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Podcasts|From Serial Productions: The Retrievals

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transcript

Back to The Retrievals
bars
0:00/3:23
-3:23

transcript


FROM SERIAL PRODUCTIONS: THE RETRIEVALS

DOZENS OF WOMEN SEEKING TO BECOME MOTHERS CAME TO A FERTILITY CLINIC AT YALE. A
FIVE-PART NARRATIVE SERIES EXPLORES THE SHOCKING EVENTS THAT UNFOLDED THERE.

2023-06-22T05:00:26-04:00

[MUSIC PLAYING]

susan burton

The women are seeking fertility treatment for a variety of reasons. They’ve had
a couple of miscarriages, and they’re pushing 40. They don’t have fallopian
tubes, or they need sperm. All of them wind up at the fertility clinic at Yale
University.

They meet their doctors, get the info, start giving themselves the shots. And
eventually, they get to the day they’ve been waiting for — the day of the first
egg retrieval.

The day of the retrieval, the women arrive at the clinic. They check in on
different mornings, in different months and calendar years. None of them are
here on the same day, but they will come out of the day with the same story.

speaker 1

They started the procedure. And, you know, I was just sort of taken by surprise,
not expecting the excruciating pain. My blood pressure started going up. I was
sweating profusely and telling them I was just in too much pain, that they had
to stop. At that point, I remember them giving me more, more of the pain
medication, and me saying, it’s not making a difference.

speaker 2

I remember yelling or kind of making like, aah, and really looking in confusion
at my nurse, the attending nurse, and her saying, I’m giving you the most I can
legally give you.

speaker 3

She said that that’s the maximum that she’s allowed to give me. So she couldn’t
give me anything else.

speaker 1

At one point, they did say that I had maxed out. I couldn’t have any more
fentanyl or versed. And I was like, how is this possible?

speaker 2

How is that even — like, how am I feeling?

speaker 1

How do people go through this?

speaker 2

I remember thrusting my hips up, saying, “I feel everything.” I don’t know. But
what are you going to do? I wanted the procedure done. I just let it happen. And
I was like, I’m awake, so.

susan burton

The patients didn’t know why they were in pain. Their doctors didn’t know
either. And in the absence of information about the pain, people came up with
stories to explain it. The patients constructed stories. Staffers at the clinic
came up with theories, too. Eventually, a nurse would tell her own story about
the pain, as would Yale.

speaker 4

The Yale Fertility Clinic is not one doctor in a back alley. This is an entire
institution that’s behind it. It’s got this reputation. How do they not see that
this is happening?

speaker 1

Am I being difficult? I mean, you just question your sense of self.

speaker 5

You are treated like a hysterical woman from the second you walk in there.

speaker 2

Like, nobody believed me.

speaker 1

I felt crazy.

susan burton

In fertility treatment, you evaluate the outcome by whether you wind up with a
baby. The outcomes here are a lot more complicated for everyone.

speaker 6

Are you kidding me?

speaker 7

That’s when I lost it.

speaker 8

I could almost feel like the bomb dropped.

speaker 9

Bullshit. No harm done?

speaker 7

There’s no way I can ever look at this lady the same way.

susan burton

From Serial Productions and The New York Times, I’m Susan Burton. This is The
Retrievals, coming June 29.


The Retrievals
June 22, 2023


FROM SERIAL PRODUCTIONS: THE RETRIEVALS


DOZENS OF WOMEN SEEKING TO BECOME MOTHERS CAME TO A FERTILITY CLINIC AT YALE. A
FIVE-PART NARRATIVE SERIES EXPLORES THE SHOCKING EVENTS THAT UNFOLDED THERE.

Transcript
transcript

Back to The Retrievals
bars
0:00/3:23
-0:00

transcript


FROM SERIAL PRODUCTIONS: THE RETRIEVALS

DOZENS OF WOMEN SEEKING TO BECOME MOTHERS CAME TO A FERTILITY CLINIC AT YALE. A
FIVE-PART NARRATIVE SERIES EXPLORES THE SHOCKING EVENTS THAT UNFOLDED THERE.

2023-06-22T05:00:26-04:00

[MUSIC PLAYING]

susan burton

The women are seeking fertility treatment for a variety of reasons. They’ve had
a couple of miscarriages, and they’re pushing 40. They don’t have fallopian
tubes, or they need sperm. All of them wind up at the fertility clinic at Yale
University.

They meet their doctors, get the info, start giving themselves the shots. And
eventually, they get to the day they’ve been waiting for — the day of the first
egg retrieval.

The day of the retrieval, the women arrive at the clinic. They check in on
different mornings, in different months and calendar years. None of them are
here on the same day, but they will come out of the day with the same story.

speaker 1

They started the procedure. And, you know, I was just sort of taken by surprise,
not expecting the excruciating pain. My blood pressure started going up. I was
sweating profusely and telling them I was just in too much pain, that they had
to stop. At that point, I remember them giving me more, more of the pain
medication, and me saying, it’s not making a difference.

speaker 2

I remember yelling or kind of making like, aah, and really looking in confusion
at my nurse, the attending nurse, and her saying, I’m giving you the most I can
legally give you.

speaker 3

She said that that’s the maximum that she’s allowed to give me. So she couldn’t
give me anything else.

speaker 1

At one point, they did say that I had maxed out. I couldn’t have any more
fentanyl or versed. And I was like, how is this possible?

speaker 2

How is that even — like, how am I feeling?

speaker 1

How do people go through this?

speaker 2

I remember thrusting my hips up, saying, “I feel everything.” I don’t know. But
what are you going to do? I wanted the procedure done. I just let it happen. And
I was like, I’m awake, so.

susan burton

The patients didn’t know why they were in pain. Their doctors didn’t know
either. And in the absence of information about the pain, people came up with
stories to explain it. The patients constructed stories. Staffers at the clinic
came up with theories, too. Eventually, a nurse would tell her own story about
the pain, as would Yale.

speaker 4

The Yale Fertility Clinic is not one doctor in a back alley. This is an entire
institution that’s behind it. It’s got this reputation. How do they not see that
this is happening?

speaker 1

Am I being difficult? I mean, you just question your sense of self.

speaker 5

You are treated like a hysterical woman from the second you walk in there.

speaker 2

Like, nobody believed me.

speaker 1

I felt crazy.

susan burton

In fertility treatment, you evaluate the outcome by whether you wind up with a
baby. The outcomes here are a lot more complicated for everyone.

speaker 6

Are you kidding me?

speaker 7

That’s when I lost it.

speaker 8

I could almost feel like the bomb dropped.

speaker 9

Bullshit. No harm done?

speaker 7

There’s no way I can ever look at this lady the same way.

susan burton

From Serial Productions and The New York Times, I’m Susan Burton. This is The
Retrievals, coming June 29.

Listen 3:23



Previous
More episodes ofThe Retrievals
August 3, 2023  •  53:49‘The Retrievals,’ Episode 5: The Outcomes
July 27, 2023  •  38:00‘The Retrievals,’ Episode 4: The Clinic
July 13, 2023  •  46:39‘The Retrievals,’ Episode 3: The Sentence
July 6, 2023  •  33:03‘The Retrievals,’ Episode 2: The Nurse
June 29, 2023  •  56:31‘The Retrievals,’ Episode 1: The Patients
June 22, 2023  •  3:23From Serial Productions: The Retrievals
See All Episodes ofThe Retrievals
Next
Published June 22, 2023Updated Aug. 15, 2023
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Hosted by Susan Burton

Produced by Susan Burton and Laura Starecheski

Edited by Laura Starecheski and Julie Snyder

Original music by Carla Pallone


LISTEN AND FOLLOW ‘THE RETRIEVALS’
APPLE PODCASTS | SPOTIFY | STITCHER | AMAZON MUSIC

--------------------------------------------------------------------------------

The patients in this story came to the Yale Fertility Center to pursue
pregnancy. They began their I.V.F. cycles full of expectation and hope. Then a
surgical procedure called egg retrieval caused them excruciating pain.

Some of the patients screamed out in the procedure room. Others called the
clinic from home to report pain in the hours that followed. But most of the
staff members who fielded the patients’ reports did not know the real reason for
the pain, which was that a nurse at the clinic was stealing fentanyl and
replacing it with saline.

From Serial Productions and The New York Times, The Retrievals is a five-part
narrative series reported by Susan Burton, a veteran staff member at “This
American Life” and author of the memoir “Empty.”

Burton details the events that unfolded at the clinic, and examines how the
patients’ distinct identities informed the way they made sense of what happened
to them in the procedure room. The nurse, too, has her own story, about her own
pain, that she tells to the court. And then there is the story of how this all
could have happened at the Yale clinic in the first place.

Throughout, Burton explores the stories we tell about women’s pain. How do we
tolerate, interpret and account for it? What happens when pain is minimized or
dismissed?




--------------------------------------------------------------------------------


LISTEN TO THE RETRIEVALS




EPISODE 1: THE PATIENTS

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Back to The Retrievals
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0:00/56:31
-56:31

transcript


EPISODE 1: THE PATIENTS

susan burton

The women are seeking fertility treatment for a variety of reasons. They’ve had
a couple of miscarriages and they’re pushing 40, they don’t have fallopian tubes
or they need sperm. One woman has a diagnosis that’s like a metaphor from
feminist sci-fi, a uterus with a single horn like a unicorn. All of them wind up
at the fertility clinic at Yale University.

A couple of the women choose this clinic because they work at Yale and that’s
what the Yale Health plan covers. Others go to Yale on the recommendation of
their doctors. But in Connecticut, you don’t even really need the
recommendation. Yale medicine, it’s a blue chip medical brand.

allison

You know, Yale is just a huge name. And you just think anything that has
anything to do with Yale is going to be the best of the best.

julia

It’s really not close to our house. It’s not where I would have gone. But we
figured, another doctor from another hospital said this is the best you can get.
And you want — of course, you want that.

susan burton

To some of the women, the clinic seems to live up to its billing. They like
their doctors, feel cared for by them. “That man is an angel,” one of the women
tells me. “He is by far the best doctor I’ve ever had.” Others are not happy at
the clinic from the start. It’s things like feeling like a number or issues with
communication. There’s a lot to communicate.

You don’t know how hard fertility treatment is until you get into it. And once
you start it in one place, it can be difficult to go somewhere else. So they
talk themselves into staying. That’s the first thing they go against their
instincts and talk themselves into.

The women drive to the clinic before work in the morning for blood draws and
then wait for the afternoon email from their nurse team. “You really have to
trust your nurse team,” one of the women tells me. At this point, she did. The
nurse team gives instructions and the women give themselves shots. These shots
contain hormones to stimulate the body to produce eggs. A side effect is
emotional volatility.

“The wind is making me cry,” one of the women says. But the thing is, you have
to stay calm, don’t get stressed. It’s so stressful trying not to get stressed.
One woman uses a fertility meditation app called Expectful. She does her guided
meditation on the beach. The app plays the sound of waves while the real waves
heave in the background. It’s absurd, but so much of this is absurd, including
the money. There’s all kinds of stuff that’s not covered no matter what
insurance you have.

Meanwhile, your ovaries enlarge and you get so bloated that your abdomen feels
like bricks. And then finally, you get to the day you’ve been waiting for, the
day of the first egg retrieval, which is what it sounds like. The eggs are
removed from the body and then fertilized or frozen, depending on what you’re
doing.

How many eggs am I going to get? That is the big question. The more eggs you
get, the better your chance of a healthy embryo, a viable pregnancy, a child.
The day of the retrieval, the women arrive at the clinic. They check in on
different mornings and different months and calendar years. None of them are
here on the same day, but they will come out of the day with the same story.

Laura arrives for her retrieval on a weekday morning in January 2020. She checks
in and changes into a gown. Two months ago, Laura was diagnosed with breast
cancer. A double mastectomy followed, then an infection and additional
surgeries. As soon as she freezes her eggs, she’s going to start treatment. It’s
a lot. Laura is trying to put all of that to the side and just focus on the
procedure ahead.

laura

was excited, like trying to stay positive. And I was just like, having been
through so much just the month prior, I was like, this is going to be easy.
Because I had been through so many surgeries and procedures, I was just like, I
know what this is like. I know what it’s like to be under anesthesia or
something and be given medication so you don’t feel things.

susan burton

The egg retrieval is a surgical procedure. A long needle is inserted into the
vagina, then pierced through the vaginal wall and up into the ovary. Laura has
been told in advance what drugs she will be getting during the procedure.

laura

Two drugs, fentanyl, and another one, midozalam or zalam. And I believe that
one’s to induce sleepiness.

susan burton

Together, these two drugs offer what’s often called moderate sedation.
Basically, the fentanyl takes away pain and the midazolam relaxes you. Some
people get drowsy with this combination. Others remain alert. The use of
fentanyl surprises some of the women. One of them, a public defender, has seen a
lot of clients messed up by fentanyl, and for a second, she’s worried. Another
woman, Katie, a neuroscientist at Yale, feels a spark of interest.

katie

And in fact, just being someone who studies addiction and studies some opioid
use disorder and as a curious person, I remember the morning of thinking, like,
OK, this will be interesting. I’ve never tried fentanyl before. So I expected to
go in and have twilight anesthesia, not full anesthesia, but not feel anything.

susan burton

The women complete the last steps before the procedure, get an IV, go over some
papers. If their partners came back with them, now their partners say goodbye.
And then it is time. The women tell what happens next.

laura

I walked myself into the procedure room because you get rolled out afterwards,
but you don’t have any medication in you. You’re just kind of hooked up to the
IV pole. And I walked into there, and you get on the chair or table, whatever
they call it. And that’s from there, they said, you’re not going to feel
anything. And they explained everything that was going to happen.

They started the procedure. And you know, I was just sort of taken by surprise,
not expecting the excruciating pain, and just letting them know that I don’t
think the pain medication is doing anything. It really feels like you’re
stabbing the needle.

angela

I felt everything.

It’s literally your most intimate parts of your body. They’re using these long
needles. And there’s also a screen so I can watch what they’re doing. And I
couldn’t. I had to try and look away because literally, each needle pierce you
feel.

lynn

As we were moving along, it was my blood pressure started going up. I was
sweating profusely and telling them I was just in too much pain, that they had
to stop. At that point, I remember them giving me more of the pain medication,
and me saying, it’s not making a difference, a nurse coming over and putting a
wet towel on my head, and another nurse holding my hand, and them comforting me
and saying, you know, you’re going to be OK.

angela

The nurse who — she was at the top of my body kind of at my shoulders, wiping
the tears away and helping me kind of hold my breath to keep myself still so
that the doctors didn’t slip with the needle, and just telling me that I was
going to be OK, that I was going to get through it.

And up until that moment, I’m so excited. Like, oh, I have 24 follicles. Like,
this is great. Like, I’m going to have a great egg retrieval. And then you’re
like, oh my god. I wish there was only one. Like, everything was counting on
that retrieval and that’s how it feels, like, the weight of your world. My
partner and I — she’s counting on me to be able to get through this and to have
this successful retrieval. And all I’m feeling is, oh my god. I need it to stop.
Is this worth it?

lynn

And you know, your feet are in the stirrups. And you know, you’re supposed to be
laying on the table, but I remember tightening up and just trying to relax my
body so that they could do what they needed to do, because I was so tense that
like, my bottom was almost off of the table.

laura

I remember like thrusting my hips up, actually thrusting my hips up saying, I
feel everything. Like, and like, nobody believed me. And it’s just like — I
don’t know. But what are you going to do? I wanted the procedure done. I just
let it happen. And I was like, I’m awake, so —

katie

No. You know, I was stone cold sober and awake. And I remember, the egg
retrieval, they kind of do them one by one or like a couple at a time, my
impression. And so you have moments in between pain to say like, what the fuck
is going on?

laura

I do remember, I think I swore. I was using curse words because it was just so
painful.

lynn

I don’t know if I can do this any longer.

laura

You know, you just have to get through it. It’s going to be over before you know
it.

melissa

OK, this is going to be over eventually.

lynn

You can do this. You can do this.

angela

You just want this moment to be over.

lynn

Get through it. Get through it.

katie

I remember yelling or kind of making like, ah, and really like looking and
confusion at my nurse, the attending nurse, and her saying, I’m giving you the
most I can legally give you.

melissa

She said that that’s the maximum that she’s allowed to give me, so she couldn’t
give me anything else.

lynn

I’m almost certain that at one point, they said that they had given me all of
the pain medication that they could give me.

angela

At one point, they did say that I had maxed out. I couldn’t have any more
fentanyl or versed. And I was like, how is this possible? ^LAURA^ How is that
even — like, how am I feeling this?

How do people go through this?

laura

I can feel that. Like, I could feel the — I don’t even know how to describe
that. Like, you can just feel them inside of there. As a woman, we’ve all been
through things with those kind of doctors and stuff. But like, this is just a
pain. It’s hard to even explain what it felt like.

susan burton

This is hard to do, but could you describe the pain that you felt?

katie

Oh gosh.

It felt like someone was like ripping something from the inside of your body.

susan burton

Yeah, which is —

katie

What they are doing, yeah. That’s what it felt like.

susan burton

Yeah, oh, I’m sorry.

katie

But I remember almost immediately thinking, or almost daydreaming in that moment
that the attending nurse had one tube going from my IV into my arm and another
tube going from my IV into her pocket. Like, it occurred to me almost
immediately that the nurse was stealing the fentanyl.

And I remember telling my friends after the procedure, my friends who were aware
of what I was going through, but who are also colleagues at Yale in addiction
research, I remember telling them like, the nurse is stealing the fentanyl,
because it seems so obvious to me. I mean, fentanyl is the most diverted drug in
medical settings. It’s like a now major driver of the opioid crisis. And it was
just really easy to imagine that someone with access to poorly controlled
fentanyl would be abusing it.

susan burton

That’s so fascinating that that’s the image that raised itself up for you,
because it is so evocative.

susan burton

Because it is so evocative, and also, because it was true. A nurse at the clinic
was stealing fentanyl, not Katie’s nurse, not the tube in the pocket. But a
nurse at the clinic was stealing fentanyl and replacing it with saline. She did
so undetected for months, which meant patients weren’t getting fentanyl in their
IVs. They were getting saltwater instead.

archived recording 1

Drug addicted former nurse is sentenced for a crime that caused unbearable pain
to dozens of women. The nurse stole drugs and then replaced them with saline
solution —

archived recording 2

Connecticut nurse admits that she swapped out anesthesia drugs for saltwater,
causing excruciating pain to women during infertility treatments.

archived recording 3

It happened at a top-rated center affiliated —

archived recording 4

Coming to you tonight with a horrible story about the extremes a fertility nurse
struggling with drug addiction took to get her fix.

susan burton

A federal investigation determined that as many as 200 patients may have been
victims of the substitution over five months in 2020. Lawyers for some of the
patients believe the real number is higher and this went on for longer. I’ve
talked to a dozen patients who believe they were victims of this. 11 of them are
plaintiffs in a lawsuit against Yale, and their lawyers were present when we
spoke.

When I started doing these interviews, I was struck by the echoes in these
women’s stories. To me, it sounded like a chorus of women saying, something is
wrong here, again and again. The patients wondered how the clinic could have
failed to detect this. And the conversations I was having made me wonder that
too.

And then I began talking to other people, staffers who’d been there, and I
learned about what went on behind the scenes. The staffers I spoke to were
horrified by what the patients had experienced. They were grappling with their
own questions about how this had happened, about what had gone amiss.

The patients didn’t know why they were in pain. Their doctors didn’t know
either. And in the absence of information about the true cause of the pain,
people came up with stories to explain it. The patients constructed stories
about why they felt pain. Staffers at the clinic came up with theories too.
Eventually, the nurse would tell her own story about the pain, which would
launch a whole new set of stories, the ones her friends and family would come up
with, the one that would get argued in court, the one Yale would tell. And all
of these stories revealed something about women’s pain, how it’s tolerated,
interpreted, accounted for, or minimized.

In fertility treatment, you evaluate the outcomes by whether you wind up with a
baby. That’s the metric by which success is measured. It all went well if you
leave with a live birth. The outcomes here are a lot more complicated for
everyone. From Serial Productions and “The New York Times,” I’m Susan Burton,
and this is “The Retrievals.” This is episode one, “The Patients.”

[MUSIC PLAYING]

When the retrieval is over, the women are wheeled out to the recovery room. And
one of the first things that happens is that they try to come up with an
explanation for their pain.

laura

They put you into the recovery room. And that’s where you meet with whoever you
were with. And I just remember, that’s when I had my phone back and I was
texting my sister-in-law, because she was my confidant for all of this, having
been through that. And she was just replying, like, oh my god, how could you —
what do you mean you felt everything? And I was just explaining to her, I’m
like, I don’t know what’s wrong. And one of the texts I said, I said, I think
I’m immune to fentanyl, because I was like, I don’t think it works on me.

susan burton

“I’m not sensitive to fentanyl,” is a common theory.

lynn

And I remember when the procedure was done, my family sort of — we have a family
text that’s ongoing. And I just remember texting them that you know, it’s hard
to believe that we have a fentanyl epidemic where people are addicted, because
it did nothing for me.

susan burton

Not all of the women were alert during their procedures. Some were more deeply
sedated. They were so out of it during the retrieval that they don’t really
remember it, or only kind of. The pain hits when they come to.

leah

It was bad instantly. And it shouldn’t really be bad instantly. Like, you
shouldn’t wake up and be in horrific, like nightmarish pain. But I woke up and I
was — I mean like, it felt like someone had been inside me and gutted me. Yeah,
it was like a gutted feeling. It was someone had been inside me, scraped me
hollow, it was burning.

susan burton

In a way, it is more confusing for the wake up later patients. They’re not
matching each stab of pain to the needle on the screen. It hurts a lot, but it’s
less explicable, and because of that, scarier.

allison

Your mind just goes to the worst possible places. You know, I’m thinking, am I
bleeding? Am I bleeding internally? Is this like, a pain is — normally, a pain
is a sign. It’s protective, right? It tells you something’s wrong.

susan burton

There’s a lot of uncertainty in the recovery room, an elevated blood pressure, a
nurse running around to get ginger ale, a doctor coming by to say, there are
fewer eggs than we expected. Are you sure you only want us to fertilize half of
them? It’s all just very overwhelming. And on top of it, some of the women feel
like they’re being rushed out of the clinic. Julia is one of them.

julia

I remember vomiting. They were giving me some fluids. I was very uncomfortable.
There was no way I could walk. They put me in a wheelchair and wheeled me out.
And I just had this feeling like, this is not right.

susan burton

Julia is 31 years old and already a college professor. This morning when her
husband drove to the clinic, she’d been frantic. There was work on a bridge near
their house and they got stuck. There’s only a short window to retrieve the eggs
before you ovulate them, and Julia was worried she would miss it.

When she arrived at the clinic, she felt a huge relief, like, we made it, both
we made it on time and we made it to this day. Now, she’s feeling something she
never expected. At home, she goes upstairs and gets into bed.

julia

I fell asleep for a little while, and then I woke up. And I was nervous. We had
a babysitter here watching my daughter. And I just wake — you wake up, you’re
like, oh my god, who’s with my kid? I need to — and I walked a few steps to try
and go down the stairs. And I realized I really had gone too far from the bed.

By this point, the pain was excruciating, I would say. And I turned to go back
to lay down on my bed again. And I mean, I don’t remember this, but I blacked
out or passed out. And I woke up on the floor. And I kind of busted my lip open.

susan burton

Julia calls the clinic, and they tell her that she should go to the ER. She’s in
so much pain that she can’t bend enough to get into a car. An ambulance is
called. And when Julia gets to the hospital, they check her out. The retrieval
is a safe procedure, but things can go wrong. Your ovary can strangulated. A
major artery can get punctured.

But none of the obvious things are wrong and nobody can explain what is. Back
home over the weekend, Julia calls on-call doctor at the clinic multiple times.

julia

By Sunday, I sort of got the sense I was annoying him.

susan burton

Julia keeps waiting for a call from her official doctor. By Tuesday, she still
hasn’t heard from him.

julia

It was impossible for me to understand how he hadn’t called me by this point.
But I called his office on Tuesday basically saying, I need to talk to you. I
wrote down what he said, and I’ve kept this note since that time. He said he was
not alarmed, but perplexed and surprised at my experience. Those words I guess,
ring pretty hollow now, right, knowing that there was a pattern of many women
who had extreme, inexplicable pain after the egg retrieval.

susan burton

What did you make of that language like, in the moment, perplexed and surprised?

julia

It was — I mean, I guess I felt crazy. I mean, I felt — I mean, by this point,
I’m asking myself like, am I being difficult? I mean, am I — I mean, you just
question your sense of self, like your ability to assess your situation
rationally, which is very disconcerting when that happens, because at least at
the end of the day, you have that, right?

You start thinking about your whole life, right? Like, I’m a pretty high-energy
person. Like, I take care of a toddler. I have a PhD. I have a job. Like, I run
marathons in my free time. Like, you have all these parts of your life that make
you feel — that give you this sense of who you are. And then I just felt like
they were treating me like I was nuts for still being in pain and just having
what I would call a difficult time.

I just left the office, I mean, crying. I just felt like nobody, nobody cares.
That’s the way I would describe how I felt in the days after, like nobody gives
a crap that this was so hard for me.

susan burton

In the days after the retrieval, other patients live out versions of the same
story. They also call the clinic. They ask, is this normal? They say, the
Tylenol isn’t helping. At home, they’re laid up on the couch. They can’t pick up
their toddler. They wonder if they really should have scheduled themselves for a
shift the next day.

[MUSIC PLAYING]

Not all staffers at the clinic are dismissive. But even when they respond with
concern, there aren’t any real answers. Some of these conversations take place
days after the procedure, like at follow ups to talk about next steps.

lynn

You didn’t really talk to the office until day five or day six, which is when I
found out that none of the eggs had survived, none were healthy enough to go to
testing. And we had to talk about moving forward. And that’s when I really
expressed my sort of shock that the procedure was as painful as it was and
talked about, if there were other pain management protocols that could be
considered at that point. And I was told that that was the best pain medication
that was available. And my doctor prescribed me an anxiety medication to take
before the next procedure.

And I remember saying to my husband, you know, I think it’s strange because I’m
not anxious about a medical procedure. It was the pain. It was severe pain, not
anxiety about going into it.

melissa

The next time that I saw my doctor, he asked me how the procedure went. And I
said, it was really, really painful. And he was kind of like a little bit
concerned, but then he just didn’t say anything after that. So I was like, OK, I
guess — and this was my first time doing it, so I didn’t know any better. So I
was like, OK, I guess it’s supposed to be painful.

susan burton

Other women are talking about what happened with family and friends.

angela

So at that point, I had talked to a couple of family members who had done
retrievals. And I felt even worse. There’s nothing like feeling shame from
another female, and unintentional too, like, that just seems weird because I was
wheeled back there and joked with the staff and then fell asleep and woke up and
was fine. And that seemed to be the general consensus between procedures at
different clinics — that oh, yeah, I was kind of alert, but I didn’t feel
anything. It was really no big deal. Like, the shots ahead of time were way
worse than the actual procedure.

And I started shutting down after hearing those stories, that this was on me.
Like, something wasn’t right with my tolerance and my ability to handle this.

[MUSIC PLAYING]

susan burton

The women are already settling on their stories about what happened to them. I’m
immune to fentanyl. It’s my fault. It’s supposed to be painful. The clinic tells
patients that they may experience mild discomfort. But now, some of them have
recalibrated their expectations, including Lynn, who will have eight retrievals
at the clinic, all of them will cause her excruciating pain.

lynn

You know, again, you hear about IVF and how tough of a process it is mentally
and physically. And I just thought, this is what I have to do. This is what I
have to do. And sort of, just thought, this is what women go through.

[SOMBER MUSIC]

susan burton

Yale declined to offer information about how reports of pain were addressed at
the clinic or to answer any other questions.

Episode one of “The Retrievals” continues after the break.

Of the 12 patients I spoke to, most are white. The one Black woman in the group
was often the only Black woman in the clinic waiting room. Everyone in the group
identified as a woman. While a couple of them were pursuing pregnancy for the
first time as they neared 40, most did not fit that stereotype.

Most were married to men, one to a woman. That patient would provide the eggs,
and her wife would carry the pregnancy. Her wife presents as more
stereotypically masculine, doesn’t wear women’s clothing. And at first, family
members were like, are you sure you want to do it this way? Yes, they were sure.

One was doing this on her own at 41 after the end of a long relationship.
Another left her boyfriend partway through the process, and then fell in love
with the new guy at the office. One was born in Iran and came to the US as a
refugee, another grew up in Jamaica. One had what she described as a horrible
childhood. She essentially had to raise herself.

Another longed to have a second baby, because she was so close to all of her
siblings. One had type 1 diabetes, and was used to everyone always attributing
all medical issues to, oh, it’s your diabetes. All of them worked — special ed
teacher, an accountant at a Maritime firm, and a lecturer at Yale in the
Department of American Studies. Her name is Leah.

Her scholarship encompasses a variety of subjects, exile and migration — she’s
the patient who came to the US as a refugee from Iran — and gender. From the
beginning of her treatment, Leah located her experience within a context of
assumptions about women patients, that they are unreliable narrators of their
own symptoms, that they are anxious, exaggerating.

leah

But I remember the first time I went in there to get ready for the ultrasound,
there was blood on the floor from a previous person’s ultrasound. And I have to
tell you, it was as ominous as the signs fucking come. And I just remember,
Navid was with me, I think. Was Navid with me? Oh no, he couldn’t go inside. He
was waiting in the car. My husband was waiting in the car.

I was just shaking. I was like, this isn’t good. I mean, it was like — it was
like, you walk in and I was like, there’s blood? You guys left blood over? What
is going on here?

susan burton

Did you did you say anything? Like, did you say that?

leah

But here’s the thing, and this is where it begins, is you are treated like a
hysterical woman from the second you walk in there. So you already know. And as
like a person who — like, I study this stuff. I teach this stuff. And you’re
there, and you’re like, this is actually what’s happening right now.

Here comes like Freud’s patient, the hysterical woman who’s childless and angry
and hormonal and terrified and bitchy and mean. And that’s how we’re going to
treat her.

susan burton

Hysteria comes from the Greek word for uterus. Ancient explanations for it
involve an empty uterus, a woman was hysterical because her uterus was not full.
Unanchored, the uterus roved through the body, which was what made women sick
and crazy. To fix hysteria, you really needed to fill that uterus up.

leah

Like so with the blood, I remember being like, there’s blood on the floor, you
know? I was really upset. And they’re like, OK. OK, I mean, it’s — it turned
right back on me. And I remember one of the nurses was like, OK, well, you can
calm down. I was told to calm down.

I mean, and then when they’re doing the ultrasounds, of course, someone’s doing
a transvaginal ultrasound, so there’s literally like this stick that’s inside of
you and they’re moving it around. And if you cringe, OK, it’ll just be like
another — it’s just another second. OK, just be patient. So you’re constantly
over-emphasizing or overdramatizing what’s happening. It’s not that big of a
deal.

susan burton

Leah felt like her doctor wasn’t listening to her. She also didn’t trust her
assigned nurse. Then came Leah’s first retrieval. She felt her pain wasn’t taken
seriously by anyone. She says they all blew her off. Leah wasn’t happy with her
treatment, but she decided to continue.

leah

Here I was, I saw it. I felt it. I was alarmed by it. But I kept going because I
wanted to have a baby.

susan burton

Leah asked for a new doctor. He oversaw her next cycle, and soon, she went in
for another retrieval.

leah

Right after you’re in that room, the anesthesiologist came up to me and she
said, you know what? You were waking up. You were waking up. We had to give you
some more meds. You know, you were waking up.

So again, you, your body, you were nervous, you were agitated, you burdened us,
you’re kind of uncontrollable body put us in a position where we actually had to
give you more drugs. You were waking up so we had to give you more fentanyl. And
I was like, oh.

But again, to them, to them, I’m this woman who’s already like on edge. I
already left the doctor because I didn’t like the doctor. So the other
physicians and the other nurses all know this about me. I’m a kind of already
unruly, perhaps entitled, overly needy woman, who’s just really angry that she
doesn’t have a baby.

susan burton

There’s a balance you have to strike as a woman patient. You have to complain
just the right amount to be taken seriously, but not so much that you seem
shrill. Still, your pain is more likely to be underestimated than men’s. Black
women are more likely to have their pain ignored no matter what they do.

All of this, we know from the literature, and also from life. In my life, I’ve
been the kind of patient where if I’ve ever spoken up, I felt like I needed to
be obsequious later to protect myself. That is what I felt I needed to perform.
Leah knew she’d need to perform a whole range of things in order to get help —
stern, docile, smart, stupid, agreeable.

And now, on a gurney in the recovery room, Leah became an observer. She would
remember what was happening. She would write about this one day. She tuned into
the language and to the emphasis that to her, seemed so interesting and fucked
up, into the syntax that seemed to place the blame on her body. But at the same
time, Leah had also internalized the narrative that her body was to blame, her
body was inadequate, deficient. That was why she was here.

Her body had had miscarriages. Her body didn’t make enough eggs. Her body
couldn’t cooperate long enough to get through a critical procedure.

leah

Oh god, my body — like, here it goes again. Not only can I not like have a baby,
I also can’t even just lay still with the right amount of fentanyl.

susan burton

In this moment, and throughout her treatment, Leah was simultaneously the writer
saying, I can name what’s happening here, and the patient saying, how could I
have let this happen. Other women occupied their own versions of this position.
Their professional identities offered them one kind of story about these events.
Their identities as patients directed them to another.

Several of them had an area of expertise that was directly applicable here in a
way that is kind of uncanny. For example, there are multiple patients who work
in health care, including one who’s designed systems for the safe storage of
medications. There’s a nurse anesthetist. She thought the anesthesia was the one
part of fertility treatment she wouldn’t have to worry about. And of course,
there’s the addiction researcher, Katie, who had the prophetic fantasy.

susan burton

What’s unique about you is that not only did something was wrong, you knew
exactly what was wrong.

katie

I did.

susan burton

Yet still, you constructed like, this other narrative to explain it.

katie

Yes.

susan burton

Like other patients, Katie had expertise that gave her knowledge. But she and
others pushed that knowledge aside. They decided not to know what they knew in
order to keep going. I wanted Katie to lay out the path to that cognitive
dissonance. I wanted her to explain exactly how she got from one story to the
other.

katie

I mean, as I’ve told you, like, I came out of that procedure, and I immediately
— I remember immediately texting my friends who are also colleagues in addiction
research at Yale, like the nurse is stealing the fentanyl. It just seemed so
obvious.

But then, you sort come out of this — I remember just coming out of the shock
and recovering from the procedure and things just go on.

No one is addressing the fact that I was sober during the procedure. And I
remember violently shaking in recovery from the shock. I don’t know that that’s
related to having the procedure with or without fentanyl, but that’s how my body
responded.

And my nurse was there. And I remember her saying, something like, I think it
was so painful because we got so many eggs. And so it was just sort of this
positive, kind of false narrative about what had happened. And so then I think I
coped by coming up with an alternate explanation, which was that I do remember
waking up during my — having my wisdom teeth being pulled when I was a kid, to
the nurse saying, shit, shit, and then giving me more drugs, putting me back
under. So the other explanation for me was that maybe I’m not sensitive to
certain opiates.

You know, and I remember also that kind of became my narrative with — my friends
and colleagues kind of remember me sort of switching to that narrative and
saying like, well, maybe you’re not sensitive to fentanyl. So I started to kind
of just tell myself a story about my pain, just try to understand — it’s a way
of just understanding my experience and thinking, yeah, maybe this is what
happened.

susan burton

The story becomes a way, not only to explain pain, but to cope with it, a way to
not only make sense of the pain, but to manage it, to tamp it down, get through
it. In this way, the story becomes the medicine that the patients weren’t given.

[SOMBER MUSIC]

The women gear up for second, third retrievals. They change their diets. They
cut chemicals out of their home. They read the books the nurses recommend, or
they get ready for embryo transfers. They make reservations at a hotel in town
so that they won’t have to drive home over a bumpy road.

Despite these efforts, some of the women miscarry. One woman wakes up about 10
days after her embryo transfer with some spotting. “Don’t think anything of that
yet,” a nurse reassures her. But the pregnancy test comes back negative. “When
do you think you might want to get started again,” her doctor asks her at a
virtual follow-up appointment. “I’m not ready,” the patient says. She closes the
telehealth, and that’s the last time she talks to the doctor. She never goes
back to that clinic. She stops fertility treatment and doesn’t know when or if
she will ever resume it. She never wants to go through an egg retrieval again.

[SOMBER MUSIC]

Fertility treatment doesn’t always result in a baby. It’s not just giving
yourself shots that’s hard. It’s the cycle of hope and loss. It just clobbers
you. And the longer you stay in it, the more the drugs mess with your head.

“It’s called the ‘Clomid Crazies’ for a reason,” one of the women tells me, “and
the money, always the money.” If your insurance covers this, it probably only
covers a few cycles. There’s so much pressure on each one. Once you have to pay
out of pocket, you’re talking maybe $15K for one cycle. And that’s the low end.

Some of the women are keeping their treatment secret. One of them can’t even
tell her own mother. “It’s hard. It’s hard to begin with, even without this
extra layer that’s been added on to this now — the pain, and the fear of more of
it.”

laura

The first time I went in clueless, thinking you’re not going to feel a thing. So
I think the second time, I had a lot more anxiety.

susan burton

Laura doesn’t get as many eggs as she hoped for the first time around. It’s
urgent that she start cancer treatment and the doctors accelerate her cycle. Her
second retrieval is scheduled for barely more than two weeks after her first.
That morning, Laura’s mother drives her to the clinic and sits in the waiting
room while Laura goes back for the procedure.

laura

And I was shocked. I was shocked again that it was the same situation. I’m
thrusting my hips and telling these — like, wide awake speaking to them. And I
was just like, I feel everything you’re doing. And that was when I — I remember
actually saying to them, I could drive myself home right now. I’m that alert.

susan burton

In the recovery room, Laura gets her phone back. And just like last time, texts
her sister-in-law. Then she sees her mom. She tells them both how much pain
she’s in.

laura

So my sister-in-law right away was like, oh my god, I cannot believe you felt
that again. But my mom, she just felt — it’s hard, because she had seen me go
through so much as it was with the cancer. Any mother who has to live watching
their daughter go through that — and then for me to tell her, this was supposed
to be a special moment because we’re preserving my fertility and — I’m sorry —
and for her to see that, it hurts her to see me in pain. You know?

You know, and I was just like, well, thank god. I think this was the last time I
had to do that.

susan burton

What did the two of you do like the rest of that day? Did she drive you home?

laura

Yeah, she drove me home and she stayed with me, because she had already been
staying with me a lot during the day after my surgeries because I couldn’t even
— at that point, I still wasn’t allowed to lift more than 5 pounds because I was
still recovering from the other surgeries. So yeah, she was with me and made me
lunch and comforted me. We were like, OK, so now we just go back to waiting and
hoping we get a good number.

And I just moved on from it, because I faced many more surgeries that year as
well. So I kind of had to just switch back into survival mode. Like, OK, now we
just battle the next thing.

susan burton

In the other surgeries you had, cancer-related surgeries, like, what were your
experiences of pain like?

laura

It’s actually interesting that you bring that up, because when I did have my
double mastectomy, I was hospitalized — I think I was in for a day or two days.
And strangely enough, the night nurse forgot to give me morphine. So I actually
was awake and in pain the entire night. And I have a gluten allergy, so they
couldn’t feed me anything because the kitchen was closed. So I spent the entire
night like vomiting because they couldn’t — they were trying to give me like
Percocets or something.

And so I know what pain feels like. And the next morning, the doctor goes, I
don’t understand why she didn’t give it to you. It was in the order. And I had a
really young nurse, whatever. This is completely unrelated to that. But you
know, I know what pain feels like. I’ve been through it.

And then when I was hospitalized at Christmas, that’s funny that you bring that
up, because my sister-in-law actually had pointed out. She goes, do you remember
when you kept telling me were immune to fentanyl? She goes, when I did a search
on my phone — I guess you can — she’s really savvy. You can type in like,
“fentanyl” in text messages, and it’ll bring up every conversation — she goes, I
actually found one from when you were hospitalized at Christmas saying that you
were on fentanyl.

And I guess she had sent me a picture of her Christmas tree. And I had made a
comment like, oh my god, did your house burn down? And she was like, what are
you talking about? And I said, I don’t know. The nurse just gave me fentanyl.
And so she goes, look, Laura, so it does work on.

susan burton

Oh Wow.

laura

You know, and this was a month prior. And that didn’t even dawn on me. Like, oh
my god. But when it came time for the other thing, I was just like, oh, it must
not work on me, because I just felt like nobody had heard what I was saying, so
it just didn’t exist. It was in my head, you know?

So yeah, so I don’t know. Was I foolish, because I didn’t like dispute it more?
Maybe not. I don’t know. But like, I believe them. You trust them.

susan burton

Months pass. Some of the women get pregnant. Others are still trying. Some of
them are still showing up at that clinic for blood draws when they open their
mailboxes in December 2020.

julia

Christmas was on a Friday of 2020. And the mail arrived on Thursday. It was
Christmas Eve, and I was busy. And I just thought, I’m not going to go get the
mail today. And I waited until Monday the 28th. And it was a nice day. I went
outside. I got the mail. And you know, I got this letter.

angela

So I got this letter in the mail. It’s nothing fancy. It’s a Yale envelope. I’m
assuming it’s a bill. The bills never stop coming with IVF.

leah

You get so much when you work at Yale, also, you just get like Yale-emblazoned
mail. And so you’re like, oh, OK, whatever. It was like this thin thing. And I
was like, oh, they changed locations or something. It’s like, this is not
important.

angela

And instead of just setting it aside, I happened to open it. And I was furious.

katie

And it says, “Dear Kathleen Garrison, I’m writing to you in my role as director
of Yale Reproductive Endocrinology and Infertility to let that we have learned
of an event that may have involved your care.”

julia

You know, that they’ve become aware that the nurse was switching out the
fentanyl with the saline.

katie

“A few weeks ago, we learned that on multiple occasions, a Yale fertility center
nurse replaced fentanyl, a routinely used narcotic medication, with a normal
salt solution, saline, in some medication vials. As a result, some patients may
have received saline instead of the intended narcotic medication during their
procedures.

While there’s no reason to believe that this event has had any negative effect
on your health or the outcome of the care that you received, we believe that you
should be informed.”

They make the stupid comment in the letter that there was no harm done from this
happening. And I don’t know if Hall was home or I called her, and I was like,
bullshit. No harm done?

lynn

Don’t send me a letter and tell me that we’re confident no one’s outcomes were
affected by this. I know my outcomes were affected by this. I know what I
experienced and went through.

angela

But Yale wasn’t going to help me. They didn’t think there was harm. They didn’t
think it was a problem. It was the most — honestly, I think it was one of the
most disrespectful ways they probably could have notified any of us that it had
happened, that oh, we had this little breach and you’re fine, no biggie. Go
about your day.

lynn

Again, no one reached out to talk with us or to see what we experienced as
patients. My only communication about it was through the letter, and that’s
still to this day.

susan burton

And yet, in addition to fury, there’s also vindication. When they learn the
news, however they learn it, the women text their twin sister, or run inside to
their husband, or weep in their kitchen.

laura

It was mind blowing. I immediately called my mother. I immediately called my
sister-in-law. And I’m like, oh, like, I don’t know. Something, it just hit.
Like, it all makes sense now.

lynn

And it was like, OK, it all makes sense. It was almost a relief — a relief to
know like, I’m not crazy. There’s nothing wrong with my body. I don’t have
something like, blocking opioids or where my body is wrong and doesn’t react to
medicine.

laura

But it also shows how much they ignored my pleas for help and saying like,
nobody believed me. So in a sense, it was like relief, just knowing that what I
felt was real.

susan burton

But there’s more. The letter continues.

katie

“The law enforcement investigation and our own review have found no reason to
believe that you were exposed to an infection due to this event. Even so, we can
appreciate that you may want further reassurance. And if you wish, we will
arrange for you to be tested for a group of bloodborne infections at no charge.”
And I was like, what the fuck?

julia

You know, those words, not alarm, but “perplexed” and “surprised” came back to
me, right? And you just feel like, so completely let down by this institution
that’s supposed to make you feel safe, and I mean, keep you safe, right, an
institution that’s supposed to keep you safe. That was gone.

susan burton

But maybe the most remarkable thing about the letter is the way it addresses
pain. It seems to be saying, you did not feel what you felt.

katie

“I also want to assure you that the fertility center routinely uses a
combination of pain medications during procedures. We closely monitor patients
for signs of discomfort during every procedure and adjust medications or add
medications as needed. In this way, we can be confident that our patients stay
comfortable, even if one medication is not working.”

Well, I don’t believe that accurately describes my experience. And then it goes
on to say, if you have any questions or want a blood test, here’s who you can
call.

susan burton

The women put the letter on the counter in shock. For months they’ve been
constructing their own stories about what happened to them. Now they have Yale’s
story, which is that this is barely a story at all. The questions the patients
have been asking all along have a new focus.

lynn

You know, as soon as I received that letter, it’s like, how does this happen?
And how does it happen at Yale, a hospital system with such a great reputation?
And how did it happen for so long? So many things had to go wrong for this to
happen as long as it did. How does an entire facility let this happen? Who
trained them? Who thought that this was OK?

I get sent home with — I get packages in the mail with sharp needle containers
and strict instructions and alcohol swabs and this crazy protocol that I’m
expected to do at home. They make you double check things. Are there puncture
marks? Did I really spend more time following directions at home for hormone
shots? Like, where were they?

katie

I think my immediate reaction was, you know what? How could this happen at Yale?
Like, why wasn’t there a better system in place to prevent it or detect it when
it was happening and respond? Why wasn’t our pain listened to?

susan burton

The women wonder about the system that failed them. But there’s something very
intimate and human that they’re wondering about too.

lynn

We were notified that it was a nurse. We didn’t have the name of the nurse in
that original letter. And so it’s sort of racing through your mind like, well,
which nurse? Because you build such a strong relationship with these people. And
you see them so often, and you trust them, and you know, build a relationship.
And so you’re thinking like, well, which nurse could this have been?

And then you’re showing up. And OK, who’s not here anymore? Who’s gone? And just
trying to figure out who it was.

susan burton

The patients know what happened. They’re about to find out who did it. That’s
next.

[MUSIC PLAYING]

“The Retrievals” is produced by me and Laura Starecheski. Laura edited the
series, with editing and producing help from Julie Snyder. Additional editing by
Miki Meek, Katie Mingle, and Ira Glass. Research and fact checking by Ben Phelan
and Caitlin Love. Music supervision, sound design, and mixing by Phoebe Wang,
with production help from Michelle Navarro.

Original music by Carla Pallone and music mixing by Thomas Poli. Inde Chubu is a
supervising producer for Serial Productions. At “The New York Times,” our
standards editor, Susan Wessling, legal review by Dana Greene, art direction
from Pablo Delcan, producing help from Jeffrey Miranda, Kelley Doe, Renan
Borelli, Desiree Ibekwe, and Anisha Muni. Sam Dolnick is the assistant managing
editor.

Special thanks to Dr. Marcelle Cedars, Calvin Hawker, Lisa Schuman, Kylie
Silver, and Dr. Maggie Smith. The” Retrievals” is a production of Serial
Productions and “The New York Times.”

Listen 56:31





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Patients at a fertility clinic experience excruciating, unexpected pain. For
months the reason for that pain remains hidden. Then they get a letter from the
clinic.




EPISODE 2: THE NURSE

transcript

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EPISODE 2: THE NURSE

susan burton

At first, the nurse uses the fentanyl at work. She takes vials from storage and
injects herself in the bathroom. Then, she starts taking the vials home — a
30-minute drive to a Connecticut town in a more rural part of the state.

This is where she’s raising her children, three of them. It’s a wealthy town,
but not hedge-fund wealth. Kids go to public school and play little league. For
a while, the nurse taught catechism at the church.

The nurse is divorced from her children’s father, who, according to court
documents, is a volatile presence in their lives. The tooth fairy will be coming
a lot, because I’m going to knock your teeth out, and maybe the ambulance will
have to come, because your jawbones will break, is an example of the kind of
thing the nurse claims the father has said.

According to a police report, the father denies making this and all such
threatening statements. But the children have said they are scared of him. The
nurse is scared when they are with him.

The nurse sees herself as the stable parent. That is who she needs to be. But
now, she is doing this thing, this thing that she needs. In fact, she needs it
to remain stable.

Sometimes she tries to stop, but she can’t. She can go for a couple of days
without using. But as the withdrawal symptoms build, she starts again.

What she does is she removes the fentanyl from the vial with a syringe, and then
replaces it with saline, one clear liquid with another. No one can see. She does
this uncountable times, and she returns an uncountable number of these vials
that say they contain fentanyl, but actually contain saline, to the stock of
drugs at work.

And then, one day, October 31, 2020, an anesthesiologist notices that a cap
comes off a vial too easily. The loose cap is discovered on a Friday, and the
following Wednesday, the nurse is questioned. She denies taking the fentanyl,
but when the results of her drug test come back positive, the nurse confesses.
She is terminated.

In January 2021, law enforcement authorities send out a letter to approximately
200 patients at the Yale clinic, telling them they are, quote, “a potential
victim in a federal criminal case.” How old-fashioned that news keeps arriving
in the mail.

But unlike the letter from Yale, this letter demands to be noticed. It’s from
the Department of Justice. And this letter says the name of the nurse. The name
of the nurse is Donna.

leah

Donna was the person handling all the phone calls. Donna was the person ordering
your meds. Donna was the person you called when you were in pain. Donna was —
you know, it was all Donna. In fact, I had the number saved in my phone as Donna
REI. OK?

susan burton

Donna was not every patient’s point person at the clinic, but for a time, she
had been Leah’s. The day Leah got the envelope from the Department of Justice,
she brought it into her kitchen.

leah

And I remember opening it up. It was like one page. And I saw her name, and I,
like — I mean, I just, like, lost it. I was, like, weeping.

susan burton

Leah knew Donna. But now that the nurse had a name, something was different for
even the patients who’d never encountered her. Now, there was a distinct
individual behind their pain. Who was she?

The patients googled her. One woman’s husband noted that Donna had become a
nurse when already in her 40s. What was up with that? Another patient zillowed
her house. Someone else looked up whether her town had well water. It did.

Because how could anyone really be sure she’d replaced the fentanyl with saline?
And what if she was just refilling the vial from her home tap? Others looked
back at my chart messages.

lynn

You know, looking back, I know that I did correspond with Donna. We talked about
medications at one point in my chart messages. So I did correspond with her, and
she did work with my insurance company to get fentanyl approved for the
procedures and, I guess, ordered for the procedures.

angela

After a pretty intense Google search, I am pretty certain that I met Donna the
couple of times I was at the clinic doing the preliminary kind of testing.

susan burton

The patients’ identities had shaped the ways they’d made sense of their pain.
Now, their identities were shaping their reactions to the person who caused it.
What Angela was looking for had as much to do with her own identity as with
Donna’s.

angela

Sometimes I have a very hard time connecting with the idea of being a victim,
especially in light of my job. So I’m a criminal defense attorney for indigent
persons, and there’s always a reason why. Why did they steal this? Why did this
assault occur?

Most people aren’t just stealing things because it’s funny. There’s an actual
reason behind it. And I wanted desperately, I think, to give her a reason, so
that I felt a little bit better.

susan burton

What would — that’s so interesting. How would knowing or imagining her reason
make you feel better?

angela

When you’re going through, I would assume, most fertility procedures, but with
IVF for me, you’re at your most vulnerable. You are physically laying your body
on the line, saying, do what you need to do to correct, kind of, the brokenness
that is me.

And so every step of the way, it’s personal, and I’ve blamed myself. And I
wanted to make this not personal, that she wasn’t trying to punish me. Whether
it was twisted, however it was, I wanted her justification to feel worth it.

susan burton

Donna’s justification wasn’t going to be in Google, or whether she justified her
actions at all. What was in her heart, how she would explain this, whether she
was remorseful or callous — that wasn’t data Angela or any of the other patients
were going to be able to find. The patients wanted to know not just who Donna
was, but what her story was.

What was the story Donna would tell about her own pain? How would she answer for
what she had done? From Serial Productions and “The New York Times,” I’m Susan
Burton, and this is “The Retrievals.” This is Episode 2, “The Nurse.”

The Department of Justice invited the patients to a video conference to learn
more about the case. On a Thursday afternoon in late January, about 50 patients
logged on. Katie, the addiction researcher, was among them.

katie

Yeah, I was at home. You know, it was still sort of peak COVID, so I was on my
laptop, signing into this call with the Department of Justice. And very quickly,
they were, kind of, letting us know, we’re here to explain to you about the
criminal case, and what’s sort of at stake, and what your role might be.

This call isn’t necessarily a for us to get your stories. We will talk to you
and — but for this moment, this isn’t the place for us to necessarily tell our
stories. But many women really needed to tell their stories, and that was really
emotional. You know, I mean, I think people felt — you feel really like you have
to get this out.

And I just — I heard other women who had nearly verbatim stories to mine, just
being in this procedure, realizing in the moment that they were having this
procedure sober, and even looking to their nurse and having their nurse say, I’m
giving the most I can legally give you, and then getting kind of similar
post-procedure false narratives about their pain. So it was just really
interesting. I mean, it was devastating to hear that that’s — you know, I was
shocked by how many women were on the call and how long this had sort of gone
on.

leah

And I remember, like, I was like, I thought I would feel better hearing that. I
felt worse, actually. You know?

susan burton

Leah was on the call, too.

leah

Well, it doesn’t — you’d think that it would make you feel better knowing other
people were in pain like you. But you don’t, actually. You feel worse. You feel
angrier. You feel more hurt. It’s more sad.

There was a woman who was talking about how she was screaming out during the
surgery, but her voice — you couldn’t hear her voice. But she was like, her —
her mouth was open, and Donna’s squeezing her hand, you know. I still can’t get
that image out of my head, you know.

susan burton

Donna had been in the room during some of the retrievals. She had administered
the saline herself. Lynn wasn’t on the call that day, but when she learned this,
she was startled.

lynn

I just remember thinking, you know, how sick she must be to be able to do that,
and then watch the women suffer on the operating tables, knowing the reason why,
and just sort of trying to figure that out — how someone could do that. It’s,
you know, tough to comprehend.

susan burton

These stories raised questions about how Donna had reconciled the patient’s pain
or didn’t, how she split that off, how profoundly dissociated she would have
needed to have been, how deep in her addiction. In a way, these stories speak to
the suffering of both parties. But it is possible to have empathy for addiction,
and also find some of the interactions the patients recall chilling, like this
exchange that one patient remembers having with Donna after her retrieval.

allison

And the next thing I remember is waking up in the recovery room. And I was in
quite a bit of pain, a lot more pain than I ever would have expected for an egg
retrieval. And Donna was my nurse, and I remember asking her if it’s normal to
be in that much pain. And she looked at me and said, yes.

leah

It’s almost like watching a kind of, like, horror reel, where women are — all of
a sudden, everyone’s kind of like, oh, yeah, I was worried. Oh, it was like — it
was like kind of being bombarded by all these women who were told to shut the
fuck up while they were experiencing something that they knew was wrong.

That was what became alarmingly clear. That became alarmingly clear to me.
People had complained that something was up with the fentanyl. People had
complained about Donna. People had complained about the treatment by the
physicians and the nurses. And you know, at a certain point, like, not
everybody’s crazy.

susan burton

The people from the Department of Justice tell the patients where things are
with Donna’s case. Some of the patients want to know about Yale. Shouldn’t Yale
be responsible?

But that’s a different question. That will be a different case, and not one the
Department of Justice will handle. Right now, they’re working on a plea deal
with Donna, which means there will likely not be a trial, though there will be a
sentencing hearing that the patients can attend. It’s possible Donna will be
sent to prison. Leah isn’t sure how she feels about this.

leah

I had to think long and hard as a person, again, who teaches work on injustice,
incarceration, trauma, et cetera, et cetera. I had to think about what it meant
for me, as someone who’d been injured, victimized, hurt, abused, to then — what
I needed — what I wanted the outcome to be for someone who had inflicted that on
me and other people.

You know, there’s this whole abolition movement going on. So you have to think,
like, well, what do I — do I want — do I want to see this person in jail? What
do I want — what do I want to have happen to Yale? What is the right outcome?

susan burton

For months after that call, Leah would continue to wrestle with questions about
the right outcome. For Katie, the addiction researcher, at least part of the
right outcome was already clear.

katie

During the call about the criminal case, my immediate take was more about the
system, you know, Yale’s responsibility, and what kind of system was in place or
not in place that allowed this to happen. Why were we ignored when we were
reporting pain — so many of us over so much time?

And I wanted, at that time — and I still want to be really careful and sensitive
to the other people who are pursuing pregnancy, who were rightfully very upset
with the nurse. But for me, as someone who studies addiction and works with
individuals with addiction, it was more important to me that the nurse got
substance use treatment. I don’t really believe in prison for drug crimes. I
believe in substance use treatment. That was my immediate reaction. And I think
that’s very much founded in my research.

susan burton

Katie uses brain imaging to explore how pathways in the brain are altered by
addiction and how people living with addiction have the power to rewire those
pathways to change the way they think and behave. The patients wanted to know
what was going on in Donna’s head. Katie had a picture of that.

Katie’s identity offered her clarity about how the criminal justice system
should treat Donna. And on that call, she learned that her perspective could be
taken into account. The patients were told that they could submit victim impact
letters to the judge. Katie got to work on hers almost immediately.

katie

You know, I was careful in writing the letter. You know, I say to you, like, I
don’t really believe in prison for drug crimes. You know, I was chatting with my
Yale Law professor friend whose house I stayed at after this egg retrieval,
getting his advice on writing this letter. You know, how can I write a letter to
a judge that doesn’t minimize my experience, but that — he mentioned, you can’t
tell a judge that you don’t believe in prison for drug crimes, because they do.

You know, what you can do is explain, based on your expertise and what you study
and research, like, that you believe in substance use treatment and your
preference for that. So yeah, I can read you this letter.

susan burton

It’s not that Katie thought that addiction absolved Donna of responsibility for
her actions. She thought that Donna had a great deal of personal responsibility.
Katie’s argument is about what we do with that in the criminal justice system,
where research shows that substance use treatment leads to better outcomes than
incarceration. Katie finished her letter and sent it off.

katie

“And because of this, I ask for leniency in her sentencing, based on my
understanding of addiction as a neuroscientist and addiction researcher. Thank
you. Kathleen Garrison.”

susan burton

I want to read now from another letter to the judge. “Dear Judge Hall, I’m
respectfully writing to Your Honor in advance of my sentencing hearing. In this
letter, I’m hoping to explain to you what I have done that brings me before the
court, the circumstances surrounding my actions, and to express the remorse that
I feel for the crime that I have committed.”

This is Donna, of course. The letter is a few pages long, and I’ll say more
about it. But I’m stopping here to say that Donna has not responded to my many
requests to speak with her. I’ve also not spoken at length with anyone who loves
her or is close to her or who knows her outside of the clinic, also not for lack
of trying.

I’ve thought carefully about how to tell Donna’s story without her
participation. Her case generated many documents that have become part of the
public record, documents that include very personal information. I’m choosing to
tell a story that includes some of these details. Who Donna is and what she was
dealing with when she came to the clinic matter, especially because by her own
telling, what she was dealing with was the reason she did what she did.

Donna herself told a story about what happened, to investigators, to friends and
family. Her friends and family, in turn, told their own stories. I’m telling you
about these stories, about how Donna and the people in her life explain these
events.

Some of what I know about Donna comes from a sentencing memorandum prepared by
Donna’s public defender. The memo includes more than 40 letters from friends and
family, beginning with one from Donna’s parents, and ending with testimonials
from people Donna has met in recovery. The sentencing memo was both an argument
to keep Donna out of prison and an intimate look into her life.

Here is how the memo lays that life out. Donna was born in 1971 and grew up in
New York State, in a place kind of like the one she lives now — a comfortable
town, but not a fancy one. Three siblings, lots of cousins, Catholic Church.

She went to a state school for college and waitressed when she was home on
break. She didn’t get her nursing license until she was in her 40s, and by then,
her life was complicated. She had three children — the oldest two twins — and
she was in and out of family court with her ex-husband, their father, over
custody and visitation.

There was DCF involvement, a finding of emotional neglect against the father.
Donna asked the court for protective orders. For her, it was expensive and
intensely stressful.

Donna is described in the letters as a devoted mother and a good friend, as
generous, tenacious, and trusted. Many of the letter-writers seem to be working
to reconcile their astonishment at what Donna has done with the integrity of the
person they know. One woman read an article about it. And the first time she
read the article, she thought Donna was the one who caught the nurse stealing
the drugs.

Most of the letters describe this kind of initial shock, and then a quick move
to support. Thus, the letters where tension is allowed to exist stand out. The
letter from Donna’s parents is one that acknowledges complexity.

“We saw our daughter starting to break, but she always said she would be fine.
Turns out, she was not fine. It was with great sadness that we read her
confession. Our sadness turned to disbelief and anger.

We are now at the point of broken hearts. How could she make the choices she
made?”

Yes, how could she? This is a question the letters are trying to answer.

And the explanation they offer, the central story they tell, has to do with
Donna’s ex-husband. As one friend sums it up, “I’ve done a lot of thinking about
what led Donna to do what she did. And I believe her main problem, and what
directly led to her actions in this case, is her relationship with her
ex-husband.”

The ex-husband’s perspective is not represented. I contacted him through his
lawyer. He did not respond.

There are lots of examples of the ex-husband’s behavior in the court record. The
one I’ll offer here is not especially shocking. It comes from a letter written
by the only person who says she knows Donna’s ex well.

She says that Donna didn’t ask her to write this letter, that she saw Donna
sitting alone in her car at soccer, and she approached her. This writer
characterizes Donna’s ex’s behavior as aggressive and often humiliating. She
says you would see Donna and her ex at, quote, “opposite ends of the soccer
field, each trying to be there for their children. She often keeps one eye on
him, waiting for the next outburst,” unquote.

The mother who was always alert for an explosion — that kind of vigilance, these
letters seem to be saying, that kind of vigilance can wreck you.

So in the story told by the letters, this chronic stress builds and builds for
Donna, until she reaches what many of the writers refer to as a breaking point.
What exactly is that breaking point? That is a part of the story Donna writes
herself. That’s coming up, when Episode 2 of “The Retrievals” continues.

The way Donna explains it in her letter, she started taking the fentanyl during
COVID. She tells the story about her ex-husband taking the kids for visitation
in March 2020. Scary time, right? Everybody newly shut inside their houses,
everything closing down.

Donna’s ex has been sick — a stomach bug, he calls it — and has postponed a
scheduled visit. The night the kids finally go over to their father’s, it seems
like he’s still sick. They call her, and they’re like, Dad is coughing a lot,
and he’s shivering under three blankets on the couch.

And he said it’s hard to breathe and it hurts to breathe. He claims that he’s
negative for COVID, but he winds up in the hospital for over a month. Donna is
frightened for her children and is furious at her ex for knowingly exposing them
to his illness, rather than canceling the visit as a precaution.

After he is home and recuperated, he wants his regular visitation with the kids,
but Donna wants proof that he’s no longer contagious. When she refuses to let
him see the children, he takes her to family court, demanding sole custody. This
is entry number 205 in their docket. And for Donna, it is a tipping point.

“I was overwhelmed by the sense that I would never be free,” she writes, “that I
would have to take more time off of work, find more money to pay the lawyer, and
engage in yet more litigation.” She continues, “I suddenly couldn’t see or think
straight anymore.” She says that it was around this time that she resorted to
taking fentanyl at work.

Donna says that a few years earlier, she had a prescription for pain in her
feet. “During the course of time that I had the prescription, I did end up
taking more than prescribed as a coping mechanism. I turned to fentanyl, because
I knew from prior experience with narcotics that it would help me to cope
emotionally and mentally with what was going on in my life.

It helped quiet and keep my mind calm. In those moments, it’s what I felt I
needed to do to endure and hold it together for my children. How this makes any
sense as difficult to convey.”

Donna is far from the only medical professional to have a substance use
disorder. That part is not unusual. I asked a former coworker of Donna’s what
might have happened if Donna had told someone at the clinic that she was
addicted to fentanyl and that she needed help.

“I don’t think medicine tolerates that,” the former coworker said, “even though
we say that we do. I think she’d have lost her job.”

The people I talked to who worked at the clinic with Donna characterized her in
different ways. Donna was not touchy-feely. Donna was efficient. Her presence
was authoritative, no nonsense.

Donna was attentive. She seemed like she genuinely cared. There were also more
negative impressions. Donna was cold, not empathetic. She was like, these
patients complain so much.

Donna’s former coworkers knew that she was contending with a lot at home. When
her ex was in the hospital, all the nurses hoped he would die, one person said.

This is the exchange that I found most telling.

I asked one former coworker, who was Donna close to? The person thought for a
moment. “I don’t think Donna was close to anyone,” they said, “but I think some
of the nurses felt close to her.”

archived recording 1

The Yale Fertility Center is dedicated to helping couples reach their dream of
having a family, with a team of competent and compassionate professionals.

susan burton

A promotional video for the Yale Fertility Center shows Donna at the clinic,
sturdy, brunette, a white turtleneck under her scrubs. She looks a little bit
like Joan Cusack. She’s in a room with a patient, and the patient has her sleeve
rolled up. And Donna is preparing to draw blood.

archived recording 2

By helping you navigate the technological, psychological, and physical needs of
the IVF process, you will gain perspective, understand your options, and feel
confident —

susan burton

In her letter to the judge, Donna describes feeling trapped and stuck. She
brings up an image of spinning around in a cage, unable to get out. When I see
Donna in this video, outwardly capable, I wonder about what she felt inside, if
she felt trapped.

Everybody saw what was going on with her ex-husband, but nobody saw that.

Nobody seems to see what’s really going on with Donna until that loose cap.
Remember, the loose cap is discovered on a Friday. On Sunday or Monday, it’s
kind of unclear. But on Sunday or Monday, Donna comes to work with 175 used
vials of fentanyl, meaning 175 vials from which she has extracted fentanyl.

She’s been keeping these vials at her house. She’d been planning to eventually
reintroduce them into the supply at the clinic, but now, her plans have changed.
That evening at work, she goes out to her car to get clothes.

She walks out to the parking lot, and from her car, gets a plastic grocery bag,
and then she brings the bag inside and disposes of the 175 vials and two sharps
containers. It’s last-ditch behavior, right? It’s something you do when you are
frantic, panicked, and the jig is up. It also seems like something you do when
maybe you want to be caught, when maybe you want to be seen.

A little more than two weeks later, Donna will confess to a team of federal and
state investigators. She will do so without a lawyer present. She will tell them
how she did it, how she would puncture the septum of the vial up to four times a
day to extract fentanyl.

She will say she always used a clean needle to put the saline in. She will say
that she’s been doing this for five months. She will estimate that during this
time, she has tampered with 75 percent of the fentanyl given to patients at the
clinic.

She will say that some of the vials had all saline and that some were a mix. She
will tell the investigators about her money problems and about her protective
orders against her ex-husband. She will tell them about the stress in her life.
She will tell them that her children don’t know. And at the end of the
interview, she will tell the investigators that talking to them has been the
best thing for her and that she feels much better.

Donna’s sentencing hearing is scheduled for a Tuesday morning in May. It’s going
to be hybrid. You can attend on Zoom or in person. Most patients who decide to
go will attend on Zoom.

It’s spring 2021 of the pandemic. Vaccines are still new. It doesn’t feel like a
whole new world yet, but Leah decides she will go in person.

leah

I kind of needed to see her. I was fascinated with how she was going to fashion
herself in this whole — in the theater. Right? So I was fascinated by that. And
also, I was — again, I’m like, I was really, really angry. I wanted to see if
she was upset. I wanted to see if she was —

I wanted to see if she was going to cry.

susan burton

But Leah’s still ambivalent about what she wants to happen to Donna.

leah

I heard 51 to 63 months, right? And I had to do the math in my head. OK, 51. And
I think they had reduced, because she was admitting to being guilty. The time
that she could potentially be sentenced was reduced.

I remember already being like —

[inhales sharply]

I don’t know how I feel about that. I don’t want people to go to prison. But at
the same time, well, what do we want to have happen?

susan burton

What happens to Donna, and whose pain matters more? That’s next on “The
Retrievals.”

“The Retrievals” is produced by me and Laura Starcheski. Laura edited the
series, with editing and producing help from Julie Snyder, additional editing by
Katie Mingle and Ira Glass, research and fact-checking by Ben Phelan and Caitlin
Love, music supervision, sound design, and mixing by Phoebe Wang, with
production help from Michelle Navarro, original music by Carla Pallone and music
mixing by Tomas Poli.

Ndeye Thioubou is the supervising producer for Serial Productions. At “The New
York Times,” our standards editor is Susan Wessling, legal review by Dana Green,
art direction from Pablo Delcan, producing help from Jeffrey Miranda, Kelly Doe,
Renan Borelli, Desiree Ibekwe, and Anisha Muni. Sam Dolnick is the assistant
managing editor. Special thanks to Pierre Cattoni. “The Retrievals” is a
production of Serial Productions and “The New York Times.”

Listen 33:03





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The patients know what happened to them. Now they learn who did it. The story of
the nurse whose own pain was also unseen.





EPISODE 3: THE SENTENCE

transcript

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EPISODE 3: THE SENTENCE

susan burton

Allicia never expected to wind up in a fertility clinic because she never
thought she’d want to have children. She grew up in Jamaica with a lot of
responsibilities for her siblings.

allicia

So I am one of five the second of said five. But I’m the first girl. And in my
culture, you are required to help your mommy out. Like, you don’t have a say so
in it.

And so bottles were done by me. Laundry was done by me since I was nine years
old. And I hated every last part of it. So I always told myself when I got
older, I didn’t want kids. And the sad part about that is I think the tongue is
so — it’s powerful. So you got to be very careful with what you say.

susan burton

What do you mean?

allicia

I think because of — I’m having chills. Because all my life I’ve said I didn’t
want kids that I spoke that into existence. Now, for a lot of people, that
doesn’t — it’s not real to them. For me, it is real.

So that’s why I mean when I say the tongue is powerful because I kept telling
myself that I didn’t want children. And I feel whoever I pray to listen to me.
And then when I wanted children, I was in a position where my only way of having
kids was via IVF.

susan burton

Allicia was in her 20s when she decided she wanted to have children. She was in
a relationship, then with the man who would become her husband — someone she met
when she moved to the US. She tried to get pregnant, and nothing was happening.
And eventually she learned that her fallopian tubes were blocked.

susan burton

Did you — at that moment when you were finding out that your tubes were blocked,
that there was an issue with your tubes, is that the thought you had then? Like,
I sort of spoke this into existence or I willed it?

allicia

Yes, definitely. I told myself that. I blamed myself. And that’s another thing,
too, is I’ve always blamed myself after that.

susan burton

On the morning of Donna’s sentencing hearing, Allicia gets ready to watch from
home. She’s going to watch on Zoom because she had thyroid surgery two days ago,
and she isn’t up for leaving the house. And before the hearing begins, I’m going
to take a second to tell you about her because Allicia starts out sympathetic to
Donna.

allicia

I felt that whatever it is that she was going through, it clouded her judgment.
And she had a lapse in judgment. And if she has a mental issue, I feel like she
deserves a second chance.

susan burton

But during the hearing, Allicia will learn something about Donna that will test
the limits of her compassion and change the way she thinks about Donna’s
culpability. The patients are still reckoning with what the pain Donna inflicted
has cost them. Now a court will determine what it should cost her.

From “Serial Productions” and “The New York Times,” I’m Susan Burton, and this
is “The Retrievals.” This is episode three, “The Sentence.”

[MUSIC PLAYING]

After Allicia found out her tubes were blocked, she was referred to the Yale
clinic. Her treatment there had barely started when it was interrupted by the
pandemic. The clinic closed down for a while for most procedures. Her doctor
invited her to join a Zoom support group of other patients. And she liked him so
much that she said yes, even though that was the kind of thing she wouldn’t
usually say yes to.

She’s not a joiner. And hardly anyone knew she was doing IVF. That’s part of why
she asked me to call her Allicia, which is her middle name.

allicia

So I was hesitant, like I said, because I’m very private when it comes to stuff
like. This but then it was everybody who was going through stuff like this. And
it was a little bit weird that I was the only Black girl in it, but then I’m in
Connecticut. So it’s not like I’m in New York.

So there’s more Caucasian people around than there is Black people. So I wanted
to see the weeks going by to see if others were joined who looked like me, but
it never happened. So I am very vocal. So I didn’t want to be the vocal person
in that group.

And then I found this girl who was way more vocal than me, and I was like, yes.
So I got comfortable. So yeah, that was it. It was like, OK, I don’t want to
talk to strangers about my life, but they’re going through the same thing. Who
better to talk to than these people? Yeah.

susan burton

The clinic Zoom group didn’t last long in early in the pandemic thing. But
before it shut down, Allicia and a few others exchanged contact info so that
they could keep meeting on their own.

The women grew close to one another. They shared stories, tips, information,
including information about the egg retrieval. The ones who’d gone through it
told the others forget about what the clinic tells you. This is going to hurt.

allicia

So in my head, I felt like that was how it was supposed to be because even
before I went to do my retrieval, they were prepping me on what I’m going to
feel and how I’m going to feel, you get what I’m saying? So in my head, all that
pain and all of that was a part of the procedure.

susan burton

Other patients experience their treatments at Yale in isolation. They went into
the retrieval expecting to feel nothing and then felt excruciating pain. This
group of patients went in expecting it to be awful. They normalized the pain for
one another. So on the day of Allicia’s retrieval, she wasn’t surprised by what
she felt.

allicia

But like I said, I wasn’t sweating it because I was told by the girls in the
group to be prepared for that.

susan burton

Wow. And so tell me about what you felt then. Describe the pain to me.

allicia

Like pressure. Pressure and you’re bleeding a little bit, too. So it’s like —
first of all, I don’t know what cramps are. I’ve never had them, knock on wood.
So for me, I couldn’t even tell you that was cramping or anything like that
because I never cramped prior.

susan burton

Wow.

allicia

Yeah. People always say that.

susan burton

[LAUGHS]:

allicia

I have real — I know.

susan burton

It just had never occurred to me that it was possible to not have cramps.

allicia

I’m telling you, I feel like my body just listened to me and was not in a
position to be making kids. I’m just assuming that’s what it is.

susan burton

Yeah.

[MUSIC PLAYING]

susan burton

Her body didn’t have cramps because her body wasn’t meant to make babies, and
she had only herself to blame for that.

[MUSIC PLAYING]

After Allicia had her egg retrieval, she reported her pain to her doctor.

allicia

So he asked about my experience — how it was and stuff like that. My retrieval
was done by him. And I told him how painful it was. And I was expecting it
because my girls got me prepared for it and stuff like that.

And like I said, I wasn’t — I’m the type of person that I don’t exaggerate. So I
wasn’t like, oh my god, I was dying. So I just made it clear that it was very
painful or whatever. So we spoke on that.

susan burton

What was his reaction?

allicia

I think he had a look on his face of concern. I don’t know what he did behind
the scenes, but you would only be doing something if you’re privy to the fact of
what it is that we’re going through. If you have never been through it, you hear
pain. And pain can be anything, you get what I’m saying? I’m assuming you’re
going to expect it to be a little bit painful.

susan burton

After that retrieval, Allicia had an embryo transfer and became pregnant. But
one morning she woke up and she was bleeding. I knew she was no longer living,
Allicia said. I just felt it. An ultrasound confirmed the worst. Allicia was 17
weeks and five days pregnant. At the hospital, they told her that she could have
surgery or she could push.

allicia

I gave birth to my baby. I chose to bring her into this world So i could see her
because she was dead inside me. And I could have done surgery, but the
opportunity for me to see her was low.

So like they told me, they could break her apart trying to get her out. And I
said, no. So they’re going through all of that. To go through all of that, all
the shots, everything else, all of that to end up not even being able to bring
that child into this world is a lot. To bring her into this world, but she’s
dead is a lot.

susan burton

When Allicia got the letter from Yale, she put it aside. It didn’t totally kick
in for her that she was a victim until a couple of months later when she got a
breaking news alert on her phone. “Yale nurse swapped fentanyl with saline.”
Allicia didn’t think she’d ever met Donna.

susan burton

Has you ever interacted with her at the clinic?

allicia

I don’t think so. Even if I did, I don’t remember her. I am not the friendliest
person. So if I’m there on business, I’m doing business and then I’m leaving.

susan burton

The girls in the group were angry at Donna. Allicia was, too. But what she felt
was complicated. She’s a manager at a forensic hospital, a psychiatric hospital
for patients who’ve been charged with crimes, but in some cases found not to be
responsible for what they’ve done.

In her job there, she’s worked with a lot of patients with addiction. And she
told me that she saw Donna as a patient. Saw her more that way than as her
health care provider.

allicia

So I was the only person supporting this lady because of the work that I do. And
I genuinely — I really and truly have my heart in the job that I do working with
people with mental illness. And an addiction isn’t seen as that, but it is. So I
felt for her.

[MUSIC PLAYING]

susan burton

Now, on the morning of the hearing, Allicia stares into her screen, waiting for
the proceedings to start.

[MUSIC PLAYING]

In downtown New Haven, Leah arrives in the courtroom, still not sure what she
wants but knowing she needs to be here to witness this. She sees Donna upfront.

leah

Her parents were there. They sat, I think, in the third row. I sat in the back
row on the other side. I sat on the prosecution side. And her parents were
there. A friend was there. I think that’s about it for her.

susan burton

The patients watching the hearing on Zoom see that the room is almost empty.
Donna and her lawyer are at a table up front. Donna is wearing a peach-colored
top and a black mask.

Many people on Zoom turn off their cameras, but some don’t. Donna’s therapist is
on there. An aunt of Donna’s from Long Island has logged on multiple times. One
of her squares shows her ceiling fan. And then the hearing starts.

Please be seated everyone, the judge says. Diane, you need to put your volume
down just a little. Thanks. No worries.

The judge is Judge Janet Hall, 72 years old, graduate of Mount Holyoke College,
appointed to the bench in 1997 by President Bill Clinton, mother of three
children, just like Donna. Obviously, I have the obligation of imposing a
sentence on you, Judge Hall says. Basically, obviously, I’ve read a lot, but I
haven’t made a decision.

And she really hasn’t. What will happen over the course of the hearing is that
she will decide in real time. The judge will think out loud. She will grapple
with what she will characterize as an unusually difficult case.

The task before her is a narrow one to determine a sentence. But in executing
that task, she will engage some of the big questions at the heart of this story.
Donna’s public defender stands. Her name is Allison Near, 46 years old, mother
of two daughters, married to a man who was a professor of ecology at Yale.
Neither she nor the judge agreed to speak with me for this story.

Attorney Near says she’s been in contact with Donna almost every day since they
met in December. And that as she’s tried to help Donna, quote, “kind of unpack
the events from June through October of 2020. I’ve learned so much about her.
And I’ve been moved and impressed by her insight into what went awry.”

And then Attorney Near begins to make her argument. Again, this isn’t a trial.
Donna has entered a guilty plea. This is a sentencing hearing. The thing being
decided today is not Donna’s guilt or innocence — just the terms of her
sentence.

Donna faces a maximum sentence of just over five years in prison. Attorney Near
is here to argue that down to as little as possible. The thrust of her argument
is Donna’s, quote, “extraordinary family circumstances.” That phrase has legal
weight. The judge is obligated to consider Donna’s family circumstances.

Attorney near points out that if Donna is sent to prison, her ex-husband will
almost certainly get custody. The judge must consider whether this is a good or
even safe outcome for Donna’s children.

[MUSIC PLAYING]

In advance of the hearing, the judge has reviewed many documents, like the
character reference letters from Donna’s family and friends, and the police
reports that contain accounts of her ex-husband’s behavior. The judge has a lot
of discretion to sentence below the guideline of five years if she decides that
Donna’s family situation warrants it.

Attorney Near finishes her opening remarks and calls a witness, a friend of
Donna’s who says she fears for the safety of Donna’s children if Donna’s
ex-husband gets custody, and that Donna’s children need her. When the friend is
done, the judge begins to wrestle with her first big question of the morning —
one about trust.

The judge says, quote, “it is just — it is a real serious offense. It is such a
breach of trust. Her relationship with the patients, the numbers who were
impacted, the level of pain I can only imagine. I don’t have a lot of
familiarity with the procedure, but I’ve spoken to women who’ve gone through it.
It is physically and psychologically difficult to begin with. Then you want to
layer it on top that you do it without pain management. It isn’t just the pain,
because that would diminish it. It is the breach of trust. What many of the
victims spoke about in those letters, about the sense of the breach of trust. I
don’t know. I don’t know there’s anything more you can say, Attorney Near. But I
can’t let you sit down without asking.”

Attorney Near says that she and Donna have talked about this very thing a lot.
That Donna has really tried to get out what was going on in her head. She
mentions that Donna appreciated the letter from the victim who talked about
addiction in the brain. But the judge is asking a difficult question.

“And you know, I think your honor is right to guess. I probably don’t have an
answer to that question, except to say that she more than accepts
responsibility.” From the judge’s perspective, there’s a lot that’s hard to
answer here.

Here is a person, Judge Hall says now, about whom I have how many letters and
other things that tell me she’s a wonderful person, a good citizen. Clearly did
something extremely bad and she caused harm to people, right? But how do you
address that in a sentencing context when I’m also considering, as I’m required
to, her history and characteristics which bring in her family? So there’s no —
as I said to you folks in a brief conference we had, there’s no right. There’s
no answer here. Forget about whether there’s a good answer or a right answer.
The judge’s style is not endearing her to Leah.

leah

I don’t know what to do. How do I sentence? She had this whole thing. It was
kind of like a “Seinfeld” episode I don’t know. Should — I don’t know. I don’t
know.

I wrote a letter. Many of the women wrote letters. And the judge talked about
how she had read all the letters, and it was so hard. It was so hard for her to
decide. And I remember as she was talking about that, I was like, oh. [SIGH]

[MUSIC PLAYING]

susan burton

But anyway, says the judge, we’re just repeating ourselves, Attorney Near. So
you said your client wished to speak. Yes, she does, Your Honor. Donna stands.

Many people in my life have asked me various versions of the question, how did
this happen, says Donna. Initially, I was unable to answer that question with
true in-depth insight. When I learned that my ex-husband had knowingly exposed
my three minor children to his COVID illness, that he would later suffer an
extended near-death hospitalization from, it created a fear and level of anxiety
in me where my children are concerned. I reached a whole new level that I didn’t
know how to process or handle.

I’ve spent the greater part of seven years working within the legal DCF and
Family Court system to protect my children. I did all of this by the book and
took pride in the same. June 2020, I hit a breaking point. And to think that
after all I have done to protect my children, that my actions have hurt them so
severely is devastating and a consequence that I will live with for the rest of
my life.

[MUSIC PLAYING]

In the back of the courtroom, Leah listens intently.

leah

Donna — I don’t think she — it was all about how she had kind of like, oh, she
needs to be with her children, and she had failed her children. I don’t know
that I heard a lot of remorse. But again, what could I have heard? What could
any of us have heard that made us — would make us feel better?

susan burton

Would an acknowledgment of the pain the patients felt have done it? Because
Donna leaves that out. She doesn’t say anything about pain at all.

And then Donna says something that surprises Leah, something that Leah and
others are learning in this courtroom for the very first time. Donna says, I am
a former fertility patient myself, and that interest is what drove me to my
interest in fertility nursing.

leah

She’s an IVF patient, too? Are you kidding me? I mean, you could almost hear.
There were people on Zoom. I can almost feel like the bomb dropped.

Everyone’s on mute. But I’m telling you, it was like a moment where I was like —
it was like an audible gasp.

The fact that she was an IVF patient herself, I had to etch a sketch my head. I
was in a kind of profound shock. It was literally like a punch to the face, a
punch to the gut. It took it to a different kind of —

susan burton

A different kind of what, right? This is exactly the question. This levels it
up, but how and on what scale? Scale of emotional violence? We started on breach
of trust. Now we are up to intimate betrayal.

[MUSIC PLAYING]

In her letter to the judge, Donna writes that she went through multiple rounds
of fertility treatment, and that her history as an IVF patient makes what she
did that much more devastating. This is the moment things shift for Allicia.

allicia

When I heard that she went through IVF, I was like, there is no way. There is no
way I can ever look at this lady the same way. That’s when I lost it because I
said to myself, there is no way me, personally, who have gone through this,
would even try to put any amount of other pain on a person who went through
that. And you went through IVF yourself. How could you possibly do this to
somebody else? it was in that moment I couldn’t look at her the same way I
looked at my patients anymore.

susan burton

Donna had known how hard it was to go through IVF, not just the physical pain of
the retrieval. She actually probably didn’t know that pain at all. She’d
probably gotten some kind of anesthesia.

What was worse was that she knew the emotional pain. She knew about the special
vulnerability of being a fertility patient. She knew this in the intimate way
you can only know it if you go through it yourself. And still she had done this.

allicia

Like I said, I am not a people’s person. So nothing anyone does surprises me
because people are who they are. So it just opened my eyes to say even when
somebody has been through the exact same thing as you, they can still turn
around and be a monster towards you.

susan burton

In the front of the courtroom, Donna apologizes to those she has hurt. It was
never my intention to harm anyone in any way. And then she winds up. Thank you
very much, says the judge.

She addresses Donna’s attorney. I guess I have one question I will ask you,
Attorney Near. I believe that I think in her statement — although I’m having
trouble finding it, eyeballing it. But I think you argue it in your brief about
how — and she just said it again, “never intended to hurt anyone.”

I struggled with that, wherever it is, when I read it. I don’t know — I don’t
know how she wouldn’t. She didn’t intend, I guess, in the sense she’s an addict.
She’s doing something she doesn’t control. Clearly, she knew the consequences of
depriving a patient undergoing this procedure of painkiller.

OK. Another big question — intent. Donna knew that her patience would suffer.
How do we deal with that? Attorney Near explains that Donna did not have
malicious intent, but she continues.

This is not any kind of ignorance about what the outcome is going to be. I guess
I was separating it out from somebody who was setting out to harm others. It is
not an excuse. It is not a justification. I just think it is a fact.

OK, says the judge. Attorney Near adds, she continued to do this because she
didn’t think, because she didn’t stop and try to reconcile the fact and impact
of what she was doing in the moment.

Sidebar for a moment, my own sidebar, my own reaction to Attorney Near. The idea
that Donna didn’t stop and think, the way it plays out is more nuanced, isn’t
it? Sometimes you do stop and think about the fact and impact, but your need is
so great that you do it anyway, or sometimes you choose not to stop and think
because you don’t want to stop and think. The whole point of your addiction is
to not have to stop and think.

It is true that Donna had an opioid addiction. It is also true that she made
choices in that addiction. OK, I’m done with my sidebar. Back to the
proceedings.

Judge Hall turns to the prosecution. You’ve been very patient, she says to
Assistant U.S Attorney Ray Miller. He gets right to it. I think there’s another
side to the story here, the US attorney says. I think the first thing we need to
think about, the first question we need to ask is why are we all here today? Why
are we here on Tuesday morning in federal court?

Well, I’ll tell you why we’re not here. We’re not here because the defendant
decided to use drugs because of difficult family circumstances. We’re also not
here, quite frankly, because she stole drugs. We’re here today because she
knowingly, intentionally, repeatedly, replaced the drugs with saline and
inflicted incredible physical and emotional suffering on the victims.

As she did with Attorney Near, the judge listens to Attorney Miller, and then
she begins to speak. She has another big question, one about institutional
responsibility.

I have a question. When narcotics are dispensed to patients, is it typical that
one person is in charge and there’s no other — there’s not a double check,
somebody who also has access to look at? Someone on the Zoom chimes in. Yes,
great question. Great question.

I’m sorry, says the judge, those of you on the Zoom are not allowed. It’s as if
you’re in the courtroom. But anyway, again, I don’t wish to take away from her
culpability. I’m not in any way asking and saying it is somebody else’s fault.
I’m just curious.

Yale’s responsibility isn’t the subject of this hearing, but this is the one
moment it’s alluded to. Aside from this, the fact that there was an
institutional failure here, a failure to prevent an employee from causing pain
to patients for months on end doesn’t come up at all.

The US attorney mainly talks about why he’s recommending the guideline sentence
for Donna — again, up to about five years. The judge tells him that he’s making
an extremely compelling case. But she still got the same problem, which is,
essentially, Donna harmed patients. But if she goes to prison, there’s harm to
her kids.

Attorney Near has put a lot of stuff in front of me that raises grave concerns,
the judge says. I don’t hear the government telling me, Judge, that’s smoke and
mirrors. She’s making it up. It’s not as bad as that.

I hold Attorney Near in the highest regard, Attorney Miller says. I don’t doubt
the veracity of anything she says. What I would urge the court to think about is
that we’re hearing one side of the story.

I’m not prepared to litigate the viability of the ex-husband as a parent. I have
no idea. He might be terrible. I have no idea. He might have other counterpoints
to what’s being said. You don’t have that perspective. So I think that need to
weigh that.

The judge is weighing that. She notes multiple times during the hearing that
there are gaps in what she knows. But she’s read, quote, “enough to raise red
flags for me.”

It is in total tension, she notes, the degree of culpability and the degree of
family circumstances that I need to consider. The judge explains that Donna’s
family circumstances don’t make her any less culpable, but that the court is,
quote, “reluctant to wreak extraordinary destruction on the family.” I don’t
know that the victims would appreciate it, the judge says.

The victims can probably appreciate the legal requirement. That doesn’t seem
that hard to grasp. What the victims don’t appreciate is the painful irony that
isn’t being acknowledged here — Donna’s status as a mother protects her. And
motherhood is why a lot of them are here in the first place. They wanted what
she has.

leah

I remember being like, why does she get to be a mom? This was the irony. Why
does she get to be a mom that we can feel compassion about when she decided that
that’s something that she could withhold from other people who were trying to be
mothers?

allicia

You’re talking about the fact that, oh, your family was falling apart. We were
trying to have a family. You got to where it could fall apart. We weren’t even
there yet. How dare you?

susan burton

Allicia had that miscarriage at 17 weeks and five days. She sees herself as
having been a mother for all of that time. As a mom for 17 weeks and five days,
I would have been willing to die so my kid could live, she said.

[MUSIC PLAYING]

The cruelty here is not just the pain of the procedure, but the chance that
Donna had had to be a mother, to continue to be a mother. And there’s an
essential incongruity, which is that Donna says that, as a mother, she wants
nothing more than to keep her children safe, but she made choices that
endangered them.

leah

The amount of fentanyl she was having and then returning to work, I just — but
then she also had to go and pick up her kids and feed her kids. And she had this
whole narrative about, oh, I was protecting them from this evil, shitty father
who didn’t care about COVID. And I thought, how did you take care of your kids?

allicia

What she was implying was she was doing everything in her power to be there for
her children. And in my head, you were doing the total opposite of everything
you should be doing to be there for your kids.

susan burton

To Allicia, there are a lot of things that just aren’t adding up.

allicia

And these are the things that was annoying me. They were making it seem as
though the reason she was doing drugs was because of her husband was — he was
being too much, or he was — whatever the reason was, to me, it was just BS, to
me.

[MUSIC PLAYING]

susan burton

The story seems like BS to a bunch of patients. She’s divorced. That doesn’t
sound very unusual to me, one of them said. Another one put it this way. For her
to blame all of it on anxiety over a divorce with her husband and COVID, that
doesn’t make any sense.

But the story doesn’t have to make sense to the patients. They aren’t the
intended audience. The purpose of the story is to keep Donna out of prison. The
story has been constructed for the person who will decide her fate. The story is
for the court, not for the victims.

The hearing is almost over, but first there is a victim who wishes to speak.
Good morning to you. And whenever you are ready to speak, please go ahead, says
the judge.

The victim speaks directly to Donna. You hurt me. You hurt me on that day, and
the pain was horrible. It was excruciating, and it was awful. For me
specifically, what was really terrible was the psychological toll that Judge
Hall has referenced because I’m a physician, and I know exactly what fentanyl
does. And I have had the procedure before, the extraction. And so I had fentanyl
before.

So this time at my second egg extraction, when they gave me the saline, I
immediately said, hey, this is saline. You didn’t give me any fentanyl at all.
And the nurse — I don’t think it was you, actually. The nurse looked at me and
said, I already gave you 25 fentanyl.

I said you need to give me another because that was saline. She gave me another
one. And I said, uh-oh that was saline also. I said I know exactly this was
saline. I can taste the saline in my mouth, and it’s not the feeling of
fentanyl.

I push fentanyl every day all the time. I give moderate sedation every day. This
is not fentanyl. And I had to look at the doctor and look at the nurse and say,
oh my god, I’m about to undergo this procedure with no sedation. And you know, I
had to undergo it because otherwise I was going to ovulate and lose all of my
eggs.

The victim says that after the procedure, she was in so much pain that she ended
up going to the ER at the hospital where she herself was a trauma surgeon.
There, quote, “the nurse I had worked with the day before didn’t even recognize
me because I was in such terrible shape. I was in such pain. All I could do was
moan. I couldn’t even communicate. I was in that much pain. And she thought I
was a drug addict. She didn’t even recognize me as her attending doctor that was
working with her in the emergency department the day before when I was on call.”

“You know, the victim says, “to me, you’re the big winner here. You weren’t in
pain. You have three children. Nobody’s going to take anything. You still have
three kids. At this infertility clinic, there’s hundreds of women who would
rather be where you are, rather have the three kids. It’s been a really
difficult time, and you kicked us while we were down. That’s all.”

[MUSIC PLAYING]

Donna’s lawyer speaks. I think it is appropriate for the victims to have the
last word today, Your Honor.

If only that were the case, Attorney Near. I’m afraid I have to have the last
word. Here it comes.

I’m still struggling, Judge Hall says. The judge seems to be trying to pull
everything together. She reflects on the patient suffering. She tells Donna,
quote, “you worked such pain on these women.” She reflects on all of the letters
in Donna’s support on her confession, her rehabilitation, her children.

The judge seems to have settled something for herself. She is ready to rule. As
I reach my decision, I keep thinking of someone who was never my colleague, but
for whom I had a lot of respect, Judge Emmet Clarie who sat in Hartford.

He sat in the days when no one with a white collar went to jail. But his
philosophy was he was ahead of his time. Everyone should have a taste. If you
would please rise. I’m going to impose a sentence.

The judge sentences Donna to four weekends in prison, alternating weekends
because of her custody arrangement. On Sundays, the marshal will make sure she
gets out in time to pick up her kids.

Obviously, I know from the victim’s point of view, this is too little, the judge
says. And I’m sure they think I’ve made a mistake. I don’t know if I have myself
or not. I do not see it, she adds immediately.

The judge named some additional conditions, including a period of house arrest
and three years of supervised release with mandatory substance use treatment and
drug testing.

Anything further that the court should address, the judge asks? Not from the
government, says Attorney Miller. No, Your Honor, Donna’s lawyer says.

All right, we’ll stand in recess. Thank you all very much. Someone on Zoom
unmutes. Do the world a favor and go overdose, you disgusting drug addict.
Whereupon, the hearing adjourned at 12:47 PM.

[MUSIC PLAYING]

susan burton

What do you make of the judge’s decision to sentence her the way she did? What
do you make of the judge’s sentence?

allicia

I think it was unfair. Here’s the kicker to a situation like this. Unless you
have been in a situation where you’re going through infertility issues, you’ll
never understand it.

susan burton

The judge had heard the victims’ stories, but she hadn’t experienced what they
did. In Allicia’s view, a story is not enough to understand the pain of another.

allicia

I can tell you how I feel less than the average person because I cannot go to
bed with my husband, make love with him and make a child. That wasn’t my way. So
my only way was the way that I chose to do it. And even trying to do that,
someone else decided to bring more pain to what I’m already feeling. It’s hard
for somebody to see that unless the judge herself had gone through IVF.

susan burton

And by that logic, the logic of identification, you wonder about the inverse.
The judge was a mother. Donna was a mother. Donna’s attorney was also a mother.
Was motherhood the decisive alliance? But Allicia thought there were probably
other reasons for the sentence, too.

allicia

Honestly, did I think it would be that little amount of time? No. Absolutely
not. But I wasn’t surprised.

susan burton

Why weren’t you surprised?

allicia

Honestly, it’s a lot of things that doesn’t surprise me in this country a whole
lot. And like she says, she will get to stay home, and she’ll be there for her
kids. And every accommodation was made for this woman.

This woman caused so many pain to so many different people, and she was
accommodated. In my mind, she was accommodated to the full extent. Now, I don’t
believe that would have been everybody else. But for her, it worked out. And
when you look around in this country, nothing surprises me anymore, honestly.

susan burton

Do you think that the fact that she’s white had something to do with her
sentence?

allicia

Absolutely. Absolutely. Absolutely. If you’re doing time for registering to
vote, and someone can take that amount of medication for herself, then that
tells me something. And everything is not about race, but a lot of things are. A
lot of things are.

susan burton

The sentence invited questions about privilege. It wasn’t just that it was so
light, it was so convenient. It was designed to fit Donna’s needs. It was
bespoke sentencing tailored to fit her needs as a mother.

leah

Donna got to say, oh, but I’m now rehabilitating, and I want to be with my kids.
And the judge said, you know what? Yeah, you’ve had a really hard — this is
really hard. It sounds really hard. Let’s make sure you can just go to prison
the weekends where you don’t have to see your kids, and then we’ll let you out
in time to go pick up your kids. I mean, is that whiteness in America? I don’t
know. What is that?

And I thought the entire time — I was like, Black women have had their children
taken away for a tenth of an centimeter of what Donna’s done. And she’s now —
she’s being protected because she represented herself as an injurious mother,
and she’s the last line of defense for her kids. And that’s OK even though she’s
a drug addict who’s putting other people’s lives at risk.

[MUSIC PLAYING]

susan burton

Leah went into the hearing not knowing what she wanted. She came in torn between
her misgivings about the system and her outrage at Donna. In a way, the sentence
kept her in that place.

Katie, the addiction researcher, went into the hearing knowing what she
believed, if not exactly what she wanted. But seeing it all play out did not
feel good.

katie

I cried the whole time. I mean, I found it really, really sad all around, Just
the nurses’ circumstances, the victims who testified — so emotional — and all of
us who experienced these horrible procedures and pregnancy losses, the poor
system in place, the criminal justice system, the whole thing I remember. And I
remembered, despite my letter and my belief in substance abuse treatment, I felt
and still feel really deeply that many women were probably really hurt by the
light sentence that she received.

I remember texting a friend something like — it was complicated. But a good
outcome, but complicated.

susan burton

Angela, the patient who works as a public defender, learned about the sentence
after the fact. She chose not to attend the hearing.

angela

At that point, I had a newborn son. And the thought of reliving it in those
moments was too much for me.

susan burton

Yeah. What do you make of her sentence?

angela

[CHUCKLES]:

Kudos to her public defender, honestly.

susan burton

When Angela learned of Donna’s crime, she’d struggled to identify as a victim.
Now her dual identities were colliding again.

angela

I think the worst conversation I had was a family member was like, well, what
would you have liked to see happen? And honestly, I don’t know. And this family
member asked me if I wanted her to have to go through an egg retrieval without
pain medication.

If that would have been enough, would you want her to suffer like you suffered?
And I dead face said I would never want someone to go through what I went
through. I don’t care if she’s the reason why it happened. I would never wish
this on her.

And just having to then explain how traumatic it was, but how I had to be OK
with her — what I think is a light sentence. She has to do jail on the weekends
and go to a drug program.

But the defense attorney in me also kind of kicked into high gear. And I was
like well, this is somebody who has a drug addiction, and they need help. And
incarcerating them isn’t going to help. They need to be able to function in
society beyond this. And she obviously lost her nursing license. So she can’t do
it again, theoretically.

[MUSIC PLAYING]

susan burton

At the end of the hearing the few people inside the courthouse stepped out into
a sparkling spring afternoon. Local news cameras followed Donna. Her attorney
put a protective hand on her back.

Donna held a sheaf of papers and averted her gaze as she left the scene. Her
case was over. But for Angela and other patients, Donna was not the only one, or
even the main one, who had something to explain.

angela

Honestly, my anger is not at her. It probably should more be at her, but it’s
not because she’s one person. And she wasn’t the nurse in my room. So what were
the rest of them doing?

[MUSIC PLAYING]

susan burton

In front of the courthouse is the New Haven Green. On the other side of it up a
little hill is Yale, a long wall of stone towers along College Street.

angela

The Yale Fertility Clinic is not a brand new setting. It’s not one doctor in a
back alley. This is an entire setup. This is an entire institution that’s behind
it. It’s got this reputation. How do they not see that this is happening?

[MUSIC PLAYING]

susan burton

Now the patients had Donna’s story. It may have been incomplete or unsatisfying,
but it had been laid out. There was another story the patient still didn’t have.
They didn’t have Yale’s story.

What we know about what happened at the clinic, that’s in two weeks, July 27, on
the next episode of “The Retrievals.”

[MUSIC PLAYING]

“The Retrievals” is produced by me and Laura Starcheski. Laura edited the series
with editing and producing help from Julie Snyder. Additional editing by Katie
Mingle and Ira Glass. Research and fact checking by Ben Phelan and Caitlin Love.
Music supervision sound design and mixing by Phoebe Wang. Original music by
Carla Pallone and music mixing by Thomas Poli.

Ndeye Thioubou is the supervising producer for “Serial Productions.” At “The New
York Times,” our standards editor is Susan Wessling. Legal review by Dana Green.
Art direction from Pablo Delcan. Producing help from Jeffrey Miranda, Kelly Doe,
Renan Borelli, Desiree Ibekwe, and Anisha Muni. Sam Dolnick is the assistant
managing editor. Special Thanks to Vincent Sutherland and Kylie Silver.

[MUSIC PLAYING]

“The Retrievals” is a production of “Serial Productions” and “The New York
Times.”

[MUSIC PLAYING]

Listen 46:39





Open this article in the New York Times Audio app on iOS.

At the nurse’s sentencing hearing, the patients learn a shocking detail that
forces them to confront the limits of their compassion.




BONUS: DID THIS HAPPEN TO YOU?

Listen 4:02




Open this article in the New York Times Audio app on iOS.

A message from Susan Burton.




EPISODE 4: THE CLINIC

transcript

Back to The Retrievals
bars
0:00/38:00
-38:00

transcript


EPISODE 4: THE CLINIC

susan burton

The patients had generally two kinds of questions about what went on at the
clinic. The first kind of questions were about the system.

esha

How could this huge system fail in such a way that this could happen? The fact
that somebody was able to walk out with bags of fentanyl in their purse and no
one batted an eye. How does that even happen?

suan burton

The second kind of questions were about the people in that system.

katie

You wonder what each person, the doctor or the nurse in the room, what their
experience of this was? What were they thinking?

susan burton

But most of the patients never got to ask those questions. Staffers were told
not to talk with patients about what happened with the fentanyl. And for some of
the patients, it was hard to bring up to.

katie

I remember going into the clinic. I never spoke with anyone about it. And I
remember that. I remember that feeling of going into the clinic and kind of
looking around. And first of all, sitting in the waiting room, which of course,
was not very full because of COVID.

So there’s maybe one or two other people around waiting for appointments or
waiting in line. But thinking like — kind of resisting the urge to say, were you
part of this? Did this happen to you? Like did you have a procedure without
fentanyl?

And then going in and seeing my nurse team, and also empathizing with them and
thinking, like did this is going on? What’s your perception of this? And what
was your experience of this? But knowing that I’m sure they were very sternly
told not to talk to anybody about any of this.

susan burton

Yeah.

katie

But then you also — I think for me, it was also not understanding where the
failure in the system was.

susan burton

Uh-huh.

katie

So not really knowing what to ask or who to ask even. Like it thinking about it
now, it feels like it would have been gossiping. But it’s not gossiping really
to say to your care team, this happened. Are you making sure this isn’t going to
happen to me again?

[MUSIC PLAYING]

angela

Why do they not care that there were numerous women who were in excruciating
pain? And they didn’t care. I get stuck there.

susan burton

The staffers I spoke to did care, and yet this happened. How? From Serial
Productions and “The New York Times,” I’m Susan Burton, and this is “The
Retrievals.” This is episode four, The Clinic.

[THEME MUSIC]

It was hard to find staffers who were willing to speak about what happened at
the clinic. Some of the reticence had to do with the fact that there’s an
ongoing lawsuit. Six months after Donna was sentenced, several patients filed a
complaint against Yale.

archived recording 1

We have another big story we’re following right now. Seven women have filed a
lawsuit against Yale University Medical School.

archived recording 2

And this is really unbelievable. The women say they were given saline instead of
fentanyl during —

susan burton

Over the next few months after that, more and more patients joined.

archived recording 3

Well, first on Fox 61 tonight, dozens more women are coming forward to sue Yale
University nearly a year after a former Yale nurse was sentenced for tampering
with fentanyl vials at a fertility clinic.

susan burton

Now, there are almost 70 patients in the lawsuit in all. But the lawsuit says
about how long Donna was doing this is a lot longer than what she says about how
long she was doing it. Donna told investigators that she started stealing
fentanyl and replacing it with saline in June 2020 when the clinic was located
in a suburb of New Haven.

But patients and their lawyers believe that she began doing it before then when
the clinic was located in New Haven proper. About half the patients in the
lawsuit say they experienced severe pain before June 2020. Some as far back as
2017. Here’s Lynn, a special ed teacher who had, maybe you remember this number
from the first episode, eight painful retrievals at the clinic.

lynn

When I did find out the dates that she had admitted to, I was angry. I am
confident that this was happening while they were still in the New Haven office.
And again, it’s too coincidental that I experienced this excruciating pain. I
know with my heart that she was doing this in New Haven and affected a lot more
women than during that five-month period that she admitted to.

susan burton

Again, Donna did not respond to my request to speak for this story. 200 patients
may have been affected during the five-month period Donna admits to stealing
fentanyl. If she started earlier, she could have affected 100 more.

One of the lawyers who represents Lynn and other patients is named Josh Koskoff.
He’s well known for his suit against the gun manufacturer in the Sandy Hook
school shooting and the related case against Alex Jones. Early on, when Josh
started getting calls from a lot of patients who said this had happened to them
before June 2020, he felt like he should share that information. He contacted
the US Attorney’s office and —

josh koskoff

I think more importantly is what I did was I also notified Yale. Once we started
to hear from a lot of women outside this time period, I thought, well, Yale
deemed it appropriate to notify the women that they knew might have been exposed
in the six-month period. So surely, they would want to notify — it would be
important for them to know that I believe this is going on for longer. And I
notified them and asked them what they were going to do about it. I shared that
information. And to my knowledge, they didn’t act.

susan burton

When I presented this to Yale they responded that the Department of Justice had
conducted a thorough investigation and concluded that this took place
specifically from June through October 2020. Yale declined to make anyone in a
position of oversight available for an interview with me. But I did talk to
staffers, people who worked at the clinic alongside Donna.

You won’t be hearing from them on tape. None of them wanted to be identified for
fear of being retaliated against or losing a job. I don’t think it’s going to
come as a surprise that I didn’t talk to any doctors who were like, yeah, for
months, patient after patient was screaming and cursing me out. And looking
back, I guess I should have done something about that.

If there is such a callous doctor, they did not respond to me. The people I
talked to were talking to me because they were troubled by what had gone on at
the clinic. Some of them had left. But this wasn’t about a vendetta, as one
staffer put it to me. This was about telling what happened to prevent it from
happening again.

I wish I could write about the staffers, like I’ve written about the women as a
cohort with a shared experience and also as individuals whose identity shaped
the way they made sense of it. But I can’t offer details about anyone I spoke
to. This makes the way I approach the story of the clinic a little more
forensic, a little more procedural, a little more like a case study in drug
diversion, which is what stealing drugs in a medical setting is called. And this
clinic could be a case study in how that happens and how it is missed.

I’m going to start the story in an office the clinic occupied for years, an
office in an older building in a medical complex off I-95. The Long Wharf exit.
And I’m going to start in the retrieval room with the drugs they use there,
fentanyl and midazolam.

These drugs are one of the first things most staffers I talked wanted to make
sure I understood. There’s a lot of variation in the way patients responded to
these drugs. Some were out of it. Some were alert, even giddy, singing along to
the pop songs, playing at a low volume on the radio.

And for some patients, the drugs were not effective enough. Even the maximum
dose of fentanyl was not enough to manage their pain. Even when that fentanyl
was actually fentanyl, the highest dose might not be enough for a bunch of
reasons, like existing tolerance to narcotics, challenging anatomy. Sometimes a
patient would be in so much pain that she would be kicking and screaming.

How often would something like that happen? One or two times a year was when
answer I got. Another person said even less. So that kind of extreme response
was unusual, but not unknown. But these drugs didn’t treat pain 100 percent for
all patients. With the medication approach that was used at Long Wharf, one
staffer told me, this procedure can hurt.

[MUSIC PLAYING]

Maybe 25 years ago, moderate sedation, like this fentanyl and midazolam combo,
used to be standard retrievals. But it’s not anymore. Today, what’s more common
is deeper sedation with propofol administered by an anesthesiologist or nurse
anesthetist. At Long Wharf, a fertility nurse gave the drugs. And there was a
limit to how much they were allowed to administer.

When I told one fertility doctor from another clinic what Yale had used at Long
Wharf she said, I’m shocked they do that with fentanyl and midazolam. In my
opinion, that is not enough for this procedure. She wondered if it was a money
saving thing.

But another doctor, who’d done hundreds of retrievals with fentanyl and
midazolam back in the day and sometimes still does, said in her experience, this
combination was absolutely fine. That as long as it was working properly. There
wasn’t anything wrong with using it.

And staffers at Long Wharf said that retrievals were generally fine. But they
wanted deeper sedation. The bottom line is that you want patients to be
comfortable for their own sake, and because comfort is necessary for safety.
There’s a long needle inside the pelvic cavity. Sudden movement presents a risk.

I wondered why Long Wharf didn’t have deeper sedation. Staffers had different
and often vague understandings of the reason. Something about the oxygen access,
one staffer said. But whatever the practical reason for not getting better
anesthesia was, there was also a cultural one.

There’s a ton of just inertia in trying to get things done at Yale, the staffer
said. And I think if someone in a position of administrative leadership decides
that something is not that important, then it just doesn’t happen.

So this is the baseline. This is the context. For years and years, Yale is
giving these drugs that offer a relatively light level of sedation for this
procedure. Patient response to these drugs varies. Some pain has been
normalized.

One of the things I wanted to know from staffers was if there was a point when
they’d started seeing more pain than usual. Nobody could identify an exact date.
But some people did remember something changing before June 2020, the date Donna
confessed to.

As one staffer put it, I remember a shift in feeling like we were doing things
reasonably well and pretty much achieving our goals of minimizing pain. And then
gradually, it didn’t seem like we were. A nurse recalled, I remember distinctly
times a patient would say, oh, my God, I feel everything.

I looked at the physician and said, I gave the max. What can I give? Whether it
was water, I don’t know. In hindsight, it makes you think it had been water. Not
everyone was seeing this.

Retrievals were divided up among a lot of different doctors and nurses at the
clinic. Often, doctors weren’t even doing retrievals on their own patients. But
staffers who did register that something seemed off started coming up with
theories to explain it, stories, the way everyone here did.

One theory was just the basic, we need better anesthesia. Another, there was a
new manager, and there was a lot of frustration with her. Nurses were leaving
the clinic, and those who remained were spread thin.

Could that have something to do with it? But also, and this was the theory I
heard most consistently, maybe it was because of this one doctor, someone who
didn’t have great hands, as one staffer put it to me, or a great bedside manner.
One staffer told me that all of the nurses were talking about how, in
retrievals, this doctor would be like, if you don’t stop yelling, I’m just going
to leave.

Another recalled of this doctor that, quote, their response was more often kind
of an impatient. I can’t do this unless you stop moving, kind of almost scolding
the patients for the discomfort that they were having. During this time, a
doctor from Yale’s family planning service was invited to the clinic to speak to
staffers about how to be more gentle during procedures.

Some staffers were offended by the idea that they needed a refresher course. One
said, we had this very sort of condescending talk about how to treat our
patients and how to be empathic and responsive. I mean, the whole thing was just
like, what is happening here? Are we all being subject to this insulting
training because of one person?

One theory that none of the staffers I talked to had was that a colleague was
stealing drugs. That’s usually how it works with diversion. People don’t suspect
their coworkers. But increased complaints of pain are a known sign of drug
diversion.

And leadership is responsible for seeing the big picture. And if a manager was
aware enough of pain to invite someone to speak on it, they should have
investigated all possible reasons for the pain, including the drug supply.

Probably, the most basic step in preventing diversion is how you handle and
store the drugs in the first place.

At Long Wharf, these systems were not great. For one, the Long Wharf clinic
didn’t have a Pyxis, a kind of secure vending machine for drugs that records
each transaction. A machine is not a solution for poor oversight, and not every
outpatient setting has one of these machines.

But two patients who worked as nurses were shocked that the clinic didn’t have a
Pyxis. I can’t even take something as simple as a Tylenol out of the Pyxis
without somebody wanting to know which patient it went to, when it was given,
how much was given, one of them told me.

A staffer at the Yale clinic told me that when they wandered to a manager why
they didn’t have a Pyxis, they were told Yale didn’t want to buy one because it
was too expensive.

The way drugs are procured is supposed to be tightly regulated too. Because
obviously, that’s a point where they could be pocketed. At Long Wharf, at least
some of the clinic’s drugs came from Walgreens, including fentanyl, like it was
somebody’s job to run out to Walgreens and pick up fentanyl. It sounds weird,
and it was, even to people who worked at the clinic.

Staffers told me that when Donna had this job, she had often been insistent in
trying to get doctors to sign the prescriptions she needed for the drugstore.
One staffer remembered, she’d be very, very, very aggressive. Another said that
Donna was constantly harassing fellows to write scripts for patients that were
going to be done the following week.

At the time, both of these staffers attributed this to a kind of mania for
organization, but both also clocked it as odd. It was, OK, she’s like super
efficient, one of them said. She’s trying to get her job done so she can go home
to her kids, take her kids to their activities.

In early 2020, the clinic moved out of the Long Wharf office to a newly
renovated building in Orange. Almost immediately, the pandemic started. One
patient remembers shaking her doctor’s hand on like March 8, and the handshake
already feeling a little strange. The clinic shut down for a while. And by the
time things started up again, it was June 2020, the month that Donna says she
started stealing fentanyl.

[MUSIC PLAYING]

At the new building, there were new drugs. Now, patients were offered deeper
sedation. Anesthesiologists came to the clinic for most retrievals, adding
powerful sedatives like propofol into the mix with fentanyl and midazolam. Some
staffers noticed a difference right away. The patients were more deeply asleep,
one of them said to me.

It was more like a full on surgery. By comparison, they looked tremendously
comfortable. But propofol, isn’t a pain drug. It just kind of knocks you out.
And to the fertility doctors, that deeper sedation likely masked the fact that
some patients weren’t getting fentanyl.

So in the procedure room, some patients appeared comfortable. But in the
recovery room, some of them came to in severe pain. At home, some continued to
feel severe pain. And that part didn’t make sense to several doctors I spoke to,
people not from Yale.

Fentanyl is short acting. Maybe it would cover pain for up to a half hour after
the procedure ends. But that’s probably it. So how to explain the severe pain
patients felt hours later or the next day? People I talked to didn’t doubt the
patients were in severe pain. They just didn’t know where it was coming from.

But any patient in severe pain after an egg retrieval should not have been
discharged, doctors said. It’s just not supposed to hurt that much. And severe
pain is a sign that something might be really wrong.

[MUSIC PLAYING]

When Donna got to Orange, she basically took over the drugs. In March 2020, two
months before she says she started stealing fentanyl, she completed an
application with the DEA that allowed her to sign controlled substance orders.
She was in charge of ordering drugs for the clinic.

The room where the drugs were stored was sometimes unlocked, and Donna was able
to enter without swiping her access card. Obviously, things went wrong with this
setup. And even more things went wrong with this setup than were reflected in
Donna’s criminal case.

Days after the loose cap was first discovered, the DEA investigated the clinic.
Their audit found that a lot of drugs went missing under Donna’s watch. 6
percent of the ketamine, 24 percent percent of the midazolam, 35 percent of the
fentanyl. This is in addition to vials she tampered with.

These are hundreds of other missing vials that just who knows what happened to
them. It’s possible that this was just very bad record keeping. The records from
this time are messy, handwritten logs. But was Donna also stealing the midazolam
and the ketamine? It is speculation to ask, but it is also weird not to ask,
given that she was stealing the fentanyl.

No matter what happened with those drugs, these are serious discrepancies. Yale
agreed to pay the DEA $308,000 fine to settle these and other violations of the
Controlled Substances Act. So that’s accountability on a regulatory level.

On a personnel level, just who was or was not looking at those logs? Who was
managing Donna? A staffer I spoke to emphasized the lack of oversight during
this time. The nurse manager was new, and it was summer 2020, the pandemic.

The clinic was operating with a skeleton crew, is how this staffer described it.
A lot was happening on Telemedicine. In retrospect, it was ripe for abuse, the
staffer said.

[MUSIC PLAYING]

The pandemic made it easier for Donna to hide what she was doing. But there is
one thing that would have been very hard for her to disguise, how did nobody
notice that she’d tampered with the vials, especially the caps? People I talked
to who work with fentanyl vials were just kind of blown away by that.

The caps on these vials pop off, and it would be impossible to reseal them the
way they came. Of course, ultimately, an anesthesiologist did notice a loose
cap. And now, the problem wasn’t that the fentanyl diversion was hidden. The
problem was with how it would be addressed.

The loose cap was discovered on a Friday. And the following week, the news was
shared, fentanyl was missing. It was almost immediately clear that Donna was
under suspicion. Poor Donna, one staffer remembers a manager saying.

The staffer thought, poor Donna. Poor patients. Lawyers advised staffers not to
talk about this even among themselves. It was all basically about protecting
Yale, one staffer remembered. Nobody cared about anything that we went through
as providers.

No one cared what patients went through. It was all just sort of minimizing this
as much as quickly as possible. The staffers I talked to emphasized that what
they went through was nothing compared to what the patients went through. But
they had also been betrayed by Donna.

And now, they had to wrestle with the repercussions of that, what cues they
might have missed, what it meant to have caused pain to their patients, or to
not have recognized the pain they were in, or the reason for it. Obviously, they
were going to talk about it with one another. I mean, there was constant
talking, one staffer said. That just wasn’t realistic. I’m sorry. It’s crazy. We
can’t keep working and not vent and provide support to each other.

Six weeks after the loose camp was discovered, Yale sent out that letter that
infuriated patients, staffers too. I found that letter so offensive, said one of
them. The letter was an official story, Yale told about these events. And the
staffer and some of the patients had the same reaction to this story. As it was
told in the letter and would be told later, the story evaded. It blame shifted.
It focused attention onto a person and away from the institution.

leah

It’s a language that doesn’t take responsibility. It individuates the problem.
So here’s this woman, who was troubled, who took advantage of an otherwise,
impeccably well-oiled machine.

lynn

And again, it’s not like what can we do to never have this happen again but
more, oh, well, it was her fault. She’s gone.

esha

I think if it wasn’t Donna, it could have been anybody else. They didn’t create
an environment where there were checks and balances, where there was a proper
policy and procedure in place that there were ways to mitigate risk.

leah

It was like, oh, here’s this problem. We’ve now eliminated the problem. But
there was a whole system of enablers. There was a whole system that helped prop
Donna up, excused her behavior, and then threw her out.

susan burton

It is a source of deep frustration for many of us that the party line up and
down has been about one bad egg, a staffer told me. I would have liked to see my
institution acknowledge mistakes, apologize to patients for a systemic failure
on Yale’s part, take ownership, and clearly outline steps to prevent this from
ever happening again.

[MUSIC PLAYING]

Two former staffers gave me the same reason for leaving the clinic, that they
felt they could not provide good patient care. To be, quote, “not proud of the
carrier providing and constantly apologizing. It’s just exhausting,” one staffer
said to me. In the end, the staffer felt that good patient care was not the
driving force at Yale. It wore me down. I got really tired of feeling like I was
expressing the same patient care concerns and either being told that someone was
working on it, or that it wasn’t an issue.

[MUSIC PLAYING]

While Yale declined to answer almost all of my questions, they did offer me a
statement. Yale deeply regrets the distress suffered by some of its patients
when a former nurse at the Yale fertility center diverted pain medication
intended for patient procedures. After Yale discovered the nurse’s misconduct,
it removed her from the center, alerted law enforcement agencies, and notified
patients who might have been affected. The center also reviewed its procedures
and made changes to further oversight of pain control and controlled substances.

That phrase, pain control. It wasn’t part of the earliest statements Yale gave
about these events, at least not the ones I’ve seen. As if it took them a while
to understand the issue here, not just the institution’s failure to control
drugs, the institution’s failure to control pain. How to think about that pain
as a patient and as a practitioner? That’s coming up after the break when
episode four of the Retrievals continues.

[MUSIC PLAYING]

Early on in my reporting, a staffer suggested to me that not all of the patients
in the lawsuit had actually been victims of Donna’s crime. Could their pain just
be the reality of the retrieval? And the moment, I did not know what to make of
the suggestion. What would it mean for me to consider the question that maybe
not all of the patients had been victims?

In situations that involve disbelief, questioning can be construed as doubt. And
to be clear, the staffer was sensitive to these nuances too, emphasizing that no
matter what, these patients had been betrayed by the clinic. Leah told me on
that original Department of Justice call, this was, quote, “the million dollar
question.” How do I know if this happened to me? And the answer was, you don’t.

My answer to this question is that the underlying issues are still the same.
Patients reported severe, unexpected pain, and that pain was not properly
addressed, and maybe hadn’t been for years before these events. For example,
after hearing this podcast, a patient who had undergone a painful retrieval at
the clinic some years ago contacted me.

Soon after her retrieval, she’d complained in writing, asking why Yale didn’t
offer, quote, “additional pain control options during egg retrievals similar to
those offered at other fertility centers here in Connecticut, such as propofol.”
After a follow up meeting to address this and other issues, a doctor in a
leadership position emailed the patient a list of action items. We’ll work on
making anesthesia available to our patients, he wrote. That was in 2014.

When this patient heard this podcast, it was like she was hearing the story of
her own retrieval. I was crying out in pain, she told me. Before the retrieval,
a nurse had assured this patient that she would hold her hand to help her
through it. I don’t want your hand, the patient remembers thinking. I want the
drugs I had for my dental surgery.

Even a decade later, her retrieval is a trauma she does not speak about.
Patients say that Yale dismissed the pain they reported. Offering inadequate
pain control is another way of dismissing pain, another way of saying, this
doesn’t matter. It’s upsetting either way. Whether patients were in pain because
their drugs were stolen or because the drugs the clinic used were just not
enough for too many patients.

When a patient is in pain during a retrieval, what do the people in the room
with her feel? Let’s walk it through. Let’s walk through the essential unit of
this story about the Yale clinic, the retrieval. Here’s how it worked at Long
Wharf.

The doctor would walk into the room. Lights are dim. Patient already there. Once
the patient was sedated, the doctor would begin. If the patient flinched, the
doctor would stop, ask the nurse to give more meds, wait for them to kick in.

If the meds still didn’t work, the same thing again. And then if there were no
more times to stop, no more fentanyl to give, the doctor might say something
have, you have this many follicles left. Would you like me to stop or keep
going? And most of the patients would say, keep going.

There’s competing interests, right? One Yale staffer said to me. They’re
uncomfortable, but they want to have a baby.

This is an impossible position for the patient, of course. The patient is
saying, yes, I want this. But what else could they say?

By this point in their treatment, there’s already so much they’ve submitted to
and so much control they’ve relinquished. And there’s a time sensitivity. A
doctor doesn’t have all day. There’s only a window of a couple hours to get this
done.

After that, the patient will ovulate and lose all of her eggs. There’s an
awareness of what’s come before this. Money, time, maybe previous losses. The
last shot before the insurance runs out. It’s not a life saving procedure, one
Yale staffer said to me. But also, I don’t think elective is the right word to
use for something that’s allowing someone to build a family when they otherwise
aren’t able to.

Doctors know what the patient has put into this and what she wants out of it.
Each time I’m doing a retrieval and getting follicles, a doctor from another
clinic said to me, I remind myself that this egg could be the baby.

But getting through a painful retrieval does not feel good.

It’s awful, one staffer from Yale told me. That’s not why I went into medicine,
to cause people pain.

So what are the people in the room with a patient feeling? A lot. It’s not that
they aren’t aware of pain. It’s that they’re attuned to multiple varieties of
it, including the pain of longing.

The patient puts up with the pain because she longs to have a child. The doctor
knows the depth of that longing. Getting the eggs causes one kind of pain but
relieves another.

[MUSIC PLAYING]

The literature on pain and fertility procedures is, for the most part, very
concrete. What should we use for pain rather than how should we think about it?
But I did come across one study with a more holistic approach. A paper on,
quote, “trust pain and exit points.” This paper explored why patients chose to
endure the pain of fertility treatment and what experiences of pain made them
quit.

It was an idiosyncratic paper, kind of a mix of the sociological and the
personal. And the research had been done 20 years ago in Israel, in a setting
where egg retrievals were done via an incision through the abdomen. But what
still felt applicable, actually what felt timeless, was the author’s conclusion
that you endure the pain of fertility treatment because you, in a way, are
already a mother.

You are in the future in which you are already a mother, and you are suffering
on behalf of your children. Put aside the notion that suffering on behalf of
your children is intrinsic to motherhood or that all fertility patients want to
be mothers. Of course, there are patients who would not use this word or find
that identity relevant.

What’s meaningful here is that you put up with the pain and the present because
of how badly you want what you want in the future, whether that is a particular
identity or anything else.

So that’s why patients stayed in fertility treatment. Why did patients leave? A
higher level of hurt is required than that of pain or humiliation alone, the
doctors wrote. Only when the women felt that the treatment endangered their
physical or mental existence that the women quit their IVF treatments.

[MUSIC PLAYING]

Some of the ill patients did stop fertility treatment. Most kept going, and most
who did had babies. That’s what matters, right? The baby is just one outcome.
What do the other ones look like for the patients and for Donna? That’s next on
the final episode of The Retrievals.

[MUSIC PLAYING]

The Retrievals is produced by me and Laura Starecheski. Laura edited the series
with editing and producing help from Julie Snyder. Additional editing by Katie
Mingle and Ira Glass. Research and fact checking by Ben Phelan and Caitlin Love.
Music supervision, sound design, and mixing by Phoebe Wang.

Original music by Carla Polone, and music mixing by Thoma Polley. Indie Chubut
is the supervising producer for Serial Productions. At “The New York Times,” our
standards editor is Susan Wesling. Legal review by Dana Green. Art direction
from Pablo Delcan.

Producing help from Jeffrey Miranda, Kelly Doe, Renan Borelli, Desiree Ibekwe,
and Anisha Muni. Sam Dolnick is the assistant managing editor. Special thanks to
Marcel Cedars, Lindsay Goucher, Cara Murray, Megan Olson, Shannon Page, Rebecca
Phelan, Lisa Szuchman, Maggie Smith, and Adam Starecheski. The Retrievals is a
production of Serial Productions and “The New York Times.”

[MUSIC PLAYING]

Listen 38:00





Open this article in the New York Times Audio app on iOS.

What we know about what happened at the clinic.




EPISODE 5: THE OUTCOMES

transcript

Back to The Retrievals
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transcript


EPISODE 5: THE OUTCOMES

This transcript was created using speech recognition software. While it has been
reviewed by human transcribers, it may contain errors. Please review the episode
audio before quoting from this transcript and email transcripts@nytimes.com with
any questions.

susan burton

The women get pregnant. Some of them see it begin. They see it begin at the
clinic, in the same place where they had their retrieval. On the ultrasound
screen, they watch as the embryo is placed in their uterus. Some of the
pregnancies stick.

Esha’s is one of them. The single embryo she implants divides in two, and she
finds herself carrying twins. They’re born in the spring eight weeks early. And
after Isha delivers, she goes back to her OB for her own follow-up.

esha

After I delivered, I went in for my six-week postpartum visit to meet with my
doctor. And it somehow came up in conversation that I was part of this suit that
was going on. And she looked at me and she said, well, what’s the big deal? I
mean, you ended up pregnant.

And she’s not the first provider that said that to me. I’m actually in the
process of switching psychiatrists, because I had a similar experience with her
recently where she said, I really don’t get what the big deal is. You were
successful. You got pregnant. What’s the problem?

susan burton

Wow. I — wow. I mean, yeah. I mean, just what a thing to say. As if the only
thing that matters is that single outcome and not the entire process.

esha

I mean, yeah.

susan burton

Outcomes of fertility treatment are typically measured by the numbers. The CDC
collects data. You can go online and look up a clinic and find out what
percentage of egg retrievals result in live births. But the outcomes here can’t
be expressed by existing options on a dropdown menu. Some of these outcomes are
not concrete. And just like the initial experience of pain, some of the outcomes
are questioned.

Really, what are their damages? One fertility doctor, someone not from Yale,
said to me about the patients in the lawsuit. What are the harms done? What are
the redressable harms? One of the patient’s own lawyers told me that when his
firm got the first call from a patient, he went home, told his wife the story,
then said, but nothing really happened to the woman. So it’s not a case. His
wife enlightened him.

Like Esha, Leia also had a weird interaction with an OB about her experience at
the fertility clinic.

leah

I was like, yeah, I mean, I had this horrible experience at REI. The nurse who
was stealing the fentanyl. And I remember that one of the older doctors, she
said to me, well, they took care of that. I said, they did? Did they? Again,
this is why, at least for me, you start talking about it and someone tells you
really politely in a very polite way, could you please shut up?

[LAUGHS]

Could you kindly shut up? This is making me uncomfortable. Please be quiet now.
The same thing. You know, like —

susan burton

The same thing. In a way, it was a repetition. First, the women’s pain was
dismissed. And now the repercussions were trivialized, too. It’s an act of
erasure. To be told that the only part of a story that matters is the end.

angela

They want pictures of the baby. Follow up. Let us know. They’re happy for you
when you get pregnant, but the institution itself doesn’t seem to care beyond
that. Beyond the results and the bottom line. I have a child. So what? I wasn’t
harmed. I have an embryo still frozen, so I wasn’t harmed. That’s good enough?
It’s not good enough.

susan burton

What are the lasting effects of this experience for the patients? And what are
the outcomes for Yale? And for Donna. From Serial Productions in The New York
Times, I’m Susan Burton, and this is “The Retrievals.” This is Episode 5, “The
Outcomes.”

[MUSIC PLAYING]

Back at the beginning of all this, Yale told patients, there’s no reason to
believe this event has had any negative effect on your health or the outcome of
the care that you received. Yale seem to be saying, your measurable outcomes
were not affected by this. Some patients wondered how that could be true.

lynn

I can’t say for certainty that we didn’t get all of the eggs that could have
been retrieved that day. But my assumption would be when you have a patient on
the table screaming that it’s painful and we need to stop, that there could have
been a much better outcome to that retrieval.

susan burton

A few doctors told me anecdotally about leaving eggs behind when a patient is in
pain. But there’s very little research on having retrievals without anesthesia
and what the outcomes of that might be. It’s just not a standard category of
study. What happens if we do a painful procedure without giving the patient pain
meds?

Allison wound up with a lot fewer eggs than she expected.

allison

I was just so upset that we didn’t have a better outcome.

susan burton

Allison is a nurse. Actually, a nurse anesthetist. She gives fentanyl on a daily
basis. I can’t imagine withholding it from somebody, she said. Allison was
skeptical of Yale’s assertion that nobody’s outcomes could have been affected.
Allison and her husband came to the clinic because they wanted to test embryos
for muscular dystrophy to rule out the possibility of passing the gene along.

Though Allison was in her early 30s and had no infertility issues — in fact, she
had one child already — her retrieval resulted in just three viable eggs and
then just one embryo. Her doctor told her he was surprised. That he would have
expected a better outcome. Allison would have, too. But Donna was her main
nurse. And one thing she wondered was if Donna’s drug use had a domino effect.

Allison had been so alarmed by what she described as the organized chaos of the
Yale clinic. That she’d recorded everything that went wrong for her there in a
list. The entries included wrong meds prescribed, lab results never reported,
conflicting instructions for a critical shot called the trigger shot.

Allison had charted all of the mistakes she observed in her treatment. And when
she found out about Donna, she wondered if Donna had been charting mistakes,
too. As in, introducing them.

allison

When I would go in for my ultrasound, she would be documenting the follicle size
while the doctor is doing my ultrasound. So what if she wrote down the wrong
thing? How was someone under the influence of drugs supposed to be able to
record things accurately? Is this why I didn’t have the outcome that everyone
thought I was going to have?

susan burton

Donna had many responsibilities for many patients’ complicated treatments.

allison

I don’t feel like if you’re under the influence you can possibly do all of that
accurately for so many patients. I just don’t see that being possible.

susan burton

Allison got lucky with that one embryo. She came out of this with a baby. But
she lost something in the process, too. Trust. Culminating in the night of her
son’s birth.

allison

So when I had my son over the summer, we were in the hospital. And they did
blood work on my newborn son. So they took my son’s blood, my newborn son. And
they told me that his blood type was B positive. And when they gave me this
information, I said, that can’t be. I’m O negative and my husband’s O positive.
I can’t have a baby with a type B blood. So you have to redraw it. I said it
must be a mistake. The lab must have made a mistake.

So then they redraw my son’s blood, and it comes back as B positive. And my mind
immediately went to the clinic messed up and they gave me the wrong embryo. And
this is not my baby. And it sounds crazy to even say that, but that’s
immediately where my head went. So now with a baby who is not even 24 hours old.
My husband laying on the hospital couch next to me. It’s the middle of the night
and I’m having an argument with the nurse saying, this can’t be right. Redraw my
son’s blood.

So now I have my husband thinking that the embryo that we implanted isn’t his or
it’s not mine. And that’s not a rational way of thinking. But that’s immediately
where our mind went, because we just didn’t trust this clinic at all. And I
thought, oh my god, this woman who I was supposed to trust, I mean, what did she
do? Did she mix up the vials? Did she label the wrong thing? Whose baby is this?
It can’t be.

Finally, after a couple hours, I went into my husband’s chart and looked at his
blood results and realized that he was B positive and not O positive. Which the
story sounds so crazy to me to even say it out loud. But that’s just the type. I
mean, that’s the impact it had on us, right? We didn’t trust them enough enough
to even think that the baby that we had was ours.

And your mind shouldn’t go there. You shouldn’t immediately think that is what
happened. And we still talk about it, because it’s just crazy to even think.

susan burton

Yeah. I mean, first of all, it doesn’t sound like a crazy story. It doesn’t
sound crazy to me at all. And it’s so powerful, because it’s the night your baby
is born. You shouldn’t have to be asking yourself the question, is this baby
mine? That should just be a night — I mean, well, it’s not always a night of
pure joy. It’s a hard few hours after —

allison

No, but that’s the memory that I have associated with that night. I mean, it’s
really scarred me. Everything that I went through. I just don’t trust — I don’t
trust anybody anymore. You think that your doctors and nurses have your best
interests at heart, and it’s really hard to regain trust in the medical
community when somebody has betrayed you like that. And I feel like that speaks
volumes coming from someone who works in the medical field myself.

katie

The negative downstream effect is just a deep mistrust of the medical setting.
Where I work, by the way.

[LAUGHS]

But more generally. I mean, I was always surprised because my twin sister was
not super comfortable in hospitals. And I always felt like, oh, I work in a
hospital. I’m extremely comfortable here going into the IVF process. It just
wasn’t as stressful for me, because I felt really comfortable. And that has
really been taken away.

camise

To trust people with something as priceless as your child or whatever it is
you’re doing to bring a child into this world and to lose that trust, it’s not
something you ever get over.

victoria

When you lose that trust in healthcare and medical practice, someone who never
really had white coat syndrome, now does.

esha

And I felt really distrustful about the other providers that I would be seeing
at Yale and when it came to them touching my body or coming near me.

melissa

I don’t know, I feel like it’s hard for me to trust doing a medical procedure
again in a way. For the most part I do, but it’s definitely made it more
challenging. For instance, I had a C-section in May for my baby. And I just felt
really a little bit nervous about, OK, am I going to feel this pain this time?

^laura

^: And he was talking to me about, these are the medications I’m going to give
you. And he’s like, and you’ll most likely be asleep. But there’s a chance that
you could be awake. And then I was like, wait, wait, what? And so I started
crying. And I just basically told him, I was part of that situation.

And he was so caring and understanding. He was like, I will make sure that
you’re not awake for anything. I will be on top of it, and I will make sure that
you’re given everything so that you don’t wake up or know what’s happening.

melissa

And I was surprised when they told me that I didn’t feel anything. But of
course, I told the doctors and the anesthesiologist that I had gone through
this. And I was like, I just want to let you know, because it makes me a little
nervous, you know?

esha

The anesthesiologist came up to me, and it was this young guy. And said to me,
OK, here’s your options. And was talking about a epidural and if we had to do
anesthesia and this and that. And the minute he said anesthesia, I mean, I was
calm through the entire thing. But the minute he said anesthesia, I looked at my
husband in pure panic and started crying.

So it really had an effect on me. It still has an effect on me whenever I come
across things when it comes to Yale. Unfortunately, they’re one of the biggest
hospitals here — I think the biggest hospital system here. And even when it
comes to my kids, I have the option between Yale and one other place. And
whenever Yale becomes the option, it sends chills through me.

julia

I had to move on after this.

In large part because of what happened with Donna when we chose to go to a new
clinic.

susan burton

Julia is the patient who was in so much pain after her retrieval, that she
passed out and went to the ER. She left the Yale clinic. But not what happened
to her there. That continued to reverberate.

julia

It’s the initial experience. It’s my daughter asking for months if I’m OK or if
I’m going to the hospital. It’s right away when you become pregnant, they test
you for HIV and hepatitis. And it’s like, that it comes back. What if? What if
they missed it the first time? I mean, why would I believe something from this
office anymore, right?

And then her sentencing is another one. Just this laughable punishment. That’s
how I would say I experienced it. Just the waves keep hitting you. They keep
coming.

susan burton

On the day Julia and I were talking about this, she was pregnant. It was 3 and
1/2 weeks before her due date.

susan burton

Do you feel differently approaching this delivery than you did approaching the
birth of your first child given everything that’s happened in between?

julia

There’s no comparison. It feels like a whole different lifetime has happened,
right? And I mean, it feels —

it feels like —

it feels like my husband and I survived a war. It’s like a battle, you know? And
it’s a very isolating experience to go through. If everything goes right. And
then you add something like the anger of the case with Donna, of the doctors
making you feel nuts.

And it’s just, I have so much — I have so much anger.

And you don’t want that to be what you — I’m sorry.

susan burton

Oh, it’s OK. Take your time.

julia

You don’t —

it’s been a process trying to let go of that. Because I have a wonderful
daughter.

Soon — soon, I’ll have a son. And I’m really actively every day working on
trying to separate the battle that led to him from him, right? And it’s hard to
explain, but they’re connected.

susan burton

The story of the baby could not be told without the story of the clinic. And
what this association felt like, this was something other patients also tried to
name. The specific way the trauma was embodied.

angela

There’s a part of me that honestly believes that the trauma from my first
retrieval is the reason we had a miscarriage. And scientifically, I know that
that is highly unlikely. But you read these stories about the trauma of birth
and how different things that you do to babies when they’re being born and at
birth can actually affect them for the rest of their lives.

And what’s to say that the process of harvesting them, that trauma isn’t
ingrained in them either?

leah

Having a child after this and being pregnant and going to these sentencing
hearings, that’s something I haven’t even talked about. Is being pregnant and
going — and how much of this did I actually, again, want my body to absorb while
I was pregnant?

susan burton

Leah got pregnant spontaneously outside of her treatment at the clinic. Her baby
was the only baby I met. A smiling baby wearing striped pajamas. He sat on
Leia’s knee. It was important for me to see a baby. Because it complicated the
way I was interpreting the outcomes. It was so confusing. I’d been feeling
empathic outrage.

It’s not the baby. Why are these people telling the patients that the baby is
the only outcome that matters? But my god, to be in the presence of a baby,
that’s literally the whole design of babies. To make you more attentive to them
than to anything else. The baby is what matters. But everything else matters,
too.

leah

I have to say, there’s some gift from God that this child was naturally
conceived and not conceived via — I have to say. And I can only, in a way, do
this because I have a child who exists that they didn’t help administer to
exist.

susan burton

And then how are you different? What are the reverberations of this for you?

leah

I don’t know how to talk about that.

[LAUGHS]

I don’t. I mean, it’s so deep, you know? That, I don’t know. I don’t know if I
could talk about that. Because it’s incredibly harrowing, violent. And in many
ways, it has been a kind of unspeakable experience. I will say that also it’s
hard for other people to hear and listen to this. People cringe. There’s a kind
of, I don’t know how to say this, but there’s a kind of —

there’s so much of your life you have to talk about when you’re talking about
this. There’s so much of your life you have to talk about. Your marriage, your
body, your psyche. Your relationships with other people the relationships.
You’re going to have down the road with other physicians. What you’re going to
do later if you want to have another child, et cetera.

That’s its own thing. So when you talk about what are the reverberations, I
mean, there — how do I even talk about my life without not talking about this?
But how do I talk about this?

[MUSIC PLAYING]

One of the things that makes me angry is that Yale and Donna have put me in this
position where I have to talk about the most intimate, raw details of my life
that maybe I don’t even want to reveal to myself. That now I’m talking to you.
But for a person who’s private and is — the other violence of this is that we,
if anything is going to happen, we have to speak about it. You know?

An added bonus, an added onus on us that, well, if anything is going to happen,
or if that it doesn’t happen again, we have to speak about it. There’s no right
turn or left turn out of this. You want there to be. Trust me, I’ve thought of
it. But that’s the other reverberation, is that we have to talk about it, you
know? That’s just only now unfolding.

susan burton

Leah and the other plaintiffs in the lawsuit against Yale have to open up their
lives for it. Do things like turn over their therapist notes. If they don’t,
Yale can seek a court order to get them. They have to deal with questions like,
describe any changes in the frequency and satisfaction of your sexual relations
with your spouse following the incident. When Leia says violence, this is part
of what is evoked for me. This kind of bullying extraction.

Of course, nobody has to join the lawsuit. I’ve heard from and of patients who
didn’t. They chose not to join out of loyalty to their doctor. Or they just
couldn’t. They’d had a miscarriage. They were in a dark place, depressed. In no
state for this.

A lawsuit is a way to hold an institution accountable. To send a message or
teach a lesson. To advance systemic change. It is also a way to get something,
to make it fair, and to announce, you should not have dismissed me. You
dismissed me once. You may not dismiss me again. One of the attorneys
representing the patients, Kelly Fitzpatrick, went through IVF herself. She told
me that this case is different from a regular medical malpractice case in many
ways, including this one.

kelly

These women were repeatedly ignored. And so that sets it apart from a regular
medical malpractice case. These women were gaslighted. They weren’t believed.
They were ignored. And that makes it different.

susan burton

They were ignored. That’s what makes it different. So how do you do that? How do
you sue for ignoring pain? This became a real question for me. Was there some
statute? It’s not like that, another one of the attorneys told me. You can sue
because they should have investigated reports of pain. That made sense.

But it wasn’t exactly my question. There’s the harm that comes from not being
believed. But then there’s the harm of not being believed itself. I kept reading
around, doing Googles like, “How do you sue for not being believed?” “How do you
sue for not being believed, women?” “Lawsuit — women’s pain not believed.”

And then I came across the perfect paper. It was called, “Miss Diagnosis —
gendered injustice and medical malpractice law.” I loved this title. Miss
Diagnosis. Like a shiny banner across your chest in a pageant for female pain.
The paper wasn’t answering exactly my question. It didn’t open with the
sentence, here’s how you sue for ignoring pain. What it did do is explore how
this issue of women not being believed in medical settings plays out in court.

The author was a young attorney named Cecilia Plaza. She’d written the paper
while still a student at Columbia Law School. She set out to answer a specific
question about the gender gap in medical malpractice outcomes, which essentially
is a question about whether women can be fairly compensated in the medical
malpractice system. And what she found is that women likely cannot.

Because the foundation of this system is, did what happened to you meet the
standard of care? If it did, you’re out of luck. Like, you’re a woman, you think
you’re having a heart attack. You go to the ER. The doctor says, it’s just your
anxiety, and sends you home. Then it turns out that you really were having a
heart attack. Can you successfully win a case against this doctor in court?

Maybe not. Because doctors misdiagnose so many women’s heart attacks as anxiety
that sending a woman home could actually be interpreted as a reasonable choice
that an ordinary doctor would make. Just to be clear, Cecilia’s paper is not a
work of opinion. It is an empirical analysis based on a ton of data. And what
Cecilia found is that women cannot expect to get as much money as men in this
system. Because dismissing women doesn’t necessarily fall below the standard of
care.

So to win that heart attack case or other similar cases —

cecilia

You would have to basically make the argument that not believing your patient’s
report of symptoms or of pain is de facto below the standard of care. That’s not
currently the case, which is a little bit mind boggling. But you would have to
make that argument, and the court would have to agree with you.

susan burton

Another thing that was mind boggling to me in all this lawsuit stuff happened in
the back and forth of discovery. In discovery, there’s a part called written
interrogatories. Each side asks questions, and the other side mostly objects.
But even given that, I was taken aback by Yale’s objections to some of the
questions on the plaintiff list.

Like, state whether there are policies and procedures concerning documentation
and/or record keeping of pain at the clinic. Yale’s objection is that this
question is overly broad and burdensome. And as to a request for a description
of the process for evaluating patient pain during and after fentanyl
administration, Yale says that this is irrelevant. Immaterial.

I got that this was part of a legal game. But it was also a microcosm of the
whole situation.

archived recording (judge)

All right, we’re on the record in the matter of Melissa Cohen versus Yale
University. Docket number 216063194. Lisa Gorski versus Yale University. Docket
number —

susan burton

The lawsuit is scheduled to enter settlement negotiations this month. That tape
is of a hearing in January. One plaintiff told me that at a recent town hall,
discussion focused on the possibility that Yale will offer a lump sum to the
group and an independent party will decide how the money should be divided up.
Those who had procedures before June 2020, the date Donna says she started
stealing fentanyl, expressed concerns that their experiences will be considered,
quote, “less worthy.”

For the plaintiff, this, quote, “has become another retraumatizing experience of
Yale/others telling women you didn’t experience what you believe you
experienced. Unless it happened between certain dates. It’s now, again, someone
not believing and discounting literally our reports of pain.” The patient’s
attorney said they could not comment on this.

Incidentally, a former Yale nurse contacted me after hearing last week’s
episode. A nurse who believes, based on what she witnessed, that Donna was
stealing fentanyl before June 2020. She told me a version of something I’d heard
from other staffers at the old clinic, the Long Wharf Clinic. This nurse
remembers frequently finding fentanyl vials with loose caps. Like so many with
loose caps that she says she sometimes had to look around for ones that seemed
properly sealed.

This nurse was alarmed by the loose caps and said she reported them to her
manager. The nurse’s understanding was that Donna had told their manager that
the loose caps were a manufacturing defect. When I asked Yale about this
account, they pointed me back to their earlier statements.

Coming up after the break, Donna gets another hearing. That’s next when “The
Retrievals” continues.

Donna received a light sentence. But at least, as one patient put it, she
obviously lost her nursing license. But that was not the case. Back around the
time Donna first confessed to law enforcement authorities, her license was
suspended. But it was never actually taken away. In April 2022, almost a year
after Donna was sentenced in federal court, she came before the Connecticut
Nursing Board seeking to have her nursing license reinstated.

archived recording

I’ll make a motion to accept the consent order as presented for Donna Monticone.

susan burton

The Connecticut Nursing Board meets monthly. And at nearly every single meeting,
the board considers multiple requests from nurses who’ve been suspended for a
substance use issue and now want to come back to work. Substance use disorder is
an illness that can be treated. A person can move through it and return.

Usually at these meetings, it’s like, here’s the motion. Do I have a second?
Discussion. All in favor, say aye. License back. And at first, it looks like
it’s going to go that way with Donna. Then a board member named Lisa speaks up.

archived recording (lisa)

OK, from what I am seeing, there is only one issue being addressed, and it’s not
the moral issue of the harm that she actually caused to patients. The drug was
substituted with — I think it’s water it said or something. That greatly
disturbs me and rises the level of seriousness in my mind.

susan burton

We’ve heard how family and friends made sense of what Donna did. We’ve heard
patients reckon with it, a federal judge. What’s fascinating about this meeting
is to hear a body of her peers react. How will, a group that includes fellow
nurses wrestle with what Donna did and what it would mean for her to return to
doing this work?

Lisa, the one who noted that there was a moral issue here, is one of the few
board members who’s actually not a nurse. She’s the executive director of a
patient safety organization. And she isn’t saying that Donna shouldn’t get her
license back. At least not explicitly. But she is troubled, and she’s trying to
get others to acknowledge that, wait, there’s something different here.

Lisa wonders if there’s some other penalty that could be imposed on Donna. Maybe
a fine. Another board member disagrees.

archived recording (geri)

It’s Geri. I don’t support it. I don’t really the purpose of that.

archived recording (patricia)

Lisa, you want to talk to your suggestion?

archived recording (lisa)

Yes. So I’m particularly concerned. It’s not just that she appropriated the
medication for herself and her own use. But we don’t know if the way she handled
things — she might have introduced bacteria, infection, or whatever. I think
that when you tamper with — the patient is getting something that they’re not
supposed to be getting. And I’m just really, really concerned that the disregard
makes it a second level up.

susan burton

She tries to articulate what that second level is.

archived recording (lisa)

It’s just a more corrupted way of thinking. It’s not just self-centered about
putting it in. It’s not having regard for the patient. And that’s what concerns
me.

susan burton

Finally, another member speaks up and backs Lisa. Someone else suggests language
they could add to Donna’s consent order, which is the document they’re working
on. Language about Donna’s reckless disregard for patient safety. Lisa is in
favor of this.

archived recording (lisa)

I like the way Stacy worded it.

archived recording (stacy)

Reckless disregard for patient safety.

archived recording (patricia)

Yeah.

archived recording (lisa)

Yeah.

archived recording (patricia)

So those are the words that you are looking to include. Is that correct?

archived recording (lisa)

With patient harm.

archived recording (stacy)

Within that vein.

archived recording (patricia)

I don’t know that we could establish — we might have to say “potential patient
harm.”

archived recording (lisa)

Potential patient harm.

archived recording

I think reckless disregard is a very important phrase put in there. Reckless
disregard for patients, whether it’s their safety or what. For their level of
pain or what. Patients under her care, she had reckless disregard for them. And
I think that should be carried into the record. I really like that phrase.
Thanks, Stacy.

archived recording (lisa)

Yeah.

archived recording (cindy)

That really applies to anyone diverting drugs, though, don’t you think?

archived recording

But this is a level that we rarely see, Cindy.

archived recording (cindy)

Yeah. I agree that the fact that she gave something else. Usually I think it’s
just don’t give anything, so I agree. But I think that reckless disregard
applies to diverting drugs.

archived recording

You’re probably right. Maybe we should see that going forward. Yeah. Let’s put
that in in our recipe book. Yeah.

susan burton

The consent order is sent back to be updated with the new language about
reckless disregard. And then a couple months later, Donna’s case comes before
the board again. On the day the board considers it, Donna and her lawyer joined
the board’s video conference. Lisa herself takes the lead on moving Donna’s
petition forward.

archived recording (lisa)

This is Lisa. I make a motion that we approve the consent order for Donna
Monticone.

archived recording

OK. Do I have a second?

archived recording (cindy)

This is Cindy. I’ll second that.

archived recording

OK. Comments, discussion, questions?

susan burton

This time, there isn’t anything substantive.

archived recording

All in favor? Aye.

Aye.

Aye. Aye.

Opposed? Abstaining. The motion passes. Congratulations. Good luck to Donna.

archived recording (donna)

Thank you very much.

archived recording

Thank you.

Thank you. Thank you.

Next on the agenda is a consent order —

susan burton

By January 2023, the suspension on Donna’s license had been lifted, and she was
officially able to practice as a nurse again. The consent order included many
conditions about substance use testing and restricted the kinds of settings in
which she’d be permitted to work.

And then just two months later, Donna voluntarily surrendered her license. I
don’t know why Donna surrendered her license. The attorney who represented Donna
before the nursing board did not respond to me. But in 2018, a senior official
in the Connecticut Department of Health said that most voluntary surrenders
happen after an accusation of substance abuse.

A surrender is not a final outcome. Donna could still apply to get her nursing
license back.

[MUSIC PLAYING]

The women have babies. They labor at the hospital or in an outdoor shower. They
come home. And before they know it, they’re thinking about things like sleep
schedules. They put a little sign on the front door that says not to ring the
bell. But they don’t come home with the baby right away. Here’s Lynn, the
patient who had eight painful retrievals.

lynn

In the end of this, ended up with my daughter Sunshine, who was born at 24
weeks, six days. So 107 days early. So we spent this last summer at the NICU.
And I think at this point, I’m still angry. And at the same time, just so
thankful that I have a baby at the end of this. Because if I didn’t have my
daughter, it’d be a very different ending. A very sad ending to all of this.

susan burton

Of the 12 women I initially spoke to, three did not have a child after all of
this. When I asked one of them if she planned to continue fertility treatment,
she said, oh no, we’re done. Another stopped for two years before being ready to
start again at a new clinic. The third is Laura.

laura

is now 43. She finished cancer treatment and then resumed fertility treatment at
Yale. She told me that she regretted not switching clinics right away. But you
just go with what you know already, she said. After a miscarriage and a couple
more tries, she became frustrated with her care there and started looking around
for other options. It’s been 3 and 1/2 years since her original retrievals.
Years of protocols and scans raised hopes. And then a reckoning.

So we had one embryo that looked really good. And we had just gotten the news
that it was abnormal. So I was devastated and traumatized again. So I said to my
boyfriend, OK, I need to go again. I found this clinic in New York. I had
already lined it up because I had done consults with all of them. Because I had
this rush. I had to have a baby. I had to have a baby.

So we drove five hours. It was 2 and 1/2 hours each way to this clinic. We were
supposed to start that night. And they were the best deal for a cash patient.

susan burton

But Laura didn’t start that night. She didn’t start taking her meds. She didn’t
start a new cycle. Cycle is the word to describe a round of IVF. Also a
compulsive loop. Laura felt like the clinic she visited were keeping her in that
loop, and she decided to take a break from them.

laura

Because these clinics make you feel like you’re failing. They don’t give you any
other options. They just want to keep giving you drugs and they don’t talk to
you about your health. I don’t know, I just — I have so much love to give, and I
just want to have a baby, I just feel like. And I know I will be a mom. I know
it will happen. But —

susan burton

One of the central tensions of fertility treatment basically since its inception
has been, OK, is this a patriarchal system or a feminist one? On the one hand,
you have a top-down system that, frankly, was designed by men. There’s tons of
drugs and doctors telling you what to do with your body. On the other hand,
being able to decide when and how to have a baby and the possibilities that
fertility medicine opens up for patients in all kinds of situations. This is
also reproductive freedom. If you have access to it. Being a fertility patient
is both a privilege and a trial. It involves both obedience and agency. Both
submission and control. There are a lot of polarities here. A lot of
ambivalence.

In the end, the central ambivalence for some of the patients is a simple and
powerful one — anger and gratitude.

katie

My doctor has retired — maybe not retired, but taken a new job in Florida, which
I just envisioned as a retirement from this mess. And even now, I have this
feeling that, well, he did his job. I got pregnant every time. These transfers
were successful every time. And so I have a lot of gratitude to this doctor for
getting me through this process, getting me pregnant each time, and then
resulting in a successful pregnancy.

At the same time, this is the person, the senior person who was in the room when
I was sober during a medical procedure at which I was supposed to have
anesthesia who has some responsibility for paying attention to that. Listening
to that. Doing something about that. So I think that I am balancing this, the
emotions around having a baby. Having a successful outcome of IVF and then the
emotions around having gone through this pretty incredible experience.

melissa

Obviously, clearly he should have pressed further and thought about, OK, well,
there should not have been pain, and I need to investigate and see what is
happening there or report it in some way. So I’m not happy with regards to that.
But he is the reason why we have a baby. So and besides this issue, I was happy
that it was successful in the end. So yeah.

lynn

The nurses and doctors that I dealt with, I have conflicting feelings. I’m
angry. I’m upset that I was — my concern in talking with them was looked over as
anxiety versus fear. And that’s all very confusing. But they still held my hand
through this journey that ended with my beautiful daughter. So I’m thankful and
angry at the same time.

susan burton

I said at the beginning that everyone told a story about what happened here, and
that all these stories revealed something about women’s pain. How it’s
tolerated, interpreted, accounted for, or minimized. So now we’re at the end.
What do these stories reveal? The short reductive answers. The ones we can
articulate now that we’ve sat with these stories and their complexity.

I’ll go in order. How it’s tolerated. That’s patience. Why did they tolerate
pain? Because they wanted to have a baby. How it’s interpreted. That’s, how did
their healthcare providers interpret it? As unusual but in the known range of
normal. And my god, what that says about, quote, “normal.”

How it’s accounted for. That’s Donna. It’s accounted for by her experience as a
mother who was a victim of a bad relationship. And that account somehow carries
weight in the criminal justice system, where Donna suffers no meaningful
consequence for the pain she caused. How it’s minimized. That’s Yale. Irrelevant
and immaterial.

Within hours after a trailer for the series went online in June, before the
first episode was even released, a woman wrote to me saying she was shaking.
That she believed that this had happened to her at Yale. I always explain it as
I was crawling up the table in agony, she wrote. Additional notes from former
Yale patients soon followed.

I was made to feel it was my fault for being overly sensitive, wrote one woman.
I have felt so traumatized and alone, confessed another. Most of these patients
had retrievals before June 2020. They never got the letter from Yale or any
other communication about it. These patients had been denied information that
could have helped them make sense of their experience.

One patient described events that took place at a retrieval in 2018. She
remembered a nurse — she isn’t sure if it was Donna — laying her down on the
table. When I said I wasn’t comfortable in that position, she said something to
the effect of, well, it isn’t a massage. You aren’t supposed to be comfortable.
I started to get teary eyed.

When the procedure began, I was awake and in pain. The patient said to the
doctor, I’m in a lot of pain. I can feel everything you are doing. Is that
normal? The doctor instructed the nurse to give more pain meds. The meds didn’t
work. The nurse then made a rude comment, the patient wrote, which I cannot
recall specifically now. Something like, we heard you the first time you said
it.

Another patient wrote that Donna was her main nurse and the first person who
made her feel supported in her choice to use donor sperm. Now the patient was
struggling to make sense of all this new information about Donna and, quote,
“who she was to me.” I am Donna, wrote another listener. This listener was not a
Yale patient. She said she was a nurse who stole drugs from the hospital where
she worked. She’s in recovery now, but this podcast and the severe reaction to
Donna online had made her feel only more shamed and unable to share her own
history.

So many laws and best practices skirted and ignored, wrote a hospital pharmacy
technician. It seems to me that even Donna could sue Yale for not protecting her
from temptation.

Most emails I’ve received are about pain. Pain that was unacknowledged, not
believed, or not adequately treated. Some about fertility treatment, some about
birth. Probably the thing I’ve gotten the most notes about are IUD insertions.
After an almost unbearable IUD insertion, one woman was told by her nurse, some
women are able to explain their whole dream vacation and don’t even the
procedure is going on. The woman looked at the nurse. I nicely replied that that
was insane.

Some of the stories describe traumas that have been processed. Other notes have
the raw power of the newly tapped. As if this has been inside maybe for years,
and it’s almost like didn’t know you could be angry about it. Didn’t realize
that this was yet another one of those things that upon reflection, oh my god,
this is not OK.

One of many things that until you hear someone speak about it, you think, as
Lynn said in the first episode, this is just what women go through. Yale refused
to respond to the lawyer’s questions about pain or to my questions about it.
About how pain was documented and addressed at the fertility clinic. Was there
even a record of this pain? Consider this a record here of the pain the women
described individually and as a chorus again and again.

[MUSIC PLAYING]

“The Retrievals” is written and reported by me, Susan Burton, and produced by me
and Laura Starecheski. Laura edited the series, with editing and producing help
from Julie Snyder, additional editing by Ira Glass, research and fact-checking
by Ben Phelan and Caitlin Love. Music supervision, sound design, and mixing by
Phoebe Wang. Original music by Carla Pallone, and music mixing by Thomas Poli.

Ndeye Thioubou is the supervising producer for Serial Productions at The New
York Times. Our standards editor is Susan Wessling. Legal review by Dana Green.
Art direction from Pablo Delcan. Producing help from Jeffrey Miranda, Kelly Doe,
Renan Borelli, Desiree Ibekwe, and Anisha Muni. Sam Dolnick is the assistant
managing editor.

Additional editing and production on this episode by Alvin Malith, Janelle
Pifer, Nadia Raman, Stowe Nelson, and Matt Tierney. Special thanks to Megan
Read, Anna Starecheski, Kylie Silver, Jen Guerra, Lee Riffaterre, Erik Tanner,
Katie Fuchs, Jordan Cohen, Victoria Kim, Jason Fujikuni, Kimmy Tsai, Ashka Gami,
Nina Lassam, John McNally, Krystal Plomatos, Sam Posner, Shvetha Zarek, Cat
Lynn, Sara Whetstone, Ryan Wade, Angie Belsos, Amanda Gabbianelli, Ellen
Bengiorno, and Jessica Leady.

And many thanks to all of the listeners who have written in with their own
stories.

“The Retrievals” is a production of Serial Productions and The New York Times.

Listen 53:49





Open this article in the New York Times Audio app on iOS.



In fertility treatment, a successful outcome is defined as a healthy baby. In
this story, the outcomes are complicated for everyone involved.

--------------------------------------------------------------------------------


BEHIND THE SERIES


YOUR HOST



Susan Burton is a longtime staff member at “This American Life,” where she has
produced, edited and reported some of the show’s most memorable episodes about
women’s experiences. She is the author of the memoir “Empty.”


◆ ◆ ◆


ABOUT THE MUSIC

Carla Pallone is a composer based in France. After classical training as a
violinist, she performed in the bands Mansfield.TYA and VACΛRME. She now
composes music for cinema and the theater, and has written music for films
including “La Fille au Bracelet,” “Libre Garance!” and “Midnight Skin.”





◆ ◆ ◆




--------------------------------------------------------------------------------





--------------------------------------------------------------------------------


CREDITS

Reported, produced and hosted by Susan Burton
Produced and edited by Laura Starecheski
Executive Editor, Serial Productions Julie Snyder
Supervising Producer, Serial Productions Ndeye Thioubou
Music supervision and sound design by Phoebe Wang
Original score by Carla Pallone
Music mixing by Thomas Poli at Impersonal Freedom
Research and fact-checking by Ben Phelan and Caitlin Love
Standards Editor Susan Wessling
Legal review by Dana Green
Art direction by Pablo Delcan
Additional editing by Katie Mingle and Ira Glass
Additional production by Michelle Navarro
Deputy Managing Editor Sam Dolnick
Producing help by Jeffrey Miranda, Kelly Doe, Renan Borelli, Desiree Ibekwe and
Anisha Muni

Special thanks to Erik Tanner, Pierre Cattoni, Lee Riffaterre, Katie Fuchs,
Jordan Cohen, Victoria Kim, Jason Fujikuni, Kimmy Tsai, Ashka Gami, Nina Lassam,
Jon McNally, Krystal Plomatos and Sam Posner.




Susan Burton is a longtime staffer at “This American Life,” where she has
produced, edited, or reported some of the show’s most memorable episodes about
women’s experiences. More about Susan Burton

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