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Brigid Bergin: This is All Of It on WNYC. I'm Brigid Bergin in for Alison Stewart. When women arrive at the Yale Fertility Clinic for an egg retrieval, they're already in an incredibly vulnerable position. They've undergone weeks of hormone shots. They might have spent thousands of dollars to get to this point. Now, they have a very small window to retrieve viable eggs before they ovulate.

When many of these women began the egg retrieval procedure and reported feeling excruciating pain despite being told they had been given the maximum dose of fentanyl, they endured it because they didn't feel like they could stop. Some women went through this incredibly painful procedure five, six, seven times possibly without any medication at all. That's because it was later discovered that a nurse at the Yale Fertility Clinic was stealing fentanyl from the clinic and replacing it with saline solution.

When this woman was caught, it only brought up more questions for the patients. Why had it taken so long to find out what had been going on? How should this nurse be punished? Maybe most importantly, why had no one taken them seriously when they told them about their pain? These questions are all explored in-depth in the new podcast from The New York Times and Serial Productions. It's titled The Retrievals. New episodes drop on Thursday. Host and producer Susan Burton joins me now. Susan, welcome to All Of It.

Susan Burton: Hi, thank you so much for having me.

Brigid Bergin: Susan, before we dive into the story itself, when did you first become aware of this story?

Susan Burton: One night in November 2021, I was at home and I was sitting on my couch. I opened my phone. You know how if you have Chrome on your phone. Chrome will suggest stories for you. I was just scrolling through my suggested stories. I saw a link to an article in the local Connecticut media that said that seven patients had just filed a lawsuit against Yale. The story gives some details about what had happened.

There was this nurse who was stealing fentanyl and there were these patients who were bringing this lawsuit. I was just instantly drawn to a bunch of different layers here even though it was a short piece. There was infertility. There was addiction. I don't actually remember how much the article said about the women being ignored or not being believed. Instantly, I just wanted to get inside this experience and find out what happened and how it felt for all involved.

Brigid Bergin: Can you walk us through a bit about what the women who even get to the point of egg retrieval, what they have to go through to get to that?

Susan Burton: Sure. To get to the point of an egg retrieval, which is what it sounds like, the eggs are removed from the body and then frozen or fertilized, depending on what you're doing with them. Before that, there are weeks of giving yourself hormone shots of going to the clinic, getting your blood drawn, getting scans all the time, measuring if you have the appropriate-- The hormone levels are optimal, and then measuring how many follicles you're growing, what size the follicles are. Then once everything is in place, you give yourself this special shot called the trigger shot, and then your retrieval happens three, four, and a half hours after that.

Brigid Bergin: Let's listen to a bit of a clip of the podcast. Here, you are speaking with a woman who describes the pain she experienced during the procedure.

Susan Burton: This is hard to do, but could you describe the pain that you felt?

Podcast Guest: Oh, gosh. It felt like someone was ripping something from the inside of your body.

Susan Burton: Which is--

Podcast Guest: What they were doing. [laughs] That's what it felt like.

Susan Burton: I'm sorry.

Brigid Bergin: Susan, is it possible that an egg retrieval, even with the proper pain relief being administered, could still be really painful for some people?

Susan Burton: An egg retrieval is like any procedure, any gynecological procedure. There are a range of ways to treat the pain and a range of responses to it, depending on one's own physical and emotional and individual history. I would say, in general, this is not understood to be an especially painful procedure. There are a number of different right protocols to treat the pain of a retrieval.

The protocol that this clinic, the Yale Fertility Clinic, used for years offered a relatively lighter level of sedation and pain control for this procedure. I think that one of the interesting layers to the story here is that not offering appropriate pain control or offering inadequate pain control is a way of dismissing pain in the same way that a patient is saying, complaining of pain, and a doctor dismissing that patient is that's a way of dismissing pain, so is offering inadequate pain control in the first place.

Brigid Bergin: Some of the women actually reported pain not just during the procedure but days afterwards. I want to play another clip of you speaking with one patient, Julia, describing her experience.

Julia: I fell asleep for a little while and then I woke up. I was nervous. We had a babysitter here watching my daughter. You wake up. You're like, "Oh, my God, who's with my kid? I need to--" I walked a few steps to try and go down the stairs. I realized I really had gone too far from the bed. By this point, the pain was excruciating, I would say. I turned to go back to lay down in my bed again. I don't remember this, but I blacked out or passed out. I woke up on the floor. I busted my lip open.

Brigid Bergin: Susan, it is one of the many heartbreaking stories that you capture in this podcast. What could account for that pain hours or even days later?

Susan Burton: Well, it was interesting when I talked to a whole bunch of fertility doctors and other healthcare providers to get context for what happened at Yale. A bunch of them would bring up something to me. They say something like, "There's something that I don't understand in this story. There's something that doesn't make sense." Fentanyl is a short-acting drug. In this story, these patients were supposed to be administered during their egg retrieval procedures.

Many of them did not get fentanyl because their nurse was stealing the fentanyl. These healthcare providers, the question they were bringing up was like, "Okay, so if they'd have full-throttle fentanyl, maybe that would last for 30 minutes after the procedure," but they would say to me, "I don't know how to explain the pain a patient felt after that." They would offer some theories.

In general, I don't think that these experts I was talking to, I don't think they were doubting the patient's pain. It was just hard to explain, right? It's not like a study that people do. You don't tell somebody, "Let's do a study. Let's tell patients that we're going to give them anesthesia during the procedure and then not give it to them and see what they feel afterwards," right?

Some of the possible theories that people came up with were, for example, if a patient is writhing around on the table, could the needle have hit something, punctured something inside? In the clip we just heard, that is likely not what happened to that patient because that patient did go to the emergency room. She did have scans done. I am no expert. I am not a medical expert.

One doctor said to me, "I wonder if the initial insult, I wonder if it takes long to recover because of the initial insult." That to me, again, as not a medical expert, seemed to me like the explanation. Why do we treat pain in the first place to prevent it from firing up and becoming out of control? That's something that really without having access to the patient's medical records, I don't know that there's a way to completely answer the question of the pain days later.

Brigid Bergin: Well, we have another clip from Julia again describing the kind of response that she got from her doctor after she had gone to the ER.

Susan Burton: Back home over the weekend, Julia calls the on-call doctor at the clinic multiple times.

Julia: By Sunday, I got the sense. I was annoying him.

Susan Burton: Julia keeps waiting for a call from her official doctor. By Tuesday, she still hasn't heard from him.

Julia: It was impossible for me to understand how he hadn't called me by this point, but I called his office on Tuesday basically saying, "I need to talk to you." I wrote down what he said and I've kept this note since that time. He said he was not alarmed but perplexed and surprised at my experience. Those words, I guess, ring pretty hollow now, knowing that there was a pattern of many women who had extreme, inexplicable pain after the egg retrieval.

Brigid Bergin: Susan, I'm wondering, and this is a big part of this podcast, but what you think Julia's story and some of these other stories that you reported reveal about how women's pain is thought about and treated in these settings?

Susan Burton: In that interaction we just heard, so what happens afterwards is she starts questioning her sanity, not in a fundamental way, but her ability to evaluate her own experience, what's happening to her. I think some of these women felt pain and then didn't trust themselves because they're saying they're in pain. It seemed to them that nobody around them was affirming that, was validating that. I think that there's a balance that you have to strike as a woman patient.

You have to complain just enough to be taken seriously, but not so much that you seem shrill. In this setting, fertility treatment, these women are there. They're putting themselves through this really arduous process. There's something they very badly want. It's almost like there's a heightened burden really to listen to complaints of pain when patients want something so much that it makes you even more vulnerable to speak up and say something that might be wrong because you just want to get through it and have a baby.

Brigid Bergin: When we're talking about women's health, and especially when it comes to pregnancy and childbirth, we know that women of color often have far worse outcomes. Rates of maternal mortality are much higher among Black women. How did race factor into the story?

Susan Burton: Of the 12 patients I talked to, 9 of them were white. The one Black patient described herself as often the only Black patient in the waiting room. That's a little wider than the demographics of fertility treatment as a whole, but fertility treatment, the demographics do skew mostly white. In this story where race really comes up is in the sentencing of the nurse who stole the fentanyl. The nurse received a very, very light sentence. Many of the patients brought up to me their own questions about, "Would she have received the sentence had she not been white?"

Brigid Bergin: Well, we're going to talk a lot more about the nurse, Donna, and more about the podcast, The Retrievals. Our guest is Susan Burton, host and producer. The Retrievals is from The New York Times and Serial Productions. New episodes are out on Thursdays. We're going to talk about more of it on All Of It here on WNYC just after the short break. Stick around.

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Brigid Bergin: This is All Of It on WNYC. I'm Brigid Bergin filling in for Alison Stewart. My guest is Susan Burton, host and producer of The Retrievals from The New York Times and Serial Productions. We've been talking about the podcast. New episodes are out on Thursdays. Susan, before the break, we started to talk about Donna. Donna is the nurse who was caught stealing fentanyl. One of the women who went through the egg retrieval process suspected right away that it was a nurse who was stealing the fentanyl. How did that patient come to that conclusion? Did she ever report her suspicions to anyone?

Susan Burton: The patient who had a suspicion, she had this suspicion immediately while she was still on the table having her retrieval. The way she describes it is like a fantasy or a daydream. This patient is an addiction researcher at Yale. She's a neuroscientist. When she was in so much pain, she thought to herself, "The nurse must be stealing the fentanyl." Fentanyl is the most diverted drug in medical settings. It made sense to her that that was happening.

Even after her retrieval, she said to some of her colleagues in addiction research at Yale, "I think this was what's happening. The nurse is stealing the fentanyl." It seemed in a way so absurd. Nobody around her was affirming the experience of excruciating pain she had. She started to tell herself really another story of like, "Oh, well, maybe it's just the way my body responds. People are more or less sensitive to certain opioids and maybe I just don't respond to fentanyl."

As far as I know, she didn't report that directly to a doctor at the clinic. She did say, she is a patient who put in writing, that she felt her anesthesia did not work and was there an option at a subsequent retrieval to try a different kind of anesthesia. Then, of course, once everything came out, she felt very, very vindicated. It was a reminder to her to trust her own instincts, her own body, her own experience.

Brigid Bergin: Susan, what do we know about what might have led Donna to the point of stealing the fentanyl from her workplace?

Susan Burton: Donna did not respond to my request to speak for the story. What I know about her comes through mainly court documents, some conversations with people who worked with her, but what I know about her reasons for doing this are through the story that she told to the judge, to the court, to her friends, and family. What Donna says is that she was going through a really rough situation with her ex-husband, that things came to a head during COVID, and she started stealing fentanyl from work.

There are a bunch of details and specifics that involve custody and visitation. Essentially, it's these years of stress from a really contentious relationship with her ex-husband, and then she cracks. She notes that she had been prescribed a narcotic for pain in her feet several years earlier and that she had recognized that she was using more of it than prescribed to cope. Again, I don't know any more specifics about her addiction history than what she herself laid out in court documents.

Brigid Bergin: The other thing that is so striking is that she was able to remove so much of this drug without anyone in the clinic noticing for so long. How is that possible?

Susan Burton: I think that is a big, enormous question in the story, and maybe one that there are these plaintiffs, these patients suing Yale. Maybe we will learn more about that once that all comes to fruition. One of the questions that anesthesiologists and people who work with fentanyl vials on a daily basis raised with me was the caps on these vials are really pretty tightly sealed on. Typically, there are different kinds of fentanyl vials but a common kind. The caps just pop off. You would know if it's unsealed. Most people, that was a big question they have.

How did nobody notice the loose caps? How did nobody notice the loose caps? Ultimately, an anesthesiologist did notice a loose cap. I think that there were a bunch of things happening in this clinic that all combined, which is usually the case in instances of drug diversion, which is what stealing drugs from medical setting is called, drug diversion. It's not always just one thing at this clinic. This was happening during summer 2020, the pandemic. There weren't as many staffers at the clinic. A lot was happening on telemedicine. It's multiple reasons and I think we'll learn more as this lawsuit continues.

Brigid Bergin: Another thing that this podcast really digs into is the question of justice and what justice should look like in the situation. You talked to many of the women about this. What did they tell you about what justice for Donna would mean to them?

Susan Burton: I think many of the women I talked to had conflicting feelings about what should happen to Donna. For example, the addiction researcher we were talking about earlier, her name is Katie. She'd been through this experience that was really painful. Based on her research, she doesn't believe in incarceration for nonviolent drug crimes. She believes in substance use treatment.

She wrote a letter to the judge saying, "I had this terrible thing happen to me, but based on my research and my expertise, I'm advocating for leniency." Then there were other patients who had various sympathies, I think, to the addiction piece of it. There's a patient who features prominently in the episode about Donna's sentencing hearing, Episode 3. This patient is named Alicia. Alicia came into the sentencing hearing pretty sympathetic to Donna, again, partly because of Alicia's own work.

She works in a setting with many patients with addiction histories. One of the things patients learned during the sentencing hearing was that Donna herself had been an IVF patient. That really switched something for Alicia, knowing how intimately Donna would have known the experience of these patients and the many levels of pain they were feeling. That shifted the outcome that Alicia wanted for Donna.

Brigid Bergin: One of the things that we hear in the episode during the sentencing hearing is you describe how the judge grappled with what a sentence would mean for Donna's kids, who might be exposed to their father and his troubled history. In essence, this woman's motherhood is a huge factor in the sentence that she receives for potentially depriving or injuring these women of the ability to be mothers. Did this consideration seem unusual to you and how did the patients feel about it?

Susan Burton: Well, this right is one of the really painful ironies of this for the patients. They show up at this hearing in person or on Zoom. They start hearing the story that Donna's public defender is telling. It's a sentencing hearing. Donna has already entered a guilty plea. Just the thing being decided is her sentence. A lot of the focus is on what are called Donna's extraordinary family circumstances. The judge is obligated to consider Donna's family circumstances.

The thing that the judge says she is balancing as she goes through the hearing and is thinking this all through is that if she incarcerates Donna, there's harm to her kids, but Donna did harm to these patients. There just comes a point in the hearing where, as one of the patients puts it, a patient named Leah, "Why does she get to be a mom? Why does she get to be a mother when she decided that this was something that she could withhold from other patients who want to be mothers?"

As far as, does it seem unusual to me? Right, there are many people who go before the court who have children, right? We all know this. Again, as this patient Leah I just mentioned, she mentions when she's reflecting on the sentencing after the fact, "How many Black women have had their children taken away or never allowed to have relationships with their children again for crimes that are less than the one in question here?"

Brigid Bergin: What ultimately did happen to Donna? What was her sentence? I think you might have mentioned that it was lenient. Specifically, what was she sentenced to? Do we know where she is now?

Susan Burton: Donna was sentenced to four weekends in prison. The weekends were timed. They were alternating weekends timed to her custody arrangement. There were other conditions of her sentence, including a period of house arrest and substance use testing, substance use treatment. As far as where she is now, I know a little about that. I probably won't say too much because Episode 5 is released tomorrow and we'll get into some of that then.

Brigid Bergin: Sure. Part of the story, of course, involves the role of the Yale Fertility Clinic and the Yale brand, so to speak. How much of a response have they given and what accountability have they accepted for what Donna did?

Susan Burton: As far as legal accountability in the wake of the loose cap being discovered, the DEA came and did an audit of the clinic. Yale agreed to pay a fine of over $300,000 for violations of the Controlled Substances Act. Those violations included-- in addition to the fentanyl that was tampered with, there were a lot of discrepancies in the logs that the clinic kept. There were a lot of drugs missing from the clinic. There was fentanyl missing, ketamine missing, midazolam missing. Midazolam is a sedative, drugs that just couldn't be accounted for. Now, there's the civil lawsuit being brought by almost 70 patients. That will attempt to hold Yale accountable in that system.

Brigid Bergin: We're going to have to leave it there for now. It is a chilling but really important story. Susan Burton is host and producer of The Retrievals from The New York Times and Serial Productions. A new episode drops tomorrow. Susan, thank you so much for joining me on All Of It.

Susan Burton: Oh, thank you very much for having me.

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