Kellen Squire: Being an ER Nurse in a Post-Roe World

by ER nurse Kellen Squire

I was at work last night when the notices began rolling in on my phone. It was a busy, busy night in the ER; both COVID and influenza A rolling WAY back up, along with our normal retinue of sick folks. I only had time to clench my teeth in anger before I had to move on to take care of my patients.

Now I’m just vomiting words onto the page here in the narrow window before I try to get a nap – I get off work at 7am and have to pick the kids up at school at 2pm – and I’m already pissed as hell. So let me do my best to elaborate on what an emergency department looks like in a post-Roe world.

In eleven years as an ER Nurse, I can tell you that I’ve learned that Republicans and Democrats actually agree that abortion should be safe, legal, and easily accessible. The real difference comes from who each party wants those rights to be available to. Democrats say they should be universal, available all American women, whereas Republicans think they should only extend to THEIR abortion. Theirs, their daughter’s, their mistresses’. Those abortions are not only okay, they’re laudable! And they definitely want it to be safe and available on demand.

This is something I’ve learned from first hand experience.

First. Hand. Experience.

Now, it used to be that to perform an abortion in the emergency department, you had to be a chemotherapy trained nurse who was not a female of child bearing age. Which, for a number of years in my emergency department, consisted of exactly one nurse- me. Our protocols have since changed because it’s never good to effectively have just one person who can do a critical procedure, but it means I’ve repeatedly seen first hand the consequences of “back alley” abortions. What happens when a crisis pregnancy center tells a desperate woman that having an abortion will make her evil. What happens when a woman is told that ectopic pregnancies can be “moved”, and that we’re lying to them when we tell them that’s not possible… so they attempt to pray their symptoms away. What happens when women are told they will be sinners, disowned by their family, but are offered no support or help from anyone.

That also means when I read about new laws specifically targeting healthcare providers, threatening them with insane fines or jail time for assisting with an abortion, I take that very seriously- because that’ll be me. That’s why they’re going after us. They know we’ll do the right thing by our patients, so they want to see how many healthcare providers they need to target before enough of us start to stand back, terrified of losing our jobs, bankrupting our families, or ending up in jail. Or end up quitting to avoid that; I certainly wouldn’t blame anyone who didn’t want to get caught in the middle of that, but our “brain drain” post-COVID is already apocalyptic as is, and if we add this to it…

We’ve lost decades- centuries!- of experience from providers who have said (rightfully!) “I don’t get paid enough to be told I have to save the country from a government that refuses to. I can get paid to do an easier job somewhere else.” That affects ANYONE who has to go to an ER. If someone you love has to seek emergency care, I’m gonna bet you’d like them to be seen by a grizzled, veteran provider, someone who has seen everything, and can pick up on the subtle signs of things going horribly wrong. That new grad nurse might be eager and dedicated, but if they don’t have an experienced professional standing behind them, all the hard work in the world can be for naught.

Now add post-Roe threats. “You even think about helping a woman with an abortion; I don’t care if they were raped, if it’s an ectopic pregnancy, nothing. You go to jail – and we’re coming for everything you own.” The implications chill me to the bone.

Obstetric emergencies are… I can’t even begin to explain how horrifying they are. How sick these women are. How close to death they can come, very easily. I had one that probably wouldn’t have survived had she rolled through our doors a mere five minutes later, or if she hadn’t been triaged by an experienced ER Nurse who knew the warning signs of what to look for in order to save her life. The last time I had to hang blood to gravity- meaning we spike a bag of uncrossmatched blood, and instead of putting it on an IV pump, just kick it wide open and let it flow into the patient as fast as it can (hopefully faster than the patient is losing it)- was for one of the incidents I alluded to above.

Women dying aren’t a theoretical here. It’s not hysteria to mention it. Quite the opposite; I don’t see how it won’t happen.

And beyond abortion… the ultimate theory underpinning Roe versus Wade is that the US Constitution granted American citizens an inherent right to privacy. It’s not that the US Constitution didn’t allow abortion – abortion was legal in 1787 in the United States – it’s that Americans have no right to privacy. If the leaked documents are accurate (and I have no doubt they are) then this is exactly the hinge Roe v Wade is going to be struck down on. Which has incredibly horrifying implications on everything from marriage rights (gay or interracial), to contraception, and beyond.

The emergency department is the big catch all in American society. Every policy failure, every inaction by our government to protect our own people, all of it ends up in our laps. And I am literally shaking to think of what the consequences will be to those of us on the front lines of emergency services.

Unfortunately, even my home state of Virginia is no longer safe ground for abortion rights. Yes, Democrats hold the Virginia Senate, but by a very slim 21-19 margin- and one of those Democrats, Senator Joe Morrissey, has already basically said aloud he’d vote to criminalize abortion… as long as the price is right.

A short summary of Morrissey’s time as a lawyer: he was cited for contempt of court ten times, jailed or arrested five times, and had his law license suspended twice before finally getting it permanently yanked after he hired a 17-year old to work as an intern in his law office and got her pregnant. He then served jail time on charges of indecent liberties with a minor, possession and distribution of child pornography, and electronic solicitation of a minor.

All Governor Youngkin needs to do is call a special session, and ask Morrissey his price. Money? Youngkin has more actual cash than Trump ever did. Building a casino in Petersburg, Virginia, which Morrissey has been trying to get done over the will of local voters? No problem. Getting his law license back? Hell, I wouldn’t put it past the GOP to vote on that openly in the General Assembly. Be rich to watch these hypocritical jerks who wailed openly about Morrissey being proof that “Democrats are pedophiles” suddenly roll out the red carpet for him… Or it would be, if only the consequences for that didn’t affect every woman in the Commonwealth of Virginia.

There’s a lot more that needs to be said here. Consequences definitely need to be metered out to politicians who were happy to dance around on this issue to try and milk it for all the donations it was worth – I will never, ever, ever donate to or support the people who breathlessly sent me fundraising emails overnight, ever again – and now real people will pay the price.

Sigh.

I wish I had something poignant to say. But I don’t. All I can say is that we have to keep fighting. I know that’s something you hear all the time – but it’s true. We fight. We back those who will fight unapologetically alongside us. And we do not stop until every single American has their constitutional right to privacy guaranteed to them.