792: When to Leave

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.

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.

Valerie Kipnis

He's shouting, evacuation, evacuators.

Nancy Updike

I see.

Valerie Kipnis

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

Valerie Kipnis

--come out.

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.

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.

Valerie Kipnis

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

Valerie Kipnis

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

Valerie Kipnis

What am I going to wear there?

Valerie Kipnis

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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."

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.

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.

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.

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.

Miki Meek

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

Miki Meek

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

Miki Meek

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

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.

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.

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--

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.

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--

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.

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.

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.

Nancy Updike

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

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--

Nancy Updike

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

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.

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.

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.

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?

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.

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.

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.

Nancy Updike

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