It’s 2015. I’m working as an interfacility paramedic. Currently, I’m standing in a small rural clinic in a large conservative state. I’m receiving a report from an RN about a woman who we are preparing to transport to a Level 1 trauma center.
When the EMT and I arrived earlier, the nurse had greeted us briskly.
“Female patient with a uterine prolapse,” she said. “We think the uterine wall has been perforated.”
I wince internally. My EMT, a 19-year-old guy who only just got certified last month, looks a little puzzled. I explain to him that a uterine prolapse means that the uterus has descended into the vagina. It’s pretty common, especially for older women. Far less common is the fact that my patient’s uterus has also apparently been torn.
“Did she explain how her uterus was perforated?” I ask the nurse.
“She stuck a piece of vacuum cleaner into her vagina,” the nurse says.
“Oh wow,” the EMT standing next to me gives a sort of laugh/cringe reaction. “I’ve never heard of THAT sexual kink before.”
The nurse and I exchange a glance. We’re both middle-aged women. We know the probable reason why our patient stuck part of a vacuum cleaner up into her vagina, but we’re not saying anything.
In 2015, abortion was legal, of course. The state I worked in was a conservative state, but it had abortion clinics. Most of those abortion clinics were in the larger metropolitan areas. The closest abortion clinic to the hospital where we were standing was over 100 miles away.
If you were pregnant and scared and alone and living in an underserved rural area, you may have had to resort to desperate measures to end an unwanted pregnancy. Even as early as 2013, long before the Dobbs decision that overturned Roe v. Wade, The Atlantic described an “open air bazaar” in McAllen, Texas, where poor women could purchase Cytotec, a stomach ulcer drug that can induce miscarriage.
Back in 2015, the EMT and I transferred the patient to our stretcher. She was on painkillers and almost content, but I didn’t like her blood pressure. Even with fluids running, her systolic blood pressure was in the low 90s and her heart rate was pumping at 110. “These numbers aren’t great,” I said to the RN.
“Yes, well, she’s bleeding internally,” the RN said. “That’s why she needs to go now.”
“Lights and sirens,” I told the EMT as he adjusted straps on the stretcher. He nodded solemnly but his eyes were shining. Going lights and sirens is still a rare treat for the younger EMTs.
I was glad he was excited. I just wanted the patient taken to the surgical center as soon as possible. I was keeping my eyes plastered to the portable monitor keeping track of her vital signs. Her vital signs showed her kissing the outer edge of hemorrhagic shock and I didn’t want her to destabilize further. I took another blood pressure reading, apologizing to the patient for the arm discomfort. Her pressure was slightly lower than it had been earlier, making me even more anxious.
“BEHAVE yourself!” I told the monitor silently, as if it was the machine’s fault that my patient had a pelvic bleed.
The trauma team was ready when we arrived at the larger hospital’s surgical center. They were gowned, booted and masked. To my relief they wasted no time transferring our patient onto a hospital stretcher and wheeling her into surgery. I talked to the nurse, typed out my own report and told the dispatch that we were available again.
It’s now been almost 10 years since I transported that patient. Roe v. Wade has been repealed. Infant mortality rates have gone up sharply in Texas since a total abortion ban has been enforced. Women are regularly forced to put their lives in danger over nonviable pregnancies because doctors are too frightened of going to jail for giving medical care.
Before Roe v. Wade was passed, the Guttmacher Institute estimates “the number of illegal abortions in the 1950s and 1960s ranged from 200,000 to 1.2 million per year,” and that hundreds of women died each year from botched procedures. The true numbers will never be known because the procedures (and often disastrous consequences) were swept under the rug and never officially reported. As it will in a post-Roe world, this affected poor and otherwise marginalized women disproportionately.
I have transported women who are mentally ill, women with substance abuse issues and women who are houseless to the labor-and-delivery units of hospitals. I transported one girl, no older than 16, from a McDonald’s (where she was working) to the hospital for preterm contractions.
Being pregnant is also dangerous. I have transported women whose babies were in breech position and required lights and sirens to the nearest high-risk obstetrical surgeon. I have transported women at risk for intractable seizures due to preeclampsia. I have transported one woman with uncontrolled bleeding and possible miscarriage because her husband had beaten her.
Recently, a 2021 interview resurfaced in which GOP nominee for vice president JD Vance lamented that “a bunch of childless cat ladies who are miserable at their own lives and the choices that they’ve made” want to ruin the country. The trope was echoed earlier this year by football player Harrison Butker, who delivered a commencement speech at Benedictine College where he castigated feminism as telling “diabolical lies,” speculating that the female graduates were likely more excited about “your marriage and the children you will bring into this world” than “successful careers.” Currently the low birth rates of millennials and Gen Z is a cause of concern among the far right. “Pronatalism” is the byword among influential right-wing voices like Elon Musk.
And yet, the repeal of Roe v. Wade will further influence women to become the very “childless cat ladies” whom Vance disdains. As I remember that woman lying on my stretcher, lethargic and pale, her blood pressure sinking as the ambulance zooms across the plains to get her to the care she needs in time, I can understand why. In a world where reproductive rights are under assault, childlessness is starting to become a much safer bet.
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