October 26, 2023 • 57 mins
Heavyweight will be back with a new episode next week. In the meantime, we’re excited to introduce you to a show we love from our friends at Serial and The New York Times. The Retrievals follows a group of women who went to the Yale Fertility Center for a procedure called an egg retrieval. For months, patient after patient complained that they were experiencing excruciating pain during the procedure. And time after time, they were essentially brushed off. Until, finally, everyone found out what was really going on.
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Episode Transcript
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Speaker 1 (00:00):
Hi Heavyweight listeners. While the team is busy working on
next week special episode, we don't want you flipping podcast stations,
so we're bringing you something from our friends at Cereal
and The New York Times. It's an episode from the
podcast The Retrievals that we've been eager to share. It's
about these women who went to the Yale Fertility Center
for a procedure called an egg retrieval. For months, patient
(00:22):
after patient complained that they were experiencing excruciating pain during
the procedure, like the anesthesia they were given didn't work
at all, But time after time, these women were essentially
brushed off until finally everyone found out what was really
going on. It's a gripping story that goes to places
you completely will not expect, places that are both deeply
(00:43):
personal and also point to larger structural failures in the
world of healthcare. Susan Burton, the reporter of the story,
does an incredible job delicately guiding you through shifting sympathies
and the complexities of the case. We've got episode one
for you, but I'm sure, like me, you're going to
want to tear through the entire set series. The Retrievals
Episode one coming up right after the break.
Speaker 2 (01:06):
The women are seeking fertility treatment for a variety of reasons.
They've had a couple of miscarriages and they're pushing forty,
they don't have fallopian tubes, or they need sperm. One
woman has a diagnosis that's like a metaphor from feminist
sci fi, a uterus with a single horn like a unicorn.
All of them wind up at the fertility clinic at
(01:27):
Yale University. A couple of the women choose this clinic
because they work at Yale, and that's what the Yale
health plan covers. Others go to Yale and the recommendation
of their doctors. But in Connecticut, you don't even really
need the recommendation. Yale Medicine it's a blue chip medical brand.
Speaker 3 (01:45):
You know, Yale's just a huge name, and you just
think anything that has anything to do with Yale is
going to be, you know, the best of the best.
Speaker 4 (01:52):
It's really not close to our house. It's not where
I would have gone, but we figured, you know, another
doctor from another hospital said this is the best you
can get, and you want, of course, you want that.
Speaker 5 (02:06):
To some of the women.
Speaker 2 (02:07):
The clinic seems to live up to its billing. They
like their doctors feel cared for by them. That man
is an angel, one of the women tells me. He
is by far the best doctor I've ever had. Others
are not happy at the clinic from the start. It's
things like feeling like a number, or issues with communication.
There's a lot to communicate. You don't know how hard
(02:29):
fertility treatment is until you get into it, and once
you start it in one place, it can be difficult
to go somewhere else. So they talk themselves into staying.
That's the first thing they go against their instincts and
talk themselves into. The women drive to the clinic before
(02:52):
work in the morning for blood draws, and then wait
for the afternoon email from their nurse team. You really
have to trust your nurse team, the women tells me.
At this point she did. The nurse team gives instructions
and the women give themselves shots. These shots contain hormones
to stimulate the body to produce eggs. A side effect
(03:13):
is emotional volatility. The wind is making me cry, one
of the women says. But the thing is you have
to stay calm, don't get stressed. It's so stressful. Trying
not to get stressed. One woman uses a fertility meditation
app called Expectful. She does her guided meditation on the beach.
(03:35):
The app plays the sound of waves while the real
waves heave in the background. It's absurd, but so much
of this is absurd, including the money. There's all kinds
of stuff that's not covered no matter what insurance you have. Meanwhile,
your ovaries enlarge and you get so bloated that your
abdomen feels like bricks. And then finally you get to
the day you've been waiting for, the day of the
(03:57):
first egg retrieval, which is what it sounds like. The
eggs are removed from the body and then fertilized or frozen,
depending on what you're doing. How many eggs am I
going to get? That is the big question. The more
eggs you get, the better your chance of a healthy embryo,
a viable pregnancy, a child. The day of the retrieval,
(04:21):
the women arrive at the clinic. They check in on
different mornings in different months and calendar years. None of
them are here on the same day, but they will
come out of the day with the same story. Laura
arrives for her retrieval on a weekday morning in January
twenty twenty. She checks in and changes into a gown.
(04:41):
Two months ago, Laura was diagnosed with breast cancer, a
double mestectomy followed, then an infection and additional surgeries. As
soon as she freezes her eggs, she's going to start treatment.
It's a lot. Laura is trying to put all of
that to the side and just focus on the procedure ahead.
Speaker 6 (05:00):
I was excited, like, you know, trying to stay positive
and just and I was just like, having been through
so much just the month prior, I was like, this
is going to be easy because I had been through
so many surgeries and procedures. I was just like, you know,
it's I know what this is like. I know what
it's like to be under anesthesia or something and given
medication so you don't feel things.
Speaker 2 (05:22):
The egg retrieval is a surgical procedure. A long needle
is inserted into the vagina, then pierced through the vaginal
wall and up into the ovary. Laura has been told
in advance what drugs she will be getting during the procedure.
Speaker 6 (05:35):
Two drugs, fentanyl and another one my dalozam or is
a lamb, and I believe that one's to induce sleepiness.
Speaker 2 (05:42):
Together, these two drugs offer what's often called moderate sedation. Basically,
the fentanyl takes away pain and the medazolam relaxes you.
Some people get drowsy with this combination, others remain alert.
The use of fentanyl surprises some of the women. One
of them, Defender, has seen a lot of clients messed
up by fentanyl, and for a second she's worried. Another woman, Katie,
(06:07):
a neuroscientist at Yale, feels a spark of interest.
Speaker 7 (06:11):
And in fact, you know, just being someone who studies
addiction and studies some opioid use disorder and as a
curious person. I remember the morning of thinking like, okay,
this will be interesting. I've never tried ventanyl before, and
so I expected to go in and have twilight anesthesia,
you know, not full anesthesia, but not feel anything.
Speaker 2 (06:30):
The women complete the last steps before the procedure, get
an IVY, go over some papers, if their partners came
back with them. Now their partners say goodbye, and then
it is time the women tell what happens next.
Speaker 6 (06:46):
I walked myself into the procedure room because you get
rolled out afterwards. But you don't have any medication in you.
You're just kind of hooked up to the ivy poll.
And I walked into there and you you know, you
get into the on the chair or table, whatever they
call it, and that's from there. They said you're not
going to feel anything, and they couldn't, you know, they
explained everything that was going to happen.
Speaker 8 (07:06):
They started the procedure, and you know, I was just
sort of taken by surprise, not expecting the excruciating pain
and just letting them know that, you know, I don't
think the pain medication is doing anything. You know, I
can it really feels like you're stabbing the needle.
Speaker 9 (07:30):
I felt everything. It's literally your most intimate parts of
your body.
Speaker 10 (07:38):
They're using these long needles, and there's also a screen
so I can watch what they're doing, and I couldn't.
I had to try and look away because literally each
needle appears you feel.
Speaker 8 (07:50):
As we were moving along, it was my blood pressure
started going up. I was sweating profusely and telling them,
you know, I was just in and too much pain
that they had to stop. At that point, I remember
them giving me more of the pain medication and me
saying it's not making you know, it's not making a difference,
(08:13):
you know, a nurse coming over and putting a wet
towel on my head, and another nurse holding my hand
and them comforting me and saying, you know, you're going
to be okay.
Speaker 9 (08:24):
The nurse who.
Speaker 10 (08:26):
She was at the top of my body, kind of
at my shoulders, wiping the tears away and helping me
kind of hold my breath to keep myself still so
that the doctors didn't slip with the needle, and just
telling me that I was going to be okay, that
I was going to get through it. And up until
(08:49):
that moment, I'm so excited, like, oh I have twenty
four follicles, like this is great, Like I'm going to
have a great egg retrieval.
Speaker 9 (08:55):
And then you're like, oh my god, I wish there
was only one.
Speaker 10 (08:58):
Like everything was counting on that retrieval and that and
that's how it feels like the whole the way of
you know, your world, my partner and I she's counting
on me to be able to get through this and
to have.
Speaker 9 (09:13):
This successful retrieval, and all I'm feeling is, oh my god,
I needed to stop.
Speaker 8 (09:19):
Is this worth it, and you know you your feet
are in the stirrups and you know you should just
be laying on the table. But I remember tightening up
and just trying to relax my body so that they
could do what they needed to do because I was
so tense that like my bottom was almost off of
(09:40):
the table.
Speaker 6 (09:41):
I remember like thrusting my hips up, actually thrusting my
hips up, saying I feel everything like and like nobody
believed me, and.
Speaker 5 (09:52):
It's just like I don't know, but what are you
gonna do? You know, I wanted the procedure done. I
just let it happen. And I was like, I'm awake.
Speaker 11 (10:02):
So.
Speaker 7 (10:07):
No, you know, I was stone cold, sober and awake.
And I remember I the egg retrieval. You know, they
kind of do them one by one or like a
couple at a time, you know my impression, And so
you have moments in between pain to say, like what
the fuck is going on?
Speaker 6 (10:23):
I do remember I think I swore I was using
curse words because it was just so painful.
Speaker 8 (10:30):
You know, I don't I don't know if I can
do this any longer.
Speaker 5 (10:34):
You know, you just have to get through it. It's
going to be over before you know it. Okay, this
is going to be over eventually.
Speaker 12 (10:38):
You can do this.
Speaker 5 (10:39):
You can do this.
Speaker 9 (10:40):
Blant this moment over, get through it, gets through it.
Speaker 7 (10:47):
I remember yelling or kind of making like ah and
really like looking in confusion at my nurse, the attending nurse,
and her saying, you know, I'm giving you the most
I can legally give you.
Speaker 13 (10:59):
She said that that's the maximum that she's allowed to
give me, so she couldn't give me anything else.
Speaker 8 (11:04):
I'm almost certain that at one point they said that
they had given me all of the pain medication that
they could give me.
Speaker 10 (11:10):
At one point they did say that I had maxed out.
I couldn't have any more fat dollar versa.
Speaker 9 (11:14):
And I was like, how is this possible?
Speaker 5 (11:17):
Why is that? Even? Like how am I feeling?
Speaker 9 (11:19):
How do people go through this?
Speaker 6 (11:20):
I can feel that, like I could feel the I
don't even know how to describe that, Like you can
just feel them inside of their you know, as a woman,
we've all been through things, you know, with those kind
of doctors and stuff, But like, this is just a pain.
Speaker 5 (11:34):
It's like hard to even explain what it felt like.
Speaker 2 (11:41):
It's this is hard to do, but could you describe
the pain that you felt.
Speaker 7 (11:47):
Oh gosh, it felt like someone was like ripping something
from the inside.
Speaker 5 (11:58):
Of your body. Yeah, which is what they were doing.
Speaker 12 (12:02):
Yeah, that's what it felt like.
Speaker 2 (12:05):
Yeah, yeah, I'm sorry.
Speaker 7 (12:09):
But I remember almost immediately thinking or almost daydreaming in
that moment that like, the attending nurse had one tube
going from my ivy into my arm and another tube
going from my ivy into her pocket. Like it occurred
to me almost immediately that the nurse was stilling the sentinel.
(12:31):
And I remember telling my friends, you know, after the procedure,
my friends who were aware of what I was going
through but who are also colleagues at Yale in addiction research.
I remember telling them, like, the nurse is stealing the fentanyl,
because it seems so obvious to me. I'm infental is
the most diverted drug in medical settings. It's like a
now major driver of the opioid crisis, and it was
(12:51):
just really easy to imagine that someone with access to,
you know, poorly controlled ventanel would be abusing it.
Speaker 2 (13:01):
That's so fascinating that that's the image that raised itself
up for you, because it is so evocative, Because it
is so evocative for example, and also because it was
true a nurse at the clinic was stealing fentanyl. Not
Katie's nurse, not the tube in the pocket, but a
nurse at the clinic was stealing fentanyl and replacing it
(13:23):
with saline. She did so undetected for months, which meant
patients weren't getting ventanyl in their ivs. They were getting
salt water instead.
Speaker 3 (13:33):
Drug addicted former nurse is sentenced for a crime that
caused unbearable pain to dozens of women. The nurse stole
drugs and then replaced them with saline solutions.
Speaker 5 (13:43):
Kind of A nurse.
Speaker 3 (13:44):
Admits that she swapped out anesthesia drugs for salt water,
causing excruciating pain to women during infertility treatments.
Speaker 1 (13:52):
It happened at a top rated ceter of affiliation.
Speaker 4 (13:54):
With a horrible story about the extremes a fertility nurse
struggling with drug addiction took to get.
Speaker 2 (13:59):
Her in a newly file. A federal investigation determined that
as many as two hundred patients may have been victims
of this substitution over five months in twenty twenty. Lawyers
for some of the patients believe the real number is higher,
and this went on for longer. I've talked to a
dozen patients who believe they were victims of this. Eleven
(14:21):
of them are plaintiffs in a lawsuit against Yale, and
their lawyers were present when we spoke. When I started
doing these interviews, I was struck by the echoes in
these women's stories. To me, it sounded like a chorus
of women saying something is wrong here, again and again.
The patients wondered how the clinic could have failed to
(14:42):
detect this, and the conversations I was having made me
wonder that too. And then I began talking to other people,
staffers who'd been there, and I learned about what went
on behind the scenes. The staffers I spoke to were
horrified by what the patients had experienced. They were grappling
with their own questions about how this had happened, about
(15:03):
what had gone amiss. The patients didn't know why they
were in pain, their doctors didn't know either, and in
the absence of information about the true cause of the pain,
people came up with stories to explain it. The patients
constructed stories about why they felt pain. Staffers at the
clinic came up with theories too. Eventually, the nurse would
(15:27):
tell her own story about the pain, which would launch
a whole new set of stories, the ones her friends
and family would come up with, the one that would
get argued in court, the one Yale would tell. And
all of these stories revealed something about women's pain, how
it's tolerated, interpreted, accounted for, or minimized. In fertility treatment,
(15:55):
you evaluate the outcomes by whether you wind up with
a baby trick by which success is measured It all
went well if you leave with a live birth. The
outcomes here are a lot more complicated for everyone from
Serial Productions and The New York Times. I'm Susan Burton
(16:15):
and this is the Retrievals. This is episode one, the Patience.
(16:41):
When the retrieval is over, the women are wheeled out
to the recovery room, and one of the first things
that happens is that they try to come up with
an explanation for their pain.
Speaker 6 (16:51):
They put you into the recovery room and that's where
you meet with whoever you were with. And I just
remember that's when I had my phone back and I
was texting my sister in law because she was my
confidant for all of this.
Speaker 5 (17:01):
Having been through that and she was.
Speaker 6 (17:04):
Just replying like, oh my god, how could you What
do you mean you felt everything? And I'm like and
I was just like, you know, just explaining to her.
I'm like, I don't know what's wrong, like so and
I even one of the texts I said, I said,
I think I'm immune defentanyl, because like I was like,
I don't think it works on me.
Speaker 2 (17:22):
I'm not sensitive. Defentanyl is a common theory.
Speaker 8 (17:26):
And I remember when their procedure was done, you know,
my family sort of, you know, we have a family
text that's ongoing, and I just remember texting them that,
you know, it's hard to believe that we have a
fentanyl epidemic where people are addicted, because it did nothing
(17:46):
for me.
Speaker 2 (17:49):
Not all of the women were alert during their procedures.
Some were more deeply sedated. They were so out of
it during the retrieval that they don't really remember it
or only kind of the pain hits when they come to.
Speaker 14 (18:03):
It was bad instantly, and it shouldn't really be bad instantly,
like you shouldn't wake up and being like.
Speaker 12 (18:08):
Horrific, like nightmarish pain.
Speaker 14 (18:12):
But I woke up and I was, I mean, like
it felt like someone had been inside me.
Speaker 12 (18:17):
And like gutted me. Yeah, if it was like a.
Speaker 14 (18:20):
Gutted feeling, it was like someone had been inside me,
scraped me hollow.
Speaker 12 (18:23):
It was burning.
Speaker 2 (18:26):
In a way. It is more confusing for the wake
up later patients. They're not matching each stab of pain
to the needle on the screen. It hurts a lot,
but it's less explicable and because of that scarier.
Speaker 7 (18:40):
You know, your mind just goes to the worst possible places.
Speaker 5 (18:43):
You know, I'm thinking, is am I bleeding?
Speaker 3 (18:47):
You know?
Speaker 5 (18:47):
And am I bleeding? Internally? Is like a pain is
normally a pain is a sign? Is protective?
Speaker 11 (18:54):
Right?
Speaker 5 (18:54):
It tells you something's wrong.
Speaker 2 (18:56):
There's a lot of uncertainty in the recovery room and
elevated blood pressure, a nurse running around to get ginger ale,
a doctor coming by to say there are fewer eggs
than we expected. Are you sure you only want us
to fertilize half of them. It's all just very overwhelming,
and on top of it, some of the women feel
like they're being rushed out of the clinic. Julia is
(19:16):
one of them.
Speaker 4 (19:18):
I remember vomiting. They were giving me some fluids.
Speaker 2 (19:22):
I was.
Speaker 4 (19:25):
Very uncomfortable. There was no way I could walk. They
put me in a wheelchair and wheeled me out, and
I just I just had this feeling like this is
not this is not right.
Speaker 2 (19:39):
Julia is thirty one years old and already a college professor.
This morning, when her husband drove to the clinic, she'd
been frantic there was work on a bridge near their
house and they got stuck. There's only a short window
to retrieve the eggs before you ovulate them, and Julia
was worried she would miss it. When she arrived at
the clinic, she felt a huge relief, like we made
(20:02):
it both, we made it on time, and we made
it to this day. Now she's feeling something she never expected.
At home, she goes upstairs and gets into bed.
Speaker 4 (20:14):
I fell asleep for a little while, and then I
woke up, and I was nervous. We had a babysitter
here watching my daughter, and I just you know, you
wake up, You're like, oh my god, who's with my kid?
I need to And I walked a few steps to
(20:35):
try and go down the stairs, and I realized I
really had gone too far from the bed. But by
this point the pain was excruciating, I would say, and
I turned to go back to lay down in my
bed again, and I pass I mean, I don't remember this,
but I blacked out or passed out, and I woke
(20:56):
up on the floor and I kind of busted my
lip open.
Speaker 2 (21:05):
Julia calls the clinic and they tell her that she
should go to the er. She's in so much pain
that she can't bend enough to get into a car.
An ambulance is called, and when Julia gets to the hospital,
they check her out. The retrieval is a safe procedure,
but things can go wrong. Your ovary can strangulate, a
major artery can get punctured. But none of the obvious
(21:28):
things are wrong, and nobody can explain what is Back home,
over the weekend, Julia calls the on call doctor at
the clinic multiple times.
Speaker 4 (21:38):
By Sunday, I sort of got the sense I was
annoying him.
Speaker 2 (21:42):
Julia keeps waiting for a call from her official doctor.
By Tuesday, she still hasn't heard from him.
Speaker 4 (21:48):
It was impossible for me to understand how he hadn't
called me by this point, But I called his office
on Tuesday, basically, you know, saying I need to talk
to you. I wrote, I wrote down what he said
and I've kept this note since that time. He said
he was not alarmed, but perplexed and surprised at my experience.
(22:15):
Those words, I guess ring pretty hollow now, right, knowing
that there was a pattern of of many women who
had extreme inexplicable pain after the.
Speaker 2 (22:31):
Egg retrieval, What did you make of that language? Like
at the in the moment, perplexed and surprised.
Speaker 15 (22:42):
It was, I mean, I guess uh.
Speaker 7 (22:53):
I.
Speaker 4 (22:55):
Felt crazy. I mean I felt I mean, you're by
this point, I'm asking myself like, am I being difficult?
Am I? I mean? Am I? I mean you you
just question your sense of self, like your your ability
to assess your situation rationally, which is very disconcerting when
(23:20):
that happens, because at least at the end of the
day you have that right you start thinking about your
whole life, right, like I'm a pretty high energy person,
like I take care of a toddler, I have a PhD,
I have a job, like I run marathons in my
free time, like I'm not, you know, like you have
(23:41):
all these parts of your life that make you feel
like that give you this sense of like who you are.
And then I just felt like like they were treating
me like I was like nuts, you know, for for
for still, you know, being in pain and just having
a what I would call a difficult time. You know,
(24:03):
I just left the office, I mean crying, you know,
I just felt like like nobody, nobody cares. That's the
way I would describe how I felt in the days after,
like nobody gives a crap that this was so.
Speaker 5 (24:24):
Hard for me.
Speaker 2 (24:28):
In the days after the retrieval, other patients live out
versions of the same story. They also call the clinic.
They ask is this normal? They say, the tail nyl
isn't helping. At home, They're laid up on the couch,
they can't pick up their toddler. They wonder if they
really should have scheduled themselves for a shift the next day.
(24:56):
Not all staffers at the clinic are dismissive, but even
and when they respond with concern, there aren't any real answers.
Some of these conversations take place days after the procedure,
like at follow ups to talk about next steps.
Speaker 8 (25:10):
You didn't really talk to the office until day five
or day six, which is when I found out that
none of the eggs had survived, none were healthy enough
to go to testing. And we had to talk about
moving forward, and that's when I really expressed my sort
(25:31):
of shock that the procedure was as painful as it was,
and talked about, you know, if there were other pain
management protocols that could be considered at that point.
Speaker 11 (25:45):
And.
Speaker 8 (25:48):
I was told and that, you know, that was the
best pain medication that was available, and my doctor prescribed
me an anxiety medication to take before the next procedure,
and I remember saying to my husband, you know, I
(26:09):
think it's strange because I'm not anxious about a medical procedure.
You know, it was the pain. It was severe pain,
not anxiety about going into it.
Speaker 13 (26:22):
The next time that I saw my doctor, he asked
me how the procedure went, and I said it was
really really painful, and he was kind of like a
little bit a little bit concerned, but then he just
didn't say anything after that. So I was like, Okay,
I guess. And this was my first time doing it,
so I didn't know any better. So I was like, oh, okay,
I guess it's supposed to be painful.
Speaker 2 (26:43):
Other women are talking about what happened with family and friends.
Speaker 9 (26:47):
So at that point I had talked to.
Speaker 10 (26:51):
A couple of family members who had done retrievals, and
I felt even worse. There's nothing like feeling shame from
like another female and unintentional too, you know, like that
just seems weird, because you know, I was wheeled back
(27:13):
there and joked with the staff and then fell asleep
and woke up and was fine. And that seemed to
be the general consensus between procedures at different clinics that.
Speaker 9 (27:26):
Oh, yeah, I was kind of alert, but I didn't
feel anything. It was really no big deal.
Speaker 10 (27:30):
Like the shots ahead of time were way worse than
the actual procedure.
Speaker 9 (27:35):
And I started shutting down after hearing.
Speaker 10 (27:38):
Those stories that this was on me, like I something
wasn't right with my tolerance and my ability to handle this.
Speaker 2 (27:55):
The women are already settling on their stories about what
happened to them immune to fentanyl. It's my fault. It's
supposed to be painful. The clinic tells patients that they
may experience mild discomfort, but now some of them have
recalibrated their expectations, including Lynn, who will have eight retrievals
(28:17):
at the clinic, all of them will cause her excruciating pain.
Speaker 8 (28:21):
You know, again, you hear about IVF and how tough
of a process it is mentally and physically, and you know,
I just thought, this is what I have to do,
This is what I have to do, and sort of
just thought, this is what women go through.
Speaker 2 (28:51):
Yale declined to offer information about how reports of pain
were addressed at the clinic or to answer any other questions.
Episode one of the Retrievals continues after the break of
(29:11):
the twelve patients I spoke to. Most are white. The
one black woman in the group was often the only
black woman in the clinic waiting room. Everyone in the
group identified as a woman. While couple of them were
pursuing pregnancy for the first time as they neared forty
most did not fit that stereotype. Most were married to men,
one to a woman. That patient would provide the eggs
(29:33):
and her wife would carry the pregnancy. Her wife presents
as more stereotypically masculine, doesn't wear women's clothing, and the
first family members were like, are you sure you want
to do it this way? Yes, they were sure. One
was doing this on her own at forty one, after
the end of a long relationship. Another left her boyfriend
part way through the process and then fell in love
(29:55):
with the new guy at the office. One was born
in Iran and came to the US as a roa refugee.
Another grew up in Jamaica. One had what she described
as a horrible childhood she essentially had to raise herself.
Speaker 5 (30:08):
Another longed to have.
Speaker 2 (30:09):
A second baby because she was so close to all
of her siblings. One had Type one diabetes and was
used to everyone always attributing all medical issues to, oh,
it's your diabetes. All of them worked a special ed teacher,
an accountant at a maritime firm, and a lecturer at
Yale in the Department of American Studies.
Speaker 5 (30:32):
Her name is Leah.
Speaker 2 (30:34):
Her scholarship encompasses a variety of subjects, exile and migration.
She's the patient who came to the US as a
refugee from Iran and gender. From the beginning of her treatment,
Leah located her experience within a context of assumptions about
women patients, that they are unreliable narrators of their own symptoms,
(30:55):
that they are anxious, exaggerating.
Speaker 14 (30:58):
But I remember the first time I wanted to get
ready for the ultrasound, there was blood on the floor
from a previous person's ultrasound, and I have to tell
you it was as ominous as signs fucking come. And
I just remember me and Navid was with me. I
think was Navid with me or oh no, he couldn't
(31:19):
go inside.
Speaker 12 (31:20):
He was waiting in the car. My husband was waiting
in the car. I was just shaking. I was like,
this isn't good. I mean it was.
Speaker 14 (31:28):
It was like you you walk in and I was like,
there's blood. You guys left blood over?
Speaker 12 (31:34):
What is going on here?
Speaker 2 (31:36):
Did you say anything to like, did you say that?
Speaker 12 (31:38):
But here's the thing, and this is where it begins, is.
Speaker 14 (31:42):
You are treated like a hysterical woman from the second
you walk in there, so you already know and like
as a you know, like a person who like I
study this stuff, I teach this stuff, and you're there
and you're like, oh, this is this is this is
actually what's happening right now. Here comes like Freud's patient,
(32:06):
the hysterical woman who's childless and angry and hormonal and
terrified and bitchy and mean, and that's how we're gonna
treat her.
Speaker 2 (32:19):
Hysteria comes from the Greek word for uterus. Ancient explanations
for it involved an empty uterus. A woman was hysterical
because her uterus was not full, unanchored, the uterus roved
through the body, which was what made women sick and crazy.
To fix hysteria, you really needed to fill that uterus up.
Speaker 12 (32:42):
Like so with the blood. I remember being like, there's
blood on the floor, you know, I was really upset,
and they're like, okay, okay, I mean, it's you.
Speaker 14 (32:49):
Know I I it turned right back on me, and
I remember one of the nurses was like, okay, well
you can calm down, you know. I was told to
calm down, and I mean, and then when they're doing
the ultrasounds of someone's doing a transvaginal ultrasound, so there's
literally like the stick that's inside of you and they're
moving it around and if you cringe, oh okay, it'll
(33:10):
just be like another It's just another second. It's just okay,
just be patient. So you're constantly over emphasizing or over
dramatizing what's happening.
Speaker 12 (33:22):
It's not that big of a deal.
Speaker 2 (33:24):
Leah felt like her doctor wasn't listening to her. She
also didn't trust her assigned nurse then kim Lea's first retrieval,
she felt her pain wasn't taken seriously by anyone, She says.
They all blew her off. Lea wasn't happy with her treatment,
but she decided to continue.
Speaker 12 (33:41):
Here I was I saw it, I felt it.
Speaker 14 (33:45):
I was alarmed by it, but I kept going because
I wanted to have a baby.
Speaker 2 (33:51):
Leah asked for a new doctor. He oversaw her next cycle,
and soon she went in for another retrieval.
Speaker 14 (33:59):
Right after you're in that room, the ANSCC others came
up to me and she said, you know what, you.
Speaker 12 (34:06):
Were waking up. You were waking up. We had to
give you some more meds. You know, you were waking up.
Speaker 14 (34:13):
So again you your body, you were nervous, you were agitated,
You burdened us, your kind of uncontrollable body put us
in a position where we actually had to give you
more drugs.
Speaker 12 (34:27):
You you were waking up, so we had to give
you more fentyl.
Speaker 14 (34:32):
And I was like, oh, but again to them, to them,
I'm this woman who's already like on edge. I already
left the doctor because I didn't like the doctor. So
the other physicians and the other nurses all know this
about me. I'm a kind of already unruly, perhaps entitled,
(34:57):
overly kind of knee woman who is just really angry
that she doesn't have a baby.
Speaker 2 (35:07):
There's a balance you have to strike as a woman patient.
You have to complain just the right amount to be
taken seriously, but not so much that you seem shrill. Still,
your pain is more likely to be underestimated than men's.
Black women are more likely to have their pain ignored
no matter what they do. All of this we know
(35:27):
from the literature and also from life. In my life,
I've been the kind of patient where if I've ever
spoken up, I felt like I need to be obsequious
later to protect myself. That is what I felt I
needed to perform. Leah knew she'd need to perform a
whole range of things in order to get help. Stern, docile, smart, stupid, agreeable,
(35:51):
and now on ajourney in the recovery room, Leah became
an observer. She would remember what was happening. She would
write about this.
Speaker 5 (35:59):
One day.
Speaker 2 (36:01):
She tuned into the language and too the emphasis that
to her seemed so interesting and fucked up into the
syntax that seemed to place the blame on her body.
But at the same time, Leah had also internalized the
narrative that her body was to blame. Her body was inadequate, deficient,
that was why she was here. Her body had had miscarriages,
(36:22):
her body didn't make enough eggs. Her body couldn't cooperate
long enough to get through a critical procedure.
Speaker 12 (36:28):
Oh God, my body, like here it goes again.
Speaker 14 (36:32):
Not only can I not like have a baby, I
also can't even just lay still with the right amount
of fatanel.
Speaker 2 (36:42):
In this moment and throughout her treatment, Leah was simultaneously
the writer saying, I can name what's happening here, and
the patient sang, how could I have let this happen?
Other women occupied their own versions of this position. Their
professional identities offered them one kind of story about these events.
(37:04):
Their identities as patients directed them to another. Several of
them had an area of expertise that was directly applicable
here in a way that is kind of uncanny. For example,
there are multiple patients who work in healthcare, including one
who's designed systems for the safe storage of medications. There's
a nurse anesthetist. She thought the anesthesia was the one
(37:28):
part of fertility treatment she wouldn't have to worry about,
and of course, there's the addiction researcher Katie, who had
the prophetic fantasy. What's unique about you is that not
only did you know something was wrong, you knew exactly
what was wrong I did. Yet still you constructed like
(37:50):
this other narrative to explain it. Yes, like other patients,
Katie had expertise that gave her knowledge, but she and
others pushed that knowledge aside. They decided not to know
what they knew in order to keep going. I wanted
Katie to lay out the path to that cognitive dissonance.
I wanted her to explain exactly how she got from
(38:12):
one story to the other.
Speaker 7 (38:14):
I mean, you know, as I've told you, like I
came out of that procedure, and I immediately I remember
immediately texting my friends who are also colleagues and addiction
research at Yale. Like the nurses stealing the fentanel. It
seemed it just seemed so obvious. But then, you know,
then you you sort of come out of the sh
I remember just coming out of the shock and recovering
(38:35):
from the procedure, and things just go on.
Speaker 9 (38:37):
You know.
Speaker 7 (38:38):
I no one is addressing the fact that I was
sober during the procedure, and I remember violently shaking in
recovery from like the shock. I don't know that that's
related to having the procedure with or without fentanel, but
that's how my body responded. And my nurse was there,
(39:00):
and I remember her saying, I think something like, I
think it's I think it was so painful because we
got so many eggs and so it's just sort of
this like positive, kind of false narrative about what had happened.
And so then, you know, I think I coped by
coming up with an alternate explanation, which was that I
(39:21):
do remember waking up during my having my wisdom teeth
being pulled when I was a kid, to the nurse
saying shit, shit, and then you know, giving me more drugs,
putting me back under. So, you know, the other explanation
for me was that maybe I'm not sensitive to certain opiates,
you know, And I remember also that kind of became
my narrative with you know, my friends and colleagues kind
(39:42):
of remember me sort of switching to that narrative and
saying like, well, maybe you're you're not sensitive defentanel. So
I started to kind of tell, just tell, myself, a
story about my pain, just try to understand, you know.
It's a way of just understanding my experience and thinking, yeah,
maybe this is what happened.
Speaker 2 (40:07):
The story becomes away not only to explain pain, but
to cope with it, a way to not only make
sense of the pain, but to manage it, to tamp
it down, get through it. And this way the story
becomes the medicine that the patients weren't given. The women
(40:32):
gear up for second third retrievals. They change their diets,
they cut chemicals out of their home, They read the
books the nurses recommend, or they get ready for embryo transfers.
They make reservations at a hotel in town so that
they won't have to drive home over a bumpy road.
Despite these efforts, some of the women miscarry. One woman
(40:54):
wakes up about ten days after her embryo transfer with
some spotting. Don't think anything of that yet, a nurse
reassures her, But the pregnancy test comes back negative. When
do you think you might want to get started again,
her doctor asks her at a virtual follow up appointment.
I am not ready, the patient says. She closes the
(41:16):
telehealth and that's the last time she talks to the doctor.
She never goes back to that clinic. She stops fertility
treatment and doesn't know when or if she will ever
resume it. She never wants to go through an egg
retrieval again. Fertility treatment doesn't always result in a baby.
(41:45):
It's not just giving yourself shots that's hard. It's the
cycle of hope and loss. It just clambers you, and
the longer you stay in it, the more the drugs
mess with your head. It's called the clomid crazies for
a reason. In one of the women tells me, and
the money always the money. If your insurance covers this,
(42:06):
it probably only covers a few cycles. There's so much
pressure on each one. Once you have to pay out
of pocket. You're talking maybe fifteen K for one cycle,
and that's the low end. Some of the women are
keeping their treatment secret. One of them can't even tell
her own mother.
Speaker 4 (42:25):
It's hard.
Speaker 2 (42:26):
It's hard to begin with, even without this extra larra
that's been added on to this. Now, the pain and
the fear of more of it.
Speaker 6 (42:35):
The first time I went in clueless, thinking you're not
going to feel a thing. So I think the second
time I had a lot more anxiety.
Speaker 2 (42:44):
Laura doesn't get as many eggs as she hoped for
the first time around. It's urgent that she start cancer
treatment and the doctors accelerate her cycle. Her second retrieval
is scheduled for barely more than two weeks after her first.
That morning, his mother drives her to the clinic and
sits in the waiting room while Laura goes back for
the procedure.
Speaker 5 (43:05):
And I was shocked. I was shocked again that it
was the same situation.
Speaker 6 (43:09):
I'm thrusting my hips and telling me like, why do
we speaking to them? And I was just like, I
feel everything you're doing. And that was when I did.
I remember actually saying to them, I could drive myself
home right now.
Speaker 5 (43:20):
I'm that alert.
Speaker 2 (43:22):
In the recovery room, Laura gets her phone back and
just like last time, texts her sister in law. Then
she sees her mom. She tells them both how much
pain she's in.
Speaker 6 (43:32):
So my sister in law right away was like, oh
my god, I cannot believe you thought that again.
Speaker 4 (43:35):
But my mom, you know, she just felt she it
was it's hard.
Speaker 11 (43:39):
Because you know, she had seen me go through so
much as it was with the cancer, you know, any
mother who who has to live watching their daughter go
through that, and then for me to tell her, you know.
Speaker 5 (43:51):
This was supposed to be a special moment because.
Speaker 11 (43:53):
We're preserving my fertility and I'm sorry, and Ford like
see that it hurts her.
Speaker 5 (44:02):
To see me in pain, you.
Speaker 6 (44:04):
Know, you know, and I was just like, well, thank God,
I think this was the last time I had to
do that.
Speaker 3 (44:12):
You know.
Speaker 5 (44:13):
Yeah, So.
Speaker 2 (44:15):
What did the two of you do, like the rest
of that day? Did she drive you home?
Speaker 16 (44:20):
Yeah, she drove me home, and she stayed with me
because she had already been staying with me a lot,
you know during the day, you know, after my surgeries
because I couldn't even at that point, I still wasn't
allowed to lift more than five pounds, so because I
was still recovering.
Speaker 5 (44:37):
From the other surgeries.
Speaker 4 (44:38):
So yeah, she was with me and.
Speaker 5 (44:41):
You know, maybe lunch and comforted me and just you know,
we were.
Speaker 6 (44:44):
Like, okay, so now we just go back to waiting
and you know, hoping we get a good number, and
you know, I just moved on from it because I
faced many more surgeries that year as well, so you know,
I kind of had to just switch back into you know,
survival mode, like, okay, but now we just battle the
next thing.
Speaker 2 (45:03):
So in the other surgeries you had, like cancer related surgeries, like,
what were your experiences of pain?
Speaker 6 (45:13):
Like, it's actually interesting that you bring that up because
when I did have my double mes ectomy, I was hospitalized.
I think I was in for a day or two days,
and strangely enough, the nurse, the night nurse, forgot to
give me morphine. So I actually was awakened in pain
the entire night. And I have gluten allergy, so they
(45:35):
couldn't feed me anything because the kitchen was closed. So
I spent the entire night like vomiting because they couldn't.
They were gift trying to give you like percocets or something,
and so I know what pain feels like.
Speaker 5 (45:46):
I've you know, I've whatever.
Speaker 6 (45:47):
And the next morning the doctor goes, I don't understand
why she didn't give it to you.
Speaker 5 (45:51):
It was in the order and I had a really
young nurse. Whatever. This is completely unrelated.
Speaker 6 (45:55):
To that, but you know, I know what pain feels like,
I've been through it.
Speaker 5 (46:00):
And then when I was hospitalized at Christmas.
Speaker 6 (46:03):
That's funny that like that you bring that up because
my sister in law actually had pointed out. She goes,
do you remember when you kept telling me you were
immune to fentanyl? She goes, when I did a search
on my phone, I guess you can. She's really savvy.
You can type in like fentanyl in text messages and
it'll bring up every conversation.
Speaker 5 (46:21):
She goes, I.
Speaker 6 (46:22):
Actually found one from when you were hospitalized at Christmas
saying that you were on fentanyl. And I guess she
had sent me a picture of her Christmas tree and
I had made a comment like, oh my god, did
your house burn down? And she was just like and
she was like, what are you talking about?
Speaker 5 (46:37):
And I said, I don't know.
Speaker 6 (46:38):
The nurse just gave me fentanyl, and so she goes, look, Laura,
so it does work on you, like oh wow, you know,
and this was a month prior and I did that
didn't even dawn on me, like, oh my god.
Speaker 5 (46:49):
So yeah, but when it came time for the other.
Speaker 6 (46:52):
Thing, I was just like, oh, it must not work
on me, because you know, I just felt like nobody
had heard what I was saying, so it just didn't exist.
It was in my head, you know. So yeah, so
I don't know. I was I foolish because I didn't
like dispute it more. Maybe not, I don't know, but
like I just I believe them.
Speaker 4 (47:12):
You trust them.
Speaker 2 (47:18):
Months pass, some of the women get pregnant, others are
still trying. Some of them are still showing up at
that clinic for blood draws when they open their mailboxes
in December twenty twenty.
Speaker 4 (47:32):
Christmas was on a Friday of twenty twenty, and the
mail arrived on Thursday. It was Christmas Eve, and I
was busy and I just thought, I'm just not I'm
not going to go get the mail today. And I
waited until Monday the twenty eighth, and you know, it
(47:55):
was a nice day. I went outside, I got the mail,
and you know, I got this letter.
Speaker 9 (48:01):
So I got this letter in the mail. It's nothing fancy.
It's Yale envelope. I'm assuming it's a bill. Bill's never
stopped coming with IVF.
Speaker 12 (48:13):
You get so much when you work at Yale.
Speaker 14 (48:15):
Also, you just get like Yale emblazoned mail, and so
you're like, oh, okay whatever.
Speaker 12 (48:22):
It was like this thin thing.
Speaker 14 (48:23):
And I was like, oh they you know, change locations
or something.
Speaker 12 (48:27):
It's like this is not important.
Speaker 9 (48:32):
And instead of just setting it aside.
Speaker 10 (48:34):
I happened to open it and I was.
Speaker 7 (48:39):
Furious, and it says, Dear Kathleen Garrison, I'm writing you.
I'm writing to you in my role as director of
Yale Reproductive Ender, Chronology and Infertility, to let you know
that we have learned of an event that may have
involved your care.
Speaker 4 (48:52):
You know that they've become aware that the nurse was
switching out the sentinel with the saline.
Speaker 7 (49:00):
A few weeks ago, we learned that on multiple occasions,
a Yale Fertility Center nurse replaced fentanel a routinely used
narcotic medication with a normal salt solution saline in some
medication files. As a result, some patients may have received
saline instead of the intended narcotic medication during their procedures.
(49:21):
While there's no reason to believe that this event has
had any negative effect on your health or the outcome
of the care that you received, we believe that you
should be informed.
Speaker 10 (49:31):
They make this stupid comment in the letter that there
was no harm done from this happening, and I I
don't know if Hall was home or I called her,
and I was like, bullshit, no harm done.
Speaker 8 (49:50):
Don't send me a letter and tell me that we're confident.
No one's you know, outcomes were affected by this. I
know my outcomes were affected by this, so I know
what I experienced and went through.
Speaker 10 (50:03):
But Yale wasn't going to help me. They didn't think
there was harm. They didn't think it was a problem.
You know that it was the most honestly, I think
it was one of the most disrespectful ways. They probably
could have notified any of us that it had happened,
that you know, oh, we had this little breach and
you're fine, No, biggie, go about your day.
Speaker 2 (50:25):
Yeah.
Speaker 8 (50:25):
Again, no one reached out to talk with us or
to see what we experienced as patience. My only communication
about it was through the letter, and that's still to
this day.
Speaker 2 (50:40):
And yet, in addition to fury, there's also vindication. When
they learned the news. However they learn it, the women
text their twin sister, or run inside to their husband,
or weep in their kitchen.
Speaker 5 (50:53):
It was mind blowing.
Speaker 6 (50:55):
I immediately called my mother. I immediately called my sister
in and I'm like, ugh, like no something. It just
hit like it all makes sense now.
Speaker 8 (51:03):
And it was like, okay, it all makes sense. It
was almost a relief, a relief to know, like, you know,
I'm not crazy, there's nothing wrong with my body.
Speaker 5 (51:15):
I don't have something like.
Speaker 8 (51:17):
Locking opioids or you know where you know my body
is wrong and doesn't react to medicine.
Speaker 6 (51:25):
But it also shows how much they ignored my pleas
for help and like saying like like nobody believed me.
Speaker 5 (51:35):
And so in a sense it.
Speaker 6 (51:38):
Was like relief, you know, just knowing that what I
felt was real.
Speaker 2 (51:45):
But there's more, the letter continues.
Speaker 7 (51:49):
The law enforcement investigation and our own review have found
no reason to believe that you were exposed to an
infection due to this event. Even so, we can appreciate
that you may want further reas insurance, and if you wish,
we will arrange for you to be tested for a
group of blood born infections at no charge.
Speaker 5 (52:06):
And I was like, what the fuck?
Speaker 4 (52:14):
You know, those words not alarmed, but perplexed and surprised
came back to me, right, And you just feel like
so completely let down by this institution that's supposed to
make you feel safe and I mean, I mean keep
you safe, right, an institution that's supposed to keep you safe. Right,
(52:36):
that was gone.
Speaker 2 (52:40):
But maybe the most remarkable thing about the letter is
the way it addresses pain. It seems to be saying
you did not feel what you felt.
Speaker 7 (52:50):
I also want to assure you that the fertility center
routinely uses a combination of pain medications during procedures. We
closely monitor patients for signs of discomfort every procedure and
adjust medications or add medications as needed. In this way,
we can be confident that our patients stay comfortable even
if one medication is not working well. I don't believe
(53:12):
that accurately describes my experience. And then it goes on
to say, if you have any questions or want a
blood tests, you know.
Speaker 5 (53:19):
Here's what you can call.
Speaker 2 (53:22):
The women put the letter on the counter and shock.
For months, they've been constructing their own stories about what
happened to them. Now they have Yale's story, which is
that this is barely a story at all. The questions
the patients have been asking all along have a new focus.
Speaker 8 (53:39):
You know, as soon as I received that letter, it's like,
how does this happen? You know?
Speaker 5 (53:45):
And how does it happen at Yale?
Speaker 8 (53:47):
You know, a hospital system with such a great reputation,
and how did it happen for so long. So many
things had to go wrong, you know, for this to
happen as long as it did.
Speaker 10 (54:03):
How does an entire facility let this happen?
Speaker 9 (54:08):
Who trained them? Who thought that this was okay?
Speaker 10 (54:12):
I get sent home with you know, I get packages
in the mail with sharp needle containers and strict instructions
and alcohol swabs and this crazy protocol that I'm expected
to do at home.
Speaker 9 (54:25):
They make you double check things, you know, are there
puncture marks? And I'm like, did I.
Speaker 10 (54:31):
Really spend more time following directions at home for hormone shots?
Speaker 9 (54:37):
Like where were they?
Speaker 7 (54:40):
I think my immediate reaction was, you know what, how
could this happen?
Speaker 11 (54:43):
At yeale?
Speaker 7 (54:44):
Like why wasn't there a better system in place to
prevent it or detect it when it was happening? And respond,
you know, why why wasn't our pain?
Speaker 12 (54:51):
Listened to.
Speaker 2 (54:53):
The women wonder about the system that failed them, But
there's something very intimate and human that they are wondering
about too.
Speaker 5 (55:01):
We were notified that it was a nurse.
Speaker 8 (55:03):
We didn't have the name of the nurse in that
original letter, and so it's sort of you know, racing
through your mind, like, well, which nurse because you build
such a strong relationship with these people, and you see
them so often and you trust them and you know,
build a relationship, and so you're thinking like, well, which
(55:25):
nurse could.
Speaker 5 (55:25):
This have been?
Speaker 8 (55:26):
And then you're you're showing up, you know, and Okay,
who's not here anymore?
Speaker 12 (55:31):
Who's gone?
Speaker 5 (55:31):
And just trying to figure out.
Speaker 9 (55:35):
Who it was.
Speaker 2 (55:40):
The patients know what happened. They're about to find out
who did it. That's next.
Speaker 1 (55:55):
That was episode one of The Retrievals. You can listen
to the whole series on Spot or wherever you get
your podcasts, and we'll be back with a new episode
of Heavyweight next week.
Speaker 2 (56:26):
The Retrievals is produced by me and Laura Starceski. Laura
edited the series with editing and producing help from Julie Snyder,
Additional editing by Micky Meek, Katie Mingle and Ira Glass.
Research in fact checking by Ben Fhalen and Caitlin Love.
Music supervision, sound design and mixing by Phoebe Wang, with
production help from Michelle Navarro. Original music by Kala Palone
(56:50):
and music mixing by Toma Poulin. Indechubu is a supervising
producer for serial productions at the New York Times Our
Standards editor Susan Westling. Legal review by Dana Greene, Art
direction from Pablo del Coon, producing help from Jeffrey Miranda
Kelly doe Bernon Borelli, Desiree Eboquois and Anisha Money.
Speaker 4 (57:11):
Sam Dolmick is the Assistant Managing Editor.
Speaker 2 (57:14):
Special thanks to doctor Marcel Cedars, Calvin Hawker, Lisa Schumann,
Kylie Silver, and doctor Maggie Smith. The Retrievals is a
production of Serial Productions and The New York Times
Hi Heavyweight listeners. While the team is busy working on
next week special episode, we don't want you flipping podcast stations,
so we're bringing you something from our friends at Cereal
and The New York Times. It's an episode from the
podcast The Retrievals that we've been eager to share. It's
about these women who went to the Yale Fertility Center
for a procedure called an egg retrieval. For months, patient
(00:22):
after patient complained that they were experiencing excruciating pain during
the procedure, like the anesthesia they were given didn't work
at all, But time after time, these women were essentially
brushed off until finally everyone found out what was really
going on. It's a gripping story that goes to places
you completely will not expect, places that are both deeply
(00:43):
personal and also point to larger structural failures in the
world of healthcare. Susan Burton, the reporter of the story,
does an incredible job delicately guiding you through shifting sympathies
and the complexities of the case. We've got episode one
for you, but I'm sure, like me, you're going to
want to tear through the entire set series. The Retrievals
Episode one coming up right after the break.
Speaker 2 (01:06):
The women are seeking fertility treatment for a variety of reasons.
They've had a couple of miscarriages and they're pushing forty,
they don't have fallopian tubes, or they need sperm. One
woman has a diagnosis that's like a metaphor from feminist
sci fi, a uterus with a single horn like a unicorn.
All of them wind up at the fertility clinic at
(01:27):
Yale University. A couple of the women choose this clinic
because they work at Yale, and that's what the Yale
health plan covers. Others go to Yale and the recommendation
of their doctors. But in Connecticut, you don't even really
need the recommendation. Yale Medicine it's a blue chip medical brand.
Speaker 3 (01:45):
You know, Yale's just a huge name, and you just
think anything that has anything to do with Yale is
going to be, you know, the best of the best.
Speaker 4 (01:52):
It's really not close to our house. It's not where
I would have gone, but we figured, you know, another
doctor from another hospital said this is the best you
can get, and you want, of course, you want that.
Speaker 5 (02:06):
To some of the women.
Speaker 2 (02:07):
The clinic seems to live up to its billing. They
like their doctors feel cared for by them. That man
is an angel, one of the women tells me. He
is by far the best doctor I've ever had. Others
are not happy at the clinic from the start. It's
things like feeling like a number, or issues with communication.
There's a lot to communicate. You don't know how hard
(02:29):
fertility treatment is until you get into it, and once
you start it in one place, it can be difficult
to go somewhere else. So they talk themselves into staying.
That's the first thing they go against their instincts and
talk themselves into. The women drive to the clinic before
(02:52):
work in the morning for blood draws, and then wait
for the afternoon email from their nurse team. You really
have to trust your nurse team, the women tells me.
At this point she did. The nurse team gives instructions
and the women give themselves shots. These shots contain hormones
to stimulate the body to produce eggs. A side effect
(03:13):
is emotional volatility. The wind is making me cry, one
of the women says. But the thing is you have
to stay calm, don't get stressed. It's so stressful. Trying
not to get stressed. One woman uses a fertility meditation
app called Expectful. She does her guided meditation on the beach.
(03:35):
The app plays the sound of waves while the real
waves heave in the background. It's absurd, but so much
of this is absurd, including the money. There's all kinds
of stuff that's not covered no matter what insurance you have. Meanwhile,
your ovaries enlarge and you get so bloated that your
abdomen feels like bricks. And then finally you get to
the day you've been waiting for, the day of the
(03:57):
first egg retrieval, which is what it sounds like. The
eggs are removed from the body and then fertilized or frozen,
depending on what you're doing. How many eggs am I
going to get? That is the big question. The more
eggs you get, the better your chance of a healthy embryo,
a viable pregnancy, a child. The day of the retrieval,
(04:21):
the women arrive at the clinic. They check in on
different mornings in different months and calendar years. None of
them are here on the same day, but they will
come out of the day with the same story. Laura
arrives for her retrieval on a weekday morning in January
twenty twenty. She checks in and changes into a gown.
(04:41):
Two months ago, Laura was diagnosed with breast cancer, a
double mestectomy followed, then an infection and additional surgeries. As
soon as she freezes her eggs, she's going to start treatment.
It's a lot. Laura is trying to put all of
that to the side and just focus on the procedure ahead.
Speaker 6 (05:00):
I was excited, like, you know, trying to stay positive
and just and I was just like, having been through
so much just the month prior, I was like, this
is going to be easy because I had been through
so many surgeries and procedures. I was just like, you know,
it's I know what this is like. I know what
it's like to be under anesthesia or something and given
medication so you don't feel things.
Speaker 2 (05:22):
The egg retrieval is a surgical procedure. A long needle
is inserted into the vagina, then pierced through the vaginal
wall and up into the ovary. Laura has been told
in advance what drugs she will be getting during the procedure.
Speaker 6 (05:35):
Two drugs, fentanyl and another one my dalozam or is
a lamb, and I believe that one's to induce sleepiness.
Speaker 2 (05:42):
Together, these two drugs offer what's often called moderate sedation. Basically,
the fentanyl takes away pain and the medazolam relaxes you.
Some people get drowsy with this combination, others remain alert.
The use of fentanyl surprises some of the women. One
of them, Defender, has seen a lot of clients messed
up by fentanyl, and for a second she's worried. Another woman, Katie,
(06:07):
a neuroscientist at Yale, feels a spark of interest.
Speaker 7 (06:11):
And in fact, you know, just being someone who studies
addiction and studies some opioid use disorder and as a
curious person. I remember the morning of thinking like, okay,
this will be interesting. I've never tried ventanyl before, and
so I expected to go in and have twilight anesthesia,
you know, not full anesthesia, but not feel anything.
Speaker 2 (06:30):
The women complete the last steps before the procedure, get
an IVY, go over some papers, if their partners came
back with them. Now their partners say goodbye, and then
it is time the women tell what happens next.
Speaker 6 (06:46):
I walked myself into the procedure room because you get
rolled out afterwards. But you don't have any medication in you.
You're just kind of hooked up to the ivy poll.
And I walked into there and you you know, you
get into the on the chair or table, whatever they
call it, and that's from there. They said you're not
going to feel anything, and they couldn't, you know, they
explained everything that was going to happen.
Speaker 8 (07:06):
They started the procedure, and you know, I was just
sort of taken by surprise, not expecting the excruciating pain
and just letting them know that, you know, I don't
think the pain medication is doing anything. You know, I
can it really feels like you're stabbing the needle.
Speaker 9 (07:30):
I felt everything. It's literally your most intimate parts of
your body.
Speaker 10 (07:38):
They're using these long needles, and there's also a screen
so I can watch what they're doing, and I couldn't.
I had to try and look away because literally each
needle appears you feel.
Speaker 8 (07:50):
As we were moving along, it was my blood pressure
started going up. I was sweating profusely and telling them,
you know, I was just in and too much pain
that they had to stop. At that point, I remember
them giving me more of the pain medication and me
saying it's not making you know, it's not making a difference,
(08:13):
you know, a nurse coming over and putting a wet
towel on my head, and another nurse holding my hand
and them comforting me and saying, you know, you're going
to be okay.
Speaker 9 (08:24):
The nurse who.
Speaker 10 (08:26):
She was at the top of my body, kind of
at my shoulders, wiping the tears away and helping me
kind of hold my breath to keep myself still so
that the doctors didn't slip with the needle, and just
telling me that I was going to be okay, that
I was going to get through it. And up until
(08:49):
that moment, I'm so excited, like, oh I have twenty
four follicles, like this is great, Like I'm going to
have a great egg retrieval.
Speaker 9 (08:55):
And then you're like, oh my god, I wish there
was only one.
Speaker 10 (08:58):
Like everything was counting on that retrieval and that and
that's how it feels like the whole the way of
you know, your world, my partner and I she's counting
on me to be able to get through this and
to have.
Speaker 9 (09:13):
This successful retrieval, and all I'm feeling is, oh my god,
I needed to stop.
Speaker 8 (09:19):
Is this worth it, and you know you your feet
are in the stirrups and you know you should just
be laying on the table. But I remember tightening up
and just trying to relax my body so that they
could do what they needed to do because I was
so tense that like my bottom was almost off of
(09:40):
the table.
Speaker 6 (09:41):
I remember like thrusting my hips up, actually thrusting my
hips up, saying I feel everything like and like nobody
believed me, and.
Speaker 5 (09:52):
It's just like I don't know, but what are you
gonna do? You know, I wanted the procedure done. I
just let it happen. And I was like, I'm awake.
Speaker 11 (10:02):
So.
Speaker 7 (10:07):
No, you know, I was stone cold, sober and awake.
And I remember I the egg retrieval. You know, they
kind of do them one by one or like a
couple at a time, you know my impression, And so
you have moments in between pain to say, like what
the fuck is going on?
Speaker 6 (10:23):
I do remember I think I swore I was using
curse words because it was just so painful.
Speaker 8 (10:30):
You know, I don't I don't know if I can
do this any longer.
Speaker 5 (10:34):
You know, you just have to get through it. It's
going to be over before you know it. Okay, this
is going to be over eventually.
Speaker 12 (10:38):
You can do this.
Speaker 5 (10:39):
You can do this.
Speaker 9 (10:40):
Blant this moment over, get through it, gets through it.
Speaker 7 (10:47):
I remember yelling or kind of making like ah and
really like looking in confusion at my nurse, the attending nurse,
and her saying, you know, I'm giving you the most
I can legally give you.
Speaker 13 (10:59):
She said that that's the maximum that she's allowed to
give me, so she couldn't give me anything else.
Speaker 8 (11:04):
I'm almost certain that at one point they said that
they had given me all of the pain medication that
they could give me.
Speaker 10 (11:10):
At one point they did say that I had maxed out.
I couldn't have any more fat dollar versa.
Speaker 9 (11:14):
And I was like, how is this possible?
Speaker 5 (11:17):
Why is that? Even? Like how am I feeling?
Speaker 9 (11:19):
How do people go through this?
Speaker 6 (11:20):
I can feel that, like I could feel the I
don't even know how to describe that, Like you can
just feel them inside of their you know, as a woman,
we've all been through things, you know, with those kind
of doctors and stuff, But like, this is just a pain.
Speaker 5 (11:34):
It's like hard to even explain what it felt like.
Speaker 2 (11:41):
It's this is hard to do, but could you describe
the pain that you felt.
Speaker 7 (11:47):
Oh gosh, it felt like someone was like ripping something
from the inside.
Speaker 5 (11:58):
Of your body. Yeah, which is what they were doing.
Speaker 12 (12:02):
Yeah, that's what it felt like.
Speaker 2 (12:05):
Yeah, yeah, I'm sorry.
Speaker 7 (12:09):
But I remember almost immediately thinking or almost daydreaming in
that moment that like, the attending nurse had one tube
going from my ivy into my arm and another tube
going from my ivy into her pocket. Like it occurred
to me almost immediately that the nurse was stilling the sentinel.
(12:31):
And I remember telling my friends, you know, after the procedure,
my friends who were aware of what I was going
through but who are also colleagues at Yale in addiction research.
I remember telling them, like, the nurse is stealing the fentanyl,
because it seems so obvious to me. I'm infental is
the most diverted drug in medical settings. It's like a
now major driver of the opioid crisis, and it was
(12:51):
just really easy to imagine that someone with access to,
you know, poorly controlled ventanel would be abusing it.
Speaker 2 (13:01):
That's so fascinating that that's the image that raised itself
up for you, because it is so evocative, Because it
is so evocative for example, and also because it was
true a nurse at the clinic was stealing fentanyl. Not
Katie's nurse, not the tube in the pocket, but a
nurse at the clinic was stealing fentanyl and replacing it
(13:23):
with saline. She did so undetected for months, which meant
patients weren't getting ventanyl in their ivs. They were getting
salt water instead.
Speaker 3 (13:33):
Drug addicted former nurse is sentenced for a crime that
caused unbearable pain to dozens of women. The nurse stole
drugs and then replaced them with saline solutions.
Speaker 5 (13:43):
Kind of A nurse.
Speaker 3 (13:44):
Admits that she swapped out anesthesia drugs for salt water,
causing excruciating pain to women during infertility treatments.
Speaker 1 (13:52):
It happened at a top rated ceter of affiliation.
Speaker 4 (13:54):
With a horrible story about the extremes a fertility nurse
struggling with drug addiction took to get.
Speaker 2 (13:59):
Her in a newly file. A federal investigation determined that
as many as two hundred patients may have been victims
of this substitution over five months in twenty twenty. Lawyers
for some of the patients believe the real number is higher,
and this went on for longer. I've talked to a
dozen patients who believe they were victims of this. Eleven
(14:21):
of them are plaintiffs in a lawsuit against Yale, and
their lawyers were present when we spoke. When I started
doing these interviews, I was struck by the echoes in
these women's stories. To me, it sounded like a chorus
of women saying something is wrong here, again and again.
The patients wondered how the clinic could have failed to
(14:42):
detect this, and the conversations I was having made me
wonder that too. And then I began talking to other people,
staffers who'd been there, and I learned about what went
on behind the scenes. The staffers I spoke to were
horrified by what the patients had experienced. They were grappling
with their own questions about how this had happened, about
(15:03):
what had gone amiss. The patients didn't know why they
were in pain, their doctors didn't know either, and in
the absence of information about the true cause of the pain,
people came up with stories to explain it. The patients
constructed stories about why they felt pain. Staffers at the
clinic came up with theories too. Eventually, the nurse would
(15:27):
tell her own story about the pain, which would launch
a whole new set of stories, the ones her friends
and family would come up with, the one that would
get argued in court, the one Yale would tell. And
all of these stories revealed something about women's pain, how
it's tolerated, interpreted, accounted for, or minimized. In fertility treatment,
(15:55):
you evaluate the outcomes by whether you wind up with
a baby trick by which success is measured It all
went well if you leave with a live birth. The
outcomes here are a lot more complicated for everyone from
Serial Productions and The New York Times. I'm Susan Burton
(16:15):
and this is the Retrievals. This is episode one, the Patience.
(16:41):
When the retrieval is over, the women are wheeled out
to the recovery room, and one of the first things
that happens is that they try to come up with
an explanation for their pain.
Speaker 6 (16:51):
They put you into the recovery room and that's where
you meet with whoever you were with. And I just
remember that's when I had my phone back and I
was texting my sister in law because she was my
confidant for all of this.
Speaker 5 (17:01):
Having been through that and she was.
Speaker 6 (17:04):
Just replying like, oh my god, how could you What
do you mean you felt everything? And I'm like and
I was just like, you know, just explaining to her.
I'm like, I don't know what's wrong, like so and
I even one of the texts I said, I said,
I think I'm immune defentanyl, because like I was like,
I don't think it works on me.
Speaker 2 (17:22):
I'm not sensitive. Defentanyl is a common theory.
Speaker 8 (17:26):
And I remember when their procedure was done, you know,
my family sort of, you know, we have a family
text that's ongoing, and I just remember texting them that,
you know, it's hard to believe that we have a
fentanyl epidemic where people are addicted, because it did nothing
(17:46):
for me.
Speaker 2 (17:49):
Not all of the women were alert during their procedures.
Some were more deeply sedated. They were so out of
it during the retrieval that they don't really remember it
or only kind of the pain hits when they come to.
Speaker 14 (18:03):
It was bad instantly, and it shouldn't really be bad instantly,
like you shouldn't wake up and being like.
Speaker 12 (18:08):
Horrific, like nightmarish pain.
Speaker 14 (18:12):
But I woke up and I was, I mean, like
it felt like someone had been inside me.
Speaker 12 (18:17):
And like gutted me. Yeah, if it was like a.
Speaker 14 (18:20):
Gutted feeling, it was like someone had been inside me,
scraped me hollow.
Speaker 12 (18:23):
It was burning.
Speaker 2 (18:26):
In a way. It is more confusing for the wake
up later patients. They're not matching each stab of pain
to the needle on the screen. It hurts a lot,
but it's less explicable and because of that scarier.
Speaker 7 (18:40):
You know, your mind just goes to the worst possible places.
Speaker 5 (18:43):
You know, I'm thinking, is am I bleeding?
Speaker 3 (18:47):
You know?
Speaker 5 (18:47):
And am I bleeding? Internally? Is like a pain is
normally a pain is a sign? Is protective?
Speaker 11 (18:54):
Right?
Speaker 5 (18:54):
It tells you something's wrong.
Speaker 2 (18:56):
There's a lot of uncertainty in the recovery room and
elevated blood pressure, a nurse running around to get ginger ale,
a doctor coming by to say there are fewer eggs
than we expected. Are you sure you only want us
to fertilize half of them. It's all just very overwhelming,
and on top of it, some of the women feel
like they're being rushed out of the clinic. Julia is
(19:16):
one of them.
Speaker 4 (19:18):
I remember vomiting. They were giving me some fluids.
Speaker 2 (19:22):
I was.
Speaker 4 (19:25):
Very uncomfortable. There was no way I could walk. They
put me in a wheelchair and wheeled me out, and
I just I just had this feeling like this is
not this is not right.
Speaker 2 (19:39):
Julia is thirty one years old and already a college professor.
This morning, when her husband drove to the clinic, she'd
been frantic there was work on a bridge near their
house and they got stuck. There's only a short window
to retrieve the eggs before you ovulate them, and Julia
was worried she would miss it. When she arrived at
the clinic, she felt a huge relief, like we made
(20:02):
it both, we made it on time, and we made
it to this day. Now she's feeling something she never expected.
At home, she goes upstairs and gets into bed.
Speaker 4 (20:14):
I fell asleep for a little while, and then I
woke up, and I was nervous. We had a babysitter
here watching my daughter, and I just you know, you
wake up, You're like, oh my god, who's with my kid?
I need to And I walked a few steps to
(20:35):
try and go down the stairs, and I realized I
really had gone too far from the bed. But by
this point the pain was excruciating, I would say, and
I turned to go back to lay down in my
bed again, and I pass I mean, I don't remember this,
but I blacked out or passed out, and I woke
(20:56):
up on the floor and I kind of busted my
lip open.
Speaker 2 (21:05):
Julia calls the clinic and they tell her that she
should go to the er. She's in so much pain
that she can't bend enough to get into a car.
An ambulance is called, and when Julia gets to the hospital,
they check her out. The retrieval is a safe procedure,
but things can go wrong. Your ovary can strangulate, a
major artery can get punctured. But none of the obvious
(21:28):
things are wrong, and nobody can explain what is Back home,
over the weekend, Julia calls the on call doctor at
the clinic multiple times.
Speaker 4 (21:38):
By Sunday, I sort of got the sense I was
annoying him.
Speaker 2 (21:42):
Julia keeps waiting for a call from her official doctor.
By Tuesday, she still hasn't heard from him.
Speaker 4 (21:48):
It was impossible for me to understand how he hadn't
called me by this point, But I called his office
on Tuesday, basically, you know, saying I need to talk
to you. I wrote, I wrote down what he said
and I've kept this note since that time. He said
he was not alarmed, but perplexed and surprised at my experience.
(22:15):
Those words, I guess ring pretty hollow now, right, knowing
that there was a pattern of of many women who
had extreme inexplicable pain after the.
Speaker 2 (22:31):
Egg retrieval, What did you make of that language? Like
at the in the moment, perplexed and surprised.
Speaker 15 (22:42):
It was, I mean, I guess uh.
Speaker 7 (22:53):
I.
Speaker 4 (22:55):
Felt crazy. I mean I felt I mean, you're by
this point, I'm asking myself like, am I being difficult?
Am I? I mean? Am I? I mean you you
just question your sense of self, like your your ability
to assess your situation rationally, which is very disconcerting when
(23:20):
that happens, because at least at the end of the
day you have that right you start thinking about your
whole life, right, like I'm a pretty high energy person,
like I take care of a toddler, I have a PhD,
I have a job, like I run marathons in my
free time, like I'm not, you know, like you have
(23:41):
all these parts of your life that make you feel
like that give you this sense of like who you are.
And then I just felt like like they were treating
me like I was like nuts, you know, for for
for still, you know, being in pain and just having
a what I would call a difficult time. You know,
(24:03):
I just left the office, I mean crying, you know,
I just felt like like nobody, nobody cares. That's the
way I would describe how I felt in the days after,
like nobody gives a crap that this was so.
Speaker 5 (24:24):
Hard for me.
Speaker 2 (24:28):
In the days after the retrieval, other patients live out
versions of the same story. They also call the clinic.
They ask is this normal? They say, the tail nyl
isn't helping. At home, They're laid up on the couch,
they can't pick up their toddler. They wonder if they
really should have scheduled themselves for a shift the next day.
(24:56):
Not all staffers at the clinic are dismissive, but even
and when they respond with concern, there aren't any real answers.
Some of these conversations take place days after the procedure,
like at follow ups to talk about next steps.
Speaker 8 (25:10):
You didn't really talk to the office until day five
or day six, which is when I found out that
none of the eggs had survived, none were healthy enough
to go to testing. And we had to talk about
moving forward, and that's when I really expressed my sort
(25:31):
of shock that the procedure was as painful as it was,
and talked about, you know, if there were other pain
management protocols that could be considered at that point.
Speaker 11 (25:45):
And.
Speaker 8 (25:48):
I was told and that, you know, that was the
best pain medication that was available, and my doctor prescribed
me an anxiety medication to take before the next procedure,
and I remember saying to my husband, you know, I
(26:09):
think it's strange because I'm not anxious about a medical procedure.
You know, it was the pain. It was severe pain,
not anxiety about going into it.
Speaker 13 (26:22):
The next time that I saw my doctor, he asked
me how the procedure went, and I said it was
really really painful, and he was kind of like a
little bit a little bit concerned, but then he just
didn't say anything after that. So I was like, Okay,
I guess. And this was my first time doing it,
so I didn't know any better. So I was like, oh, okay,
I guess it's supposed to be painful.
Speaker 2 (26:43):
Other women are talking about what happened with family and friends.
Speaker 9 (26:47):
So at that point I had talked to.
Speaker 10 (26:51):
A couple of family members who had done retrievals, and
I felt even worse. There's nothing like feeling shame from
like another female and unintentional too, you know, like that
just seems weird, because you know, I was wheeled back
(27:13):
there and joked with the staff and then fell asleep
and woke up and was fine. And that seemed to
be the general consensus between procedures at different clinics that.
Speaker 9 (27:26):
Oh, yeah, I was kind of alert, but I didn't
feel anything. It was really no big deal.
Speaker 10 (27:30):
Like the shots ahead of time were way worse than
the actual procedure.
Speaker 9 (27:35):
And I started shutting down after hearing.
Speaker 10 (27:38):
Those stories that this was on me, like I something
wasn't right with my tolerance and my ability to handle this.
Speaker 2 (27:55):
The women are already settling on their stories about what
happened to them immune to fentanyl. It's my fault. It's
supposed to be painful. The clinic tells patients that they
may experience mild discomfort, but now some of them have
recalibrated their expectations, including Lynn, who will have eight retrievals
(28:17):
at the clinic, all of them will cause her excruciating pain.
Speaker 8 (28:21):
You know, again, you hear about IVF and how tough
of a process it is mentally and physically, and you know,
I just thought, this is what I have to do,
This is what I have to do, and sort of
just thought, this is what women go through.
Speaker 2 (28:51):
Yale declined to offer information about how reports of pain
were addressed at the clinic or to answer any other questions.
Episode one of the Retrievals continues after the break of
(29:11):
the twelve patients I spoke to. Most are white. The
one black woman in the group was often the only
black woman in the clinic waiting room. Everyone in the
group identified as a woman. While couple of them were
pursuing pregnancy for the first time as they neared forty
most did not fit that stereotype. Most were married to men,
one to a woman. That patient would provide the eggs
(29:33):
and her wife would carry the pregnancy. Her wife presents
as more stereotypically masculine, doesn't wear women's clothing, and the
first family members were like, are you sure you want
to do it this way? Yes, they were sure. One
was doing this on her own at forty one, after
the end of a long relationship. Another left her boyfriend
part way through the process and then fell in love
(29:55):
with the new guy at the office. One was born
in Iran and came to the US as a roa refugee.
Another grew up in Jamaica. One had what she described
as a horrible childhood she essentially had to raise herself.
Speaker 5 (30:08):
Another longed to have.
Speaker 2 (30:09):
A second baby because she was so close to all
of her siblings. One had Type one diabetes and was
used to everyone always attributing all medical issues to, oh,
it's your diabetes. All of them worked a special ed teacher,
an accountant at a maritime firm, and a lecturer at
Yale in the Department of American Studies.
Speaker 5 (30:32):
Her name is Leah.
Speaker 2 (30:34):
Her scholarship encompasses a variety of subjects, exile and migration.
She's the patient who came to the US as a
refugee from Iran and gender. From the beginning of her treatment,
Leah located her experience within a context of assumptions about
women patients, that they are unreliable narrators of their own symptoms,
(30:55):
that they are anxious, exaggerating.
Speaker 14 (30:58):
But I remember the first time I wanted to get
ready for the ultrasound, there was blood on the floor
from a previous person's ultrasound, and I have to tell
you it was as ominous as signs fucking come. And
I just remember me and Navid was with me. I
think was Navid with me or oh no, he couldn't
(31:19):
go inside.
Speaker 12 (31:20):
He was waiting in the car. My husband was waiting
in the car. I was just shaking. I was like,
this isn't good. I mean it was.
Speaker 14 (31:28):
It was like you you walk in and I was like,
there's blood. You guys left blood over?
Speaker 12 (31:34):
What is going on here?
Speaker 2 (31:36):
Did you say anything to like, did you say that?
Speaker 12 (31:38):
But here's the thing, and this is where it begins, is.
Speaker 14 (31:42):
You are treated like a hysterical woman from the second
you walk in there, so you already know and like
as a you know, like a person who like I
study this stuff, I teach this stuff, and you're there
and you're like, oh, this is this is this is
actually what's happening right now. Here comes like Freud's patient,
(32:06):
the hysterical woman who's childless and angry and hormonal and
terrified and bitchy and mean, and that's how we're gonna
treat her.
Speaker 2 (32:19):
Hysteria comes from the Greek word for uterus. Ancient explanations
for it involved an empty uterus. A woman was hysterical
because her uterus was not full, unanchored, the uterus roved
through the body, which was what made women sick and crazy.
To fix hysteria, you really needed to fill that uterus up.
Speaker 12 (32:42):
Like so with the blood. I remember being like, there's
blood on the floor, you know, I was really upset,
and they're like, okay, okay, I mean, it's you.
Speaker 14 (32:49):
Know I I it turned right back on me, and
I remember one of the nurses was like, okay, well
you can calm down, you know. I was told to
calm down, and I mean, and then when they're doing
the ultrasounds of someone's doing a transvaginal ultrasound, so there's
literally like the stick that's inside of you and they're
moving it around and if you cringe, oh okay, it'll
(33:10):
just be like another It's just another second. It's just okay,
just be patient. So you're constantly over emphasizing or over
dramatizing what's happening.
Speaker 12 (33:22):
It's not that big of a deal.
Speaker 2 (33:24):
Leah felt like her doctor wasn't listening to her. She
also didn't trust her assigned nurse then kim Lea's first retrieval,
she felt her pain wasn't taken seriously by anyone, She says.
They all blew her off. Lea wasn't happy with her treatment,
but she decided to continue.
Speaker 12 (33:41):
Here I was I saw it, I felt it.
Speaker 14 (33:45):
I was alarmed by it, but I kept going because
I wanted to have a baby.
Speaker 2 (33:51):
Leah asked for a new doctor. He oversaw her next cycle,
and soon she went in for another retrieval.
Speaker 14 (33:59):
Right after you're in that room, the ANSCC others came
up to me and she said, you know what, you.
Speaker 12 (34:06):
Were waking up. You were waking up. We had to
give you some more meds. You know, you were waking up.
Speaker 14 (34:13):
So again you your body, you were nervous, you were agitated,
You burdened us, your kind of uncontrollable body put us
in a position where we actually had to give you
more drugs.
Speaker 12 (34:27):
You you were waking up, so we had to give
you more fentyl.
Speaker 14 (34:32):
And I was like, oh, but again to them, to them,
I'm this woman who's already like on edge. I already
left the doctor because I didn't like the doctor. So
the other physicians and the other nurses all know this
about me. I'm a kind of already unruly, perhaps entitled,
(34:57):
overly kind of knee woman who is just really angry
that she doesn't have a baby.
Speaker 2 (35:07):
There's a balance you have to strike as a woman patient.
You have to complain just the right amount to be
taken seriously, but not so much that you seem shrill. Still,
your pain is more likely to be underestimated than men's.
Black women are more likely to have their pain ignored
no matter what they do. All of this we know
(35:27):
from the literature and also from life. In my life,
I've been the kind of patient where if I've ever
spoken up, I felt like I need to be obsequious
later to protect myself. That is what I felt I
needed to perform. Leah knew she'd need to perform a
whole range of things in order to get help. Stern, docile, smart, stupid, agreeable,
(35:51):
and now on ajourney in the recovery room, Leah became
an observer. She would remember what was happening. She would
write about this.
Speaker 5 (35:59):
One day.
Speaker 2 (36:01):
She tuned into the language and too the emphasis that
to her seemed so interesting and fucked up into the
syntax that seemed to place the blame on her body.
But at the same time, Leah had also internalized the
narrative that her body was to blame. Her body was inadequate, deficient,
that was why she was here. Her body had had miscarriages,
(36:22):
her body didn't make enough eggs. Her body couldn't cooperate
long enough to get through a critical procedure.
Speaker 12 (36:28):
Oh God, my body, like here it goes again.
Speaker 14 (36:32):
Not only can I not like have a baby, I
also can't even just lay still with the right amount
of fatanel.
Speaker 2 (36:42):
In this moment and throughout her treatment, Leah was simultaneously
the writer saying, I can name what's happening here, and
the patient sang, how could I have let this happen?
Other women occupied their own versions of this position. Their
professional identities offered them one kind of story about these events.
(37:04):
Their identities as patients directed them to another. Several of
them had an area of expertise that was directly applicable
here in a way that is kind of uncanny. For example,
there are multiple patients who work in healthcare, including one
who's designed systems for the safe storage of medications. There's
a nurse anesthetist. She thought the anesthesia was the one
(37:28):
part of fertility treatment she wouldn't have to worry about,
and of course, there's the addiction researcher Katie, who had
the prophetic fantasy. What's unique about you is that not
only did you know something was wrong, you knew exactly
what was wrong I did. Yet still you constructed like
(37:50):
this other narrative to explain it. Yes, like other patients,
Katie had expertise that gave her knowledge, but she and
others pushed that knowledge aside. They decided not to know
what they knew in order to keep going. I wanted
Katie to lay out the path to that cognitive dissonance.
I wanted her to explain exactly how she got from
(38:12):
one story to the other.
Speaker 7 (38:14):
I mean, you know, as I've told you, like I
came out of that procedure, and I immediately I remember
immediately texting my friends who are also colleagues and addiction
research at Yale. Like the nurses stealing the fentanel. It
seemed it just seemed so obvious. But then, you know,
then you you sort of come out of the sh
I remember just coming out of the shock and recovering
(38:35):
from the procedure, and things just go on.
Speaker 9 (38:37):
You know.
Speaker 7 (38:38):
I no one is addressing the fact that I was
sober during the procedure, and I remember violently shaking in
recovery from like the shock. I don't know that that's
related to having the procedure with or without fentanel, but
that's how my body responded. And my nurse was there,
(39:00):
and I remember her saying, I think something like, I
think it's I think it was so painful because we
got so many eggs and so it's just sort of
this like positive, kind of false narrative about what had happened.
And so then, you know, I think I coped by
coming up with an alternate explanation, which was that I
(39:21):
do remember waking up during my having my wisdom teeth
being pulled when I was a kid, to the nurse
saying shit, shit, and then you know, giving me more drugs,
putting me back under. So, you know, the other explanation
for me was that maybe I'm not sensitive to certain opiates,
you know, And I remember also that kind of became
my narrative with you know, my friends and colleagues kind
(39:42):
of remember me sort of switching to that narrative and
saying like, well, maybe you're you're not sensitive defentanel. So
I started to kind of tell, just tell, myself, a
story about my pain, just try to understand, you know.
It's a way of just understanding my experience and thinking, yeah,
maybe this is what happened.
Speaker 2 (40:07):
The story becomes away not only to explain pain, but
to cope with it, a way to not only make
sense of the pain, but to manage it, to tamp
it down, get through it. And this way the story
becomes the medicine that the patients weren't given. The women
(40:32):
gear up for second third retrievals. They change their diets,
they cut chemicals out of their home, They read the
books the nurses recommend, or they get ready for embryo transfers.
They make reservations at a hotel in town so that
they won't have to drive home over a bumpy road.
Despite these efforts, some of the women miscarry. One woman
(40:54):
wakes up about ten days after her embryo transfer with
some spotting. Don't think anything of that yet, a nurse
reassures her, But the pregnancy test comes back negative. When
do you think you might want to get started again,
her doctor asks her at a virtual follow up appointment.
I am not ready, the patient says. She closes the
(41:16):
telehealth and that's the last time she talks to the doctor.
She never goes back to that clinic. She stops fertility
treatment and doesn't know when or if she will ever
resume it. She never wants to go through an egg
retrieval again. Fertility treatment doesn't always result in a baby.
(41:45):
It's not just giving yourself shots that's hard. It's the
cycle of hope and loss. It just clambers you, and
the longer you stay in it, the more the drugs
mess with your head. It's called the clomid crazies for
a reason. In one of the women tells me, and
the money always the money. If your insurance covers this,
(42:06):
it probably only covers a few cycles. There's so much
pressure on each one. Once you have to pay out
of pocket. You're talking maybe fifteen K for one cycle,
and that's the low end. Some of the women are
keeping their treatment secret. One of them can't even tell
her own mother.
Speaker 4 (42:25):
It's hard.
Speaker 2 (42:26):
It's hard to begin with, even without this extra larra
that's been added on to this. Now, the pain and
the fear of more of it.
Speaker 6 (42:35):
The first time I went in clueless, thinking you're not
going to feel a thing. So I think the second
time I had a lot more anxiety.
Speaker 2 (42:44):
Laura doesn't get as many eggs as she hoped for
the first time around. It's urgent that she start cancer
treatment and the doctors accelerate her cycle. Her second retrieval
is scheduled for barely more than two weeks after her first.
That morning, his mother drives her to the clinic and
sits in the waiting room while Laura goes back for
the procedure.
Speaker 5 (43:05):
And I was shocked. I was shocked again that it
was the same situation.
Speaker 6 (43:09):
I'm thrusting my hips and telling me like, why do
we speaking to them? And I was just like, I
feel everything you're doing. And that was when I did.
I remember actually saying to them, I could drive myself
home right now.
Speaker 5 (43:20):
I'm that alert.
Speaker 2 (43:22):
In the recovery room, Laura gets her phone back and
just like last time, texts her sister in law. Then
she sees her mom. She tells them both how much
pain she's in.
Speaker 6 (43:32):
So my sister in law right away was like, oh
my god, I cannot believe you thought that again.
Speaker 4 (43:35):
But my mom, you know, she just felt she it
was it's hard.
Speaker 11 (43:39):
Because you know, she had seen me go through so
much as it was with the cancer, you know, any
mother who who has to live watching their daughter go
through that, and then for me to tell her, you know.
Speaker 5 (43:51):
This was supposed to be a special moment because.
Speaker 11 (43:53):
We're preserving my fertility and I'm sorry, and Ford like
see that it hurts her.
Speaker 5 (44:02):
To see me in pain, you.
Speaker 6 (44:04):
Know, you know, and I was just like, well, thank God,
I think this was the last time I had to
do that.
Speaker 3 (44:12):
You know.
Speaker 5 (44:13):
Yeah, So.
Speaker 2 (44:15):
What did the two of you do, like the rest
of that day? Did she drive you home?
Speaker 16 (44:20):
Yeah, she drove me home, and she stayed with me
because she had already been staying with me a lot,
you know during the day, you know, after my surgeries
because I couldn't even at that point, I still wasn't
allowed to lift more than five pounds, so because I
was still recovering.
Speaker 5 (44:37):
From the other surgeries.
Speaker 4 (44:38):
So yeah, she was with me and.
Speaker 5 (44:41):
You know, maybe lunch and comforted me and just you know,
we were.
Speaker 6 (44:44):
Like, okay, so now we just go back to waiting
and you know, hoping we get a good number, and
you know, I just moved on from it because I
faced many more surgeries that year as well, so you know,
I kind of had to just switch back into you know,
survival mode, like, okay, but now we just battle the
next thing.
Speaker 2 (45:03):
So in the other surgeries you had, like cancer related surgeries, like,
what were your experiences of pain?
Speaker 6 (45:13):
Like, it's actually interesting that you bring that up because
when I did have my double mes ectomy, I was hospitalized.
I think I was in for a day or two days,
and strangely enough, the nurse, the night nurse, forgot to
give me morphine. So I actually was awakened in pain
the entire night. And I have gluten allergy, so they
(45:35):
couldn't feed me anything because the kitchen was closed. So
I spent the entire night like vomiting because they couldn't.
They were gift trying to give you like percocets or something,
and so I know what pain feels like.
Speaker 5 (45:46):
I've you know, I've whatever.
Speaker 6 (45:47):
And the next morning the doctor goes, I don't understand
why she didn't give it to you.
Speaker 5 (45:51):
It was in the order and I had a really
young nurse. Whatever. This is completely unrelated.
Speaker 6 (45:55):
To that, but you know, I know what pain feels like,
I've been through it.
Speaker 5 (46:00):
And then when I was hospitalized at Christmas.
Speaker 6 (46:03):
That's funny that like that you bring that up because
my sister in law actually had pointed out. She goes,
do you remember when you kept telling me you were
immune to fentanyl? She goes, when I did a search
on my phone, I guess you can. She's really savvy.
You can type in like fentanyl in text messages and
it'll bring up every conversation.
Speaker 5 (46:21):
She goes, I.
Speaker 6 (46:22):
Actually found one from when you were hospitalized at Christmas
saying that you were on fentanyl. And I guess she
had sent me a picture of her Christmas tree and
I had made a comment like, oh my god, did
your house burn down? And she was just like and
she was like, what are you talking about?
Speaker 5 (46:37):
And I said, I don't know.
Speaker 6 (46:38):
The nurse just gave me fentanyl, and so she goes, look, Laura,
so it does work on you, like oh wow, you know,
and this was a month prior and I did that
didn't even dawn on me, like, oh my god.
Speaker 5 (46:49):
So yeah, but when it came time for the other.
Speaker 6 (46:52):
Thing, I was just like, oh, it must not work
on me, because you know, I just felt like nobody
had heard what I was saying, so it just didn't exist.
It was in my head, you know. So yeah, so
I don't know. I was I foolish because I didn't
like dispute it more. Maybe not, I don't know, but
like I just I believe them.
Speaker 4 (47:12):
You trust them.
Speaker 2 (47:18):
Months pass, some of the women get pregnant, others are
still trying. Some of them are still showing up at
that clinic for blood draws when they open their mailboxes
in December twenty twenty.
Speaker 4 (47:32):
Christmas was on a Friday of twenty twenty, and the
mail arrived on Thursday. It was Christmas Eve, and I
was busy and I just thought, I'm just not I'm
not going to go get the mail today. And I
waited until Monday the twenty eighth, and you know, it
(47:55):
was a nice day. I went outside, I got the mail,
and you know, I got this letter.
Speaker 9 (48:01):
So I got this letter in the mail. It's nothing fancy.
It's Yale envelope. I'm assuming it's a bill. Bill's never
stopped coming with IVF.
Speaker 12 (48:13):
You get so much when you work at Yale.
Speaker 14 (48:15):
Also, you just get like Yale emblazoned mail, and so
you're like, oh, okay whatever.
Speaker 12 (48:22):
It was like this thin thing.
Speaker 14 (48:23):
And I was like, oh they you know, change locations
or something.
Speaker 12 (48:27):
It's like this is not important.
Speaker 9 (48:32):
And instead of just setting it aside.
Speaker 10 (48:34):
I happened to open it and I was.
Speaker 7 (48:39):
Furious, and it says, Dear Kathleen Garrison, I'm writing you.
I'm writing to you in my role as director of
Yale Reproductive Ender, Chronology and Infertility, to let you know
that we have learned of an event that may have
involved your care.
Speaker 4 (48:52):
You know that they've become aware that the nurse was
switching out the sentinel with the saline.
Speaker 7 (49:00):
A few weeks ago, we learned that on multiple occasions,
a Yale Fertility Center nurse replaced fentanel a routinely used
narcotic medication with a normal salt solution saline in some
medication files. As a result, some patients may have received
saline instead of the intended narcotic medication during their procedures.
(49:21):
While there's no reason to believe that this event has
had any negative effect on your health or the outcome
of the care that you received, we believe that you
should be informed.
Speaker 10 (49:31):
They make this stupid comment in the letter that there
was no harm done from this happening, and I I
don't know if Hall was home or I called her,
and I was like, bullshit, no harm done.
Speaker 8 (49:50):
Don't send me a letter and tell me that we're confident.
No one's you know, outcomes were affected by this. I
know my outcomes were affected by this, so I know
what I experienced and went through.
Speaker 10 (50:03):
But Yale wasn't going to help me. They didn't think
there was harm. They didn't think it was a problem.
You know that it was the most honestly, I think
it was one of the most disrespectful ways. They probably
could have notified any of us that it had happened,
that you know, oh, we had this little breach and
you're fine, No, biggie, go about your day.
Speaker 2 (50:25):
Yeah.
Speaker 8 (50:25):
Again, no one reached out to talk with us or
to see what we experienced as patience. My only communication
about it was through the letter, and that's still to
this day.
Speaker 2 (50:40):
And yet, in addition to fury, there's also vindication. When
they learned the news. However they learn it, the women
text their twin sister, or run inside to their husband,
or weep in their kitchen.
Speaker 5 (50:53):
It was mind blowing.
Speaker 6 (50:55):
I immediately called my mother. I immediately called my sister
in and I'm like, ugh, like no something. It just
hit like it all makes sense now.
Speaker 8 (51:03):
And it was like, okay, it all makes sense. It
was almost a relief, a relief to know, like, you know,
I'm not crazy, there's nothing wrong with my body.
Speaker 5 (51:15):
I don't have something like.
Speaker 8 (51:17):
Locking opioids or you know where you know my body
is wrong and doesn't react to medicine.
Speaker 6 (51:25):
But it also shows how much they ignored my pleas
for help and like saying like like nobody believed me.
Speaker 5 (51:35):
And so in a sense it.
Speaker 6 (51:38):
Was like relief, you know, just knowing that what I
felt was real.
Speaker 2 (51:45):
But there's more, the letter continues.
Speaker 7 (51:49):
The law enforcement investigation and our own review have found
no reason to believe that you were exposed to an
infection due to this event. Even so, we can appreciate
that you may want further reas insurance, and if you wish,
we will arrange for you to be tested for a
group of blood born infections at no charge.
Speaker 5 (52:06):
And I was like, what the fuck?
Speaker 4 (52:14):
You know, those words not alarmed, but perplexed and surprised
came back to me, right, And you just feel like
so completely let down by this institution that's supposed to
make you feel safe and I mean, I mean keep
you safe, right, an institution that's supposed to keep you safe. Right,
(52:36):
that was gone.
Speaker 2 (52:40):
But maybe the most remarkable thing about the letter is
the way it addresses pain. It seems to be saying
you did not feel what you felt.
Speaker 7 (52:50):
I also want to assure you that the fertility center
routinely uses a combination of pain medications during procedures. We
closely monitor patients for signs of discomfort every procedure and
adjust medications or add medications as needed. In this way,
we can be confident that our patients stay comfortable even
if one medication is not working well. I don't believe
(53:12):
that accurately describes my experience. And then it goes on
to say, if you have any questions or want a
blood tests, you know.
Speaker 5 (53:19):
Here's what you can call.
Speaker 2 (53:22):
The women put the letter on the counter and shock.
For months, they've been constructing their own stories about what
happened to them. Now they have Yale's story, which is
that this is barely a story at all. The questions
the patients have been asking all along have a new focus.
Speaker 8 (53:39):
You know, as soon as I received that letter, it's like,
how does this happen? You know?
Speaker 5 (53:45):
And how does it happen at Yale?
Speaker 8 (53:47):
You know, a hospital system with such a great reputation,
and how did it happen for so long. So many
things had to go wrong, you know, for this to
happen as long as it did.
Speaker 10 (54:03):
How does an entire facility let this happen?
Speaker 9 (54:08):
Who trained them? Who thought that this was okay?
Speaker 10 (54:12):
I get sent home with you know, I get packages
in the mail with sharp needle containers and strict instructions
and alcohol swabs and this crazy protocol that I'm expected
to do at home.
Speaker 9 (54:25):
They make you double check things, you know, are there
puncture marks? And I'm like, did I.
Speaker 10 (54:31):
Really spend more time following directions at home for hormone shots?
Speaker 9 (54:37):
Like where were they?
Speaker 7 (54:40):
I think my immediate reaction was, you know what, how
could this happen?
Speaker 11 (54:43):
At yeale?
Speaker 7 (54:44):
Like why wasn't there a better system in place to
prevent it or detect it when it was happening? And respond,
you know, why why wasn't our pain?
Speaker 12 (54:51):
Listened to.
Speaker 2 (54:53):
The women wonder about the system that failed them, But
there's something very intimate and human that they are wondering
about too.
Speaker 5 (55:01):
We were notified that it was a nurse.
Speaker 8 (55:03):
We didn't have the name of the nurse in that
original letter, and so it's sort of you know, racing
through your mind, like, well, which nurse because you build
such a strong relationship with these people, and you see
them so often and you trust them and you know,
build a relationship, and so you're thinking like, well, which
(55:25):
nurse could.
Speaker 5 (55:25):
This have been?
Speaker 8 (55:26):
And then you're you're showing up, you know, and Okay,
who's not here anymore?
Speaker 12 (55:31):
Who's gone?
Speaker 5 (55:31):
And just trying to figure out.
Speaker 9 (55:35):
Who it was.
Speaker 2 (55:40):
The patients know what happened. They're about to find out
who did it. That's next.
Speaker 1 (55:55):
That was episode one of The Retrievals. You can listen
to the whole series on Spot or wherever you get
your podcasts, and we'll be back with a new episode
of Heavyweight next week.
Speaker 2 (56:26):
The Retrievals is produced by me and Laura Starceski. Laura
edited the series with editing and producing help from Julie Snyder,
Additional editing by Micky Meek, Katie Mingle and Ira Glass.
Research in fact checking by Ben Fhalen and Caitlin Love.
Music supervision, sound design and mixing by Phoebe Wang, with
production help from Michelle Navarro. Original music by Kala Palone
(56:50):
and music mixing by Toma Poulin. Indechubu is a supervising
producer for serial productions at the New York Times Our
Standards editor Susan Westling. Legal review by Dana Greene, Art
direction from Pablo del Coon, producing help from Jeffrey Miranda
Kelly doe Bernon Borelli, Desiree Eboquois and Anisha Money.
Speaker 4 (57:11):
Sam Dolmick is the Assistant Managing Editor.
Speaker 2 (57:14):
Special thanks to doctor Marcel Cedars, Calvin Hawker, Lisa Schumann,
Kylie Silver, and doctor Maggie Smith. The Retrievals is a
production of Serial Productions and The New York Times
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