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?


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  1. This is in response to your June 2018 tweets.

    Years ago a well meaning friend gifted me an astrology reading. It missed all of my health problems and never saw domestic violence coming.

  2. Hi

    I don’t use twitter and cant see any email contact here so posting an answer to your question here will have to do.

    Hippocrates did exist approx. 300 BC. However the writing attributed to him extends over several hundred years and became known as the hippocratic school of thought.

  3. We also have the right wing conservative Christian contingent who think they have a right to have laws passed according to their theology. I’m Christian and although I believe abortion is a last resort, it is between a pregnant woman and her doctor whether or not she has one. I have no business making decisions for others. Also, other people, especially men, politicians and health insurance people do not have the knowledge to make medical decisions.

  4. Dear Kiddo

    I am straight. And I never cared if someone was gay or not. I was one of the popular kids and never felt that insulting someone made me feel better. The bullying will hurt because it was done out of ignorance, jealousy and or stupidity. If he is a truly popular kid, he won’t remain one for long. This won’t mean much to you right now, but trust me, as you get older, go to university you’ll find people that will accept you as you are.

    1. Keith, did you intend to post this comment elsewhere? It doesn’t seem to belong here.

  5. I assume that Mississippi would like to beat TX in the race to win the prize for Most Maternal Deaths, because you can always get another woman.

  6. Mississippi has one of the highest maternal mortality rates in the country. These politicians don’t care about already-born women or school children, as much as they do about their so-called right to life and their right to bear arms.

    Thank you for thoughtfully describing the difficult decisions we obstetricians face in providing compassionate, non-judgmental care to our patients.
    The ignorant righteousness of these lawmakers
    is astounding.

  7. It’s not for the fetuses, it’s not even for themselves. It’s to get reelected. Who knew.

  8. It’s not about woman’s life, it’s about trying to protect it from the Supreme Court. God wouldn’t let a pregnancy go bad for a good woman so it’s not something that actually matters.

    Why don’t you ask them if they would pass a law mandating that a skydiver can’t pull their reserve until they are no more than 400 feet above the ground.

  9. “The hospital attorneys, […} decided this law meant the medical equivalent of stepping in front of a speeding car.”

    Didn’t your attorneys realize that, in this comparison, they are basically saying “when it’s already too late to do anything to save the person in harm’s way”?
    I mean, in real life, if you see someone stepping in front of a speeding car, there is generally nothing you can do to prevent an accident. Unless you are really close and the car is really far away.

    Well, I guess it’s an accurate comparison, at least. I’m no gynecologist, but I know a bit about microbiology, and if you wait for someone infected by bacteria to enter into sepsis shock to treat them…

    @ tumbleweedstumbling

    I tend toward the same position, with the added arguments that anti-abortion policies tend to be accompanied by opposition to contraception, opposition to accurate sex education (beyond “don’t do sex”) – well, everything which is actually effective at reducing the numbers of abortions (and infanticides).
    Also, I have read too many stories of pregnant women whose pregnancy went awry (ectopic, internal bleeding, infection…) and the medical staff – not just one doctor, but the full department – was too fearful of doing anything, because the fetus is still inside. Very likely dead or dying.
    I mean, if cases like this are not a “medical emergency”, if even cases where there is no fetus to “save” are off-limit, then what? The anti-abortion position has nothing to do with ethics or reality.

    1. Agreed. I have major issues with some of the ethics (and lack thereof) of portions of the pro-choice side as well but overall I think far less damage is done by just keeping government out of this. I am in favour of the Canadian position which is basically no government involvement.

  10. The premise that ALL women who must end their pregnancies CHOOSE to do so because they don’t WANT a baby is dreadful. Just dreadful. Many of these women have already chosen their nursery colours. I actually do agree that these men believe that women are just not clever enough to make decisions like this. Poor wee things – we just need protecting from ourselves while we are procreating. I hate these men – i really do.

    1. It doesn’t matter why she wishes to terminate her pregnancy. It isn’t my business, or your business, or anyone’s business other than the woman and her doctor. There are as many reasons as there are women. The implication of your post is that somehow some reasons are more acceptable than others and that is the start of control and restriction.

  11. I wrote Gov Bryant to suggest that he leave this matter between the woman and her Dr like we do in Canada.

  12. Not particularly a comment on this blog entry but I had to share something with you—I know you dislike people on the internet trying to sell crap and I was hoping you would look at this website: It is crazy and misleading let alone not science based. I am afraid that women will buy what she is selling with her “100 percent effective contraceptive” and I’ve already had two patients ask me about it.

  13. This is why I am “prochoice” even though I mostly don’t like abortions. In the final analysis the only one who should be making that decision is the pregnant woman guided by her doctor(s). No one else should be making that decision, certainly not a politician, lawyer or some government clerk.

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