3. Trust Women
SYNOPSIS
Illustration: Nicole Xu
After Dobbs, many states in the middle of the country severely restricted abortion – but Kansas stood out as an exception. As a result, a small clinic in Wichita called Trust Women became an unexpected oasis for abortion care. In this episode, we bring you inside the clinic to learn how they handled the overwhelming influx of patients.
This episode briefly mentions violent imagery and actions targeting abortion clinics. Listener discretion is advised.
LISTEN
Featuring
Christina Bourne, MD MPH
Ashley Brink
Zack Gingrich Gaylord
Catalina Moreno-Hernandez, RMA
And other contributors who wish to remain anonymous
Credits
Host & Co-creator: Ali Block, MD
Co-creator: Emily Silverman, MD
Lead Producer & Editor: Molly-Rose Williams
Producer, Editor & Audio Engineer: Sam Osborn
Producer & Editor: Jessica Yung
Student Producers: Anjali Walia, Dahlia Kaki, Fiona Miller, Mulki Mehari, and Treya Tompkins
Assistant Producer: Carly Besser
Chief Operating Officer: Rebecca Groves
Series Illustrator: Nicole Xu
Music: Blue Dot Sessions
Resources
Sponsors
The Nocturnists: Post-Roe America series was made possible in part by the Josiah Macy Jr. Foundation and the Danziger Family Fund at The Chicago Community Foundation.
Support for The Nocturnists’ medical student producer program comes from the California Academy of Family Physicians Foundation.
The Nocturnists is supported by the California Medical Association, and people like you who have donated through our website and Patreon page.
TRANSCRIPT
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The Nocturnists: Post-Roe America
Episode 3. Trust Women
Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Ali Block
It was the winter of 2022 the first time I flew out to Wichita, Kansas. I've been an attending in California for eight years and a first trimester abortion provider for over a decade. But I wanted to learn second trimester abortions, both because I was moving to a new part of the country that needed second trimester providers. And also because I knew the Dobbs decision was coming, and I worried that soon a lot of women wouldn't be able to get their abortions in the first trimester. So I went to Trust Women, one of the highest volume abortion clinics in the country – not as an attending, but as a 40-year-old medical trainee.
I never thought Wichita would become such a big part of my life, somewhere I probably couldn't have pointed to on a map before I visited. But after I got the skills I needed, I kept going back as one of the clinic providers. Each time I returned, the staff was facing some fresh new crisis. First S.B. 8, then the Oklahoma ban, then Dobbs, patients from hundreds of miles away were streaming to Wichita, and the clinic was scrambling to accommodate the rush.
Today, you'll join me on one of my bi-monthly trips to Kansas. We'll take you inside the clinic so you can see firsthand what happens when a small town clinic suddenly has to absorb the reproductive health needs for a vast swath of the country.
Christina Bourne
Do you have like caffeine and everything that you require for starting your morning?
Ali Block
This is Dr. Christina Bourne. We used to work together in California and she was my original connection to Trust Women.
Christina Bourne
I've never been like chased by so many stray dogs in my life as I have in Wichita. Yeah, my name is Christina Borne. My title is I'm our medical director. And kind of what that means is to make sure that we are meeting medical care standards and guidelines and saying medically afloat.
Ali Block
Christina says the job looks pretty different now than she thought it would when she first got offered the position back in 2021.
Christina Bourne
And I was like, Sure, it'll be like a pretty chill job. I'll take it on for a year. This was July 2021. So right before S.B. 8, lol.
At that point, like it's hard to think about what the impact was going to be. So you know, Texas was chugging along at like 55,000 abortions a year. And then to say like, Oh, nobody in Texas can get abortion access past six weeks. So like, where are these, you know, 50,000 people gonna go? Our phones literally blew up. We had to, you know, invest in like more staff, a whole new phone system. Really think about what our role in this geopolitical crisis was going to be. Like, how much could we bite off? How much did we feel like was our responsibility as like a very small, nonprofit independent abortion clinic?
Ali Block
Through S.B. 8 and Dobbs, Christina was the only doctor working at Trust Women that lived in Wichita full time. Most of the nurses and support staff are local like her but the physicians who actually perform the abortions mostly fly in from out of state. It can be hard to find local providers with the skills and willingness to provide abortions in more conservative states like Kansas. So it's common for clinics in places like this to fly in doctors for a few days at a time to staff the clinics – doctors like me.
This makes Christina's role as medical director pivotal. If a patient comes in with a placenta I'm concerned about I, call Christina. She's the only one who knows how to coordinate with the local imaging center for an urgent formal ultrasound. So we can offer the patient a procedure that day. Things don't work in Kansas the way they do back home. So Christina's expertise makes her the linchpin for fly-in doctors at Trust Women.
Christina Bourne
It's a tough thing, especially when like most folks are flying in from like very pro-abortion states. People just aren't used to working in hostile places. Like you know, outpatient physicians are used to like certain levels of hospital backup and like kind of a more robust infrastructure.
Zack Gingrich Gaylord
The overwhelming majority of our doctors are traveling from other places. And that's in large part just due to the stigma and violence associated with providing abortions in this region of the country.
Ali Block
That's Zach Gingrich Gaylord. He's the communications director at Trust Women. He's an affable anarchist with a big beard and huge Kansas pride.
Zack Gingrich Gaylord
Well, I grew up in Wichita and my parents were both organizers and activists in different ways.
Ali Block
As a kid in the 90s, he had a front row seat to the fight around abortion rights that took place at Dr. George Tiller's clinic, a fight that got national news coverage. This was the same clinic that would eventually become Trust Women.
Zack Gingrich Gaylord
Dr. Tiller was one of the few providers in the country that would do abortions later in pregnancy. There was a summer that anti-abortion activists, you know, descended on Wichita and had massive protests at the clinic. There was also plenty of violence and vandalism, some arson and then flooding. So there was you know, a lot of attention on Dr. Tiller and the clinic during that time.
Ali Block
On May 31, 2009, Dr. Tiller was assassinated in Wichita outside his local church by anti-abortion activists. I was a third year medical student in California at the time. And I remember hearing the news and seeing how much it impacted the family planning community. Trust Women started a few years later in 2013, in direct response to Tiller's assassination. It was the only abortion clinic in Wichita when it opened. Trust Women still practices out of this building today. The Trust Women building is off the highway behind huge concrete walls. They're completely nondescript. 25 feet of gray concrete, you only know it's there because of an old sign with their logo – an infinity symbol.
Christina Bourne
Oh, yeah, this guy's always here. Like, like I said, I was like three antis sitting at a table with like the giant, decapitated fetus van.
Ali Block
The first time I drove up, I wasn't surprised to see a few protesters. There always are at every abortion clinic I've worked in, but the giant truck with a picture of an ISIS beheading, alongside some pictures of bloody fetuses. That was new to me.
Christina Bourne
That guy is like there a lot. I really don't know who that guy is in particular, but yesterday there was like one particularly like hostile extremist out there. I was like... He's been rolling around more.
Ali Block
When you walk in, you go past the security guy.
Christina Bourne
"Hey, what's up Beau?"
Ali Block
And the metal detectors, which are not standard issue at clinics where I've worked in other parts of the country. There are some keycard access doors. You can go straight into the waiting room if you're a patient or into the back, a labyrinth of hallways and locked doors, which leads you to where the medical staff hangs out.
Kate
The morning is always pretty calm here.
Ali Block
Kate, one of the nurses here is prepping for the day by filling syringes with lidocaine, which is used for numbing patients' cervixes before procedures.
Kate
The morning is the stressful part of the day for the front desk staff. And it's chill for us back here and then it kind of switches around 11am or so. Noon, it starts getting really crazy back here and it chills out up front. We'll probably be doing between 15 and 20 procedures today, depending on how many people show up. So in the morning, it's like the quiet before the storm and then they all arrive in a hoard.
Ali Block
On the other side of the hall, Catalina one of the medical assistants is prepping the procedure rooms.
Catalina Moreno-Hernandez
You can follow me we're just kind of setting the OR rooms right now... Thank you so much. So setting up just making sure that we connect all our machines, get everything ready. Set up the basics for the day.
Ali Block
On a day like today, I'm usually there with another doctor from out of state and a handful of nurses, medical assistants, and other staff. We'll see anywhere from 30 to 60 patients – about 20 to 30 for medication abortions who receive a pill and pass their pregnancy at home, and 15 to 25 for surgical abortions. These days, about a third to half of our surgical abortions are D&Es – procedures for people 14 weeks and beyond. At the clinics where I've worked in blue states, there are at most one or two second trimester cases a day. At Trust Women, the rates of later procedures are much higher, because of all the delays patients experience in accessing care.
The back area of the clinic is where we're hanging out all day charting, seeing patients, and drinking coffee. There's a small lab for patients to get their hemoglobin levels checked and other lab tests, two curtained-off areas for ultrasounds, and a central counter where all the clinicians buzz around and shuttle patients from one area to another.
Catalina Moreno-Hernandez
I'm usually the gal that they call anytime we have a patient that has very high anxiety or needs more emotional support.
Ali Block
This is Catalina again.
Catalina Moreno-Hernandez
I'm the best hand-holder you'll find here at the clinic, I want to say. So they usually always call me to come in here. They're like, "Cat, we need you in OR1." and I'm like, "I'm on it." And I just kind of coach patients through their breathing, reassuring everything is safe, everything is okay. Making sure that they feel at ease.
You'll usually get very high blood pressures because of the nervousness and anxiousness. I do have a lot of patients that, you know, also come in very shut down, don't really want to talk or anything. Then once the procedure is over, it's just a flood of tears because of the relief. And one of the things that I've learned is not like everybody comes in mad or not wanting to talk. It's just they're carrying so much. And then you'll see that, after their procedure's over, that they're just like, (exhales).
Ali Block
This is what makes Catalina so upset about the anti-abortion protesters outside the clinic.
Catalina Moreno-Hernandez
There's patients that when I do their intake, that they're like, "Oh, yes, they were clinging on to my car," or they're scared because they take pictures, and they're from Texas, and they're afraid that they're going to get reported. So it's... These patients just come in already... their minds are so full, and then they have to deal with the protesters and the harassment that they get from them.
I always want to go back home, I just want to make it safe through the day help patients and get home safely to my cat, and my daughter, my husband. Yes, she is seven. She, yeah, she just tells me you know, "Be safe, Mommy." Because there have been times where my husband has had to bring me to work with my daughter. And I just tell her, you know, cover your eyes. It's just an ugly truck outside. Once we get onto the parking lot, you can open them, just to try to protect her from seeing those graphic images. Yeah.
Ali Block
The morning is pretty quiet with everyone taking care of their own tasks until the morning huddle with all the medical staff.
Staff member
All right, we're gonna huddle everybody, right?
Christina Bourne
At 9:30 we do a team huddle and just start to talk about some of our cases that might be harder, maybe I'm concerned about, and do like a little bit of brief teaching. Like, why do I care that this person's had five C-sections? Why do I care that this person has like, you know, a history of an ectopic pregnancy, things like that.
You know, people in this region are not young and healthy, quote unquote, as most people kind of like view abortion care. These are Medicaid non-expand states. These are states that experience a severe amount of systemic disenfranchisement and the ramifications of a racist society. So, like people have a lot going on medically.
Ali Block
Ever since S.B. 8, and now Dobbs, morning huddle has been even more important than it used to be. Trust Women staff is operating at near full capacity every day, and so the efficiency of their systems are paramount. On top of this, patients are traveling farther than ever to get there. Up to 10 or 11 hours each way. Follow up appointments are no longer an easy option. At this point, the clinic staff operate like a finely tuned orchestra. And while the doctors like me and Christina are there to provide abortions and offer our clinical expertise, the conductor of this whole show is Ashley, the clinic director.
Ashley Brink
I'm one of those people that's like, I love to complete a task and then I'm like, "Okay, check it off. I did it." And running an abortion clinic is a never-ending... Like fix one problem, three more pop up.
Ali Block
Ashley grew up in Kansas and worked at Trust Women from 2013 to 2016. Right after the clinic first opened. Their office is papered floor to ceiling with pro-choice posters. And on any given day, there'll be in their usual uniform, a pro-abortion T-shirt and scrub pants. When they got offered the job as clinic director, they were living in Colorado and working at a Planned Parenthood.
Ashley Brink
I had no intentions of ever moving back to Kansas. My partner got into law school in Kansas. And I was like, "Okay, have fun at law school. I'll be in Denver. I'll see you on the holidays." And a month before he left for school, one of our executive directors who I worked with when I worked here previously, called and said, "What are you doing and do you want to be my clinic director in Wichita?" We had just resigned our lease like we had, like we had, I had no intentions of leaving. For me, when your community asks for help, when your community calls you back, you got, you have to do it.
Ali Block
That was two months before S.B. 8. So, like Christina, Ashley arrived just as things were blowing up. They didn't feel prepared.
And then nine months later, Roe fell.
Ashley Brink
Like we had no staff when I came in. Now it's huge. But yeah, I had to do what I had to do to get us through. Those days were dark days.
Yeah, I was like, this is the thing we've been talking about. This is the thing we've been fearing for the years and years, you know, since I've started doing this work. And knew it was coming, when it came. I had two staff members in my office and I was just like, "Okay, y'all," and we had patients that day, we had patients in the building, and I like walked out and told the staff, I was like, "Hey, like, take the time you need right now, like this doesn't change what we're doing today." And we put all of our energy into seeing the patients that were in our building.
Ali Block
And at that point, Trust Women only had six staff members and only a few were full-time. It was one of two abortion clinics in Wichita, one of five in Kansas, and Kansas had suddenly become the only state among a sea of red states in which abortion was legal. Ashley knew they needed to jump into action immediately.
Ashley Brink
Thankfully, I have a lot of friends in the movement, sadly, that work at clinics that can't operate and provide abortions anymore. And so they've been able to like, give us some of their medications or equipment and such. I was like, "Is it too soon to text?" Like, "Can I have your shit?" Like, "Sorry! Sorry about what happened! And can you help us? Look at me, can we have some of your stuff?"
The number of patients we're seeing is more than we've ever seen before. It used to be maybe 150 patients a month, 200 maybe was like a lot. And we're over 500 pretty consistently now. Before, you know, they were all from Kansas with like a trickle from surrounding states. And now two-thirds are from Texas, with a smattering from all the other southern states. And we might get less than 100 patients from Kansas a month now, like 80. And we're in Kansas. So, where are they going? You know, to Colorado, Illinois, when some of them probably just live right down the street from this clinic. And they have to go to another state because they can't get an appointment here.
Receptionist
And how many...? Four weeks, so you're six weeks exactly today. When she, OK...
Ali Block
Every patient who comes through Trust Women has to first make an appointment over the phone. The call center is a small room with a couple of phones and two people sitting at desks answering them. In the corner, a kid home from school plays on an iPad. The lines are always busy. They put the rings on silent to help with the noise. But on each phone, there's four red lights that constantly blink, which says there's always someone else on the other four lines.
Receptionist
Of course. Yes, ma'am. The 14th of February at 12pm. Of course, you have a good one, bye.
Jessica Yung
Is it a really busy day on phones?
Receptionist
Um, not too crazy. Usually I've seen busier days. But today it's pretty steady, which was nice.
Jessica Yung
Like the red is constantly going.
Receptionist
Yeah, for sure. But usually, I believe our director said that we get about 16,000 calls per day. So that's fun. But we definitely try our best. The sound is very low on these phones, but I can still hear it like in the back of my head sometimes. So that's fun.
Jessica Yung
You can hear it?
Receptionist
Sometimes. Trust Women, how can I help you? Si, como...
Ashley Brink
We know that we're not, we're meeting a need, we're not meeting the need. I had six to eight staff members, some were part-time and some are full-time. And now we're up to like 23 or 24 staff members. So we've tripled the staff, but 16,000 I don't have the staff for that. No one has the staff for that. I need a bigger building. I need a bigger parking lot. We've had to get more like seating in our building because like there just weren't enough chairs. It's just like, every time I brought on new staff, I'm like, now I don't have enough computers. Now I don't have enough desks. So people were sharing like we don't have enough phones. Like it's just like nothing is ever, it feels like nothing is ever enough.
Zack Gingrich Gaylord
And then this is our admin and up here.
Ali Block
This is Zack again.
Zack Gingrich Gaylord
So they just check in all the patients, answer phones.
Ali Block
By midday patients from all around the country are arriving. Insurance and Medicaid are banned from covering the cost of abortion care in Kansas except in very limited circumstances. So, like so many clinics across the country, Trust Women relies on independent abortion funds to cover costs for patients who aren't able to pay themselves. This requires constant behind the scenes fundraising, not just to make sure that patients can get affordable abortions, but also to ensure that everyone at Trust Women gets paid a fair wage.
After patients check in, they make their way to the first of three waiting rooms. Each one is intended for patients at a different step in the day. Yet another example of the systems designed to accommodate as many patients as possible. Each room is decorated with encouraging posters, free snacks and aromatherapy sticks.
Zack Gingrich Gaylord
We have the third waiting room.
Molly Rose-Williams
That's so sweet.
Zack Gingrich Gaylord
Yeah, we're looking at a TV with a fish on it.
Ali Block
The Trust Women staff have done their best to create a refuge from the storm beyond their walls. But the push and pull of state regulations still finds its way in.
Zack Gingrich Gaylord
At first, when you come back here, you get a consult. And then you'll go to the first waiting room we saw. You have an ultrasound. And at that point, you have to wait half an hour, before any procedure or getting your medication or anything. That half an hour is state-decided that you needed some time to like really marinate on it.
Ali Block
Abortion is banned in Kansas after 22 weeks, patients have to wait 24 hours after an initial counseling session before undergoing a procedure. And then again for 30 minutes after their ultrasound. On top of this, Trust Women is seeing more complicated cases, like second trimester abortions for people who weren't able to get care in their own states. And so are accessing care weeks, if not months, past when they normally would have.
In clinics where I've worked in less restricted states, when a pregnant person with a complex medical history shows up, there's a pretty low threshold to refer them out to a higher level of care. Maybe there's someone in their second trimester with a history of C-sections, or they have anemia with a low blood level, or even just someone with diabetes on insulin. All of these conditions can pose a slightly higher risk in the procedure. So when there's a major medical center with resources nearby, it's easier just to refer them out.
In Kansas, there's nowhere else to go. So the Trust Women staff need to make a judgment call. Go ahead with the procedure, if it feels safe, or turn the patient away, knowing that they may not be able to access the care they're seeking without a long, expensive journey to a less restricted state. All of this against the backdrop of a building that has definitely seen better days.
Ashley Brink
I feel like every day is a new thing. There have been times I've walked in and there's like, truly, in this hallway like this toilet overflowing and water on the floor. I've come in and there have just been like tiles that have broken because there was like a small pinhole leak in a pipe that was leaking through the wall. Like you can't make it up. Like, it's just like, it's old. And so just like any old building, it has things that need to be fixed and updated. And, you know, things break, like heaters.
Ali Block
And, sure, that stuff is to be expected. But it's so much harder when you're an abortion clinic in a hostile environment.
Ashley Brink
I mean, we've been through almost every plumber in town, every electrician, like a lot of times the protesters will harass them coming in and out and if they see they have their logo on their truck, then sometimes the protesters will call their place of business. And just, "Why are you working at the abortion clinic?" Those harass... those like contractors, and some of them just won't work with us anymore. And not because they don't believe in what we do. Sometimes that's what it is. But it's because they don't want to keep getting harassed. They don't want phone calls and like their staff to get harassed, which like I get, and also like we deal with that every day.
We've even had like Uber drivers refuse to pick patients up here. We've had DoorDash refuse to deliver here. They've had to like send it back and get another delivery person to deliver it. Like I remember when I used to work here before. There was like one food place in town that would deliver to Trust and it was Jimmy John's, no one else would. Pizza Hut. It didn't matter. No one would deliver to us, but Jimmy John's. So we all ate a lot of Jimmy John's for a long time. Jimmy John's every day – all day, every day. I'll never eat it again.
Ali Block
Honestly, after the security trainings, the constant heckling from anti-abortion protesters and daily stories from the staff about how their jobs impact their personal lives, it can sometimes feel like a fluke that abortion care is still legal at all in Kansas.
Zack Gingrich Gaylord
Kansas currently has a fairly robust protection for abortion care in our state constitution. And that was decided by the court case Hodes & Nauser versus Schmidt.
Ali Block
The 2019 decision was made based on an arcane constitutional article written back in 1861.
Zack Gingrich Gaylord
In the state constitution, Kansans have a right to bodily autonomy, and they viewed that as also a right to abortion care. So it's very difficult for the legislature to pass or enact new restrictions on abortion care.
Ali Block
That means that the most limiting and restrictive TRAP laws can't take hold in Kansas, and the right to abortion remains protected for now. But it's also created Trust Women as an unlikely and under-resourced abortion care haven, wholly dependent upon, while also antagonized and attacked by, the very community they serve.
Against this backdrop, the Trust Women staff have needed to figure out how to respond to an unprecedented change in how they do their work. As part of this process, they've needed to have some tough conversations.
Ashley Brink
We as a team decided that we would never prioritize anyone's abortion over another. In this movement, there's been a lot of judgment placed on the validation of whose abortion is more important, whose abortion is more valid or morally just, and we're not in the business to do that. And so our policy became really first-come-first-serve. Even with that policy, we know that the people who are still going to be able to get appointments are the people who can afford to call, and redial, and redial, and redial. They have a friend, and a parent, and a partner who can call, and call, and call at the same time for them. You know, the people with privilege are still going to be people who are getting appointments over others, because they're not working. Oh, sorry, one second.
Beau
Some of protesters came into the parking lot. They followed a car in here. I've stopped calling the police.
Ali Block
That's the security guy, Beau.
Beau
But I'm gonna go ahead and ask him to wait somewhere else.
Ashley Brink
Yeah, I'm cool with that. I'll come out and we'll gameplan.
Beau
OK, and I'll have that guy leave.
Ashley Brink
Yeah, yeah. Cool. Thanks, Beau. Oh, hold on, no, one second. Yes? You're okay.
Madison
He's here! Oh, your face... I started crying!
Ashley Brink
I'm finishing up a call. I will go and talk to you in a minute. I love you, Madison.
Her nephew just got born. So she's like, I'm crying. I was like, ok I'll be out in a minute.
Ali Block
Part of the clinic's response to Dobbs has been the policies and systems they put in place. But maybe a bigger part has been a massive internal culture shift.
Zack Gingrich Gaylord
Because you cannot solve it. That almost means you can do it in the way that works for you. You know, if it doesn't do us any good to do abortions 24 hours a day for two weeks if that means all our staff quits in two weeks...
Carissa
We used to not cap our schedule at all. So we would have two days a week where we just kind of went balls-to-the-wall, for lack of a better phrase.
Ali Block
Carissa, a medical assistant at Trust Women, has been here for four and a half years, and remembers intimately how things used to be.
Carissa
60, 70, 80 patients on the schedule, and we would just blindly go in and do what needed to be done. And we would leave whenever we were done – sometimes 10, 11, 12:00 at night and have to come back again the next day and do it all over again. I would be the only person in the room with the doctor doing the procedures. I would chart vitals with my right hand, and I would scan with ultrasound with my left hand.
Ali Block
Over the past few years, the Trust Women staff have been undergoing a process of radically rewriting the narrative around how an abortion clinic can run. They cap the number of patients they see in a day, increase the number of staff, all decisions made not by the doctors who work here or by Ashley, but by the staff themselves.
Christina Bourne
Our whole thing is to dismantle hierarchies and like the people that I'm their bosses of, truly are the ones that like trained me that know who I am as a person, know who I am as a provider. And I don't feel any sense of being somebody's like, boss or anything like that. Like I know the providers that work here are super solid, super good. And we've cultivated a really sweet and like precious community here. It's really cool kind of being in our clinic. It is like a whole organism, like we all like work and function so well together.
Ali Block
At the heart of this culture shift is Ashley, the clinic manager.
Ashley Brink
When I was asked to come back and like manage this clinic, that was my goal – to be able to foster a workplace that... How do you... You know, jow do you manage under capitalism? Like ew! But like doing the best that I can to like foster a place that people truly enjoyed being in.
Kate
She also just knows the ins and outs of the clinic. Like she could do pretty much everybody's role other than like, performing the abortion herself. But like every other part of the job she's had to do at one point or another. She knows how to clean the lab, you know, chart the vital signs, pretty much every aspect of the job.
Ali Block
Here's Kate again.
Kate
It feels like she really understands what we're going through. Like when we have a super busy or stressful day and we're like, "Oh my gosh, Ashley, this, that, or the other thing. Like, this is what could have made the day better." She understands that.
Ali Block
I can't tell you enough how different Trust Women is from any other clinic I've worked at. Healthcare is an incredibly hierarchical field. And abortion care is no different. That means in most places I've worked, the physicians are at the top of the ladder, despite the fact that we're often the ones in the room who are there the least. It's not uncommon for abortion providers to work one or two days a week or even per month. The staff on the other hand, the nurses, the medical assistants, the front desk, the people who show up every day are expected to live by whatever decisions the physicians or higher-ups make about how the clinic should run.
At Trust Women it doesn't work that way. When there's a decision to be made, the staff makes it. As a fly-in doctor, I'm a guest in their workplace. Working according to the systems they design. The difference is palpable. People are less burnt-out. The relationships among the staff at the clinic are incredibly close. Things don't simmer under the surface.
This intentional culture shift started before the fall of Roe, but it feels like it's been a central part of what's allowed the clinic to keep operating since then. And the reality of being an abortion provider, especially in a restrictive state, is that the hits just keep coming.
Ashley Brink
We're right now, we're dealing with the possible banning of Mifepristone. Just like anything in abortion care, we're having to like overnight pivot and figure out what our alternative to using Mifepristone is. So we've been meeting with attorneys and meeting as group to determine like what we're going to do, alternatively, if that happens, when that happens. And then we have to have like a staff in-service about the change in protocol. I'm definitely back in my, this is like, I went through like a dark three to six month period where I was like crying almost every day – at my desk. And the staff were like, "Who's gonna make Ashley cry today?" It is none of them that make me cry. It's like, the weight of everything. But like, I think this last week has been kind of like that. I've like noticed I've like cried every day. And I'm like, "Oh, no! What's going on? Where are we back here again?" So, it's fine. The, wait, like I said, the staff, we all take care of each other. We all go through the days, or weeks, or months, where we just, we're pushing through.
Ali Block
By six o'clock, there are only a few people left in the clinic, a couple patients in recovery, and a few staff wrapping things up. Dana, one of the nurses, is making sure everything is ready for the next day.
Molly Rose-Williams
How was your day?
Dana
You know, I came in later than anyone else... So it was like kind of chaotic for me because I couldn't just got thrown in. It's like, everybody's like, you know, everybody else was on go-mode. And I got in and like, "They're on go-mode. And I have to get up to their speed like right now." And I'm like, "I need some time." But, it was good though. It was good. Just get stuff done, and go home, and come back and do it again tomorrow.
Ali Block
This work isn't easy, on so many levels. But underneath the noise, the protesters, the TRAP laws, the political infighting and stigma, abortion care is incredibly special work. Dana says at the end of the day, this is what keeps her going.
Dana
I love... and this is the thing with me. I also worked in correctional nursing. I love to take care of the people that nobody wants to take care of. I want to take care of the people that are beggars, like you know, regular normal people don't treat right. I want to make sure that that person gets treated with dignity, when they come to see us, or when they come to see me anywhere I'm working. People need to be treated with dignity, no matter who they are, what background, any of that stuff. None of that matters.
And here, it's like such a personal emotional thing for them to be here. So you just want to be like the best nurse you can be for them, just the best person you can make for them. So they feel comfortable, and they don't feel bad about the choices they made. I mean, that's, you know, something I can't control. But I can sit them in the chair, I can try to make them laugh, I can get them juice, I can get them cookies, baby them a little before they leave, and make them feel warm and fuzzy. So that's what I like to do.
Ali Block
At the end of her shift, we took Dana into one of the waiting rooms. She almost never goes in there she told us because she's usually in the back helping with procedures. But we wanted to show her something we thought she'd enjoy. On the wall, there's a pinboard with handwritten notes from patients.
Dana
I don't come in here enough and I don't get to read them.
Ali Block
There's a sign that says, "Leave one, take one".
Dana
"You are powerful, you are loved. Stay true to yourself. Love yourself no matter what. Love, Anonymous-named person." Oh, wonderful. I have never read these. Okay, "Everyone is so kind and made me feel very comfortable. I love health care providers that are genuinely concerned. And it was every single one of you guys. Thank you, God bless." And that makes me happy. Right. "You are beautiful." But I guess the concept is, you can take a note or you can leave one. Or you can do both.
"You got this. Breathe." "Don't feel ashamed. Your body, your choice." "Remember to love yourself and surround yourself with those who love and support you." Just like, your affirmations beautiful affirmations. And thank you and gratitude.
Ali Block
The Nocturnists: Post-Roe America was created by me, Ali Block and Emily Silverman. Our lead producer was Molly Rose-Williams and our producers were Sam Osborn and Jessica Yung. Jon Oliver helped with the mixing and Carly Besser assistant produced. Thanks to medical student producers, Anjali Walia, Dahlia Kaki, Fiona Miller and Mulki Mehari, and pre-health intern, Treya Tompkins. Our Chief Operating Officer is Rebecca Groves. The series illustrations are by Nicole Xu. The Nocturnists theme music is by Yosef Munro and all additional music comes from Blue Dot Sessions.
The Nocturnists: Post-Roe America series was made possible in part by the Josiah Macy Jr. Foundation. The Nocturnists is supported by the California Medical Association, a physician-led organization that works tirelessly to make sure that the doctor-patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org.
Our show is also made possible with donations from listeners like you. Thank you for supporting our work in storytelling.
If you enjoy our show, please follow us in your favorite podcast app so you don't miss an episode. You can also help others find us by telling your friends and colleagues, posting this episode on social media, and leaving us a rating and review in your favorite podcast app.
To contribute your voice to an upcoming project or to support our work with a donation, visit our website at thenocturnists.com. You can also find resources with more information about the state of abortion in the U.S., as well as ways to advocate and get involved, at the series website. I'm your host, Ali Block. See you next week.