My four other pregnancies didn’t go so well. After Sam, carrying a baby past the first trimester proved impossible. I had one miscarriage early in the first trimester; a second in which the baby’s heart stopped beating between the ninth and 10th week; and then two ectopic pregnancies, a condition in which an embryo implants outside the uterus. If not treated, ectopic pregnancies can be deadly.

In one of those four pregnancies, I underwent a D&C (dilation and curettage) ― in the first trimester. And in two others I was treated with a drug called methotrexate, .

I fear what will happen to women who find themselves in similar circumstances, with Roe v. Wade overturned by the U.S. Supreme Court on Friday. restricting abortion and the use of that drug in an abortion. In all, , which tracks reproductive health policy, 26 states are likely to ban or severely restrict abortion.

Both ectopic pregnancies sneaked up on me. I was 39 when I stopped using birth control and left the rest to chance.

A few months later, I was spotting for more than a week and shrugged it off to an unusual period.

I also had a sharp pain on my lower left side when I extended my leg to get out of the car, or sometimes when I jogged or turned my hips a certain way.

“Have you taken a pregnancy test?” a friend asked after I described my symptoms.

It was positive. I drove to urgent care where a doctor confirmed my pregnancy with a blood test and performed a transvaginal ultrasound. But there was nothing in my uterus ― no sign of a fetus.

The doctor told me I was miscarrying. I asked her if it was possible this might be a “tubal” pregnancy, the term my friend had used when I called her that day. I did not know at the time the medical term was “ectopic.”

“No,” the doctor said. “We didn’t see anything in your fallopian tubes,” referring to the thin passageways that deliver the fertilized egg from the ovary to the womb, or uterus.

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She sent me home and told me to call my gynecologist for a follow-up.

I did. The nurse said my doctor wouldn’t see me until I finished miscarrying. Wait until I stop bleeding, in other words.

Over the next many days, the bleeding got worse, and so did the pain. I took another pregnancy test. It was still positive. I called my doctor’s office. The doctor still wouldn’t see me ― I was still miscarrying.

A few days passed and nothing changed. I searched “ectopic” on the internet.

I decided to drive myself to the emergency room.

A blood test showed I was still pregnant. A doctor ordered another transvaginal ultrasound. It was extremely painful. The technician performing the procedure told me it wasn’t supposed to hurt.

“But it does,” I told her.

When it was over, the emergency room doctor confirmed what I already knew ― there was no baby in my uterus. And the pain on the left side? The technician couldn’t get a good look at the left tube or the area around it because there was so much gas in my abdomen.

The doctor sent me home.

It was now two weeks since that first home pregnancy test. I was still pregnant. No baby in my uterus. Still bleeding. Still in pain. I lay in bed that Saturday morning and cried. I asked my husband to call my gynecologist’s office. The doctor looked at my chart ― at the lab results from the two blood tests I had over a period of two weeks. Most significantly, my human chorionic gonadotropin (pregnancy hormone) levels had increased over time, meaning I wasn’t miscarrying. The embryo was growing somewhere outside of the uterus. “Get her to the emergency room,” the doctor said. “She has an ectopic pregnancy.”

The most common spot for an ectopic pregnancy to occur is in one of the fallopian tubes. As the embryo divides and grows, if the fragile tube ruptures, a woman could bleed to death. It’s the in the first trimester.

In the emergency room, I was given a shot of methotrexate. It’s an old drug, originally prescribed to treat cancer. It targets fast-growing cells and is sometimes used for early stage abortions. It’s the gold standard for treating many ectopic pregnancies that have not ruptured … yet.

After the shot, I went home and went to bed. I slept the entire day. For the next week, I had my blood drawn and my HCG levels tested every three days. The shot is working if the levels decline between Day Four and Day Seven. In my case, that didn’t happen. My HCG levels stayed about the same. The fetus wasn’t growing, but the pregnancy hadn’t ended either.

My feelings were so complicated and, even now, nearly two decades later, I have trouble articulating them. On one hand, I felt as though I was slowly killing my baby. I knew logically that this was a pregnancy that could never reach full term. And if left untreated, it could have killed me. I was afraid. I felt like a walking time bomb. Every time I stretched out my left leg, I felt a sharp pain. What if some sudden movement caused the tube to rupture? I desperately wanted my HCG number to decline to save myself, and that made me feel incredibly guilty.

I changed doctors by the end of that first week when my gynecologist was still unable to see me. My new doctor told me I needed another shot of methotrexate. Again, I had to have my blood drawn every three days. This time, my HCG levels declined. By early August, about two months after I first discovered I was pregnant, my levels were finally close enough to zero that I was no longer considered pregnant.

More than two years passed. I was 41. I’d given up on having another baby, but I had all the early signs. My breasts were sore, I was tired, and, instead of having a regular period, I was spotting. And I felt that pain on my lower left side. I took a pregnancy test. It was positive. I went to the emergency room. I told the triage nurse I had the same symptoms as before.

Once you’ve had one ectopic, you’re at of having a second.

The hospital ran blood tests and confirmed I was pregnant. My HCG number was low ― it turns out, there is such a thing as being only a little pregnant.

I had a transvaginal ultrasound that again was painful. There was no fetus in my uterus, but this time the technician saw something near my left ovary and fallopian tube. Still, it wasn’t definitive.

The ER doctor told me it could be a corpus luteum cyst ― a common growth that sometimes appears on a woman’s ovary after ovulation.

Perhaps I was simply in the very early stages of pregnancy, the doctor said, and it wasn’t ectopic. I could give it a little more time, she suggested, and see what happens. She left the decision up to me.

I found myself alone in the emergency room, crying hysterically. I called my sister.

“I don’t know what to do,” I told her.

“What does your gut say?” she asked.

I told the doctor I wanted the methotrexate.

On Monday morning, my regular gynecologist called with a more decisive diagnosis. She believed I had a second ectopic pregnancy. As it turns out, one doctor’s corpus luteum cyst is another doctor’s ectopic pregnancy. This time, I needed only a single shot of methotrexate. My HCG levels continued to decline, and within weeks I was no longer pregnant.

For the next decade, I lived in fear of becoming pregnant. I felt like a baby killer. I asked my doctor to tie my tubes, but she discouraged me, saying it wouldn’t be 100% effective against another ectopic pregnancy. My husband wouldn’t get a vasectomy, and I had a Mirena IUD inserted ― it releases a small amount of hormone and is 99% effective in preventing pregnancy. I kept pregnancy tests under my bathroom sink until I was 53 ― I must have taken 50.

A few years ago, I saw about an that would require doctors to implant an ectopic pregnancy inside a woman’s uterus or face charges of “abortion murder.” Such a procedure is medically impossible. How dare he. It sent me down a rabbit hole where I discovered .

Ectopic pregnancies are considered rare. But rare is a relative term. Especially if it happens to you, not once, but twice. Nearly . Ectopic pregnancy occurs in as many as cases ― that’s more than 100,000 women. What’s more, diagnosing ectopic pregnancies is not straightforward; , as does my own experience.

― or they may not. They may also rupture and lead to death. I don’t know what would have happened to me had I not been prescribed methotrexate in both instances. But I’m confident my odds of surviving would have been substantially lower without the protection of Roe v. Wade.

Joanne Faryon is a professor at the Columbia University Graduate School of Journalism and an independent journalist and producer.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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Most of the machines are in use, often by people who’ve suffered a brain injury or stroke. Some of those residents are in a vegetative state and have remained on a ventilator for years.

State officials are working to consolidate ventilators where they are most urgently needed. But so far, the supply in nursing homes has not drawn the same attention.

Or course, commandeering those units would set up a monumental ethical dilemma: Do you remove life support for a long-term nursing care patient in order to give a COVID-19 patient a better chance of survival?

The highest number of machines, about 2,300, is in California, where the state has created designated nursing home units for people on life support, officially called subacute units but known pejoratively by some doctors as New York has the second most, 1,822, according to state officials.

Already, one nursing home on Long Island has lent a nearby hospital 11 ventilators that were not being used, leaving just five for its residents.

“The hospital came to us last week and asked, ‘Do you have any ventilators?’” the nursing home assistant administrator said on the condition of anonymity because he was not authorized to speak to the news media.

“We left ourselves with the bare minimum,” he said. In all, three hospitals reached out to the nursing home for ventilators ― it had to say no to the other two.

New York Gov. Andrew that ventilators not in use by hospitals be redeployed to ICUs. And he’s calling in the New York National Guard to facilitate the order. “We know where every ventilator is,” Cuomo said Sunday.

Nursing home ventilators are not included in his order, but they are included in the state’s tally of the machines.

Dr. Michael Kalafer, a pulmonologist and the medical director at two San Diego subacute units, said he can’t imagine taking one of his patients off a ventilator because it’s needed for someone else.

“I severely doubt we’ll take [a hypothetical] Mrs. Smith off a ventilator because she’s 80 and has been on it for a few years and has not gotten better,” Kalafer said.

But these are precisely the decisions bioethicists are being asked to weigh in on as the country confronts the crush of COVID-19 patients overwhelming the health care system.

And in some cases, to give people who are severely brain-injured a lower priority when it comes to access to ventilators. Disability advocates oppose such guidelines and filed complaints with the Department of Health and Human Services last month, according to . And although states and health associations can draw up recommendations, they are not legally binding.

“From an ethical point of view, for people who are not conscious, if it’s a matter of removing people from a [ventilator] who are not going to recover, I think it’s a hard decision, but one that in an emergency has to be made,” said a professor of sociomedical sciences at the Mailman School of Public Health at Columbia University.

Bayer has been a member of the World Health Organization and in 2011 served on an ethics subcommittee that advised the Centers for Disease Control and Prevention on the allocation of ventilators in the event of a severe pandemic.

He and several other ethicists said these decisions should not be made at the bedside but by triage committees or people in supervisory roles. And the guidelines ought to be uniform and transparent. That’s why the CDC, the state of New York and medical associations like the American College of Chest Physicians have drafted ethical recommendations for deciding how to ration lifesaving equipment like ventilators in the event of a pandemic.

The California Department of Public Health in 2008 released : They don’t specifically address ventilator allocation, but rather resources in general. Doctors should consider the likelihood of survival and change in the quality of life as opposed to the ability to pay or the perception of a person’s worth when there are not enough medical resources to treat everyone in need.

When updated its ventilator allocation guidelines in 2015, it considered the question of withdrawing ventilators from nursing home residents, or chronic ventilator patients, to save the lives of those who grow critically ill during a pandemic.

“Are we comfortable sacrificing this group in exchange for saving more lives?” asked Stuart Sherman, the executive director of the task force at the time.

That question drew much debate, but the group ultimately decided that “chronic” vent patients should not be included in the pool when considering how to allocate ventilators during a pandemic. The task force does recommend prioritizing ventilator therapy based on who is likely to survive using a SOFA ― Sequential Organ Failure Assessment ― score.

Cuomo, whose daily televised news conferences have made “ventilators” a household word, is not making decisions based on those guidelines. The task force report is not a binding policy document, according to a spokesperson from the governor’s office.

In the U.S., there are about the kind needed to treat the most severe cases of COVID-19. An additional 10,000 to 20,000 ventilators are in the government’s National Strategic Stockpile, and 98,000 basic models, the kind often in nursing homes, exist that could be used in a crisis.

In the simplest terms, ventilators push oxygen into the lungs. The machines in ICUs are more powerful and have better monitoring systems than those in a nursing home.

Kalafer’s patients need ventilators to do the work for respiratory muscles. He said they could be used in a pinch during the pandemic. But the real issue is finding enough staff trained to operate and monitor the machines.

Meanwhile, a group of bioethicists, physicians and public health experts are recommending that in a shortage, health care workers could disconnect people from ventilators who have little or no chance of recovery to put them in service of those who do.

The recommendation is the first of six listed in published in the New England Journal of Medicine last month.

It did not consider the people who’ve been on vents long term.

“Honestly, before you emailed me, I thought about those patients but never thought about the actual number and how important that might be,” said Dr. James Phillips, one of the paper’s authors and chief of disaster and operational medicine at George Washington University Hospital.

“For patients who have devastating neurological injury and are deemed to never recover and who require ventilation for the rest of their lives, I think it’s an ethical conversation to have with those families to determine if it’s a more appropriate use of resources,” Phillips said.

One ventilator can save multiple lives. The average time a person sick with COVID-19 who needed a ventilator was 11 days, according to an article that looked at critically ill patients in the Seattle region. Using that number, eight people could potentially be saved over three months.

It is an especially complex moral dilemma when considering the withdrawal of treatment from someone who has lived several years on a ventilator, said Govind Persad, an assistant professor at the University of Denver Sturm College of Law and one of the authors of the NEJM paper.

Persad offered a hypothetical scenario.

“A 78-year-old grandmother has been on ventilator support for 5 years in a subacute facility and is expected to remain on it for the foreseeable future. Covid-19 has reached a senior apartment complex nearby, and doctors are looking everywhere for more ventilators,” Persad wrote.

“They think one more ventilator would give them a chance of saving another 78-year-old grandmother in the senior apartments who is growing worse with viral pneumonia, and, once she is off the ventilator, to save some of her neighbors, who are not yet sick but who they expect to be sick in a few weeks.”

Who gets the ventilator?

Persad suggested it should go to the grandmother in the senior apartments because she is likely to need less time on the ventilator, enabling the ventilator to be used to save her neighbors later.

As he put it: “We save her in order to save more lives, not because of quality-of-life judgments.”

The real-life decision is more problematic and heart-wrenching.

Nancy Curcio’s daughter Maria, who was born with a disabling form of cerebral palsy, was on a ventilator as an adult in San Diego for about three months in 2004. She was eventually weaned off the machine but lived the remainder of her life in a nursing home with a breathing and feeding tube, unable to walk or talk. She died in 2017 at age 57.

“I would be very upset if a doctor said I have to take her ventilator away for someone to live,” Curcio said. “But I can understand in triage this is what a doctor has to do. Would I like it? No. I would want to run away with the ventilator.”

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).