We Are Back! + Outlawed

Dan's laughing at me.

I'm laughing because you wrote a good script, but you won't read it.

Okay, I'll start over.

Okay.

Is this thing on?

Because it hasn't been on in quite some time.

We were gone for a bit there because I couldn't tell if this thing was on.

This is so stupid.

I love it.

Just kidding.

We were gone because we were trying to figure out how to earn a living making this show.

And we think we have an idea.

We're making this a weekly program.

That's right, the dream.

Every week.

Inside your earholes.

We'll be back in just a few weeks with new episodes about the American dream and how big-time jerks are making it impossible to achieve.

In the meantime, I want to share an episode of a new show I've been producing all about abortion.

What is it?

Who gets them?

What's going on now since Roe was overturned?

And is anyone getting arrested and thrown in jail?

Yes.

You will learn all of this and more on Outlawed.

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Quote-unquote, enjoir.

And please subscribe to Outlawed.

I remember boarding the flight.

I sat in a window seat,

and honestly, I felt like a fugitive running from the law.

Today on Outlawed, we're going to zoom in on a location that has repeatedly been at the center of this fight over reproductive rights.

And we'll give you a few seconds to take a guess of where that place might be.

Texas.

Did you get it?

I got it.

Texas is a big state.

It is.

It's big.

A lot of people of reproductive capacity.

And an unusual feeling of independence among Texans

and state pride.

You know, my wife is from Texas.

Yeah.

And we met in college.

And she said that most

Texan freshmen, including her, had displayed Texas flags in their room.

That is not something that others, people from other states do frequently.

Yeah, I don't, I don't travel with a North Carolina flag.

I mean, I do love North Carolina, don't get me wrong, but I don't carry a flag.

Yeah, there's something about Texas pride.

Yeah, I worked with a resident in residency who

he and his wife are both from Texas and they had their first child here.

And he brought a bucket of Texas soil for her to give birth over at the birthing center.

Yeah.

I mean, like, yeah, nowhere but Texas.

Nowhere but Texas.

And so we wanted to talk about Texas because the bans on abortion there started really before Dobbs.

Yeah, and that means that they have some of the earliest experience with the abortion bans, some of the most extreme experience with abortion bans.

And the structure of their abortion law is very different than other abortion restrictions in other places.

Right.

And they have part of their law, really, anyone can come after you if they suspect that you've performed an illegal abortion.

Yeah.

You may have heard of it.

It's called the vigilante law.

And it encourages people essentially to tell on their neighbors and to sue their neighbors that they think that they've been involved in abortion.

And specifically says that people defending in those cases end up having to pay the cost.

And so it's a really punitive law and a bad way to structure, well, a good way to structure a law to prevent people from doing something you don't want them to do, I guess, but a bad way to structure something that inhibits public health.

Right.

And because abortion, like we've talked about, is a component of health care, it's hard to draw a line at, you know, when is someone performing abortion care?

When is someone performing just part of reproductive health care?

So I've noticed that a lot of the media portrayals do start in Texas.

They are of people who died as a result of not being able to get care in Texas, people who have become famous because they've spoken out about their inability to access abortion care and need to travel outside the state.

And there has been a fair amount of media coverage of doctors leaving the state because they don't feel that they can safely practice there, and it's just not worth it for them to

have that level of risk in their job.

So Texas, in my mind, is a little bit like the canary in the coal mine, right?

Of what's going to happen if Dobbs has these same impacts on states around the country.

Today, we're going to have a conversation with two people from Texas who have first-hand experience of what these laws mean for them and their lives.

One is a physician trying to provide care to the highest-risk patients that she sees, and the other is a patient who found herself needing abortion care and having to flee her state to get it.

Both of these folks have asked to be anonymous for the purposes of this podcast, but their stories are very much real.

So, I'm a board-certified OBGYN, and then I did an additional three years of training in high-risk of step drugs.

Dr.

Allison is a maternal fetal medicine specialist, and we are just using her first name to protect her in this episode.

She is a high-risk pregnancy doctor, so she cares for people who have complicated pregnancies because of their own health, or perhaps complicated pregnancies because of something that's going wrong in fetal development, and sometimes both.

She works in a really restrictive setting in Texas, and so she's seen a lot of her patients harmed by the abortion restrictions there.

The law in Texas is that abortion is always illegal unless the life of the mother is threatened.

The mother is in imminent danger of either death or severe harm.

You know, these laws were written by people, you know, without much medical or scientific knowledge, so they're not written clearly and they're interpreted differently by different physicians, different hospitals, different groups.

And it's, I think, it's designed to

make people hesitate and not offer abortion, except in the most extreme circumstances.

If you perform an illegal abortion in Texas, you can be found guilty of a felony, you can have fines of hundreds of thousands of dollars, you can go to jail.

So you're

opening yourself up to a lot of personal

legal liability that's not covered by your malpractice insurance.

But it's so confusing and it's changing all the time that I have people who I trust in

my department and who are very connected to kind of the legal landscape of abortion care and I go to them for clarification.

And I think a lot of people even within my department and my group

have misunderstandings about the laws.

Dr.

Allison's going to talk about how these constant changes in the legal landscape affect the training of resident physicians and medical students who she works with.

As a teacher, as someone who has been a residency director, I know how important it is to give those trainees comprehensive training about how to take care of a patient who comes in with a problem.

And I think when you're living in a state where the laws impede your ability to give good care, it also impedes your ability to be a good teacher.

And like 40% of medical residents in the country, the residents who Dr.

Allison works with live in a state where abortion care is restricted.

And that means that they are not getting a full scope of OBGYN training.

They get very little teaching about abortion, and they're confused and fearful, and they see

attendings who are confused and fearful, and they have lots of questions.

They don't know what's true and what's not.

And they certainly see abortion as a scary other thing that is not a core part of our field,

which has a lot of ramifications because abortion care is the same care that we provide when there's lots of complications during pregnancy.

When you have a miscarriage, that has a complication, when you bleed after delivery.

There's lots of times when abortion care is an essential part of an OBGYN's job.

So as a maternal fetal medicine physician or a high-risk obstetrician, a lot of what I do is read ultrasounds.

So when someone goes in to have an ultrasound in the middle of their pregnancy to see is everything growing and developing normally, are they having a boy or girl?

It's something that

everyone in our country has during pregnancy.

Sometimes we find, sadly, you know, complications.

And in extreme situations, I can think of several in the past year, a situation of something called anencephaly, where the top part of the fetus's skull doesn't form, and thus there's no brain tissue.

So the fetus has a lethal, very severe complication, and it's a devastating diagnosis to make.

And I've made this diagnosis twice I can think of in the last six months.

The other time when it comes up for maternal fetal medicine physicians in restrictive states like Texas is when a woman is so sick that we're deciding is she sick enough to meet the criteria for

you know the life of the mother is threatened which is a vague and confusing criteria and so maternal fetal medicine physicians are the ones who are debating along with other sub-specialists is she sick enough we've had patients come in who

have a miscarriage you know they have

their fetus has no cardiac activity no heartbeat right so there's no potential to perform an abortion because the fetus has has died

and the person is coming in infected.

They have sepsis due to an infection in the uterus, so they're very sick,

all their vital signs are off, their lab values are very

abnormal, and they have a real risk of getting sicker and even dying.

Sepsis has a quite a high mortality rate, even in healthy, or previously healthy pregnant people.

So it's a very serious

medical condition.

And if your sepsis, if your infection is coming from the uterus, the only way that you will get better is to remove the pregnancy.

And we have had multiple situations where someone's in this situation and I know that they are only going to get sicker and sicker and potentially die if we don't offer a dilation and curatage to evacuate the uterus, which is the procedure we use for an abortion, but also a procedure we use all the time not to perform abortions, to take care of women having miscarriages, to treat postpartum hemorrhage.

It's a core part of obstetrics and gynecology that frequently is a life-saving procedure.

But because of all of the fear and concern, there's a lot of bureaucratic hoops you have to jump through.

Multiple physicians have to agree, and you have to talk to the head of the hospital, and et cetera, et cetera.

So it delays care in a life-threatening scenario, which I was always trained that sepsis is an emergency, and you must respond to it immediately.

And so, to see it,

you know, to see this law

put people's lives at risk is really

just

horrifying.

And then to tell them, Because I feel like it's our obligation to be transparent with our patients.

So, to say, and I've said this multiple times, you have an infection in your uterus, it's very serious.

The only treatment is to deliver the baby, either with an induction or

an evacuation of the uterus, but we have to wait because you live in Texas and we have to get this extra sign-off.

Because I feel that I must say that to the patient.

I feel like it's my obligation to be honest.

And they look at you like

you're insane, right?

Because

they're mothers, they're wives, they're community members.

I mean, they're people who want to live and they have lives and people who depend on them.

So essentially what I'm saying is I have to put your life at risk because of the state you live in.

So Dr.

Allison is talking about patients who have risky pregnancies and the risk really isn't the same for everyone.

And pregnancies have a spectrum of risk.

There are risks to fetal development and risk of the pregnancy itself, risk of other medical complications.

Pregnancy is not always rainbows and butterflies for people.

It can get really complex and patients can get really sick.

And so for someone who is diagnosed with a birth defect, they may have time to go out of state to get care if they have the means to do that.

But for patients who are developing a complication of their own health, like worsening heart disease or heart failure, worsening kidney disease, cancer, these are unfortunately common things that we see in patients of reproductive age.

And if you're in Texas, you may not meet the criteria of being sick enough to get care.

We also see patients who have complications to the pregnancy itself, like their water has broken early or they develop early preeclampsia, which is a condition unique to pregnancy that causes high blood pressure and other organ disease.

And we actually know from a study out of Texas what happens to patients when they're forced to continue a pregnancy under these circumstances?

And the answer is that patients unsurprisingly get sicker.

If you wait for someone to get sick before you are able to intervene, if you make them sit and wait for themselves to get sick enough for you to treat them, well, they have complications.

And so people had life-threatening complications.

They had bad infections.

They ended up in the intensive care unit.

They had blood transfusions.

All because they didn't get the care that they needed to as soon as they needed it.

And of those 28 patients that they kind of watched, because that's what SB 8, the restrictive law in Texas made them do, of those 28 patients, 27 of those infants or pregnancies had passed by the time the paper was written, and the 28th infant was in the ICU with a very poor prognosis.

And so

these doctors caring for these patients had to tell patients that they had a medically futile

pregnancy and they had to wait for these criteria to get care knowing that it wasn't going to bring a baby home.

It wasn't going to maintain that person's health and it's really hard being the patient sitting and listening to that and being told that you can't get care because of your zip code.

So doctors had to tell patients that they had no choice but for them to continue the pregnancy until they got sicker.

So totally futile risk for the patient, simply so that the doctor could comply with the law in order to be able to treat them.

For many of these patients that are in the hospital with these complications, they have families, husbands, spouses, partners that are supporting them, and it's hard for them to understand why they're being denied care.

And it's, you know, some of them have never been pregnant before, faced a disparity in care simply because you're carrying a pregnancy.

I work with a very marginalized, underserved population, and almost none of my patients can leave, so it's just not an option for them, sadly.

I also work in another hospital with patients who have a lot more resources, where I see almost every single patient with that diagnosis will leave and seek abortion care in another state.

And it just is so unfair that my poor patients who don't have the means to leave don't have that choice.

And so I feel very sad about that.

And it makes me want to stay and to see them and to see them weekly.

And it's almost like I feel like I,

it's so unfair that they have to suffer this.

And the disparity is so,

so striking that like I want to be there with them because it would be easy.

It'd be much easier for my mental health in a lot of ways to just move to another state.

But I've worked here for years and we have very high-risk patients and some of the poorest maternal health outcomes in the country and some of the most marginalized patients in the country.

And I don't want to abandon them.

They need high-risk obstetricians.

We had the chance to talk with a patient who did have the means to leave the state about what it was like to have a diagnosis that meant she needed to travel for abortion and then what it was like to actually leave to get that care.

I am 35, mother of two,

been married to my husband for about five and a half years, both working parents.

We are busy people.

We got pregnant quicker this time than we did with my first.

So I was so pleasantly surprised.

And so I was feeling really good.

You know, my first pregnancy was, for lack of a better word, fairly easy, thank goodness.

And so I guess ignorance is bliss.

I kind of was happy-go-lucky at the beginning of my pregnancy with this, with my second.

In the anatomy scan, you know, they take all these pictures of the baby, right?

Like they're taking like hundreds of pictures of the spine and the heart and the lungs and everything to make sure everything's formed properly.

And I remember the.

The tech was taking a lot of pictures of, it was a boy, of his heart.

And when she left the room I looked at my husband and I said she was really spending a lot of time on the heart and he said you know don't think anything of it the doctor came in and the first thing she I'll never forget the way she looked at me um

and said you know

the heart didn't form properly

and immediately I couldn't hear her because I just started crying because I knew when the tech was taking all of those photos of the heart something wasn't right

um so when she told me that I immediately started crying.

And from that point forward, it was the craziest three weeks of my life.

And truly, from the minute we got that news, the next three weeks were

a complete

life-changing, altering experience.

So we got into the pediatric cardiologist that morning.

Like my doctor made it an emergency appointment.

And the pediatric cardiologist, when we got there, the tech took almost a thousand, I want to say it was like close to a thousand pictures of the heart.

We were in there for 45 minutes to an hour of her just taking pictures of his heart.

And when we finally met with the doctor, We sat in a little room that I remember it so vividly.

It was a little round table with three chairs and it had no windows.

And she pulled out these diagrams of a heart and was kind of telling us all these scientific terms and what was going on with his heart and that his heart didn't form properly and he was missing a whole part of his heart and

we were told that he had what was called truncus arteriosus which is basically in layman's terms he didn't have a pulmonary or artery this doctor told me upon birth

my son would have to have immediate heart surgery

be put on a bypass machine like eight hours to create a pulmonary artery and put a conduit into his heart.

Now,

she made it sound like it's one surgery and then you're done until they start growing out of the conduit and then they have another surgery later and then you're done.

And life expectancy is kind of who knows.

This is a very rare heart defect.

She made it seem like

we would have a couple heart surgeries in his life, but otherwise he would live a normal life.

And we were like, okay, this isn't ideal, but we can handle that.

In the coming days, we started talking to experts.

I mean, my husband is an attorney, so to say data is his best friend is an understatement.

We started really reaching out to our network.

And honestly, I feel very privileged that we had a network to reach out to.

We spoke to multiple pediatric cardiologists.

We spoke to pediatric cardiovascular surgeons.

many OBGYNs, experts in this area.

We spoke to a chief cardiovascular surgeon at a very well-known hospital.

And the picture that was painted for us was very, very different.

The baby's truncus arteriosis, there's like a range of severity.

His was very severe.

What was told to us at one point is on a scale from one to five, one being simple, five being the absolute worst, his condition was probably a four.

There was a pivotal moment.

Um, we were talking with

um

a

cardiovascular surgeon that we were connected with through our network,

and he gave us a very interesting story.

He said, Look, well, my husband straight up said to him, If this were your daughter or this were you, what would you do?

And he said, I we wouldn't move forward.

He said, What's really interesting is that he was, he said to me, I was at a conference once where they put up like a question saying, like, here's a situation.

What would you recommend as a doctor?

He said, and everyone kind of answered one way, right?

And it was like, move forward with the pregnancy, you know, do surgery, et cetera.

And then the second phase of the question was, this is your daughter or your wife.

What would you recommend?

And like 85% of the room, and this was all cardiovascular surgeons or doctors, 85% of the room said they would terminate the pregnancy.

And he said to me, he said, do you both work?

We said, yes, we both work and we're both very ambitious people.

He said, one of you will need to stop working if this pregnancy moves forward.

He said, do you have another child?

I said, we do.

He said, that child's life will be significantly impacted by this.

He said, you will spend the majority of your time in and out of the cardiovascular ICU.

And he said, and the prognosis of life expectancy.

Life expectancy is kind of unknown with something like this due to the severity.

And he said, you will spend this child's life in and out of the ICU until eventually he doesn't make it.

And he told us a personal story, you know, too, about how he had a sibling that had a very tough medical condition and the impact it had on his family.

And

in that moment, we made the decision that we were not going to move forward with this pregnancy because, one, we had a child that we needed to provide her best chance at a happy life.

And two, I wasn't going to bring a child into this world and watch it suffer and and die

i wasn't going to do that

and it's unfortunate because no one could steer us everyone was afraid to steer us

i went to a doctor's appointment and told one of my doctors about this and

They gave me resources on a sticky note.

We were not given the information, in my opinion.

We weren't given the full story.

I remember thinking, I cannot believe

this is real.

Like, you know, you know about the laws, you know that in Texas, if you aid, if a doctor aids anybody in an abortion, they could go to, they could potentially go to prison for life.

And so I just didn't, it didn't

become real for me until that moment where I said, holy shit.

And I thought to myself, like,

I am privileged and networked.

I will be able to figure this out, but 99% of people cannot.

And this is insane.

And I walked away with that sticky note and it was such like a,

is this real life?

Like, is this really what the world has come to?

I have a sticky note for resources to get the medical care that I need so that I don't have to bring a child into this world to watch him suffer and die.

Is that really where we're at?

The first thing I started doing was Googling what states can I get help in?

And, you know, my mom and I created a chart of like the laws in every state and where we could possibly go.

And

luckily, I, I, I was able to go to North Carolina and get the care that I needed.

You know, it took us a couple of weeks to do our research.

So once we made the decision, I was 20 weeks pregnant.

You can't just get on a plane and go.

You know, I got this news at 18 and a half weeks.

Then we had to do research.

And then once the decision was made, we have to book flights.

I had to get an appointment, which I, you know, I couldn't get one tomorrow.

I I had to get an appointment.

I had to arrange childcare.

I had to take time off from work.

My husband had to take time off from work.

I had, you know, it's like

there,

it's not to, I can't just go get help.

So our options became limited in terms of where we could go.

And so in North Carolina, the laws at that time were 20 weeks and six days.

So I flew to North Carolina and I wanted to get on North Carolina soil like as soon as possible because I was afraid every day I was like going up against a time clock.

So I decided to fly up there like three or four days before my procedure was scheduled because I was just, I needed to get on North Carolina soil.

So I flew by myself

and I remember boarding the flight.

I sat in a window seat.

I remember taking off looking out the window and honestly I felt like a fugitive running from the law.

I didn't want to tell anyone why I was going to North Carolina.

I didn't want to tell anyone what I was doing there.

I didn't want anyone to stop me, not like have a conversation with me, but like I was fearful because I live in Texas that had anybody known that I was doing this, that like the police were going to show up at my door.

And I know that sounds like it's, you know,

not a logical fear, but it really is a logical fear.

And I remember looking out the window as we were taking off, thinking like, I feel like a criminal.

I'm fleeing the state

because it's illegal to get the help I need there.

there.

So when I went in to have the procedure,

you know, they've got me all ready to prepped for surgery, right?

And

it's so funny.

I always say procedure.

I can't ever like get the word abortion out of my mouth for some reason.

And so when they were prepping me, I have to, you know, they give you a form to sign.

And the form makes you say, what is your relationship to the deceased?

It's like, well, first of all, what would the relationship be?

Like, what do you mean?

What's, it's very obvious what the relationship is.

There's only going to be one answer to this.

I was so taken aback.

And it was right before they were going to give me my anesthesia.

Then on the back of the form, it asked, what do you want to do with the remains?

Do you want to send it to a funeral home?

Do you want to dispose of it?

All of these things.

Do you want footprints?

And I looked at it and I just started crying.

And the doctor, God bless him, he was a a resident, grabbed the form and he said, I'll take care of it.

You know, just check the thing.

I'll take care of it.

Like he swiftly got it out of my view.

But that, like less than two minutes later, they put me under anesthesia.

The procedure went well, thank God, because I was under the care of professionals.

It was safe.

It was legal.

You know, I stuck around for another day.

And to be honest, I felt super empty.

I felt weird.

I was mourning the loss of a pregnancy that I deeply wanted.

I questioned myself if I made the right decision multiple times that day.

I wasn't ready to come to terms with the fact that the pregnancy was over.

To say that when women do this, that they aren't mourning something, that they don't feel a sense of loss is also very wrong.

I felt a huge sense of loss, huge.

Also, after my procedure, I got home and two days later, my milk came in.

So that was like salt in a wound.

So I had to dry up my milk.

I, you know, men won't know this, but for the women out there, it is extremely painful, extremely painful.

And every day I would wake up like leaking and with wet shirts and all this stuff.

And I would just think to myself, God, are you kidding me?

Like, isn't it enough that I had to go through what I went through?

Now my body thinks I literally delivered a child and it's acting like I need to have a source of food for this child.

It was just salt in the wound completely horrible.

Can I say how much like generally the cost is of something like this?

It's upwards of $20,000.

You have to like, that's not cash people have just lying around.

And I got back and I ended up telling my employer because to me, I wanted them to know

our benefits plan covers X.

You should know the impact this has on the employees that you employ.

I was pleasantly surprised that

the person I spoke to said, wait a minute, that's not right.

We intend to cover this kind of stuff.

Thanks for pointing out what was in the plan document.

That's incorrect.

We cover this.

We will reimburse you for every penny.

And we will also reimburse you for your husband's and your flight and your hotel and food costs.

It was truly an amazing moment where I said to myself, Wow, I feel super lucky to work for an employer like this.

And I was able to take some time off.

And my mother-in-law kept my daughter while we were gone.

You know, it was really hard to be away from her.

She was my, I called her my ray of sunshine during all of that.

She was the only thing that kept me getting out of bed in the morning during all of this.

And,

you know, it's really hard to be in a bad mood around a two-year-old who's, you know, so pure.

So being away from her and going through this was almost harder because I didn't have my ray of sunshine that I, you know, needed.

It's weird in these situations, you almost need your kids more than they need you.

And so when I got home, I will never forget running through the back door.

And I just went and grabbed her.

And I think I held her and hugged her for a straight five minutes.

Opinions expressed on this podcast are our own.

Philanthropy is helping us highlight these stories, and we hope you'll continue to support this work by subscribing and sharing the show and getting involved in your local community.

You can find us on Substack at outlaw.substack.com if you want to hear more about some behind-the-scenes information about the making of this podcast.

This podcast is executive produced by us, Dr.

Beverly Gray and Dr.

Jonas Swartz, and Jane Marie.

Production by Little Everywhere.

Thanks to Nick Thorburn and Patrick Ford and Maker for our score, and Jamal Walton for original artwork.

Extra special thanks to everyone who lent their knowledge and expertise to this episode.

You can email us at outlawedpodcast at gmail.com.

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