When you were 8, you could control the wind. The trees would listen, waving their long branches at you. The leaves would applaud as you made your way down Marcus Street. That was when the birds called your name and the squirrels followed you.

Back then, imagining was easy. Secret hidden treehouse sanctuaries that rivaled Peter Pan and the crew. The red wagon that could take you far, far away. That was when you still carried around that white stuffed dog, a bit nappy and dingy. You took him everywhere but don’t recall his name. 

I can tie my earliest days of imagining to my time spent growing up and playing in the woods. Crowns made of the twigs from privets. Mud pies made with hose water in rusty pans, baked in old broken ovens behind the house. 

I was molded from the clay soil in Deep East Texas, in the small city of Lufkin. This region has an antebellum history shrouded in violence, mystery, and resilience—much like the ecosystem of the Big Thicket, which is arguably the most diverse in the world. 

By total population, Texas is the Blackest state in the country and home to over 500 Freedom Colonies—Black townships founded after Emancipation—because of the large plantation economy that depended on slave labor. But we are not equally distributed. East Texas, where I’m from, is the beating heart of Black Texas. It’s a place where the majority of enslaved people were concentrated, and it’s where 90 percent of cotton was grown in the state.

From very early on, the Black women around me drew the maps that guide my life’s trajectory. I have had the privilege of growing up under their watchful eyes. My earliest memories of Black womanhood were not only of my young mother, aunties, and cousins, but my great-great-grandmother, great-grandmothers, and grandmothers. 

The author with her mom in San Augustine

When I wasn’t at school or with my cousins, I was with my Ain’ B—my aunt. She was an English teacher in the Houston area at the time. When she visited her small East Texas hometown, I would eagerly jump in her car to ride along. During her college years—in the early 2000s, when I was still in elementary school—I would go with her to classes at Jarvis Christian University, an HBCU tucked away about 20 miles north of Tyler.

I would take those trips with my older cousin. When we weren’t at my aunt’s lectures, we would participate in praise dance performances with her and her Delta Sigma Theta line sisters. My aunt was the perfect picture of beauty. Clear and dark skin, high cheekbones with long straight hair, beady piercing eyes like my great-grandmother’s. She always smelled of perfume and Chi hair oil. She would play songs like “The Battle Is the Lord’s” by Yolanda Adams.

It was my Ain’ B who introduced me to the Rev. Bettie Kennedy. I remember sitting on the floor of Rev. Kennedy, whose house was located off Paul Avenue in the historic and predominantly Black Lufkin Land portion of the city, which today includes sizable Latino and white populations as well. 

It was from the Rev. Kennedy’s petite, light-skinned body sitting in a rocking chair that I would hear stories about the African masks and spears on her cluttered walls. It was the first place where I learned about cowrie shells being used as money and for religious rituals. In the early 2000s, it was at her feet that pride in my Blackness was cemented. I found the language to recall a home within myself. 

These stories of my matrilineal line have been whispered to me since childhood, coalescing and engulfing me like kudzu vines—forming along the roadsides of my own journey.

It was on Marcus Street that you remember no longer being a young girl, when you had to come into yourself. It was around the age of 8. 

That nameless stuffed dog, you gave to a real rescued hound your grandfather and stepfather brought home one night. The rescue was flea-ridden and sad, so after they washed him, you snuck into the backyard and into the doghouse. You sang to him and left your gift. The next morning, both were gone. One was sick, and the other was no longer yours to hold onto. 

I remember crying the first day of first grade. That was when I discovered there was no nap time like there’d been the year before. That was important because I wasn’t getting adequate sleep at night. Like far too many Black and brown girls, I was living with the ramifications of a broken system under capitalism.  

That year, I went to Brookhollow Elementary, in what was once a more affluent neighborhood of Lufkin. This year was memorable because it was the first time I remember being targeted by my teacher. There was a petite, blond-haired, blue-eyed girl who would pester me. One particular day, she kept putting her nails in my face and telling me to call them pretty. After I ignored her, my teacher put her hand in my face and forced me to call both her and the girl’s nails beautiful.

For me, my memory will always call me back to the Thicket.

Around this time, I began to form an opinion of myself from the lens of the outside world. My self-perception was being forcibly remolded.  

According to a 2017 report from Georgetown University, adults view Black girls as less innocent than white ones. That was true for me in that class. I got in trouble not for talking but just for being a child who was curious about the world. 

Once, my backpack fell on the floor. At the time, my family was living in a low-income housing complex that, like others, had roaches. I reached inside my backpack to grab my winter cap before we left to go  outside, and two small ones crawled out. In disgust, the teacher made me stand outside with my cap in hand upside-down, held by two fingers in case more roaches emerged. 

You were 8 when the suicidal ideation began. You would have daydreams about running your forehead into a giant rusty nail sticking out of your grandfather’s wood-chipped wall, there in the room where you spent your infant and toddler years after your mom had you young. 

You weren’t afraid of death. In fact, it was your first memory. 

When you were around 1 or 2, you swallowed a quarter from a swept-up pile your mother made in the middle of the floor. You blacked out and remember floating in a bright white light. You were weightless and had no worries. Your mother said she remembers screaming while she hit your back until the coin came up. She claims you were too young to remember. But you do.

“Survival is the greatest gift of love,” wrote Black feminist author Audre Lorde. “Sometimes, for Black mothers, it is the only gift possible, and tenderness gets lost.”

The women I grew up with are backwoods women. Women who come from a tradition of both nurturing to survive and knowing how to navigate the land with their guns and knives. 

My grandmother talks of my great-grandmother as a tough woman. She was a cigarette-smoking Aries I remember from my childhood and family photos of her on a couch, laughing with a Budweiser in hand. She made cracklin’ cornbread and held long dinner-table conversations.

(Top) The author’s grandmother on a motorcycle. (Middle- left) The author’s great-grandmother. (Middle-right) The author’s great- grandmother handled payments for sharecropping jobs. (Bottom) The author’s grandmother on a cruise (Scan from photo album)

My own mother describes her grandmother as observant. She could be seen frequently taking walks on our family land, surveying the plants closely because she knew something we didn’t. Like many Afro-Texans, the women in my family come from hunters and farmers who had an advanced understanding of the local ecology. 

My great-grandmother worked for a white family down the street as a housemaid. She began having kids when she was around 14, and she eventually had 13 children. My grandmother said her mother became a bit more discontent by the end of her life.

I can only imagine the sacrifices she had to make for her and our family’s survival.

You remember reading Maya Angelou’s I Know Why the Caged Bird Sings. You were an avid reader then, hiding from the rest of your family in backrooms. 

You were around 9. Your aunt had fed you Maya, as she usually did with books back then. In that book, you found the language for what had happened to you. You didn’t know it was bad, but you knew it wasn’t good. You had questions about your body parts. Once, your mama told you to never let anyone touch you, but you were too young to understand. All you knew then was that you found the language. 

Those nights on Marcus Street were heavy. Waking up to the yelling, your stepfather and your mother, pregnant with your youngest sister. Back then, you still believed you could fly far, far away. 

During this time, I was babysitting my siblings and cousins while our parents were away for work. My starkest memories of having to take care of others began then. When my middle sister or cousins made a mess, I was responsible for cleaning it up. When the younger kids got into trouble, it was my responsibility to get them out of it or risk being punished myself. This, researchers have also found, is another way that childhood is cut short for Black girls.

Maya’s work gave me the gift of story. But the love for storytelling had been planted already. Much of this was learned listening to my grandparents. They were and are my solace. They were where I could be in my girlhood, unbothered and protected. 

My fondest moments were spent outside with my grandfather, walking the land with his Black Mouth Cur hunting dogs and driving along backroads. My time with my grandmother was spent looking over the counter as she kneaded dough for dumplings, cleaned greens for Sunday meals, or patted hot-water cornbread into shape before frying the dough. When she wasn’t in the kitchen, she was in the garden planting tulip bulbs or mowing her lawn, which she’s still able to do. With a Budweiser in hand like her own mother, she still plays us under the table at dominoes.

She grew up as a backwoods woman, raised off-grid in nearby San Augustine along with 12 other siblings. She still shares memories of hunting blackbirds with her brothers, which they’d pluck for their parents to fry. She resisted and resented being forced to wear dresses. Instead, she wanted to hunt and roam the woods.

She met my grandfather through her brothers, who were his hunting buddies. He was a tall, dark, and handsome woodsman from Woodville. They met after they’d each had two children—she had her first at 17—and after his first wife passed. They lived on land bought and cultivated by my grandfather’s family. For Black Americans, stories like this are increasingly rare—as 90 percent of agricultural land for Black farmers has been lost since 1910, in part due to forced property sales, intimidation, and limited access to financing.

My grandmother talks begrudgingly about this time. She speaks of how my grandpa’s family despised and mistreated her. She didn’t have a job; she was a stay-at-home wife.

She later found work after my mother left the house. The independence enabled her to get a divorce, over her mother’s objections, and rent out a trailer. By happenstance, the owner of the trailer was selling the property. After some negotiation, she was able to get her own land and settle in the woods alone—an achievement in a country where Black women have long been denied ownership through discriminatory lending.

There, on her land, she could care for herself. It was a place where she would find her freedom, not subject to rules like wearing a dress. A place to be with the trees.

In fifth grade, you wrote an essay titled “Rigamortis.” It was the description of a black, gooey blob that had been following you everywhere. Sitting in your gut. She filled you with lies about yourself, and the only time you could quiet her was when you read or wrote in your journal—lying under the same trees as your ancestors.

Back then, you were beginning your ascent into your matriarchal role.

One time, when you were hanging in the garage with the men, you got a whoopin’. Your mom had told you about it before, but you just wanted to spend time with your grandfather—away from the gendered expectations. It was your mother trying to protect you from what you faced as a young girl, but she didn’t realize she was too late. 

My mom was the youngest child. As a kid, she would sometimes sneak off to steal and, in one case, crash my uncle’s motorbike. She would trudge through what were still the forests of Lufkin Land to sneak behind the nearby chip factory and take from the dumpster. She and her siblings would even go cow-tipping—a practice I scold them for today.

Much of her childhood was also spent with my grandfather. She was a daddy’s girl, which is a privilege I’ve been afforded in short supply. She remembers back-road rides down tributaries of Highway 59 as well as hunting and fishing trips.

My mother was a star basketball and volleyball player who got in trouble in practice and on the school bus for joking and talking. Once, she made the whole team have to take laps. She’s always been the funny, goofy, quick-tempered cousin. A bit calmer these days, in her late 40s, she is still as spirited and free as she was when she was younger, which I know because I saw my mother become a woman.

She was only 17 when she became pregnant with me. It was the first time she’d had sex, she would tell me when we talked about the subject, which she hadn’t discussed with her own mother. During that time, her greatest shame was walking down the hallways of her school with her belly her senior year. 

Today, Texas is home to some of the strictest abortion laws in the country. Teen births remain high, as sex education programs often rely on an abstinence-only approach. Reproductive health disparities hit Black and rural women the hardest. Oftentimes, when young parents must come into themselves, it’s the eldest children who witness and experience the ramifications of that learning. 

Early on, my mother was intentional about making sure her three girls knew about sex, even answering the questions of friends whose parents weren’t as open. 

After experiencing a torrential relationship with my birth father, she later married my stepfather. Although he made sure we kids were able to experience the fun parts of childhood, he had a temper. Some nights, my middle sister and I would stand in the doorway of our living room, hoping our crying would silence their yelling. 

During those years, my mom’s disposition was a bit rough toward me. Often, the survivors of domestic violence, physical or verbal, take some measure of their pain out on their children. As much as I love and respect my mother, and as much as we get along today, it took a toll on me, just as a similar roughness took its toll on her own mother and her grandmother before.

“I know the anger that lies inside of me like I know the beat of my heart and the taste of my spit,” wrote Lorde. “It is easier to be angry than to hurt.”

Today, my mom talks about how much she loves her solitude. Seeing her take back parts of her life with no kids at home defines for me the womanhood that has now been passed through generations.

Driving on Highway 59, you know you’re home when chills come over you like a wave grabbing and settling the floating parts of your body into itself. The trees grow thicker. The air smells emptier. The familiar sounds of truck engines, busy streets, and nosy people turn into the sounds of warblers, chichi birds, crickets, and cicadas. Here, your heart doesn’t race. Your body knows where home is. You don’t want to be far, far away.

Since I was a kid, my mother told me and my sisters to leave our hometown. If we didn’t, we would be stuck. So, for a long time, I didn’t return. Just an occasional visit during the holidays or to pick up urgent mail. 

“All water has a perfect memory and is forever trying to get back to where it was,” writes Toni Morrison in a 1987 essay. “Writers are like that: remembering where we were, what valley we ran through, what the banks were like, the light that was there and the route back to our original place.” 

For me, my memory will always call me back to the Thicket.

Where I’m from, backwoods women learn the truth that our lives are entangled in the ecology of the land. We are the children of maroons and Freedmen who knew which crushed plants stopped bleeding and how cobwebs in the dusty corner of a room could sanitize wounds, who opened their windows during storms to spiritually cleanse their homes and sat on porches observing the animals to foresee the incoming season.

As time moves on, we lose the language of our ancestors, but our bodies will always know the technologies of the land. And even when the names of the terrain no longer lie on our tongues, we’ll always know it by heart—even when we fly far, far away.

The post A Love Letter to the Black Woodswomen of Deep East Texas appeared first on The Texas Observer.

Amanda Eyre Ward is an Austin writer and author of 13 novels—three of which are set in Texas and the rest scattered all over the world. Her latest book, Arrivals and Departures, out June 16, delves deep into the dark world of international romance scammers and how they masquerade as lovers by employing deepfake videos, rom-com scripts, and high-pressure sales pitches. Some even have scammer handbooks, scam universities, and how-to rap songs. 

Ward recently spoke with the Texas Observer about her book, what she learned about the scammers who live everywhere from Lagos to Austin, and about how some Texas-based fraud detectors are exposing them.

TO: I love that you dove into the world of scammers because, of course, they’re everywhere. You spent two years researching them. And along the way you visited members of the International Association of Certified Fraud Examiners in Austin, right?

So, a mom friend of mine said, “I run this thing. Do you want to come?” And my jaw dropped. I was almost done with the novel at that point. But wow! I didn’t know there were lawyers [and investigators and accountants] whose entire job is dismantling scams and finding scammers in Texas. They are fascinating people. And this is what they do every day. So they’re telling stories in this throwaway tone that are just so insane. Like the person who got billions of dollars out of a nursing home…it was a resident. 

And I met scammers and I met people who were scammed. And people who are scammed, to a one, kept going when it was pretty clear that it was a scam. They just continue, and this happens in my novel.

Even when you’re positive objectively that this person is scamming you, when you wake up in the morning and someone says: “If you send me $10, my dear, and tell me about your day,” it’s like Stockholm Syndrome. It’s worth the $10 to keep pretending that there is this person who loves you and wants to hear about your day.

That’s very sad.

I know. It’s sad, but it’s all just fascinating. And this was before [artificial intelligence]—the deepfakes and psychology. The scammers know what they’re doing. 

I started my research, honestly, [on] TikTok. And on TikTok and YouTube, there are “Yahoo Boys,” what they call the Nigerian scammers and a new book just came out about them. [The Yahoo Boys: Love, Deception, and the Real Lives of Nigeria’s Romance Scammers by Carlos Barragán] 

But anyway, the Yahoo boys have classes. So they’re like: “Join my class, I’ll teach you how to do it.” And there’s universities.

And then I found out there were Americans doing it. Then I found there were kids in Austin doing it…

One thing you shared in a post is that so often they pretend they’re surgeons when they’re using deepfake AI videos. Why?

I found a training manual in Chinese—a “pig butchering manual.” That’s what they call the scamming, is pig butchering. And it explains what you should say about why you can’t be on screen. For example, you are to say you’re autistic and you can’t really talk to people’s faces.

(Courtesy of Amanda Eyre Ward)

Anyway, you asked about the surgeons. So one of the things that I found out through my research was that the deepfake technology can take a kid in another country or a kid in Austin and make them look like a handsome age-appropriate man or woman… However, the mouths don’t always work right. Some of the movements are a little janky, but usually the voice works, the face works, but the mouth cannot keep up; the mouth flaps with the words. So they decided to make them surgeons so that they could call from the operating room with their mouths covered. And a lot of the romance scammers are supposed surgeons for that reason.

I have noticed that there’s a lot of doctors and military fake profiles on platforms like Facebook, and they tend to have first names for both their first and last name (Brian George, etc.)

A lot of military because when you’re in the military or like on an oil rig you can sort of explain [ the anomalies]. Like if you send a gift link, and if they hit it, it’ll tell [the location]. But if you’re in the military, you can explain why you’re in Yemen, for example, or Iran when you say you’re from Brooklyn. [They say] things like, “I need money to go on leave to see you.” They’ll say, I have a week, this is the only week, and this is how much the plane ticket is…. It’s always very stressful and very specific.

Tell me about the people you found doing this in Austin?

I have kids who go to Austin High and I always talk to them about what I’m doing. And a lot of them are friends with kids from all over the city. … I said this is what I’m researching [and] they said there’s kids doing that here… and I went to their social media and contacted some of them… And they are not as much romance scamming, the kids that I met. They are pretending to be your grandson who was in a car accident. 

You also delve into addiction and mental illness in this book. Your character Lee, the reality TV star, is introspective about her drinking and depression. You’ve been open about your own recovery journey. How do you infuse what you know about drinking and recovery into a character like that?

The question is, “How can I not?” … It’s my obsession, you know, I grew up with an alcoholic dad. I’ve been sober for 12 years and it always comes up. And it’s something I just find endlessly fascinating. Addiction, because you’re not in control of what you’re doing and it’s so ruinous. And why does it happen to some people and not others and how do you escape it and how do brains work? 

I thought, if somebody reads this and they’re reading it [for] the romance scams, they’re reading it for the Greek beach scenes, the love, and they also understand very specifically how mania and bipolar lows happen, so maybe that they’ll recognize someone in their own life and either be more understanding, [or] be more helpful….

So that is really important to me to remove the stigmas around these issues and also about addiction.

You have several books set in Texas: The Lifeguards, set in Austin, The Same Sky, your book about the border…and Sleep Towards Heaven—that’s my first novel about a librarian from Austin and women on death row in Gatesville. So three books set in Texas.

Do you tend to choose a place for a book, or do you tend to say, “I’d really like to write about this place” and then travel there to do your research?

Texas is endlessly fascinating to me. And I could set all of my books there. But I also lived in Athens when I was younger. My next book is set in Hawaii, where I’ve spent a lot of time. My daughter goes to camp there. I think it’d be hard to write a book from a tourist point of view if you’re just in a place for a day or two. So it’s more places I know well.

It’s more, I get obsessed with ideas like romance scamming.

What other other tricks did you find that scammers were using that aren’t ones that people might expect?

Well, here’s one thing I didn’t know: In the really organized systems, the main source of income for a lot of geographical areas is scamming dumb Americans and Europeans. There are different levels of scammers. So if there’s a bunch of kids, like the lowest level, will just be sitting around a generator in a slum in Nigeria, for example, and texting hundreds and hundreds of people a day. So most people don’t answer when you get those silly texts, like, “Jane, are we meeting for lunch?”

So once they get an answer, it goes up to the loaders. So the loaders—because a lot of them don’t speak English—have purchased scripts. So if you have enough money to purchase a script to do a little back and forth, well then you can be a loader.

And then the next level, once they really get going, there’s pickers. Then there’s the AI guy. There’s the video guy. They will hire a local woman to come be the video person or they can do the deepfake. And it all depends on your level. And your level depends on if you can speak English, if you know how to do more of the technical stuff. I mean, it’s just so organized. I thought that was amazing.

That is amazing and creepy.

And so creepy. And then one of my biggest places for research is the AARP podcast called “The Perfect Scam.” And it is fascinating. It’s probably hundreds of stories of people who were scammed. And it’s everything from love to things like, you buy a dog who doesn’t exist, …and you’re paying and they’re saying: “Oh my God, I’m 10 miles fromAaustin and my truck broke down and I need a little bit of kibble for the night at the motel, can you just send me 15 dollars?”

And people just keep going—they’ve spent hundreds of dollars and they’ve seen pictures of the puppy and they’re gonna pay another $15 when it’s so obvious! 

This interview has been edited for length and clarity.

The post Inside the Dark World of Romance Scammers appeared first on The Texas Observer.

We have a plan for the day you are born and the day you die. 

We can make you breathe—or at least try to—when your lungs fail and your blood can no longer clot. At the Texas Medical Center (TMC) in central Houston, we repair spinal defects before birth and replace hearts after a mother’s cardiovascular system collapses. I have watched doctors bring women back from the dead. It is an astonishing and beautiful thing.

But when your baby is diagnosed with a lethal anomaly, we cannot help you. Not because we lack the training or the skill. Because the law forbids it.

If you learn about fetal anomalies only online, it might distort your sense of scale. Around 3 percent of pregnancies are complicated by a life-limiting anomaly. At the TMC, that means roughly 800 families a year—or about two a day—learn that their child will not survive birth or will die minutes after. As the region’s referral center, we deliver this tragic news more often than our colleagues at other facilities.

We are not afraid to weep with our patients. A diagnosis like this is a fault line; there is life before and life after. Some choose to continue their pregnancies. We do everything to help them deliver safely. This choice is not without risk. These mothers take on the dangers of delivery—eclampsia, hemorrhage, disseminated intravascular coagulation—to spend a few moments with their dead or dying baby.

Others are willing to take on the risks of pregnancy only if there is the possibility of a living child on the other side. This is a more than reasonable position, especially as Texan women have poor maternal health outcomes overall. According to recent federal and state data, the Texas maternal mortality rate is higher than the U.S. average. And Black women in Harris County die from pregnancy-related causes at nearly four times the rate of their white counterparts.

You can study the data for years. Read the journals. Analyze the case reports. Until the very real threat of dying while giving birth starts to feel abstract, like something that happens only to someone else. Spend a week on a maternal-fetal medicine team at the TMC, and that distance disappears. The only thing that matters is the patient in front of you, who cannot get the care she needs.

ABORTION CAN ALSO SAVE LIVES.

I remember the patient who destroyed my sense of scale. The shape of her red stud earrings. The chocolate from Trader Joe’s that her husband piled in the corner of her room. The bright smile she beamed at the entire team even when we woke her up at 5 in the morning for pre-rounds.

It wasn’t her first pregnancy, but it was her first real chance at a live birth. Before being transferred to the TMC from a rural Texas hospital for this pregnancy, our patient had previously endured multiple miscarriages and several failed rounds of IVF. She wanted this baby more than anything. More than she wanted to avoid the serious risks to her own health—an autoimmune condition made her more likely to miscarry and more likely to experience serious complications—or the obscene mountain of medical bills piling up in her mailbox at home.

We realized something was wrong near the end of her first trimester. The resident couldn’t find the baby’s kidneys on ultrasound. We already knew the baby was small for its gestational age, but we’d attributed the growth restriction to our patient’s existing autoimmune disorder. This new knowledge, combined with a low amniotic fluid index, sent up several red flags at once. When the attending took the probe, her face went white.

For most parents, an ultrasound is pure joy. A first glimpse, a tiny nose that looks like dad’s, a photo to send to the family group chat. But when an ultrasound reveals a lethal fetal anomaly, each image is the unwinding of a miracle.

Our attending clicked through the frames again. The resident was right. There were no kidneys.

In a healthy pregnancy, fetal kidneys create the amniotic fluid that protects the body and allows the lungs to develop. Without this fluid, the lungs fail to develop properly. Even worse, without this protective amniotic buffer, the fetus is slowly crushed in the womb. 

Most of these babies die before birth. Those who survive delivery gasp for air until they suffocate in their parents’ arms. When we explained this to our patient, she howled as though someone had trampled her heart. Her husband slumped at the end of the bed, shredding a chocolate wrapper between his fingers. Our attending held back her own tears until the husband asked if he could donate his kidneys to their baby. As she explained that surgery couldn’t fix this, her voice shook. 

Then, the parents asked whether this meant they qualified for the narrow exceptions to Texas’ abortion ban, especially given the autoimmune disorder that had brought the mother to the TMC in the first place. But there is no exception in Texas for lethal fetal anomalies. And our patient was too sick to travel out of state.

When we left the room, the parents and the entire medical team had been stunned into silence. I remember thinking that it couldn’t get worse than that heartbreak. Until it did.

Days later, the patient’s room was empty. I asked the resident what happened to her. Overnight, in a cruel turn, her own kidneys had begun to fail. She was transferred to the ICU, and I started working with another team in the hospital. I never learned what happened next.

Every morning after, I imagined running into her husband in the elevator, standing with his usual bag of snacks, telling me that his wife made it through the hellish ordeal. But I never did.

I grew up believing abortion was a sin. My parents raised me in a conservative religious community just outside Dallas, where I was taught that hormonal contraception was an “abortifacient” and that women who defied church teaching might be punished with miscarriages.

The more I learned about medicine—and how quickly a healthy pregnancy can turn deadly—the less certain I became about the worldview I’d inherited. When I discussed the case of the patient with the autoimmune disorder with a physician from the community that I grew up in, he agreed that ending the pregnancy was likely safest, before adding that women “shouldn’t use abortion as birth control.”

Others from my past have been less generous. They now accuse me of defending “baby killers,” or simply of using a tragic case—a woman too sick to continue her pregnancy, a baby too sick to survive delivery—to justify what they deem to be a barbaric procedure. To those who share this view, I ask them to consider this: Abortion can also save lives.

Before Roe, hospital wards were filled with women dying from botched abortions. The procedure was legalized, in part, because doctors recognized a public health crisis. Even now, I’m grateful that many patients can safely self-manage with pills ordered online for a few dollars. And I worry about the women who can’t, like an incarcerated patient whom my colleague recently cared for.

Her baby was diagnosed with acrania, a rare malformation characterized by the partial or complete absence of the fetal skull. This is always lethal. Some women, by virtue of their own resources or with help from abortion funds, are able to travel to a state that doesn’t restrict abortion care—but this wasn’t an option for this patient.

I think about Samantha Casiano and her daughter, Halo, who lived for four hours before suffocating in her parents’ arms. I think about Kaitlyn Kash, who was denied an abortion after her baby was diagnosed with osteogenesis imperfecta, a lethal condition that leaves bones so fragile they can break in the womb. I think of Tierra Walker, who died of preeclampsia at 20 weeks pregnant, found lifeless in her bed by her 14-year-old son.

These cases are a direct result of legislation that forces our patients to continue perilous pregnancies. These intolerable, unimaginably cruel laws meet the threshold of a human rights crisis and will only continue to cause harm.

How many more preventable maternal deaths will there be in Texas? How many more times will we delay necessary care to satisfy political imperatives unmoored from medical evidence? How many more times in my medical training will I sit with a patient and help her write a birth plan for the dying?

Every one of those questions has the same answer: too many.

The post A Birth Plan for the Dying appeared first on The Texas Observer.