Medical Examiner

In Texas, How Much Pain Does It Take to Get Medical Care?

A paramedic wheels a woman into a hospital room.
Houston Fire Department paramedics transport a woman to a hospital in Houston on Sept. 14. John Moore/Getty Images

Last month, Fatima Abdelwahab, a Sudanese American resident of Houston, was diagnosed with an ectopic pregnancy—but only after it burst her fallopian tube, becoming a full-fledged medical emergency. There are a lot of reasons it might have taken a while for Fatima to get the treatment she needed: Ectopic pregnancies can be difficult to diagnose, health care facilities may have been swamped, and Abdelwahab was often in too much pain to question her doctors at length. Maybe her doctors wanted to make sure they weren’t jumping to conclusions. But in hindsight, Fatima is left with many questions. Did Texas’ abortion ban stand in her way? Were her physicians even were even allowed to treat her? Texas’ anti-abortion law makes an exception for when the mother’s life is in danger—but how much danger does it take to trigger medical care? On Thursday’s episode of What Next, I spoke with Abdelwahab about what happened to her and the insidious ways abortion bans are coming between women and their doctors. Our conversation has been edited and condensed for clarity.

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Mary Harris: Can you tell me about your first inkling last month that something could be wrong?

Fatima Abdelwahab: My period came a few days earlier than it typically does. I’m on birth control. That was a little odd to me, and then my cramps were really bad, but I ignored it because I thought it was probably just that I was exhausted after traveling.

When did you think you needed to get a doctor involved?

We were driving to visit my parents on a Friday night, and right after we got there, on Saturday around 1 a.m. is when I felt like this is unbearable. We drove over to an urgent care and as soon as I got in I told the guy out front, please, if there’s anything you can do to get me in quickly, I feel like something’s going to explode. I held my left side and I felt pain, especially in that area.

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How quickly do they see you, and what do they tell you?

It was probably fairly quickly after the urine pregnancy test, when the doctor came in told me, “You’re pregnant.” I was just shocked because] I’m on birth control, and this is not the first thing that came to mind at all.

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And you have a real period. You’re having real bleeding and cramping.

Exactly. And in my mind I’m thinking, even if I’m pregnant, I don’t know if the pain should be this bad. Then there was the thought of how Roe v. Wade was just overturned and I’m a Black woman and my mom had lost two friends, one prior to birth while pregnant, the other after birth—that’s what started coming through my mind instantly. So there was this fear that what if something is wrong?

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What did the doctor say about what should happen?

At that moment, he said, we had to do some bloodwork and an ultrasound, and they’ll get some morphine to help with the pain. The ultrasound was extremely painful. It was transvaginal. They did the topical one as well. Then the doctor came in and said, “We’re not seeing anything. So this could be a ruptured cyst. It could be a viable pregnancy. It could be an ectopic pregnancy. It could be a miscarriage.” That was ultimately the takeaway of me going to urgent care that night: no resolution to what I was feeling or what was happening.

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Thursday morning I woke up and the cramps were worse and my flow was heavier for sure than it had been the days before.

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At this point, you’ve been having your period for a pretty long time, and it sounds like it’s not abating, when it usually would after a week.

Exactly.

You went to an ER, not realizing until she arrived that it wasn’t connected to a hospital.

The doctor that came in was not compassionate at all. I felt like I was committing a crime for even coming there. I got asked questions like, “Which ER did you go to before? Why didn’t you go back to them? Why did you come to this E.R.?” It was crazy to me that I was getting asked this question when I’m in so much pain visibly and could barely talk.

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Then he finally did more bloodwork. Another transvaginal ultrasound.

My third transvaginal ultrasound. Again, I was told they don’t see anything, and he thought I was having an incomplete miscarriage. That was the first time that I’d heard like, This is not a viable pregnancy. That was the first time I’d heard, like, You’re having a miscarriage. It was a lot to take in. When I asked what I should do about the pain, the response was, Unless you’re filling up a pad an hour or basically hemorrhaging, there’s nothing we can do for you.

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You found out were miscarrying five days after you first reported symptoms. That Thursday evening, you were at her sister’s house when you started to feel worse, and the pain was distinctly on the left side.

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I had been told I was going through a miscarriage, so I’m thinking, why am I feeling pain specifically on my left? I went to the bathroom at some point and started passing these really big clots. I felt the cramping get really, really bad, worse than it had been all the days prior. I started to feel really nauseous and dizzy.

You passed out briefly and then went to a hospital and talked to yet another doctor.

Pretty much immediately they gave me morphine. I asked if I could have something stronger, and the doctor said, “If you want something stronger than morphine, then we both need to agree that this is a miscarriage,” which, she thought it was a miscarriage but also had had to let me know there was that chance it could be viable. And if it is viable, anything stronger will harm the baby.

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When did you learn that you had an ectopic pregnancy?

It wasn’t until I went to my OB the following day.

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Nearly a week since you’d first experienced symptoms.

She kind of pushed around my abdomen and said: “I think maybe you have an ectopic pregnancy. I’m not doing surgeries today. My colleague’s on call. I’m going to call and get started on your paperwork, so head over to this hospital.” We left her office and drove immediately over there.

Once at the hospital, you received another ultrasound, showing an ectopic pregnancy: The embryo had implanted in the left fallopian tube, instead of the uterus. And the tube had burst, which can lead to life-threatening internal bleeding.

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That was when I was finally told, “Here’s what’s happening: You have a ruptured ectopic pregnancy. We’re going to check your vitals, get some more blood. You’ll be in surgery soon.” I just kept nodding my head because the pain was unbearable, completely unbearable. I’ve never felt such pain in my life.

From what I understand, ectopic pregnancies can be hard to diagnose and hard to see on an ultrasound. Does that make a difference in how you understand what happened to you?

I’m not sure, honestly. I think about moments when I went to the ER was asked, “Why are you here?” It just really upset me and made me wonder, would it have made a difference? I know it’s no one’s fault if they weren’t able to see it. If it’s not there, it’s not there. There’s nothing they can do about it. But I do wonder, having heard “this is a miscarriage” twice on Thursday, like, why wasn’t I given anything else? There was no clarity, always “Well, we’re not sure what’s happening.” That was really frustrating and upsetting, and it just made me feel like, why isn’t anyone able to tell me what’s happening? I’m at nearly a week now of being in and out of health care offices and no one having a solid answer for me.

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Did anyone at any point during your treatment mention Texas’ abortion laws even obliquely?

No, not at all. Not a single person.

When I did a little reading about ectopic pregnancies, I found that in the past, before the Supreme Court ruling, doctors seemed to worry a lot that they acted too quickly may have terminated viable pregnancies. They came up with these guidelines encouraging doctors to slow down when it came to diagnosing this, like do multiple ultrasounds to confirm, wait a little while. Is there a chance that that’s what your doctors were doing here?

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I think if it were my personal choice, I just would have been like, I can’t move forward with this pregnancy. I would hope that it doesn’t take this much pain, that it doesn’t take a pregnancy to rupture for me to actually get help. Because of all that pain that I went through, I’m traumatized to even think about having kids. It was a lot.

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Has anyone talked to you about how your experience might have affected your fertility?

My OB told me that my chances were significantly lower. I don’t have my fallopian tube.

It’s hard to know how the abortion laws affected your care. But hearing your story, it sounds like the laws created a cloud of suspicion where, for any medical professional you interacted with, there was already some kind of break in the trust you had because you didn’t know why they were treating you one way or another, and you were a little suspicious.

Absolutely. I think everyone’s on edge, unsure. There’s so much confusion. I think, had it been a year ago, maybe people would have acted in a more urgent manner. Maybe I would have been able to get things resolved sooner.

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