Transcript

792: When to Leave

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Prologue: Prologue

Nancy Updike

From WBEZ Chicago, it's This American Life. I'm Nancy Updike, sitting in for Ira Glass.

OK, Val, what are we looking at?

Valerie Kipnis

So this video, it's from the front lines of the war in Ukraine. It's from a few weeks ago and it's in Bakhmut, which is a city in the eastern part of the country. And the video is shot by this guy who's part of a team of volunteers who help people get out. He's filming it on a camera that's inside his front coat pocket or something.

Nancy Updike

Yeah, I can tell it's kind of herky-jerky because he's running. Now he's walking, actually. There are low buildings all around, like, three or four stories.

Valerie Kipnis

Yeah, and there are no people in sight.

Kuba Stasiak

Evacuatziyu.

Valerie Kipnis

No cars-- it's totally empty.

Nancy Updike

All right, I'm going to stop here for some quick background. Valerie, who's been talking me through the video, is my colleague, Valerie Kipnis, a producer at the show. She speaks Russian, understands Ukrainian. She has been watching a lot of these videos, which are a genre in this war.

In Bakhmut, the fighting has been terrible for months. The city may already have fallen by the time this airs. Tens of thousands of people left the city in earlier waves. The deputy prime minister of Ukraine said the other week, quote, "If you are rational, law abiding, and patriotic citizens, you should leave the city immediately."

But at every front line, in every war, if it's a city, there are people holding out. In Bakhmut, maybe several thousand, many elderly or disabled people, those caring for them, also diehards. And so ordinary people, like the guy who shot this video, have taken it upon themselves to put on bulletproof vests, somehow get into Bakhmut, and get people out, take them to a refugee center where they'll be safe.

All right, back to this video that Valerie is showing me. The volunteer, a guy named Kuba, is in Bakhmut, looking for an older woman, who seems to be one of the last people left in this one apartment building. OK, he's running up the stairs.

Valerie Kipnis

And you can see this building is totally destroyed. You can barely see it but it has a huge hole in it.

Kuba Stasiak

[RUSSIAN SPEECH]

Valerie Kipnis

He's shouting, evacuation, evacuators.

Nancy Updike

I see.

Valerie Kipnis

And so he's trying to shout, hey--

Kuba Stasiak

[RUSSIAN SPEECH]

Valerie Kipnis

--come out.

Kuba Stasiak

[RUSSIAN SPEECH]

[DOOR OPENING]

[RUSSIAN SPEECH]

Woman

[RUSSIAN SPEECH]

Kuba Stasiak

[RUSSIAN SPEECH]

Nancy Updike

Oh, there she is. He found her.

Valerie Kipnis

And he's saying, hey, I'm a volunteer. My name's Kuba. I'm here to take you out. I'm here to take you to peace. And she's like, I'm not ready. I'm not ready. I'm not packed. And he's like, there's lots of bombs. We have to go.

Nancy Updike

There's clearly no heat. She's in a coat and a hat, and she's got her glasses.

Kuba Stasiak

[RUSSIAN SPEECH]

Valerie Kipnis

She's like, what do I take with me? And he's like, passports and pictures of loved ones. That's it, let's go. And she's saying, I need to pack grapes, and maybe some sort of pancakes, or chocolate. And he's like, there's going to be everything there. Come.

Nancy Updike

And then the video jumps ahead, and suddenly, they are outside walking.

Woman

[RUSSIAN SPEECH]

Kuba Stasiak

[RUSSIAN SPEECH]

Woman

[RUSSIAN SPEECH]

Valerie Kipnis

She goes, I got less ready than I would have if there was a fire.

Woman

[RUSSIAN SPEECH]

Valerie Kipnis

And she goes, and my shoes are all broken. They're all falling apart.

Woman

[RUSSIAN SPEECH]

Valerie Kipnis

What am I going to wear there?

Kuba Stasiak

[RUSSIAN SPEECH]

Valerie Kipnis

And he's like, there will be everything there.

Kuba Stasiak

[RUSSIAN SPEECH]

Valerie Kipnis

There will be everything.

Nancy Updike

And how many of his videos have you watched?

Valerie Kipnis

Oh, man, dozens? Over 100?

Nancy Updike

These evacuations are a whole thing that's happening. There are loose networks of people who do it. There's no one organization behind it, but evacuators just go in, like this guy, Kuba. Sometimes he gets into town and all he has is a name, maybe from a family member who contacted him, like, can you get out my grandma or my cousin? Maybe he has an address if the person is still there. And if Kuba can't find it or he's running out of time, he just jogs through the streets, calling their name out.

Kuba Stasiak

Lilia! Lilia!

[DOG BARKING]

Lilia!

Nancy Updike

The problem is, people don't always want to go. A lot of people he meets don't want to go. They're not ready, or they don't want to be rescued. Some don't want to leave property, or they don't want to abandon other family members who won't leave.

Some think the worst is over or will soon be over, and that once one side or the other wins, everything will calm down, and they'll just learn to live with the outcome, whatever that is. Valerie's been talking with this guy, Kuba Stasiak, who works in the east, including Bakhmut. He's a young man, 28. He's Polish. His group has people from all over, including Ukrainians. Kuba says when he's trying to persuade people to go, sometimes maps help.

Kuba Stasiak

I show them that Russians are pushing from every single direction that they can, and in a couple of days there will be nothing. And that on the next day, there may be-- I mean, there is a risk that tomorrow we won't reach their house because Russians will cut off the last road.

Nancy Updike

Kuba told Valerie that when he started doing this almost a year ago, he wanted to convince every person he talked to to leave. But he's gotten very used to hearing no.

Kuba Stasiak

Because back then, I was trying to convince anyone, anytime. And right now, when there is a heavy shelling and somebody is telling me to, pardon my French, [BLEEP]. I'm just, like, whatever, of course. Yeah.

Sure, you can't help anybody, especially when they are just hostile towards you. You can't do nothing. And it's naive to think, to believe that you can, because you can't. You just can't save the whole world, that's what I'm trying to say.

Nancy Updike

Even some yeses, he's found, are kind of a no. That woman he evacuated, who wanted to pack up grapes and pancakes, Valerie says he took her to a refugee center in a city called Kramatorsk.

Valerie Kipnis

It's about an hour away from her home, and she was so upset, Kuba told me.

Kuba Stasiak

She wasn't happy about the leave. She asked me, I mean, why did I took her to such a wild place? She had this perspective that I, I don't know, tricked her or something, so she was upset. She was telling me that she wants to go back. And I was like, but the city is dying. City is kaput.

And she was like, OK, so I will die with the city. And I was like, OK. End of conversation. What can I do?

Valerie Kipnis

And they kind of lost touch for a little bit, and it turns out that she ended up having her relatives send her back East, to a Russian occupied area, where maybe it's not the front line, but it's due to be dangerous soon. And Kuba, after he heard that, he went back to her house just to look at it. And he saw--

Nancy Updike

The house he evacuated her from?

Valerie Kipnis

That's right. And he went to look at it and he saw that, specifically, her apartment had been destroyed by another strike. And I think he felt sort of this sense of validation, like, you would have been killed if I had not taken you out. But she was still sort of unhappy and ended up going back to an occupied region.

Nancy Updike

What did she mean, a wild place?

Valerie Kipnis

I think she meant that it wasn't home. That's what I really think she meant.

Nancy Updike

But this show is not going to be about nos or yeses. It's about people weighing when to go. And one reason Kuba and others go back to the same city again and again is that sometimes a person who's been a no, no, no, no, no, for months, is suddenly a yes, please. It is time.

Valerie managed to reach someone Kuba helped get out of Bakhmut two months ago. That man, Roman, had been living there with his parents, who were in their 70s. And he told Valerie what changed for him because he actually first met Kuba months ago and was like, nah, we're good, even though things were bad.

Roman

[RUSSIAN SPEECH]

Valerie Kipnis

I almost got killed nine times in Bakhmut. I got caught in gunfire. I got caught in explosions in the center of the city while I was crossing the Nikolaevsky Bridge, even there I almost died.

And in a home I almost died. It was really serious. I'm telling you, nine times. I was even talking to Ukrainian military and I was telling them, I kind of got used to it already. And they said, that's a bad habit.

Roman

[RUSSIAN SPEECH]

Valerie Kipnis

And then things got worse, and worse, and worse, and all of a sudden, the telephone wires by our house were all dangling. And then I saw that there was gunfire on the houses, on the roads, on the fences. And then I just went outside of my house and I just saw the bullets ricocheting.

And I just thought, that's it. I don't think we'll make it. And I started talking to my parents, I just don't think we'll make it. And I told them, we got to do something. It's either we leave, or we die.

Nancy Updike

They decided to go. And there's a video of this evacuation, too, Roman and his parents. Roman's father seems very frail. In the video, one of the evacuators is helping his father shuffle backward over this metal beam that's a makeshift bridge over a river.

The father is holding on and moving very slowly.

Roman

[RUSSIAN SPEECH]

Valerie Kipnis

And there was an explosion. It was all black, and it was just like, the house over, my neighbor's house, that it fell, the missile. And then, when we got out of there, I just said, wow, look how quiet it is. You can actually be here. You could just sit here and relax, and it was just like, it was where we lived that they were attacking.

And then, when I got to Kramatorsk, I started looking around and I saw civilization, and light, electricity, and the trolley buses working. And I just felt this sense of elation, a smile cross my face, or something. Actually, the first time that they took these cookies out onto the table, I just-- I felt so happy. It had been so long since I had even seen them.

Do you understand? I hadn't seen loaves of bread. Sure, I had coffee, but still, that was hard to come by, and cookies. And I had forgotten what that tasted like, and it just felt so amazing to have them finally.

Roman

[RUSSIAN SPEECH]

Valerie Kipnis

But to be totally honest, I still yearn to go to my place, to my home.

Nancy Updike

Today's show-- "When To Leave." How do you know when it's right to make a decision that is so often full of doubt, guilt, consequences for other people?

And even afterward, sometimes forever afterward, regret and longing, and second guesses. We have two stories today with high stakes and complicated choices. Stay with us.

Act One: First, Do No Harm

Nancy Updike

Act One, First, Do No Harm. Let's start right in, with a calm, rational person assessing a new reality, getting a feel for what it means, and deciding what to do. Miki Meek reports.

Miki Meek

Amelia Huntsberger has a story she tells about what it's like to work at a small, rural hospital. She's an OB-GYN in Northern Idaho, in a place called Sandpoint. And early on, she got called down to the emergency room to examine a woman.

The woman had passed out. She was hemorrhaging a lot of blood. She was miscarrying.

Amelia Huntsberger

I took her to the operating room and I transfused a bunch of blood products. And her labs were starting to be a bit abnormal, and I asked for the lab to get me platelets. The nurse supervisor who was on that night said, oh, well, we don't have those.

And I said, oh, we don't have any platelets? Oh, no, we don't have those in the blood bank here. Oh. So she told me that we could get them from Spokane. And I was like, great. Well, let's activate that right away. And she said, oh, OK. Yeah, they come by taxi.

Miki Meek

Like yellow cab taxi?

Amelia Huntsberger

Right? And I said, really? Seriously? Blood products are going to be put in a cab and then come to the hospital from Spokane, which is an hour and a half away? And we were in the winter then. She said, yeah, they'll come by cab.

Miki Meek

Most doctors fresh off years of training at fancy urban hospitals might look at an experience like this and want to run from it. But for Amelia, this was her plan, her first choice. She grew up in a place like Sandpoint-- beautiful, rural, surrounded by mountains.

She did her first delivery in middle school. It was a baby lamb. She used to help her dad out during lambing season. And all through med school she was like, why shouldn't people in rural places get the best care?

Amelia is someone who generally takes stuff on if it needs doing. Whenever there's some unpaid committee job no one wants, Amelia signs up. Not in an ego way, it's more like, why wouldn't you do that?

Amelia's husband, Vince, he works at the same hospital. He's an ER doctor and he also grew up in a small town. They met in medical school and wanted to settle in a place like this because they knew rural hospitals desperately need doctors. Yes, practicing medicine here in Sandpoint means platelets arrive by taxi. But also, Amelia said, you really get to know your patients. It's nice running into them all over town.

Amelia Huntsberger

Half of the day is people that I know, who I'm delighted, like, what are the updates? When's your granddaughter coming home? When somebody comes up to me in the grocery store and wants to ask a question about vaginal discharge, that's not awesome. But when a patient comes up to me and wants to show me her grandchild who I delivered, that's really delightful.

Miki Meek

Amelia's whole life is in Sandpoint. She and Vince have raised all three of their kids here. Recently, her parents moved here, too. But I've been talking to Amelia for months, over the phone and in person, not because she loves the place, but because she thinks it might be time to leave.

Amelia did not see herself as an abortion care provider. She's a general OB-GYN, so she sees everyone from teenagers to 90-year-olds. She does pap smears, prenatal care, breast exams, STIs, prescribes birth control, delivers babies. She's got the bulletin board to prove it.

And right now, there are lots of stories about pregnant people dealing with the fall of Roe versus Wade and changes in state laws. But this story is about their doctors. I started calling OB-GYNs when the Supreme Court overturned Roe because I wanted to know what their jobs are like now and how they're changing. And I started hearing about doctors who were thinking of leaving their states because of new laws that criminalize a whole range of common OB-GYN care.

Idaho is one of those states. It passed some of the most restrictive abortion laws in the country. No exceptions for the health of a pregnant person, no exceptions to save the life of a pregnant person. Here's how state senator, Todd Lakey, one of the sponsors of the bill that would soon become law, talked about what should happen in the case of, for instance, a serious pregnancy complication.

Todd Lakey

If the decision was based solely on a question of some type of health, then you're talking about taking the life of the unborn child. So that weighs more heavily than simply health.

Chairman

Go ahead.

Green

Thank you, Mr. Chairman, and just a follow up. So just, I guess, a yes or no, the health of the woman is irrelevant? Yes or no.

Todd Lakey

I would say it weighs less, yes, than the life of the child.

Miki Meek

Lots of people had concerns about the laws. Even the governor, who is anti-abortion, sent a letter to the state senate saying that some parts of these bills would, quote, "In short order, be proven both unconstitutional and unwise." He signed them into law anyway.

Idaho's new laws are also some of the most punitive toward doctors. They cover any pregnancy that has a, quote, "fetal heartbeat." Though in the early stages, it's not a heartbeat, in a normal sense-- it's electrical activity in some tissue that will eventually become the heart.

The sound you hear with an ultrasound machine? It's created by the machine. But that counts as far as the law is concerned. If a doctor does anything to terminate a pregnancy with a fetal heartbeat, they can be charged with a felony and imprisoned for up to five years, even if, say, they have a patient who is miscarrying, bleeding uncontrollably, and they're trying to save their life.

Also, there's this phrase in Idaho's new laws, "affirmative defense." What this means is, in theory, the laws do allow for abortions in the case of rape, incest, or to save the life of a pregnant person. But if a doctor does that, they can be arrested, and have to prove in court with, say a report from the police attesting to rape, or somehow prove that their patient would have died, and a jury would have to agree. Under Idaho's new laws, it's kind of like doctors are assumed guilty, instead of assumed innocent until proven guilty. It doesn't sound legal, but it is.

When the abortion ban went into effect, after Roe was overturned, Amelia's first thought was not, we got to leave Sandpoint. She was not at that stage. The stage she was at was, let's fight.

If enough doctors speak out, if people understand the reality, they will understand the dangers of these laws and they'll want to change them. Amelia was already on a committee tracking maternal deaths. The state hadn't had one of those, she helped create one.

She was also heading up the state chapter of the American College of Obstetrics and Gynecologists, ACOG. No one else raised their hand to do it, but Amelia did. So naturally, when a lawsuit was filed against one of the new abortion laws in Idaho, Amelia was part of a coalition trying to change these laws. She knew the lawyers needed testimony from OB-GYNs laying out specific emergency medical care they'd been providing for years, that now, under the new laws, was criminal.

Amelia Huntsberger

So I think, OK. Well, I'm going to reach out to as many OB-GYNs as I can think of and have contact information to, and just see if anybody would be willing to make a declaration. And then I kind of realize, I myself have provided care like this.

Miki Meek

So Amelia, who had started out trying to find other OB-GYNs to write about their experiences to help change these new laws, instead started writing about herself, her own medical practice. She'd never thought of herself in the same category as providers of so-called elective abortions, what happens in abortion clinics. She thought of that as a different thing, even though she'd written the word abortion in her patients' medical charts for years.

The medical term for miscarriages before 20 weeks is spontaneous abortion. About one in five pregnancies end this way, so she treats patients for this all the time. Anti-abortion rhetoric had so effectively separated abortion from health care that, in a way, they'd gotten separated in Amelia's head, too.

Amelia signed her declaration and submitted it. Her written experiences, and those of other OB-GYNs, it all made a difference in the strictness of the law, a small but significant one. The day before the trigger laws in Idaho were about to go into effect, a federal judge agreed to allow emergency abortion procedures that go through actual emergency rooms, for now.

Miki Meek

Did that feel like a big win?

Amelia Huntsberger

Yeah, tremendous relief, hopeful. That felt like, OK, somebody is really seeing this with a clear eye and a rational mind, and is like, well, obviously this doesn't make sense.

Miki Meek

Every other part of the laws still went into effect the very next day. And around that time the idea of leaving popped into Amelia's mind for the very first time. She popped it right back out.

Amelia Huntsberger

Hold up. Pause. Let's just see. Let's just see. Let's just see. The circumstances in Idaho are not set in stone. Things are still changing and moving. And so let's see where this goes. Surely this is going to be reined in.

Miki Meek

This is the same calculation some of the other doctors I've talked to are making-- wait and see. But one of the things they're all waiting and seeing about is, who will be the first OB-GYN put on trial and possibly put in prison for providing health care to one of their patients?

Amelia, back at work, had a whole bunch of new stuff to sort through in her mind with these laws. The new laws defined abortion as the use of any means to intentionally terminate a clinically diagnosable pregnancy. So ectopic pregnancies, for example, came up all the time in her clinic.

An ectopic pregnancy means a fertilized egg is sitting outside of the uterus, and sometimes has what the law calls a fetal heartbeat. It's not viable. It can be fatal. And the longer it sits there, the more danger the patient is in.

Amelia Huntsberger

What am I supposed to do with a patient like this? Per the total abortion ban, I need to wait until she's really sick. I can't act just to protect her health. I should be waiting until I'm saving her life. This is totally opposite of my medical training.

Miki Meek

Her medical training was, try to stop things before they become life-threatening. The solution used to be straightforward. She'd remove ectopic pregnancies with a quick surgical procedure or inject a drug that would end the pregnancy.

One day, Amelia had a patient like that. Their pregnancy test was positive, but Amelia could not find a fertilized egg in their uterus. An injection was clearly the best option. So while the patient was in the exam room, Amelia started calling administrators at her hospital, asking, can I do this? She later talked to some lawyers about what she could do in this kind of situation.

Amelia Huntsberger

One answer that I got was that it's probably 90% safe, legally. What does that mean? So you're saying I have a 1-in-10 chance of spending two years in jail with a felony? Is that what you're telling me right now?

Miki Meek

And 1-in-10 sounds pretty risky.

Amelia Huntsberger

Right. I got three kids. I mean, what? That's not reassuring to me. It's also not a definite answer. It's like, well-- you know, like that. [HEMS AND HAWS]

And then, I have another lawyer who I've been in contact with who says, take care of the patient. Do what you've been trained to do. Take care of the patient.

Miki Meek

Amelia advised her patient to go to the ER. The ER-- chaotic, impersonal, and usually more expensive for the patient. But that's the only workaround she had to make sure the patient got the care they needed while protecting herself under these new laws. Amelia started sending all of her ectopic pregnancies to the ER.

Here's another thing Amelia realized about the way the laws are set up. Even though ER doctors in Idaho should theoretically be protected from criminal prosecutions, a prosecutor could still decide to try and charge her husband Vince anyways. And under the law as it stands, people can definitely sue doctors, including ER doctors, for damages. So it was dawning on Amelia that it was possible that she and Vince could both now be sued by multiple family members of a quote, "preborn child."

Amelia Huntsberger

The father of the preborn child, a grandparent of the preborn child, a sibling of the preborn child, or an aunt or uncle of the preborn child. So when I read this, does this mean that the father of a rapist, that the sister of a rapist, that the brother of the rapist can sue the physician? It absolutely does.

Miki Meek

Family members can each file individual separate lawsuits asking for a minimum of $20,000. And they have up to four years to file a lawsuit.

Amelia Huntsberger

All right, back to the language of the law, statutory damages in an amount not less than $20,000. So just take note, instead of having, here's the ceiling, this is the maximum, we start with a minimum payout.

Miki Meek

So all of that was on Amelia's mind when another patient came into the clinic. She had an ectopic pregnancy that ruptured. Amelia put a camera into her patient's abdomen.

Amelia Huntsberger

And I'm like, oh, my gosh. There is way more blood than there was described on the ultrasound that this person had 60 minutes ago. We have got to move quickly.

Miki Meek

The bleeding could kill her. And the way to stop the bleeding was to abort the pregnancy, which was never going to be viable anyway.

Amelia Huntsberger

When you do surgery like that, where it's an emergency and somebody's having ongoing, active bleeding, that's already high stress. And that sort of high stress, I trained for that. I know what to do with that. I can handle that.

Then, you add in this other weird layer of, is her brother going to not understand that this was a not-viable pregnancy and that her life was at risk? And what about her mom? What about her partner? What about her sister?

Do these people understand how serious this condition is, or do they only understand that I removed a pregnancy that had a heartbeat? I don't know. How am I supposed to know?

Miki Meek

She started looking at her patients' charts as evidence she might need in court. She wrote down words like, life-threatening, and high chance of mortality for some theoretical future lawsuit.

Another case, a patient came in to see her for a biopsy of the lining of their uterus. Amelia found herself worrying, wait, what if she's pregnant? The person had mentioned they hadn't been using contraception.

Amelia Huntsberger

And so then I'm thinking, well, wait a minute. When was her last menstrual period? We're definitely doing a urine pregnancy test, but what's the plausibility that there could be a pregnancy that isn't detectable yet, super, super early stages?

Miki Meek

In these early stages, a P-Test is not definitive. It can still come up as negative.

Amelia Huntsberger

If I had a quarter for every single time that somebody said, there's no way I'm pregnant and then has a positive pregnancy test, then I'd be rich.

Miki Meek

If there was any chance that this patient was pregnant, a biopsy could inadvertently terminate this patient's potential pregnancy.

Amelia Huntsberger

So there's part of me that's like, we should not do anything today. She needs to use effective contraception for a month and then come back, and then I can do this procedure once I'm really sure that she's not pregnant. But that's also really impractical for this person who's driven hours to come see me.

And further, she has a medical problem that needs attention. She's already waited to see me. This visit has nothing to do with pregnancy.

Miki Meek

Amelia didn't send her back. She treated her. This is what it means for Amelia to have these laws in her head all the time, to have to think of every single person who enters her office as pregnant or possibly pregnant, to have that become her constant focus.

More and more, she's finding that what she believes is good care, the kind she's obliged to provide under medical malpractice laws, is in direct conflict with what the new laws say. And she knows these laws are in her patients' minds, too, because they're asking her, will I get in trouble for this or that? Is this legal-- worrying about that on top of whatever actual medical problem they came to her for. In other states, there have already been numerous reports about doctors delaying care for pregnant patients, or even turning them away because of new laws criminalizing OB-GYN care. Some patients have almost died and ended up in the ICU.

Amelia and her husband for months were pinning their hopes on Idaho's Supreme Court overturning the state's abortion laws. That was their big wait and see, while in the back of her mind, there was this growing, nagging feeling. Will we be able to keep living here if the court's decision doesn't go our way?

Amelia Huntsberger

I'm just so agitated as I am describing all of this. And the intensity level is just so high for me. And my friend says, well, so when do you just put this all down and just take a break?

And I'm thinking, what does she mean? Take a break? How can I take a break? I'm literally vibrating out of my body. I mean, that's also a problem, that inability to escape this. I don't know how to put it down, just sort of this, walking around, whether at work or at home, and just these deep sighs, just feeling-- [SIGHS] like there, see? I do it without even thinking about it.

Miki Meek

She was having trouble sleeping-- a first for her.

Amelia Huntsberger

Laying awake at night and thinking about this or that, and I think just the tension that you're holding in your body or having to think about taking a deep breath because you've been holding your breath all day.

Miki Meek

Amelia and Vince have had some wild conversations in the last few months. They have talked about the possibility that both of them could end up in jail, or face multiple lawsuits with potentially massive civil penalties, or lose their medical licenses. Chances are probably small, but also, it's impossible to be sure.

Amelia Huntsberger

What happens if both of us are in jail for two years? Who is raising our kids? We know, yeah, we have a plan for our kids if that happened.

Miki Meek

What is your plan?

Amelia Huntsberger

Family.

Miki Meek

She didn't want to say more about who exactly their kids-- 11, 8, and 6 years old-- would go to. It was the first time I'd seen her look physically uncomfortable answering a question. She kind of pursed her lips and shook her head no. She just couldn't go there.

A couple months ago, a few things happened that moved the idea of leaving from the back of Amelia's mind to the front. The first took place in a car parked outside the state capital in Boise.

She was with another OB-GYN. They'd been talking to the people in the governor's office about expanding Medicaid coverage for people who'd just given birth. So they were sitting in Amelia's rental car and her friend turned to her.

Amelia Huntsberger

And she had told me at that point that she was deciding between different job options.

Miki Meek

Job options in another state. This was a huge blow to Amelia. She'd been a key ally in this fight. Then, right after that conversation, Amelia caught up with another friend, a lawyer who'd also been fighting these laws. Amelia remembers her saying--

Amelia Huntsberger

I haven't told many people this yet, but I'm planning to leave. So in the same day, in Boise, these two people who I respect, and admire, and trust told me, this state is not a place for me anymore. And I'm planning my exit.

Miki Meek

And then, the state Supreme Court ruling she and her husband Vince had been waiting for came down. Amelia was at home and on her day off when it happened.

Amelia Huntsberger

I happened to look at my email and there was this message from one of the lawyers that just said in the subject line, Supreme Court decision out, not good, will follow up later. And I just kind of was panicked of, what does this mean?

And so then, I'm trying to do this Google search. Nothing comes up. And so then I'm like, well, I've got to go. I've got to pick up my kids. So I get in my car and I drive to school pickup, and then I'm waiting in line and the car's in park.

Then, I pull out my emails again to just try to see, can I find anything about this? And then other people are linking to a summary, and this and that. And I'm sobbing, right? I was just like, the Supreme Court in Idaho believes that all three abortion laws are constitutional.

Miki Meek

The court carved out one small exception-- ectopic pregnancies, but not miscarriages, not deadly fetal anomalies, or anything else. Amelia broke the news to Vince. She says the first question he asked her was--

Amelia Huntsberger

Is this it? Is this the tipping point, was his question to me. Is this a place that we can continue to live, and practice medicine, and raise our family?

Miki Meek

What did you say?

Amelia Huntsberger

Yeah, I think I'm not at the tipping point yet. And I asked back to him, are you? Is this the nail in the coffin for you? Are you done? And we're not there yet, right? We're not at the tipping point yet.

Miki Meek

Do you know what your tipping point is?

Amelia Huntsberger

No. I'm not-- I'm not sure. Obviously this Supreme Court decision is a big blow, and I don't know exactly where that line is of what I can tolerate.

Miki Meek

Vince's job in the ER still had some protection. That federal court ruling still holds for now, allowing emergency abortion procedures that go through actual emergency rooms. But everything felt precarious.

Amelia and Vince now talk about leaving almost every day. Sometimes leaving can be an act of protest, but Amelia feels like it would be a retreat, a giving in, like, I can save myself but I'd be leaving my patients behind. She's worried that if she left, her clinic could collapse.

She's one of only four OB-GYNs, and one of the others is thinking about leaving, too. Amelia says, if they did leave first, she'd probably have to leave, too. If Amelia or one of her colleagues does leave Sandpoint, the options for finding a replacement are bleak. The last time an OB-GYN left her clinic, it took them two years to find another one, and that was before Roe fell. Idaho already has a severe shortage of doctors, one of the worst in the country.

Amelia Huntsberger

I was looking at social media and somebody was talking about a person who is completing their OB-GYN residency and was looking to come to the Pacific Northwest. And there was all this, hey, we've got an opening in Washington. We've got an opening in Oregon. We've got openings in Montana.

And I'm like, hey, there's all sorts of openings in Idaho. And then I'm laughing out loud because I'm like, who is going to be finishing their residency training and being like, I definitely want to go to the state with the super strict abortion laws that criminalize health care? I literally laughed out loud, and that's awful, right?

I'm laughing about how ridiculous it is that somebody would choose to come and practice medicine here. That's terrible. That should be very alarming to anyone. But I didn't-- I was like, it's like, you laugh so you don't cry. I don't even know. Yeah.

Miki Meek

Did you post, there's tons of openings in Idaho, or did you know better?

Amelia Huntsberger

I sure did. And I was like, I mean, but then you have to deal with the laws here. But I'm like, legit, if you're willing to deal with the laws, I will hook you up.

I know all the people who are looking. I got you. But you're not going to want to come here. Are you kidding me? I know that. I mean, if you do want to come here, cool. Like I say, I'll help you.

Miki Meek

If 1 is, never leave, and 10 is, we got to go, where are you on that spectrum right now?

Amelia Huntsberger

I don't know how to answer that.

Miki Meek

What makes it hard?

Amelia Huntsberger

[SIGHS] I don't want to leave here. And just turning it into something more black and white like a number scale does-- feels hard. I don't want to leave, but I don't know if I can stay.

Miki Meek

Some doctors have decided to leave. I talked to two OB-GYNs-- one had just left Texas, the other, Tennessee. Their jobs are different from Amelia's because they're high-risk OBs, and so they're seeing some of the most difficult cases.

They told me they were just like Amelia when new abortion laws went into effect in their states. They also wanted to stay. And they also didn't know what their tipping point was and wanted to keep treating their patients.

And each of them described the same kind of moment to me. One day, they found themselves in a terrible situation with a patient, brought on by trying to comply with the new laws. One of them had to send a patient to another state in an ambulance. It was a five-hour ride. The patient's blood pressure was rising, and by the time she got to a hospital, her kidneys were starting to fail.

The other doctor had to turn away a patient pregnant with twins. One of the twins was going to die and the doctor needed to intervene to save the other's life, but he couldn't because of the laws. He doesn't know what happened to the patient, but he knew, I need to leave.

Nancy Updike

Miki Meek, she's one of the producers of our show. Coming up, is there a statute of limitations on telling a friend, I thought you were way off base? We'll find out together. That's in a minute, from Chicago Public Radio, when our program continues.

It's This American Life. I'm Nancy Updike, sitting in for Ira Glass. Today's show, "When To Leave," or if.

Act Two: The Leaving Expert

Nancy Updike

We're at Act Two of two. Act Two, The Leaving Expert. The whole idea for this show came from me reading a story by Masha Gessen, a New Yorker story, Masha is a staff writer there. Reports a lot on Russia, among many other subjects.

Masha grew up in the Soviet Union then moved to the United States as a teenager and lives here now. The New Yorker story was all about leaving, about Russians leaving Russia. Masha was just about to board a plane to Russia when Russia invaded Ukraine a year ago. And almost immediately after landing, Masha started hearing from people, from friends, about leaving.

Masha Gessen

I'm trying to think who the first person was. I think it was actually Vera, my closest friend. And I think the conversation was, sort of, we're thinking of leaving. We're thinking of getting tickets to Georgia. Vera has family in Georgia.

Do you think we should go now, or in a couple of months when our 16-year-old gets her foreign travel passports? Was it still going to be viable to leave in a couple of months? Were they going to close the borders? But it still felt almost abstract. And then, a couple of days later, she said, we're leaving Wednesday.

Nancy Updike

And then, while Masha was at Vera's place for their goodbye gathering--

Masha Gessen

Another mutual friend of ours came by and he was sort of saying, why do you feel you have to leave? What's the big deal? There's always time.

Nancy Updike

Not an unreasonable question, Masha thought at the time. That night, overnight, more leaving. Masha went to the last independent television station in Russia, TV Rain, and saw a whole scene unfolding. Staffers at the station had gotten word that the prosecutor's office was investigating TV Rain for quote, "extremism," which meant any one of them could go to jail for years.

Staffers also heard that special forces were coming to search the studios. Other media outlets had been searched before and people had been roughed up. So staff members who were at the station--

Masha Gessen

Ran out of the building, sort of huddled in a pub outside, trying to book tickets on their cell phones. So there was this sort of call and response where people would be like, Bishkek, two tickets. I'm grabbing those.

Nancy Updike

Right, like an auction. Yeah, yeah, do I hear--

Masha Gessen

It wasn't even an auction. It's hard to--

Nancy Updike

I know they weren't auctioning them off, but the sort of publicness of it.

Masha Gessen

Yeah, and a sense of rush, and just very adrenaline-y, and very desperate.

And then, the next day, I went to visit other friends. And I walked in and I realized, oh, this is their goodbye party.

Nancy Updike

Oh, my god.

Masha Gessen

And so the friend from the night before, the one who had been asking, what's the point, was also there. And he said, I'm leaving tomorrow. And that was just like, he looked like he was shell shocked. Because I think something had changed inside him that--

Nancy Updike

From one day to the next?

Masha Gessen

From one day to the next. And he wasn't even-- he couldn't process what had changed. He knew it had changed and he knew he was leaving, and he was shocked by what he was doing.

Nancy Updike

Within a week, all of Masha's friends had left Russia, all of them.

Masha Gessen

And I don't want to say that they're running for their lives, which is another very important aspect of this whole immigration is, because people are acutely aware that they're not running for their lives, that there are, in fact, other people who were running for their lives at that very same time.

Nancy Updike

In Ukraine.

Masha Gessen

Because of the same war, right?

Nancy Updike

Yeah.

Masha Gessen

But that they're running to salvage their sense of selves and to be able to be in the world.

Nancy Updike

It's hard to gauge how many Russians have left the country in the last year. Tens of thousands, hundreds of thousands? It's a lot, whatever it is. People have left for all sorts of reasons. One reason? New laws.

Masha Gessen

There were a couple of different laws that they passed a week after the full-scale invasion began, one that made it punishable to call the war a war, and another was that made it a crime to discredit the armed forces of Russia.

Nancy Updike

And that's one of those wide-angle laws that you can do that without realizing that's what you're doing if somebody really wants to--

Masha Gessen

That's exactly--

Nancy Updike

--make the case.

Masha Gessen

--right. So in a way, it's a more insidious law than-- because calling a war a war, you know what you're supposed to do. You know what you're not supposed to do. But, of course, terror works much more effectively through laws that are vague and that can't possibly be uniformly applied.

Nancy Updike

There's another reason I wanted to talk to Masha in particular about leaving. Masha is a bit of a leaving expert, like I said, not just as a reporter but in their own life. Masha has moved countries three times, each time with no idea if they would ever live there again.

The first time was when Masha was 14 years old and the whole family left the Soviet Union to come to America. Then, Masha moved back to Russia in the '90s. They went in 1991 on a reporting assignment.

The Soviet Union was in the final stages of unmaking itself. And what was left was the most exciting place on Earth to Masha. It was Russia remaking itself. Masha also felt something unexpected there, they felt at home, a profound experience after so long away.

Masha spent the next 22 years living there, loved it, never wanted to leave. And then, Masha did leave Russia and moved back here. Seeing their friends leave now reminded Masha of just how hard that decision had been, to know when to leave. It was also about new laws.

Masha Gessen

Even when they were considering the first law against so-called LGBT propaganda to minors, it seemed so absurd.

Nancy Updike

This was back in 2012.

Masha Gessen

And I was like, I was supposed to testify. This was still at a time when one-- someone like me-- might go and testify in the Human Rights Council. And then the person who was organizing the hearings said, yeah, there's no way they're going to pass it. We're not going to hold a hearing. Let's not draw more attention to it.

And then, of course, they passed it. And the Parliament started talking about removing children from families. And I went to protest and got beaten up. And it's not like it was news, but I'd never actually been beaten up before.

Nancy Updike

Do you think you were targeted specifically?

Masha Gessen

Yes, I was definitely targeted specifically, in broad daylight, with the police looking on. It's a profound experience, even if you know that sort of thing happens to other people, even people you know. And then, they passed a law banning adoption by people who are in same-sex relationships or have citizenships of countries where same-sex marriage is legal. And my oldest son is adopted, so then it was just like, we have to leave.

Nancy Updike

That now describes you and your family so specifically.

Masha Gessen

Exactly. So we put my oldest son on a plane, and then--

Nancy Updike

How old was he?

Masha Gessen

He was 14.

Nancy Updike

14 is the same age Masha was when the family left the Soviet Union, a whole cycle of leaving and leaving again. Masha told me that, in the mix of feelings they've had in the last year, seeing and talking to friends who've left Russia is a strange kind of relief.

Masha Gessen

In a way, the world has become mentally more-- it makes more sense.

Nancy Updike

To you?

Masha Gessen

To me and to us as a group that we're on the same side of not only the mental border but the physical border.

Nancy Updike

For years after Masha left, while friends stayed, Masha sometimes wondered, worried, did I make the right call by leaving? Could I have stayed, too?

Masha Gessen

There was a nagging thought of, well, maybe it was possible to live there. And so maybe I overreacted. Maybe I was hysterical about Putin. He's terrible, but how terrible is he?

And now, a lot of that is just-- that's just gone. He is as terrible as anyone has ever been. I was definitely not hysterical. And no, it wasn't actually possible to have a life there.

Nancy Updike

And are people saying that to you? Is anyone saying to you, I thought actually you were a little off the deep end and now I see what you mean, or something?

Masha Gessen

Yeah. Yeah, people have said that. And it's funny because I even heard it from people who didn't actually say to me, you're crazy, years ago, but now have said, OK, I thought you were a little-- maybe overreacting a little, but I was wrong.

Nancy Updike

These conversations just seem so strange to me, to have somebody say that and to-- I don't know. It seems so sad. It's like, oh, yeah. I kind of wish you were right, I wish I had overreacted.

Masha Gessen

Exactly. And I mean, that was always my go-to phrase, like, I'll be really happy if you prove me wrong.

Nancy Updike

Yeah. Yeah.

Masha Gessen

If I'm being emotionally honest about it--

Nancy Updike

Yes, please.

Masha Gessen

--of course, I don't wish that I'd overreacted because the amount of regret I'd have if I'd overreacted would be unmanageable. So it's not like I'm full of schadenfreude for having told you so. But, yeah, there's an odd sort of emotional peace with having things fall into place.

Nancy Updike

I asked Masha if they ever think about leaving this country. Masha had a few different answers to that. My brain bookmarked this one.

Masha Gessen

Dissidents, Soviet dissidents were great for setting down rules to live by. And I think one of their rules was, you're useless in prison or dead. But as long as you're not in prison or dead, and you're not facing a significant risk of going to prison or being dead, make a difference where you are. I think that's a pretty-- this country is so far from our losing the ability to make a difference.

Nancy Updike

Yeah. Yeah. I guess I wonder if you have an eye on laws changing here, laws that would feel threatening to you personally.

Masha Gessen

I mean, I think that once you've immigrated once in your life it's always a possibility. So yeah, even though I'm not actively thinking about leaving the United States, it's not a crazy possibility for me. It could happen. Personally, it's complicated because I have kids here, and some of them are semi-grown. So then you start having other kinds of roots.

But, for example, and this is not a terribly unlikely scenario, it becomes impossible to get hormone treatment in this country. That, for me, would be a question of my personal health. And I'd probably actually have to leave. Yeah.

Nancy Updike

When I first started making this show, I imagined it being about leaving all sorts of places, but it's all about the same place-- home, a place you love. If you're lucky, you have some choice in the matter and time to think about it. But it's a choice to break your own heart.

Credits

Nancy Updike

Today's show was produced by Diane Wu and Chris Benderev. The people who put together today's show include Jane Ackermann, Phia Bennin, Zoe Chace, Sean Cole, Michal Comite, Aviva DeKornfeld, Cassie Howley, Valerie Kipnis, Seth Lind, Alaa Mostafa, Stowe Nelson, Katherine Rae Mondo, Nadia Reiman, Ryan Rumery, Alissa Shipp, Alix Spiegel, Lilly Sullivan, Christopher Swetala, Marisa Robertson-Textor, and Matt Tierney.

The Managing Editor is Sarah Abdurrahman. Senior Editor is David Kestenbaum. Our Executive Editor is Emanuele Berry. Special thanks to Agnieszka Suszko, Kylie Cooper, Wendy Heipt, Leilah Zahedi-Spung, Alireza Shamshirsaz, Alison Block, Kate Connors, Rachel Kingery, Mary Ziegler, David Childs, and Cheryl Strayed.

Our website, ThisAmericanLife.org, where you can stream our archive of over 750 episodes for absolutely free, again, ThisAmericanLife.org.

This American Life is delivered to public radio stations by PRX, the Public Radio Exchange. Thanks, and happy birthday, Ira, to our boss, Ira Glass. I once saw him get recognized for his voice, and he does have mixed feelings sometimes about the questions people ask when they recognize him in public.

Amelia Huntsberger

When somebody comes up to me in the grocery store and wants to ask a question about vaginal discharge, that's not awesome.

Nancy Updike

I'm Nancy Updike. Join us next week for more stories of This American Life.