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Delaney CoyneAugust 29, 2023

Amid the chaos of the Covid-19 pandemic, Katie Garrison, a neuroscientist who researches addiction at Yale University, arrived at the Yale Fertility Clinic for her egg retrieval. An egg retrieval is a delicate, time-sensitive procedure. It must take place 34 to 36 hours after the final hormonal injection so that the patient will not ovulate and lose those eggs. Within this window, the medical team inserts a large needle into the vagina, pierces the vaginal wall and moves up to the ovary, where they retrieve the eggs. The team at Yale administers midazolam for sedation and fentanyl for pain management. Having dedicated her life to studying opioid use disorder, Katie was curious to see how she would react to fentanyl. She did not find out.

Instead, Katie experienced excruciating pain on the operating table, telling the Yale team that she was “stone-cold sober and awake.” She later described the pain, saying, “It felt like someone was ripping something from the inside of your body,” which is, of course, what was happening. An expert in addiction research, it immediately occurred to Katie that her nurse was stealing the fentanyl. It is, after all, the most diverted drug in medical settings. After the procedure, Katie was shaking and shocked. Her nurse suggested that perhaps it was so painful because they retrieved so many eggs. Katie later told herself that she must not be sensitive to certain opiates. It was both parties’ way of making sense of Katie’s pain.

It was not until December 2020 that Katie received a letter in the mail from Yale confirming that her original suspicion was largely correct—although her nurse was not diverting the drugs, another nurse, Donna Monticone, was indeed stealing the clinic’s fentanyl and replacing it with saline. Katie also realized that she was not the only victim of this substitution. A federal investigation found that as many as 200 patients may have experienced egg retrievals without fentanyl between June and October 2020.

The letter from Yale told affected patients that “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.” “The Retrievals,” a podcast hosted by journalist Susan Burton and produced by The New York Times and Serial Productions, pushes back on this claim, insisting that outcomes are complex in such a case. With the same propulsive storytelling on which Serial Productions made its name, Burton follows 12 women who experienced painful retrievals at Yale to ask how this could happen. Moreover, “The Retrievals” investigates what this incident reveals about women’s pain—how it is explained, tolerated, minimized and dismissed by medical institutions, legal systems, health care providers and, sometimes, women themselves.

“The Retrievals” is a story about women’s pain and the stories we tell about it.

The five-part podcast begins on the micro scale, with the first episode describing the patients’ experiences and the second introducing us to Donna Monticone, the nurse who admitted to extracting the fentanyl from up to 75 percent of the clinic’s vials and replacing them with saline. Burton treats Monticone’s addiction with empathy without belying her responsibility in the patients’ suffering. “The Retrievals” thrives in this nuance. Monticone receives a lenient sentence, in large part because she is a mother. Motherhood shields Monticone from the full weight of the law; it is also the thing her victims want so desperately that they would sit on an operating table, writhing in pain, and consent to continue an egg retrieval without medication.

The voices of the women with whom Burton spoke are interspersed throughout the podcast’s production, gripping listeners with their accounts of pain, longing and hope. Their witnesses elucidate with stomach-churning clarity how so many patients would allow the doctor to continue such a painful procedure, especially one that is not strictly medically necessary. Lynn, a special education teacher who experienced eight retrievals at Yale without fentanyl, recalled, “You hear about I.V.F. 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 women go through.”

Our cultural image of the mother as martyr rears its ugly head here, placing women in a position where they undergo excruciating pain for their potential children. There is a deeper failure here, however, in that pain management is not just administered for patients’ comfort but their safety. With a long needle in the pelvic cavity, sudden movements and spasms present a serious risk, one that the team at Yale should have addressed immediately. Instead, they continued, even discharging women expressing severe pain after their retrieval, a sign that something may have gone wrong.

To reduce these women’s experiences of I.V.F. to the baby at the end of it, as beloved as those babies are, ignores the reality of the women’s trauma and the fullness of their humanity.

In the second half of the podcast, Burton moves to a case-study style assessment of institutional accountability at Yale by following a lawsuit brought by 70 patients against the clinic and conducting anonymous interviews with staff. Here, we learn that this is not just a story about Monticone. We learn that Yale, an institution with a then-$31.2 billion endowment, did not have a Pyxis, a medication dispensing machine that records each transaction. Nor did they provide propofol, a deeper sedative commonly used in egg retrievals. Instead, when met with increased reports of pain, Yale sent a doctor to speak to staffers about being more empathic during procedures, never investigating other reasons for these reports like the drug supply.

Burton’s experience at “This American Life” shines through in her compassionate tone and investigative skills, which place this story within the context of a medical culture that normalizes women’s pain. Women, and especially women of color, are more likely than their male counterparts to be dismissed for reports of pain in medical settings. Our broader culture denigrates the hysterical, childless woman and venerates the docile, self-sacrificial mother: “This is what women go through,” the series reminds us, again and again. At its core, “The Retrievals” is a story about women’s pain and the stories we tell about it.

“The Retrievals” speaks to the tendency to reduce medical science to a kind of scientific problem-solving, rather than the profoundly human endeavor that it is. Burton reminds listeners that I.V.F. outcomes are measured in live births—an essential part of the picture—but insufficient in capturing these women’s suffering and the breach of trust. Of the 12 women Burton spoke to for the podcast, nine ended up having children.

But to reduce these women’s experiences of I.V.F. to the baby at the end of it, as beloved as those babies are, ignores the reality of the women’s trauma and the fullness of their humanity. Camise, a former Yale patient, told Burton, “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.” Yale said that the incident had no impact on their outcome of care. Burton, and the women’s testimonies elegantly woven throughout the narrative, insist that the process cannot be extricated from the outcomes. Their pain mattered—and it still does.

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