4. Uprooted
SYNOPSIS
Illustration by Nicole Xu
Leilah Zahedi-Spung never planned to leave her life behind in Tennessee. But after Roe fell, she found herself having to make an impossible decision about the future of her career. In this episode, we examine how political events can upend clinicians’ lives and communities.
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featuring
Scott Dunn, MD
Zachary Halversen, MD
Leilah Zahedi-Spung, MD
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
Audio Engineer: Jon Oliver
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 4. Uprooted
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
Welcome back to The Nocturnists: Post-Roe America. I'm Dr. Ali Block. In March 2023, Sandpoint Idaho made national news for the first time in its 125 year history.
Media Clip
“A small hospital in North Idaho is getting national attention tonight after it announced late last week that it is closing its Labor and Delivery services.”
Ali Block
Bonner General, Sandpoint's only hospital–and the only hospital for two counties in Idaho and surrounding communities in Montana and Washington–cited multiple reasons for the closure. But one of the main contributing factors, they said, was the Dobbs decision.
Media Clip
“The hospital announced the closure of its Labor and Delivery services Friday. The hospital says it's struggling to retain staff because, in part, of Idaho's anti-abortion laws.”
Ali Block
The community was thrown into disarray. Everyone had a different opinion on the matter.
Media Clip
“We Democrats raised the alarm every which way we could and said, ‘There's no health exception in this; you're going to criminalize doctors and put them in an impossible situation for trying to save women's lives.’ We knew, eventually, doctors were going to be leaving the state then.”
Ali Block
Today we start in Sandpoint, Idaho. What happens to a place when its clinicians are forced to leave? What's it like to be pushed from your home because of your work? And what becomes of the healthcare workers and communities that are left behind?
Scott Dunn
Well, the biggest impact locally has been the loss of our obstetricians, a group of four that essentially collapsed within the course of just a couple of months.
Ali Block
This is Scott Dunn, a Family Medicine physician at Bonner Health.
Scott Dunn
They were delivering 350 to 400 children a year in our hospital, and they are gone. It all just happened in the blink of an eye. After a hundred and eight years; they've been delivering babies here for 108 years. My first thought was, "Well, we can fix this. There must be a way." So I called the hospital CEO and I said, "We need to meet." "Okay," she said. "Let's get everybody together and meet," which we did the following week. And I just asked her; I said "Is this irreversible?" And she said, "No, I don't think it's irreversible." So there was some hope, and then we had a second meeting. But, the poison already had gotten in the water.
Zachary Halversen
It was a Friday afternoon, I think, I got the email. And, one of their reasons was Idaho's legal and political climate seems to be changing, and this is going to make recruitment harder. And...
Ali Block
This is Zach Halverson, also a Family Medicine doctor in Sandpoint. He works at a clinic across the street from the hospital.
Zachary Halversen
Do I think that the Dobbs decision played a big role here? I think it played a small role.
Ali Block
It turns out the hospital had been losing money for a while, and the Labor and Delivery floor was one of the most expensive and least profitable departments. The Board's most recent attempt at cutting costs had been to redefine the responsibilities of the Labor and Delivery nurses. When there were patients in labor, the nurses would work Labor and Delivery. But otherwise, they'd work in other departments. The nurses union refused.
Scott Dunn
In the week leading up to the announcement, apparently, the nurses all got a pink slip. The hospital said, "You're fired. But, we might be able to rehire you in a week or so, if we can reorganize."
Ali Block
The hospital planned to fire them, and then rehire them with legally rewritten job descriptions.
Scott Dunn
You can imagine... The nurses freaked out. I think they were also given a gag order, so that they couldn't speak out. But, you know, in a week's time, half the nurses are gone. There's like, "I'm not gonna stick around for the ship to go down."
Ali Block
Meanwhile, the legal and political pressures in the state meant that a couple of the OBs were on their way out as well.
Media Clip
“Dr. Amelia Huntsberger has delivered babies and treated miscarriages at Bonner General for more than a decade. But soon after abortion became illegal here, she saw a patient with a ruptured ectopic pregnancy.”
Ali Block
Of the four OBs, Huntsberger was the most publicly outspoken about the dangers of Idaho's trigger ban that went into effect after Dobbs. The law failed to make exception in the case of ectopic pregnancies. "A critical oversight," she said.
Amelia Huntsberger (clip)
“I knew that I needed to do what my oath requires me to do, to prioritize the safety of my patient. And I also knew that I was putting myself, theoretically, potentially, at risk of felony charges. Which would have a minimum of two years in jail, loss of my medical license for six months.”
Ali Block
Huntsberger also headed up the Idaho State Maternal Mortality Review Committee. The same week as the Labor and Delivery closure announcement, Idaho lawmakers voted to remove funding for the committee, even though Idaho's maternal mortality rates were among the highest in the country at 40 deaths per 100,000 births. For Amelia, this was the last straw.
Media Clip
“Dr. Huntsberger and her family have decided to leave Idaho.”
Amelia Huntsberger (clip)
“This isn't a safe place to practice medicine anymore.”
Ali Block
So while the Dobbs decision wasn't the direct reason behind the closure, it had created a landscape that was hostile to maternal care. For the OBs in Sandpoint, it made more sense to practice elsewhere, rather than fight a losing battle against the hospital and the state legislature. It also meant that new OBs wouldn't be moving to the community anytime soon. The chances of hiring new ones was impossibly slim.
Scott Dunn
Turns out there aren't a lot of people who are dying to come to a state where basically anybody could sue them for care that they perceive as being related to some kind of an abortion, or even speaking about abortion. There's just... There's just no obstetrics at all. If you're pregnant, fifty miles away is the referral center now.
Zachary Halversen
Bonner County itself services 49,500 people. Boundary has 12,500 and they are almost exclusively serviced by us. And then, because we're the panhandle, we're influenced by Western Montana, and Eastern Washington. So that's another 10 to 20,000 that come in here. And for this hospital to make these decisions and close the Obstetric department is criminal, in my mind.
Scott Dunn
I mean, the biggest impact really has been on the community, my colleagues. My friends, who just had to up and leave in the course of a couple months, change their lives, move their kids out of school, sell their house, you know, everything.
Zachary Halversen
They were driven out. I mean... Just feels a lot like "We don't want you to do what you're doing, so we're gonna close your shop." I don't know. I just picture a band of people from the hospital with torches and pitchforks, driving them out. I mean, that's just kind of how it feels. Right? These people that are wonderful people, and now we've just we've lost them.
My daughter and one of the obstetrician's daughters... They were best friends at school. And she was the last one to go, Dr. Morgan. You know, I mean, that hits me on a personal level too, because now... I mean, are they going to stay connected? Are they going to be able to see each other? Or is it just, "Okay, we're starting just a whole new life." It just...it just doesn't make sense.
Unfortunately, we don't have people coming and picketing. You know, the community was in shock, but there hasn't been enough localized outcry to make that change.
Scott Dunn
What I worry about is, I think... The perception is that we don't support, you know, families who are having babies. You know, that's hostile to providing care. And so it's not as attractive. And so we become a greater community. Which is unfortunate, because then you become a dying community. I worry about my daughter. She's 26. She hasn't had a family yet, but I hope she does. But not here.
Ali Block
The clinicians and people of Sandpoint are still trying to figure out what this all means for their community. And the four OBs who left, they're not alone. For many clinicians, in the wake of Dobbs, it's become impossible to disentangle the care we're allowed to offer from the kinds of lives we're able to lead. For Part Two of today's episode, we talked to one clinician who was faced with the impossible decision of whether to stay or go. Meet Leilah.
Leilah Zahedi-Spung
My name is Dr. Leilah Zahedi-Spung. I am a Maternal-Fetal Medicine physician and abortion care provider.
Ali Block
Leilah was born and raised in Georgia and left the state for the first time after finishing med school to do her Maternal-Fetal medicine fellowship in St. Louis. That's where her story starts today, at the tail end of Fellowship, with a job offer she felt she couldn't pass up.
Leilah Zahedi-Spung
It was truly my dream job. I was gonna get to do private practice, as well as work with residents. I was working four days a week. It was everything I wanted.
Ali Block
The clinic was in Chattanooga, Tennessee, at one of the six abortion clinics in the state. The seventh had been burned down by anti-abortion activists a few months earlier.
Leilah Zahedi-Spung
I knew I was moving to a restrictive state. It's not like I was disillusioned, but it was less restrictive than where I was at the time. RBG hadn't died yet; the Dobbs case hadn't been put on the docket yet. Like, things were in a very different place. And I felt like there was precedent to keep from a lot of these really restrictive laws going into place; that the Supreme Court could never, in good conscience... It's laughable now... overturn Roe. That was the best median between those who didn't want any abortions happening and those of us who feel that abortion is life-saving in every single instance. And so I felt like we were safe for a while. Safe enough.
Ali Block
At the time, abortion in Tennessee was legal up to viability, which generally happens around 24 weeks. She'd be navigating a mandatory 48-hour waiting period and a variety of other TRAP laws, but that was nothing new for her. After all, she'd done all her training in conservative states.
Leilah Zahedi-Spung
It was a community that, like, I grew up in. Right? Like, I grew up in the Southeast. I wanted to give back. That was the place I wanted to be; it was my home. Like, I am a huge football fan. I love the summertime. Like, the heat is a part of me. And I wanted to be in a place where I had a big gorgeous porch, so that I could sit and drink rosé and watch football. Like, that's what I wanted, for my kids and for me. And, so we made it happen.
I mean, it was utter chaos. I had a five-month old and a two-and-a-half-year old, and we were trying to move into this house. And it was 5 million degrees outside, because that is July in the South. We had very limited furniture. Like, it was... It was just complete chaos. It was complete and total chaos at all times.
Ali Block
They moved into their house with the big porch. And pretty soon she had her first day at the University of Tennessee. This was the first time she'd be operating as an Attending physician, without supervision.
Leilah Zahedi-Spung
It was weird. I mean, one: because I've never been on my own. Like, I was very well trained. I had exceptional mentors throughout all of my process. And I felt very comfortable. But it's, like, very weird to be on your own. I felt like an intern again. I was like, "Can I prescribe Tylenol? Because that's allowed. Do I get to make decisions by myself?"
And then on top of that, I was also doing abortion care. So I was working with a clinic based out of Memphis and was planning to travel there once a month to do abortion care. And then it became abundantly clear that I also was the only person trained to do D&Es in the entire city that I was in. Anything over 14 weeks was mine.
Ali Block
Leilah said there was just no way she could have known ahead of time what working in such a restricted place would look like.
Leilah Zahedi-Spung
I mean, it was great, I was happy to do it. I grew a ton as, like, a physician, in general. But it was like a "thrown into the deep end, figure out how to swim" kind of situation.
I remember the first time I did a D&E, and it was on a patient who... It was a highly desired pregnancy and the fetus had, like, a lethal anomaly. And I offered to do footprints. So I did the procedure. And then, you know, did the footprints, and made sure that they were perfect, because that was the only thing they were going to have their child that they wanted. And I remember the scrub tech being like, "This is so beautiful, that you can do this for patients." And she then went on to request to be in every single one of my cases. And it was like so... I mean, right? Like, this is something that I felt like was basic; what we always did for our patients, something that I have learned from the people who mentored me about how to take care of people in this space. Because abortion care is really complex. And you can know you don't want your child to suffer, and still know you don't want to continue that pregnancy, at the same time. But that doesn't mean you didn't want or love or need some closure about what that pregnancy meant for you. And so that was really beautiful to have that moment with her, and it was eye-opening to me. That, like, it was just those small things. That me honoring that pregnancy and that child meant so much to the people in the room.
Ali Block
Leilah was happy. She was getting to spend more time with her patients than she ever had before, train residents, which she loved, and work four days a week, which gave her time to be around as her daughter entered preschool and her son took his first steps. The neighbors in their small town warmly embraced them. And after two years of pandemic and eleven years of medical training, Leilah felt like she was finally living again. Meanwhile, the anti-abortion machine was churning away.
That December of 2021, Leilah got tapped to speak, on behalf of the Society for Maternal-Fetal Medicine, against S.B. 8, the newly proposed Texas law that would ban abortion after six weeks. She spoke to the crowd from the steps of the Supreme Court, testifying on how dangerous she believed the ban would be to pregnant people throughout Texas. Looking out at the crowd, she said it hit her for the first time. If this could happen in Texas, could it happen everywhere?
Leilah Zahedi-Spung
And that was kind of the first time that I was like, "Oh, God, this is real. This could happen." But I still, naively, despite the new makeup of the court was like, "There's no way. There's so much precedent. There's no way."
So I went, and I did that. And then, of course, there was nothing for months and months and months. And then the leak happened. And I was in utter and complete shock. And I was like, "Nope, there's no way they will change this." But I also, simultaneously, got a message from my co-Fellow who I trained with at Wash U, who was out here, in Colorado, at the time, and was like, "Do you need a new job?" And I was like, "No, it's gonna be fine. Why would I need a new job? This is not real."
He was like, "I don't know, Leilah. I think maybe you should think about a new job." And I was like, "No, it's gonna be fine." And he kept pushing, and was like, "Here's my division director's number, we're hiring." And I was like, "Thank you, not happening." And this was over several weeks. We, like, kept going back and forth. And then, at one point, he finally sent an email with both of us and was like, "Terry, this is Leilah, my co-Fellow. She's wonderful. I think you should talk to her." And I was like, "Damn it, like stop pushing me into this corner, to realize that I might need to make a change for my life."
Ali Block
It took a few months. But finally, Leila gave in and started a conversation.
Leilah Zahedi-Spung
I was very honest with her. I was like, "I don't want to leave my job. I love where we are. I love the residents-in-training. I love my partners. I absolutely love this community of patients and providers that I'm taking care of. I don't intend on leaving. But, if Roe gets overturned, I may need to find a different solution." And she was like, "Okay. Well, how 'bout we do this? We'll just do the interviews, and we'll wait until we see what happens with Roe." And I was like, "Okay." So I did another interview with several other people, and I told them the exact same thing. I mean, like, this was like an insane interview. Like, I literally am telling them, "I don't want the job". And they're like, "So how about the job?" And I was like, "I'm not leaving unless this very unlikely thing happens." And they were like, "Okay." So then we, like, took a break. And then, of course... I was on vacation, like so many of my colleagues in June, when the decision came down.
We were out of country. And so, once my phone connected to WiFi, I got like 200 messages. And I looked at my husband, and I said Roe got overturned. Like, I knew... I didn't have to read anything, but, like, there was no other reason for me to have 200 messages than that being the reason why. I was still very much in denial. I also didn't have a good grasp on, like, what was going to happen in Tennessee, or how that was actually going to affect how I took care of patients. Because I couldn't imagine a law that had no exceptions. I just thought that was asinine.
Ali Block
Leilah wasn't the only one scrambling to figure out what this would mean. Like many states across the country, Tennessee had a slew of restrictive abortion laws that had been passed pre-Dobbs, but had been prevented from going into effect by Roe. Now those laws were all suddenly made legal. But state courts around the country were scrambling to figure out which of the laws they could implement.
Leilah Zahedi-Spung
So, about 72 hours after Roe got overturned, our immediate trigger ban went into effect, which was a six-week ban, but it had some pre-prescribed exceptions for maternal life. And it even had in there like for pre-viable PPROM (which is where, like, the water breaks early), and a couple other things. So we had some wiggle room there, that I could still take care of people.
It was still terrifying. But then I got connected to the rest of the community within Tennessee and we started talking about the ban that was gonna go into effect and it was supposed to go into effect like 30 days after the order got filed. And it became abundantly clear to me, over those next couple of weeks, that that was a complete ban, with no exceptions.
The only protection, quote unquote, was something called an affirmative defense, which essentially is where if I had performed a life-saving abortion for someone who was, like, bleeding to death. I then would be charged with a felony, and the burden would be on me to prove to this jury of not-my-peers, of lay people, why I did what I did was to save this person's life. But I still would be charged with a felony. And, even if I wasn't convicted, I would have definitely lost my license during that time period, and my job. And no one could really tell me how they were going to protect me. So, I hired my own criminal defense attorney, like a mob boss. And she's fantastic, thankfully. But, that was the only way I felt like I could, in some way protect myself. And then my husband and I started having very difficult discussions about what we needed to do.
I had an Illinois license. So I had planned to go up to Illinois to keep my skills up; to go to an abortion clinic there and provide care, on my free time. And I was told by my lawyer and by the lawyers of the clinic that I was the most high-risk provider because I had an active Tennessee license, and I practice medicine in the state of Tennessee. And if any complications came out of what I did for patients in Illinois, despite it being legal there, the medical board could come after my license. I mean, it was just like... I was just... every turn I made, it was like a rock and a hard place.
And it was awful, because I didn't want to leave. You know, I was uprooting my kids again, for like, the second time in two years, and my spouse, but the new DA in Chattanooga was on a witch hunt. And I was sending people out of state for evidence-based medical care that I could provide, but that I couldn't do, because they weren't dying enough. It was like an out of body experience every single time.
Ali Block
Ultimately, Leilah didn't really feel like she had a choice. As a young abortion provider, in the most restrictive state in the country, there was too much to lose if she stayed.
Leilah Zahedi-Spung
And I had just started my job. Like, my career was just... I spent 11 years training to get to this point, and now my entire livelihood could be gone in a moment. Like, if you get charged with a felony, that's it. There's no more, like, new licenses, new jobs. Every single application you ever fill out for the rest of your life asks you if you have ever been charged with a felony, and that is a giant red flag. Like, I would never be able to get license or credentialed again. The analogy I kept using (because I'm a southerner who loves football), was I felt like I was like a senior quarterback who was going back for his senior season, just waiting to, like, tear my ACL, before I got to the draft. Like, just biding my time for something terrible to happen.
So, we moved out of our house three days before Christmas, into an Airbnb, which we called "The Christmas cottage" to make it wonderful for my children. We sent a lot of letters to Santa to make sure he knew where we were going to be, too. And then we moved.
I loved the community that I was taking care of there. And like, some of the best text messages I've got are from some of the chiefs who I trained, telling me like, "I did my first D&E today, because of you." And that is just not happening there anymore.
Ali Block
The abortion landscape in Tennessee was in shambles. Many providers left, and the providers who remained face the strictest laws in the country. No abortions, no exceptions, not even to save the life of the mother. Even terminating an ectopic pregnancy left a clinician vulnerable to be charged with a felony.
Leilah Zahedi-Spung
I mean, our... Our practice is doing amazing, amazing job with the hand that they have been given.
But I also left them. Right? Like, I... I left and I feel very sad about that. And like, a lot of guilt about I didn't have what it takes to cut it or I didn't... There's so many emotions wrapped up into that that, like, it's hard to even put into words. But, like, ultimately, at the end of the day, we first have to do no harm to ourselves. And I was doing so much harm to myself. I was on edge all the time. And I mean, I really wish I could have just turned it off. I mean, like, "Okay, well, that shit sucks. But like, I'll just be a regular doctor." Like, I do, so that I wouldn't have had to, like, uproot my entire life. But it's just not in me. I can't... I can't turn off that part of me. But they're suffering there. And I know that.
Ali Block
So, Leilah is in Colorado now. She has the same title, but it's very different.
Leilah Zahedi-Spung
Yeah, so I am a high-risk obstetrician here. And then I also do abortion care. And it's just so nice to be able to just provide medical care, without inserting any politician into that relationship with my patients. I don't have to talk about anybody else, other than the person who is sitting in front of me and whoever is there to support them. And we get to make a decision together, about how they want to continue the pregnancy or not. There's no timeline. I don't have to tell them something awful, and be like, "By the way, you have 20 minutes to tell me whether or not you want to do this, because we need to sign a consent form for 48 hours from now so you can come back, so we can take care of you, But, like, we're running up against a clock. Like, there's no clock. Like, it's just... I lay hands on my patients; we have a conversation, and we make a decision together.
Ali Block
It was an adjustment for her, a total culture shock.
Leilah Zahedi-Spung
My division director for complex family planning is someone who trained in many of the same spaces that I did, (Georgia and Missouri) and then has been out here. So when I'm like, "This seems wild, that we can just be like, "Oh, you want an abortion today? Great. We'll do that." Like what? In what world? And she's like, "Yes, welcome to Colorado."
Ali Block
In many ways, Colorado is a world away from Tennessee, when it comes to abortion. But even Colorado isn't exempt from the post-Dobbs fallout. Leilah told us that, in the year since the decision, patient volume at the Maternal-Fetal Medicine group where she practices has gone up eight times. Still, it's a very different world from the one she knew in Tennessee.
Leilah Zahedi-Spung
I talked with a reporter last week, who was like, "If the laws here change, would you come back?" And I said, "No. No, I can't ever go back.”
Ali Block
Leilah and her family are coming up on their one year anniversary of moving to Colorado. She says she still loves and grieves the loss of Tennessee, and misses living in the South, but has no doubts at all that coming to Colorado was the right decision for them.
And it gets easier every day. They're learning to love Colorado. Just the other day, it rained, snowed and hailed, before jumping to 90 degree temperatures the following week. And last winter, Leilah learned to ski. She may not be a Coloradan at heart, but she's learning to make a home in the place she's landed, and grateful for the opportunity to just do her job.
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.
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I'm your host, Ali Block. See you next week.