“Are you the only politician in Virginia who’s ever done an abortion?”

by Kellen Squire

In light of multiple bills being introduced to the Virginia General Assembly, including proposals for complete bans on abortion and contraception, along with a budget proposal by the Governor to set aside money to prosecute women who seek one, a national news outlet contacted me, asking about my opinion on that legislation, and posing the question in the title of this piece. I decided to it directly, here, so the people of the 55th District (and all Virginians) know where I stand, unequivocally.

Yes; it appears that I am the only legislative candidate in Virginia, and one of the very few in the entire country, that’s ever actually performed bedside abortion care for a patient.

I’ve never made it a secret we perform abortions in the Emergency Department when necessary – I have written about it several times, such as when I warned about what the consequences repealing Roe v. Wade would be.

In the ER, it’s nurses who stand in the room with patients, helping field the questions that come up during and after physicians see them, explaining to patients what they can expect to happen. It’s nurses who get into the chemotherapy-rated protective gear we’re required to use for the medications that are needed, and it’s nurses who administer them – oral, injectable, or intravenous- to our patients as they’re ordered by our physicians. And if a patient is unstable (or needs any kind of surgical intervention), it’s nurses working to stabilize them until we can get them to the OR.

But what we do isn’t rare, and it shouldn’t be newsworthy. Tens of thousands of ectopic pregnancies happen each year – 2% of all pregnancies are ectopic, and bleeding from those account for 10% of all pregnancy related deaths alone. Without an abortion, they are universally fatal every single time. And that’s not even mentioning patients with a septic uterus, a failed miscarriage, patients whose water breaks at 12 weeks – all things hundreds of thousands of people in this country go through each year, only magnifying the reality that being pregnant in America is deadlier than any other high-income country.

Do you know how quickly ectopic pregnancies can turn bad? In an instant. You can go from mild discomfort to rolling on the floor, screaming in pain, in the blink of an eye. Until recently, the most blood I ever gave to a patient wasn’t for a gunshot wound, or a motor vehicle collision, or an industrial accident. It was to a young patient, a parent with kids in school, who almost bled to death in their car from a ruptured ectopic on the way to the hospital.

Usually, when nurses transfuse blood, we do so sedately; via an IV pump over the course of several hours. Not this time. I can still vividly remember the physical feeling of squeezing the multiple units of uncrossmatched, O-negative, emergency blood the blood bank rushed up to us, using my own hands creating a makeshift pressure bag, trying to replace blood faster than she was losing it. The OB surgeon later told me if she’d have come in even five minutes later, she’d have been dead.

For the millions of American women who cannot access regular, affordable OBGYN care, the ER becomes a literal lifeline. I simply never considered I might be one of a handful of politicians in the entire country with that experience. I didn’t even think I was the only one in Virginia, because there is an OBGYN in the Virginia Senate- a Republican from the Richmond area. Clearly, as a physician, and given the facts listed above, abortions – especially those for miscarriages and ectopic pregnancies- must be a part of their everyday practice… right?

But I was made aware of an alarming truth: upwards of eighty percent of OBGYNs refuse to take any abortion training in residency– a statistic that is likely to become only more stark in the post-Roe environment- forcing patients in need to find another OBGYN, or more frequently, come to the ER seeking care.

I get it can be difficult. Every case is a little different. Some patients are understandably calm, as what we do is incredibly safe. Some patients are terrified at the dichotomy of feeling essentially fine, but trying to reconcile the fact they are literally hours from death without proper treatment. Some are sobbing, inconsolable, at a loss that is still incomprehensible to them. Some- far too many, particularly in a largely rural area like mine – worry that the simple act of having agency over their own body will make them a “sinner”, that they will be forsaken by their family for having an abortion. Some ask desperately if there is any other way, anything else that can be done, or ask what I would do if it were my wife, or my daughter, in their shoes- but often, even giving my assurance I’d want my loved ones to do the same thing doesn’t help.

In short, what I do personally isn’t any different than what tens of thousands of my colleagues in emergency departments across the country do every single day. We provide healthcare to our patients; abortions are simply one of the ways we provide it. It is not unique, and should not be controversial. Abortions – whether for medical emergencies, as we do in the ER, or any other reason – are personal, medical decisions that lie solely with a pregnant person.

Unfortunately, that’s not the country we currently live in, and why I’ve found myself writing this piece. Watching politicians argue that “ectopic pregnancies should have rights” and attacking healthcare providers for exposing their extremism makes my stomach churn. You could argue this is happening because these legislators simply don’t have the first hand experience my colleagues and I, in emergency departments around the country, have – a perspective that should never be absent when the legislature is arguing over such a critical issue. That the reason they claim what we do in the ER is “different” and somehow “doesn’t count as abortion”, that they insist “nobody would object to it” while simultaneously writing laws that make what we do illegal, is simply out of ignorance.

To be fair, it is unequivocally true that states with emergency department physicians and nurses in their legislature have become national leaders on protecting the reproductive rights of their citizens. But it’s clear that too many people who should know better are more than happy making bizarre arguments like “IUDs are abortion”, that “women shouldn’t have control over their own body”, or “every miscarriage should be investigated as a crime” as long as they think making that argument benefits them politically. Or simply and openly don’t care at all, because to them, it is all about power and control over women’s bodies.

I have to mention that I was warned repeatedly not to make this news public. When I ran for office in 2017, I was told I needed to do everything I could to hide this news, or else not only would I lose, I might cause other candidates to lose. But even now, I have been told “(You shouldn’t) talk about providing abortion care like you’re proud of it!” That “(the GOP) won’t care what you do in the ER, they’ll label and harass you forever.” I was also warned, distressingly seriously, about the very real threats my family and I are now likely to get.

But I refuse to back down or apologize for any of this. This is who I am. This is what I do. This is what providers across the country do. And I’m going to Richmond to ensure my colleagues and I – and the patients we serve every single day – can continue to both provide and access that care openly. My concern for my family’s safety is balanced against making sure I am always doing the kind of work that will make them proud.

The emergency department is a place where people with no other options go. We are the last line of defense for our community’s safety net, and it’s our ethical, moral, and legal duty to care for every single person who comes through our doors, no matter the emergency or their ability to pay. Through epidemics of mental health crises, respiratory illnesses, and gun violence, we are the ones who are asked to hold the line and handle every single failure of our government to act to protect all of our people.

This crisis – the reproductive rights crisis – is no different. Medical providers will keep doing what we’ve always done. Again, it shouldn’t be special. It should be routine and completely uncontroversial. But if there are extremists out there hell bound to make an issue out of what we do, I’ll be damned if I’m going to back down or run away.

Nobody – not my family, not any of my colleagues, no women, no patients, nobody – should have to fear for their lives simply for providing or accessing healthcare for themselves. For exercising their Constitutional right to have agency over their own body.

I fight for that every day in the ER. I’ll fight for it every day in Richmond. My patients, my constituents, and my fellow Virginians deserve nothing less.