S02 Episode 1: The Case

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Speaker 4 6 a.m. in Chicago.

Speaker 4 Of course, the shot starts at the lake.

Speaker 4 Camera pans over the water and the magnificent buildings rise from the shoreline, twinkling in the dawn light.

Speaker 4 We continue across the city, still bird's eye view, over the grid, over the elevated tracks and wide highways, coming to rest in a western suburb.

Speaker 4 Drop down to a brick bungalow where, inside, a woman, late 30s, moves softly past the bedrooms where her children sleep. and steps out the front door to meet the morning.
Winchell of 20 below.

Speaker 4 She hurries to a minivan and as she pulls away from the curb, we see the streets frosted with salt, the moon shining high and hard, and we see her work ID where she keeps it on the center console, the words board certified RN, and her name in all caps.

Speaker 4 This is Mindy Figueroa.

Speaker 4 Mindy says she was made to be a nurse.

Speaker 5 I think I was just born to be in healthcare. Like as a kid, my sister would find all the dolls and the ballet slippers at the Dollar Tree section, but I always got the doctor kit.

Speaker 5 The stethoscope, the little syringe, always, always, always.

Speaker 5 So it was just always a thing.

Speaker 4 Mindy was the first one in her family to go to college. Her parents came to this country undocumented from Mexico, worked factory jobs, earned citizenship.

Speaker 4 Mindy paid her way through school, got her degree, started out at a small hospital, and after a few years, transferred up to a big one, UI Health at the University of Illinois at Chicago.

Speaker 4 She works on the labor and delivery floor with patients about to have babies.

Speaker 5 I've been told many, many times that as soon as I walk in a room, they know I like my job and

Speaker 5 I love coming to work. And I feel like they feel that.
So I walk in a room and good morning. My name is Mindy.
I will be here until 7 p.m.

Speaker 4 We watch this happen. Mindy, stepping cheerfully into a labor room, her face framed by two neat braids.
And then we carousel through shots of Mindy at work.

Speaker 4 Mindy strapping a fetal monitor to a patient's belly. Mindy at the nursing station, holding a plastic pillow up like show and tell, her colleagues doubled over in laughter.

Speaker 4 Mindy, her face grave, bursting through the door of the OR.

Speaker 5 Mindy loves the intimacy of labor and delivery, and that adrenaline, that switch from it's calm to to now it's time to run and also i mean i just like blood in general i like yes like do you mean like literally like you like blood yes and everyone on the unit knows it if there is a hemorrhage if there is heavy bleeding they know i am the person i like to weigh it i like to quantify the blood um i like to clean it up um blood clots coming out of a after delivery and we're pushing on their belly and there's it's almost like popping a pimple like okay let's get it out of there to prevent more bleeding and i feel like i'm really good at recognizing when we're trending towards too much blood because i i am actually watching i watch every birth i watch every c-section like i don't sit and chart as soon as the incision starts i watch it because i it's just intriguing to me i it's i've been doing this for 14 years

Speaker 5 and it still amazes me that there's an incision on an abdomen, but there's a baby there. So I watch every delivery.

Speaker 4 This story is going to be about one of those deliveries that Mindy watched. One that changed things for her and for her hospital.

Speaker 4 There are more than 2,000 deliveries a year at UIC. It's a public hospital, not a fancy one, and it's located right in the middle of the city, in the medical district.

Speaker 4 Establishing shot of the hulking building, dawn breaking open the sky above.

Speaker 4 A humble hospital in Chicago, a hard-working nurse, a delivery with stakes. How could we not tell this like a medical drama?

Speaker 4 A medical drama. Its emphasis is on the world inside the hospital, on the heart and the heroism of the people who work there.

Speaker 4 and their relationships with one another, on how their interactions with patients are shaped by their own stories.

Speaker 4 But what happens in a hospital also reverberates outside. And on this show, we're going to see that too.

Speaker 4 Because this delivery that Mindy watches, it doesn't just change things at UIC.

Speaker 4 It could change things for the entire country.

Speaker 4 And now let's pull back, get the whole hospital on the frame, and end the opening credit sequence with this image. This boxy building on a sub-zero morning.

Speaker 4 But we know that behind that imposing facade, it's warm. We're already invested in the human drama inside.

Speaker 4 Black screen.

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Speaker 4 The action of the episode begins with Mindy in a nearly empty elevator. Closer to to 7 a.m., change of shift.
You can barely fit. It's sardines.
But Mindy's early today. She's almost always early.

Speaker 4 She's the one who will have cleaned the break room by the time her coworkers arrive.

Speaker 4 At UIC, your coworkers have your back. Mindy could say this about all of the nurses on her crew.

Speaker 4 One of those nurses is Clara Hawkhauser. We see her emerging from the locker room in gray scrubs in a scrub coat.

Speaker 4 Not everyone wears a scrub coat, but Clara does, because it has better pockets and because it covers her tattoos.

Speaker 4 Clara has large, wise eyes, as if she sees more than other people. She's a natural at nursing, but it wasn't obvious that it was where she would wind up.

Speaker 11 I

Speaker 11 like a high school dropout. I really did not do well with school and

Speaker 11 long story short, I just was like, never mind, I'll get my GED and I started working and I worked in a coffee shop.

Speaker 4 One day Clara got a massage and then she became a massage therapist. And she found the clients she liked best were the pregnant clients.
So then she decided to become a midwife.

Speaker 4 But after finishing her degree, she just wanted to start working. And as a nurse, she could do that sooner.

Speaker 4 She started as a mother baby nurse and eventually switched to labor and delivery.

Speaker 4 She never thought she would have her own kids.

Speaker 11 I definitely never planned on having children. I definitely always felt like, oh,

Speaker 11 emotionally, a little dysfunctional family. Yeah.

Speaker 11 I

Speaker 11 identified like purely as a lesbian. I didn't,

Speaker 11 I was not able to conceptualize what it meant to be bisexual, that like wasn't an option. It's either you were gay, you weren't gay, you know?

Speaker 4 Yeah.

Speaker 11 And it just, not that you can't have babies with women, but

Speaker 11 I just, all the things, I just thought, no, no, no, no. I love little babies, but I do not want to be a parent.

Speaker 4 And then Clara got divorced from her wife. She met a guy.
They got married. Suddenly, Clara understood she didn't have to be, as she puts it, a perfect magical special person to have children.

Speaker 4 She was 40. With her husband, Clay, she did IVF, and soon she was pregnant with twins.

Speaker 11 I was incredibly excited and could not believe that two embryos took one, you know, like it just all seemed surreal. Like, I can't believe it worked the very first transfer.

Speaker 11 But I, of course, was really nervous about

Speaker 11 the outcome because I see firsthand all the time the ways in which pregnancies can go sideways and there are no guarantees that anybody goes home with a baby at the end.

Speaker 11 So it's just like another layer of worry.

Speaker 4 Yeah.

Speaker 4 Yeah.

Speaker 4 Clara would go home with her babies. That's not where this story is going.

Speaker 4 She would also be delivering at UIC herself.

Speaker 4 On a medical drama, when the healthcare provider becomes the patient, it's a twist. But this isn't a twist.
It's our premise. We don't know how this matters yet, but it will.

Speaker 4 It matters that this patient is not a visitor, that she's not someone who leaves, but someone who stays.

Speaker 4 A twin pregnancy at age 40, there was definitely a chance that Clara would need a C-section, but she wanted to avoid it.

Speaker 11 I wanted so badly to have a vaginal delivery. I did not want to have surgery, but because I was older, because I'm a bit fat, you know, I just was like, oh, God.

Speaker 4 Clara also wanted to avoid delivering in the operating room.

Speaker 4 Typically, if you're having twins, you can labor in a labor room, but you have to deliver in the operating room, even if you're delivering vaginally. It's a safety thing.

Speaker 4 Just be in the right room if something goes wrong. But Clara really did not want this.

Speaker 11 But the idea of having to deliver in the operating room was horrifying to me. I was just terrified of the OR more or less.

Speaker 4 How come?

Speaker 11 Delivering in the operating room always just seems so awful to me. I don't know.
It's a really, it's this really narrow metal table.

Speaker 11 You're flat on your back.

Speaker 11 You're not restrained, but like, where are you going to go? You've got an epidural. You're going to be hooked up to more monitors.
You're, you know, it just

Speaker 11 like it takes away any of that just like safety and autonomy and, you know.

Speaker 4 Yeah.

Speaker 4 One of the things Clara did want was for Mindy, her coworker, to take pictures of the birth.

Speaker 4 So

Speaker 5 I have a side hustle, like a photography, like it's a hobby, but like

Speaker 5 I take our coworkers' birth pictures.

Speaker 4 Mindy's always taken pictures. Back in college with the little cameras you'd hang on your wrist.

Speaker 4 Eventually she got a camera with a big lens that attached and taught herself how to use it from YouTube.

Speaker 5 And then one of my nursing friends was pregnant and she's like, will you take some pictures of me pregnant? Like she's like, I don't like to go to places.

Speaker 5 And so I took a few of her and like made them black and white and they were exceptional. And I was like, ah.
And then when she had her baby, she's like, can you take pictures of my baby?

Speaker 5 And she paid me. And I was like, you don't have to pay me.
But she paid me like $200. And I was like,

Speaker 5 that's a lot of money. Like, no, I'm not a professional.
And it just took off from there. Yeah.

Speaker 4 Do you take like if somebody's having a cesarean, like, would you take a picture of like the surgical field?

Speaker 5 Yes. Yeah.
Like, I'll take a picture of like the bloody canister. And I do ask, I do ask like how graphic I can get.

Speaker 5 Cause I will literally take a picture of turd like coming out, you know, like I will photograph it all because I am not squeamish, but there's people who are like, that's too much.

Speaker 5 Or like, like, if they're doing like skin to skin and it's a beautiful photo, I make sure I cover the nipple so that they can use that photo.

Speaker 5 Yeah, I just kind of gauge like who they are. How graphic are we doing? And I think Clara was one of those who's like, let's do it all.

Speaker 4 On April 19th, 2022, Clara arrived at the hospital for a scheduled induction, which is when you get drugs to start your labor.

Speaker 4 Now we flash back to see her on that day. She and her husband, Clay, are crossing the street from the staff garage.
Clara's purposeful, leading the way.

Speaker 4 Clay's just passed the bar, is going into criminal defense, did an internship advocating for victims of police brutality.

Speaker 4 It matters that you know something about Clay, so that he's a little more than just the cutout husband, more than just the husband watching the main event.

Speaker 4 At the employee entrance, Clara badges in.

Speaker 11 I was coming in for, um, I was scheduled for an evening induction. So I thought, yeah, I like that.
I like those evening inductions. So I'll come in at night after dinner

Speaker 11 and I'll get the initial stuff and go from there.

Speaker 4 On the fourth floor, Clara enters her labor room. Room five, the best one.
That's where they try to put you if you're a staff member. Her coworkers have decorated it for her.

Speaker 4 She changes into a gown, climbs into bed.

Speaker 4 Clay sets a Bluetooth speaker on the windowsill, opens his phone, starts the playlist. Push it, it's on everyone's playlist.
The Beach Boys, don't worry, baby.

Speaker 4 And so far, Claire's not worried. Even when she receives the drugs to start her labor, everything feels surprisingly okay.

Speaker 4 By around lunchtime the next day, she's in some pain from her contractions and is debating whether it's time to go for an epidural.

Speaker 11 And I felt really, uh,

Speaker 11 really kind of neurotic about it, like not wanting to get it too soon because I wanted to be able to stay upright and keep moving.

Speaker 11 And but you don't want to wait too long because then you're dying in pain. And yeah, one of my co-workers and midwife came in and talked with me.

Speaker 11 I was just like, All right, Clara, it's fine, just get it. If you're ready, you can get it.
It's not, it's nothing to get perfect here.

Speaker 11 Like, if you, if you want it and you know you want it, just do it. So, Heather did my epidural.

Speaker 4 Heather Nixon, the head of obstetric anesthesia at UIC.

Speaker 4 Charismatic, assertive, boss lady, but not bossy.

Speaker 4 Let's actually meet Heather on the way into the room. Let's watch her leaving her office downstairs on the anesthesia floor.
Heather's office?

Speaker 4 Mini fridge, on top of it a framed photo of four women dressed up for girls' night. A black leather couch with a hot pink pillow, where lots of times Heather spends the night.

Speaker 4 Heather is 51, with two daughters in college, but she's the one with the energy of a college kid. Can sleep anywhere, pop up bright-eyed at weird hours.

Speaker 12 My residents actually did a skit once with me. Like they do the end-of-the-year kind of like roast of the attendings.

Speaker 12 And it was like a skit where it was like three in the morning and they kept answering the phone. And I was like, hey, it's Nixon from Anesthesia.
And

Speaker 12 they're like, we have no idea how you're always awake. Like you're always like, let's talk about stuff.
Like at three in the morning, I'm like, I don't know. So.

Speaker 4 Heather has lived in Chicago for 30 years, came to the city straight after finishing college.

Speaker 4 She knew she wanted to be a doctor, but she had to pay off student loans first, so she worked as a shop girl in a bar off Rush Street, t-shirt tied up, abdomen showing.

Speaker 4 Anesthesia itself came as a surprise to Heather. It wasn't a specialty she'd ever thought she'd want to do, but she had a mentor who made her fall in love with it.

Speaker 4 This is the case for a lot of anesthesiologists.

Speaker 4 There's a common misconception that this is the doctor who just puts you to sleep. But there's a lot more to it than that.
The surgeon surgeon has their head down in the surgical field.

Speaker 4 The anesthesiologist is watching over all of you.

Speaker 4 When Heather discovered the subspecialty of obstetric anesthesia, she had a feeling like, OB, this is my tribe. These are my people.

Speaker 12 I think you'll find two types of anesthesiologists. You like the ones who are the introverts who like to kind of hide behind the drapes with the sleep patients.

Speaker 12 And then there's the type that really like to engage with their patients. And those are kind of maybe the tribe of OB anesthesiologists, the ones who want to be there talking to their patients.

Speaker 4 Many OB anesthesiologists proudly identify the same way. They like awake patients, not sleeping patients.

Speaker 4 Now we catch back up to the action and we see Heather enter Clara's room and begin arranging her equipment on a tray. Clara sits erect on the bed, waiting.
Bed pumped up high, her feet dangling.

Speaker 4 She'd asked for Heather to do her epidural, like, like, hey Nixon, you gonna be around?

Speaker 4 Heather was happy to do it. She does this for all her providers, delivering if she can.
Not that a resident couldn't do it, but you want to take ownership if, God forbid, something goes wrong.

Speaker 4 Close on Heather's gloved fingers, touching Clara's spine.

Speaker 4 Now we're going to watch Heather actually do this procedure. We're going to be talking a lot about procedures on the show, and viewers need to be grounded in them.

Speaker 4 And does anyone really know what an epidural is? Besides the thing you can get for pain when you're having a baby?

Speaker 4 Now we see Clara take an anxious peek over her shoulder and Heather telling her, no, no, I'll talk you through it.

Speaker 4 You'd think nurses and OBs, they'd be the most relaxed about that epidural, but they're just as nervous as anyone.

Speaker 4 From her tray, Heather picks up something that looks like a swizzle stick, like what you use to stir a cocktail. This is actually a large hollow needle.

Speaker 4 In its placement in Clara's back, this might cause someone to turn from the screen for just a second, so I'll tell you what Heather's doing.

Speaker 4 She's inching that needle into Clara's back, a little deeper, a little more, until the tip enters what's called the epidural space. Heather finds that space by feel.

Speaker 4 There's a ligament she's looking for.

Speaker 12 And not everyone's ligament feels the same.

Speaker 12 Some of them feel really rubbery. Some of them feel kind of like crackly or popply, you know, popping.
Some of them feel kind of really like gentle.

Speaker 12 Like almost when you pass through, you're like, oh, something, something's different, but I can't, I'm just going to stop there.

Speaker 4 Now Heather threads a thin plastic tube, a catheter, you know this word, through the large hollow needle until the plastic tube is inside the epidural space as well.

Speaker 4 We could go one level deeper with the science, explain that the epidural space is not really a space at all, just potential space.

Speaker 4 But I won't get into this, just nod to it so the doctors watching can be like, on this show they know what they're talking about.

Speaker 4 Now Heather slides the needle off the plastic tube, which stays in Clara's back. Anesthetic drugs will be delivered through the tube, bathing the nerves near her spinal cord.

Speaker 4 Clara is relieved when the procedure is over.

Speaker 11 Even though it wasn't like a painful needle or something like that, it was such a strange, unnerving feeling, that pressure in your spine or whatever. But I got it and it was fine.

Speaker 11 But then around dinner time, I think was the first time that things, the trouble started with my epidural, where I didn't really even understand what was happening because it was just in my vagina that I felt pain.

Speaker 11 So I wasn't really, I wasn't aware of contractions.

Speaker 11 It was just all of a sudden, it felt like my vagina was just being shredded. I don't know.
It literally felt like, like somebody had like a steel-toe boot and was just kicking around in there.

Speaker 4 Oh, geez. geez.

Speaker 4 Clara's epidural is topped up with more drugs. And that does the trick.
She's more comfortable right away.

Speaker 4 A couple hours later, at 11 o'clock, Heather signs out to the anesthesiologist on the overnight shift and fills him in on Clara.

Speaker 12 When I was signing out, I was like, hey, you know, this is the deal. It's working, blah, blah, blah.

Speaker 12 And so I didn't anticipate any problems when I left.

Speaker 12 Otherwise, I would have probably stayed.

Speaker 12 Like in hindsight, now I'm like, you know, one of the things I'm always like for my, you know, providers that I'm taking care of, like, I kind of stay, just stay in the hospital because I just don't even want to, you know, I just want to be the one who's there if anything happens.

Speaker 4 We see Heather get in her car, drive away from the hospital. What happens after she leaves? That's coming up after the break.

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Speaker 4 Clara had been comfortable when Heather left.

Speaker 4 But several hours later, she's having the same pain again.

Speaker 4 And other things are going wrong too.

Speaker 4 Her labor is stalling. Her blood sugar is climbing.
So are the baby's heart rates.

Speaker 4 Clara knows she's headed for a C-section, but she requests one last half hour laboring on her hands and knees just to see if that will help.

Speaker 4 Now we see the room, dark except for the lights of the monitors. Clara on all fours in the hospital bed.
Close of her forearms, we briefly glimpse the tattoos.

Speaker 4 We remember for a moment that Clara has stripped Alaira off for us. There's a lot of vulnerability in what she's allowing us to see.

Speaker 4 The only other person in the room is Clay. That was another thing Clara had requested.
Just please, everyone clear out and give me one more try.

Speaker 4 But the try try doesn't work and there's no more time to waste.

Speaker 4 The nurses unplug Clara from her monitors and push her cumbersome bed down the hall to the OR.

Speaker 11 But I was like, okay, it's going to be fine. It's going to be fine.
My baby's going to be born. So.

Speaker 5 And yet she called me around three or four in the morning that they had decided to do a C-section.

Speaker 4 Mindy was at home, asleep. but she got right out of bed and grabbed her camera bag.
We see her strap over her shoulder, hurrying down the bungalow's front steps and into her minivan.

Speaker 5 So I raced over there and it was a little bit of an urgent case, meaning it's not what we call a crash, like where we literally just rip cords out of the wall and run.

Speaker 5 It was like, all right, we're doing this now. Let's move.
So I mean, I'm only 10 minutes away from the hospital when there's no traffic.

Speaker 5 So I raced over there and I parked on the street because I'm like, it's an urgent case. Like I need to go because they might start before before I get there.

Speaker 5 I even got a parking ticket that day because at night you don't pay for the meters, but I was there so long that in the morning they gave me a ticket. But anyways.

Speaker 4 Up on the fourth floor, Mindy takes a plastic wrapped surgical suit from a closet and pulls the cover all on over her clothes. Then she turns toward Clara's OR.

Speaker 5 And I walked in when she was on the operating room table and I actually have a beautiful photo of her.

Speaker 5 She has not seen these photos or I gave them to her, but I don't think she's ever been able to look at them.

Speaker 5 But it's the door of the operating room halfway open and she's laying there with like her arms out and she's looking at me smiling. And

Speaker 5 yeah, so then I mean when I got there and I took that picture, just her joy and I almost sensed relief. She knew I was there.

Speaker 5 And we we are all either night shift nurses or day shift nurses. And even though we're all one team, there's like more of a friendship and like bond.
Like day shift nurses, we all know how we work.

Speaker 5 And like night shift, we don't work with them ever. So like, we don't know how they roll, you know? So I think that smile was like, I'm having my babies.
You made it to take my pictures. You're here.

Speaker 5 You're one of me, one of our team. So yeah.
And I, I, too, was like, yes, I'm here for you. And

Speaker 5 this is why this case is so hard because I feel like I failed her 100%.

Speaker 4 When Mindy arrives, Clara is still being prepped for surgery. She's flat on her back in the OR, which is obviously not where she wanted to be.

Speaker 4 The L and D operating rooms at UIC are relatively small, out of another era. Mint green tiles on the walls.
Like you're stepping into the showers at a YWCA. Harsh light.
But Clara is calm.

Speaker 4 We see her now through Mindy's viewfinder. Her eyes closed.
The expression on her face, my God, it's the embodiment of a word whose use is rarely earned. Beatific.

Speaker 5 And I took pictures of everything. Like I took pictures of like Clay and her holding hands.
I took pictures of like the teams waiting, two different teams for two different babies.

Speaker 5 Pictures of like anesthesia working. Just I like to take pictures of people there because we never get to do that because of privacy laws.

Speaker 5 So for them to know that I'm on their team, like it's almost like here's a picture of you actually in a case.

Speaker 4 Surgery is getting closer now.

Speaker 4 There are poles on either side of Clara's bed and soon a giant piece of medical paper will be stretched between the poles, blocking Clara's view of her abdomen.

Speaker 4 This paper is called the drape and it both protects the surgical field from contamination and protects the patient from the sight of her open body.

Speaker 4 The anesthesiologist has added more drugs to Clara's epidural, making it strong enough to get her through the surgery. Now the doctors need to test to see if the anesthesia is working.

Speaker 4 Tight on the skin test, it's so weirdly basic, the anesthesiologist poking Clara with a broken tongue depressor. Another doctor does something more severe.

Speaker 4 clamping Clara's belly hard with a surgical instrument. Clara feels none of it, and that means they're ready to go.

Speaker 4 There's a decision to make about the C-section, how much of this procedure to show.

Speaker 4 Like Mindy said, how graphic are we doing?

Speaker 4 We're not going for gore on this series, for showing open bodies for the kick of it, but we do want visceral, all the meanings of that word.

Speaker 4 Viscera, literally, that's what's inside a patient's abdomen. But also how that word is applied to art.
Art that's visceral. It's of the body.
It attends to the body.

Speaker 4 Hopefully it makes you feel something in your body. A visceral aesthetic, muscular, close to the bone.
Raw but not sensational. Not shying away.

Speaker 4 Okay, enough self-regard, enough theory. What does this mean in practice?

Speaker 4 Now the surgeon calls out, incision, and then cuts into Clara's abdomen, just above the pubic bone. We're not seeing the scalpel in her flesh, okay?

Speaker 4 But just know that this kind of cut is is called a bikini incision. Bikini sounds tiny, but this cut is big.

Speaker 4 Once Clara's abdomen is open, the surgeon needs to reach the uterus. The uterus is behind a pair of muscles.

Speaker 4 Now we see, actually see, the surgeon and the OB resident position themselves on either side of Clara and pull.

Speaker 4 These two women in scrubs pull so hard to separate this muscle that their bodies lean back like in tug-of-war.

Speaker 4 This is a very physical surgery. When Clara is a nurse in a C-section,

Speaker 4 she either covers her eyes or looks away for this part.

Speaker 4 But of course, today, Clara is the patient.

Speaker 4 We go behind the drape now, tight on her face, but something's different, radically different.

Speaker 4 It was just moments ago that she was beatific,

Speaker 4 but now her mouth is tight.

Speaker 11 I just remember all of a sudden just being like, oh my god, I don't feel good, you know? Yeah.

Speaker 11 And I, I don't know, I assumed I was just panicking. You know, I assumed that I just needed to relax a little bit.

Speaker 4 A few years earlier, Claire had had a panic attack during another surgery at UIC. An eye surgery.
Cataracts. Weird to have them at such a young age.

Speaker 4 In the surgery, a different kind of paper drape had been unfolded over Claire's whole body. like a death shroud, so that she was entirely covered in blue paper except for a hole over one eye

Speaker 4 and then she'd heard the doctor say you need to give her something else she's hyperventilating

Speaker 4 all through her pregnancy she'd been worried that if she needed a c-section she would have a panic attack again

Speaker 11 and so i had spoken with dr nixon about strategies for how to deal with that if i panic yeah and we talked about the different medicines they can give And that sometimes in that case, nitrous oxide is really nice, you know, just breathe the gas for a little little bit because they don't last that long.

Speaker 11 So like maybe you can just breathe the gas for a minute or so. And it'll pass and then you'll be fine, you know?

Speaker 4 Yeah.

Speaker 11 So I asked,

Speaker 11 can I just have some gas or something? And he put the mask on and it just, it just was getting worse. And I remember feeling very nauseous

Speaker 4 and

Speaker 11 just saying that I wasn't. okay

Speaker 4 and um

Speaker 11 and then everything was really fuzzy and hazy and i'm am not, I guess, thankfully able to necessarily recall it in as much detail as I could at first.

Speaker 11 But I,

Speaker 11 it was an unfathomable amount of pain.

Speaker 11 And I remember

Speaker 11 begging them to stop.

Speaker 5 And it wasn't until she just kept begging, like, please, please, please.

Speaker 5 And one of the attendings, she looked at me and told me to tell her that it was okay. She told me to tell her partner, please tell him it's okay.
So

Speaker 5 at that moment, I was no longer a friend or like an advocate. I was more like a staff member being told by the doctor, like, it's fine.

Speaker 5 So I remember telling Clay, like, Clay, you know, this is normal. This sometimes happens.

Speaker 5 And Clay, I remember his body language was very like, yeah, okay, like I hear you, but don't talk to me. And I remember being like, Oh my gosh, because he was so stressed out.

Speaker 5 That's one thing I regret the most that that provider looked at me and said, Tell them it's okay.

Speaker 5 And that I did what she told me to, knowing that it wasn't okay. I think that's one of my biggest things that I replay over and over again.
That I didn't say,

Speaker 4 It's not okay.

Speaker 5 Like, can we stop?

Speaker 4 Clara's anesthesia is not working. She is now in the middle of major abdominal surgery, and she can feel that surgery.

Speaker 4 Clara knew this could happen. She had seen this happen.

Speaker 4 Intraoperative pain during cesarean?

Speaker 4 Healthcare providers know about it. Patients don't.

Speaker 4 When Clara herself first started working on L ⁇ D and patients in labor would tell her, for my last baby I had a C-section and I felt everything, Clara would think to herself, that can't be true, there's no way who would do that.

Speaker 4 And then she saw it happen and now it is happening to her.

Speaker 4 Visceral, that key word. What Clara is feeling is visceral pain, meaning pain that originates inside her abdomen.
When the doctors did the skin test, Clara didn't feel it, right? She was numb.

Speaker 4 But sometimes a cesarean patient is numb when you test her skin, and when you open her up, you find she's not.

Speaker 4 There are a lot of reasons for this, but in the moment, the reason for the pain doesn't totally matter. What matters is that you treat it.

Speaker 4 The babies. We miss the delivery, but we see them now at the edge of the room in newborn warmers, and we understand they are healthy, that they are okay.

Speaker 4 but Clara is not.

Speaker 4 We see Clara punching the drape, as if trying to hit the OBs.

Speaker 4 What are the OBs doing on the other side of the drape? What are they understanding? What are they feeling? Why are they ordering Mindy to tell Clara's husband everything is alright?

Speaker 4 We don't know the answers to these questions yet. We're on the side of the drape with Clara and the anesthesiologist who's giving her supplemental drugs, fentanyl, ketamine.

Speaker 4 Is he doing the right thing, giving her those drugs? We don't know this yet either, but the feeling we convey now is that something is wrong, very wrong.

Speaker 4 What's going on inside for Clara is that all these drugs have her hallucinating.

Speaker 4 Is this the kind of show where we do a magical realism thing of inhabiting her consciousness? I mean, it could be, yes, why not use it this way? Why not use it to show what Clara is seeing?

Speaker 4 A story I heard, I'll say this fast. A mother is given ketamine during her C-section.

Speaker 4 Her baby is born, and the nurse brings her the baby, and the patient says, This is a lovely baby, but this is not my baby. My baby does not have two heads.

Speaker 4 I heard this story from a doctor. It happened while she was still a resident, and she told me that after that woman, she never used ketamine for a cesarean patient again.

Speaker 4 What Clara is seeing, we see now. Colors and shapes.
If you're a certain kind of person, you might be fine looking at an open abdomen, but freaked out looking at hallucinations.

Speaker 4 Clara feels unable communicate.

Speaker 5 She was just so slurry like please, please, like stop.

Speaker 5 No, no, no.

Speaker 5 Like she sounded like she was out of her body at that point.

Speaker 5 And I almost started thinking like I know she's had issues with like post-traumatic stress type issues. So I'm like, maybe this is not pain thing, maybe it's a psychological thing.

Speaker 5 And you know, I mean, this happens a lot where patients complain of pain and we brush it off as she's anxious. It's just pressure.

Speaker 5 But it wasn't because she would feel anytime they touched or like did the cautery, like she would say the burning, she could feel the burning.

Speaker 4 The cautery instrument is called the bovie. It stanches bleeding.
And the red hot pain of it is something Clara remembers precisely.

Speaker 4 Something that years later would wake her up in the middle of the night. The seer of that instrument, Clara exclaiming, ow, and a doctor saying, we'll move to the other side.

Speaker 4 What?

Speaker 4 There's still a lot of surgery left after the delivery. And now we're going to see a part I know some people might not want to see.
Praise for it. I'm giving you the warning.

Speaker 4 The doctor is lifting Clara's uterus out of her body and resting it on her abdomen. It's like a giant shiny Easter Easter egg.
The uterus has been exteriorized, that's what this is called.

Speaker 4 And the reason we're seeing this is, please remember that Clara can feel this, can feel her organ being lifted out of her body. Oh, and at some point during all of this, Clara starts throwing up.

Speaker 4 Now the surgeon sticks a good portion of her forearm into Clara's body. What we see in the shot is just the arm disappearing into the abdomen.

Speaker 4 She's using a pad of gauze to check for internal bleeding.

Speaker 4 Again, the point is, Clara is feeling this. Now we hear her scream, why are you doing this? Make it stop.

Speaker 4 And now we do, as if on her command, we leave the surgery. We need to get out of this OR where bad things are happening and we don't understand why.

Speaker 4 Outside of the operating room, An obstetric anesthesiologist named Corey is arriving for his 7 a.m. shift.
Corey, we're not going to meet Corey as a main character.

Speaker 4 Maybe he's someone who will be developed later in another episode. He's trim and boyishly handsome.
We watch as several nurses urge him toward the OR. Corey, you need to get in there now.

Speaker 4 Corey pushes open the door and enters the room just as the surgeons are putting the final stitches in Clara's skin.

Speaker 11 And then all of a sudden, at some point, it was over. And I just,

Speaker 11 the first thing I remember is just sort of looking around. and then Corey was there.
He's one of the, like, he's one of the anesthesiologists. Yeah.

Speaker 11 And I remember seeing Corey and he came right by down my face because I was still on the table, but all the drapes or everything was gone and done. And Corey was right there.

Speaker 11 And I remember I was just like, oh, Corey, you'll, you know, I was just like, oh, you'll help me.

Speaker 4 Corey, Clara knows him, trusts him. Unlike the other anesthesiologist, she had no idea who that guy was.
We see some relief in Clara's face, and we see Corey holding back tears.

Speaker 4 And even though there's no resolution or total explanation, at least we know that Clara is being cared for.

Speaker 4 Corey wheels Clara to the recovery room, the pack you, and as soon as she's settled, Corey goes down the hall and calls his boss, Heather.

Speaker 12 He calls me and he's like, Heather, something happened. And I was like, okay?

Speaker 12 Like, what's going on?

Speaker 4 Heather was at home. She'd been at the hospital so long the night before that that she got the day off.
Corey told her about Clara.

Speaker 12 Oh my god, no, no, no, no, no, no, no, no, no.

Speaker 4 Like that can't, that just can't be.

Speaker 12 And I was like, Corey, what happened? He's like, I don't even know.

Speaker 12 And

Speaker 12 I just felt...

Speaker 4 I felt horrible.

Speaker 12 Like I felt like I shouldn't have left the hospital, right? Like that I

Speaker 12 should have just stayed until she was safely taken care of, of, right?

Speaker 4 That she had delivered, that I had

Speaker 12 let her down and that.

Speaker 4 And

Speaker 4 then I got mad.

Speaker 12 And then I got really mad.

Speaker 4 Heather is mad because she's in charge here. And she's an anesthesiologist.
The thing the anesthesiologist is in the room to do is manage pain.

Speaker 4 Cutting someone's body open and then operating when they can feel it. That is not supposed to happen.

Speaker 4 That's something from history or from war.

Speaker 4 But in the United States, it happens 100,000 times a year.

Speaker 4 That's the best estimate of how many patients have significant pain during cesarean.

Speaker 4 Not all of these patients feel the exact same intensity of pain or at the same parts of the surgery or for the same length of time.

Speaker 4 But the pain they feel is significant.

Speaker 4 Most people don't know about this. Until recently, I didn't.
I learned of it from listeners to season one of this podcast. It doesn't matter if you haven't heard season one.

Speaker 4 The details are less important than the common experience it described. Pain a doctor didn't listen to.
Pain a doctor didn't adequately treat.

Speaker 4 That experience resonated with many listeners, and hundreds of them, mostly women, began writing to me with their own stories.

Speaker 4 One afternoon, I opened a note that was unlike any any I'd received so far.

Speaker 4 I had a C-section, the email began, where anesthesia was not properly administered.

Speaker 4 I remember telling them I could feel the cutting, the moving of my organs, the burning, shocking, brutal pain, and being told that wasn't possible and that I would just have to tough it out.

Speaker 4 To me, this listener's experience seemed so out of range that it might be singular.

Speaker 4 Then I opened two more of these notes.

Speaker 4 Soon I understood this was a subject subject that would come up again and again.

Speaker 4 C-sections are the most frequently performed surgery in the world. In the U.S., there are 1.2 million of them a year.
So 100,000 patients a year feeling pain during cesarean. That's 8%.

Speaker 4 Some people say the rate is even higher. There's no other surgery where this happens.
No other major surgery where it would be acceptable for 8% of patients to feel that surgery.

Speaker 4 8% is a brand new number from a recently completed study. It didn't replace an old number.
It's the first number of its kind.

Speaker 4 Until now, nobody had ever done a study like this, asking thousands of patients in the US and Canada whether they felt pain during their C-sections.

Speaker 4 But now the study has been done by doctors who recognize that this is a problem and that putting a number to it is a step towards solving it.

Speaker 4 And this is what this story is about.

Speaker 4 Not just that there's a problem with severe pain, but that people are trying to solve it.

Speaker 4 As soon as I finished season one of the retrievals, people began asking me, what are the solutions to fixing this problem in medicine of dismissing women's pain?

Speaker 4 I was surprised the first time I got this question about solutions. Obviously, I should not have been surprised.
But I didn't have a bullet point list. How to shift an entire culture.

Speaker 4 How to listen to women patients. These are really complicated issues.
And solutions had not been the focus of my reporting. I'd looked at what went wrong.

Speaker 4 Exploring what went wrong doesn't automatically translate to solutions on how to make it right.

Speaker 4 But this question made me curious. Well, what are the solutions?

Speaker 4 It turned out that a bunch of people interested in pain during cesarean were thinking about the same thing.

Speaker 4 So here we go, a case study in solving one of medicine's most persistent problems, listening to women patients and adequately treating their pain.

Speaker 4 Told through the experiences of four women, Clara, Heather, Mindy, and Susanna, who run up against this problem and take it on. with efforts that touch both individual patients and entire countries.

Speaker 4 How do they do this? What can they change? And what does it cost them?

Speaker 4 Back at the hospital, Clara has been moved from the pack you to a bed. It isn't long before she hears from Heather.

Speaker 11 It was that day. She was really upset, too.

Speaker 11 She was really sorry that it happened.

Speaker 11 Yeah.

Speaker 11 Because Corey, obviously, yeah, corey told her

Speaker 11 anyway

Speaker 11 and she was really sorry

Speaker 12 the first the first time i saw her she looked at me and she goes heather

Speaker 4 what the

Speaker 4 what the

Speaker 12 heather and i just went i'm so sorry

Speaker 4 and

Speaker 12 you know she was really it was hard she was really really raw she was not okay

Speaker 12 and i said to her you know i said listen

Speaker 12 when you're ready, I'd love to just get some information from you. I said, Because I'm going to take this beyond where we are right now.

Speaker 12 I said, I'm going to make sure that institutionally, like this doesn't happen again. And I'm going to make sure that people hear about this and that this can be used for good.

Speaker 11 She wasn't going to let it go and she was going to take action. You know, she was going to do something to prevent this from happening again.

Speaker 4 And now we see Clara in her bed, and we follow her gaze out of the window, out of the hospital, down to the street, where we pause for a second over Mindy's minivan, an orange parking ticket on the windshield.

Speaker 4 And then we continue across the city, arcing back over the same elevated tracks and wide highways we traversed earlier. Only now it's dusk instead of dawn.

Speaker 4 And when we get to the lake, we turn around so that we can see the sunset over those magnificent buildings, their windows fiery with the day's last light.

Speaker 4 And we hold that shot as the music swells and the credits roll.

Speaker 4 From Serial Productions and the New York Times, I'm Susan Burton, and this is the Retrieval Season 2: The C-Sections.

Speaker 4 Next up, Heather.

Speaker 4 The Retrievals is written and reported by me, Susan Burton, and produced by me, Julie Snyder, and Ben Phelan. Julie edited the series.
Ben did research and fact-checking.

Speaker 4 Be sure to sign up for our newsletter, where each week we'll share more reporting from the show, listener stories, and reading lists. Go to nytimes.com/slash serial newsletter.

Speaker 4 Music Supervision, Sound Design and Mixing by Phoebe Wang. Original music by Dan Powell, Fritz Myers, and Nick Thorburn.
Carla Pallone composed our theme song, and it was remixed by Dan Powell.

Speaker 4 Additional production by Mac Miller. Additional mixing by Catherine Anderson.
Editing help on this episode from Jessica Weisberg, Laura Starcheski, and Jen Guerra.

Speaker 4 Our standards editor is Susan Westling. Legal review from Dana Green.
The art for our show comes from Pablo Delcon and Eric Tanner. The supervising producer for serial productions is Inde Chubu.

Speaker 4 Additional producing comes from Mahima Chablani, Jeffrey Miranda, and Corey Beach at the New York Times. And Sam Dolnick is deputy managing editor of the New York Times.

Speaker 4 The study I mentioned, the one in which patients were asked if they felt pain during their C-sections, was led by James O'Carroll.

Speaker 4 Special thanks to Katie Fuchs, Elizabeth Livingston, Blair Arthur, Vanessa Lehner, Rachel Roberts, Lynn Holland, Carolina Mendoza, Jamie Daly, Elizabeth Davis Moore, Nina Lassam, Jordan Cohen, Victoria Kim, Maddie Maciello, Kelly Doe, and John Pappas.

Speaker 4 The Retrievals is a production of Serial Productions and the New York Times.