194: A Physician's Duty

Allison Langer  0:03  
I'm Allison Langer.

Andrea Askowitz  0:04  
I'm Andrea askowitz, and this is writing class radio. You'll hear true personal stories and learn how to write your own stories. Together, we produce this podcast, which is equal parts heart and art. By heart, we mean the truth in a story. By art, we mean the craft of writing no matter what's going on in our lives. Writing class is where we tell the truth. It's where we work out our shit. There's no place in the world like writing class, and we want to bring you in today, we bring you the fifth story in a seven part series called our abortion stories to support yes on four, which is an amendment that will bring abortion rights back to Florida. A few weeks ago, we did a live show in Miami, Florida featuring seven heartbreaking but also heartwarming and triumphant stories covering all aspects of abortion and healthcare. We're bringing you one a week until the election, November 5. 2024 if you're listening after November 5, these stories are still amazing and informative, both in content and craft. If you're just tuning in, like if this is your first time listening to this podcast, please listen to episode 190 to learn how our live show, our abortion stories, came to be and why we feel stories can change hearts and laws. Today's

Allison Langer  1:32  
story is by Dr Cecilia Grande, who is an OBGYN here in Miami, Florida, and what you're going to get is a doctor's perspective on how this abortion ban is affecting the medical doctors here in Miami and all of Florida who are trying to fulfill their Hippocratic Oath. Back with Dr grande story after the break, we're back. I'm Allison Langer, and you're listening to writing class radio. Here's Dr Cecilia grande reading her story a physician's duty.

Cecilia Grande  2:10  
Good evening. I want to thank all these very brave women that are telling their stories today. I grew up in Puerto Rico when I was five, and someone asked me what I wanted to be. I said physician. I didn't say doctor. I said it in proper Spanish, medical physician. That was me at five. I've been a physician now for 30 years. I practice gynecology here in Miami, and I love it. I want to start by saying pregnancy is not a benign state. Pregnancy is not a disease either, but a lot can go wrong, and the tragedy of the current six week abortion ban is that this law prevents doctors like me from doing our jobs. The law delays common sense standard care. Now doctors have to jump through hoops, while women can get sick and even die. A few years ago, before the six week ban, I had a patient who was 10 weeks pregnant when she had an incomplete, spontaneous abortion, which in lay terms is a miscarriage. She bled so much, we had to transfuse her. Her cervix was open, which means she was open to infection and were bleeding. There was no question she would have to go to the opening room for evacuation of the uterus in order to stop the bleeding. By evacuation of the uterus, I mean an abortion. This abortion was the standard of care that saved her life. If my patient came today, her care would be delayed because she still had an embryo inside of her today, she would not be transferred immediately to the operating room. First, I would have to document that there was a rupture, then, because there's cardiac activity, I would have to justify the need to intervene and evacuate her uterus. These are unnecessary delays. This is medical malpractice. Delayed care in this case, could lead to more bleeding and infection at best, that causes infertility at worst, death. Since Florida's ban went in too low two years ago, I've seen this happen way too many times in May of this year, with the six week ban, the agency of Healthcare Administration released guidelines allowing for immediate care. By that, I mean abortion for three exceptions, rupture membranes, which means your water breaks, ectopic pregnancies, which means a pregnancy is not in the uterus, and molar pregnancies, which means the patient. Has an abnormal, aggressive placenta. These guidelines seem humane, but they're grossly inefficient. There are many, many more exceptions that we need. Each clinical scenario is unique and cannot be anticipated. Another exception allows abortion when the mother's life is in danger. This sounds humane, but is very, very gray. Dr sung are now forced to wonder, when is my patient's life in danger enough for me to do something about it. The law also gives an exception, as we heard before, for victims of rape and incest, this exception might be the most deceptive. Almost anyone would agree that a woman who has been raped should not have to carry the rapist's child. But the exception, as we heard, requires a court order. Let me explain, most women don't report rape or come forward fast enough. They go home, they get under their covers because they have been violated. So requiring that these women go through the court system is simply cruel. These guidelines on this guidelines, on the surface, appear to be reasonable, even kind, but all exceptions, part of my French, are bullshit. Deborah dorbert from Lakeland, Florida, could not be here today because of life and work. Deborah was not my patient, but I know her doctor explained to her that her baby would not live long enough after birth, Deborah was 23 weeks pregnant when she found out her fetus had Potter syndrome, which means the fetus did not and would not develop kidneys. Deborah and her husband wanted an abortion. They wanted to end their suffering, but because this happened last year here in Florida, Deborah needed permission from the hospital where she went for care. The law states that an abortion can be granted if two physicians certify in writing that the fetus has a fatal abnormality. Let me tell you, in this climate, doctors are afraid. We face penalties of $5,000.05 years in prison if we're challenged, Deborah was forced to carry her fetus to term. She went through 12 hours of labor and delivered her baby 94 minutes later, her baby died in her arms. Recently, I attended an OBGYN conference in Orlando, one of my colleagues turned to me and said, these are choices. We can either delay care and wait for patients to get deathly sick, we can force women total term, or we can do what we know is right, but face the danger of prosecution. I grew up Catholic, and I know plenty of people who say Abortion is murder. Now this may sound counterintuitive, but safe, legal abortions save lives before Roe, the rate of maternal death from illegal abortion was 10% after Roe, and for the past 51 years, the rate of death from legal abortion is zero. Medically necessary abortions save lives. There are other consequences from this current abortion ban. We've already seen a 25% reduction in applicants for opioid resistance in Florida and good doctors shall live in the state who don't want to practice here under this oppressive loss. And guess who suffers every patient who needs gynecological care, that is every woman in the state. In 1994 I graduated from medical school during the ceremony, while I stood in my toga, I took the hypocratic oath, which basically is to respect basic bioethical principles, which are, number one, respect bodily autonomy. Number two, non maleficence, which means we don't create harm. Number three, beneficence, which means we do whatever we can to benefit the patient. And number four, justice, which means we treat everybody equally. I'm standing here today because the current law violates every principle of bioethics. I'm Catholic, but I'm a physician, and these four pillars of care are my duty. Thank you for coming tonight. You.

Allison Langer  10:00  
I love that she says, Thank you for coming tonight.

Speaker 1  10:02  
I just loved her so much. I

Allison Langer  10:06  
mean, we had the benefit of seeing all these people in person, which doesn't always happen on our podcast, right?

Speaker 1  10:11  
She just has such a calm presence. I think that

Andrea Askowitz  10:15  
this doctor is so strong and so fierce, and she is the voice of authority, everything about the way she speaks, the way she stands, the way she presents. I am. I am so impressed with her, and I'm so grateful that she is speaking out against the current abortion laws in Florida. Yeah, I love her story. I think that what kind of got lost on stage, though I hear it, and I want to make sure that the listener of our podcast hears it, is that there really is a story here, like here is the story of a woman who, as a little girl, even at five years old, had this seriousness about her. She didn't just want to be a doctor. She wanted to be a physician. I mean, there is like an elevated sense for her, from her beginning memories about what it meant to be a doctor. And I feel like she's carried that for 30 years, and I feel like that's so cool. It came up again when she was telling us what it was like for her to take that oath. So she's there in her toga. You know, I got this sense that she's like, she is taking it so seriously.

Allison Langer  11:32  
Yes, 100% and I love the way she says, toga,

Andrea Askowitz  11:36  
toga, exactly. Yeah, she's in her toga, and she's like, I'm stepping into this field, and I'm going to do right by it. And now she can't protect her patients, right? She cannot protect her patients. And then she lays it out so clearly, I God, I want everyone in the world to hear the story, yeah, because

Allison Langer  11:56  
if she does, then she could be fined $5,000 and serve five years, five years in prison for if she's challenged. I mean, I get that. There needs to be oversight. There is oversight. These doctors are not going off rogue trying to use their own discretion. They are doing what is right for their patient. It doesn't matter what they think or what they believe. They are trying to save their patients. It's not about what she believes. Like, maybe she doesn't even feel like abortion is right, but she's there. She does believe in a women's right to choose. A woman's right to choose. She's Catholic. It's not like she's like going rogue or something. She just wants to save her patients if that's what they need, and that's what they come to her for. They have, you know, pregnancies that need to be terminated. You know, because they're in danger, the patient is in danger. She wants to be able to save her patient without worrying about going to

Andrea Askowitz  12:54  
prison. She laid out the exceptions to the abortion law in a way that I thought was so like my mind just it blew my mind. So there are three exceptions for fetus, like if the fetus is in danger, and they and she says there are so many more exceptions that we need. And then she talks about the mother's life, that if the mother's life is in danger, and everybody always says, like, Well, if the mother's life is in danger, if there's something wrong with the fetus, but like, how do you know when the mother's life is in danger? Enough? And that's what she told us, You can't legislate the mother's life, that idea, and then the rape exception. That one is just infuriating to me. And I love this doctor for just like all right, let me explain, when a woman is raped, she is not going to get a court order for the most part. Most of the time, no,

Allison Langer  13:55  
because they don't even want to report. We went over that in episode 191, in the series, and it's just, you know, here's a woman that was helping her students. She was an Ariana dorm, and she was helping them report, and then when it happened to her, she couldn't even report. So, right? It's not, it's gray. It's gray.

Andrea Askowitz  14:16  
It's not a fair exception. It's a it's a cruel exception. It does, it's not it's meaningless. And this doctor says, excuse my French. These exceptions are bullshit, and they are, yeah, doctor's hands should not be tied the end period, no mas.

Allison Langer  14:31  
And just a couple more things about the law before we get to some of the writing, the fact that women can't get standard care, like all women, forget whether you're having an abortion or, you know, or problems with a pregnancy. I mean, if you're trying to get an appointment with a doctor, you can't get in

Andrea Askowitz  14:45  
because they're leaving the state, right? Right? Doctors are leaving the state, and doctors don't want to train here, yeah. What about this beautiful line? Sorry, I've I, I wanted to just mention the line about some some say she's Catholic and she's. Some say Abortion is murder. And this might sound counterintuitive, but abortion save lives. That's freaking true. Can

Allison Langer  15:08  
we just go over really quickly what this yes on for amendment does state? Because I just think some people think, Oh, we're just going to be killing babies at nine months. That's absolutely false. Do you have the leg to say it, read it, the amendment says no law shall prohibit, penalize, delay or restrict abortion before viability or when necessary to protect the patient's health as determined by the patient's healthcare provider. There's a second part, but because the amendment can only address one thing at a time. Voting yes on four does not change parental consent. So I know people have said but they that's not what we're arguing here. We're just talking about the viability situation and the six week ban that we want to go back to viability just like in Roe v Roe v Wade, thank

Andrea Askowitz  16:02  
you, Dr Cecilia grande for sharing your story and thank you for listening. Dr Cecilia Grande is an OBGYN and has been practicing in Miami for 30 years.

Allison Langer  16:18  
Writing class radio is hosted by me, Allison Langer and me Andrea askowitz. Audio production by Matt Kendall, Evan serminski and Aiden glassy at the sound off media company. Theme music is by Kenny karade. There's more writing class on our website, including stories we study, editing resources, video classes, writing retreats and live online classes. If you want to write with us every week, or if you're a business owner, community activist group that needs healing, entrepreneur and you want to help your team write better, check out all the classes we offer on our website. Writing classradio.com Join the community that comes together for instruction, an excuse to write and the support from other writers to learn more, go to our website or patreon.com/writing class radio, a full list of our sponsors and a link to donate to yes on four can be found in our show notes. A new episode in this series will drop every Wednesday until the election.

Andrea Askowitz  17:15  
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Tara Sands (Voiceover)  17:29  
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