Gov. Phil Bryant of Mississippi signed the Gestational Age Act into law on March 19, 2018. This is a law that bans abortion after 15 weeks unless there is a “medical emergency” or a “severe fetal anomaly.” The law was placed on temporary hold March 20, 2018, how long the stay will last is not known. The only thing I know for sure is this will not be the last attempt to reduce abortion access using medical terminology that is impossible for doctors to navigate.
We doctors don’t use the words “medical emergency” to decide when to give or rather when to withhold care. I’m also fairly certain the phrasing “medical emergency” means very little to the 12 politicians who sponsored the Gestational Age Act, to those who voted for it, and to the Governor who signed it into law. I reached this conclusion because I am one of the few people who has called a politician to ask if a patient was sick enough to meet his definition of “medical emergency” so she could have an abortion.
It was my first abortion consult after the law in Kansas changed in 1998 making abortions at the University of Kansas Medical Center, where I worked at the time, illegal unless it was a “medical emergency,” defined as needing an “immediate abortion” to prevent death or “irreversible impairment of a major bodily function.”
The doctor who called me to help his patient had that clipped tone that many of us in medicine do when things are going poorly, as if shortening the words ever so slightly gets you to that hopefully lifesaving step just a little faster.
He proceeded to tell me about this pregnant woman and her terrible disease. She was deteriorating more rapidly than expected. If she were not pregnant perhaps her prognosis would improve?
Medically it was very sound thinking.
It is a terrible illness that leads a pregnant woman and her doctor to the conclusion that ending a wanted pregnancy is the next step. These are conditions that gather family and friends and then leaves them adrift in waiting rooms, hallways, and cafeterias with faces shiny and swollen from tears and lack of sleep. At least I hoped this woman had family like this. I had learned that sometimes when a pregnant woman is ill and needs an abortion there is no one who comes. Sometimes there wasn’t even a friend’s phone number in the chart to call. In those situations, I would sit for a little while at my patient’s bedside and even though she was still unconscious I would plump her pillow or straighten her blanket. It was nothing, but it was everything.
I let the doctor tell me this woman’s medical history and then I asked if she were about to die right now?
It is a strange question. In rare situations when we are short staffed we doctors might triage so we can give our attention to the sickest or the person who will benefit the most, but doctors don’t ask if someone is actively dying. At least not until the government made us.
The doctor yelled. Not really at me, more in exasperation.
I didn’t blame him. We are not misfortune-tellers we are doctors. Asking a doctor to predict the hour of death, to distinguish between dying here and now and might die tonight or perhaps tomorrow or maybe next week is an abomination and yet here we were and I had to ask.
I explained the new law and that to have an abortion the mother’s life had to be in “immediate” jeopardy.
What did that mean? I was a doctor who did abortions and practiced obstetrics and I didn’t know. The doctor who called for my help, whose business it was to take care of very sick people, didn’t know. The hospital attorneys, because those are the best people to make medical decisions right after politicians, decided this law meant the medical equivalent of stepping in front of a speeding car. Death himself must be in the room and unhooking the intravenous, except we can’t see death or predict when He will arrive so that complicates things.
When a woman is pregnant her life is always in greater jeopardy than if she were not pregnant. There are the regular medical misfortunes such as ruptured membranes and infection, placental abruption and catastrophic bleeding, or severe high blood pressure. Pre-pregnancy illnesses, such as diabetes and systemic lupus erythematosus, even when well-controlled can deteriorate rapidly threatening organs and lives. Then there are uncommon catastrophes like cardiomyopathy (a failing heart), or the truly bizarre like Mirror syndrome. There are countless permutations and combinations for how pregnancy can kill or maim a woman. Just when you think you have seen it all you realize that you have not and it is always worse than you expected.
Textbooks just don’t do obstetrical terror justice.
The whole point of good medical care is to never get to the point where “immediate” death is minutes away, situations like the blood bank is exhausted but the bleeding hasn’t stopped, or oxygen levels that are dropping but the ventilator can’t deliver any more pressure without bursting the other lung, or an implanted pump has stopped boosting a failing heart. Good medicine, the medicine we all want, is reversing course many, many steps before.
The hospital attorneys told me that doing an abortion for this woman could rouse an overzealous District Attorney and result in criminal charges, something my malpractice insurance would not cover. It would also get fired. The only way for me to help this woman and keep my job and protect myself from criminal prosecution was to call the politician who wrote the words “medical emergency” and “immediate action” into the law and seek his permission.
And so, it fell upon me, a 31-year-old Canadian doctor two years out of training with a precarious immigration status to challenge a state politician.
It took several hours to track him down because politicians don’t take call for medical emergencies.
A hospital attorney patched me through to this man. I had reviewed statistics and projected outcomes with the other doctor involved and was prepared for every possible question. I did not plan to explain the technical words to emphasize the point that if you do not understand them then maybe you might realize that you have no business trying to govern with them.
I got maybe two, maybe three, sentences out.
He stuttered, like a schoolyard bully caught mid punch by a teacher who then quickly smiles and changes course with his fist to pat the head of his intended victim in faux concern.
“Of course, doctor, do what you think is necessary,” he said.
No additional explanation just, “Of course doctor, do what you think is necessary.”
There was an uncomfortable silence. I didn’t want to thank him so I said something like, “Okay, great.” And that was it.
What a disconnect.
To claim that abortion is such an evil and so unnecessary that you feel legislation is required, as if doctors are rounding up wanton women for pleasure abortions, and yet you fold with the slightest challenge.
If what a board-certified OB/GYN thought was necessary was enough then why have a law? Do these laws come about because politicians believe the lies that some so freely spread about abortion’s place in medical care? Is it a desire to make life miserable for women? A complete disregard for facts because being an anti-choice braggart is good for political fundraising? Or all three?
I ask the politicians of Mississippi how sick must a pregnant woman be after 15 weeks to have an abortion in your state because I read your law and I don’t know? Is there a blood pressure cutoff for the “life-endangering physical condition”? An oxygen or creatinine level that portends “irreversible impairment of a major bodily function?” Must a woman with pre-viable ruptured membranes be septic to be “endangered by a physical disorder” or will an elevated white blood cell count and a tender uterus suffice?
To Governor Phil Bryant and any politician who seeks to wield the misery of women as a political weapon I ask what does the life of a pregnant woman mean to you and what will you tell me if I call you one night to ask?
I was proud to sign House Bill 1510 this afternoon. I am committed to making Mississippi the safest place in America for an unborn child, and this bill will help us achieve that goal. pic.twitter.com/O0O4QeILLx
— Phil Bryant (@PhilBryantMS) March 19, 2018