Having been advised not to keep her 10 weeks 0 by Dr. Barry Grimm and Dr. Mack Goldberg, obstetricians at Vanderbilt University Medical Center based on the guidance of recommendations from the Society for Maternal-Fetal Medicine, an association of 5,500 experts on high-risk pregnancy, Mayron Michelle Hollis was desperate to have an abortion as she stood to lose her bladder, her uterus and her life.
Her embryo had become implanted in scar tissue from a recent cesarean section, and she was in serious danger. At any moment, the pregnancy could rupture, blowing open her uterus.
Dr Mack Goldberg, who was trained in abortion care for life-threatening pregnancy complications claimed that the muscle separating her pregnancy from her bladder was as thin as tissue paper; her placenta threatened to eventually invade her organs like a tumour. Even with the best medical care in the world, some patients bleed out in less than 10 minutes on the operating table, Goldberg said. According to the doctor, the longer they waited, the more complicated the procedure would be.
However, it was August 24th, and performing an abortion was hours away from becoming a felony in Tennessee. There were no explicit exceptions. Prosecutors could choose to charge any doctor who terminated any pregnancy with a crime punishable by up to 15 years in prison. If charged, the doctor would have the burden of proving in front of a judge or jury that the procedure was necessary to save the patient’s life, similar to claiming self-defence in a homicide case.
The doctors didn’t know where to turn to for guidance. There was no institutional process to help them make a final call. Hospitals have malpractice lawyers but do not typically employ criminal lawyers. Even local criminal lawyers weren’t sure what to say — they had no precedent to draw on, and the attorney general and the governor weren’t issuing any clarifications. Under the law, it was possible a prosecutor could argue Hollis’ case wasn’t an immediate emergency, just a potential risk in the future.
Goldberg was only a month into his first job as a full-fledged staff doctor, launching his career in one of the most hostile states for reproductive health care in America, yet he was confident he could stand in a courtroom and attest that Hollis’ condition was life-threatening. But to perform an abortion safely, he would need a team of other providers to agree to take on the same legal risks.
Hollis wanted to keep her uterus so she could one day get pregnant again. That made the operation more complicated, because a pregnant uterus draws extra blood to it, increasing the risk of haemorrhage.
Goldberg tried to rally support from his colleagues for a procedure that would previously have been routine.
First, Goldberg and a colleague tried the interventional radiology department. To lower Hollis’ chance of bleeding, Goldberg wanted doctors to insert a special gel into the artery that supplied blood to her uterus to reduce its flow. But that department’s leadership didn’t feel comfortable participating.
Next, they approached a maternal-fetal medicine specialist who a week earlier had said he would be able to provide an injection to stop the fetus from growing and decrease blood flow. But once the law went into effect, that specialist grew uneasy, he told ProPublica. He asked that his name not be used because of the sensitivity of the issue.
The specialist would have to do the procedure in a room of nurses and scrub techs with an ultrasound image projected on the wall — all potential evidence that could be used against him in a trial. He thought about his family, and what it would mean to go to prison. “I’m so disappointed in myself,” he told Goldberg and his colleague as he refused to participate.
On August 26, the day after the ban, Goldberg informed Hollis he would be unable to carry out the procedure. He explained that Vanderbilt couldn’t offer an abortion that would try to preserve her uterus — only a hysterectomy that would end the pregnancy and extinguish any chances she could ever get pregnant again.
Grimm told ProPublica it was his understanding that ending the pregnancy this way would comply with the law’s provision for avoiding irreversible impairment to a major bodily function. Other doctors involved in her care confirmed they felt their only option for providing an abortion was to sterilize her.
Grimm told Hollis they could help her arrange to travel out of state, where doctors could perform an abortion and possibly save her uterus. Each day that passed would make that more difficult. Going to Pittsburgh, where Goldberg had connections, was her best option, but would require days of travel to complete paperwork and comply with Pennsylvania’s state-mandated waiting period.
On Dec. 8, Hollis started bleeding. She was nearly 26 weeks pregnant. She insisted on driving herself to Vanderbilt, an hour away from her home; her husband joined her in the passenger seat and panicked when she started to pass out. They called 911, and an ambulance drove her the rest of the way. After being attended to, the hospital released her after three days, planning for her to return in two weeks, when her pregnancy had reached seven months.
Hollis’ husband called an ambulance, and they took her to a local hospital to be stabilized and airlifted. But bad weather meant the helicopter couldn’t fly. Finally, two hours later, they returned to the ambulance, which drove her to Vanderbilt, where she met the doctors ready for the procedure.
Once Hollis was under, Grimm helped make the incision. Typically, patients emerge from a C-section with a small, horizontal cut below their bikini line. But this delivery called for a vertical gash that stretched up past her navel so doctors could have full exposure to her uterus. It allowed them to see where the bleeding was coming from and gave them the best chance to control it.
Careful not to disrupt the placenta, which was attached to the bladder and ballooning outward, Grimm gently removed a baby girl. She emerged weighing one pound and 15 ounces, limp and unable to breathe on her own. Doctors dried and intubated her, wrapped her and placed her under a radiant warmer to try to keep her organs from shutting down. No one knew if she would survive.
Then, Dr Marta Crispens, a gynaecological oncologist trained to deal with big tumours, began work on removing the uterus. Later on, Hollis was given a blood transfusion and the operation ended.
Hollis and her daughter made it through alive, however, Baby Elayna spent the first week of her life in the neonatal intensive care unit, enclosed in a plastic crib that resembled an aquarium. Nurses bustled in and out to the sound of beeping that monitored the baby’s fluctuating breathing and heart rates.
After four days, Hollis had to leave Elayna in the hospital and go home. There was no availability in charity housing for parents of NICU babies, and she needed to take care of Zooey, her other child.
Then, three days later, sheriff’s deputies showed up at Hollis’ door and took her to jail. Prosecutors were charging her with a felony over an allegation that she left Zooey unattended in a car. She faced eight to 30 years in prison. She paid $6,000 in bail, erasing the savings she and her husband had hoped to use for parental leave. A judge’s order prohibited her from having any contact with Zooey, so her husband took over child care. With nowhere to go, Hollis spent the night in her car outside the hospital, going inside for Elayna’s feedings.
Then she got a call from the Department of Children’s Services. They were opening a new case because THC had been detected in Elayna’s umbilical cord. Hollis believed it was due to delta-8, a synthetic THC legal in Tennessee that doctors recommend avoiding during pregnancy. Hollis said she took it after the stress of her first hospitalization to help her sleep; she considered it less dangerous than the heavy antidepressant drugs her doctors had prescribed. Grimm wrote a letter to the department in her defence; he saw THC as a minor issue and emphasized her consistent negative tests for deadly drugs.
According to Hollis, she felt gripped with anger over her situation. The way she saw it, the same system that had forced her to risk her life offered little support to help her family stabilize in the aftermath. If she had been able to get an abortion, she thought, “My life could be so different right now.”
About a week after Elayna was allowed to be taken home, she began showing signs of respiratory distress. One night, she suddenly stopped breathing. Hollis performed CPR until police officers arrived and saved Elayna’s life.
Over the following days, doctors found she had rhinovirus and outfitted her with a breathing machine. They told Hollis it was possible Elayna could have a bacterial infection, such as meningitis, in the fluid around her brain. To find out, they would need to do a spinal tap, but they worried it would destabilize her further. Doctors are on their best in catering for baby Elayna thus far.