Just a warning that this episode describes a traumatic birth experience and uses medical language to describe anatomy.
Billboard:
Ariel Lavery: Women’s bodies are of particular interest to a lot of people these days, including myself. And, as we all know, the focus of that interest can easily become political. But understanding what it’s like to live in a female body requires understanding of the nuances. In fact, the female body is really new frontier in the realm of medical research. Some of us rely heavily on the recommendations of the medical community while others lean more on our beliefs. In rural areas of the country our beliefs may be influenced more by our communities than we realize. Is there a common healthcare experience among us women who make our lives in the rural crannies of America? And how has that experience shaped us, made decisions for us, without our even knowing?
(Ambient sound of the street fades in)
Ariel Lavey: Do those dogs know you?
(sound of dogs barking)
Samantha Stanley Evans: Yes. So I took the postal exam when I was 19.
Ariel Lavery: You did?!
Samantha Stanley Evans: I did.
Ariel Lavery: This is Sam.
Samantha Stanley Evans: I'm a definite…hmmm… women's advocate, I'd like to think. Pro women.
Ariel Lavery: I’ve known Sam for several years now, almost since she began as my mail carrier in 2020. She’s the only mail carrier I’ve ever gotten close with, a testament, in part to the capacity for connection in our small community, but mostly to Sam’s unflinching ability to befriend anyone. This year, Sam started giving me more than my mail. She started giving me her story. We got to talking in front of my mailbox one day, about everything she’d been through in her reproductive life and I was surprised by the diversity of experiences she’s had. Sam is like most of us, having developed a foundation of beliefs at a young age that gets shaken and altered as we get older.
Samantha Stanley Evans: I still think we're very behind on that.
Ariel Lavery: …with women's ability to live…?
Samantha Stanley Evans: …make their own decisions. When you're done-I think every woman knows. When they’re done having kids they’re done!
(Ambient sound of street fades out)
Ariel Lavery: People and experiences come in and out of our lives. Spouses, faith, local culture and even the healthcare system itself can help shape our beliefs about our bodies. Like most women, Sam has had to make a lot of choices about her own reproductive health. And she’s had to overcome resistance from providers on those choices.
Samantha Stanley Evans: Your biggest red sign is, like, we're bleeding, like, severely anemic infusion level bleeding.
Ariel Lavery: Some of the extreme events Sam has lived through have vexed her husband, Brian. And these moments have helped to shape his politics, in some surprising ways.
Brian Evans: I'm a very conservative Republican.
Ariel Lavery: While he shares many of the same memories with Sam, his description of those memories doesn’t often align with hers, especially as it pertains to the history of the family’s healthcare bills.
Samantha Stanly Evans: I mean, I remember being up there and crying because I didn’t know if I was going to be able to buy my kids diapers.
Brian Evans: I did not want children.
Ariel Lavery: But before you jump to any conclusions, based on what you’ve heard, you’ve gotta listen to their whole story. There’s a lot to untangle about how they describe a lacking US healthcare system that has them tied up in endless bills.
(theme music starts)
Samantha Stanley Evans: I mean, as a mom, you’re not gonna steal my joy.
(theme music swells)
Ariel Lavery: We’re hearing from women near and far this season about how living in rural America affects their health. In this first episode we’re going to hear from a person who represents the healthcare challenges every rural woman could face, even though her journey has been unusual. Today, Delivering Our Story: Surrogacy, Health Insurance, and Our Personal Politics, on Middle of Everywhere, telling Big stories from the small places we call home.
(theme music ends)
Scene 1: Opposites Attract
Samantha Stanley Evans: So I'm Samantha Evans and I am a mail carrier for USPS. I was born in Freeport, Illinois.
Ariel Lavery: Freeport is a town in Northern Illinois about 2 hours, driving distance from Chicago, but culturally a world away.
Samantha Stanley Evans: Went to college at Eureka College, home of Ronald Reagan! Decided to go to cosmetology school.
Brian Evans: So I moved to Northern Illinois, and met Sam.
Samantha Stanley Evans: He actually was in farm chemicals. So he was making, making a pretty good living.
Brian Evans: My name is Brian Evans. I’m 46 years old. I was born and raised in Calloway County, which is where we’re at now. I don’t like being labeled as a Christian conservative. It just really bothers me that just because I’m very conservative I must be a Christian conservative. No, I’m just conservative. I want what’s best for myself, my family, and the country. I moved when I was 22. I had been here my whole life and I needed to go away. I was very inebriated that night. And she gave me her phone number. And she said if you remember, if you remember who I am, call me.
Samantha Stanley Evans: He called me the next day. I had said, I’ll go on a date with you, but you have to shave your beard off. (laughing) so he shows up like the next day or something like that…and he had shaved his beard off. And I was like, do not ever shave your beard off again. (laughing) ‘Cause he looked like Uncle Fester. (laughing)
Brian Evans: All my friends were married or getting married. I was in no hurry to get married. Some of my friends thought I never would get married.
Samantha Stanley Evans: We were engaged two weeks later.
Brian Evans: And we’ve been together ever since.
(Upbeat guitar music begins)
Brian Evans: She wanted a houseful. And because she's from a large family. This is gonna sound bad. I did not want children.
Samantha Stanley Evans: I'm the youngest of four. So I was like, Let's have 12 kids!
Ariel Lavery: Two years later they bought their first house in Rochelle, IL.
Samantha Stanley Evans: And I got pregnant the night we moved into our house.
Ariel Lavery: Their daughter Sloan was born in April of 2007, and just seven months later, Sam became pregnant with their son, Berrett.
Samantha Stanley Evans: Barrett was born with, I prefer to call them abilities because I'm just a super optimistic person and I think everything is how you take it.
Brian Evans: We've gone back and looked at the ultrasound pictures. And you can see this in the ultrasounds but nobody told us.
Samantha Stanley Evans: it's not like he was missing his heart. I'm picking to be optimistic. But Brian, lost his mind.
(slow, conscientious music fades in)
Brian Evans: I was excited. That was my namesake. You know, he’s gonna carry my name. I had a daughter. Now I’ll have a son. I’m sitting there drinking a six pack of beer. Life’s good.
Brian Evans: Watching the Cubs play baseball. Cubs won that day, so I’s like it’s gonna be a good day. She had Berrett. And when you're so excited, and you're up on a mountain and the mountain gets knocked out from underneath you by one word that the doctor says. That'll screw with you.
Ariel Lavery: As Berrett saw the light of the world for the first time, the doctor saw something too.
Brian Evans: He's got a cleft lip, but it's not that bad.
Samantha Stanley Evans: Okay, like, Joaquin Phoenix, you're gonna be a handsome dude. Like, all right, and I was fine. Like I was over it. Good doctors, everybody. I had a great pediatrician in my pocket. Not even a problem. However, Brian, on the other hand…
Brian Evans: He looked like an octopus. I mean, you know, poor kid. I mean, he didn't ask for it.
Samantha Stanley Evans: Brian first got upset with the OB.
Brian Evans: I was just very distraught and irate with her doctor. You know, I worked with chemicals, and I'm like, did I do this? I mean, is this, is this my fault because of handling all these chemicals, even though I'm wearing PPE?
Samantha Stanley Evans: So I picked up my phone. I'm like, I love you. You're not going to ruin this for me, like. So I called his best friend. And I was like, Hey, come pick up Brian.
Brian Evans: So I left. we went and drank. And we got the kid's name tattooed on my arms. And I didn't go back that night.
Samantha Stanley Evans: I mean, as a mom, you're not gonna steal my joy.
Brian Evans: Was that fair to him as a child, a small baby? No, not at all. I don't know if I was embarrassed. Or just… I guess I was in shock. I would look at him. I waddn't mean to him or anything. But you know, I'd look at him and go, and I'm paying for something you know, I did here. But I don't know what.
Samantha Stanley Evans: You know, he grew up in a Bible Belt. Like he grew up down here. So he was like, God hates me. We’re very different. Like we're very, I don't want to, I don't want to bash him cuz he's come a long way.
Ariel Lavery: Well I mean you could almost say like, you’re Illinois and he’s Kentucky?
Samantha Stanley Evans: Yeah! Battle of the north and the south! No, I’m just joking… (laughing)
(Intense guitar strumming)
Scene 2 : Making it in IL
Ariel Lavery: How does a Blue-stater marrying a Red-stater with very strong feelings and reactions make it work? Sam possesses the rare ability to belong wherever she’s at, whoever she’s with.
Samantha Stanley Evans: I claim to be Switzerland.
Ariel Lavery: Meaning she sees herself as neutral. She made a point to tell me that, in their family, don’t discuss politics in the house, around the family table. And I haven’t heard her refute Brian’s disdain for where she’s from either.
Brian Evans: Northern Illinois, is a horrible place to live.
Ariel Lavery: Brian felt that taxes and the cost of living in Northern Illinois was beyond what the family could manage. I got a sense that he attributed the expense of living there to their proximity to liberal leaning Chicago.
Brian Evans: It really made me nervous to bring a child into the world when we did. I don’t want to see my kids live in a socialist country.
Ariel Lavery: Sloan was born in 2007, the end of the Bush presidency, and Berrett was born in 2008, in the first year of Obama’s term. I got the feeling that the changing political climate, plus the tax policy of the state they were living in filled Brian with resentment. He describes himself as someone willing to generate his own wealth, not wanting to rely on government handouts. And though she’s never said as much, I think Sam sees herself the same way. Yet Sam and Brian started seeing their funds stretch beyond their limits. Baby Berrett had myriad medical issues that popped up in his first year. And at just four months old he went in for his first lip surgery.
Samantha Stanley Evans: I remember getting the first bill from Berrett’s surgery, and it was $750,000 before insurance! So then after insurance, it was like $23,000. We don't make $22,000 worth of money to offset this. And then of course they do the let's make payment we can't make like, that's still $150 a month that we don't have, like, that's food out of a middle class family’s mouth.
Ariel Lavery: Did you start thinking about the cost associated with these things… because you guys were already struggling financially.
Brian Evans: Heck yeah. Heck yeah.
Samantha Stanley Evans: I can remember going to Walmart with quarters, because I had to pull everything I had to pay for his medication. I remember being up there and crying because I didn’t know if I was going to be able to buy my kids diapers.
(pause)
Samantha Stanley Evans: So luckily, my mom is like a magician of letters.
Ariel Lavery: Sam described her mother as a master linguist, having worked at Edward Jones and Raymand James, dealing with contracts and financial language all day.
Samantha Stanley Evans: So we applied for financial assistance. And luckily that first surgery was completely wiped out.
Ariel Lavery: Her mother’s explanation for how she went about doing this was surprisingly simple.
Georgia Stanley: I think I played on sympathy, sympathy and truth.There is a word for the department that every hospital has where you can write for forgiveness or for latitude on your bill. Every hospital has that.
Ariel Lavery: I believe what Sam’s mother was talking about here was Charity Care. Which, since the Affordable Care Act was enacted, every non-profit hospital is required to offer to patients who cannot afford to pay. I did a quick search of our local non-profit hospital’s webpage to see if I could find a link to information on this or an application packet somewhere and was totally stumped. Maybe my webpage navigation skills are not quite up to snuff, but I couldn't find a link anywhere. It wasn’t until I typed a few of the title words like “financial assistance” and the name of our hospital that google linked me directly to a pdf of the financial assistance packet. To complete the packet for submission you need to include documentation like W2’s, pay stubs, and zero income statements for every working age person in the home, plus a screening for Medicaid.
(somber guitar music begins)
Georgia Stanley: It sounds like a lot of work, and it is, especially today when everything is digitalized. To just tell somebody you can’t afford it does not cut it anymore. Somebody’s gotta pay for the ones that don’t pay. And it seems like the ones who can’t afford it get charged the most.
Ariel Lavery: When we come back we’ll hear how Sam used her own body to help pay for the family’s increasing healthcare costs, and what kind of hoops she had to jump through to do it.
Scene 3: Becoming a Surrogate
Ariel Lavery: Welcome back. When we left, the remaining bill from Berrett’s corrective surgery was forgiven after Sam’s mother wrote a letter to the hospital. Do you remember her comment saying those who can least afford it pay the most? Totally true! My local hospital offers expectant mothers who can pay upfront and ahead of time a 25% discount on their birth. Do that math… For Sam, now, with two young children requiring a lot of time, attention, and money, her dream of having a houseful of kids was beginning to wane.
Samantha Stanley Evans: I was still wanting to be pregnant, but not with my own children.
Ariel Lavery: A couple of years after Berrett’s birth and, with lots more experience finding and paying for his healthcare needs, Sam learned about a new opportunity while she was working in the salon.
Samantha Stanley Evans: She had come into the salon. And I think it was highlighting her hair at the time. And she was in the middle of doing egg donation. So when she told me about it, I was like, that's super awesome, but no one wants my eggs like I'm six, two and 240 pounds. No one wants my eggs! But that turned into, oh, you’d be interested in carrying a baby? And I was like, sure. And she's like, well call this lady and she gave me a phone number and I was like, Oh, I gotta talk to the Brian. So I went home that night. What do you think about surrogacy like it would help with medical bills? I want to go back to school to become a teacher of cosmetology. It would help us finish our house. Potentially the income at the time is amazing! And ironically in the state of Illinois surrogacy at the time was not a taxable service.
Brian Evans: I was fine with it. She explained everything to me. She wanted to help somebody that couldn't have kids give back.
Samantha Stanley Evans: We had an unofficial interview, meet up with the lady from this agency, and she's like, well, let me see your insurance booklet, and in the back of the insurance booklet, there's a laundry list of exclusions. If it's on your exclusion list, you're automatically knocked out. Well, luckily, even though our deductible was absolutely insane, surrogacy was not excluded. So I am now moved from maybe she might be able to be a surrogate to Holy cow, let's get her pregnant!
(upbeat trumpet and guitar music)
Ariel Lavery: So Sam was moved up to the next round.
Samantha Stanley Evans: Let's play the dating game!
Ariel Lavery: There was quite an intense vetting process Sam and Brian had to go through.
Samantha Stanley Evans: Do you believe in extraterrestrials? Do you believe in voodoo? Someone told us that they denied a lady because she believes in reincarnation. We had to answer, and I'm not joking you, like 1000 question paragraph.
Brian Evans: And she starts asking me these questions. Do you have any trouble with another man looking at your wife's vagina while she's giving birth? And the first thing I can think of is, what?
Ariel Lavery: But many of the questions were obviously meant to protect both parties in the event of something going wrong.
Samantha Stanley Evans: Do you have a religious preference? How do you feel about abortion? What if this child has Down syndrome or CP that they find out in your ultrasounds or, you know a whole bunch of things like, I have to tell them? No, I don't feel comfortable having an abortion if your child has Down Syndrome.
Ariel Lavery: Sam was forced to come to terms with her views on some very tricky beliefs,
like the fact that she never wanted to have an abortion, even in the face of a couple spending close to a hundred thousand dollars to make this baby.
Samantha Stanley Evans: I have strong views on women using it as birth control, especially being a surrogate to use my body to help couples have their children.
Ariel Lavery: And this is a position that Brian and Sam stand together on, using almost the exact same language.
Brian Evans: I don't agree with abortion in one case: birth control. That is where I will step over here and I will get on the conservative Christian side of the fence.
Ariel Lavery: However…
Brian Evans: I think a woman has a right to have an abortion. If certain people hear this I know I will probably get read of the riot act over this but I don't care. I've been wanting to say this for a long time. You don't know where she's at financially, mentally, spiritually, and physically. That needs to be her decision, her decision alone.
Ariel Lavery: With Sam’s beliefs now permanently imprinted on paper, she was matched with a couple.
(upbeat trumpet and guitar music)
Ariel Lavery: It took three tries for Sam to get pregnant with their baby, but in their third and final attempt…
Samantha Stanley Evans: E Stuck!
Ariel Lavery: We’re calling the baby E to protect their identity.
Samantha Stanley Evans: It was the most rewarding thing I could have done as a human. I think my mom became an addict because she was like, this is so much fun!
Georgia Stanley: It was just a beautiful thing.
Samantha Stanley Evans: After that, I was definitely on a high. I was definitely like, the coolest ever. Yeah. Where's your baby at? Well, I don't have it. But you definitely just had a baby. You're right! It's not mine!
Ariel Lavery: While Sam was feeling awesome about her ability to follow through with surrogacy, Berrett, at age three, was in need of another surgery to fix the scar tissue built up in his cleft lip. It was a simple procedure that, afterward, revealed another hard truth about Berrett's condition.
Samantha Stanley Evans: He had pulled out each individual stitch and the lip was starting to rot. But that led us to realize that he has a little bit of a sensory disorder.
Ariel Lavery: In the years since this incident Berrett has been diagnosed with ADHD, broad spectrum autism, and epilepsy. So the family's medical bills have been increasing. But the opportunity for surrogacy was still there.
Samantha Stanley Evans: Just because it was super awesome the first time why not…?
Ariel Lavery: She played the dating game again.
Samantha Stanley Evans: I ended up picking J and B.
Ariel Lavery: Another couple whose names we’re omitting,
Samantha Stanley Evans: Pregnant first shot.. Unfortunately, the delivery this time had a horrible turn of events. I had something called a retained placenta. I found out at that time, you know, if you do not discharge your placenta in a timely manner, you ultimately have to have a hysterectomy or a DNC.
Ariel Lavery: … or a dilation and curettage.
Samantha Stanley Evans: I unfortunately did not have my doctor deliver me. I had a gentleman doctor deliver me very old school, very seasoned. He actually manually after I had down dilated, went in with his hand.
Ariel Lavery: Sam’s mother was in the delivery room with her and witnessed what Sam could not.
Georgia Stanley: They had to go in and physically remove the afterbirth. She was not aware of the doctor, like putting his entire hand up her vagina to get this afterbirth out. It seemed like days but I'm sure it was only like 20 minutes to an hour. It was it was very traumatic for me because I sat there, held her hand, and watched, which I wish I hadn’t.
Samantha Stanley Evans: I lost a severe amount of blood, I probably should have had an emergency hysterectomy. Luckily, I have not been assaulted, sexually or anything like that. But that might be the only way I can explain that trauma. Three days later. I mean, I would just cry.. And I don't want to say it was PTSD, but it was bad.
Scene 4: After Effects
Ariel Lavery: For three weeks, following the birth, Sam was in the lowest point of her reproductive journey. She was diagnosed with postpartum depression, despite her and her mother arguing that this had everything to do with the horrific placental extraction she went through. And then, just as she was beginning to feel better, her body started rebelling against her.
Samantha Stanley Evans: I just remember it being horrible all the time.
(intense guitar strumming)
Ariel Lavery: About a year after her last surrogacy, Sam started having regular cramping, heavy periods, and mood swings. She started talking to friends and doing a bit of research about her symptoms and determined that she wanted to pursue a hysterectomy, the one she didn’t get for her retained placenta.
Samantha Stanley Evans: If I would have had to have a hysterectomy? You know, I think it was like $5,000 bonus, because you're, you're losing your productive organs. Well, the first physician that I went to was locally and he was just like, oh, there's gotta be something wrong. Let's run all these tests. It’s the only way I'm gonna get insurance to approve a hysterectomy. And I didn't know any better. So I was like, Okay. And then when the whole dollar amount thing came up, I was like, nope!
Ariel Lavery: Sam was extremely agitated that the doctor wanted to try other treatment options before surgery.
Samantha Stanley Evans: Well, let's put you on birth control. And I am not, I'm definitely... Yes, my son is on lots of medication. But I am not a pharmaceutical person at all. And it pisses me off that the first thing you want to do with a pain is prescribe a pharmaceutical. Your biggest red sign is I've had my cycle for a full year. Not like little cycle. Like, we're bleeding like, severely anemic infusion level bleeding.
Brian Evans: I didn't know someone could bleed for a year and not die. But I it was, it was bad, They wouldn't approve it. Because like, they told her she wasn't old enough. She wasn’t having enough problems. I mean, basically any way you could think to say no, that's what she heard.
Ariel Lavery: In 2021, after eight years of trying to get the surgery, going from one provider to the next, Sam finally got her hysterectomy. In order to get this done Sam left behind the model of care suggested by doctors in her local rural area. She sought out a female OB at a larger, hospital an hour away who ultimately diagnosed a hysterectomy as necessary.
Samantha stanley Evans: Please. Thank you. You’re the best. Saving my life.
Scene 5: Beliefs?
Ariel Lavery: At this point it’s obvious that Sam’s reproductive journey is incredibly unique. There are so many avenues of investigation we could have gone down when hearing about each step of her experience and a myriad of ways that living in remote and rural areas complicated the pathway. For example, did you know that Michigan completely bans commercial surrogacy and even imposes prison time and a $50,000 fine for engaging in any way! Think about how just over the lake, in the state of Illinois, Sam’s family didn’t even have to pay taxes on the money she earned from her surrogacies. So she was able to use her body to help bring in the cash! Pay for the family’s accruing medical bills. Yes, I know how that sounds. But this type of allowance in her insurance plan could have offset the higher premiums she was paying simply because she is a woman. And, having waded through so much of the American healthcare system, finding some loopholes, but continuing to confront the changing needs of her family, Sam obviously has some feelings:
Samantha Stanley Evans: Hmm. All of it is… Like, I don't get political, but it is all so corrupt! The whole medical field from insurance to the base level all the way to the doctors. It is all about the mighty dollar.
Brian Evans: Insurance, you have to have it. But I don't like it. It's, to me it's a scam. Remember HMOs $20? $20 co pays?
Ariel Lavery: Yeah.
Brian Evans: Yeah, yeah! HMOs were great. Then we went to Obamacare or the, the him coming into office and with the promise Obamacare. He scared the insurance companies. HMO went away. The company I work for was a small Mom Mom and Pop organization. They couldn't afford to keep our HMO.
Emily Gee: So there’s nothing in the ACA that was specific to HMOs.
Ariel Lavery: I spoke with Emily Gee, Vice President of the Center for American Progress, about health insurance.
Emily Gee: That said we do see a decrease in the HMO takeup among the people who have employer sponsored insurance. The big trend over the past couple decades has been the rise of, so called, high deductible health plans. Those high deductible health plans became popular because of a law that was passed in the early 2000s that attached those plans to health saving accounts.
Ariel Lavery: This was the Medicare Prescription Drug Improvement and Modernization Act, signed by President Goerge W. Bush. And employers can get a tax write off for contributions made to an employee’s Health Savings Account or HSA. So even though, in Brian’s experience, their healthcare challenges started happening under Obama, these laws were made much earlier. When Sam listened to Brian’s interview, yes I did let her listen, she was surprised at how different his recollection was from hers. He has said that Sloan’s birth was the only one covered by the HMO. Thus, making Barrett’s healthcare costs exorbitant in comparison. But I asked for Sam’s clarification on this.
Samantha Stanley Evans: Um…I think we had HMO both times. Oh.. he’s gonna kill me. He’s one of those guys that talks a really big game sometimes, I think, to kind of puff his feathers up. I don’t know. But when he said he was at the hospital drinking and drank a six pack I was like, no you weren’t. (laughing) Oh yeah I was, I snuck it in. No! Well, you wouldn't know you were in too much pain. No! I know you were not drinking at all the ho… Yeah I was. (laughing)
Ariel Lavery: And by this time you might be confused about what affected what and why we’re even talking this much about insurance history. So suffice it to say despite their shared anxieties, Brain and Sam have very different recollections about what affected their healthcare costs. And, naturally, both Brian and Sam are going to look for reasons this has been such a struggle for them, looking at things like shifting political leadership. But what if the solution lies elsewhere?
Brian Evans: Canada, does a lot of things screwed up. I do agree with… I would be fine giving you more tax dollars at Walmart grocery store gas station to get free health care.
Ariel Lavery: So you believe in universal health care?
Brian Evans: Yes! Everybody deserves health care.
(pause)
Samantha Stanley Evans: He doesn't believe in socialism, but Canada has free health care. Isn't that socialism? Brian doesn't know what he's talking about. Because if you're a socialist country, you have free healthcare. We actually need to talk about this because I was like, eeww.
Ariel Lavery: Many experts would not say that universal healthcare is socialism. There is a term that we could use to describe capitalist countries that have universal healthcare: socialized medicine. And some people have said that the ACA or Obamacare, has been the first big step toward socialized medicine in the United States, for better or worse.
Emily Gee: So the ACA did lead to one of the biggest expansions in US history.
Ariel Lavery: And it has done some really important things for protecting people’s access to healthcare, especially for women.
Emily Gee: The ACA is really important for women having access to high value health care. One aspect of this is the ACAs preventative services provisions that guarantee that women have access to well women visits with no copay. It made birth control free. It also protects people who have preexisting conditions, whether that’s a chronic disease like diabetes or asthma, or even a C section! In the pre ACA days, women could be charged more for health insurance because they’d previously had, a had a C section.
Ariel Lavery: And what about our rural friends?
Emily Gee: A big problem in rural areas is that there just aren’t providers at all. You know, you might have to travel far to see a specialty provider to get care at a hospital. We’ve seen a lot of rural hospitals close over the last couple decades.
Ariel Lavery: But even with local access to hospitals will rural residents take advantage ?
Samantha Stanley Evans: I don’t see local doctors. It cost me less money for me to go to Mercy in Paducah with, I think, better physicians and better practices, than it cost us to go to Murray the first time.
Ariel Lavery: In other words, better healthcare for less money. Rural residents in general across the country have less access to high quality healthcare. It’s harder to obtain for a number of reasons. And when I asked Sam if government should focus on getting dollars into rural healthcare systems to bolster the accessible care…
Samantha Stanley Evans: I don't think that there should be money poured into this.
Ariel Lavery: A surprising answer.
Samantha Stanley Evans: Then people are going to start moving into your rural areas and then you're going to be more populated than what you were before. You're gonna raise your housing value. You're gonna raise your taxes. You're gonna become Chicago before you know it.
Ariel Lavery: Sam and Brian’s perspectives raise so many questions that may have answers on both sides of the political spectrum. Would socialized medicine improve rural access to high quality healthcare? And how does improved healthcare effect local economies? Women sometimes need immediate care with a thorough diagnosis that a local doctor may not be able or willing to offer. So how do we standardize proper healthcare access for women in this environment?
Conclusion:
Samantha Stanley Evans: (ambient sound of street and mailboxes) I think every woman knows when they're done having kids, they're done.
Ariel Lavery: We’ve leaned heavily on Sam in this episode to offer insight into rural experiences as we open a new season focused on women’s healthcare. And I admittedly was putting pressure on her experience to offer wisdom and solutions to open our season with. I did ask her directly to talk to me about what choices women have available to them.
Ariel Lavery: I just want to touch on this stuff with you while you’re on your mail route.
Samantha Stanley Evans: I think I’m gonna disappoint you. (sounds of Sam walking and delivering mail) I think women and healthcare… they…I think, and this is all I think and I guess it’s all my opinion. I think when a physician says, oh you want a hysterectomy. You know that we can’t put those organs back in there. They almost want to double triple quadruple check… Even when you ask a question like starting with, Are you sure? That shows a doubt into your mind. Are you sure? Ariel, are you sure your hair is red? Are you sure? To me it looks more Auburn and then you're gonna go home and be like, oh, maybe it is more auburn because it's automatically put into your head. Well, are you sure?
Ariel Lavery: I truly love this analogy, women are asked this all the time: Are you sure? Are you sure that you don’t want to make use of this organ you’ve been endowed with? I would say, yes, we want our doctors to do their due diligence, and sure, women’s healthcare needs are often defined by their reproductive systems, but there is an entire body with a thinking and feeling brain that is intimately connected to those organs. There are women who never want to use these organs to have children. There are women who don’t have female reproductive organs at all. So, in rural systems that might be antiquated, more expensive, or lacking in diversity, what does care look like for women who might not be defining themselves by their anatomy?
(ambient sound of street comes in)
Samantha Stanley Evans: So I mean I guess that’s, that’s kind of my answer.
Ariel Lavery: And that's the end of your, your armful of mail.
Samantha Stanley Evans: That's the end of my armful of mail and I'm not even taking anything back.
(street sound fades out)
Credits:
Ariel Lavery: This episode was produced by me, Ariel Lavery. Our editor is Josh Adair, who also gets his mail delivered by Sam and can attest to just how delightful she is. Thank you to Annie Davis, our intern, for fact checking and proofreading this script. You can find images of Sam on our website at middleofeverywherepod.org or on Instagram and Facebook at middle of everywhere pod and Twitter at rural underscore stories. Our theme music was composed and produced by Time on The String Sound Studio in Paducah Kentucky. Other scoring comes from APM music. This is a production of WKMS and PRX. This program was made possible, in part, by the Corporation for Public Broadcasting,a private organization funded by the American People.