feel unwelcome, and St. Jules, in a telephone interview said that, although he had asked for time to reflect on the situation, he probably would have asked her to resign.

"She told me she wouldn't defend the church's position on abortion," he said -- although both he and Horak noted that abortion was not part of the curriculum for her class. "She would be a catechist, speaking publicly for Planned Parenthood. And she would be speaking in favor of upholding the availability of late-term abortion. I saw a conflict there. I really didn't think she could do both."

"I certainly feel compassion for her," St. Jules added. "I do not condemn her personally."

Nevertheless, Horak said she feels excluded, compounding the pain she feels. "We don't think that what we did was morally wrong," she said. And she feels her public appearances -- which have been unpaid, except for expenses -- are important to keep a procedure legal that physicians had recommended in her case.

As she looks back on it, Horak wonders how it all happened. "We are just simple people from a small town in Illinois," she said. "How we were able to get the best care in the world to try to save our son? I don't know how all that happened. Now, after so many years, to have somebody tell me I'm morally unfit to teach children ... I don't think so.

"There was an outpouring of love when all this happened and now suddenly I feel that I'm being attacked."

National Catholic Reporter, November 8, 1996