Farewell Dolly plus AOC's Eggs

We mourn Dolly Parton. We discuss Alexandria Ocasio-Cortez’s egg freezing and what it means for reproductive justice in America. Plus, the baby born from the California-Texas surrogacy case.

• Dolly Parton’s Imagination Library
• Donate to support Imagination Library
• Top Movies with Dolly Parton

AOC Egg Freezing

• One of AOC’s blogs on egg freezing
• Arghavan’s essay on egg freezing
• Fetal Personhood laws
• Arghavan’s substack essay with links to data on egg freezing
• Arghavan’s research on parental leave during residency
• Arghavan’s research on the costs of family building
• Arghavan’s research on barriers to family building
• Systematic review on outcomes with frozen eggs
• Alyssa’s essay series on The Retrievals podcast

More Topics

• Background on the legal issues when a surrogate refused to have an abortion
• Hypoplastic Left Heart Syndrome
• Norwood Procedure
• WNBA update: Enes Kanter Freedom thrown out of game
• Canada/US trade war
• US threatens more sanctions against Iran

💊Take Two and Call Me in the Morning💊

• Broadway à la Justin Bieber
• Purple Skeletons
• 99 Flock Balloons

Thanks for listening to The Present Illness! 

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Credits

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

Don’t take medical advice from random people on a podcast. This show is for informational purposes, is meant to be fun, and is certainly not medical advice. Please, take your medical questions to a qualified professional. Nothing we say represents our employers or anyone else. 

Transcript

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I believe that the conservative movement, the anti abortion movement, absolutely despises the fact that she is educating so many people. Mm-hmm. Mm-hmm. That this is even an option. That this is even a thing. And in fact, a thing that in a functioning democracy might actually be supported, in addition to things like paid parental leave and, Uh-huh. you know, baby support and like access to food and all those other things that would in a you would think in a pro family environment already you'd think we'd have those, Hi there, fellow nerds. Welcome back 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 underdiagnosed. I'm Arghavan Salles, a surgeon scientist, and your friendly neighborhood doom scroller in residence. And I'm Alyssa Burgart, an anesthesiologist and bioethicist who and health law like their EKGs full of spikes and surprises. The present illness is where we dig into public health, politics, culture, and ethics with a scalpel in one hand and a meme in the As a note to our listeners, we often talk about tough topics that can be intense, activating, and so if you need to take a break, we totally get it. Indeed. We want to give a big thank you to everyone who's listening and some extra special love to our subscribers on whichever platform you've subscribed or followed us. And a warm welcome to anyone who just stumbled in from mourning the loss of one of the greatest people to ever have lived, Dolly Parton. National treasure. ~ I was actually in the O R on Tuesday when a friend of mine,~ who I bonded another physician who I bonded with over music,~ texted me that she had passed and just it's a real real bummer. I would like to have had many, many more years of Dolly Parton in this world. Well, you know, ~ people online have a lot of feelings ~ about her. And one of the things that I've seen a few times is that like idea that the Grim Reaper like really messed up here, like the was the address not clear? W was the name not clear? I've seen people suggesting that the gim Grim Reaper needs to be on a performance improvement plan. Mm, mm. ~ For the bad choices being made. As we've lost, you know, Catherine O'Hara this year, Hayden Panettiere very recently. I mean, so sad. obviously so many wonderful people. And anyway, so I don't know what's going on with the Grim Reaper, but I don't approve of ~ the current performance. Okay. ~ Dolly Parton, of course, was a musical. Powerhouse is not even a strong enough word.~ you know, I think it was a few years back, forget in what interview that it like kind of came to light that she had written Jolene and I Will Always Love You on the same day. Mm-hmm. Mm-hmm. Like most people can't write either of those songs or that caliber of song, like ever. I mean, I certainly can't ever in my life. And she had those two just incredible hits on the same day. and she is one of the people who has used her wealth. for so so much good. Mm-hmm. you know, she has the Imagination Library where they send books out to children. One I believe is one book a month. They've Mm-hmm. shipped out over 330 million books for some children. That those are the only books they'll ever own are the books that they got from the Imagination Library. she had a ~ an eagle it wasn't a preserve But like she had eagles at Dollywood and they had released like 180 of them into the Smoky Mountains, which is amazing. she has given money to so many causes where our government has fallen short. people affected by fires in Tennessee,~ people affected by Hurricane Helene ~ in Tennessee. Let me millions of dollars. She she gave a million dollars to the efforts to create a vaccine for COVID Mm-hmm. in the early part of the pandemic.~ there's a there's also a common trend amongst people who like prof like high schoolers who perform in bands, where Yeah.~ she has bought the un band uniforms are very expensive. Yep. Yep. And so she has bought those for just hundreds and hundreds of high schoolers who wouldn't otherwise have been able to afford ~ band uniforms. Yes. And I believe she did that in particular for ~ schools that had ~ a lot of black students in them, Mm-hmm. based on like what what's been reported. She had, you know, a lot of revenue that came in from Whitney Houston singing I Will Always Love You, and she invested that back into black communities. She was a staunch advocate for the entire LGBTQ plus community. ~ She once entered a Dolly Parton lookalike contest and lost to a drag queen.~ and there's these great Yeah, She's also like super funny. very I love watching her interviews because she just she's so disarming. And I love the way, you know, she talks about how one of her origin stories that she'll tell is about, or that she did tell,~ was about how, you know, they saw a woman in town who was, you know, very made up, you know, wearing sort of sparkles and big lipstick and all that. And how her mom said, well, that that woman's just trash. And she was like, I want to be trash, mama. And Yeah, exactly. Yeah, she talks about how she thought that woman was beautiful, Yeah. like whatever her story was that she thought she looked beautiful. And so she wanted to look like that.~ and she obviously has starred in numerous films. nine to five is one that probably a lot of people remember. It was all about working women and Mm-hmm.~ the way women are treated ~ in the workplace and their fight for equality. Pretty great that she did that.~ anyway, I mean she's like I mean an absolute icon. We cannot summarize all of her incredible accomplishments here. She was ~ Miley Cyrus's godmother. I hope that Miley has good support around her because I know they were very close. Yeah. ~~ fifty-five Grammy nominations and ten wins. I mean third most nominated women actually in Grammy history, second only to Beyonce and Taylor Swift. Wow. Talk about a legend. Absolutely. Somebody had posted, you know, that she because she had a recent performance, I don't remember exactly one with Miley, where she's, you know, super dressed up, heels, everything. They were like, I want people to remember that she didn't die a frail woman. She died a rock star in leather and heels. And I mean, she was performing right to, you know, almost to the end. ~ she loved music. She loved people. And I I think she loved working. I think she loved Mm-hmm. like building her business and like being the best at things and really incredible to see all the things she accomplished in in just eighty years. I know. If somebody had said like 80 years old, she was just a kid. And I I know they were, you know, kind of joking, but like she had so much left to do, and even in her own words, she said that. And I mean, she really did so much for education, like probably Mm-hmm. more than any other private individual who's not directly involved in teaching.~ she also had like the employees at Dollywood all get free tuition, books, supplies, everything to Mm-hmm. Yeah. further educate themselves. ~ A s a story I had heard about when she had started the book, like making sure that kids had access to books, was about Yeah. how her father was illiterate. And Mm-hmm. you know, she had actually hoped that maybe he would want to learn to read and he was like, Nope, just happy to see you doing what you're doing. And ~ yeah. Yeah, Yeah, but he said he was very proud of her for that program. Yeah. for really investing in the future of so many kids and especially starting off in Tennessee with so many children ~ in Tennessee who had truly nothing. A similar Mm-hmm. you know, she grew up in deep, deep poverty. And you talk about a a rags to riches story on blood, sweat, and tears. I mean, what a what a wild, wild ride. ~ for anyone so much. And so much talent, you know. Like she had talent, but then also such a strong work ethic. You know, it's like you have to have Yeah. all the things. and she's such a great demonstration of if you like what it right, to to have that level of success and then what it means to give back. Because she also had I mean, again, we could go on all day and why don't want us to, but like I do want to add one more program, which is that she had ~ I believe it was in the county that she grew up that the graduation rates for high school were only I believe like sixty five percent or so. And so she started this program where people would get paired with a buddy. And if they both graduated, they each got five hundred dollars from her. wow. And the and the dropout rate dropped significantly,~ down to somewhere like five to ten percent or something. I mean, can you imagine having like Dolly Like Parton personally rooting for you?~ Yeah, I know. I mean what she's just incredible. Anyway. well, for anybody who is I mean, whether you love Dolly or whether you're you're Dolly curious,~ Okay. Jad Abamrad's ~ he from NPR had a wonderful multipart series about her called Dolly Parton's America. Jad Abamrov's dad is actually a a physician and took care of Dolly. And so that's how he ended up meeting her and ~ being able to to put together this entire series really about her life and her career. ~ and I think it's just it's a lovely I'm gonna re listen to it. It's been a number of years and it's fabulous. Yeah, that's a great recommendation. And I would just challenge anyone listening to maybe read a book in honor of because as we've discussed before,~ like the we have a real literacy crisis and probably not mostly with our but even to set to be a model for other people.~ maybe if I'm we haven't been doing any reading, we should pick something up now.~ well, I'm a big reader. I actually I and I'm I'm attached obviously with all these like accoutrement for the podcast, but I have ~ Dolly Parton's song teller book, which is also lovely. So if you're looking to check it out from your library, I'm gonna be honest with you, there might be a wait at your Yeah. local library ~ worth it. And yeah, I love that recommendation. Read a book. Love books. Yes. It's one of the best ways that we can support her. Also, her family did put out I believe a request to if if people want to give in a financial way to support the Imagination Library. Which I think is in all fifty states now. Well, I just okay, I have not fact checked this, but somebody told me they have actually shipped books all over the world. wow. I thought it was in the US. So again, I haven't fact checked that one, but that's what somebody just said on one of my posts. I'm gonna look it up right now. Okay. ~~ 31 years of Dolly Parton's Imagination Library, and it says that they are now located in in besides the United States, Australia, Canada, the Republic of Ireland, and the United Kingdom. Pretty fantastic. And they do, I believe, a book a month until age five. Somebody had posted their kids like a graduation letter Mm-hmm. from the Imagination Library. It was very cute. Well, so it's so I have a bunch of friends that are it that live in Tennessee and I was in a band with a bunch people from Tennessee. And I remember them saying, like, well, you know, Dolly Parton sends our kids a book every day. And I What are you guys talking about? Or not every day, sorry, like every every month. And I had never heard of it because we didn't have it in California until fairly recently. ~ but yeah, my friends who have who have kids in Tennessee like taught me about this many years ago, and it's been so fabulous to like watch it grow. Yeah, and they're I believe they're like age appropriate. So they have like a specific progression Yeah, yeah, yeah. Mm-hmm. for the books as the kid ages. And so it is kind of like graduating, like you made it through our program.~ anyway, it's very sweet. ~ read a book, listen to that podcast, we'll put a link, check out a book, buy a book, whatever,~ I love it. in honor of the great, the wonderful, unique, ~ incomparable Dolly Parton. Incomparable Dolly Parton. Mm. uh gone too soon. Absolutely.~ okay, that's a downer. I did not want to have to talk about that today, but she's absolutely worth it. well, Yeah. ~ should we talk about egg freezing? Should we talk about should we talk about AOC? Yeah, that's like the perfect segue. Yeah. ~ Should we talk about how like everybody needs to know about reproductive stuff? Yes, I think we absolutely should talk about that. So we mentioned this, I think two episodes ago that AOC was kind of blogging her experience with egg freezing. And this had a certain parts of the population very upset.~ because how dare she?~ she's 36, how dare she do this? She should just have a kid. Why didn't she have a kid already? Slash, why is she telling us so much personal information? Why don't you mind your own business? Yeah. Because we have to police what women do and and what women don't do. We just have to police women. That's like the function of society.~ anyway, so she had this, you know, multi-part series where she every day talked about what was happening in her egg freezing process. She talked about ~ why she was doing it, the egg freezing, and also why she was blogging it. which has a lot to do with wanting to raise awareness. Of the procedure itself and ~ in terms of her blogging it and bringing attention to the lack of accessibility. So she had to save up. I think we talked about this when we brought it up before that she had to save up to be able to do this. And, you know, a lot of insurance doesn't cover egg freezing or IVF or any of that.~ and so she wanted to, I mean, she clearly is interested in trying to put forward some legislation may. make it more affordable to people because right now it really is like for people who have a decent amount of disposable income, which is just not that Mm. much of the country. and so yeah, so she she basically every day gave updates and kind of had like certain points that she was trying to get across ~ about the specific injections, what the hormones are, what the hormones do to the follicles. You know, for folks who aren't familiar, the basic idea is that You take medications to encourage more follicles to develop so that and to develop kind of together as a cohort so that by the time you get to a retrieval, ~ you have multiple ideally follicles that hopefully have eggs in them. And then you're able to retrieve those eggs and then freeze them for future use. Now you could also go straight from the retrieval to IVF.~ meaning that you combine those eggs with sperm and create embryos if you know what sperm you want to be using to create those embryos. And AOC folks may not have realized had been engaged and then is no longer and has not been for for some time. So she was not freezing embryos, she was freezing eggs. ~ which is actually the most common reason that in this country women will proceed with egg freezing is because they don't have a partner.~ you know, other cases include like if you know you're going to have your ovaries removed because of cancer, for example, or cancer risk ~ related to a genetic condition,~ then this can be a way to preserve fertility before you lose your ovaries. But the majority of people who ~ seek egg freezing, this is according to the data, is because they don't have a partner yet or they're not sure about the partner they're with. and Mm. so they wanna kind of reserve the right kind of. You know, some people talk about it as an insurance policy, which I don't think is accurate and we can talk about why.~ but it's kind of like it gives you a sense that you can freeze time Hm. in a way. ~ and that's I think what's attractive about it for a lot of people. So anyway, so she ~ went through what are the hormones, she's gone through the costs, you know, that these medications are very costly. And also the costs vary depending on how long it takes for you as an individual for your follicles to develop to the point that they are appropriate for to proceed with a retrieval. and that makes it hard to plan. So she's also talked about the unpredictability of it all. You know, starting at a certain point in time, you will have ~ ultrasound and lab every other day or so until they say, okay, we're ready. And then your retrieval maybe the next day or two days later. And the day of your retrieval, you can't work at all, you're under anesthesia. So it's a very difficult schedule for most people who work. Because what kind of job can you just be like, okay, I'm off tomorrow, or I'm off two days from now, no notice whatsoever, right? As a physician, like we don't really have that flexibility.~ And like not get fired. yeah. ~ so that's another part of what's challenging about this process that she talked about. ~ and I think, you know, from my perspective of someone who has tried to freeze eggs, I I ~ tried three cycles and this was years ago ~ when I was 38 and 39 and I didn't get any eggs. I've written about this before. But ~ from my perspective, I think what's really great about I mean there's lots of things that are really great about her doing this. One is to your point about like people should know more about our reproductive health and how these things work,~ what options exist. So I think she's really raised awareness for a lot of people.~ she's normalized that sometimes we don't have everything in place to have kids when we want to.~ and so then we start thinking about what are our options? How do we keep that hope alive? I mean, that's kind of how what I think these procedures offer is some hope. Mm. and as a prominent politician, someone whose name is being thrown out there as potentially running for president in 2028. I think it's extraordinarily powerful for her to be taking people along with this very personal journey.~ so I I think like no matter what amount of education we as physicians want to do, we would never have the reach that she has. Mm-hmm. Even even the reproductive endocrinologists who, you know, write books about this like I don't see any of us having anywhere near the reach that AOC has had. So it's a huge public service that she's done. Well, and I think there's just one of the things I'll just also say is this is a when you have the ability to look online and see someone who has gone through a procedure that you're considering going through or something that you know that you're gonna need to go through,~ this process of having digital witnesses available is really, really helpful. And what's nice in terms of the fact that she's been documenting her experience. is that she is providing that digital witnessing for a wide variety of people who otherwise may have a hard time even understanding that like there are other people on the internet who are also documenting this process and sharing it, but you're not going to find them necessarily the Yeah. That's right. way that you're going find AOC when like every newspaper in America is, you know, talking about whether or not they think they that she should share it or not. Yeah, that's right. And and it has really put a lot of conservatives into like a frenzy. A tizzy. Ooh, a tizzy. There's in a tizzy. Yeah. Yeah. Why didn't why didn't she have kids already? my gosh. You're t you should plan for the future? What? No, because she should never you know, according to them, right, she should never have had this career because if she didn't have this she would have already been able to have kids and she wouldn't need to do this. Which of course may or may not be true, right? Like not having a career like as p as in politics in politics does Oops. I mean, not guarantee that you can find a partner. we know some of the most incredible women on earth, including yourself, right? Who are like figuring out how to have a family, what kind of a life do you want to have, and when there is not some partner available who is like Mm-hmm. a good fit for your life, a good investment, Yeah. Well if you will. so so that's so I that brings up another interesting point. So I think there's a lot that people don't understand about egg freezing and I'm not a reproduct reproductive endocrinologist. I'm just someone who's dealt with infertility for like eight years. So I have a patient perspective, but also have read some of the research, you know, on the medical I think one of the things that people don't understand or maybe don't~ realize t exactly is that it doesn't really give you control. Like, you know, AOC when she set out to do this said she was doing this to take control of her life. And I had, you know, I think we talked before about this piece that I had published in Time,~ where I my my tweet about it was like, Can women really take control of our fertility?~ because I also had that same thinking about it. Like if I do this, it'll give me control. And then I'll have these eggs. And then if I find a partner later, then I can use these eggs. And so I think that's a very common set. I'm not saying everybody thinks that way, but I think a lot of women approach it thinking that way. Like I'm this gonna again be an insurance policy for me. So that even if it takes a while to find someone, when I do find someone, I'll have these eggs sitting there. And I think what what it really offers us Egg freezing, what it really offers us is a little bit of hope that something might be possible later. Because it's far from a guarantee for many reasons. One is that you don't know, no matter how many eggs you froze, you don't really know their quality. So one of the things about freezing eggs that ~ in terms of like what information you get is you don't or what you don't get is you don't get feedback on the quality of those eggs. So even if you're able to freeze like a huge number of eggs, you don't know how many of them will successfully be fertilized. And They can't like look at them and be like, these ones are awesome. They I believe, okay, again, this is not my medical specialty, but I believe what they do is they look at the maturity. They have to be what's called M2. So if they're not at that maturity, they won't get frozen at all. But beyond that, they can't predict as of now which eggs would get fertilized. And in fact, when you go to thaw the eggs, which is what you have to do before you later combine them with sperm, you lose some number of eggs every time. There's attrition kind of at every stage. Mm-hmm. So let's say you you freeze like 30 eggs, some number of those eggs will not survive the thaw. And then you'll go to try to fertilize the remaining. And then maybe you get, you know, any it's hard again, people cannot predict six embryos, eight embryos, ten embryos. I don't know. Mm-hmm, mm-hmm. You get some number of embryos. Of those embryos, the question will be, how many of them are euploid? Or at least for a lot of Hm. people, that would be a question, is like how many of them are chromosomally normal?~ And the older the eggs are, the older the person is when the person freezes their eggs, right? The fewer of those embryos will have a normal number of chromosomes.~ and so you may end up with, even starting with 30 eggs, like one, two, or zero healthy embryos. There Mm-hmm. was a segment on ~ 60 Minutes a few years back where they were talking about egg freezing and they had interviewed a woman who had frozen 30 eggs. I believe in her early 30s. I wrote about this in my sub stack, I can put a link. But ~ she had 30 eggs and then later on met a partner and they went to thaw those eggs and make embryos, and they ended up with one embryo that was unhealthy. And by then it's like kind of late is the problem, right? Because the if you Yeah. think about egg freezing as like it's gonna give me a chance later, the challenges and you don't know. How many embryos you'll get. And often, not always, but often it may be that you're trying to use those eggs so far down the line that you may no longer have the ability to freeze more eggs yourself or retrieve more Mm-hmm. eggs yourself to be able to do further rounds of IVF. Or if you do, that you know you're older, the quality of them is less, you know, et cetera, it gets harder and harder. And so I think that part a lot of people maybe don't fully appreciate. Mm-hmm. And For lots of reasons, you can imagine, like if you're younger when you freeze your eggs, right, you have more likely to get more eggs on a given cycle, which is good. And they're more likely to be healthy eggs, which is also good. And the more likely you are to actually meet someone and maybe not need to use those eggs. Right? Just because Mm, mm-hmm. Which is ideal. right. But then you will have like gone through this whole process and spent all this money and then be paying all these storage fees, right? And then not eventually not ended up using them. I mean, the data in a systematic review that came out, I think, two years ago, showed that only about 11% of people who freeze eggs end up going back to use them. Now, they didn't ask people why not, right? The ones who didn't Mm-hmm. come back. So is it because they met someone and they had kids otherwise, or is it because they never met anyone and so they never wanted to make embryos? Or, you know, we don't we don't really know what happened. Of the 11% who came back, only about 29% of those 11% were successful at having a single live birth. So a single child. Now of course, again, there's likely variability like based on how old you were when you froze those eggs, how likely excuse me, how likely you were to be able to have a live birth. And they didn't break it down that way in the paper. But these are some of the things that I think not everyone is aware of and also not every fertility specialist tells you about when you're having a consultation for egg freezing.~ and also to be fair to those doctors, there's a lot that you get told during those first couple of visits. So maybe even they do tell you, but it gets lost in the in the shuffle. But I just know that for me personally, I do not recall. Again, they may have said it, I don't know, but I do not recall being told that, for example, I might not get any eggs. I didn't know that was a potential outcome. Or that. W I mean you might say that's naive and that's fair, but that's just the truth of my experience. Mm-hmm. And I didn't know that, you know, I could go through a cycle and take all these medications and get fifteen days, sixteen days, eighteen days in, which is long. Usually they don't go that long, but just keep going, keep going, keep going, spend all this money only to then cancel the cycle and never even go to a retrieval. That's not a thing that I knew was a possibility. So imagine how stunned I was, right? To have taken that time off work and ~ spent all that money and like the roller coaster ride of the hormones, all the labs and the ultrasounds, and then be like, so actually we're not gonna do anything this time and we're just gonna have to start all over. I mean, that was really brutal for me. Yeah.~ anyway, that's obviously one extreme of outcomes, and for most people it's not that.~ but you know, if you're like in your mid to late 30s and you get like six eggs, eight eggs. That's not a great likelihood of success. There's not a great likelihood of success that you will end up with a live birth from just that, unless you do Mm. multiple cycles. There's a paper that came out 10 years ago. So it's a little bit older, looking at like how many, based on your age group, how many and and how many eggs you have, what your likelihood of having one live birth would be. So as you can imagine, the older you get, the more eggs you need, but also the harder it is to get those eggs when Hmm. Yeah. you're older. So anyway, these are just some things that I think are are useful for people to know as they're thinking about maybe going, you know, doing this and freezing the eggs and having to pay those storage fees. Like, and to be clear, I I'm a proponent of this. I have talked for a long time and written multiple research articles about how as a physician, I feel that medical schools should be covering this. Residency Mm. programs should be covering this. Like we should have the options to do whatever we think is right.~ And I just think that it's appropriate for us to have be given the right expectations, like the accurate expectations of what we can get, because it's not an insurance policy. It's not a guarantee, but it's a possibility that something in the future out if you even come back to try to use them. That is a lot. And I remember ~ there was a point I can't and I can't remember when this was, where like a bunch of the big tech companies started paying Mm-hmm. Mm-hmm. for egg freezing and it was I mean, these are the same companies that like give people three meals a day because they expect you to be there all the time. and had a lot of not great press around the way they treat women. And so I remember there being a point at which suddenly they were like, We're a great company. We're offering egg freezing. And I was like, huh. I mean, great, great benefit. Also interesting move. Yeah, I mean, I think that's the challenge of it. Like I I definitely want it to be available in all these Mm-hmm. procedures because there's lots of other reasons, right, that people another reason, for example, that people will use IVF is if they have a genetic~ abnormality and their partner has a known genetic abnormality and together they could, you know, yield harmful ~ combinations, then it some people will end up doing IVF for that reason because then they Mm-hmm. can test the embryos and then make sure that they are transferring a healthy embryo. So it's not all all these these procedures are not necessarily just for ~ fertility, like infertility, lack of a partner kind of situations. Sure. Also, obviously if you're a single like I am a single person, you're gonna need to have some version of these procedures to have a baby with your own genetics if that's what is of interest to you.~ or same-sex partners, right, will end up needing often something. Although, you know, you could do IUI potentially, intraunion insemination, which means not having to do egg retrievals and all that just depends on lots of factors. But anyway, point is that there are many different instances where people may use some version of reproductive endocrinology technology. And in a lot of cases it's not covered. So I I absolutely think it should all be covered for whoever needs Mm-hmm. it whenever they need it. And I think for, you know, the conservatives who are like, this is ridiculous. Women just need to prioritize family, have kids earlier, you shouldn't need any of this stuff. You know, they refuse, it seems to me, it ref that they refuse to see why people aren't having as many children and why they're not having them at as young an age. And a big part of it is economics, right? That we don't have, we're not making money. most of us, you know, if we have a really terrible ~ problem of wealth inequality in this country, then we have like no social services, basically, right? Like you can't count on health care for you or the baby. You can't count you cannot count on low cost or free child care ~ for for that child once you have it. You can't even count on paid parental leave because we don't have federal paid parental leave in this country. So even just those three things like already you're you're working hard, you're working multiple jobs, like where how are you supposed to make that happen? And so our government, instead of making policies that would help people who do want to have kids to be able to do it, instead takes this like judgmental stance of like, well, how come you didn't do it already? Well, yes, and so I mean it's interesting, right? Because like we have this super pro natalist, conservative agenda right now. And so you would think, like, why would they be unhappy that people are having babies? But obviously there's all this misogyny involved. But the other aspect of it is the fetal personhood movement, which is so the anti abortion movement is incredibly ~ opposed to IVF and to pretty much anti-fertility and anti-infertility ~ measures for lots of reasons. And like ~ you know, as far as the Catholic Church and a bunch of ~ you know, more conservative Christian sects, like they see all of this as being ~ just supporting abortion that, you know, I remember there's been, you know, many movements over the years about protecting embryos and that each of those embryos needs to be adopted out to like some person who's who's obligated to turn it into a a fetus. I mean, it's ~ it's really deep seated in that I think a lot of this opposition to also watching a powerful woman go through this process. I believe that the conservative movement, the anti abortion movement, absolutely despises the fact that she is educating so many people. Mm-hmm. Mm-hmm. That this is even an option. That this is even a thing. And in fact, a thing that in a functioning democracy might actually be supported, in addition to things like paid parental leave and, Uh-huh. you know, baby support and like access to food and all those other things that would in a you would think in a pro family environment already you'd think we'd have those, but I mean, just to be clear, like some European countries people have a year or eighteen months of paid parental leave.~ and how I dreamed of that. ~ when I had my babies and I was in residency, how I dreamed of going back to, you know, my Swedish roots, going to Sweden, Mm-hmm. Mm-hmm. Yeah. you know, having a baby in Sweden. I don't I I think I would have been really happy. It sounds pretty great. But we are making different choices here. And then we're saying, but then why aren't you having babies? I mean, the other thing we didn't talk about is accommodations for pregnancy. in in particular in more physical professions, like in medicine, right? We have, I mean, part of the reason, like even if I look let me just say, even if I had a partner when I was a resident, I personally would not have wanted to, and I know lots of people made different choices and every choice is valid. I personally would not have wanted to have a baby during residency because I didn't want to be taking call while I was pregnant. I didn't want to expose a fetus to that erratic schedule. More importantly though, for me, I didn't want to have to come back four weeks later or six weeks later, which was the most that I could get at that time, which also would have meant not taking a single vacation the rest of that year. You Mm-hmm. know, and I know women do it. I did it. Don't recommend. Don't recommend. I yeah, I I could not conceive doing that myself. when I was in my when I was the chief resident, my last year of residency is when I got pregnant with my son. And I was making this cal a different calculus, right? Of like, I I did not use I did not need IVF. I happened to be married to a lovely person who I wanted to have children with. and in a goal to avoid needing these reproductive Mm-hmm. technologies, I was like, Well, you might as well have a baby and Yeah. Yeah. suck it up. And I desperately needed. a week of vacation so that I wouldn't, you know, do murder. And so there Mm-hmm. was only three weeks left for me to take off after my son was born and do not recommend. Yeah. I mean it's it that's again totally valid choice. And that's the impossible position that people are in, specifically in medical in the medical training context, because our training is so very long. Yeah. Well, and I mean, obviously there's lots of people where they have a baby and they have n no sick days at all. They don't have a pr they don't have any protection at all.~ and I remember even for ~ for myself, if I wanted to take more time off, the option I was given was unpaid time off, including potentially losing access to my health insurance, which Mm-hmm. I had through work, and therefore having an uninsured baby. I was like, What? Seems like a great idea. I was like, what are we doing? No, that's wild. I mean, the thing that happened, I remember that was like a big deal when I was a resident was the American Board of Surgery basically said that if you wanted to take more time off, unpaid, mind you, if you wanted to take more time off, they would let you do an extra year. That was the Well, I was solution. Like if you need to take more than this, you know, four to six weeks, whatever it was at the time, we will let you, and then you will need to do an extra year.~ we I basically we called it being punished for having a baby. So, like because I had had a child, I had had a child right before I started my residency. And so I had started residency later. And at the time, there was this long tradition of women just saving up their vacation to basically Are there pay back the time they had taken off. And I had diligently done that. So my intern year, I only took one week of vacation because I was trying to buy back. Mm. That time so that I could graduate on time. Because if you don't graduate on time, you might not be able to get into your fellowship. You might not be able to get the job that you want. Mm-hmm. Yep. There's like all of these things that are built in.~ but my hospital ~ changed their mind ~ when they went through a merger or something. And like my whole life got up in it. Anyway, the point is it's it's hard enough for all of us to like figure out how to have the families that we want and be able to. you know, have the children or not have the children we want and parent the way we want in a culture writ large that clearly doesn't actually Mm-hmm. want us to do that. And the other thing I wanted to just say, to come back to the to the political issues related to this is that, you know, the conservative movement is really pushing, I mean, they're they're they're anti-birth control. There's this whole movement going on of all of these social media accounts pushing the exact same like anti-birth control. Mm-hmm. lies. and pushing again this like trad wife lifestyle of like get married as young as possible, don't get an education. And in fact, choosing to not get an education and choosing instead to get married exceptionally young and have as many babies as possible, that that's actually the best thing. And of course, what does that do? It keeps all of these young, vibrant women who might otherwise want to change the world in some other ways. And and you're busy at home raising kids and having and doing that. Which, you know, some people genuinely want to spend their time that way. And I applaud them and you should get to do that. But for a lot of us, I mean, I I wouldn't my brain would have melted. Like Mm-hmm. I love my children and I never in a million years would have wanted to stay home with them all the time. I was becoming Mm-hmm. a great doctor and that was really awesome. And I don't regret making that choice. Mm-hmm. Yeah. And I think we just have not broadly in our society, or certainly not within the profession of medicine, decided that we should be supporting those choices in the way that people really need to be able to have a kid in a humane manner during that critical period of time. I mean, for folks who don't know, for the majority of people, medical training overlaps with our peak years of Mm-hmm. fertility. And so, you know, for a lot of people who do, you know, end up having a kid during training, that is why. Cause they're like, either I do it Mm-hmm. now and then like at least I know my eggs are healthy, you know, or whatever, most likely. Or I wait till later and then who knows what's going to happen. You know, whether I'll even be able to, you know, get pregnant without reproductive endocrinology or even with endocreproductive endocr endocrinology, will it even work for us? You know, those are that's a trade-off that I don't feel we should have to make and to your point though, like the W and I shouldn't have there are to fight with the government to get to do it also. Yes, also true. And for all anybody who works in a field where they, you know, are contingent workers or they're hourly workers,~ they don't even have vacation of any kind, much less parental leave. And and because of again, our economy being what it is, like can't even afford time off. And that is also absurd and terrible. And makes it harder for them to have children. So like if we if we think that we want to live in a country where people should have more kids, then we need to make policy decisions that will support people having those kids or just let people do what they want to do. But what we're doing now, which is yelling at people for not having kids, but then also making sure that all the policies make it as hard as possible to have kids is the stupidest version or combination of those things that I think we could have. Have kids, but only this one way. But also, like, Mm-hmm. I mean, it's clearly like I mean, there's so much racism. Well, there's also this is And also only if you're wealthy. Yeah, yeah, exactly. the thing, right? There's so much classism and racism around this Yes. conservative ideology of like I mean, all the panic around teens not having as many kids is so gross. Especially because Yeah. by the way, many teens who get pregnant are by adult men.~ Yes, because you're talking about this data that these data that have come out showing that for the first time we had more women in their 40s having babies than teenagers, and a segment of our population has really just lost it over that, as if that's hugely problematic because we should have teenagers game. I mean, that's like a Yeah. that is a huge success for sex education. Mm-hmm. And reach reproductive autonomy and like Did you did you see how ~ Trump lost that whole thing on like he was trying to completely gut sex education? I think it was earlier this week or or late last week,~ Trump was trying to like make all these changes to the Teen Pregnancy Prevention Program. ~ Mm. and a judge has blocked them. Unfortunately, it's not gonna, it's not gonna reinstate all the funding that has been held back Mm. from them so far, but like still huge win to like not allow this ridiculous. anti sex education, anti support for teens go through. So at least that was good news. We got that. You know We got that. always nice to have some good news. that just reminded me tangential, but Linda McMahon, who is our secretary of education, believe it or not, ~ was on some TV show talking about how ~ you know, kids are going to school and then being transitioned to another gender at school and that we've gotta stop this ~ terrible She's so dumb. practice. And you know, like one person was like, if you dropped off your kid If you dropped off your daughter and picked up a son, you please go back. You picked up the wrong child.~ and lots of people commenting on how hard it is to even get a school to give your child like Tylenol.~ and they think we there's like my gosh, so true. yeah, they think there's like a secret operating room somewhere there. And then also people like teachers have a really hard time getting supplies, right, for their classrooms and they have to pay for it out of pocket or fundraiser use like whatever Amazon wish lists, et cetera. So we can't get supplies. What we're supposed to believe is that we can't get supplies for the classrooms, but we can do complicated surgery on kids without anyone knowing. Yeah, it's obviously absurd and part of their whole like culture war~ further attacks on trans people for no reason aside from being terrible people who want to distract from everything, all the crime they're actually doing. They're Yeah. like, look over here. From being the worst. well, I we there's a number of other stories that we wanted to be able to tell you all a little bit about. ~ and looking at the time, I think it's time for us to do that. Yeah. you know, there's been this big surrogacy case, which, you know, this is somewhat of a of an add-on to the fact that we've been talking about infertility care.~ but there's a couple in California that had hired A Alaska-based nurse to be their surrogate~ to basically gestate their baby, their fetus. And unfortunately, that fetus was found to have hypoplastic left heart, and the family had wanted to have an abortion, which was something that this person had the surrogate had agreed to in their contract, that this was this is all something that had been discussed ahead of time. However, that surrogate decided that she did not want to do that. And actually absconded to Texas so that she could be in a state where abortion was not available. and Certainly, she didn't just hop on a plane, she got a conservative group to fund this whole endeavor for her to move to Texas. Well, and not to mention all of the publicity around this is obviously completely orchestrated to facilitate this pro life narrative. You know, Ken Paxton, the governor of Texas, has been involved. and so this baby baby boy pardon? Attorney General. He's the attorney general. gosh. Pardon me. I'm Yeah, he's running for office, but I think he's running for Senate. Hopefully he doesn't get that. But anyway, he's the attorney general. Greg Abbott is the lovely governor,~ yeah, Craig Abbott. God, they're all so awful. of course. They are all so awful. They're all awful. I have a hard time keeping them straight because they're so terrible. Yes, understandable. Thank you for correct for the correction. so after the surrogate had ~ been taken to Texas, funded by going to Texas by these anti-abortion groups, the baby was born on August twelfth in Dallas, Texas. The baby has this condition called hypoplastic left heart syndrome, which I'll put a link to ~ Kind of an explanation of that because it's sort of a complicated thing. You know, as a pediatric anesthesiologist, it's something we see. ~ but I think for most folks, this is not a common thing for folks to be aware of. the baby has had the first stage of a series of complicated surgeries that are available for babies with hypoplastic left heart syndrome to potentially survive. so the baby has had the first surgery called a Norwood. on August 25th, the parents released a statement saying that their baby is quite critically ill.~ so it's not it's not clear that things are really going well at this time. So we're gonna have to see. There's a lot of really complicated legal issues around this case. And obviously, there is a, you know, live-born child. There's a lot of fights that are happening around who are the parents of this child, because they're it should be the parents who started this whole process of hiring the surrogate.~ but this has become incredibly complicated ~ through this process. Yeah, and I think that custody battle is kind of the heart of where things are right now and why this like conservative group wanted to support this to be be able to say, look at these terrible parents who, you know, wanted to end this pregnancy when in reality, you know, they wanted to minimize the suffering of this fetus that then became baby, who now has an extraordinarily complicated medical situation. with unclear, I think, life expectancy from what we're hearing. but that's but that's part of And like s and like what like the pro the so-called pro-life movement Mm-hmm. does is they they completely ignore quality of life and valuing dignity ~ and want to frame people who want to preserve that as being murderers. And one of the things that I think's really hard is like the the survival for kids who go through all of these procedures for kids who are born with hypoplastic left heart,~ It's it's very these are very intense surgeries. They're major cardiac surgeries.~ you know, people oftentimes are very worried when an adult has has cardiac surgery. You imagine putting a tiny, tiny baby through that. ~ there are other surgeries that happen if they survive. There are other surgeries that happen when they're older.~ and the majority of these patients, under kind of the best of circumstances, eventually need a heart transplant. And sometimes they need both a heart transplant and a liver transplant, which In in my work as a liver transplant anesthesiologist, that's one of the ways that I end up taking care of these kids when they're for those that survive. But like some of these kids don't survive, even Mm. with access to all of these procedures. And so it's not like it's one of the things that's so hard about watching~ the anti-abortion movement take this out on families who who are trying to make informed choices Mm-hmm. about how to to to have the babies that they want to Mm. have to raise families in the ways that they want to raise them.~ this just really flattens all of that. And like we we should want families to make informed choices. We shouldn't want choices to be thr, you know, shoved down their throats and onto the their children. Yeah, and in the meantime, they have this now medically very complex baby, and the parents are not allowed to take the baby to California. So the procedures for now until there's like a judge making a decision, you know, the procedures are happening in Texas. I mean, it is so ob obviously stressful to have a sick child and to have to do everything that they're doing while going through a legal battle while having take take care of that child in a state where they do not live is Mm-hmm, mm-hmm. a type of cruelty that should not be happening here. Yeah. Yeah. So ~~ yeah. we'll keep track of that case.~ another nice piece of news, a federal judge blocked Idaho from prosecuting doctors who provide health abortions. ~ so this is in opposition to Idaho's Defense of Life Act and their Fetal Heartbeat Act.~ Mm-hmm. so hopefully this means that maybe a few more physicians will be willing to practice in Idaho. Which has been a huge problem. Yeah. I mean that's that's great news. And we've seen a number of ~ obstetric gynecologists leaving the state of Idaho because of Mm-hmm. the changes that came to the to the laws there after ~ Roe versus Wade was overturned. So Yeah. that's a that's a win. Thank you for sharing that.~ I had a couple of quick updates. So we talked before about these two former NBA players who had declared themselves for the WNBA draft. And the WNBA has now officially said they are not eligible.~ basically, this is a sideshow, we don't want any part in it. One of the men, Ines Cantor Freedom showed up at a WNBA match earlier this week and got into an altercation essentially, of like a fighting match, a yelling match, I should say, with one of the players. So this is, you know, how you prove that you really care about protecting women's sports is to come and harass the women players in the league. You literally like I you can't make this stuff up. Well, what is interesting to me is like people are gonna always do weird things that, right? Like that guy clearly has nothing else to do and is looking for 15 minutes of fame. People do weird things, but what I have a harder time understanding is all the people in my who are like calling him her, even though he's not actually trans and not making any efforts to transition. I just these fucking idiots, I just I And and then and then, you know, yelling at people like me saying I thought I thought you guys wanted to support trans people.~ yeah, they're making a mockery of trans people. And you're not gonna like play some word game to get me to be like, yeah, Ines Cantor Freedom belongs in the WNBA. When he's clearly harassing these women who have worked so hard to build this league, and the league is having the best year that they've ever had in terms of engagement. And ~ Well, it's just so threatening to him, I imagine. That that the women have their own league. I mean, also they're better basketball players than he is, so that's tough. Yeah. Yes. That is that is very hard to accept. So anyway, so we'll ~ see how that story develops. But that was the update that I want to give. The WMB has officially said, yeah, we're not playing this game. These people are not eligible. Let's move on. and then All right, you and you asked me before we started recording if I knew what was going on with the Canada trade war and I said I said not really. Uh-huh. Yeah. So that's the next thing And so is ~ the the the the trade war we are now in with Canada.~ you know, of course, our president had last year threatened all these massive tariffs and levied tariffs on all sorts of countries. And we had been in some sort of negotiation process with Canada and that up. and Mark Carney, the prime minister of Canada, was like, we're not doing this. He pulled back the negotiators, said, We're not talking to you anymore. We're done. We're gonna levy tariffs back on you all, and we're gonna maybe take take our toys and leave in the sandbox. and you know, there's a number of things. So so my understanding of the situation is that negotiations had been progressing, but then all of a sudden, kind of at the last minute, the US team, if we can call them that, had a bunch of new demands and some of them were like they're different people making demands were perhaps at odds with each other because yeah they're not that coordinated. Anyway, so the reaction that that was why that there were all these additional demands that they included things like dictating the terms under which Canada trades with other countries. We have no right to do that. Let me listen, the the degree of surprise that I have that this administration has botched that is zero. Yeah, no, I know. ~ one of the kind of sticking points was around the French language,~ you know, which is obviously prominent in Quebec and and and used by people in other parts of Canada as well. And the details of what exactly was being demanded are not total totally clear, but something along the lines of the US not wanting to have French language instructions and packaging, ~ but also maybe not wanting Canada to have that But I but like I like is unclear. it because it makes me feel fancy. I want To have the French on there. I want, you know, the products that come from Canada to make me feel a little bit fancy. Well, they are definitely fancier than us. and so anyway, so so Mark Carney, when he made his ~ statement, said, you know, they're they're attacking the French identity of Canadians and we're not going to stand for that. So America. Yeah. Yeah. Well, and then Doug Ford, I mean, there's lots of things going on there, but ~ basically we have antagonized one of further antagonized one of our biggest allies, and it's not going to bode well for anyone who has a business where they are doing trade with Canada.~ so another win, another win for MAGA making things so great. This makes me want to watch Sterling Point even more because it's in Canada. Yeah, we should actually support more Canadian Ha ha. businesses. We should buy Canadian. I mean, forget it. Anyway. the last little bullet point before we get to Take Two and Colony in the morning,~ is there it the US-Iran war continues. I you know, I thought it was a two-week thing that was supposed to happen. It would be over so soon before we knew it. The total victory would be ours. Anyway, ~ that continues. The US has now threatened additional sanctions that are kind of more severe than sanctions that they've had in place before.~ so yeah, it's great. It's yeah, just to gonna wrap up any day now.~ we're losing, losing, losing. I saw somebody, somebody commented on a post I had about the Canada trade war and they said people in Iran are watching going, see what we're dealing with? Anyway, war is not funny, it's terrible. Alright. Well ~~ but that's what's happening. So take two and call me in the morning. I need to put cleanse the palate. Prescribe me something, Arghavan. Okay, so what I want to share today is ~ a woman who I found on TikTok. And she does let me see what she calls it. She says, singing songs from Broadway musicals as Justin Bieber. Okay, so just imagine I'm gonna play you a clip, but it's already kind of a funny premise because I don't really think of Bieber style as Broadway musical style. But anyway, okay, so here I'm gonna play you. But this is one of my favorite things where you mash up a like a type of music, like or like sing like this person, but sing this other song. Like I think that's so fun. Yeah. I agree. So here she is. I dreamed a dream and time goes. Worth the living. I dream the love would never die. Dreamed that God would be forgiving. And I was young and Okay, that's enough. Dreams remating you stay. All right, all right, all right. She's great. Her name is Hope. I'll put a link to that. ~ but I mean like she Amazing. Well I'll tell you I really has his mannerisms and the you know, Mm-hmm. anyway. Yeah, I will say I never contracted the Bieber fever. Did you did you ever contract the Bieber fever? I had some songs I really liked a few years back, kind of in the maybe middle phase of his career. Not very early on, I was not a big B Ru fan, Mm-hmm. Mm-hmm. but there were a few songs I liked. But lately, I just don't know. Like I think he super talented. I do not have that voice, right? Like he's Yeah, sure. clearly just super talented. And troubled, like so troubled. And I know Mm, mm. he's been through a lot. And it's hard for me to watch him like get on the stage. I think it was right at the Grammys in like boxer shorts and nothing else. And not I mean, Yeah. Okay. Yeah. again, he has a beautiful voice. But like I I just feel for him, like as a kind of prote I mean I don't know him, but I just feel like can can you like go take care of yourself for a while? Like don't do this performance Yeah. thing. Do what you need to do to like get into a healthier space. Hmm. Hmm. I mean, I don't know. I'm not trying to diagnose him or anything. I just it it doesn't seem normal.~ Mm. and I and I just wonder if he's really like work through and I don't know if you really ever can work through whatever it is that he's experienced. Anyway, what is your recommendation? Sure. Sure. So one, you know, I love a weird science thing. Like I like things Mm-hmm. that are like, and I like things that are like, you know, a little creepy. I mean, maybe just a little bit. huh. so I am gonna put a link in the show notes to people who can check out a purple skeleton. ~ and part of what is, and it's naturally occurring. And ~ it's from this Instagram account called It's Mad Science, and it's for people who are interested in like California coastal ecology, the ~ California sea otters eat these purple spined~ sea anemone and they turn if they because they eat so many of them they turn their they actually turn their bones purple which I had no idea like I am really I love otters. I had no idea that it would actually stain their bones. Yeah. It is. Fascinating fascinating~ so I'm gonna put a link to that because I just think it's like so cool. I feel that maybe you should have been a marine biologist. In another life, in another life. Yeah. Yeah. and then the other one I'm gonna share, you know that song 99 Luft Balloons?~ Yes. lovely song. There is a really fun. If I knew the words I would sing it for you anyway. I I actually remember All I know is nointy noise and I I know I learned all the words, like I think it's in German. I think I learned all the words when I was in Mm-hmm. high school. I don't remember them all.~ but I love that song. And there is a really lovely video. I'm I'm part of the Flock Camera Hater Society. Yeah, sure. And there's a wonderful video called 99 Flock Balloons, and Mm. it is of some artists with a child.~ they have all their faces covered. And they take a bunch of red balloons and use it to do all this like filming around these flock cameras. And then they just they just happen to leave the the balloons tied to the post with the camera and they just they just happen to cover And I just thought it was delightful. And so I would Ha ha ha. love to share that with all of you. Perfect. Thank you so much. Flock cameras are are terrible. But they're just getting replaced, I think, with is it axon? Like, I mean. They we need to get rid of all of these companies. They're all terrible. I agree. ~ so on that note, I think that's it for this week's episode. if you didn't like what you heard, this has been the Triumphant Tradwife podcast. If you liked it, don't forget to subscribe to the Present Illness, leave us a review review, and please tell other folks to check us out.~ follow us on TikTok, Instagram, and YouTube at the Present Illness, and you can stay on top of all of our TPI related news. We will be back next week with more headlines, hot takes, and doom scrolling, hopefully wrapped in some laughs. Until then, agitate, hydrate, take a nap, and we'll see you next time on the present illness. Production by Arghavan Salles and Alyssa Burgart, editing by Alyssa Bergart, social media by Arghavan Salles original music by Joseph Uphoff. Don't take medical advice from random people on a podcast. This show's for informational purposes. It's meant to be fun, and it is certainly not medical advice. Please take your medical questions to a qualified professional. This podcast our hobby doesn't represent our employers or anyone else.