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Hi, it s Elise Lunen, host of Pulling the Thread.
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Today s guest is the brilliant Susan Burton, author of the gorgeous memoir Empty and the host of the chart-topping New York Times podcast, The Retrievals.
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Hi, it s Elise Lunen, host of Pulling the Thread.
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On this show, we pull apart the web in which we all live to understand who we are and why we re here.
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Pulling the Thread is about big questions.
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Why we do what we do, how we can understand our own experiences within a larger spiritual and historical context,
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the ways in which we might begin to understand ourselves and each other better, and what s required to heal ourselves and our world.
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I ll be joined in conversation by luminaries and wise elders, those who have laid tracks on their work and lives to help us bring meaning and understanding to a world that often feels chaotic and overwhelming.
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My hope is that these conversations spark moments of resonance and plant tiny seeds of awareness so that we might all collectively learn and grow.
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I mean, I do think that I have an abiding interest in women s bodies, in how our bodies can be, you know, determinative, how they can suggest certain identities, how they can preclude certain identities, how our bodies can, you know, hold lots of possibilities.
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Like, I noticed I just said the sort of negative parts first, I think because it took me until I was in my mid-40s when I finished this book and published it.
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to understand the possibilities of a body, the transformative possibilities of living in and living from a body and taking pleasure in my body in a way that, it s not that I had never taken pleasure in it.
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There were certainly things I did that gave me pleasure, but my body was primarily something, there was a lot of self-loathing directed at my form.
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So I think that that s,
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Yeah, I think, I m trying to think if there s another way to describe the connection between the book and the podcast beyond just the fact that I do think that we have a lot of stories about living in these bodies as women.
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So says Susan Burton, whose voice you might recognize from the incredible New York Times and serial podcast, The Retrievals, which explores the experience of women who underwent egg retrieval at the Yale Fertility Center with saline in lieu of fentanyl because a nurse named Donna was replacing the drugs in service of her addiction.
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The series is a beautiful exploration of whose pain matters and the type of medical gaslighting that s far too common in the lives of women.
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Susan is a veteran staff member at This American Life and the author of this stunning memoir, Empty, which explores her own uneasy relationship with her body.
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Though she s in recovery now, a description she holds lightly, Susan spent the first few decades of her life struggling with binge eating disorder.
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We explore all of this in our conversation, which I ll take you to now.
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Congratulations.
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It is so exhilarating.
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It has been amazing to see the retrievals just sitting on the top of those charts.
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Oh, well, thank you.
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I mean, it s been amazing for me, too.
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I never would have expected that a podcast about women s pain would be in that top spot for weeks in a row.
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Yeah.
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But this is the whole point, in some ways, right?
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Is that these stories about women and our bodies, there s this idea that it doesn t matter and no one cares.
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And au contraire.
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Au contraire.
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You know?
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Right, exactly.
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Well, all of us who have been women and had these experiences with our bodies, right?
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Maybe we all could have predicted that listeners would respond to it.
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Yeah, for sure.
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It was one of those shows, and I m sure that anyone listening to this podcast most likely has already listened to the series or has heard about it, most likely from a friend.
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And the pings were all the same, which was, this is speaking into existence something that we ve all felt, and yet it s rare to hear these things clearly articulated when so much of our culture is about instead sort of the facts of the case, right?
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Like the Theranos shock horror of culpability and criminality rather than the quiet, very quiet story of the people who are actually affected.
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So, for all of us, will you just tell us the story about how this even came to you?
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Sure.
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Okay, so the retrievals, the podcast.
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I first learned about the events at the center of it one night in November 2021.
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It was a Friday night.
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I was home from work.
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It was late.
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I was on the couch.
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I was scrolling through my phone.
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And in like the Discover feature in the Chrome app, in my list of suggested stories, there was a local news story from a Connecticut outlet.
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I actually can t remember if it was a TV outlet or a newspaper, but like, you know, the New Haven Register or something like that.
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There was a story that said that these seven women had just filed a lawsuit against Yale University because of this thing that had happened to them at the fertility clinic affiliated with Yale.
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At that clinic, a nurse had been stealing fentanyl and replacing it with saline.
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And the reason it affected these women is the fentanyl was used as pain medication during a procedure they had there, the egg retrieval procedure, which is a pretty standard part of IVF.
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I mean, an essential part of IVF.
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So immediately, I just wanted to know
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what happened and how it felt for everyone involved.
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I mean, it just grabbed me immediately.
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I was drawn to a number of the themes to women s pain, to addiction, to infertility, to the longing to be a mother.
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Yale, where I went to college, so I had a sense of the landscape
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And by the next morning, I had already downloaded every legal document available about the nurse s criminal case and had already contacted the lawyer representing the patients to find out more.
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Yeah.
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I mean, it s a quiet case, right?
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ultimately and again like there are no teasers in our conversation because the podcast itself it s not a true crime podcast right it s about the untold story of the women and and sort of the lack of ownership the lack of institutional ownership
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And what often happens, I think, in any medical establishment, which is like an absolute refusal to say, we re so sorry, right?
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It s a typical response.
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I don t know.
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What do you think that is?
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Is it a fear of legal ownership?
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Or why do you think that there s so much
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Gaslighting or just a lack of acknowledgement of a bad out.
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I don t even want to say a bad outcome.
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But what was that?
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So, yeah, I mean, one of the background clinic sources I spoke to said to me, you know, I think Yale thinks we need to cover our asses and we can t apologize.
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And I think that
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There s no like law written out that says if you apologize, you are liable for this thing that happened to patients in your medical facility.
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That s not exactly how it s written.
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But because nobody from Yale as an institution spoke to me, I can t say exactly what the rationale was.
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I should say the patients were sent a letter by the clinic.
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So what happened was for months, these patients
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At the clinic, we re experiencing a lot of pain during this egg retrieval because they were supposed to be getting fentanyl.
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And sometimes they weren t getting fentanyl.
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They were getting saline instead.
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And nobody knew what was going on except for this nurse.
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Eventually it was discovered.
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And the patients who were identified as possible victims received a letter from Yale.
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And that letter does contain, now I can t remember the exact words, but there is a what I would characterize as a mild apology.
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But there was also a lot of language in that letter that could be interpreted, to use the word you just did, as gaslighting.
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For example, there s a sentence in the letter, and I m probably not going to get it exactly right, but there s some sentence like,
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You know, we use at the Yale Fertility Center, we use a variety of medications.
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And in this way, we can ensure that patients are comfortable even if one medication is missing.
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And, you know, I spoke to one patient who was just like, well, that does not characterize my experience.
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Right.
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Because, of course, the point was these patients were not comfortable.
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They were in excruciating pain.
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And then, you know, you made such a good point earlier that I wanted to touch on really quickly, which is that, yeah, as far as true crime, like, I didn t totally understand that this was a true crime podcast until I opened up, you know, Apple Podcasts the morning the, you know, either the trailer was released or the first episode was released and saw it, true crime.
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And of course, that makes sense, right?
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It makes sense.
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But I always really saw it as an emotional investigation.
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So the quietness that you ve identified
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That was really what was driving me.
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Well, and it s interesting.
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True crime is the category.
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It s a whole nother conversation of like a container for our shadow, sort of like the way that we experience or allow ourselves to experience all of those darker emotions in a way that feels safe and outside of us.
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But that s a conversation for another day.
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I mean, going back to
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My dad s a physician and lung doctor and an intensivist and he was present, you know, in the emergency.
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If someone was in a car accident and my dad was on call, most likely he was there at two in the morning and he was present for a lot of trauma, like acute physical trauma.
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And he did a lot of ongoing, you know, he was a primary care doctor for a lot of aging adults.
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And somehow, he s not a surgeon, but he had to do various procedures and he was never sued.
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And I think part of it is that he s a great doctor, certainly, but that he pushed against this idea that you couldn t be present and you couldn t be sorry for an outcome.
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Even if it wasn t the outcome that you wanted, even if things might have gone differently.
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And he would say that he always pushed himself to be present within those deeply uncomfortable and painful moments with families when it was so much easier.
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And again, I think a lot of doctors understandably rely on this sort of, well, you shouldn t apologize.
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It could make you liable, instead of just sucking it up and being willing to go and be present with people in pain and say, I m so sorry.
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This is not the outcome that I know you wanted or that I wanted, and that that, he thinks, alone.
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And my mom, who s a nurse and ran my dad s practice, so was paying all of this
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I ll practice insurance like it s these are high stakes conversations for doctors certainly and in the health care system and she had an aneurysm when I was in high school and my parents flew to Arizona to see sort of the best surgeon in the world it was behind her eye
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and this doctor saved her life.
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You know, she was in an induced coma.
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It was very scary.
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And the team left a piece of gauze in her head.
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And so she ended up having to have another brain surgery down the line, this like recurrent double vision, clear malpractice.
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And what was so interesting about it is that ultimately my mom, even though it was like theoretically
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felt like traitorous.
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My mom ended up suing the practice and remodeling her kitchen.
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And she did so because he would not apologize.
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There was never any acknowledgement from the doctor of, and she was like, you saved my life.
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My gratitude is endless.
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And this happened and they wouldn t acknowledge.
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And she was like, okay, the fact that you can t just, all I wanted was an acknowledgement.
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And so now I m going to have to sue you.
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Well, you know, I mean, first of all, my God, I m so sorry that happened to your mother.
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I m so glad that she s OK.
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That s terrifying.
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And, you know, the research shows that patients are less likely to sue when there s an apology and transparency.
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And the story you just told, like, like, bears that out.
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I do want to say that the clinic sources I spoke to, you know, across the board, those who were still at the clinic when this was all uncovered,
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They did try to apologize individually to patients as best they could.
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And they wished, you know, that their institution, they wished that Yale would step up and take ownership and accountability and, like, offer transparency and offer an apology.
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But I think it can be really hard to have those conversations.
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And it sounds like your father was really attentive to the importance of that.
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I m Rachel Martin.
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After hosting Morning Edition for years, I know that the news can wear you down.
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So we made a new podcast called Wildcard, where a special deck of cards and a whole bunch of fascinating guests help us sort out what makes life meaningful.
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It s part game show, part existential deep dive, and it is seriously fun.
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Join me on Wildcard, wherever you get your podcasts, only from NPR.
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So switching back to these women and their pain and the all of the research that suggests that women, particularly women of color, people of color, right, are under medicated for pain, under assessed.
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What is that?
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What do you tie that to?
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I mean, I think, you know, for women, there are long historical and cultural precedents for seeing women patients as hysterical,
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as unreliable narrators of their own symptoms.
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You know, I think that there s recent research right about there is a study from UVA that came out several years ago that showed that even medical students rated the pain of a black patient as maybe not rated the pain of a black patient as less, but it documented these like really disturbing beliefs that the medical students held about black patients, for instance, that
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skin was thicker, so the nerve endings weren t as sensitive.
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And these are medical students, right?
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So there s all kinds of really entrenched gender and racial bias in the interpretation of pain in our health care system.
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Yeah, and I would also say that for women, there is, particularly when it comes to our reproductive organs, and I want to talk about even the language of IVF, harvesting, the way that our bodies are sort of depicted as these vessels, right?
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To be harvested inherently is so strange.
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I don t know what words are better, but that feels awful to hear.
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but that there s this already this natural split amongst women or the way that we sort of rate each other s experiences in the birthing room as like, did you do it quote unquote naturally?
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I guess, you know, to have an epidural is not quote unquote natural, but the way that we ve already created, I don t know, labels
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to divide women amongst those who are, quote unquote, having natural childbirth and can take the pain?
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I don t know the way that we valorize that.
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Oh, yeah.
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Oh, yeah.
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No, I think it s I think the valorization of pain, especially around childbirth, is so fascinating.
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I mean, the thing with the uterus.
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Right.
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So that s where, like the word hysteria comes from.
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Like uterus is, you know, derived from when you get a hysterectomy.
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And the whole thing since antiquity, like the idea that the uterus, like if it didn t have a baby in it, it roved around the female body.
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Right.
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The wandering womb.
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And that s what made women sick and crazy.
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And it s just nuts.
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Right.
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But you see this played out today in all the ways that we talk about women being emotional and hormonal.
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And it s all to do with, you know, wanting to have children or pregnancy or childbirth.
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I know it s so you know, I have I have two children.
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And I birthed them a while ago.
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One of them just started college and the other one is about to be a sophomore in high school.
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But with one birth, I had an epidural and the other one was unmedicated.
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And that was the word I landed on.
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I was like, OK, I don t want to use this word natural for all the kind of reasons you name.
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It seems like there s like a hierarchy of kinds of birth and I m not going to fall into that.
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But I don t know if unmedicated is really any better, you know.
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But I remember not feeling like I had the right word and my reasons for wanting to do it that way.
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I m somebody who has had a lot of fear historically in medical settings.
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And I was more scared of the anesthesia than I was of the pain.
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I was scared, you know, that the epidural would be placed wrong.
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I was scared I would have the epidural headache.
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Like those fears were so enormous.
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And I always felt like I was, you know, some strange, anxious outlier.
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But in reporting this story, you know, I did a lot of research about egg retrievals and
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you know, because the patients in this story went through these retrievals without getting pain medication.
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And Yale told them, like, your outcomes weren t affected by this.
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And the patients that I spoke to were just like, first of all, that s just like such an insensitive statement.
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But also, could that really be scientifically true?
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And so I went looking for research about having egg retrievals without pain medication.
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Unsurprisingly, there s very little research about this because it s not like a typical category of research.
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Like, let s do a really painful procedure on patients and not give
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meds.
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But this couple studies that existed were mostly about patients who were more anxious about the anesthesia than about the pain.
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So that doesn t exactly fall into the category of like, oh, you know, valorizing pain.
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It s tougher and more noble to do it without.
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But I think that what does happen is when one does feel pain, then you start to question yourself like, oh, am I just weak?
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Can I not handle this?
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And that s what happened to a lot of patients in the story is they blamed themselves for something that was absolutely not their fault.
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Yeah.
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No, I had two medicated births, both induced, so pitocin and epidural.
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And I also had the experience with my first of, and I loved the epidural.
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I hadn t slept.
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I mean, I had slept obviously, but I was so uncomfortable.
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I was physically so huge.
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I have a very, I d call it inflammatory response to pregnancy where I gain like
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60 plus pounds regardless of what I do and I hadn t really been sleeping at all and I got the epidural and took a nap.
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And then my epidural failed or it didn t keep up with my labor.
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I think my labor was very slow and then it got going.
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And I mean I would count myself as having a high pain tolerance and I know Pitocin makes everything a little bit more extreme.
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I don t think you can have Pitocin without an epidural but
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Oh my God, if there had been a knife, I would have cut my child out of me.
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My husband was crying.
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It was during a nursing shift change.
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And so there was no one.
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Finally, someone came in to be like, what s happening?
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What is happening?
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I mean, I sounded like a wild animal.
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Yeah, my husband was crying.
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I guess he probably should have got gone on the floor.
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He didn t want to leave me.
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Anyway, it all worked out.
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It all worked out.
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But that one
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hour without that epidural before they could, you know, find the anesthesiologist and get me back on track was unlike any, I mean, it was, I wouldn t wish it on my worst enemy.
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It was so wild.
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Oh my God.
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It must have been awful.
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I mean, with my first, you know, my water had broken.
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I had been more than 24 hours and the doctor was like, I m going to give you Pitocin and I will not give Pitocin without an epidural because it s cruel.
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Like, it just sounds like the most horrendous pain.
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I mean, I had the same reaction to the epidural as you.
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I was just like, oh, my God.
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Oh, my God.
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I mean, I didn t know it was fentanyl until after.
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But yes, it was like bliss.
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I mean, which I know is a scary thing to say, but I just was like, this is the best feeling I ve had in nine months.
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Like, thank you for this reprieve and rest.
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Yeah, yeah, no, it was such a good lesson to me as far as just, you know, as somebody with my history of somebody who d been so fearful, just like, oh, my God, this like this is the benefit of treating pain.
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I think I was probably able to have a vaginal birth because of the, you know, because of the epidural.
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I think I was so tense.
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My God, that hour though, when you were just like raw with Pitocin.
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It was a mess.
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A nurse was like walking by and she, you know, she was like, what, what s happening?
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I mean, it was just like chaos.
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Like she had just gotten there.
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She was like, I gotta find my shoes.
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Let me call your doctor, you know, just like, whoa.
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Cause I had just been plodding along and then they looked and they were like, oh my God, don t push.
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It got really crazy, really fast.
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Unfortunately, everything worked out.
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And I think, too, with like with things like childbirth, you can say, oh, it s pretty simple, stupid, like we ve been doing it for, you know, ever.
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And this happens to women every day routinely.
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And also it is incredibly dangerous.
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And I just want to also say, having grown up in a medical family where I would, you know, typed my dad s transcription, I spent, you know, every day after school in my dad s office filing charts.
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et cetera.
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And I would go across the street with him.
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I would hang out in the nurse s station.
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I would watch procedures as a child, which is so odd.
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But endoscopies, colonoscopies.
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Can you imagine now someone saying, do you mind if this 12-year-old watches us?
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give you a colonoscopy.
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This is like from another time.
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This is from like our parents  generation.
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This is pre-HIPAA.
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You were like across the street and then you were going in.
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I can t believe this.
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It is from a different time, different rules back then.
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But also what was so painful
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And I ve, for the most part, had incredible experiences with my physicians.
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And then to hear the way that that trust can become broken.
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And then also what happened, clearly, to so many of these women, understandably, is that you have to presume, and I think that this is very common in America, it s part of the rise of wellness culture, and it s one of our sort of healthcare laments, is the hypervigilance required
2
SPEAKER_02
on the part of patients who either go through an experience like this or feel like nobody s listening when they re explaining what s happening to them and therefore it s on them.
2
SPEAKER_02
These things that should really not be any of our concerns, right?
2
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The whole point of going into a hospital to give birth is handing over your life and the life of your child
2
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to your health care team so that they can ensure your safety.
2
SPEAKER_02
And then to feel like that s broken, that you re the one who needs to be in charge, is such a trespass.
2
SPEAKER_02
Like, the assumption of hypervigilance is so wrong.
2
SPEAKER_02
Like, it s so unhealing, right?
2
SPEAKER_00
Yeah, no, unhealing.
2
SPEAKER_00
You re right.
2
SPEAKER_00
That s a good word to use.
2
SPEAKER_00
I mean, you know, I think, like, a couple things I want to respond to.
2
SPEAKER_00
One, you know, I ve heard from from multiple, you know, doctors, doctor listeners who ve who ve talked about that sense that that is what is so painful for them about listening to the story is how these patients lost trust in this system, you know, and that feels that s hurtful.
2
SPEAKER_00
And again, I m not, you know, even talking specifically about people from Yale, but just doctors in general.
2
SPEAKER_00
And then, you know, I think one of the things when I was researching the story and reading a lot about, you know, women s pain and the dismissal of women s pain in medical settings, I kept coming across these articles that would be like, you know, 10 tips, how to advocate for yourself with your doctor, you know, what to do if your doctor is not listening.
2
SPEAKER_00
And that kind of advice is obviously valuable and important.
2
SPEAKER_00
But it was just really striking that so much of the time the onus was on the patient to be in charge of this problem.
2
SPEAKER_00
And it seems to me to be where solutions like different training in medical school to facilitate these conversations, to underline the importance of listening, to teach how to listen.
2
SPEAKER_00
And again, not that like those things aren t happening at some level, but there s some kind of disconnect for sure.
2
SPEAKER_00
And then just even the idea, you know, talking about going into the hospital for a birth and thinking about why are there so many doulas in hospitals now, right?
2
SPEAKER_00
Because it s like you need another person to advocate for you.
2
SPEAKER_00
There are, again, there are lots of other reasons to hire a doula, but one of them is to have an advocate for you at that really vulnerable time.
2
SPEAKER_02
Yeah.
2
SPEAKER_02
No, I mean, and it s also why I insisted that my parents come to Los Angeles.
2
SPEAKER_02
I mean, I think that they kind of wanted to anyway.
2
SPEAKER_02
My husband s amazing.
2
SPEAKER_02
He s very sweet.
2
SPEAKER_02
But he is not the sort of person who goes to get aggressive with anyone.
2
SPEAKER_02
Not that that s what I wanted, necessarily.
2
SPEAKER_02
But you can t be the person.
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SPEAKER_02
You can t be
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SPEAKER_02
the person and it was interesting just thinking about in the process of going back through my experience like my desire to be a quote-unquote good patient and then the other feedback that you ll get from women such as like if you want an epidural make sure you ask very early because other people will unless you re prepared to get strident and quote-unquote crazy
2
SPEAKER_02
because other women will come in and their craziness, these are, I just remember hearing these words, their craziness will outweigh yours if you re not willing to get nuts and so they will quiet women down according to sort of the volume level.
2
SPEAKER_02
And so be prepared to be bumped, ask early because it will invariably take much longer.
2
SPEAKER_02
I remember getting that, which I, on some level I understand, but it s also messed up, Susan.
2
SPEAKER_02
Like it s just so gendered, really.
2
SPEAKER_00
It s so gendered, it s so messed up.
2
SPEAKER_00
And it s so messed up that you have to like jump the epidural.
2
SPEAKER_00
Like you have to, everybody will get crazy.
2
SPEAKER_00
So the only way to like get the epidurals- The people who are really screaming will outrank you.
2
SPEAKER_00
Exactly.
2
SPEAKER_00
It s so messed up.
2
SPEAKER_00
But one of the things, you know, that was so interesting to me in this story was that so even though there s this like weirdness around like the crazy ones will get it.
2
SPEAKER_00
There s still this culture of like you re going to go into that hospital and you are going to ask for what you need for your birth.
2
SPEAKER_00
But in fertility treatment, it s really different.
2
SPEAKER_00
You re really dependent on, you know, many clinics is a nurse team.
2
SPEAKER_00
You re really dependent on your providers to guide you like daily.
3
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in each step of these really complicated treatments.
3
SPEAKER_01
Like, there s no book you can buy.
3
SPEAKER_01
There s no way to do it yourself.
3
SPEAKER_01
There s no DIY version of this.
3
SPEAKER_01
And that, you know, kind of submission makes patients even more vulnerable than they already are in this really physically and emotionally demanding process.
3
SPEAKER_00
I also wanna talk to you about the experience of so many, in that gaslighting, in that sort of like, this can t be normal, this level of pain, and also this like, oh my God, I m somehow immune to fentanyl, right?
3
SPEAKER_00
Which is what they were told.
3
SPEAKER_00
Like they d been given the maximum dose and therefore like fentanyl, quote unquote, like didn t work on them.
3
SPEAKER_00
I don t know if that s an actual medical reality, but that seems,
3
SPEAKER_00
somehow implausible.
3
SPEAKER_01
So some of the patients who, you know, they were they went into this procedure.
3
SPEAKER_01
They assumed they would get fentanyl.
3
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They came out of the procedure.
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Some of them had felt everything during the procedure.
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SPEAKER_01
Some of them were more sedated and didn t feel pain until they came to in the recovery room.
3
SPEAKER_01
But so immediately they started coming up with like
3
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theories and stories about why this had happened to them.
3
SPEAKER_01
And a number of them were like, oh, I must not be sensitive to fentanyl.
3
SPEAKER_01
It s not possible to be, you know, immune to fentanyl.
3
SPEAKER_01
People can have, you know, varying levels of sensitivities to different opioids.
3
SPEAKER_01
But being immune to fentanyl is like not a thing.
3
SPEAKER_00
Yeah.
3
SPEAKER_00
No.
3
SPEAKER_00
I mean, that seems impossible to fathom.
3
SPEAKER_00
The other part of the story, and I think that every woman who has a child can very much relate to this, was the conversation sort of about the outcomes.
3
SPEAKER_00
And the, well, you had a baby, and some of the women didn t, and it wasn t successful for them.
3
SPEAKER_00
For some, it was.
3
SPEAKER_00
For some, they had, I think you used the word, spontaneous pregnancies.
3
SPEAKER_00
So outside of the fertility clinic, they just happened to get pregnant.
3
SPEAKER_00
But there s this like, well, you got the baby, you had the baby, you achieved the result.
3
SPEAKER_00
So what does it matter?
3
SPEAKER_00
Right?
3
SPEAKER_00
And then you talk about, I can t remember your exact words, but you re talking about actually seeing one of the babies and the design of babies and the way that they automatically pull attention.
3
SPEAKER_00
Because one of the things that was so
3
SPEAKER_00
shocking and sad to me, which is such a right, I think, of matressens, like such a right of becoming a mother, is that you spend 10 months seeing your doctor with increasing regularity, everyone s concerned about you, and then suddenly you have a baby and you are just a vessel and no one cares.
3
SPEAKER_00
And you go and get your six-week checkup,
3
SPEAKER_00
They don t really even take blood work or make sure that you re replenished in any way.
3
SPEAKER_00
And then you re done.
3
SPEAKER_00
And the baby is seeing the doctor with abundance and a tremendous amount of attention.
3
SPEAKER_00
And you are just the carrier.
3
SPEAKER_01
Yeah, I mean, that that drop off that cliff when you have a child is pretty huge.
3
SPEAKER_01
I mean, the patients in the story, the first one, you hear her tape in the story.
3
SPEAKER_01
Her name is Isha.
3
SPEAKER_01
And she said to me, she told me an anecdote about going to her OB for the six week postpartum follow up.
3
SPEAKER_01
And she mentioned that she was part of this lawsuit against Yale.
3
SPEAKER_01
And the obstetrician was like, well, what s the big deal?
3
SPEAKER_01
You got pregnant.
3
SPEAKER_01
And in the tape, you can just hear me reacting.
3
SPEAKER_01
I was just stunned, right, that that would be a response, like as if the only outcome that mattered was the birth, was the baby.
3
SPEAKER_01
And, you know, in fact, that is how the success of a fertility treatment is measured.
3
SPEAKER_01
That s, you know, the success has to be measured some way.
3
SPEAKER_01
And in a way, it makes sense, I suppose.
3
SPEAKER_01
But just the fact that, you know, the only part of a story that matters is the end is kind of erasing everything that came before it.
3
SPEAKER_01
And so I felt sort of, you know, empathic fury.
3
SPEAKER_01
But then I, in the course of doing the interviews, I eventually met one of the patient s babies.
3
SPEAKER_01
And it really complicated the feelings I was having.
3
SPEAKER_01
It was a really important experience to remember like, oh, my God, like the baby matters.
3
SPEAKER_01
Right.
3
SPEAKER_01
Like I d been having all these feelings like, why are they telling the women that the baby is the only thing that matters?
3
SPEAKER_01
But the baby does matter deeply.
3
SPEAKER_01
But all the other things matter, too.
3
SPEAKER_00
Yeah.
3
SPEAKER_01
Yeah.
3
SPEAKER_00
Well, there s no similar conversation where the needs of the son displace the needs of the father.
3
SPEAKER_00
It s just not part of our cultural conversation in any way.
3
SPEAKER_00
It s such a strange conversation, and yet somehow it s not strange in the context of women.
3
SPEAKER_00
There is this, and in some ways it makes sense, of course, because we do theoretically host and carry children and birth the next generation.
3
SPEAKER_00
And the way the medical conversation, the harvesting of our eggs, the use of our bodies, I mean, it s all very strange.
3
SPEAKER_00
It s very parasite host.
3
SPEAKER_00
It s not like, wow, your body is this incredible,
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SPEAKER_00
creative, alchemizing, magical, God-like instrument, right?
3
SPEAKER_00
Instead, it s this, like, it s very, I don t want to say, like, medical isn t the right word.
3
SPEAKER_00
It s just very displaced.
3
SPEAKER_00
It s like, this has nothing to do with you in so many ways, right?
3
SPEAKER_00
The way that we medicalize it or take away all of its magic.
3
SPEAKER_01
Well, just even when you re talking about what happens after pregnancy, it s almost like it s barely an epilogue.
3
SPEAKER_01
Like I remember.
3
SPEAKER_01
So again, right.
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SPEAKER_01
This is a while ago.
3
SPEAKER_01
My son just went to college.
3
SPEAKER_01
So this is more than 18 years ago.
3
SPEAKER_01
But like I remember my copy of What to Expect When You re Expecting.
3
SPEAKER_01
And like you get to the end of that book and there s like little bits about maternity leave.
3
SPEAKER_01
But then the next book you go to is like your baby s development.
3
SPEAKER_01
You know what I mean?
3
SPEAKER_01
But there s like lots of stuff that I mean this stage after pregnancy.
3
SPEAKER_01
Right.
3
SPEAKER_01
I mean there are so many women who struggle with PPD.
3
SPEAKER_01
I had an awful tear after the birth of my first child and tears like weren t anywhere in the literature I d read.
3
SPEAKER_01
You know, I couldn t stand up.
3
SPEAKER_01
I couldn t sit down.
3
SPEAKER_01
It hurt to nurse.
3
SPEAKER_01
I thought I was going to have this pain forever.
3
SPEAKER_01
It was excruciating.
3
SPEAKER_01
It was so bad.
3
SPEAKER_01
But there was nothing telling me about it, you know, until that six week appointment with the obstetrician.
3
SPEAKER_01
It wasn t addressed until then.
3
SPEAKER_01
Yeah, it s interesting.
3
SPEAKER_01
I m in a place right now.
3
SPEAKER_01
So I m about to turn 50 and I m very, you know, aware of my fertility in a different way.
3
SPEAKER_01
Right.
3
SPEAKER_01
Not that I
3
SPEAKER_01
wanted to have more children, but I m very aware of like, oh, I am moving out of this fertile stage.
3
SPEAKER_01
And that s, you know, that s its whole own thing, right?
3
SPEAKER_00
It s a whole own thing.
3
SPEAKER_00
And it s interesting, the whole question about paramenopause and menopause, and in so many ways, it s exciting that suddenly, we re having a lot more collective conversations about it.
3
SPEAKER_00
And then at the same time, to watch it become commoditized and commercialized and pathologized, medicalized, like those are important conversations certainly about, you know, HRT and estrogen and yes, like, let s have those conversations openly and publicly and more research, etc.
3
SPEAKER_00
And yet at the same time,
3
SPEAKER_00
It, again, always brings it back to the body and the function of the body of women outside of what it is to actually be a woman.
3
SPEAKER_00
And I mean, I guess I would, in the conversation about perimenopause, menopause, matrescence, like there is such a spiritual, regardless of your beliefs, even if you have none, there is such a spiritual, historical,
3
SPEAKER_00
certainly cultural conversation that we re also just not really having about these massive life changes and instead it always comes back to the body and like what s happening to the body and like let s talk about our hormones and
3
SPEAKER_00
It s excruciating.
3
SPEAKER_00
And I also I want to turn here and talk about you and your body because having read your completely stunning memoir, I don t know how I miss maybe did this come out in COVID sort of totally.
3
SPEAKER_00
Why not in June 2020?
3
SPEAKER_00
Yeah, yeah.
3
SPEAKER_00
Totally.
3
SPEAKER_00
I m sorry.
3
SPEAKER_01
No, it s okay.
3
SPEAKER_01
I m thrilled that you read it.
3
SPEAKER_01
Thank you.
3
SPEAKER_01
Yeah.
3
SPEAKER_00
All right, so your memoir is stunning, and I think for anyone too.
3
SPEAKER_00
In the same way that The Retrievals might be codified as a true crime podcast, but it s not about crime at all.
3
SPEAKER_00
It s not about plot.
3
SPEAKER_00
It s not like, look at this crazy life, look at all of these things that happened to me, although certainly things happened to you.
3
SPEAKER_00
Instead, it is such a gorgeously written exposition of your relationship to your body and binge eating disorder.
4
SPEAKER_01
Well, for anyone who loves memoir, it s beautiful.
4
SPEAKER_01
And then it s such, I feel like, necessary read.
4
SPEAKER_01
It was so helpful for me to even understand this sort of the compulsive and or addictive part.
4
SPEAKER_01
Eating disorders, it s not really discussed, right?
4
SPEAKER_01
Like, I don t think that people even understand that it is in of itself, it s not bulimia.
4
SPEAKER_01
And it, again, lives on that spectrum of permitting and restricting, the spectrum I think every woman embodies, even if we don t go to the extremes.
4
SPEAKER_01
But can you talk a little bit – I mean, obviously, that must in some way relate to your interest in this story.
4
SPEAKER_01
talk about that a little bit?
4
SPEAKER_00
Yeah, for sure.
4
SPEAKER_00
So so so my memoir, Empty, it tells the story of the eating disorders I kept secret for decades, binge eating disorder and anorexia.
4
SPEAKER_00
And it s primarily focused on my adolescence and college years and very early adulthood.
4
SPEAKER_00
I mean, I do think that I have an abiding interest in in women s bodies, in how our bodies can be, you know,
4
SPEAKER_00
determinative, how they can suggest certain identities, how they can preclude certain identities, how how our bodies can, you know, hold lots of possibilities.
4
SPEAKER_00
Like I notice I just said the sort of negative parts first, I think, because it took me until I was in my mid 40s when I finished this book and and published it.
4
SPEAKER_00
to understand the possibilities of a body, the transformative possibilities of living in and living from a body and taking pleasure in my body in a way that it s not that I had never taken pleasure in it.
4
SPEAKER_00
There were certainly things I did that gave me pleasure, but my body was primarily something, you know, there was a lot of self-loathing directed at my form.
4
SPEAKER_00
So I think that that s
4
SPEAKER_00
Yeah, I m trying to think if there s another way to describe the connection between the book and the podcast beyond just the fact that I do think that we have a lot of stories about living in these bodies as women.
4
SPEAKER_01
There s a certain point when you talk about sort of the literature on, you talk about it as like going up to, I also went to Yale, so I was like Atticus and all of these places I ve spent a lot of time, that Atticus chopped salad with, so random, with canned corn.
4
SPEAKER_00
Oh my God, I can picture that.
4
SPEAKER_00
Now that you said that, I can picture sitting across from somebody at a table.
4
SPEAKER_00
Oh my God.
4
SPEAKER_01
Yes, and I had my own weird eating stuff at Yale only primarily because I was depressed.
4
SPEAKER_01
So I was like, it wasn t it was not what was happening to you.
4
SPEAKER_01
But it was like, I sort of liked that salad at Atticus.
4
SPEAKER_01
And I would go and get Denali moose tracks ice cream at Yorkside pizza.
4
SPEAKER_01
And like, that s kind of what I ate.
4
SPEAKER_01
I mean, it was not good.
4
SPEAKER_01
It was not healthy and candy.
4
SPEAKER_01
I think I was just so low that I was looking for sugar.
4
SPEAKER_01
However, all of that aside, when I read it, it felt to like so you write about sitting in the library across from sort of what what existed, which wasn t a lot memoirs of anorexia and bulimia and like couldn t locate binge eating disorder because you weren t vomiting, you were just binging.
4
SPEAKER_01
And you talked about it as sort of body, the way that it was described as these body image disorders.
4
SPEAKER_01
And obviously there s like a lot of dysmorphia, we re all familiar with that.
4
SPEAKER_01
But to me, it also like so much of the book read about your discomfort in just being in a body, right?
4
SPEAKER_01
And it s that Marion, this woman, Marion Woodman, who was this young analyst who wrote, Addicted to Perfection.
4
SPEAKER_01
And she wrote a lot about anorexia and bulimia as like,
4
SPEAKER_01
Anorexics looking to sort of escape, to like vaporize, become spirit.
4
SPEAKER_01
You talk about that lightness of like trying not to leave treads on the carpet, just sort of your fixation on lightness.
4
SPEAKER_01
So she was like, they just want to disappear and bulimics tend to want to concretize themselves somehow, like make themselves more solid, more real.
4
SPEAKER_01
I don t know if that s resonant, but it felt to me like you were like, no, this isn t actually about image, although clearly it was for you as well.
4
SPEAKER_01
But it felt also about what it is to be in a body, a woman s body.
4
SPEAKER_01
And then with pregnancy too, it s like you re cohabiting.
4
SPEAKER_01
You re hosting.
4
SPEAKER_01
It s such a strange relationship, this being a woman with a womb.
4
SPEAKER_00
You know, yeah, I mean, it s so strange.
4
SPEAKER_00
It is so strange.
4
SPEAKER_00
I mean, I think, you know, the the analyst you just mentioned, I think the thing that that I ve discovered through, you know, the the therapy I ve done over the past several years is that I ve really come to see eating disorders as as disorders of desire in large part.
4
SPEAKER_00
So so in the you know, the two examples you just gave, you know, the anorexic wants to vaporize and the bulimic, it s sort of more more concretized somehow.
4
SPEAKER_00
Both of those are about wanting right.
4
SPEAKER_00
It s about it s about these these wants that that that somehow.
4
SPEAKER_00
that the person, you know, desire is somehow disrupted, right, in the eating disordered patient.
4
SPEAKER_00
And it kind of gets turned back in the body.
4
SPEAKER_00
And when I look back on my history and think of all the, you know, all the wants and desires I wasn t admitting to, right, because of the things that we are conditioned to want or, you know, ways we re conditioned to be, I think some of that was in there for me.
4
SPEAKER_00
But but then as far as body image, I mean, you know, I definitely grew up in a family where there was a lot of emphasis on on appearance and on weight.
4
SPEAKER_00
You know, we always had like the latest scale from the sharper image.
4
SPEAKER_00
But I once I started, once I sort of got into the eating disorders, they sort of take on a life of their own.
4
SPEAKER_00
And when you were talking earlier about kind of the compulsive and addictive piece,
4
SPEAKER_00
That that was something that was really big for me during those those years in college.
4
SPEAKER_00
I write about an empty.
4
SPEAKER_00
This was in the early 90s.
4
SPEAKER_00
And and I felt, you know, I I deep I felt in my bones that that what I had this was akin to an addiction.
4
SPEAKER_00
You know, I would binge.
4
SPEAKER_00
I would resolve not to.
4
SPEAKER_00
And, you know, hours later I would be doing it again and I would go up to the stacks in Sterling Library and I would look for information about what I was experiencing.
4
SPEAKER_00
I would read the few memoirs that was that were available.
4
SPEAKER_00
And there was there was nothing right that that exactly reflected my experience.
4
SPEAKER_00
And I think that, you know, that s an experience I think a lot of people can relate to is having this problem that you know is a real problem, but it s like it s hard to find, it s hard to name.
4
SPEAKER_00
And maybe that s another connection with this material in the retrievals.
4
SPEAKER_00
All of these women having this experience of pain that was so real, but that they couldn t, you know, they couldn t figure out.
4
SPEAKER_00
They didn t have enough information about what was really happening to them.
4
SPEAKER_01
Yeah, and these experiences in our bodies are so ephemeral and fleeting and then you sort of question yourself too as part of it.
4
SPEAKER_01
I mean, that s natural.
4
SPEAKER_01
Was that real?
4
SPEAKER_01
How strong was that compulsion?
4
SPEAKER_01
But was the pain really that bad?
4
SPEAKER_01
And then when you re on the other side of these things, when there s like peace and equanimity, you can sort of devalue everything that came before, which is why I think projects like this are so important because yes, there s, you can say, oh, the outcome, you know, nobody died.
4
SPEAKER_01
There were no adverse effects from the saline.
4
SPEAKER_01
I mean, the whole thing is just nuts.
4
SPEAKER_01
And, and yet,
4
SPEAKER_01
Like, it happened, and theoretically happens, and how do we get better?
4
SPEAKER_01
Or not better, but like, how do we, yeah, acknowledge these experiences and learn?
4
SPEAKER_01
And this is important.
4
SPEAKER_01
I think all of these, the cultural conversations that can invade and puncture the mainstream, particularly around women s health and the concerns of women, it s like that s what makes everyone suddenly say, oh shit.
4
SPEAKER_01
You know, this happened, right?
4
SPEAKER_01
And I m sure Yale was like, OK, well, this is not good.
4
SPEAKER_01
But we re all going to move on.
4
SPEAKER_01
And who knows?
4
SPEAKER_01
It s unclear what changes to procedures that they ve made.
4
SPEAKER_01
But it happens.
4
SPEAKER_01
Because now you made a podcast that everyone is talking about.
4
SPEAKER_01
And every medical institution, I would imagine, is saying,
4
SPEAKER_01
What are our procedures?
4
SPEAKER_01
What are our processes?
4
SPEAKER_01
What happens when a woman in the middle of a procedure says, I m experiencing pain, right?
4
SPEAKER_01
There has to be some sort of cultural reform from this, I would imagine, even if you don t hear about it directly.
5
SPEAKER_01
Yeah, I mean, I hope so.
5
SPEAKER_01
I really hope so.
5
SPEAKER_01
And I mean, I think that, you know, even even in the so the the last episode, you know, came out four or five weeks ago.
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And even in the time since then, you know, I ve already seen, for example, like, you know, fertility clinics doing little videos for their patients or little, you know, info for their patients on their website about like, here s the kind of pain relief.
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Here s what to expect.
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Even that is like, that s great, right?
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To set expectations about pain, to present the management of pain as a conversation that can be had.
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My hope is that I have heard from somebody emailed yesterday, a couple days ago, a professor saying that she intended to teach it as in an ethics class to first year med students, which is really amazing and gratifying.
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You know, I think one of the things that that was so interesting to me in reporting the podcast was so there s this thing that happened at this clinic, right?
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So the nurse was stealing the fentanyl.
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The patients weren t getting fentanyl.
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But part of the reason it took a little while to figure out what was going on.
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I mean, there were there were multiple reasons, but but one of them was was that some amount of pain had been normalized around this procedure.
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There was an expectation that patients would experience a certain amount of pain, partly because
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the drug combination this clinic was using offered a relatively light level of sedation for the procedure.
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And so I think that s another thing that I hope becomes part of the conversation, right?
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We ve all had gynecological procedures.
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where that have been painful.
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And they don t, you know, they don t have to be.
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There are some gynecological procedures that are inherently painful.
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It s a very sensitive area.
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Sometimes there are emergencies, right?
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But there are ways to treat the pain of those procedures.
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And I hope that that s a conversation that patients can have with their doctors and doctors can have with one another.
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Well, thank you for this.
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I know you re probably not going to tell us, but are you working on another book?
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Are you working another podcast?
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What s next?
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Is there anything that you re really interested in?
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I mean, I m still sort of in that phase where I m just decelerating from all of this.
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I don t know exactly what s next.
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I do have a lot of ideas, as you anticipated in your answer.
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I m the kind of person who
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who tends not to say what the thing is until I m pretty sure it s actually a thing.
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But and I think also, I mean, you know, you just finished a book.
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You probably know the feeling of like you put your heart into something for so long and it s sometimes it feels impossible.
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Like, oh, what will I ever be interested in again next?
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I m not exactly in that.
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I do always have like other things I m interested in.
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But you know what I mean?
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When you re sort of like I m in transition.
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No, and what s the biggest conversation that you can have about any of these things and then have it on the most subtle level, which I think you seem to be a master of.
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Oh, thank you.
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There s something just so quiet, ephemeral, and insistent about Susan as a storyteller.
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There s something about her ability to speak into existence what hasn t been said and the way that being a woman and having our own experiences and our own bodies can be so isolating, particularly around questions of what is quote unquote normal or what a good woman looks like, feels like.
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This is from her memoir, Empty.
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A last thing or two about recovery.
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In the beginning, I was acutely aware of what I d lost.
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I lost the secret.
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I lost the quote-unquote security of being the thinnest in a room, on the beach, in line for iced coffee.
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I lost the power to eat nothing, and with that, I lost the source of my strength.
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Gradually, I became more aware of what I was gaining.
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I gained an understanding that the last sentence in that quote-unquote lost sequence is ridiculous and profoundly sad.
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I gained connection with others, which I d craved.
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I gained a voice.
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There s so much in eating disorder literature about the illness emerging at the moment when an adolescent girl self-silences or loses her voice.
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The eating disorder becomes the way you speak, telling the story of what replaced my voice in adolescence was what, in middle age, gave me my voice back or showed me what it could be.
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And in retrievals, she gave voice to so many women in an experience that is both stunning and strange and also all too familiar.
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If you liked today s episode, please rate and review and tell a friend.
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You can find show notes and full transcripts of the episodes at EliseLuhnen.com.
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While there, please sign up for my sub stack.
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I send a short note every Wednesday about topics that are aligned with this show and a deeper dive most Sundays.
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Or follow me on Instagram at EliseLuhnen.
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And finally, if you haven t already, please consider picking up a copy of my New York Times bestselling book, On Our Best Behavior, The Seven Deadly Sins and the Price Women Pay to be Good, available wherever you get your books.
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It s an exploration of how women have been conditioned for goodness, men for power, and all the ways we ve been programmed to police ourselves and each other according to these cultural ideas of what it is to be a good woman.
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I d also like to give a huge thank you to my sponsors who make this show possible.
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Please support them the way they support this podcast.
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This has been a presentation of Cadence 13 Studio.
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If you enjoyed this episode, please listen, rate, review, and follow Pulling the Thread.
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Available now for free on Apple Podcasts, Spotify, Odyssey, or wherever you get your podcasts.
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I want to give a shout out to Phil Svitek, Lauren Legroso, Mary-Kate McDonough, Allie Brockman, and the entire Kedans13 team for producing these episodes, and to Valero Deval for my key art.
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Take care of yourselves.
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I ll see you next time.