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Easing My Grief by Eating Like Anthony Bourdain

Maybe it’s because I’m paranoid by nature; maybe it’s because, now, the news cycle is never not stomach-churning. But when I see a celebrity’s name unexpectedly trending on social media, my first reaction is often to worry that something terrible has happened to them. (My second, lately, is to wonder if they’ve been outed as a monstrous sexual predator.) But early last Friday, when I woke up and first spotted Anthony Bourdain’s name on Twitter, the possibility — either possibility — didn’t remotely occur to me. The celebrity chef, writer, and Parts Unknown host always seemed more full of life than anyone I could imagine. Bourdain died by suicide in France, where he was shooting an episode of Parts Unknown. Even now, a week later, it’s difficult to believe. And it fucking sucks.

I lost most of that morning. In a haze of grief, I read his 1999 essay in the New Yorker (a hilarious, blistering piece that, among other things, warned of the dangers of ordering restaurant fish on Mondays), then the profile of the late chef published last year in the same magazine, then thumbed through my paperback copy of Kitchen Confidential, and then scrolled numbly through the remembrances that comprised most of my Twitter feed. It was comforting to see that I wasn’t the only one feeling like the wind had been knocked out of me, and doubly shocked that I was taking the loss of someone I’d never met as hard as I was. Bourdain’s bawdy wit, curiosity, and equal capacity for profound empathy and scathing cynicism made him a hero of mine — an all-time New Jersey great, a true pork roll, egg, and cheese of a man — as he was to so many others. He was, in my estimation, about the best possible representation of America abroad, especially in the Trump era; he was an outspoken advocate for the #MeToo movement. He was hungry in every sense of the word.

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I thought throwing myself into work would make me feel better, but work didn’t want to cooperate: I had a meeting and an interview scheduled that day, but both, for unrelated reasons, needed to be moved. So I decided to eat my feelings instead. Before I left my apartment, on an impulse, I sent off the kind of tweet that I usually delete a few endless unfaved minutes after posting, which is to say that it expressed a genuine, difficult emotion and not just a joke about a squirrel I saw eating garbage: “I am sad, so I have decided not to do my work and instead to go outside and eat something I’ve never eaten before.”

I took the 7 train from Long Island City, where I live, to Jackson Heights. Actually, I accidentally took it one stop too far, to 82nd Street, and walked west down Roosevelt Avenue back to 74th Street. Almost in spite of myself, I felt my mood lightened by the sunshine, fresh air, and being surrounded by other human beings. I started to receive responses to my tweet, from fans of Bourdain’s pledging to do the same, to leave their culinary comfort zones and try something new. That helped, too.

Lhasa Fast Food is hidden in the back of a cellphone store, past a jeweler and above a luggage shop. I felt hungry — suddenly, extremely hungry — for the first time that day when I wandered inside. Despite its unusual location, the tiny Tibetan restaurant is an increasingly less-hidden gem, having been warmly reviewed by the New York Times, Eater, and Bourdain himself. He dined there in the Queens episode of Parts Unknown. I’d come for the momos, Himalayan steamed dumplings, a dish I’ve wanted to try for years. I’d forgottten about Bourdain’s visit to Lhasa until my momo-related Googling led me directly to it — once I remembered, my lunch plans made themselves obvious.

Two oversize thermoses, one full of sweet tea and the other of salty butter tea, invite diners to pour their own cups for $1 each. A large portrait of the Dalai Lama, set before a snowy mountaintop, gazes down from above the register. From where I sat, I made direct eye contact with a photo of Bourdain with owner Sanggien Ben mounted on the wall. The pleasingly pleated beef momos (eight for $6) were delicious, and even more so when dipped in the black vinegar and fluorescent orange sepen, a truly spicy Tibetan hot sauce, available on every table.

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I replied to my original tweet with a photo of the momos, and was pleasantly surprised to discover my mentions were full of reports of first-time eats from around the country and beyond, many with images. There was mofongo and pineapple cornbread, pork and preserved egg congee, tater tots with kalua pork, and a late-night expedition to Waffle House. There was spinach gözleme from a Turkish food stall in Germany, Yukgaejang in Massachusetts, grilled venison in Spain, and (apparently lackluster, but still) takoyaki in Manhattan’s Zuccotti Park. The rapper Heems, who dined with Bourdain on Parts Unknown, sent me a photo of a custom-ordered Swedish biryani. Sometimes, I learned, the results of this experiment were incredible. Sometimes, not so much (sorry, again, about the takoyaki). But there was a universal sense of pleasure in the exploration: The world felt smaller, and much larger, all at once.

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I’m still sad. Maybe you are, too. But expanding your horizons and seeking out experiences different than those you’re accustomed to — and maybe patronizing a small, family-owned business while you’re at it, or having a conversation with someone you might otherwise never have encountered — is a fitting tribute to a man who encouraged us to do exactly that. So go get some momos.

 

If you or someone you love is in need of help, call the National Suicide Prevention Hotline at 1-800-273-8255. It is free, operates 24-7, and provides confidential support for people in crisis.

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Health Healthcare THE FRONT ARCHIVES The Harpy

Limned With Terror: One Life With Notes of Panic

I had my first-ever panic attack late at night on a couch in Tatarstan. I had gone to Russia that summer of 2010, after my sophomore year of college, for a State Department Russian-language program in Kazan. My hosts were a young couple who appeared to hate their concrete-walled, un-air-conditioned apartment nearly as much as they hated each other. All night I could hear their whispered fights, hissing like a choking gas through their bedroom door to the couch where I slept a few feet away. At first I thought they might have been whispering sweet nothings. Then my Russian improved.

The night it happened I had been drinking — a little — and had indulged in a habit I was just then developing, smoking strawberry-flavored, ultra-thin cigarettes that sold for fifty cents a pack. It was around midnight, and I lay on the couch in my sweaty nest of sheets, feeling my heart beat rapidly against my breast. I breathed in and breathed out and stared at the cracks in the ceiling, but my heartbeat didn’t slow; it rabbited as if I were climbing an invisible staircase, though I was lying flat on my back, my palms pressed to my sternum. I began to feel a star-shaped pain radiating through my hands, and it was accompanied by a wave of such pure fear that I bolted to my feet, gasping so profoundly I must have looked like a silent-movie star enacting surprise, and dashed to the balcony. I stared at the onion-domed cathedral opposite, whose bells woke me at 6 a.m. every Sunday, felt the wind curve off the metal and dry up the sweat that drenched my face. I dialed my mother, a doctor, and confessed: I had been smoking. I had been drinking. Now I was convinced some retribution — divine or simply physical — had fallen on me. My heart hammered like a handyman gone mad, leaping in my chest, and I knew I would die there, on that balcony in Kazan, punishment for how far I had strayed. I was so dizzy I grasped at my host parents’ clothesline for a hold, dislodging several pairs of socks; I felt my gorge rise and choke me.

My mother’s sleepy reassurances — you’re fine, it’s probably nothing — did little to dispel my certitude that the end had arrived for me. I was twenty and not quite ready to give up on the idea of having a future. So I balled my hands into fists and knocked urgently on the bedroom door of my hosts, explaining in my elementary Russian that I was dying, that I needed help immediately. “My heart has gone out of its mind,” I said. “My heart, something’s wrong. I can’t breathe.”

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“That happens to me really often,” my host “mother,” Asya, told me. She must have been in her late twenties, prone to wearing tiny miniskirts and velour; earlier that week, I had watched her husband, Seryozha, smash her laptop because he had seen a photo of her with another man on it. I couldn’t believe that she had looked death repeatedly in the face and survived: She was so thin her hip bones jutted out. I panted like a dog, caught in the grips of my whirring heart and ragged breath, and asked her to call emergency services. After she dialed the number she put on a full face of makeup before the paramedics arrived.

I wound up getting an impromptu electrocardiogram on that saggy couch in the center of a living room that had seen more than its share of despair. The electrodes were cold against my overheated chest; the line they spat out on graph paper made a series of perfectly regular peaks. I don’t remember the medics’ faces, only their hands, and their murmured reassurance. They gave me a drink they said was “herbs.” I hadn’t died, somehow. As dawn broke over the cathedral I finally fell asleep.

The happy part of this story is that I learned what panic was, eventually, and that it isn’t a fatal condition. The unhappy part — the untidy part — is that it’s never left me.

In the eight years since that night, the rhythm of a panic attack has become far more familiar to me, if no more pleasant. I don’t know what caused that first attack, although my family history is rife with anxiety — from the inherited trauma of Holocaust survival to more garden-variety Ashkenazi nerves. Panic has become a looming presence in my life, filling my throat with bile at the most inopportune moments: a job interview or a simple meeting; in the dark crowd of a rush-hour subway; on planes, at my desk, in the middle of the night, when my pulse blares in my ears and I know my body is about to burst all over my sheets like a punctured water balloon.

More than simply the blaze of fear and pain of a panic attack, panic disorder, which I have since come to know with terrible intimacy, is about how panic and escaping panic warp life. In the hopes of staying clear of panic’s terrible sequence of sensations, I bend my life away from its triggers, walking circuitous routes through my days. The ways my phobias control my behaviors are profound, and I keep them secret from most people, evading questions about my own evasions. Panic has its own logic separate from earth-logic; it’s not fear, but another plane, an Upside Down of the mind, in which everyday things (a two-block walk to the bodega in the dark; a ride on the J train; a plate of fish that might have bones) become limned with electric terror. To nerves primed to sing with fear, everything is a monster. Sometimes, after panic recedes, there’s a grim humor to it all: like a shape, menacing in the dark, that turns out to be a blender, or a shirt on a hanger. My life is full of this black and secret comedy.

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Once, just after I graduated college, I could not leave my parents’ house for a week; the thought of stepping out even onto the suburban sidewalk convulsed me with fear. In the end I broke that seal by climbing into the very back of my mother’s SUV, behind the seats, and staying there in the fetal position as she drove across the George Washington Bridge, to her profound bemusement.

There are other times when I wear my terrors lightly. I cling to routine — what’s familiar feels safe. When I push myself, sometimes I am pleasantly surprised; other times, I regret such excursions profoundly. 

I have no tidy end to this story — no “it gets better” tale, except that I’m on medication now, and the full, flushed eruption of panic is a comparatively rare occurrence. Flashes of panic singe me enough; my relationship to sleep is not a happy one. I am not the person I was when I got on that plane to Kazan at twenty: fearless, thrilled to taste new phonemes on my tongue. These days my phone is full of notes to myself, written in moments of psychic agony: You aren’t dying. You haven’t died any of the times this has happened before. You are going to be OK. You are going to be OK. You are going to be OK. Please, please let me be OK. Oh god let me be OK. In the sweat and pain of my brain’s misfired fear, I can smell and hear and feel everything — the hyperarousal of terror, they call it. Perhaps it helps me write, feeling so keenly. I admit that in the grips of this condition my life is smaller than I could have imagined. But still, I live. I am going to be OK.

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Health Healthcare THE FRONT ARCHIVES

Too Sad to Move: On the Paralysis of Depression

On my honeymoon we hiked a glacier at the border of Argentina and Chile, about as far south as you could go before hitting Antarctica. No organic life moved. Neon blue water faded to the shore into a milky hue due to particles of ice. The shore was rock, the redbrown of a lion. The glacier sliced in white sections shot with the same chemical blue as the waters. The guide said the blue came from the sun. When ice gets super cold and dense, light refracts off it differently; the color shows more intense. We slipped and climbed in our rented spiked shoes and caught panoramas of water and rock and air. It was like no sensory experience I’ve had, save staring into a canvas — pure color, something by Gerhard Richter, maybe. Occasionally we’d meet a blue sliver in the ice plunging more than a mile. The guide told us to beware; if we tumbled to the bottom we might not die, but we’d break every bone, lie in pain until they somehow got us out.

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A bedrock of pain linked us, so this caught our attention. By then we’d developed a game, my husband and I, that we called: “Should we just kill ourselves?” It involved saying the phrase, then pondering the question. (The rules were unstated but understood.) We played when faced with a task that felt insurmountable, some paralysis, due to career, or other people, or family. Paralysis was something I felt I would live with always. My first therapist couldn’t figure it out, met with silence my description of sitting on the couch unable to move, circles of thought moving me instead, arguments against living. I’d found her after calling my dad, after considering walking into traffic with a seriousness that was new. No one we knew from India or with roots there had a therapist, at least not openly; but my dad was a pragmatist, and we didn’t need more death. The smell of my mom’s cremation was still in my nose, every word still in my head from the letter I slipped under her bathroom door a few days before she fell from a stroke that came like a surprise wave — blaming her for the hands that touched me when only hers should have, for denying me when I asked for therapy years later.

Now she was dead and I worried she didn’t know that I also didn’t blame her, that I loved her. I went to an old escape fantasy, first shared at the office of my pediatrician in Texas, who laughed when I asked for a pill that could turn me back to a baby. Some darkness always lay in wait to get me and I felt I couldn’t stand it — kids laughing in the shadows, or grown-ups who hated me, or, always, hands. I imagined the whole world sharpened to a point against me, a vision helped along by the many times people would stare: when I walked into a classroom, the only brown kid; when we entered a gas station on a road trip. Some years later a girl around my age, seven or eight, shot herself with a gun in the bathroom of her fancy prep school nearby. I was transfixed by the story, couldn’t stop thinking of a girl my age being so decisive while I stayed wishy-washy. I contemplated the knives in our kitchen, asked my mom what she’d think of a girl my age going that way, covered my tracks by saying I’d heard of such a happening. She said she’d think the girl was sick. I didn’t want her to think badly of me, so that was that.

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I don’t know where the urge to kill oneself comes from, if some of us have it and some of us don’t. My mom didn’t seem to have it. She had no hair or ability to walk or talk, and still she raised her arms every day to exercise them, on the hope she would get strong enough to live through surgery to remove the tumors that caused the stroke, a cancer growing in hiding until it made itself known by wrecking her in a second. Watching her I felt awed, and confused. If it’s not a kitchen knife that gets you it’s a rotting hole in your belly from the feeding tube, physical pain if not emotional. At amusement parks, I’d get to the end of the line and turn around, bow out, push through all the people to exit the experiment. I knew I’d never fight as my mom had, given the chance to die. Why waste time along the way?

Biology tells me I’m programmed to want to live. So many sperm could have made their way to the egg. Clearly the one that did had will, a survival instinct, expressed years later in my dad insisting I live by securing outside help. That day on the ice, my husband and I considered dying, but only because the glacier was more beautiful than anywhere else we could go. Better to die there, we reasoned, than return to a place of paralysis. I’ve found it helps to physically move, the way stretching can stave off the stiffening of joints that comes with another sort of disease. But healthcare is expensive in this country, people too busy to talk on phones, therapy treated as a luxury good. I do not know what one does without a biological proxy for the survival instinct, engaging your will to live when it is lost to you, who calls the numbers, writes the checks, lifts your arms in exercises when you can’t move.

If you or someone you love is in need of help, call the National Suicide Prevention Hotline at 1-800-273-8255. It is free, operates 24-7, and provides confidential support for people in crisis.

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Health THE FRONT ARCHIVES Uncategorized

Fighting the Darkness That’s Always There

Each depressive episode is a battle in a war that will never end. Sometimes, you can see the enemy coming, its march toward you set up in straight lines like a British military exercise, and you have time to fortify yourself, to build up your habits and your friends and your resources to protect you. But sometimes, when everything seems fine, and the horizon looks clear, you face a guerrilla attack. Every episode, you must fight not for victory, or power, or glory, but simply to continue, to stay alive.

Here is a list of habits I have constructed to keep me here: I walk every day for more than an hour. I exercise three times a week. I do not have more than three drinks at a time. I try to eat vegetables every day. I see a therapist weekly for an hour. I get eight hours of sleep. I take two pills every morning. I go to museums and walk in nature and do things I like even when I cannot feel anything from them at all. I am fighting like hell, and I am so tired.

“What merely a few weeks ago had seemed beautiful to her, was no longer beautiful, it was nothing,” Karl Ove Knausgaard writes about his wife’s depression in his new book, Spring. “She hated it. There was nothing she wanted more than to free herself of it. It ruined her life, she often said. There was something other inside her that took her over.”

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That other, that creeping terror, that darkness is always there. It creeps around the edges of your vision even on the best days. If you get to the darkest part, and you are all alone, danger is there waiting for you. I’m a solid six out of ten.… I’m drawn to negatives in life, and I dwell on them, and they consume me.… If I get a couple of days a week at a seven, fuck, it’s great,” Scott Hutchison, the former frontman of Scottish indie rock band Frightened Rabbit, recently told Noisey.

I say “former” because last month, Scott Hutchison lost the war. Designer Kate Spade lost last Tuesday; celebrity chef Anthony Bourdain on Friday.

In the past year, four beloved musicians got stuck in the dark space and couldn’t find their way out. Chester Bennington of Linkin Park lost his war last July. Chris Cornell lost last June. Tim Bergling, the Swedish DJ-producer who performed as Aviciilost in April. I know how all these men died. I shouldn’t, but I do. I know how Kate Spade and Anthony Bourdain died. I know if they left notes. I know what method they used. There are guidelines to reporting on suicides that are perfectly clear: Don’t describe it. Sharing these details, we know, is statistically dangerous.

Among the depressed — those on the front lines — war stories are allowed, encouraged. The more people who know you’re scared and tired, in theory, the more people you have on your team. Rarely do those stories leave the safety of like-minded people with the same fears. And so we all — those of us with the brains that lie to us, who can see the vignette of depression always just there — know plenty of people struggling with our same fears. But depression manifests itself differently in different people. Its symptoms are both weight gain and weight loss, sleeping all the time and not at all. It is a loss of pleasure, a slowing of the brain and the body, an absolute conviction that those around you would be better off without you. And it is hard as hell to talk about. In the wake of these deaths, more people have been writing about this struggle, talking about it, opening up. Robin Pecknold of Fleet Foxes admitted Saturday in an Instagram post to once having been “dangerously and actively suicidal,” and that “suicide has been an at-many-times daily part of my psychic reality.”

I’m a high-functioning depressed person, and I am not brave. For years, I hid those thoughts from everyone, kept them tucked away from even those closest to me. They were too damning to share, I felt, too terrifying. I could hide the darkness — not from myself, but from everyone else — behind good grades and hard work and productivity. It feels easier, safer, to be more like Kate Spade, to tell no one how extreme your feelings are. But it isn’t actually. In a statement, Spade’s husband said that she struggled with both anxiety and depression, took pills, saw doctors, fought. But still he was blindsided; her death was a “complete shock.” 

Mental health remains stigmatized: To take an antidepressant is still, in some perceptions, an undeniable weakness; to see a therapist means that you must be broken. We are getting better at admitting that people have depression; we are even trying as a society to talk more about it. But suicide? Suicide seems, in the court of public opinion, like another level of mental illness, something beyond depression. But it’s not. The darkness can arrive at any moment. Ready or not.

These deaths are devastating. They are not romantic. They are brutal and terrible and so, so sad. Suicide is no one’s first choice. Suicide is an act a person commits because they feel they have no other option, because they feel — as David Foster Wallace so eloquently put it — like a person who jumps from the window of a burning building: “It’s not desiring the fall; it’s the terror of the flames. And yet nobody down on the sidewalk looking up yelling, ‘Don’t!’ and ‘Hang on!’ can understand the jump. Not really.” Suicidal thoughts only make sense if you’ve at one point opened the front door of your consciousness to find them on the doorstep already pushing their way in.

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As Chris Gethard says in his HBO comedy special Career Suicideabout his lifelong battle with clinical mental illness, “Sometimes people just break.” It seems like more and more people are breaking, and not only artists or famous people or the rich. Depression does not discriminate. The National Alliance on Mental Illness says that one of the action steps in preventing suicide is simply to talk openly and honestly about it. Not to debate its ethics, but to check in on people you love, even if they seem fine, explicitly about suicidal thoughts.

The hardest part for me about Scott Hutchinson’s loss, about Kate Spade’s loss, and Anthony Bourdain’s loss, is that we know they were fighting. Hutchison was even brave enough to talk about it publicly. He knew he was depressed, and he told us. He was vulnerable, and open, and he still failed. He found art that could mend him, and friends who could support him. He made mistakes, of course, but he was relatable. He lost a battle so many people are fighting. What happens if you fight like hell and still lose? You can know everything, be doing everything, and it might not be enough.

Perhaps the most important, most constructive thing we can do is continue to speak openly and honestly about the battles we are fighting; to listen, as Scott did, to each others’ stories and fears. Depression did not deserve to take any of these people. And it does not deserve to take you.

 

If you or someone you love is in need of help, call the National Suicide Prevention Hotline at 1-800-273-8255. It is free, operates 24-7, and provides confidential support for people in crisis.

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Normel Person THE FRONT ARCHIVES

Sick to Death

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Healthcare NEWS & POLITICS ARCHIVES THE FRONT ARCHIVES

NY State Government Is Bad For Your Health

When a Republican congressman from Buffalo, Chris Collins, tried to save the shambolic effort to repeal Obamacare, he had a novel idea that just about everyone else hated: make the state government pay the full share of Medicaid expenses for upstate and suburban counties.

“Collins tried to play New Yorkers for fools, and while we know he is a financial fraudster, his latest insider trading scheme backfired and didn’t outsmart the people of this state,” fumed Lieutenant Governor Kathy Hochul.

Governor Andrew Cuomo, so enraged by the $2.3 billion the state would have to drum up if Donald Trump and Paul Ryan’s American Health Care Act ever passed with Collins’s amendment, threatened to sue, raise taxes, and close hospitals. Since New York City was excluded from the Collins proposal, the city’s sole GOP House member, Dan Donovan, also panned the amendment, and came out against the AHCA. Because Ryan and Trump concocted such an awful piece of legislation, it was never brought up for a vote, and Obamacare survived.

Since Collins is a staunch ally of Trump, Democrats and more moderate Republicans could easily dismiss his amendment as a cynical maneuver to secure passage of a flawed bill. In our ultra-partisan era, ideas that emerge from unexpected places are immediately taboo. If it reeks of Trump, the average liberals says, we just don’t go there.

But Collins and his upstate colleagues were actually talking a lot of sense. Counties have been sharing the costs of Medicaid for fifty years, thanks to legislative wrangling dating back to the Nelson Rockefeller era. To pay for expenses that a state would normally cover — New York is the only state in the country that forces localities to pay a large chunk of their Medicaid costs — counties must keep property taxes unusually high. In Collins’s Erie County, for example, about 84 percent of its property taxes are devoted to Medicaid expenses.

Collins’s ally in the fight was John Faso, a freshman congressman from the Hudson Valley who will be in a pitched battle to win reelection next year. Faso understood the amendment was a winning issue because if it ever passed, property taxes would dramatically decrease. The only real problem with the Collins amendment was the unfairness of exempting New York City.

Cuomo claimed it would be “impossible” for the state to close the gap in lost Medicaid funding, but $2.3 billion in a $150 billion budget represents a crumb that could be replaced in other ways. The tax-averse Cuomo could propose a more progressive state income tax or find savings elsewhere.

Rather than do the sensible thing and advocate for the state to take on the Medicaid costs, a few members of Congress from New York are doing Cuomo’s bidding by introducing a hopeless piece of legislation. The Democratic lawmakers, including Eliot Engel and Tom Suozzi, are seeking to adjust the formula that determines how federal matching dollars for Medicaid go to the states, potentially netting New York an extra $2.3 billion. The Republican-controlled Congress will never even consider this.

More importantly, Cuomo and these members of Congress could actually make New York a bulwark against Trump’s madness by supporting an assembly bill to bring single-payer healthcare to the state. Assemblyman Richard Gottfried’s proposal would install a Canadian-style health system statewide, which would amount to a beefed-up version of Medicare paid for by tax increases. Though the assembly passed his legislation before, the Republican-run state senate — in GOP hands thanks to Cuomo’s lackluster efforts to help senate Democrats and his empowering of a breakaway group of Republican-aligned Democrats — has never even given the bill a committee hearing.

Local governments deserve to be free of a Medicaid burden that should be paid for by the state. And New Yorkers deserve serious healthcare reform that looks nothing like what Trump and his right-wing enablers have dreamed up.

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Healthcare THE FRONT ARCHIVES

New Yorkers To Trump: Healthcare Is A Human Right

If President Trump and the Republican Congress ever find a way to repeal the Affordable Care Act, 2.7 million people in New York State would lose their health insurance coverage. This past Saturday, hundreds of people marched from Midtown to Central Park in support of the New York Health Act, a bill that would offer universal healthcare. The bill has been stalled in Albany for years, but would save tens of billions of dollars.

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Healthcare NEWS & POLITICS ARCHIVES THE FRONT ARCHIVES

Escape NYC On These Five Superb, Train-Accessible Hikes

Spring is here, and for those wanting to stretch their legs outside, several day-hikes and overnight backpacking adventures are available just north of the City. All of these hikes are accessible by train, in some cases in conjunction with a cab ride.

These particular hikes are not for those desiring a mildly-exerting walk in the woods. They offer dramatic mountain views and, as such, are strenuous, though doable for most fit people. As with any hike, these routes require basic navigational competence based on an actual map, not Google. (While Google Maps may work in a pinch, you can’t depend on service.)

Proper equipment is essential, beginning with a map (I can’t say it enough: get a map), boots and bug spray. You’ll need a backpack to carry water and food. For overnight trips, additional overnight equipment is required, obviously, including a lightweight backpacking stove, shelter and sleeping bag. For maps and other equipment, this author prefers to shop at Tent & Trails, an outfitter on Park Place in lower Manhattan, near City Hall.

More information about these hikes and others can be found on the website of the New York-New Jersey Trail Conference, which also maintains the trails listed here.

A view of Breakneck Ridge from Mount Taurus. The Breakneck Ridge Trail goes straight up the nose of the ridge, from left to right.
A view of Breakneck Ridge from Mount Taurus. The Breakneck Ridge Trail goes straight up the nose of the ridge, from left to right.


BREAKNECK RIDGE

The Breakneck Ridge Trail, in the Hudson Highlands, is the gold-standard of day-hiking trails around New York City.

The highest peak in the Hudson Highlands is Beacon Mountain, at 1,611 feet, but the most picturesque place is where the Hudson River first flows into the Highlands, just north of West Point. There, two mighty precipices stand sentinel on either side of the river: Storm King Mountain to the west and Breakneck Ridge to the east.

The Hudson Line of the Metro-North railroad provides easy access to Breakneck. In fact, the railroad runs through a tunnel at the base of Breakneck Ridge itself, and on weekends a small whistle-stop lets hikers on and off the train there. (Monday through Friday, the station at Cold Spring is the closest station.)

The trailhead for the Breakneck Ridge Trail is at the base of Breakneck Ridge on Route 9D, just north of the road tunnel that runs through the base of the ridge, parallel to the train tunnel. The Breakneck Ridge Trail is marked by white “blazes,” which are square-splotches of white paint on the trees and rocks adjacent to the trail. Follow the white blazes all the way up.

This hike is especially strenuous and steep. It includes scrambles up rock ledges and cliff-top traverses. At the top, sweeping views await of the Hudson River Valley, and to the north all the way to the Shawangunks and the Catskills.

From the top of Breakneck, continue north on the white-blazed trail to where it meets with a yellow-blazed trail in a small dip between peaks of the ridge, about .5 further on from the final “peak” or ledge. From the junction, follow the yellow-blazed trail down, as it passes a spring and a primitive rock shelter.

The Hudson river flowing through the Hudson Highlands.
The Hudson river flowing through the Hudson Highlands.

Another .5 miles or so further on the yellow trail ends at a red-blazed trail, and there you have three options for returning to the train station at Cold Spring. Either way you choose, you can’t lose, because each offers something unique.

The easiest way to go is to turn right onto the red trail and follow an old road out past the remains of a derelict mansion. The hardest way to go is to turn left on the red trail, to its junction .2 miles away with the blue trail. Follow the blue trail 1.0 miles to a junction with a white-blazed trail on the right. Follow the white-blazed trail right, up Mount Taurus (where more dramatic views await) and down back to Cold Spring.

The last, longest and most remote way to return to Cold Spring is go as you would as if you were going up Mount Taurus on the blue trail, but instead of turning onto the white trail, continue straight on the blue trail all the way to the road. At the road, turn right and walk the road downhill, back to Cold Spring.

Winter sunset as seen from the top of Anthony's Nose. Bear Mountain is to the left, and Popolopen Torne to the right, directly behind the curve in the Palisade Interstate Parkway, seen in the middle.
Winter sunset as seen from the top of Anthony’s Nose. Bear Mountain is to the left, and Popolopen Torne to the right, directly behind the curve in the Palisade Interstate Parkway, seen in the middle.

ANTHONY’S NOSE via THE CAMP SMITH TRAIL

Eleven miles south of Breakneck Ridge, another significant precipice with dramatic views stands on the east side of the river: Anthony’s Nose. As with Breakneck Ridge, Metro-North’s Hudson River line from Grand Central is your access. Take the train to Peekskill. Cab or walk the 2.2 miles to the trailhead at the old Bear Mountain Toll House on Route 6/202. Follow the blue-blazed trail that begins behind the old toll house.

The trail climbs into the southern edge of the Hudson Highlands as they rise just north of Peekskill. The trail is rocky, and steep in some places, and features increasingly better views the higher it climbs. The trail follows a slim right-of-way along the road, but in most places at a higher elevation so road noise is minimized.

At 2.7 miles, the trail gains the first of several rock outcroppings high above the river, which offer both summer and winter views. At 3.1, you arrive at the top of Anthony’s Nose itself. The Bear Mountain Bridge juts out across the river below you. Bear Mountain itself rises on the other side. Freight-train tracks on the other side of the river complete the rugged, pastoral picture.

You have 5.5 miles to go. Follow the blue-blazed trail .5 further on to its junction with the white-blazed Appalachian Trail. Follow the white-blazed Appalachian Trail roughly 3 miles north to its junction with a blue-blazed trail. (This will be the second junction with a blue-blazed trail since the road-crossing just before Canada Hill.) Follow the blue-blazed trail to the road and road-walk to the Metro-North station at Garrison, or find a way through the Glenclyffe preserve on the west side of Route 9 to the station.

On weekends, and only on weekends, when the trains stop at Manitou Station (a small whistle-stop like Breakneck’s), you can cut 3.5 miles off the hike by turning left onto the Appalachian Trail after Anthony’s Nose, following the Appalachian Trail down to Route 9, and road-walking to the Manitou Station at the bottom of the mountain, beside the river.

A winter view of Anthony's Nose, the Bear Mountain Bridge and the Hudson River as seen from Popolopen Torne.
A winter view of Anthony’s Nose, the Bear Mountain Bridge and the Hudson River as seen from Popolopen Torne.

POPOLOPEN TORNE via MANITOU STATION

Standing nearly 1,000 feet high, just north of Bear Mountain, a jagged spike of bare stone called Popolopen Torne sticks straight up into the sky. From the top of the Torne, a rare 360-degree panoramic view can be had that takes in Bear Mountain and Harriman State Park to the South, the Hudson River and Anthony’s Nose to the east and West Point Reservation to the north and west.

There is no water there, but if you carry enough water you can camp overnight at the top of the Torne. If you’ve never stood on a mountaintop at night and been totally surrounded by stars, this is a good place to experience it for the first time.

On weekends, take the Metro-North Hudson line to Manitou and road-walk to and across the Bear Mountain Bridge. On the other side of the bridge, go to the traffic circle and bear right onto 9W, toward West Point. On the other side of the traffic circle, cross 9W and find the trailhead for the red-on-white blazed Popolopen Gorge Trail.

Follow the red-on-white blazed Poplopen Gorge Trail to the blue-blazed Timp-Torne Trail. There, go right and follow the blue-blazed trail across the bridge and up, and up. Return via the Timp-Torne and Twin Forts trail through Fort Montgomery, across the suspension foot-bridge over Popolopen Creek, back to Manitou.

The famous view of NYC from the West Mountain lean-to.
The famous view of NYC from the West Mountain lean-to.

WEST MOUNTAIN via SUFFERN-BEAR MOUNTAIN TRAIL

Fifty miles north of New York City at a height of 1,257 feet, a primitive, three-sided shelter constructed of wood and stone stands at the top of West Mountain. Shelters like these are called “lean-tos,” because of the way they’re constructed.

The West Mountain lean-to is famous to those who hike the Appalachian Trail, because the shelter is the one place where New York City can be seen from the trail itself.

But the West Mountain shelter is not just for those who hike the Appalachian Trail, and can be used by anyone, at any time of year. By train, the West Mountain shelter is best accessed by the Suffern-Bear Mountain trail from Bear Mountain. On weekends, take the Metro-North Hudson line to Manitou and road-walk across the Bear Mountain Bridge to the trailhead. Other times, take a Hudson Line train to Peekskill and a $20 cab ride to the Inn.

The Suffern-Bear Mountain trail begins behind the Bear Mountain Inn. From the Bear Mountain Inn follow the Suffern-Bear Mountain trail 3.3 miles to the top of West Mountain. Stay the night at the shelter, return to the Bear Mountain Inn via the Appalachian Trail or continue on the Suffern-Bear Mountain trail.

A stand of trees in Harriman State Park.
A stand of trees in Harriman State Park.

SUFFERN-BEAR MOUNTAIN TRAIL

A Stiff New Trail Calls to Hikers,” was the headline of a 1927 New York Times article written by Edward Torrey, detailing a hike over the then-new Suffern-Bear Mountain trail. “This new trail is twenty-four miles long, following the curves of ridges, dipping into gaps for springs and waterholes, yet pursuing a course intended to combine with scenic values a reasonable degree of directness,” Torrey wrote.

I hiked it south to north, from Suffern to Bear Mountain, over two days in January. This is not for beginners.

Start at Pennsylvania Station and a ride on New Jersey transit to Suffern. Walk forward in the direction the train was traveling in and follow the road that parallels the tracks north, as it passes under the New York State Thruway. After the last house, find the rock-ledge on the right where the a yellow-blazed trail begins, and follow the trail up into a small draw. Follow the yellow-blazed path 24 miles to Bear Mountain.

At .3, a southern lookout affords a sweeping view of the vast carpet of suburbia that stretches from the foot of the mountain all the to New York City. Say goodbye. From here, the trail turns north into the remote southern part of Harriman State Park. Bisected by numerous power-transmission and natural gas pipelines, this section of the trail feels open and rugged, as the cuts allow sweeping vistas of undulating hills for miles into the distance.

At roughly 4.0 miles the first of three lean-tos on the trail is reached, the Stone Memorial shelter. The Big Hills Shelter is another 3.5 miles further on and, after that, 3.1 from the end of the trail at Bear Mountain, is the West Kill Mountain shelter described above. Water sources abound along the trail, even in dry summers (you’ll need to purify it, of course).

Generally speaking, the trail is a wild roller coaster of a hike, particularly at the north end. The steepest part of the trail is the climb up Pyngyp Mountain, right after the trail crosses the Palisade Parkway. The climb involves scrambles up steep, near-vertical rock. Dogs cannot make the climb. Wise backpackers carry a 30-foot length of strong cord, so that they can climb free up the steep spots, and pull their backpacks up behind them.

I did it in winter, when it was covered in snow.

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Even Rightbloggers Admit That Trumpcare Sucks

If you had been listening exclusively to Republican propaganda for the past several months, you’d expect the long-delayed introduction of their Obamacare repeal-and-replace bill last week to be greeted with hosannas, especially by our friends the rightbloggers. But instead the American Health Care Act went off like a stink bomb and has been denounced by nearly everyone — including the AMA, AARP, and even some Republican Senators.

So conservatives had to go to Plan B — or, in some cases, Plan B-minus. Either they said they, too, were against the bill — not because it was too stingy like everyone said but because it was too generous; or they shrugged and told followers, look on the bright side, at least it’s a step in the right direction, i.e. destroying all hope of a sane national health care policy.

As anyone who has ever met a Republican would expect, the GOP’s American Health Care Act (AHCA) would take from the poor and give to the rich, strip coverage from millions of Americans, and reduce the quality of coverage from those lucky enough to keep it.

Congressional leaders and administration officials didn’t bother to deny this, but spun it as best they could, which was not very well at all — HHS Secretary Tom Price said “nobody will be worse off financially” (seeming to assume that insurance has no financial value), and Rep. Jason Chaffetz suggested anyone who was losing coverage could afford it by buying more “rather than getting that new iPhone that they just love.”

Some conservatives complained that AHCA gave too much to the poor and the sick, and bestowed upon it the derisive name “RINO care” after an extinct breed of Republican that, it is said, could pass a safety net without trying to shred it.

“Still an aspect of socialism,” said Sarah Palin. “Not a market-oriented plan,” said radio shouter Mark Levin. “…They have embraced the progressive agenda, and Barack Obama and the Democrats have won.”

Objectivist-Republican Senator Rand Paul was displeased that, instead getting only derisive laughter in exchange for their lost Obamacare subsidies, Americans would under the AHCA receive tax credits, which are still socialism. “A family that makes $30,000 a year could actually get $14,000 that they didn’t pay,” he gasped — fourteen grand that could have gone to a corporate donor!

At Conservative Review, Daniel Horowitz raged that the bill did not repeal “the mandated essential benefits” of Obamacare — which include emergency services, preventive examinations, eye care for children, prescription drugs, etc., though Horowitz seemed to think they meant “sex change operations” and “maternity care for men.”

Mainly the hardliners were angry that sick people would be covered and healthy people would pay for it — an essential feature of health insurance.

House Speaker and AHCA pitchman Paul Ryan tried to blunt this criticism by saying, he, too, couldn’t accept a healthcare system in which the fortunate helped the unfortunate: in a much-mocked PowerPoint presentation, Ryan complained that under Obamacare “young and healthy people are going to go into the market and pay for the older and sicker people. So the young healthy person’s going to be made to buy healthcare, and they’re gonna pay for the person who gets breast cancer in her 40s…” Can you imagine anything more unfair and — yes, I’ll say it — un-Christian?

Ryan proposed instead creating high-risk pools for the sickies, which didn’t work when when the feds last tried it as the Pre-existing Condition Insurance Plan (PCIP) program, perhaps because they didn’t clap hard enough for it.

Still, sociopaths across the nation complained that Republicans were still making healthy people who would never get sick pay for people who had been fated by a merciful Creator to suffer illness. “Who really wants to pay the health coverage of the 500 pound fat woman at home? I don’t,” said Cash McCall. “Who wants to pay for some reckless gayblade that comes down with HIV?”

Required by his exalted position to put it a classier way, David Harsanyi of The Federalist referred to the pre-Obamacare state in which millions of people were one misfortune away from chemo they couldn’t afford or medical bankruptcy as “an imaginary humanitarian crisis,” like flying saucers. Democrats created Obamacare as a fake remedy for a fake crisis, Harsanyi continued, in order to gain “social engineering and coercion, allowing technocrats to dictate how a third of the economy functions,” as required by the Third International.

Nonetheless, Hansanyi sighed, the GOP’s “Obamacare Lite” might have to do, and encouraged readers to look on the bright side: For one thing, at least it stripped funding from Planned Parenthood and ended much abortion coverage, offering Christians hope of a back-alley coat hanger revival. And there was also the prospect of “expanded health savings accounts, and creating real-life illustrations of successes,” such as, perhaps, some scrappy poor kid buying his own asthma medicine with money he would have otherwise wasted on shoes and a winter coat. People are sure to relate!

At National Review, establishment conservatives mainly made excuses for how bad the bill sucked.

Ramesh Ponnuru argued that since “aspects of Obamacare are popular,” Republicans had to give their bill some ugly features in order to avoid a Senate filibuster (though how the non-budgetary parts of the poorly-conceived bill would pass the Byrd Rule is hard to figure).

His colleague Liam Donovan asked readers to sympathize with the Republicans, for “harsh judgment on the American Health Care Act has been rendered without acknowledging the parameters within which Republicans are forced to work…”

Dan McLaughlin also pleaded for understanding: “A total and immediately effective repeal with no backup plan would create losers who would be angry and sympathetic,” he admitted, so the lousy GOP bill was “driven not by a desire to produce the best plan for the country’s future, but rather by a desire to address the difficulty of transitioning out of the bind created by Obamacare’s entrenchment over the past four years.” You can’t make a libertarian omelette without breaking a few social contracts!

“It is much too early to draft eulogies for this effort,” said Yuval Levin, as one does when things are going great.

strap it on tight called for “Great Communicators” to sell the bill to citizens, then wrote a column disqualifying himself from the job (“Thrilling as it might be to throw the parachute out before the jump, it remains safer to strap it on tight and add in a backup for good measure”).

Others just overtly moved from the now-traditional liberal-tears “Fuck Your Feelings” approach to a “Fuck Our Principles” one: At the Daily Caller, for example, Joe Alton warned that Democrats were “propagating the (false) belief that Republicans are mean-spirited and uncaring” and advised that though “the price tag on Medicaid expansion has been a hefty one… losing governorships, state houses, and, perhaps, even the House of Representatives, carries an even higher price for conservatives and the country.” Insert Blazing Saddles phoney-baloney jobs clip here.

Why did they even roll this out? Gotta start somewhere. We can assume this bill will undergo many changes — not to make it less horrible (any bill they pass and The Leader signs will suck), but to make themselves look like they’re being responsive to the Will of the People instead of driven by campaign donor demands and deep-seated anti-social impulses to ruin the country.

Given citizens are liking Obamacare better the closer Republicans get to killing it, expect the GOP to try a lot of new things to convince us — maybe, for example, sending citizens a free Lord’s Prayer novelty key chain for every essential health benefit they take away — before ramming it through. If not for the millions of people who’ll suffer from it, I’d say it would be fun to watch.

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Five Decades After Roe v. Wade, Doctors Train to Keep Abortion Out of the Shadows

The procedure is nearly silent. The tools are portable, easy to fit into a large purse or small knapsack. The “no touch” technique, in which the doctor’s hands never make contact with the portion of the instrument that enters the woman’s body, is ideal for “low-resource settings,” sans electricity or sterile facilities. Even the way my fellow students and I learned to hold the tenaculum (long metal pincers used to grip the cervix) ensured the procedure could be virtually undetectable once it was completed. These are abortions you can do in the dark, with a $20 plastic tube and the flashlight on your phone. Though we were encouraged to assist one another, instructor Brent Monseur assured us that “in real life, you can do this completely solo.”

What he didn’t say was, in a post-Roe future, we might have to.

While still technically legal in all fifty states, abortion has been slipping down the back alley for years. Between 2011 and 2014 alone, 17 percent of the country’s dedicated abortion clinics disappeared, thanks in large part to waves of extremely restrictive state laws. Mike Pence, the vice president, is an anti-abortion hard-liner who signed an Indiana abortion law that the Washington Post called one of the strictest in the nation.

General clinics offering prescription terminations have surged in their wake, with the combination of mifepristone and misoprostol or similar drug cocktails now accounting for close to half of early abortions. But those drugs, too, are tightly restricted, leaving Etsy stores selling herbal abortifacients and Twitter accounts hawking misoprostol without a prescription to fill the gap. The Trump administration wants to leave abortion to the states, in practice making it disappear from much of the country.

Despite this — or because of it — interest in abortion rights is soaring. Since the election, organizations big and small have been inundated with medical students, volunteer clinic escorts, and hand-holders looking to put their bodies on the front lines of the battle for reproductive freedom.

Practicing first- trimester abortion skills at a Medical Students for Choice workshop

“We’ve never had anywhere near that level of demand,” said Lois Backus, executive director of Medical Students for Choice (MSFC), which runs the abortion training intensive program I attended last month. A kind of abortion boot camp for aspiring providers, the February training received close to 200 applications for just 30 spots. Students had traveled from across the country to attend the weekend-long conference in Philadelphia, and for many, the hands-on practicum was the highlight of their trip.

“Oh my God, this smells amazing,” cried 22-year-old Lisa Lavelanet, an aspiring pediatrician with a wax-print headwrap and flawless winged eyeliner, as she set up to perform the country’s most contested medical procedure. To her right were the tools of a first-trimester abortion: the thin metal tenaculum, two plastic cervical dilators, a long, pliable cannula, and a manual vacuum aspirator. To her left lay the patient, an insentient and overripe Hawaiian papaya.

Cheap, plentiful, and remarkably analogous to the female reproductive system, papayas have for years been the go-to model for early-term abortions. In the process, papaya workshops have become a kind of gateway drug to abortion training for American medical students, many of whom will neither see an elective termination nor even hear one discussed throughout their formal education.

“My course director for this next block is a man who is pro-life — that’s our women’s health course director,” said Hytham Rashid, 27, of Nova Southeastern University, who recently taught his own papaya workshop in Jerusalem. “In South Florida, I don’t even know where the Planned Parenthood is. That’s a real issue for medical students — we don’t even know where the resources are because it’s not in our curriculum.”

Given how difficult it is to learn about abortion, you’d expect the first-trimester procedure itself to be complicated. It is not. Among the greatest victories of the anti-abortion rights movement has been to convince Americans that abortion is as invasive and potentially life-threatening as liposuction, when the reality is closer to a breast biopsy.

“People really do think you’re taking them into an OR and chopping up their uterus,” said Clara Johnson, a 26-year-old student at the University of Oklahoma. “Really it’s only a little more complicated than a Pap smear.”

In fact, a manual vacuum aspirator looks uncannily like a LifeStraw, the personal water filter system survivalists keep in their go kits. It takes more upper body strength to inflate a soccer ball than to generate the 60 millimeters of mercury vacuum pressure needed to evacuate a uterus, and significantly less time to complete the procedure than to read this article from start to finish.

“The procedure itself was not traumatizing at all,” said Queens artist Poppy Liu, 26, whose short film about her abortion, Names of Women, debuted the night after Trump’s inauguration. “I was awake the whole time. It lasted under two minutes.”

While the right to a surgical abortion of the kind taught in papaya workshops is a keystone battle of the pro-choice movement, the introduction of abortion drugs that can induce terminations has changed the landscape. In 2014 fully 45 percent of American abortions performed before nine weeks gestation were induced by a combination of pills, usually mifepristone and misoprostol.

Activists see these so-called medical abortions as a ray of sunshine in the otherwise stormy climate for reproductive rights. A few even consider early surgical abortion essentially obsolete.

“I don’t understand why anyone would be teaching us in the U.S. to be using a vacuum aspirator when all you have to do is take a pill,” argues public health researcher and medical abortion evangelist Francine Coeytaux. “Even if you go to Planned Parenthood or a clinic and you choose a medical abortion over a surgical abortion, you’re pretty much doing it yourself.”

Coeytaux says that in some countries, the proportion of abortions induced through medication is now close to 90 percent. “We’re only at half because we have such a provider bias about it being done by doctors,” she says.

Abortion pills, however, still have drawbacks. While many women see surgical intervention as more frightening than taking a pill, the medication-induced abortions are functionally chemical miscarriages, and tend to hurt a lot more. The prescription “works well for women who prefer what they think of as a ‘more natural’ method,” Backus told me, but it costs roughly the same as a surgical procedure and takes an average of four to five hours at home.

Jessa Jordan, 25, a model and burlesque performer in Philadelphia, says her medication-induced abortion included “very intense cramps” that made it “very difficult to walk.” Jordan says that she would have been more fearful going into a surgical procedure, but still recalls the drug-induced miscarriage as intensely painful. She compared the six-hour process to the discomfort she experienced having her back inked at a tattoo convention. “That’s by far one of the most painful tattoos I’ve had, and if I had to scale the pain between that tattoo and having the abortion, I’d say the tattoo was about a seven and the abortion was about an eight and a half,” says Jordan.

Planned Parenthood supporters gathered in Lower Manhattan in February to protest Republican plans to defund the pro-choice organization.

In addition to being painful, medication-induced abortions can be surprisingly difficult to get. Many states have created byzantine hurdles, turning what could at least be a home procedure into one that requires multiple trips to a doctor or hospital.

“It’s just as hard to get one in Texas as it is to get a surgical abortion,” says Leah Payne, 27, a commercial insurance manager for an oil and gas company in Fort Worth, Texas, and a Planned Parenthood volunteer who had her own medical abortion in 2008. “It’s three appointments to take four pills in my mouth and a week of doxycycline,” and that was almost ten years ago, before the state enacted its most restrictive laws.

Restrictions on medications like mifepristone and misoprostol have, ironically, sent some women back to illegal abortions with gray-market misoprostol alone. The prescription-free pills are an ad-hoc Plan C, and even the most cursory Google search suggests they are cheap and abundant where traditional abortion care is not. Rights activists, like Coeytaux, see medication as the future of legal abortions, and the gray market as an important stopgap in places where abortion is increasingly inaccessible. “It’s going to be a while before we can make it officially over the counter, but I think we already have a lot of access,” to cheap, safe, do-it-yourself abortion care via the internet.

The future of reproductive choice may well hinge largely on over-the-counter prescriptions. For the moment, however, the election has created a surge in support for clinics that even a decade of successively more egregious anti-choice legislation could not. In the months since November, Payne, the Texan, says the number of would-be volunteers looking to escort patients from their cars to the clinic or to simply help out with clerical work at her local Planned Parenthood have increased tenfold.

“There’s a Planned Parenthood not far from my house, and we have gone from training five or six people to having fifty to sixty people in a room for a training,” Payne told me. “I’ve been involved with politics from the time I was sixteen and I’ve never seen anything like this.”

The change isn’t limited to anti-choice states like Texas. New York City’s Doula Project, whose “abortion doulas” support patients in local Planned Parenthood clinics, received triple the normal volume of applications for its spring 2017 training. “We’re all in danger of losing our reproductive rights in the next four years, and it’s pretty terrifying right now,” says Doula Project spokeswoman Sarah McCarry. “I think that people are looking for very tangible forms of activism that can be a way to channel that fear.”

While for some it might seem surprising that the Doula Project, known mainly for help with childbirth, would train “abortion doulas,” those who have had abortions never fail to cite the volunteer who held their hand through the procedure as a source of enormous comfort and relief.

Planned Parenthood supporters gathered in Lower Manhattan in February to protest Republican plans to defund the pro-choice organization.

“You have this very intense connection with someone for a short period of time,” McCarry told me of her experience as an abortion doula. “People will come in and say ‘this is a terrible thing to be doing.’ And I’m like, ‘you’re the tenth person I’ve seen today.’ There are thousands of people who are going through this. I think that can be very comforting for people who have no idea how common abortions are.”

Organizations like the 1 in 3 Campaign and Shout Your Abortion are working to erode the stigma surrounding elective terminations in the United States, but the continuing availability of reproductive choice still depends on a vanguard of young doctors. Just thirteen states allow abortions to be performed by physician assistants and some advanced nurses. While attacks on abortion care are overt, their impacts on medical education are more subtle — and in much of the country, far more insidious.

“A lot of places in the South or Midwest, there are no providers within the medical student’s community,” Backus explained. Medical students are likely to observe an appendectomy as part of their third-year clinical rotations. Not so with abortions — just six percent of which are done in teaching facilities — though they are more than twice as common.

“We have to actually ship them other places,” Backus said of medical students and residents who seek abortion training, often sending them to hesitant providers at stand-alone clinics who may never have had an apprentice before. Now, even those slim ranks are being stretched to the limit, as clinic closures cripple care in the South and Midwest. In states like New Jersey, where the number of clinics offering elective terminations has actually increased, virtually all new providers offer medical abortions alone.

Even as activists press for over-the-counter access to medications, workshops like those from MSFC provide a crucial — and even increasingly important — link between future doctors and the basic tools of reproductive choice.

“We did the papaya workshop [at a student event] and that’s what really got me interested,” said medical student Jeremie Oliver, a onetime Mormon missionary and aspiring plastic surgeon whose square jaw and Midwestern good looks belie an upbringing on Oahu’s impoverished North Shore. “I think if you talk to everyone in the room, the vast majority would say that they don’t get formal training on these topics in their medical school curriculum. It just doesn’t exist right now.”

Close to 20 percent of medical school programs never mention abortion, either in lecture or clinical rotations, and while abortion training is technically mandated for residents in obstetrics and gynecology, at least 16 percent of programs don’t teach it, and only about half make it a routine part of their curriculum. So even many OB-GYNs leave medical school unfamiliar with how to perform the procedure.

Read the companion piece to this article: <a href="/news/in-1967-abortion-meant-indignity-fear-and-pain-9743640" target="_blank">In 1967 Abortion Meant Indignity, Fear and Pain</a>.

That’s an omission that MSFC is trying to remedy by expanding the pool of providers beyond the traditional realm of women’s health. For every aspiring OB-GYN I met at the abortion training intensive, I also met a future pediatrician, plastic surgeon, or family doctor. I even spoke with a Dallas-based neuroscience MD/Ph.D. student who parlayed her papaya workshop into an informal rotation volunteering at a local abortion clinic.

“I like to see things for myself,” she told me matter-of-factly. “I wanted to seek it out, especially because there are all of these restrictions here in Texas.”

In a way, letting future doctors in many specialties see for themselves is the goal. The purpose of the intensives isn’t to churn out new abortion specialists, but to familiarize doctors across many medical fields with a treatment that one in three American women will undergo in their lifetimes.

“I think that incorporating abortion into general care is important for destigmatizing it,” said Libby Wetterer, 24, an aspiring family physician and first-year medical student at Georgetown, whose associated hospitals are prohibited from performing elective terminations.

Wetterer is Catholic and only became pro-choice in college. She said she never imagined herself actually doing elective terminations until she began applying to medical schools and realized she might not have the opportunity to learn them.

“If Roe v. Wade gets overturned, having more physicians trained to perform abortions is really important,” Wetterer told me. “I see it as a responsibility.”

Correction: Because of an editing error, an earlier version of this story incorrectly referred to a “Plan B-induced miscarriage.” The procedure that Jessa James underwent was a medical abortion, which is induced with misoprostol and mifepristone, not the Plan B emergency contraceptive pill.