In today’s interview, Leah Libresco Sargeant speaks to Dr. John Bruchalski. He is an OB/GYN based in Virginia, and the author of the recent memoir Two Patients: My Conversion from Abortion to Life-Affirming Medicine. Sargeant is the creator of Other Feminisms, a substack focused on the dignity of mutual dependence. Their conversation has been edited for length and clarity.
Leah Sargeant: Dr. John Bruchalski, you’re an OB/GYN who used to practice what people would think of as the full spectrum of obstetrics and gynecology, including abortion. And that’s something you chose to walk away from.
I want to ask you a little bit about that choice and about what your new practice looks like, starting with one of those pivotal moments you described in your book when you went into the operating room for an abortion and were confronted by a baby. Can you tell me about that night?
Dr. John Bruchalski: At that point, I’m working at a pregnancy center at night, but during the day, I am doing the full spectrum of OB/GYN, including aborting healthy children, sick children, just about for any reason at any time. Abortion on demand.
And that dissonance is becoming more and more tense for me.
So there I am in one room saving a 22-weeker because the mother desperately wanted it. She’s praying, she’s begging, she’s imploring. We have her in Trendelenberg [a position to forestall premature labor], kind of tilted backwards. We’re using medication and antibiotics, and she’s getting better.
In the other room, mom didn’t want it. She’s like, “No, just get rid of it.” And what did I do? I broke her water and pitted out the baby [administered Pitocin to induce labor].
Now the baby comes out and I lift it. And usually when a baby’s born alive in an abortion, we suffocate it [by not assisting breathing].
But it felt a little heavy. I threw the baby on the scale and lo and behold, 505 grams [over the legal limit, requiring life-saving treatment], I had to call the intensive care nursery. In walks Dr. Debbie Plum [from the NICU team], she takes one look and says, “Hey John, you’re better than this. Stop treating my patients as tumors.”
This baby weighed about a pound and a quarter. Its skin was translucent. It made noise, it was obviously human, part of our family. But the dissonance is: no, call it a fetus, it’s not wanted.
It’s unwanted. So therefore we need to terminate it. The mother doesn’t want it, society doesn’t want it.
LS: I was really moved reading your story of that night and that delivery. I went and looked up kind of what that critical threshold was for the baby. And it was five grams, you said, over the limit.
And so I looked up, what else is five grams? A sheet of paper. A sheet of paper weighs five grams. And that was the measure of what made someone a person or not in the hospital.
JB: That’s exactly right. Once you remove medicine from truth and justice and equality and equity and ecology, five grams—a sheet of paper or whatever the mom wants. It’s a desire.
I began to see my heart hardening as I was doing more and more abortions. You go from the little ones that have no bones to the ones that have bones, and eventually you realize something’s not right here. You think now it’s human, at one point it wasn’t. But no: I later realized that if mom and dad give us the egg and sperm, it’s a human life. Period.
LS: I want to dive in on that shift in vision. I think of these arbitrary thresholds (five grams, one more week) as the things that mark the change from objects to persons. And these thresholds are particularly painful in the context of abortion, but they’re also problems in a lot of places in medicine.
For example, doctors might say: “Oh, you’re not quite sick enough for a transplant. But once your numbers move by 0.1 on this scale, we’ll be able to treat you differently.” And I know that in some cases those numbers come out of a real place of care, of we have to make these decisions based on aggregate data. But as a doctor, how do you balance “These numbers tend to work overall,” and “I have a single patient in front of me I want to advocate for?”
JB: You always hate the disease, but you always love the patient. That’s the core of medicine.
For instance, the thyroid gland has a normal range, but that normal range is based on an aggregate, it’s not your range. So in my practice, one of the ways I’ve done this just in medicine is if your TSH is above a two, it’s telling me that it’s working too hard.
Well, why not try a little bit of supplementation or kelp or iodine? You have to look at the individual person and listen to her story. And that’s what happened that night when I tried to kill that baby. She was further along than I thought. Once you start becoming callous to human lives, it becomes a calculus: put in the numbers. You meet the bar. I’m convinced it’s like the train platform at Auschwitz-Birkenau. You go here, you go there based on some line drawn between human and non-human. Some people are part of the human family and some are not.
And I think medicine, because we’ve been a part of eugenics and a part of destroying the weak forever, there’s a dark side to medicine that you really have to be careful about. There’s a better way to practice.
LS: I appreciate that, especially because I think this is an issue, again, that’s certainly in stark relief in obstetrics and abortion, but it’s not limited there. I got a quote from the book here.
“We were taught to trust our patients above all else. And for whatever reason, this woman felt the abortion would make life better. It wasn’t my place to question her choices. I was there to help women.”
And I can tell that your practice is moved by love in both cases when you were providing abortions, now when you’re eschewing them.
But there’s also this pressure from the medical system that the doctor is a vending machine, that you’re there to provide a service. And that’s not limited to abortion. So how do you resist that vending machine pressure, even in a pro-life practice? Where does that pressure come from?
JB: Modern bioethics is based on patient autonomy. I don’t do abortions anymore because they’re not good for unborn, the most weak. But it’s also not good for families or moms, psychologically, medically, that sort of thing. Or even for me as the abortion provider: I’m still post-traumatic. It was part of my life.
When I became this holistic, integrated, life-affirming doctor, I will try many alternatives to see where the data leads us. And you realize that when you listen to your female patients, they are live books.
LS: I like that metaphor because I’ve been in the position where it feels like I have to advocate for myself against a doctor. And so I’m sympathetic to someone who feels like they’re coming in to try and kick the vending machine to get the treatment to come out.
I think good medicine relies on a trust that isn’t there for many patients with their doctors or for doctors with their hospital system, at every level. That lack of trust is part of why people are so skeptical about the possibility that there’s a way to treat both patients; instead, they expect it to be a zero-sum game.
When you look at the statistics on maternal mortality in America, it’s clear many doctors aren’t treating both patients. They may be shortchanging mother and child, but it’s clear moms are getting shortchanged. The most famous recent example was Serena Williams, a famous woman, an important woman, a rich woman having to drag herself off her hospital bed to beg to be checked for a condition she knew she had that was putting her in danger of death.
And when I see those stories, I understand why people who are pro-choice and who care about women say, “I don’t trust the pro-life movement to write laws that won’t leave women in trouble, even if hypothetically it’s possible to do perfect practice.”
I’m going to give you a specific example: imagine a woman who comes in with premature rupture of membranes at 19 weeks. Is it possible to take care of her and the baby? Certainly. Do they expect the doctor is going to do it? No.
So how do you respond to that lack of trust where it’s possible to practice medicine, in a way that woman and baby are taken care of, but manifestly we don’t? How do we advocate a system of laws that puts the appropriate weight on the baby’s life when we know we don’t put that weight on the mother’s life, even in an uncomplicated delivery?
JB: I have to be honest with you, that’s a very hard question because “the life of the mother” exception is a political reality. It’s not scientific.
The only way that you can regain this trust, I believe is not politically, it’s actually by witnessing. So Tepeyac OB/GYN and Divine Mercy Care, what we do now is just out there trying to respond to this question that you ask me. In our practice at Tepeyac, we probably have eleven women whose water broke at 15 weeks. And they all delivered children over 34 weeks.
LS: How do you have a conversation with a mom in that position about what the risk is like? Because I think that risk really worries people.
JB: You can tell a mom in that position that the world literature that has researched water breaking early says you should be able to wait. It says you have to monitor her very closely, along with following her baby. So I tell these moms that we’re going to be taking her temperature every day, morning and night. And by monitoring them closely, we will deliver you as soon as there’s any sign of infection. Because if there is, we then target the infection, not the baby.
You would never tell her, “Well, I’m going to kill your baby to save your life because you might die of an infection.” That’s bad medicine and bad anthropology. In our practice, sometimes this decision to keep monitoring rather than abort the baby leads to polarization between dads and moms. Many dads are like, “No, don’t do this, let’s end the pregnancy now.” And the mom says, “Well, wait a second. I’m not sick yet. I don’t want to give up yet.”
When I aborted those children right away, I would’ve said to the mother: “I saved your life.” But in our collection of thirteen, fourteen cases at Tepeyac, they all made it. And I’m just interested in accompanying people through really tough illness and disease without pitting the mom against the baby.
When young pregnant women come to the office and are considering abortion I say, “I’ve done that. I used to do abortions in this case, but I don’t anymore.” And I tell them: “You can go elsewhere. I can’t help you do that, but you can always come back to me for any complications. Why? Because I value you. I value your decision even though I don’t do it. You’re always welcome with us.” And you’re trying to meet them in their shame, in their pain which often tells them that they have no choice and that they have to get an abortion: “I have no choice. I have to do this.”
LS: I want to ask you about that open door. Your story isn’t simply as a story about walking away from abortions. You didn’t just give something up, you deliberately took on something new.
You talk about having a particular call from Mary to “always see the poor and see them daily.” That’s very different from just saying “I won’t perform abortions anymore.” It changed where you could practice as much as not doing abortions did. Can you talk about what that changed for you as a doctor beyond just, “I won’t do abortions”? How did that change where you and how you could practice?
JB: When I was in undergrad and in medical school, I went and worked in Appalachia. But [students in medical school often] want to go on mission trips. Well, with all due respect, just look in your own community. There are men and women who live right next to you who are living below any level of dignity.
People like Paul Farmer from Harvard working in Haiti show that health is based on relationships. Medicine is an act of mercy. Again, you hate the disease, but love the patient. By collaborating in community, you can build a space where abortion becomes unwanted and children welcomed.
It’s very rewarding to practice excellent women’s health that is collaborative, integrated, holistic, and listens to their bodies. Children are not STDs. Fertility is something to be collaborated with rather than suppressed.
LS: I wanted to ask about the practicalities of living out that commitment. When a woman walks in your door who’s vulnerable, how big is the gap between the care she needs and the money available for it?
LS: Just ballparking, what percent is able to be paid for, and what percent has to come from donors?
JB: We were a for-profit medical practice. And all my bean-counter accountants were saying, “You got to stop seeing the poor.” Well, I couldn’t because that’s obedience. I believe in alms-giving because it’s very connected to medicine as mercy.
So practically, we probably raise 40 to 50 percent of the cost of our care. People sometimes ask, “Well, what was your plan, John?” I had no plan.
I have a budget now, but somehow I don’t think of it as seriously as my board does. I’m so grateful to my board for trying to keep us on the straight and narrow.
But I had dinner with Mother Angelica years ago. She was so excited about what we did before she died. She said, “Johnny, just remember, my son, budgets are for people who are fearful.” And I can tell you in my life, I’ve never been outdone in generosity. That weekend that we realized that our malpractice premiums tripled from a total of $80,000 to $240,000, and we had one month to cover it. A bunch of patients created an email list and we raised $242,000 in a weekend. It’s about having so much street credibility that you can go to your patients and beg.
LS: Let me ask you one last question. This is for someone who may be starting medical school who has a strong pro-life commitment, but wants to avoid the coarsening effect of medical school. They want to avoid that sense of becoming a vending machine that does procedures, not a person in relation with the patient.
What should this person take on outside of school as a counter-formation to the conventional formation of medical school?
JB: Two things: keep up your prayer life, that quiet time, however you do that. The second piece is to reach out to places like us at divinemercycare.org who can then connect you with Christian Medical and Dental, Catholic Medical Association, where you realize you’re not alone.
I was at the University of Virginia twelve years ago, a fourth-year resident walks up to me after my talk, during which I had asked: “If abortion is so good, why don’t more of us do it?” He comes up and says, “Do you really believe, Dr. Bruchalski, that life begins at fertilization, human life?” I said: “Oh, yeah. And it deserves our care.” He goes, “You’re the first person in twelve years of my academic training ever to have said that.” He said, “I find it fascinating.”
Transforming hearts through healthcare comes by one-on-one.
LS: Thank you so much for making the time to talk to me today. Dr. John Bruchalski, the author of Two Patients: My Conversion from Abortion to Life-Affirming Medicine. Thank you so much for your time.