The Present Illness

Labor & Dismissal

• Alyssa Burgart & Arghavan Salles • Season 1 • Episode 9

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Activation Awareness: This episode discusses serious pregnancy complications and the dismissal of women's health concerns.

In this week's episode of The Present Illness, Drs. Arghavan and Alyssa deliver a stat consultation on two viral stories about Black women receiving substandard obstetric care. With surgical precision, they dissect the case of Karrie Jones at Dallas Regional Medical Center, who was kept in a wheelchair for admitting questions while in active labor, and Mercedes Wells, who was turned away from Franciscan Hospital in Indiana only for her husband Leon to deliver their baby on the side of the road. Their differential diagnosis includes systemic racism, dismissal of women's pain, and healthcare systems operating with more red tape than gauze.

This TikTok from OB-Gyn Shannon Clark gives her expert take.

Fact check: Texas did not disband their maternal mortality review committee—Georgia did, after ProPublica reported on deaths in Georgia.

Resources mentioned:

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Thanks for listening to The Present Illness with Drs. Arghavan Salles and Alyssa Burgart!

Follow us on TikTok and Instagram @ThePresentIllness

Credits

  • Production by Arghavan Salles and Alyssa Burgart
  • Editing by Alyssa Burgart
  • Theme Music by Joseph Uphoff
  • Social Media by Arghavan Salles

Arghavan Salles (00:00)
Hey there, fellow nerds. Welcome to another episode of The Present Illness, the podcast where two physicians try to make sense of a world that's a little febrile and definitely underdiagnosed. I'm Arga von Salas, a surgeon scientist and your friendly neighborhood doom-scruller in... Doom-scruller. Doom-scruller in residence. I don't know what a doom-scrull is.

Alyssa Burgart (00:21)
That's a new diagnosis on the differential.

And I'm Alyssa Burghardt, an anesthesiologist and bioethicist who tracks news and health law like they're EKGs full of spikes and surprises. Depressive illness is where we dig into public health, politics, culture, and ethics with a scalpel in one hand and a meme in the other.

Arghavan Salles (00:46)
a thanks as we'd like to shout out every week to everyone who's been listening, people who have followed or subscribed to our podcast. We really appreciate you. And if you're leaving reviews ⁓ or ratings, we love that as well. And a warm welcome to anyone who just stumbled in from watching our president repeatedly berate women journalists.

Alyssa Burgart (01:04)
Ugh, so gross. Well, we are glad that all of you are here. ⁓ Gentle activation warning for our listeners. We're going to talk about some serious ⁓ pregnancy complications and dismissal of women this week. And so if you need to take a break from this, like, we totally get it. ⁓ Let's get into it.

Arghavan Salles (01:21)
Well, first thing I wanted to share real quick before we get into that very important topic that you just mentioned is I wanted to do some updates and corrections from last week's episode. One minor correction, which is that there was an email among the many that we had talked about that were in the trove of Epstein emails. There was one in which a person said they didn't want to get to Jeffrey Epstein's house too early and run into Trump.

Alyssa Burgart (01:45)
Mm.

Arghavan Salles (01:45)
And

I had made an assumption, you know what happens when you assume, I had made an assumption that the person writing that email was a woman and it turns out it wasn't, it was a man and it was in fact a Kuwaiti, someone who had previously been a minister in the Kuwaiti government. So I just wanted to clarify that or correct that I should say. And then the other thing or another thing is I wanted to update folks because we had a bit.

Alyssa Burgart (02:00)
Okay.

Arghavan Salles (02:09)
Fair bit of discussion about Larry Summers, the former president of Harvard, the former US secretary of the treasury. And when we recorded last week, what had happened was there were multiple emails that were of concern. Although I think at the time of our recording, we only had that one where he talks about, you know, basically women are stupid and, you know, and it was kind of a nonsensical, very hard to understand email. But there were additional emails that really demonstrated he was

continually basically or repeatedly getting coaching from Jeffrey Epstein for how to manipulate and sexually harass a mentee. yeah, absolutely disgusting. And what has happened since we last recorded is that Larry Summers ⁓ said that he was gonna back off of what he called his public commitments.

Alyssa Burgart (02:42)
Ugh.

Arghavan Salles (02:56)
Then shortly after that, he stepped down from the board of OpenAI. The New York Times announced they were not going to renew his contract as a contributing writer. He was removed as a senior fellow from the Center for American Progress. And there's some other things if people are interested. I've posted a lot about that on my other channels. ⁓ And importantly, what he had said in that statement a few days ago was that he was going to continue teaching. And that is no longer the case. So Harvard...

first had announced that they were going to do an investigation on the emails. ⁓ And that was going to include looking into the emails Larry Summers had sent, but also other folks at Harvard or affiliated with Harvard, including his wife. I don't think we talked about this last week, but his wife also had email exchanges with Jeffrey Epstein, and Jeffrey Epstein had donated money to support her work, ⁓ like a fair amount of money to support her work. So they're going to be investigating that. And then yesterday, we're recording this on Thursday, November 20th,

Yesterday, there was an announcement that he's not going to finish out this term as an instructor. The other people who've been involved in teaching the courses he's been teaching are going to take over. He's apparently not teaching any classes next semester. While this investigation continues, he's also been removed as the director of the Mossavar Rahmani Center, which is one of the name titles actually that he has been holding in recent years. So I just wanted to give

That update for folks as to what has happened with Larry Summers. And I think those are the key things as follow-ups from our conversation last week. Of course, sorry, one more obviously major thing is that Congress voted, of course, to release the Epstein files. And that bill was then sent to the president who did sign the bill, but he added a number of stipulations. So it's a little unclear what we will actually see. But for those who've been fighting for a really long time to get these files released, that's a major, major...

Alyssa Burgart (04:46)
Mm-hmm.

Arghavan Salles (04:52)
landmark event that happened this week, notably coinciding more or less with another press conference of survivors that the survivors had at the Capitol again this week.

Alyssa Burgart (05:03)
and like

super powerful imagery ⁓ leading up to the vote of survivors holding up pictures of themselves when they were the age that they were groomed and trafficked and assaulted.

You know that. And I think we mentioned last week, you know, the things that Megyn Kelly had said about, they're not Jeffrey Epstein's not really a pedophile. He's not. It's a big difference between, you know, I forget if she said five year olds or whatever, but it.

Arghavan Salles (05:33)
She said five-year-olds

and she said eight-year-olds and she said 15-year-olds. But her big thing was 15 is different from eight as though pedophilia with a teenager is less worrisome than pedophilia with a child. Although I would argue they are both terrible, atrocious, horrific.

Alyssa Burgart (05:51)
Yeah, and still children. Yeah, I mean, and I'm, somebody who gives a lot of lectures about adolescence and developing autonomy. And how do we think about, you know, what kids can consent for and what they can't consent for? And when do kids assent? And when do they not assent? And how do we support them through difficult decision making? And nowhere in there? Is it okay to rape them? That's really the key. Nowhere in there? Is it okay?

Arghavan Salles (05:55)
Yes.

for us.

Alyssa Burgart (06:22)
to rape minors.

Arghavan Salles (06:25)
Well, I know we have other things to talk about, but I do want to on that point just say that there has been a lot of conversation around that point since Megyn Kelly's comments with, as I'm sure you can imagine, a number of conservative people essentially supporting her position and trying to normalize attraction to teenagers. So one of the things that she said in her comments was that,

are barely legal. you know, obviously 18 is actually the age of legality, not 15, but also

Alyssa Burgart (06:59)
Yeah, they're

not barely legal. That's what's most important about this, that is an incorrect assertion.

Arghavan Salles (07:04)
Correct, they're absolutely not legal. ⁓ But also she talks about whether people seeing you on the street with this person might believe that this person is 18 instead of 15, as though that's a thing that matters. anyway, aside from me and Kelly, all I wanted to point out was that she's not the only one who seems to think sex with children is allowable if those children are 15.

or 16 or 17. And that's not what our law says and it is absolutely disgusting.

Alyssa Burgart (07:40)
Yeah, and it's, I mean, I have so many thoughts on this. But the other thing is that you when you hear rhetoric from, you know, various people about like, oh, I'm waiting until she's 18. And then I'm going to go after her. It's like, that's gross also. And this idea that you're going to groom somebody so that once they are technically able to make decisions for themselves, in a legal fashion that you're then going to pounce on them.

It's gross. ⁓ Do not love. What was also, though, I will say a surprise for me, I did not think that a day would come that I would be like Marjorie Taylor Greene, great job. But I, you know, I'm here to be surprised and didn't realize that her and I shared values. And it turns out that we found one. It turns out that she is on the side of don't rape kids. And that those are the two sides I really care about in this argument. And ⁓

Arghavan Salles (08:11)
No.

Alyssa Burgart (08:39)
Never thought I'd see the day, but here we are.

Arghavan Salles (08:41)
In agreement with Marjorie Taylor Greene. Yeah, it's interesting. There's a lot of, there's been a lot of discussion about whether this is her, not just this piece, but she has come out, you vocally against our president in a number of ways to the point that he has now denounced her publicly. And so, you know, people are having a lot of thoughts about what this means for Marjorie Taylor Greene. And I agree with those who have basically said, yeah, she's just an opportunist. She's trying to do what she thinks will lead to.

her own personal success ⁓ based on her constituents and who she's trying to appeal to more than standing on any sort of principle.

Alyssa Burgart (09:12)
which

I and also I don't want to think that ⁓ there's certainly plenty of people on both sides of the aisle that are doing the very same thing. They're, know, politicians will politician. So with that.

Arghavan Salles (09:33)
Yes. So with that,

let's talk about what you mentioned at the beginning. There's a couple of viral stories that I think you wanted to bring up. And in case our listeners haven't heard about them, I think they're really important.

Alyssa Burgart (09:48)
Yeah, thank you. I think it's been a really ⁓ shocking week outside of the Epstein cases in that there's been two viral videos in the last week or so showing black women in labor not receiving the care that they should receive when they're in active labor. And so there's two cases. ⁓ We'll put videos in the show notes. But Karrie Jones was at Dallas Regional Medical Center.

and trying to get ⁓ medical care there. There's a video that her mother took of her clearly very, very uncomfortable in immense pain, having very frequent contractions, and the nurse doing her intake really having quite a flat affect and not ⁓ seeming to express any sort of empathy or a sense of urgency with helping to get this woman ⁓ in to get care. And then according to the video,

Arghavan Salles (10:40)
Thanks.

Alyssa Burgart (10:46)
her baby was delivered, you know, the video says 12 minutes after they finally finished this admitting ⁓ documentation. And it just really demonstrates that that's also minutes, you know, as an she might have gotten pain control when she should have gotten, you know, IV fluids, there's a lot of care, you know, when you present to a hospital that should be part of that in terms of making sure that you're having a safer delivery.

Arghavan Salles (11:11)
for folks who haven't seen the video, I just want to paint the picture a little bit because not only, as you said, was the nurse flat of affect and not showing any care whatsoever as this woman was writhing in pain, but she also had her back fully turned to the patient. She was at a computer screen a few feet away and not...

on the side. Like when I say her back was to the patient, I really mean that the patient was behind her and she did not make attempts to turn around and look at the patient, to make any kind of eye contact, to suggest that she cared about what was happening for that patient. She was just at, and how many children, how many times have you been pregnant? And who is your primary care doctor? Like this urgency of what was happening behind her just went completely over her head.

which, know, like I don't know that person who knows what she was thinking, but what it looks like is that she had just no care whatsoever for the patient who clearly needed help.

Alyssa Burgart (12:10)
Yeah, and the patient was just, well, initially sitting in a wheelchair, but as the video goes on, is like, you know, really unable to stay seated because she's in so much pain and continues to try to actually get into other positions to try to alleviate her pain. It's really difficult to watch, but it is really important. And I think it's obvious to anyone who's watching it, like, this is a medical issue. Like, there is an urgent thing that is happening here, and I don't think that you actually need much medical training.

to look at that video, which is, think, why it's really heightened, captured the American attention right now, despite all of the things reaching for our attention. Because I think that almost everybody can look at that and say, wow, something's wrong here. This doesn't seem like the kind of care that a person should be able to expect when they're about to deliver their baby. And then the other, again, related case was in Indiana at a Franciscan hospital in Crown Point, Indiana.

a woman named Mercedes Wells had presented to this hospital, ⁓ was there apparently for five or six hours, I can't recall, had been told that her labor had not progressed, that she was only three centimeters. And I've got a video that I'll link in the show notes that ⁓ shows part of the video, but also gives an OB-GYN giving their ⁓ assessment of sort of what they can expect. And when the patient, so the patient never saw a doctor, they saw a triage nurse,

who said that her exam had not progressed and so sent them out the door. The baby was delivered in the car by the husband who had to actually call 911 to understand what to do and then they had to go back to the hospital. And so these were both women who had presented, they had wanted a birth in a hospital, had wanted to have access to support and care and they were turned away.

both of these cases really demonstrate how we're in this maternal morbidity and mortality crisis in the United States where our outcomes are terrible across the board and they are the most terrible by orders of magnitude for Black women in this country. And so it's horrible what has happened to both of these families and this is happening all over the country all the time.

Arghavan Salles (14:35)
Yeah, they, I

don't know if we explicitly said it, both of the women that we're talking about are Black women. And in this country, depending on which data you look at, Black women are three to four times or Black pregnant people, I should say, are three or four times more likely to die due to pregnancy related causes than are white women. And this is true regardless of level of education or income or other factors that sometimes people want to look at in order to try to victim blame. And that is

Alyssa Burgart (14:51)
Mm-hmm.

Arghavan Salles (15:05)
multifactorial like all other things, but one of the things I usually like to point out that I think is important to point out in these conversations is that one of the main risk factors for this is racism. It's not race, but it's racism. And it's the fact that we, as a society, don't care for Black people and especially for Black women. The data within our own profession suggests that we don't take

Alyssa Burgart (15:16)
Mm-hmm.

Arghavan Salles (15:30)
black people's pain as seriously. don't treat it in the same way as we treat white people's pain. And we also there's data that shows that medical students think black people have thicker skin than white people, which is not true. Just as two examples of kind of racist beliefs that many people hold. In addition, you have the broader

Alyssa Burgart (15:35)
Mm-hmm.

Arghavan Salles (15:54)
structural types of racism like environmental racism and housing segregation and food deserts. There's all sorts of other reasons ⁓ that again are highly correlated with racism that lead to poorer health outcomes for Black people in this country and poor maternal health or pregnancy related health for Black pregnant people.

Alyssa Burgart (16:14)
Yeah, and then the other issue that's related to maternal morbidity and mortality and maternal health outcomes is infant health outcomes and infant maternal, pardon me, infant morbidity and mortality. And the March of Dimes releases an annual report card on every state in America talking about these outcomes specifically for preterm birth because we have so many preterm births in this country and the country, our country as a whole,

got a D plus in 2024. That's the data that was just released. that's, it turns out, I mean, you and I have done a lot of school. And I will say, I would have been very embarrassed to get a D plus in a grade ever in my life.

Arghavan Salles (16:47)
Is that bad?

Yeah, I'm not sure my mom would have let me survive childhood if I'd gotten a D plus ever.

Alyssa Burgart (17:06)
America, your mom is pissed.

Yeah, mean, a D plus is not a good grade. We do not want this grade. And Indiana, where one of these cases took place, got a D. And Texas, where the other case took place, also got a D. ⁓ And looking through the other data, you and I are both in California. California overall got a B minus.

still not a good grade in my opinion. Like I want A plus care for our patients. I want every person in America to have the ability to actually get A plus care. And these graphs ⁓ really show the disparate access that people are getting to good care. We're seeing how, you know, there's a number of factors that can influence preterm birth, getting to your points about environmental issues.

Arghavan Salles (17:36)
Thank

Alyssa Burgart (17:57)
issues that are causing people to have ⁓ co-morbid conditions that are impacting their pregnancies, that are impacting their experiences, how safe is a neighborhood, how much violence is somebody exposed to. All of these things can also contribute not only to maternal health outcomes, but additionally to infant health outcomes. I know you won't be surprised, those things are linked. so it was particularly interesting to me

Arghavan Salles (18:18)
Mm-hmm.

Alyssa Burgart (18:25)
that both of these cases have come out around the same time and the same week that the March of Dimes data has come out. And I always look for the March of Dimes data because it's super useful in terms of understanding sort of what's happening overall in the country in terms of ⁓ pediatric care. ⁓ And it's impossible to, in addition to the care that these patients have received or not received, ⁓

inadequate care that they've received. We know that overall many black women are experiencing this substandard care. And we've seen this with incredibly famous black women who have either died or nearly died from pregnancy related complications. know, your wealth is not inherently protecting folks from these outcomes. And then in addition, ⁓

Arghavan Salles (19:12)
Nor is status.

Because

if you think about someone like Serena Williams, who may be one of the women you're referring to, when she had, I think it was Olympia, I think that's her name. ⁓ But when she had her baby, Serena had already had a pulmonary embolism, a blood clot to her lung in the past. And she was concerned that she had another pulmonary embolism after delivery. And the healthcare workers at the hospital just kept telling her she was anxious or trying to reassure her.

and she was the one who had to push to get a CT scan, which is the most common way that we diagnose a pulmonary embolism. And when they finally did one, lo and behold, they found that she had a pulmonary embolism and she needed to go on blood thinners again. And that is one of the greatest athletes of all time. Some might say the greatest. And despite her wealth and her...

fame and the fact that I'm pretty sure she was not shy about voicing her concerns and still had trouble getting her healthcare needs met just gives you a sense of how hard it must be for other women and in particular women of color, including black women in this country because of the layers of sexism and racism that misogynoir.

that just is such a strong force, unfortunately, in healthcare as it is everywhere else in our society. I had also shared, I think it was two years ago, there was an Olympic gold medalist, Tori Bowie, who died at her home during delivery. And she had, unlike the two women you brought up today, she had actually chosen not to go to the hospital because she didn't want to go to the hospital. She didn't trust.

Alyssa Burgart (20:47)
Yes, yes.

Arghavan Salles (21:02)
that we were gonna take care of her. And she had either preeclampsia or eclampsia depending on what source you look at, which is a significant risk factor for bad pregnancy outcomes and really was not receiving the care that she should have been receiving. But that's because look at when you see videos like these ones that you mentioned, like why would anyone want to expose themselves to that to be dismissed for hours to be sent

out of the hospital to deliver your baby in a moving vehicle, in the case of Mercedes Wells, or to not even be taken to a proper labor and delivery suite, in the case of Kerry Jones, why would anyone want to put themselves through that? And I had posted videos about this before and people will say, well, how do you know it's racism, like for Tori Bowie, like she was at home, she didn't even go to the hospital. Yes, why do you think she didn't go to the hospital? Take that step back, think about it.

what made her not want to go to the hospital because we're not blaming that woman for not wanting to expose herself to what we've seen in these videos in the last week. And it had unfortunately a catastrophic outcome for her. And I don't know what would have happened, right? If she'd gone to the hospital, maybe she would have been treated the way these women were. But all of that is on us is what I'm trying to say.

Alyssa Burgart (22:06)
Mm-hmm.

Mm

Well, and I can say, as a white woman who was a senior medical student when I delivered my first child, was a senior, I was a chief resident when I delivered my second child. And the amount of advocacy that I had to do to be taken seriously, that I had to do to not be sent home to have my baby in the car was outrageous. And I absolutely benefited from not only being a physician, from being a white woman,

from being just all of these, my obstetrician happened to be on call and knew I was coming in. There's all of these things that made it so that I was able to advocate for myself. And the idea that as a tennis player that you have to diagnose your own pulmonary embolism, mean, that's bananas. It should not take this level of expertise when giving birth is a pretty common thing to need to do.

Arghavan Salles (23:11)
So thank

Alyssa Burgart (23:20)
as a woman of a certain age. Like.

Arghavan Salles (23:21)
Well, and

I will just say that, you know, we see from the conservatives a huge push, right, for more babies. Supposedly, that's what their rhetoric says, that we are even was the Dr. Oz who said that we are under-babied in this country. What a ridiculous term. ⁓ And there are many reasons why people are choosing to have fewer children, including that we don't pay people a living wage and how people can't afford to have children are very expensive. But also, yeah, when we don't

Alyssa Burgart (23:48)
Mm-hmm.

Arghavan Salles (23:51)
offer pregnant people appropriate care. I we have some of the worst pregnancy outcomes in the entire world, certainly compared to other ⁓ wealthy countries. We provide really poor quality care on average, and that's not to say anything bad about our OB-GYN colleagues. I think it's a lot of systemic issues. But overall, because we don't have healthcare for everyone, because we don't give people a living wage, because people don't have access to healthy food, there's lots and lots of reasons, but we have

poor pregnancy health outcomes. So going back to Tori Bowie for a second, her Olympic gold medal team for the four by 100 was Alison Felix, English Gardener, Tiana Bartolotta and Tori Bowie. Three of those four women had severe complications of pregnancy. And Alison Felix wrote about it, recommend, we can put it in the show notes, I recommend people her essay, because she wrote about it for Time Magazine at the time about how we have got to take these stories and use them to make

Alyssa Burgart (24:38)
Mm-hmm.

Arghavan Salles (24:48)
change. And I was so glad to see people paying a lot of attention to the two stories that you mentioned that have been going viral on social media. And I can't help but think this is not a new story, unfortunately, in this country. And we've had, as you said, famous people, wealthy people, influential people who've had these experiences. And what are we doing about it? That's my question, because I saw, for example, at Dallas Regional Medical Center,

People had posted that the nurse was fired, which I think was later corrected to she was put on leave, I believe. I mean, that's fine, that's good, that's good. But what about the system that allows for someone to treat a patient that way? Clearly she felt that was, yes. I mean, she clearly felt that was an appropriate way to treat a patient. I mean, when, why? How do you have a hospital where people think that? You know what I mean? Like this is a much deeper problem than that one.

Alyssa Burgart (25:29)
That's a culture. That's a culture.

Arghavan Salles (25:45)
nurse.

Alyssa Burgart (25:47)
Well,

and this gets to something that you and I have talked about a lot in terms of things related to sexual assault culture and rape culture is that it's not ever one bad apple, folks. This is not a bad apple situation. It's that we have a culture, we have a society that has decided we don't need to listen to certain people. We don't, you know, the misogynoir. We don't need to listen to black women. We can dismiss them.

Arghavan Salles (26:01)
Mm-hmm.

Thank

Alyssa Burgart (26:17)
We can treat them callously. We can make fun of their presentations of pain and therefore dismiss them. You know, this is a culture.

Arghavan Salles (26:28)
And it goes back, if we may be historical for a moment, to J. Marion Sims, who I think we've mentioned in a previous episode. He's the so-called founder of gynecology, and he was straight up experimenting on black enslaved women without pain medication. The entire profession started there. So.

Alyssa Burgart (26:34)
Ugh.

Arghavan Salles (26:49)
And I do want to acknowledge we have a lot of OB-GYN colleagues who are very concerned about this and doing a lot of education online and I'm sure in their hospitals and I'm not at all suggesting that this is all their fault or anything like that because like you said, it's a systemic issue. But it even starts from the very foundation of the profession with that man. And I wanna just directly address that this is not

Alyssa Burgart (26:59)
Mm-hmm.

Mm-hmm.

Arghavan Salles (27:19)
all separate from what's happened with abortion bans after Dobbs, which was the decision that overturned Roe. And that decision taking away access to abortion, we knew was going to disproportionately affect women of color, including black women. And that is exactly what has happened. ⁓ And there are many, many examples of this, but just ⁓ yesterday ProPublica put out another article. They've been...

They've done such excellent reporting on what's happened in post-Obs America. So if folks care about that, I would really recommend you look at the reporting in ProPublica and consider supporting them if you have the means. But they have a piece that came out yesterday about a woman named Tiara Walker, who was 37 years old and pregnant. And she was not well. She had high blood pressure and she was having seizures and she was hospitalized repeatedly and asked for an abortion.

Alyssa Burgart (27:47)
Agreed.

Arghavan Salles (28:15)
in her first trimester because she was worried about her own survival. She had a son who was at the time 14 years old and she had a partner and she wanted to live with and for and be with them. ⁓ And they did not give it to her. And she continued to have, again, multiple complications. She developed a blood clot in her leg that was so severe they needed to do what's called a thrombectomy. So they had to physically remove this clot. That's very unusual to have to do.

And she saw over 90 physicians, 21 of whom were OBGYN specialists. Not a single one of them offered her an abortion. And I want to be clear that that is because of the law in Texas. In Texas, anyone who helps someone get an abortion not only is fined a significant amount of money, I think it's $100,000, but they can spend, can be, sorry, punished with 99 plus years in prison.

And so what happens if you say, hey, if you help this person with an abortion, you may spend a hundred years in prison. You can imagine just basic human psychology that people will be very reticent to provide that care. And that's what we see in case after case. This case, ⁓ Tierra Walker is not the first and she won't be the last that we hear about, but she had at least preeclampsia if not eclampsia.

And the indication for an abortion is definitely that. She was a very high risk patient, but because the way these laws are written in a lot of states, including in Texas, it's unclear what it means, they have these exceptions, right? Because I'm sure someone out there is thinking like, isn't there an exception for the life of the pregnant person? And yeah, in a lot of states, there are these exceptions, but they don't work because there's no definition of.

what does it mean to be threatening the life of the patient? So the very first time she had a seizure during her pregnancy, I think one could argue that was a threat to her life. But clearly none of these over 90 physicians who saw her thought that they could make that argument. And these are laws that are enacted by people who don't know anything about medicine. And by the way, Texas's maternal mortality committee was disbanded.

Alyssa Burgart (30:31)
Yeah, so we don't even have data from that group, which is one of the most important areas we need data from because their, ⁓ their abortion restrictions actually started over a year before the Dobbs decision because of the SB eight legislation. And so we, it is a black box in Texas. Like we actually do not know what is happening on an aggregate data and an aggregate way, ⁓ the way that we would typically have collection of data and analysis of that data.

And so that's the other element that's happening with ⁓ maternal morbidity and mortality data is this effort to really suppress access to this information.

Arghavan Salles (31:08)
Yeah, Senate Bill 8, SB 8 is the bill you're talking about. was, people may remember that it was called the vigilante bill and it was this, they set this precedent that basically anyone can report someone for helping someone to get an abortion. And it really tries to turn

turn people against each other, right? Everyone can be monitoring you. And I think that is part of what's happening in cases like Tiara Walker's because in the hospital, let's say you're a physician taking care of her, let's say you think she should have an abortion, you also know there's a nurse, there's an MA, is a whoever else involved in the care who could report you if they disagree. Even if medically you're right, going through a trial or whatever the process might be if someone reports you because they just think.

Alyssa Burgart (31:29)
Mm-hmm.

Arghavan Salles (31:57)
Right? That's not a high bar for reporting. They just think that you're doing the wrong thing. I that can have really serious consequences for a person's career. And I've seen a lot of people online say like, well, doctors just need to do the right thing. And I understand that sentiment. And imagine if I'm the doctor and I go ahead and do like in this case, offer an abortion, perform an abortion, and then people, whoever reports me, and then I end up in prison. Who am I helping?

I helped this one person, but that's it. That's the end of my career and I can't help anyone else. So when we think about it from a system level, although I understand the sentiment, it really is not practical to say individual physicians should just do what I think we all know is right because then they may be taking themselves out of practice and then leaving patients with fewer physicians around who can care for them, which is part of what's happened in Idaho, by the way, a number of the OBGYs in Idaho have left because they feel they cannot provide the care that is necessary for their patients.

Alyssa Burgart (32:56)
Yeah, and I will say that, for example, in Texas, ⁓ almost 50 % of counties in Texas are maternity care deserts already. each individual person who's willing to provide abortions, ⁓ who would otherwise be willing to provide abortions in Texas if it were not for this law, if those folks lose the ability to practice because they do the right thing, to your point, it further compounds.

this maternity care desert situation where there is just very little access to care under the best of circumstances right now. ⁓ And the other thing that's hard, this is why so many of these laws, and you see how ⁓ this has worked so effectively in the abortion space that it's moved on also to, for example, gender affirming care, is these laws are not saying, hey, we're gonna go after pregnant people, although South Carolina wants to do that. ⁓

Arghavan Salles (33:27)
.

So, you.

Mm-hmm. Mm-hmm.

Alyssa Burgart (33:49)
They go after physician practice because they know that if it were not for these giant fines and felony charges and jail time, that physicians would do the right thing. But these legal barriers have been made explicitly as high as possible so that even physicians will not be willing to take that risk in this setting.

Arghavan Salles (34:10)
Well, and even if, another point, I agree with that, even if a physician, individual physician says they want to offer that care, they have multiple layers of review in the hospital and legal, their general counsel may very well say no, even if the doctor says yes, and you can't go against the legal counsel of the hospital.

And that also complicates matters. If folks remember Brittany Watts is a woman who was pregnant in Ohio and was having a miscarriage and she had gone to the hospital twice seeking care and they had gotten so held up by seeking legal counsel for whether they could provide care for this woman who was having a miscarriage. It has nothing to do with abortion, but she just was having a miscarriage and it took so long that both times she left because she was like, what am I doing sitting here? I could just sit at home if that's all you're gonna do. And she ended up having a miscarriage at home and then she was arrested.

because of whatever the way she treated the, they call it a corpse. Anyway, that's another, and that's, she's not the only one that's also happened to a woman in Texas and also happened to a woman in Georgia. And it's currently happening by the way, to a woman in South Carolina. You just mentioned South Carolina, but she also had, we have limited data, but miscarriage is my understanding and is being prosecuted for that, for abuse of a child, I believe is what they've charged her with.

But these are all.

Alyssa Burgart (35:33)
The manipulation

of legal language is really special.

Arghavan Salles (35:36)
it sure is. And that's intentional. And I'm linking all of these things because one, these abortion bans are about so much more than abortion. They're about pregnancy care, as we're seeing in these cases of miscarriages that are being criminalized. And two, that in the data, whether it's anecdotal like what I just talked about, if you look at ProPublica again, has done some really excellent reporting.

Alyssa Burgart (35:54)
Mm-hmm.

Arghavan Salles (36:03)
If you look at who's affected by and large, it's women of color who already were marginalized. And guess what? Laws like these further marginalized those who are most vulnerable. And I'm sure that was intentional, you know, by legislators. I don't know about, you know, somebody who just goes to church and thinks pro-life is the right thing to do, but the legislators, that's what they, I mean, this is not a, none of this is a surprise. My colleagues and I have a piece we published in Ms. think about a year ago.

looking at the impact of these abortion bans on both maternal and infant mortality and surprise, surprise, both became worse after, after daubs and after access to abortion became more difficult in this country. And not, and all of this is predictable. These are choices. These are choices.

Alyssa Burgart (36:41)
Mm-hmm.

Absolutely, it's totally.

These are choices. And that is exactly what, when I was presenting at ASBH about impacts of dobs beyond what sort of maybe people who aren't really paying attention as closely, I used ⁓ maps from like pre-dobs, post-dobs, and also overlaid maternal morbidity and mortality and infant morbidity and mortality. And it is a very obvious visual trend when you have these sort

Arghavan Salles (37:18)
We.

Alyssa Burgart (37:19)
color coded maps and you're like, wow, that's how much worse it is. And it's just so horrifying that before jobs, we

were saying this is a crisis in America. We need to take better care of pregnant people. We especially need to take better care of pregnant women of color because they are disproportionately being harmed in our supposed care delivery system. And yet instead, we've made a million choices.

Dobbs being just one of them, to actually fuel the fire and then, do it with this moral superiority complex that's just so false. For folks who are interested in ⁓ learning more about pregnancy criminalization, there's a book that I really highly recommend ⁓ called Policing the Womb from Michelle Goodwin, and I'll drop a link in the show notes. And then there's a really detailed report that came out of an organization called Pregnancy Justice that talks about criminalization of pregnancy that I think is just.

Arghavan Salles (37:50)
Okay. Thank you.

Alyssa Burgart (38:18)
I mean, it's horrible to read, but it is a rich, rich document in terms of what do we know about who has been harmed in the criminalization of pregnancy. And so when we think back again to these two folks that we were talking about at the beginning, Kerry Jones and Mercedes Wells, you can also see how if these folks had not appeared to a hospital and had had a home delivery and then their baby had died, they may have then been criminalized for that too. So it's like all these things about

Arghavan Salles (38:43)
Mm-hmm.

Alyssa Burgart (38:46)
Who's willing to get care? Where are they willing to get care? What care are you actually going to get access to regardless of whether you show up? And then what's going to happen if you don't get care in the way that somebody decides later on you should have? How are you going to be punished for that too? And the multiple ways that black women in particular are just so underserviced and poorly treated is it is horrifying.

Arghavan Salles (39:17)
Yeah, and there was a case, speaking to what you were just saying, there was a case in Texas, I believe, last year, if I remember correctly, or might have been earlier this year. We can put it in the show notes, but a woman had a miscarriage in a fast food establishment. And instead of helping her, the employees called the cops. And then she also was charged with, I believe it was,

Alyssa Burgart (39:34)
Yes.

Arghavan Salles (39:41)
abuse of a corpse or something like that because she had a miscarriage. mean, what was she supposed to do? That's the other thing is like a lot of people will come into my comments and be like, well, it's her own fault because she didn't do whatever was the right thing. I'm like, what was the right thing to do? Like, let's say you have a miscarriage right now at home. What is the right thing to do? What are you supposed to do?

Alyssa Burgart (40:02)
I these are, I

mean, the number of people who like don't know anything about miscarriage, people who, mean, miscarriage, that's the other thing too, right? For, and I think this is still true, it's something very few people talk about, even though miscarriage is incredibly common. And so it's this like taboo topic where like nobody talks about it.

Arghavan Salles (40:16)
Mm-hmm. Yeah, I believe it's one in four. One in four pregnancies.

Alyssa Burgart (40:22)
Yeah, and you know, it's already something that people don't talk about. So then when like you have this miscarriage and then you're criminalized for this very common thing, it just makes no sense. And then the other thing I wanted to say also about this criminalization of pregnant people, abortion criminalization is I don't know if you saw from 404 media, who's also been doing a bunch of incredible reporting demonstrated how

The Texas Sheriff's Office basically used this high level surveillance data from ⁓ a company called Flock that has all of these like community users who can buy these cameras, communities can buy these cameras, and they're basically just collecting massive amounts of surveillance data. Drivers can have them in their car collecting data, and so it's basically just roving surveillance. And so the Texas Sheriff's Office, when a woman was trying to escape a

Arghavan Salles (41:14)
Thank

Alyssa Burgart (41:19)
interpersonal violence in her relationship, happened to be pregnant,

and this man reported that she was gonna leave the state to get an abortion. And so they tracked her using all of this surveillance data. So it's like, you can't even, and that's one of the highest risks of, we've been talking about the harms that can happen when people present for hospital care. I mean, one of the leading causes of maternal mortality,

is women being murdered by their partners. And so we're also not making it so that women can leave these relationships and we're gonna surveil them and we're gonna accuse them of crimes rather than looking at the person who's actually causing direct harm to the person.

Arghavan Salles (42:02)
mean, that's ⁓ definitely intentional. there's some states, I can't remember now how many, but where you can't complete a divorce while you're pregnant. And so this reproductive coercion will keep pregnant people in a partnership that they no longer want to be a part of that may be unsafe for them. ⁓ And I don't know that there's a lot being done about that currently. The other thing,

that came up for me while you were talking just now was there are these abortion trafficking bills. ⁓ I mean, it's very hard to say that phrase because it's a made up nonsensical phrase. Yeah. But the basic idea of these

Alyssa Burgart (42:39)
Uhhhh... Uhhhh...

I mean,

it clearly, but clearly like trying to capitalize on human trafficking as a genuine, terrible, horrible crime and then turning and then using it against people who are trying to end a pregnancy like, ⁓

Arghavan Salles (42:58)
Yeah, for any number of reasons, Because they, maybe because their life is at risk, maybe because the fetus has already been experienced fetal demise. know, like there's lots of reasons a person, lots and lots of reasons a person might want to have an abortion and they are all valid. And ⁓ so what they've done in Texas, I forget which county it was, but they had a bill that I believe, now I actually can't remember what happened with it. I'll look it up and put it in the show notes.

they were suggesting that if you, if anyone who was helping a pregnant person get through this county with the purpose of having an abortion wherever they were going to, anyone who was, again, similar idea that it's anyone helping the pregnant person could be reported by anyone else and then could be prosecuted. I've not heard of any cases of them actually doing that, but Idaho, I believe also had a bill like that ⁓ that I don't think was passed in Idaho.

Alyssa Burgart (43:39)
⁓

Arghavan Salles (43:58)
⁓ But that's another way that they're trying to control what pregnant people do with our bodies. And I find it really bizarre. Like, why do you care what I do with my uterus? Like, I don't understand why that's your business at all.

Alyssa Burgart (44:14)
Get

out of my uterus. Get out of my uterus.

Arghavan Salles (44:16)
Yeah, I never invited you in. ⁓

Gross. Yeah.

Alyssa Burgart (44:20)
Unwelcome.

Don't be gross.

It is really gross. Like so many of these laws, I'm just like, why are we trying to control everybody? Why are you trying to control so many women? Stop it. Get some, get a hobby.

Arghavan Salles (44:25)
⁓

think it would be one thing.

Alyssa Burgart (44:38)
Get a hobby. There's other things you can do with your time, folks. Have you considered golf, knitting, knife sharpening?

Arghavan Salles (44:42)
Do you know there's go ahead. Golf, yeah, you know what's even cheaper though is just streaming.

YouTube, just watch YouTube. There's so much. There's so much you can learn. Go to YouTube University. You don't even have to leave your house. You don't have to buy like golfing equipment. You don't have to buy golf balls. You know, like you just turn on your computer. Very easy, very educational, you know.

Alyssa Burgart (45:04)
So folks,

this is what we recommend. If you are an anti-abortion activist and you are listening, we are really hoping that you can just get a better hobby.

Arghavan Salles (45:17)
Get a better hobby. And one thing that I do just wanna mention too is that I think it might be at least somewhat slightly, it might feel different if the folks who are pushing these forced birthers were also pushing for food for children, like free breakfast and lunch at school, for example. Exactly. Or pushing for...

Alyssa Burgart (45:39)
Like you mean like supporting things like snap.

Arghavan Salles (45:45)
universal child care or universal health care or any of the things that help us actually live. Like to me, that's what pro-life is. Helping people get health care, helping people get access to healthy food, helping people actually live. But instead, they're crafting all these laws and different ways to control pregnant people to force birth, even when the fetus is not going to survive, mind you. That's another consequence of these abortion bans. But

you're gonna make sure that the fetus is birthed and then abandon both the fetus and the pregnant person and say, you're gonna have to make do as best you can. There was a great report again from ProPublica that came out, I think it was maybe two years ago, I'll find it, we'll put it in the show notes, of a woman who did not wanna have another baby. She didn't have great employment status, her partner didn't have great employment status ⁓ and ended up having a child that had a lot of needs.

and had a feeding tube, for example, because they weren't able to eat on their own. And it was so hard for them to get this child the care the child needed because if she worked, if the mother worked, then they made just slightly too much for them to qualify for, I believe, Medicaid in that state. so then it didn't make sense. They didn't have enough money to survive if she didn't work, but if she worked, then they lost services.

The whole article, if folks read it, like I challenge you to read that article and come away thinking that any of these policies are pro-life because it just was such a clear demonstration of how hard it is to support life with laws being the way that they are in some of these states.

Alyssa Burgart (47:22)
you

Absolutely. You know, I wanted, as you were talking, I was thinking about, you know, the term, the phrase reproductive justice was coined by a group called Sister Song. And I just thought I would just share that definition with our listeners that they've used. so says, Sister Song defines reproductive justice as the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.

And I have read that statement so many times ⁓ over the years. And it's to the point where when I read it, it feels like a prayer. I'm not a religious person, but it feels like it's this prayer for what I want to be accessible to every person. And it is so deeply, deeply horrifying to me that these laws that you've talked about, that I've talked about,

Arghavan Salles (48:08)
Mm.

Alyssa Burgart (48:30)
This is not justice. These are not making our communities safer. These are not making our communities stronger. These are terrorizing our families. These are terrorizing young families. These are terrorizing people who wish to not have children, people who wish to take care of the children they already have. I mean, it's just, we are so far afield from reproductive justice, and it's truly horrifying.

Arghavan Salles (48:57)
And

we're moving in absolutely the wrong direction. We're getting further and further from it. Is there anything, this is hard question, but is there anything we can recommend to our listeners if they ⁓ are also concerned about this and want to try to take some sort of action?

Alyssa Burgart (49:15)
Yeah, well, ⁓ I mean, I know that donation time is coming up. So for people who have the means, ⁓ I think there's a couple of organizations that we can recommend. Sister Song is one of them. ⁓ Black Mamas Matter Alliance is an organization that does just incredible work ⁓ nationally around this issue in particular of taking care of black parenting people, black birthing people. ⁓ To your point, the reporting that's coming out of ProPublica, know, places like ProPublica, ⁓

Abortion Every Day, Rewire News Group, you these are organizations that are really committed to bringing these stories to light despite efforts to keep these secret. So I think those are all examples that you can do for folks. know, March of Dimes, again, March of Dimes is doing incredible work every year trying to really highlight this data on preterm birth. So if that's an organization that aligns with things that you're interested in, all of these groups, not the journalism groups, but the nonprofit groups are all places that people can volunteer their time.

Arghavan Salles (50:12)
Mm-hmm.

Alyssa Burgart (50:12)
⁓

And continue, and we need to talk about these issues. I know that that seems so pedantic, but like we actually just need to talk about this more often. And you and I do, and there's certainly people in our social media feeds that are talking about these issues. But I think for a lot of folks, this is still just below the surface.

Arghavan Salles (50:32)
Mm-hmm. No, I think you're absolutely right because as we know in our society, like if something doesn't directly affect you, it may not come across your feeds, may not come into your awareness. ⁓ And I think you gave just a lot of really good recommendations. And I do want to just remind folks that there are ongoing legislative issues related to

Alyssa Burgart (50:56)
Mm. Mm-hmm.

Arghavan Salles (50:56)
the care

of pregnant people and the care of children. And even, yes, related to abortion, but also more broadly, like you mentioned, SNAP and the impending cuts to Medicaid. A lot of like 40 % of SNAP recipients, as we've said before, are children. I don't have the numbers at my fingertips for Medicaid, but a lot of the recipients there are also children.

We as a country are intentionally making choices, making policy decisions that make it harder for children and people who care for children to live healthy lives. So all that to say to the extent that you have a congressperson or representative who you feel willing to contact about this, any of these related issues. I think that I know we all feel exhausted by constantly contacting folks. ⁓

But especially if you're in a state where there's, because there's so much to be so, so happy about. But especially if you're in a state like South Carolina, which you alluded to earlier, that is considering making abortion punishable by death to the person, to the pregnant person. That's the ⁓ first state I think that would be punishing the pregnant person. And I think that's because in general, think conservatives recognize punishing the pregnant person is not a popular choice.

And yet, I think they're trying to move that window of what's normal and what's acceptable so that we'll now think, yeah, why not? You know, how did she not want to have that baby, put that woman in jail? So anyway, all that to say, I do think that there's still legislative issues related to this that we can try to influence and push our representatives on.

I think probably not for where you and I live in California, but certainly in other places that remains an issue.

Alyssa Burgart (53:01)
Excellent. Well, know, Argavan, this has been a really important topic. I know it's not the last time that we're going to talk about reproductive health and reproductive justice. I'm really glad that we got to talk about these two cases that have really captured the American imagination this week. And, ⁓ you know, I just think for a switch of gears, why don't we talk about what's bringing you joy this week?

Arghavan Salles (53:23)
Okay, I have a couple, but I think I'm gonna go with The Beast in Me. So The Beast in Me is a, and I wouldn't call it joy exactly, it's a thriller, but it's a show on Netflix that came out recently with two excellent, amazing actors in the key roles who are Matthew Reese and Claire Danes. And I am on, I'm out of office. Well, who doesn't, you know, from.

Alyssa Burgart (53:47)
you know I love Claire Danes.

Arghavan Salles (53:50)
back, know, child of the 90s, child of the 80s, like we're all gonna love Claire Danes. But I've been off, I've been out of office. So I watched the whole thing this week. And I mean, it's only, I don't know, whatever, eight episodes or something like that. But it's very gripping. If you're looking for a distraction from the mess that is our real world, I think it's very good. But it is dark. So that's why I was like, I don't know if this is exactly joy, but it's very well done and very captivating. So I'll just say that.

How about you? What's bringing you joy?

Alyssa Burgart (54:20)
Excellent. Okay.

Well, I just saw a video this morning that my girlfriend sent me. So we're recording this the week before Thanksgiving. And ⁓ there was a video that was wine pairing for all of your MAGA relatives. And I have some MAGA relatives. I'm not having Thanksgiving with any of them. ⁓ But it was very funny about what you could pair with particular people if you have to hang out with them ⁓ in your festival meals.

And so there were very specific wines that were being recommended to pair. So I will share that in the show notes. And then the other thing that happened this week is my friend Courtney Maum has a book coming out, a novel called Alan Ops Out and the cover was released today, which is very exciting. And this book ⁓ is about a guy, think he's like an ad executive and he decides that he's just like done. He's just done with this whole world of like rich people and advertising and all these things. And so he like,

decides he's gonna, like throws away his phone and decides he's gonna live in his backyard in like the dog house or something. I haven't, the book hasn't come out yet, so I haven't been able to read the whole thing, but I'm very, I'm excited. Like I love waiting for a new book, love to read. And especially when it's somebody that I know putting it out, it's like extra delicious.

Arghavan Salles (55:20)
Hmm.

Well that's fantastic. When does the book come out?

Alyssa Burgart (55:41)
Ooh, good question. Let me look that up really quick. Sorry Courtney, that I do not know immediately off the top of my head your book release date.

Arghavan Salles (55:46)
That's

okay. We can also just put it in the show notes.

Alyssa Burgart (55:54)
I'm gonna look it up really quick. ⁓

Okay, you can pre-order it now, but the book comes out June 2nd, so not until the early summer. So June 2nd you can get Alan Ops out.

Arghavan Salles (56:07)
Okay.

like to opt out. I know we're at the end of our episode but did you ever watch Seinfeld? There's an episode where a creamer tries to opt out of mail.

Alyssa Burgart (56:22)
No. How does it go?

Arghavan Salles (56:23)
I feel like that except for

I want to opt out of everything. Well, he goes to the post office, because he's just tired of getting mail. We get all this junk mail, even now, right? Many years later, we still get all those pamphlets and things. I don't know about you, but they just go straight in the trash for me. so he goes down to the post office and he's like, I want out. I don't want mail. I don't want to do mail. I'm done with mail. And they're like, you can't do that. And Newman, of course, for those who've watched the show, Newman is like...

Jerry's arch nemesis and he's a postman. So Newman's there and he's like, keep your, keep your voice down. You can't, you can't talk about that. Anyway, so I think about that sometimes and it came up for me because the title is Alan Ops Out, but I was like, I also would like to opt out of a lot of things that are happening. I would like to opt out. Yeah, yeah. Of so many things. Mail is one of them. I also would opt out of mail. I would like to opt out of emails. Also, just no more. don't, I don't, I don't want to do it.

Alyssa Burgart (57:20)
Email.

Arghavan Salles (57:21)
do anymore. I've had enough. But anyway.

Alyssa Burgart (57:23)
I want to light my email on fire.

Arghavan Salles (57:30)
Yeah, that's very reasonable. It's a very reasonable thought to have. Because you and I both lived in a time before email. So we remember that there was a time when like if somebody wanted you to do something, they would have to call you. There was no texting. They would have to call you. Yes. And say, hey, like for this project, can you do x, y, thing? And then you could maybe say, no, or I don't have time, or not on this timeline. But now you just get these emails that are like,

Alyssa Burgart (57:40)
Ugh, it was beautiful.

on a land, on a landline.

Arghavan Salles (58:00)
So glad you're gonna do x, y, things by this date and you're like, well, I guess I am.

Alyssa Burgart (58:07)
So this is how I like to describe email is it is a list of assignments for a class you did not know you signed up for.

Arghavan Salles (58:15)
Yeah, and you would like to opt out of it, most likely. At least I would like to opt out of it.

Alyssa Burgart (58:19)
That's correct.

Drop out.

Okay, well, I think this has been really exciting. I'm glad that we've been able to talk about these issues. I think that's it for this week's episode.

Arghavan Salles (58:25)
Alright.

If you didn't like what you heard, this has been This Past Weekend with Thea Vaughan. If you liked it, don't forget to subscribe to The Present Illness. And again, if you can, leave us a review or rating and tell literally anyone you know to listen to us.

Alyssa Burgart (58:49)
You can follow us on all the places. We're on Instagram, we're on TikTok, ⁓ at The Present Illness, and you can stay on top of all of our TPI related news.

Arghavan Salles (58:57)
And we will of course be back next week ⁓ with more headlines, hot takes, doom scrolling, and hopefully some more laughs than we had this week.

Alyssa Burgart (59:07)
Until then, agitate, hydrate, take a nap, and we'll see you next time on The Present Illness. And just a reminder, don't take medical advice from random people on a podcast. This show is for informational purposes. It's meant to be fun, and it's certainly not medical advice. So please take your medical questions to a qualified professional.

Arghavan Salles (59:26)
Excellent.


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Alyssa Burgart, MD, MA

Host
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Arghavan Salles, MD, PhD

Host