Nicole Freehill and Haley Beavers Khoury

[00:05] NICOLE FREEHILL: My name is Nicole Freehill. I am 47 years old. Today's date is June 22, 2024. Location is New Orleans, Louisiana. The name of my interview partner is Haley Beavers. Coury and relationship to partner. I am your mentor.

[00:24] HALEY BEAVERS KHOURY: My name is Haley Beavers Khoury I am 29 years old. Today's date is June 22, 2024. We are in New Orleans, Louisiana. I am interviewing doctor Nicole Freehill and she is my mentor. Okay, so what is your first memory of me?

[00:42] NICOLE FREEHILL: So I met you by email, but that was not the official meeting. The first official meeting. I remember thinking that you were very poised, very mature, made great eye contact when we first started talking. And by the end of our first meeting, I thought, wow, she's going to do great things and has a very bright future.

[01:06] HALEY BEAVERS KHOURY: Thank you. That's very kind. Okay, so you're from, you're from New Orleans. Yes. When you were growing up, how did people talk about abortion? Or did they even talk about abortion?

[01:20] NICOLE FREEHILL: So what I remember being a kid is my family. I was raised Catholic, as a lot of people in New Orleans are. And I remember my aunt is extremely religious and has always been very, quote, pro life. And I remember her bringing me one time when I was probably about nine ish to pickethe in front of an abortion clinic. And I didn't really completely understand what abortion was. I just remember she had promised me that we could go to Mackenzie's bakery and I could pick out a treat afterwards. So I was very motivated by that. But that was my very first memory of anything relating to abortion. There wasn't much conversation or other memories that I have regarding abortion until I became more college, medical school age. Did anything change at that point? So I think at that point, I became more aware of, obviously, what abortion was. And I also found out about Roe versus Wade. And when I learned about Roe versus Wade and learned the date that Roe v. Wade was, was, you know, passed. It was my birthday, but four years before I was born. So I was like, oh, wow, that's really cool. And I'm so special. But also I think what connected me to Roe v. Wade early on, besides the birthday, is the fact that I'm adopted. And when I, I've always known I was adopted, my parents always told me from when I could remember, I thought, wow, that's really cool, that not only do I share this kind of date with this right that was given to women to abort a pregnancy, but also my birth mother decided four years after she could have had a legal abortion to not have an abortion and to find a family for me that I'm very grateful for because my family is amazing.

[03:35] HALEY BEAVERS KHOURY: Thank you for sharing. I feel like a common narrative from anti abortion individuals that I hear is this idea that we shouldn't focus more on adoption. Do you feel like being somebody who was adopted has shifted or changed your views on abortion at all? Because that's such an interesting perspective that not many people have.

[04:00] NICOLE FREEHILL: Yeah, and I think that's a fantastic question. I've been asked that before. Like, doesn't that shape your viewpoint that, you know, you could have been aborted and you weren't? And honestly, no. I still very strongly believe in the woman's right to choose whatever it is that she wants to choose, whether it's abortion, adoption, to parent that child. I think that I have a unique viewpoint and perspective that I have shared several times with patients who are struggling with. I'm not sure if I want to do adoption or not. I don't know if I can do that. And I have shared my personal experience on, at least from my viewpoint, how amazing adoption can be. So I think that it has given me a unique viewpoint and a unique way to share that particular option with a patient in a different way than probably a lot of other physicians have. But it has not changed my personal belief in a woman's right person's right to choose.

[05:01] HALEY BEAVERS KHOURY: Okay, cool. Why did you decide to go into medicine?

[05:05] NICOLE FREEHILL: So I actually went into medicine because of the doctor patient relationship. I was always a very science math oriented person from very young, and I really thought initially that I wanted to do biochemistry research. And when I got into the lab and started doing biochemistry research in my beginning of my college years, I absolutely hated it. And I said, whoa, I have to switch gears. And my next door neighbor growing up was also my family physician, but he was not only my family doctor for basically the first 24 years of my life, but he was also my neighbor and almost like a grandfather figure. And I was very close to his kids, and he was just this amazing person that I always looked up to and always had this really great relationship with. And my mom was like, why don't you talk to him and get his advice of, do you think? Because I was like, I don't know about medical school. And he said, look, come and shadow me in the office. You can see what it's about from my side of things, not from the patient, but from my side and see if it's anything you're interested in. So I went in and shadowed him a couple of days, and it really just brought about what I had been missing in the lab was the relationship building that he was able to do, and he was still able to explain to me, like, some of the scientific background, and this is why I choose this antibiotic, even though I didn't understand all of it. But he was able to combine that scientific background that I really craved, but also, obviously, the interaction that I needed to be happy.

[06:33] HALEY BEAVERS KHOURY: So then why did you choose to become an Ob Gyn?

[06:36] NICOLE FREEHILL: Yeah. So when I started my medical school journey, I definitely was thinking primary care because of my neighbor. But I went into my third year of medical school, where we do our rotations in each specialty, kind of open minded, but also more thinking, probably internal medicine, and then maybe specializing to something where I can do procedures, because I was interested to do procedures, but I wasn't really sure about surgery. So I was really thinking kind of maybe interventional cardiology. But my second rotation was ob GYN. And at the beginning, I said, oh, this will be cool. It'll be fun. I'll get to deliver a baby. It'll be my first time, really in the OR. I can do surgery, see what that's like. And the third day of my rotation, I delivered my first baby, and I was just, wow, this is the most amazing thing I've ever been a part of. And I came home and told my husband, and he was like, oh, my God. I saw the excitement on your face. I knew that day that you were going to be an ob gyn. It still took me the entire rotation. But once I finished the entire rotation and saw not only the obstetric side of things, but also all the gynecology and the office, and I love the breadth and width of what we can do in ob gyn, taking care of patients from when they're very young adolescents all the way through until they're elderly, post menopausal, I love the variety and also the relationship building.

[08:03] HALEY BEAVERS KHOURY: Can you paint a picture of that.

[08:04] NICOLE FREEHILL: First baby that you delivered? Yeah. So when I was on call my third day, I had my upper level resident who I was working with, and he was like, okay, who's on call tonight? And I raised my hand. He said, okay, you're gonna take patient so and so in this room because she's getting closest to delivery, and we want you to definitely get a delivery while you're on call. I was like, okay. So I met the patient, was involved with her care. When it came time for her to actually have the baby, I got gowned up in my, you know, gown and my boots and my resident had gone over all the maneuvers of labor, how to deliver a baby, and he said, look, just put your hands on top of mine. I'll guide you. We'll do it together. And I was like, okay, I'm ready. I was very excited, very scared, but I was ready. And we're standing in between the patient's legs, ready for her to have the baby. And as soon as she was about to have the baby, he whispered in my ear, he's like, oh, and if the attending asks if you've done this before, say yes. I was like, oh, my gosh, I haven't done this before. I panicked for a second, and then the baby was out. As I was panicking, it happened, and it was just so amazing, not only to watch and to see, but to actually be a part of it, to have my hands involved with delivering the baby, handing the baby to the mother, I was just, yeah. Shaking with both fear still, but also just great interest and amazement at what had just happened, because I had never seen a delivery before that day.

[09:36] HALEY BEAVERS KHOURY: So that's incredible. You're making me nervous, because I am, like, very much like, I'm gonna do primary care, but I start my rotation, my clinical rotation next week in Ob GYN, and I have also never seen at birth. I've never been in an or as a rising third year medical student. I feel like I know what I like, but there's so much out there, and it's like, oh, no. Hearing your story, I'm like, am I gonna change my mind? What was that like for you, like, changing your mind?

[10:06] NICOLE FREEHILL: I wrestled with it a little bit. I knew that I loved what I had just finished after I did my rotation, but I also knew that I had internal medicine coming up. And then now I was really interested in the OR. So did I want to do surgery? It kind of opened up this whole, oh, my gosh, I don't know. And then I wrestled with what I knew about Ob GYN or what I've been told as far as the lifestyle is really hard, and the call schedule can be hard, and the malpractice is a lot of money and all of these negatives, but there was absolutely nothing that could replace the. All the positives of what I experienced and what I could tell my life as an Ob GyN would be like. And I kept an open mind still throughout each of the rotations coming after that. And I said, can I picture myself doing this? And I was like, no. There were a few things. I was like, oh, maybe. But nothing ever reached that level that Ob had set, and I think I recommend this to a lot of students, is just keep an open mind. Absolutely. See what hits you and what you really love doing while you're on your rotations, because you can be surprised sometimes. Absolutely. Like, I completely changed tracks of what I wanted to do. It can solidify what you think going into the third year, but it can also, I think it's so important when you've spent so much of your life dedicated to your education, you still have many years to go. You want to be doing something that you love, because no matter what area of medicine you choose, it's going to be hard. It's going to have its good moments, it's bad moments, all of the things, but you want to be in love with what you're doing. That is what has kept me going through some really difficult call schedules, some really difficult times, especially recently, is I absolutely love what I do.

[11:59] HALEY BEAVERS KHOURY: Yeah. I was going to ask, do you still love what you do? You still feel that spark?

[12:04] NICOLE FREEHILL: Absolutely.

[12:05] HALEY BEAVERS KHOURY: And that you feel like that's kept you going through current events and just like, the recent onslaught on reproductive rights and your career, your job, what you do, it is.

[12:18] NICOLE FREEHILL: It is part of many things combined keep me going. But that is definitely the fact that I absolutely love what I do and I feel very strongly about it. 100% keeps me going.

[12:29] HALEY BEAVERS KHOURY: That's great. So, speaking of just, like, hard things, do you, what was your. I guess, like, where were you when you found out that, like, ro fell and, like, what, what did that day look like for you? And, like, the following days, what did that look like for you?

[12:48] NICOLE FREEHILL: It was a very interesting day. We had heard the leaked opinion prior to the actual date, so. And I can't. I honestly cannot remember where I was when I heard about the leaked opinion. I'm not sure, but we knew that the decision was coming and we knew, unfortunately, very likely, what the decision was going to be. But I had a trip planned with my husband for our 20th wedding anniversary. We were going away and we were gone for five days. And the morning of the decision was the morning that we were on a plane flying to our trip, our destination. So when we landed and I turned on my phone off of airplane mode, I saw the news banners, I was like, oh, gosh. I was like, well, this is kind of what I expected. I was very upset, but I was, like, not surprised. And being away for five days, I immediately started getting requests for interviews. And my husband is a saint and fantastic. And I said, I really think I need to do some of these, and I think it's important. And he said, go ahead, that's fine. I did some on Zoom. I did some on the phone while we were in the middle of our. Our trip. So it was a very interesting beginning of that fall of Rome. Yeah.

[14:09] HALEY BEAVERS KHOURY: Yeah. And so we're what, like two years out? Almost to the day, I think, of that. Of that day. How do you feel like your work has changed?

[14:20] NICOLE FREEHILL: So my work has changed in many ways. The actual, just in the clinic, in an exam room with a patient, besides some of the legal changes, the interactions that I have and the way I take care of women has not changed that much. But the structure surrounding it and sometimes depending on the situation that I have with a patient, if I have a patient who is struggling with what to do with a pregnancy that was unplanned, that has clearly changed some. I used to be able to refer a patient who either had chosen abortion or was considering options and giving her all the resources that she needed. Refer her to an abortion clinic that was in New Orleans, or there was one in Baton Rouge, one in Shreveport. You know, within a four hour drive, she had access to several places to obtain an abortion, if that's what she decided. So obviously, immediately after Roe felt that was different, I could not say, hey, there's a place a mile down the street from here. And that access and the way that I counsel patients changed because of that. But I think one of the biggest ways that my career and the way that I do my work changed Washington. The amount of work that I started to do to minimize the impacts to not only our patients, but to our students, like you, to my fellow colleagues, you know, there was a trigger ban that was put into place that a lot of people, myself included, did not really understand. It uses medical terminology. It uses terminology that is not medical and is very ambiguous to someone who operates on a medical terminology standpoint. That's how we communicate to each other. And medicine is using certain terms and also legalese. I never took a legal class. I am not skilled when it comes to anything regarding lawyer talk. And so I had to educate myself. I had to find resources and find people. And thankfully, I was able to find a. A reproductive health rights lawyer who walked me through what the bill means, broke it down, you know, took out the jargon. And then I started immediately working with, okay, how can we clarify this? How can we make this better? How can we, you know, make sure that whatever we can do for our patients, we do the best way we can? Because as we've seen, unfortunately, the lack of clear guidelines with what's legal, what's not. The fact that medical terminology is not used in these laws. It is very confusing to physicians. And then you have immediately, as of June 24, two years ago, when row fell, the criminal implications. And that was obviously a big factor for a lot of physicians being very scared and having a lot of fear revolving abortion care, miscarriage care, just everything. And if you take that fear out of it, if there wasn't a criminalization piece, you still have the law piece that needs to be clarified and corrected. But you put the two together, and you have a perfect storm for a lot of bad outcomes for patients. And that's what we've been seeing, and I've been doing my very best to try to correct some of that. I don't know how much of an impact I've had, but I'm trying. And that's what I think is one of the big focuses and how a big change in what I do just on a regular, day to day basis has been since Ro.

[18:20] HALEY BEAVERS KHOURY: You know, as patients, we're so used to seeing doctors polished and having all.

[18:25] NICOLE FREEHILL: The answers in some cases, like certain scripts or something that you're following.

[18:30] HALEY BEAVERS KHOURY: So what was that like when you were trying to figure out what you could and couldn't say?

[18:34] NICOLE FREEHILL: Do you remember, like, phone conversations with.

[18:36] HALEY BEAVERS KHOURY: Colleagues where you guys were like, shit.

[18:39] NICOLE FREEHILL: What are we gonna do? Like, what did that look like for you? Yeah, I mean, we definitely. There was a few weeks, if I remember correctly. A few weeks, a month. I can't remember the exact timeframe where it was very much. So, like, okay, I know abortions, quote, illegal, but if you have an exception, does that fall into what? What does this medically futile term mean? It does that. Does that patient fall into that? Does it not? And unfortunately, I had a patient who very beginning of this fell into this, and this is a patient who was in her mid thirties. I had been seeing her for an abnormal pap smear and helping her with the workup of an abnormal pap smeareende along that path of having to refer her on to a specialist, to a gyn oncologist, because of a severe precancer that was found on her cervix. We also found a growth in her vagina, and the growth was biopsied and found to be vaginal cancer, which is exceedingly rare and very difficult to treat because it's so rare and very aggressive. There's not as many conventional guidelines, and it's very hard to know exactly what the best treatment is. But you basically get very aggressive with treating vaginal cancer throughout that course, until she had the right before she had the biopsy. She then found out that she was pregnant. It was not a planned pregnancy, but a desired pregnancy because she already had, I think, one child, maybe two, and she was not opposed to having another one. But as soon as she had that diagnosis of the vaginal cancer, it noticed, explained to her how bad the outcomes were. Unfortunately, in most cases of vaginal cancer and how rare it is, and the aggressive treatment that is needed, which includes a hysterectomy with removal of the top portion of the vagina, but also significant amounts of chemotherapy. And even then, it just matters how quickly you can treat, how quickly you can get this cancer out and start this aggressive treatment. She realized that her life was at risk, and she was very early pregnant. And she said, I want to have an abortion. I need to make sure I'm as healthy as possible. I need to be here for my child that I already have, and then that's what I need to focus on. And this all happened, I think it was a week, maybe two after Roe fell, and so it was very difficult to navigate. Does she fall into the exceptions? Even if she does, how do we document this? How can we move forward? What kind of abortion procedure can we do? It was a lot of confusion and a lot of back and forth and a lot of. That's the timeframe that I really started to understand the law, the trigger law, much more in detail and much better, because I had to, with this patient that had this, you know, unfortunate diagnosis and had to make a decision for her safety to proceed with an abortion.

[21:50] HALEY BEAVERS KHOURY: Was she able to obtain that abortion? She was in this state, or did.

[21:54] NICOLE FREEHILL: She have to go in this state?

[21:55] HALEY BEAVERS KHOURY: Okay. Because it was deemed she was.

[21:57] NICOLE FREEHILL: Yes. That she fell into the exception. I don't remember the exact wording, but the. Basically the exception for maternal health, for preventing death of the mom.

[22:07] HALEY BEAVERS KHOURY: If it all began when you were working with that patient or any other patient specifically, are these decisions that you are making alongside other physicians, with legal teams, lawyers, that kind of thing, what does that process look like when you come across a patient who is potentially falling under these very ambiguous terms?

[22:29] NICOLE FREEHILL: Yeah, so it's all of the above. It definitely can be other physicians, like, specifically the gyn oncologist that I was working with, with this patient's case. But a lot of times, it's high risk. OB doctors or maternal fetal medicine specialists and lawyers, for sure, have a couple of really amazing lawyers who, like I said, really broke down the laws and really helped with the ambiguity and the gray zones or ins and outs of the law and what, you know, in their opinion, being experts in this field, what was allowed, what was not. And still to this day, even though now two years seems kind of incredible, sometimes only two years in, I feel like I do know the law very well. And most of the time, I can already know, like, this is going to be allowed, this is not going to be allowed. But it's still. There's still definitely some physicians and specialists that I rely on, and I still will contact one of the two lawyers that I know very well and be like, hey, I just want to double check this with you. So definitely having a team and having a support system around has been very beneficial for patient care.

[23:39] HALEY BEAVERS KHOURY: How does that make you feel, though? Like contacting and having to consult lawyers. You have your own medical judgment. You went to medical school, you did residency, you're an expert in your field, and you're still having to, like, consult with people who are not necessarily experts in your field. How does that make you feel?

[23:57] NICOLE FREEHILL: Well, I think that consulting with the lawyers that I know has felt like a very good, just congenial relationship and a very natural relationship having to navigate this, because we both have the same interests at heart. We both have the same goal of taking the best care of patients and making sure that we get patients the care that they can receive. But it definitely. I feel that on the flip side, the criminalization piece of this trigger ban has been the most hard pill to swallow because I have spent, like we were talking about earlier years of my life, hundreds of thousands of dollars in debt. It just. I have dedicated myself to be able to take care of patients, and for someone to threaten to put me in jail when I have, you know, I have not been anyone who's ever been arrested. I have stepped foot inside of a courtroom once when I was had to do jury duty. I mean, I, you know, as physicians are in general, we're very risk averse. We follow the rules. We do all the things to make sure that we are successful in our careers. And for there to be this ten year, I forget how much money. I mean, all these penalties and to have potential for losing my medical license, being a felon, and it is just flabbergasting. And it is just so hard to wrap my head around the lack of trust. That bill is a result of a huge lack of trust of the medical community in general and of specifically ob gyn sentience surrounding abortion. And it just really, that's one of the things, there's many things that make me angry, but that's one of the things that makes me very angry, because I really do strongly feel that if we didn't have the criminalization piece to this ban, the fear and the bad outcomes we've seen for patients, the delay in care we've seen for patients very likely would be significantly different, and we would not be having as many stories of all of these terrible things that have happened to patients as we do now. And it is just. Yeah, it's also hurtful because I've spent so many years dedicating myself to this career and to this profession and to my patients. For someone to question that I'm going to do something illegal. I've never done anything illegal in my life. I mean, maybe not. I won't go that far, but I have never come close to committing a felony in my life. It's hard.

[26:51] HALEY BEAVERS KHOURY: Speaking of committing felonies and just laws, with the recent reclassification of misoprostol and mifeprestone, I think that got a lot of error. Okay. Yeah. So those two drugs are very commonly called abortion drugs. They have other uses, for sure, but they are most commonly used to help empty the uterus in the event of a miscarriage or an elective abortion, that kind of thing. From my understanding, they are used daily in an Ob GYN setting. They are very safe drugs. We've known that for decades. Extremely safe drugs. But this summer, two or three weeks ago, we, during this very interesting legislative session that we just had in the state of Louisiana, they passed a law reclassifying those drugs as a class four, I think, which is confusing, but essentially, it makes it a little bit different, the ways you, like, prescribe them and, like, how who can have them and the consequences of having them. So that bill hasn't been signed into law yet, I don't think. But there probably will be.

[28:14] NICOLE FREEHILL: It's going into effect in October.

[28:16] HALEY BEAVERS KHOURY: Okay. Yeah, it's going into effect in October. So I. So I will be done with my ob gyn rotation at that point. So presumably I won't be able to see the effects. But, like.

[28:24] NICOLE FREEHILL: Right.

[28:24] HALEY BEAVERS KHOURY: How do you feel about that?

[28:25] NICOLE FREEHILL: Oh, so very loaded question. So, yeah, I mean, mifepristone and misoprostol are very commonly used medications. They have very useful ways that. And you're absolutely right. We utilize them daily. Specifically misoprostol. Mifepristone, which is more commonly known as the abortion drug. It can be used for induction of labor for a healthy, viable pregnancy. It can be used for miscarriage management is actually a very good use for miscarriage management in conjunction with misoprostol. Much better outcomes when you use the two together than one of them alone. It also used in Cushing's syndrome, so some other non ob gyn uses. It is very safe. It has been around for many decades, but was approved by the FDA in 2000. And since 2000, we have over 6 million women who have used mifepristone in combination, usually with misoprostol, but with extremely low adverse outcomes. Serious complications are 0.04%. That is almost as low as or lower than tylenol, so it is exceedingly safe. Same with misoprostol. Misoprostol can be used in conjunction with mifepristone for miscarriage management, for abortion care. It is also most commonly used for induction of labor. You go to any labor and delivery unit across this entire country, and they are using misoprostol every single day for induction of labor. It is also used for treatment of postpartum hemorrhage. It is a very inexpensive drug that works very well to treat a postpartum hemorrhage, and it has saved tens of thousands of lives across the entire globe. To treat postpartum hemorrhage, it does not have to be refrigerated. It is very mobile, it is very cheap. You can swallow it, you can chew it, you can let it dissolve in your mouth, you can put it in the vagina, you can put it in the rectum. It is a very versatile drug, and again, extremely safe. It is also used to treat acid reflux. It has other non ob gyn uses. So I can't express enough how commonly these medications are used and how safe they are, but they have now been reclassified to a schedule four, which makes them a dangerous drug in the eyes of the law, and it puts them in the same class as medications that can actually be dangerous and can have an addictive potential and abuse potential. So things like oxycodone or OxyContin, Ativan, Xanax, many others. The fact that they're in this same schedule, the same classification is very angering because they will never be abused. As far as someone taking them to make them feel a certain way, they have no addiction potential. They are just drastically different than every other medication in this class, and it can potentially really affect what's going to happen to our patients. I really think that an inpatient standpoint, so use in labor and deliveries for induction and things like that are less likely to be impacted. But it's just so hard to know for sure what's going to happen, but from an outpatient standpoint. So one of the things that we use misoprostol on a very regular basis for is anything in an outpatient clinical setting. In my office say that we have to get through the cervix and into the uterus. So if we're placing an IUD in the uterus for contraception or to help with bleeding, if I have to do a biopsy inside the uterus to rule out a precancer or a cancer, anything like that, we can give a patient misoprostol to make their cervix more easily accessible. So as far as getting through the cervix with greater ease and with less pain to the patient, so they are used very commonly for those different situations in an outpatient setting, the patient takes them before they come in. They come in, we can get through the cervix much easier, do whatever it is we need to do. They also, a lot of times have more comfort, less pain, because it's not a challenge to manipulate through the cervix and into the uterus. That is where I'm really concerned. We're going to have a big pushback, because when Ro fell, we immediately started having problems when we were using cytotech. I'm sorry, misoprostol in any way, shape or form. On an outpatient standpoint, if I was giving a patient a medication, a prescription for misoprostol, I was oftentimes getting a patient call back and saying, hey, the pharmacy will not fill this for me. Or I even had a pharmacist call and say, I'm not going to prescribe an abortion drug. And I have to say it was very challenging to navigate being like, this is not an abortion drug. This is what I'm using it for. I gave you a diagnosis code for whatever the procedure is that I'm using it for, for the miscarriage that I'm managing, whatever it is. And to navigate that for my patients was difficult to be questioned, to have pharmacists, you know, basically say, I'm giving patients medicines that's going to cause an abortion. I'm like, no, I'm not. I know what the laws are. I'm not doing that. It was challenging. So that was when it was just post row and they were not schedule four. So the fact that they're going to be scheduled for in October. I'm very concerned that we're going to see more of that pushback and more difficulties getting it outpatient. The other thing that I learned through this process, which I had no idea, is that schedule four medications, not only are they regulated and have a totally different process of how you keep them in the pharmacy, they have to be locked up in a different way. How much the quantity you can keep in a pharmacy is different, but the manufacturing process is also regulated. So just getting the raw materials to make these medications and the manufacturing process, I know we're one state, and hopefully, if this stays to one state, very likely that process will not change greatly across the United States and won't have a major impact. But if other states decide to do this craziness that Louisiana has done, we could potentially see manufacturing issues and decreased numbers of these medications and therefore, outcomes regarding induction of labor, miscarriage, management, treatment of postpartum hemorrhage. All of these things could be greatly impacted. And I'm trying to be the person at the top of the hill stopping that little pebble to roll down to become the boulder, because I just feel that there's just too much unknown about making these medications schedule four when they clearly, from a medical standpoint, have no business being classified in this category.

[35:38] HALEY BEAVERS KHOURY: Yeah. What's it like being an educator of, like, residents and medical students through all of this? Because things are changing so fast, and you're learning on the fly through no fault of your own, and also potentially feeling responsible for the future of medicine and, you know, upcoming physicians. How does that make you, like, how do you navigate that? How do you feel about that?

[36:05] NICOLE FREEHILL: Yeah, it is very much so on the fly. Being very open and honest and transparent with all of my learners, like you, residents, even colleagues who I work with. I think that's been one of the most useful things, is just saying, I don't know, and we need to find out and being very honest about what's going on. I think that reassurance, as much as I can to students, residents, and even colleagues, that we can still educate you and make sure you have the skills that you need. We can still teach you how to evacuate a uterus in an emergency situation because you need to have that skill as an OB GYN, we can still talk about abortion care. We can still talk about all the things regarding abortion. We are still allowed to do options counseling. So there are still a lot of things that are. I'm able to reassure a lot of students in residence, like, I'm going to do my very best to make sure that this doesn't negatively impact you. However, in the very beginning, it was a little bit of a cluster of going, oh, my gosh, what is this going to do? How are we going to navigate this? How does this impact everybody from an education standpoint, for sure, over the first year, there was a lot of stuff that was figured out and a lot of ways that we kind of worked things out on the fly. And I think that our education situation now, I can only speak to what's happening in New Orleans. I cannot speak to other parts of Louisiana, but our education situation that is happening now in New Orleans is really the same, if not potentially at a slightly better point than what it was before the fall of Dobbs. I'll tell you that that was obviously a huge eye opener and a huge instigation for myself and many other physicians to say not only do we need to make sure we're meeting the minimums of education, but we need to take it a step further. Like, we need to make sure that we're going over this in much bigger detail. We need to have our students, our residents not only prepared for some of the basics, but some of the not basics, like we don't know, especially in the beginning, where coat hanger abortion is going to happen. Were we going to see a lot more patients coming in septic and extremely sick? What was going to happen? So we really ramped up the education side of things, and it has not always been easy. It's been a very difficult road. But I really do feel that our residents and students are at a better point right now than they were two and a half years ago. Not necessarily easy to get to that endpoint, but I think that we took that response and kind of ran with it as far as we need to be over aggressive.

[39:14] HALEY BEAVERS KHOURY: Do you feel like attitudes in the program amongst the learners are hopeful?

[39:22] NICOLE FREEHILL: I think there's a mixture. I think that a lot of students and residents are very resilient and very dedicated to taking care of their patients and making sure that they can do anything and everything for them. But I also feel there is a little sense of hopelessness occasionally, and especially students in residents that are not from Louisiana. They're just very disheartened by the state of things and the way that our patients are restricted. And I think that it is something that we need to use as a catalyst to keep them moving forward, to keep them engaged, to keep them realizing how important the fight for our patients and their rights and their access to good medical care and to receiving the proper care, how important that is. And I think that most students and residents have had that response. More so than a woe is me. This is terrible.

[40:33] HALEY BEAVERS KHOURY: Yeah.

[40:33] NICOLE FREEHILL: I think all of us feel that way on some days. I have that. I have those days where I'm like, my gosh, this is so bad. But more often than not, I pick myself up and say, we've got to keep going and we've got to keep fighting. And I know I'm right, and that is important.

[40:52] HALEY BEAVERS KHOURY: Yeah.

[40:53] NICOLE FREEHILL: Have you asked Hailey how it's been like for us? Absolutely. Yeah. So your entire medical education has been in a post row era. So how has that been on you as a student?

[41:06] HALEY BEAVERS KHOURY: Yeah. So I can only speak for what I know. I entered medical school August of 2022, so just after Ro fell. And I think that. And this is probably because I have just gotten older and a lot of other things, and I'm just paying attention more. But I think especially with COVID with just, like, everything that happened the summer of 2020 with George Floyd and all of these protests and all of these political things going on, that I came into medical school, like, extra ready to learn about how politics and medicine interact. And I feel like that I have been a little disappointed with how I have seen them interact and how I'm taught as a medical student. I have had physicians say that politics and medicine don't mix. Once you're in the OR, it doesn't matter because you're scrubbed in and you're there for the patient. And I've had physicians say these kinds of things to me, and I'm like, okay, well, I'm a student. I'm a learner. I'm supposed to be learning from you. That doesn't make any sense to me. So post row coming in, wanting to know, like, okay, well, actually, how does this affect me and not really knowing because no one would really talk about it in an undergraduate medical education setting. So, like, in my first and second years of medical school, in the first and second years of medical school, we learned the science. We learned the physiology, the biochemistry, the genetics, all of that stuff. And I think that my school does do a good job of incorporating larger concepts into that. And at the same time, the emphasis is so much on the science that I worry that for people in my class who aren't just interested in, like, activism or justice or, you know, reproductive justice, they might get the impression that those things don't matter. So it's been. I feel very. I don't know if, like, gaslit is, like, the right word. But I'm like, is this a. Like, are things bad? Like, is this something I should worry about? I'm not really sure, because, like, I'm learning from people who don't seem to think that it doesn't matter. But then, on the other hand, I'm working with amazing physicians who are driving up to Baton Rouge to testify in the legislature, who are taking Saturdays off to, like, provide healthcare to the unhoused community. So it is. It is very much a wild ride of, like, I am here to learn, but I don't know how to learn outside of what's happening in the larger context, because, like I said, I want to go into primary care. I want to absolutely, no matter what I do, incorporate reproductive health and sexual health and gender affirming care and all these things into my practice. Will I be able to do that here? I don't know the answer to that. I think that it's just very odd to be building a career with this, you know, big, kind of, like, rain cloud looming over me.

[44:19] NICOLE FREEHILL: So big question mark. Yeah.

[44:22] HALEY BEAVERS KHOURY: How does it feel? Honestly? It depends on the day. There's definitely days where I'm like, I can't do this anymore. Like, I am an older medical student. I took five years off in between undergraduate and going to medical school. So I'm a little on the older end. You know, I'm married. I have, you know, I don't have kids. I don't know if I want to have kids. But there's all these things that I'm like, okay. Like, I'm doing a really hard thing. Like, medical school's really hard. Like, it's taken a lot out of me. And it is very. It can be very depressing to see kind of what you mentioned earlier, these legislators, these people who are writing the laws question what I'm, you know, my knowledge and question what I'm doing with my entire life. And then it also is just very difficult to watch patients be harmed, too, because that, at the end of the day, is what concerns me the most. I don't know. Like, if I want to practice medicine, if I can't give my patients everything that they need to, like, make the best choices for them. I was at a school based health center shadowing a few months ago, and if you go on, like, the Louisiana government website, it's a government funded, school based clinic. The only rule for these schools is that you cannot talk about birth control. You cannot prescribe birth control. You can test for Sti's. You can diagnose somebody with gonorrhea or chlamydia or whatever, but you cannot give out condoms. You cannot. We had a patient come in who. I was there for 4 hours. One of the patients was this precious teenager who every month she's missing, like, two days of school because her periods are so bad. She hasn't seen a gynecologist. She doesn't have access to get to a gynecologist just based upon her situation. The only place she's seeing a physician, a doctor, any healthcare provider, is at this clinic. And we cannot give her the one thing that probably she needs, which is some kind of birth control, essentially, to help regulate her cycles and make them a little bit better. And that was like, I was just the med student. I was just taking this patient's history. I was just learning about her symptoms, you know, getting ready to present it to the doctor who was overseeing me. And I was like, what do we do?

[46:46] NICOLE FREEHILL: And then you get this slap in the face of, yeah, that's the right treatment. You're right, but we can't do it.

[46:52] HALEY BEAVERS KHOURY: Yeah, we sent her home with tylenol, and she had told us that tylenol, like, wouldn't touch it. It's so. It's so frustrating because that is something that is led, that is. That is dictated to us by people who do not practice medicine, and this person is going to be harmed for it. Like, she is missing school.

[47:09] NICOLE FREEHILL: And what I would say to you is, keep that fire in your belly. Use it, channel it to try to do your very best to change that situation, because you know that what happened to that patient is wrong. And you know already, even though you haven't gone through your residency training, you haven't completely finished your journey in education, you knew the right treatment. You know better than what the laws say. And that fire in your belly and that gumption and that drive is what we need in our state and in many other states, many other areas to keep things going, hopefully move that needle in the right direction, even if it's just a nudge. It took decades to take down Roe. It possibly might take decades to change the situation, but we're never gonna get there if we don't have people who are dedicated and fiercely loyal to that idea of not harming patients, of giving patients the best treatment that. The treatment that they need to. Giving patients the options to giving patients bodily autonomy.

[48:18] HALEY BEAVERS KHOURY: Yeah. What are, like, how do you keep that fire alive? Because that's the other thing, too. Like, some days I'm like, oh, my God, I can't do this, and other days, I'm pumped up and I'm driving like Baton Rouge to, like, give a testimony, and then it fluctuates, so I don't know any tips.

[48:34] NICOLE FREEHILL: That's natural you're gonna have. I mean, good days, bad days, ups and downs. But I feel that most of the time, when I start to think about all of my patients and their situations and all of the specifics, like you just said, with your patient, and also the anger that I feel sometimes when I have gone to the legislature and trying to educate, you know, with completely pure intentions of making things better for patients, I keep that close. I keep that close. I think about that often. I have boys, they do not have any girls. I have two kids that are boys. But I think about their future partners, and I just. I know I have to keep going. Does help me so much to have found people who feel the same way, to have colleagues, to have friends, to have loved ones who feel the same way both in and out of medicine, to have the support and the relationships that I've been able to build throughout this process. There's a lot more people who are out there who are going to have your back, who feel the exact same way.

[49:48] HALEY BEAVERS KHOURY: Absolutely.

[49:49] NICOLE FREEHILL: There are a lot. There are a lot of people who are going to be against you and have different viewpoints. But I think that knowing that I'm doing the best thing for my patients and I'm doing the best thing for all of our constituents in our state and other states moving forward, that's a huge driver for me.

[50:09] HALEY BEAVERS KHOURY: I wanted to ask about the folks that don't have your back, because you.

[50:13] NICOLE FREEHILL: Mentioned encountering people in med school who.

[50:16] HALEY BEAVERS KHOURY: Teachers who are telling you that politics isn't part of it. Do you remember specific memory?

[50:22] NICOLE FREEHILL: You don't have to name names, obviously, but a professor who said something that really pissed you off. And did you say any?

[50:28] HALEY BEAVERS KHOURY: Did you stand up to them? Did you say something?

[50:31] NICOLE FREEHILL: Or was it just a memory of.

[50:32] HALEY BEAVERS KHOURY: Somebody saying something that was totally off base? Okay, so the first semester of medical school, for me, again, was the fall right after the fall of Roe v. Wade, right after DobBs. We, as part of our curriculum at my school, we do have to take like, a population health class. And it's essentially just like a precursory intro whatever, to anything that might fall under, like the population health bucket, almost like a public health. We learned a little bit about the healthcare system, how it works, just a myriad of things. Anything that they wanted to teach us, it was kind of like a spot where they could kind of dump it as much as it related to public health. And we did have a lawyer come in from somebody who, I don't know what law they practiced exactly, but the intention of that course or that specific class was to discuss abortion law in Louisiana as it had changed. And I went into that class so excited because I was like, I cannot wait to learn more about what this means for me as a student, somebody who wants to practice in this state and stay in this city and do reproductive health care. I was so excited. Went in with a bunch of questions, and the lawyer just had a slideshow of the law. And it wasn't like it was. It was so. First of all, it was so boring because legalese is just, to me personally, so boring. And so he's going through point by point, and all of it is very confusing because it just doesn't. I don't know. I found it very confusing.

[52:21] NICOLE FREEHILL: Yes.

[52:22] HALEY BEAVERS KHOURY: So at one point, I think. I don't remember the exact question I asked, but I had asked a question, and he gave sort of like a offhand remark about how following the laws or something about, like, the writers of the constitution wouldn't have, you know, this is how we interpret the law. Something basically, essentially saying, like, our founding fathers, you know, who wrote the constitution, who wrote the Bill of rights, you know, made this intention, and this is how we read the law. I don't know, something along those lines. And my response to him was, when the founding fathers wrote the Declaration of Independence and then the constitution, you know, and all of this stuff, like, women couldn't vote till 1920, like, we were still enslaving people. We. This. We can't. I was like, how, like, what does it mean for us to be interpreting a law like this based upon that perspective? Because, like, based upon that perspective, I wouldn't be able to, you know, like, my thoughts wouldn't apply to this. Like, it was just so strange to me. And the. The professor moderating the class told us all to calm down. She was like, this is getting too heated. We need to change the subject. And then I was very upset because I felt like. Again, I went into this, like, really excited because I was very curious because I was like, this is something I know is going to affect people. I've worked with pregnant patients in my career before this, like, I. I know what this looks like. I know the field. And it was just met with this, like, this is getting too much. Calm down. Really, like, kind of, like, hysterical thing. And that blew my mind.

[53:56] NICOLE FREEHILL: Isn't that so patronistic? It would calm down, honey.

[53:59] HALEY BEAVERS KHOURY: Yeah, it really was.

[54:00] NICOLE FREEHILL: And I think that we need to keep fighting against that. Yeah, I'll be calm, and I want to be. And I will not be calm when the time calls for it.

[54:08] HALEY BEAVERS KHOURY: Exactly.

[54:08] NICOLE FREEHILL: And I can keep my cool a lot, but it is. Yeah. Nobody needs to tell me what to do. Right. Nobody needs to tell you what to do. You're a grown woman.

[54:17] HALEY BEAVERS KHOURY: I'm a grown woman.

[54:18] NICOLE FREEHILL: And I think that was a big potential there for that to be a great opportunity, like you were saying, and it wound up being a patronizing, very negative, extremely negative experience. And I'm so sorry that that happened because, and I think that that is a big missed opportunity for not only you, but a lot of other students who are very passionate about making the healthcare system better, about making the right changes for our patients, and also understanding the laws. Because as much as I'm a strong believer, I do not think that the legal system should be involved in the classroom. Yes, but I'm sorry, misspoke. In our clinics, in our exam rooms, in the operating rooms, in the delivery rooms. There should not be laws. We have our own code that we operate under. First, do no harm.

[55:16] HALEY BEAVERS KHOURY: Yeah.

[55:17] NICOLE FREEHILL: These laws put me into a situation where I am doing harm.

[55:20] HALEY BEAVERS KHOURY: Yes.

[55:21] NICOLE FREEHILL: And that moral injury and that double duty, having to choose a path sometimes that, you know, is not the right path from a medical standpoint. It is a terrible situation for any of us to be put in. But I think that understanding. It's absolutely correct that we need to understand the laws. We need to understand them so that we can hopefully change them, make them better. Right. So that they align with what we as physicians do and what we need to do for our patients to keep the population healthy. And it is definitely a big disservice that. And as you're continuing your medical education, hopefully there's more in the correct fashion of teaching regarding laws that you get. Yeah, that's all I can say about that.

[56:11] HALEY BEAVERS KHOURY: Or just even not like, being shut down, too. Absolutely. That was, it was. It was a very odd situation to be in, especially so early. That was like two months into my medical school education, and I was like, okay, this is where we're at. Amazing. Noted. We just had about five minutes left. Coming up on the hour. Okay, the next interview starts at 430, right? Is that right?

[56:34] NICOLE FREEHILL: Yes.

[56:34] HALEY BEAVERS KHOURY: So we definitely have some more going. I also have a question to Mia, if that's okay. Sure. I'm just curious. You both mentioned interacting with the legislature directly.

[56:45] NICOLE FREEHILL: Amy machine testified that.

[56:48] HALEY BEAVERS KHOURY: I'm wondering how it felt for both of you to come face to face.

[56:52] NICOLE FREEHILL: With these people who are, you know.

[56:56] HALEY BEAVERS KHOURY: You'Ve explained the frustration around. How did that feel to kind of.

[57:00] NICOLE FREEHILL: Come face to face with that?

[57:01] HALEY BEAVERS KHOURY: What motivated you all to go into.

[57:04] NICOLE FREEHILL: So I have a lot to say about that.

[57:06] HALEY BEAVERS KHOURY: Me, too.

[57:07] NICOLE FREEHILL: Let's do it. So the very first time that I went to testify up at the Capitol was actually a year before the Dobbs decision. So something that was not related to the trigger ban. And I was petrified because I had never done anything like this before. Going into a legislative session, you know, you're given all these rules of, you only have three minutes, and then they might ask you questions, they might not. You have to fill out this card, either a green card or red card, either for or against all these things. It was. It was just brand new world to me. And I was. I was ready. I'd been prepped on, like, you know, this is what you should testify. This is how you should testify. These are the things to say. Use a patient example. It has more impact, all of that. But nothing prepared me for when the bill in question, because it was a reproductive health rights bill. And there's a lot of very clear legislators either are very against or very for each bill, depending on what it is. And a lot of the legislators in that session were not present because they just didn't want to be bothered to hear testimony like mine. I think I was testifying against a bill the first time I went, and I was like, wow, more than half the seats up here are empty. That's interesting. And then I noticed when all the testimony was done, they came back in and they all sit down with their cups of coffee, and then they all vote, and they all vote against what I just came and spent my entire day doing and trying to make an impact and knowing that it didn't change a darn thing. And I did not get asked one question. It's like, what? How are they saying they're listening to their constituents? When I came up here, I took a vacation day. I drove to Baton Rouge. I spent hours in this room waiting to say my three minutes, and then I'm so clearly dismissed. I mean, they couldn't even sit in the room and look at me while I'm testifying. They had to get up and go into their coffee breaks. And I've seen that multiple times since I've gone back because I'm glutton for punishment. I keep going back. But these legislators that do not believe in the science of reproductive health care they get up and they walk out of the room. And that is infuriating because they are not doing what they swore to do for their constituents. They are not listening to the facts or they listen to the, quote, facts of physicians. And this angers me so much that come and testify in opposition of whatever it is I'm saying. And they say, oh, these laws won't affect patient care, but they're also very strong anti abortion doctors. They're also very strongly religious. And they also, I don't know how they do this because it's against our hippocratic oath, but they routinely do not treat patients in the correct way, even before these laws, even before this trigger ban. And because these legislators already have a mindset of what they know. They want to vote and how they want to vote, they don't listen to me. They listen to these other physicians. And it is, I think it's just a huge disservice to the people of Louisiana. And this is from legislators across the state. Now, there are some, absolutely, I will say the reverse side, the flip side coin is that there are some who definitely are very interested and they want to hear, even if it's not what their own personal viewpoint is. I have met those legislators that really want to hear what I've seen and what my stories are and what my education, you know, says as far as these laws or the impact to patients. And I applaud those members because we need all members to be like that. You can have your own bias one way or another coming in, but you need to listen to your constituents, who also happen to be experts in certain areas, to then make the best decision for the constituents and for the people you're representing. Not for you, not for the people who are giving you money and are lobbying you, but for your constituents. And, yeah, it's very disappointing to see that for a lot of legislators, again, not all, but for a lot. That is just not, that's not happening. They're there for themselves. They are not there for the people.

[01:01:53] HALEY BEAVERS KHOURY: Yeah, I would say everything you would say. Yeah, the first time I went, I I don't know. I, I guess, like, it's hard for me to just remember that, like, not everybody is like me. And so, like, when I do something, I, like, really commit to it. Like, like, I'm in, I'm going to class. I am attending that meeting. I am there. And, yeah, to see them, to see just, and when I was there, the bills that were being presented to these committees, because you go in, it's not even like, they're voting on it to become a bill or a law at that point. They're just voting on it to maybe have it leave this committee to then be voted on to be, whether it becomes a bill or a law or whatever. I'm sorry. And so, yeah, the absence is very loud. It is very loud. But I think for me, so when I first testified, it was this spring, and so this was. It's been, you know, two years after Roe. We, you know, it's been two years after Louisiana's trigger ban went into place, and we are still hearing reports and stories of physicians who are afraid to practice reproductive healthcare because of the ambiguity, ambiguity of the law. And so the bill that I was testifying for was essentially just like, we're gonna reclaim. We're just gonna clarify this. It was totally a harm reduction thing. It was not even trying to, like, reverse the abortion ban. It was. I mean, honestly, like, at first, when I was approached to see if I wanted to testify as a medical student, I was confused, because I was like, well, this kind of seems like we're, like, for the abortion ban. And they're like, no, no, no. At this point in the game, like, what we have to do is harm reduction might often look like amending bills that we don't agree with. And just because we don't agree with that bill doesn't mean we shouldn't amend it. So I went up to testify. I had my little white coat on. I was so nervous, I was shaking in the back. And they call my name and I go up there and I say my bit. And I think that I had two people ask me questions. And when they pressed their little button and they asked me questions, thankfully, they were pretty, pretty. I will. None of this is easy. They weren't easy questions, but they were questions I felt comfortable answering. But one thing that did, one of the questions was related about one of the members of that committee had made a remark that, oh, you know, we know that residents aren't leaving the state to practice medicine. We know that medical students aren't leaving the state because of the laws. They're leaving it because of things like long compete agreements. And I just. I was so floored that I was being spoken for in that body by somebody who clearly had never talked to a medical student, because the other thing, too, in addition to that just being completely false. Medical students don't know what like, a non compete is like. Most medical students are straight out of college. Like, they've never signed a non compete. It's just like, it was just very, like, okay, I am being spoken for here, so I better speak for myself, because if not, they will put words into my mouth, you know? And why were medical students actually leaving, though? So we are still looking at reasons why medical students and residents are leaving. A recent. The data is all. It's very new. We're still looking at trends. The AAMC, which is essentially the body that helps place residents in, you know, their residency programs and place physicians across the country for training, released a report that there are. I think there was a 25% decrease in applicants to states with very strict abortion laws. So, again, this is new data. We're still seeing what the trends are, but immediately, we're seeing a decrease in applicants to programs, to residency programs, and specialties like Obgyn em all specialties. All specialties in states that have very restrictive abortion bansite.

[01:05:49] NICOLE FREEHILL: And why do you think that is? Do you think it's just because of their training, or do you think it's more.

[01:05:57] HALEY BEAVERS KHOURY: I think that it can be very scary, and I'm not. I don't know. I'm speculating here, but as somebody who's in school in, like, the deep south and who is somebody who has read a lot of history and knows my stuff, there is, I think, this myth of the south being very racist and very backwards, and it's just a place where progress goes to die. And we're seeing that because of all of these laws. And I do think there is a fear that for people who are applying to these programs, who are not from places like Louisiana, who don't know the fantastic physicians we have, the fantastic activists we have, the, like, great work that's being done. There's a fear of, like, coming here. Yeah. I mean, I really, truly believe that I have family members. I mean, I'm from Ohio, so it's not like that's, like, a blue state, but I have family members who will text me regularly with, like, when you get out of that state, girl, like, did you see this newest thing? And, like, send a news article? And I'm like, okay, I know this is bad, and it sounds bad because it is bad. And also, like, there's. The work being done here is, first of all, so important and necessary, but also very inspiring. Like, I don't think that. I don't know. Like, I mean, I would much as I would love to, like, not have to worry about things like abortion bans and, like, assaults on gender affirming care, and, you know, the list goes on. I'm learning how to survive down here. And that's kind of the way I spin it of, like, okay, like, I am gonna be so well equipped to deal with any nonsense that comes my way because I am dealing with it daily. And that's exhausting. And it's certainly not something I would wish on anyone. But I do think that there is an element of people who are just scared to come practice in these states.

[01:07:46] NICOLE FREEHILL: Absolutely. Again, I think it comes down to fear, not only fear, of your professional training, and are you going to be taught all the things that you need to know? But, I mean, that really only is basically internal medicine. I mean, a little bit of this touches every specialty, but specifically, like, you know, ob GYN, internal medicine, and, er, some of the big players as far as, like, most impacted. Right. And then, I mean, orthopedics, they're not gonna be really greatly impacted, but it's gonna touch every specialty. But when you see a decrease across the board in every specialty, applying to states with restrictions on reproductive healthcare, what that says to me, and granted, I am also speculating, but what it says to me is that they're not only thinking about their training, but they're thinking about themselves and their loved ones. And, you know, 50% or more, slightly more than 50% of all medical students now are female. They're thinking about the fact that they, for the most part, have a uterus and could get pregnant and what is going to happen to them if they get pregnant and don't want to be, or if they have a complication with their pregnancy or they have a fetus that has a malformation that's incompatible with life and will not survive, what is that going to do to them? What is that going to do if someone is married? If you have a male resident who's married to a female resident, female, and doesn't want that to happen to their wife or their partner? It is so broad. I think it crosses more than just what's going to happen to my education. And that's what I want people to really see is this affects so much more than what a lot of people realize. And I think that abortion care is so much more complicated than what most people think of it as so much more complicated.

[01:09:42] HALEY BEAVERS KHOURY: Couple of follow ups for y'all that.

[01:09:44] NICOLE FREEHILL: Are things that you've been talking about. So, first of all, I'm sorry, but I don't know when medical students would.

[01:09:49] HALEY BEAVERS KHOURY: Be able to normally perform their first abortion. You said you're about to do your obgyn.

[01:09:56] NICOLE FREEHILL: Would that have been when you would.

[01:09:57] HALEY BEAVERS KHOURY: Have seen an abortion or participation?

[01:10:00] NICOLE FREEHILL: Yeah.

[01:10:00] HALEY BEAVERS KHOURY: From my understanding, yes. As a medical student, if I were in a state that had abortion, that was legal. Abortion was legal. My first encounter with abortions would be in my ob gyn rotation. This also, just to go back to, like, just the complications that arise when, like, laws use medical words that are very broad in medicine. I will see a DNC, undoubtedly, on my rotation, and undoubtedly, that is an abortion. Right. So I'm gonna be seeing these techniques performed. Is it an elective abortion? No, no, not right now.

[01:10:41] NICOLE FREEHILL: D and C. D stands for dilation and c stands for curettage or basically removing the tissue that's inside the uterus. And we use the term d and c for a lot of things. So we can be going into the uterus and taking out the lining, the tissue that's in there that creates your period to diagnose abnormal bleeding or bleeding problems. We can be going in because someone's had a miscarriage and a failed pregnancy, and there's tissue left inside from the pregnancy that needs to be evacuated. Basically, if you go through the cervix and into the uterus and remove tissue, that's a, d and c. And it is the most common procedure that ob gyns perform. It is used almost on a daily basis in a lot of. I mean, I do a, d, and c probably at least once a week for many different reasons and many different contexts. And you need to learn. That is one of the essential things as an Ob gyn, is to learn how to evacuate a uterus, whether it's for bleeding abnormalities, whether it's for a pregnancy failure, whether it's for a complication of pregnancy. You need to have that skillset. And yes, during the third year objoin rotation is when you should first be exposed to that. The idea of all of the uses of this procedure and then to seeing the procedure, because what we do for a failed pregnancy, to evacuate the uterus versus a, quote, elective termination. When someone has elected to terminate a pregnancy, they're identical. It's identical procedure, and it's a very important procedure to learn.

[01:12:19] HALEY BEAVERS KHOURY: Yeah. And I think so I'll be learning the procedures. What I am sad to miss out on is the counseling opportunities. And just, like, what they'll be able to do that. Yeah, I mean, of course, like, I'm expecting people to come to me who are pregnant, you know, to where I'm, you know, studying, looking for options. And, yes, the counseling will be done. It'll be done in a way that maybe would be different if abortion were legal. So, yeah, I don't know. It's. Yeah. But to answer your question, I will be experiencing that firsthand. And the only difference is that if.

[01:12:56] NICOLE FREEHILL: It'S elected or not, correct. If a d and C is being done because somebody is electing to terminate their pregnancy because that is their choice for their pregnancy, that is where the law says we can't do that. The law clearly states if we have a failed pregnancy, a miscarriage of any kind, because a miscarriage is a lay term, it is not a medical term we use in medicine. The term that we use for the ending of every pregnancy, other than a full term delivery, is abortion. If you have a miscarriage where you start to cramp and bleed, and then you pass the fetal tissue, that's an abortion. If you go to the doctor, you're pregnant, you think everything's fine. You have an ultrasound, and they say, I'm sorry, but the baby's heartbeat stopped. That is an abortion. Everything that ends a pregnancy, whether it's something that you had no control over or something that you can choose to do no matter what, it's an abortion. And there's different terms that go in front of that. You know, elective abortion, spontaneous abortion, incomplete abortion, inevitable. There's all these terms, but basically ending a pregnancy is an abortion.

[01:14:08] HALEY BEAVERS KHOURY: I guess this is bringing to me.

[01:14:10] NICOLE FREEHILL: Something you've already mentioned, which is there's.

[01:14:12] HALEY BEAVERS KHOURY: This gray haze of ambiguity that has.

[01:14:16] NICOLE FREEHILL: Enveloped the medical community in the last.

[01:14:18] HALEY BEAVERS KHOURY: Couple years, and I'm just wondering, how does that feel, to navigate that and maybe take me back a little bit?

[01:14:26] NICOLE FREEHILL: Nicole, like you had mentioned, I think.

[01:14:29] HALEY BEAVERS KHOURY: One patient, but I was wondering if there were other patients that have really.

[01:14:32] NICOLE FREEHILL: Stuck with you and trying to navigate that fog. So I think that I'm in a very unique, and thankfully, a very good situation where I am having some really good legal advice from the very beginning, being taught what the laws mean, what the ins and outs are, what we can legally still do, what we can't, like where that line is. I have had that education, and I understand it very well, and therefore, a lot of my colleagues around me also. We're all in this situation. But if you go to rural Louisiana, where we already have maternal healthcare deserts, and we already have many parishes, we call them parishes here, not counties, many parishes that do not have obijuam providers. You have a doctor that's been practicing obijuan by themselves with nobody else in their parish in a 50 miles radius for 25 years, and they're not gonna. They're gonna look at these laws, and it's like reading Greek. They're gonna go, I don't. I don't know what this means, and I have no idea what I can and can't do. So guess what? I'm just gonna, like, not do anything, and I'm just gonna go, oh, you're bleeding, and you're pregnant. I can't help you. Go to the nearest hospital. Go to this hospital. Go here, go there, go to the big city. So most of our state, most of the physicians in our state, and most of the patients in our state are under that situation. It's very different when you get to the big medical centers, the big cities patients, I'm sorry, physicians who are lucky, like myself, to have relationships with lawyers who have been able to help them navigate the understanding of the laws. And I think that that is what I've tried to point out since the very beginning, because I realized very early on, as soon as I was able to learn the laws and really understand them, then I was like, okay, I might not agree with them. I can have an opinion on, you know, and say, this law is not great and not a good law for our patients, but I understand them, and I know what I can do, what I cannot do. I know where the law lies as far as my safety from being put into jail. But that is a rarity. Most physicians do not have that situation. And when a physician, because I had a very short amount of time, that I felt this myself. When a physician is operating under the guise of fear, that is not the best way to navigate any situation, whether it's patient care, whether it's deciding about something that could impact your patients. Like, should I stock this medication that can help with miscarriage management or not? I mean, so many situations, fear will cloud judgment, and we need to take the fear out of this. For our physicians, it's a totally different conversation to me to say, do we agree with these laws? Do we need to change these laws? I have some strong opinions, and I think very strongly, yes, we need to change these laws, and we need to do our very best to reverse them. But I also, right now, what I know, I know the little rock that I can chip away, the little bit that I can get to, is trying to get rid of as much fear as possible, because that is a huge part of what's playing a role in our outcomes, that we're seeing some of the bad patient outcomes, patients who are being sent away from emergency room after emergency room bleeding, hemorrhaging during a miscarriage, that's in process. And as soon as they get to an ER and if that fetus still has a heartbeat, unfortunately, there are a lot of physicians who are like, oh, I'm scared. I don't know these laws. You need to leave. I can't treat you. That is not what should be happening, and that is not legally what can be done. You can still treat that pregnancy. I mean, that miscarriage that's happened. You can treat that patient because the patient should come first. The mother should come first. Always. This is. This is the caveat in OBGYN. This is what we learn from a very early standpoint of, you have two patients you're caring for, right? When you get to, like, a full term pregnancy, you have a two patients you are caring for. You have to sometimes choose a patient, and that choice should be the mother. That is just what is supposed to be done. And the laws, they don't always align with that. But when you come to, like, a miscarriage management, that should be very clear to physicians that the law still allows you to treat that.

[01:18:58] HALEY BEAVERS KHOURY: Can I bring it back to you?

[01:19:00] NICOLE FREEHILL: Yeah.

[01:19:02] HALEY BEAVERS KHOURY: You testified about exceptions for rape and incest. You told some really hard patient stories there.

[01:19:09] NICOLE FREEHILL: Yeah, I'm sure there are others, too. But you've been managing to push past that fear in a lot of ways. But I'm wondering if, especially in the.

[01:19:18] HALEY BEAVERS KHOURY: Months after Roe, what has stuck? What or who has stuck with you?

[01:19:24] NICOLE FREEHILL: I think that that patient that I first talked about with the vaginal cancer diagnosis, she was able to get her abortion, but the way that it had to happen, because of everything going on in our state and still the confusion at that point, that very early post row world, she had to have her labor induced at a very early gestation, so very early in her pregnancy, not anywhere close to where we usually induce a labor. Like, you know, a lot of people will know the term induction of labor because a lot of us who have been pregnant have had their labors induced for one reason or another. When you induce a pregnancy early on, it takes longer. It's a harder process, and you have a much higher risk of complications like infection and hemorrhage. Unfortunately, this patient had her induction when she delivered, she hemorrhaged, she lost over a liter of blood, had to have a blood transfusion that could have been avoided. And that sticks with me, that I did the best that I could by her, but it still was not what should have happened. And even patients that I haven't been personally involved with, I've heard and have now met some of the patients that have been involved in situations who have been actively hemorrhaging, having a miscarriage, in a highly desired pregnancy. But you can lose so much blood so quickly, whether it's early in pregnancy, when you're having a miscarriage, but especially later in pregnancy, there's so much blood going through that uterus and you can lose a lot of it very quickly. And, you know, patients who are being sent away from er after er, soaking through pads, soaked blood, running down their legs and being sent away, that is just a travesty. That is not what should be happening. And those stories and those patients and people stick with me because we need to do better. You cannot ever avoid every single situation of a patient should have been treated earlier, treated differently, unfortunately, that is, we're human. There's never going to be a perfect, but we should strive to make those situations very few and far between and always choose the best path for the patient. And laws should not limit that. And that's not where we are in this state and that needs to change. So you mentioned at the very top that you went to an anti abortion protest. A quick picture of what it looked like from the eyes of a child. Yeah, I'm trying. The very vague recollection I have of it was basically like standing there with a sign. And it wasn't like a lot of chanting or moving, but just basically standing in front with. And I don't even remember what the sign said. And there were maybe like six to ten other people. It was not a huge amount. And we were there for a couple of hours. Maybe it was not a huge amount of time, but it was just very. As my, like 910 year old self, I was just sitting there going, hmm, what am I going to get from the bakery after? That was my motivation. I had no real cognizance of what I was doing. And it wasn't until later on that I was like, oh, my goodness, I cannot believe that I was there. I cannot believe that I did that. What did that sign say? I don't even know. No, I remember, and I love my aunt dearly, but I remember my aunt being like, you know, people are killing their babies. And I was like, oh, my goodness. Oh, that's, that's bad. And I mean, in my little brain, I think I was, you know, picturing like this murder scene, hanging knives, being stabbed, like, you know, what, what you thought of as murders a nine year old. And I don't even remember if there were any patients that walked past or if, if there were, there was definitely nothing that severe that happened. But I just remember thinking, oh, sure, I'll go with you for that. No, murder's wrong, right?

[01:23:44] HALEY BEAVERS KHOURY: Yeah. I do not mean to one up you, but I've been to the March 4 life in DC twice when I was in high school.

[01:23:52] NICOLE FREEHILL: Oh, my gosh.

[01:23:52] HALEY BEAVERS KHOURY: So I have a little bit more clear memories. I can talk about that. A little bit of. I love your story about this, because you, as a nine year old, not having any idea why you were there, really, to me, feels no different why I was there when I was. I think I was 16 and 17, so, you know, a bit older, you know, a bit wiser. But there was still. I was with my church youth group, and it was billed as this kind of like a retreat. Like, we're gonna get on a bus, we're gonna go to DC. We're gonna go to the march for life. There was, like, this church concert thing in a stadium with, like, adoration. And, you know, it was very much. But there was no education on, like, why we were there. We were there because people are murdering babies. And I look back on that, I'm like, okay, I'm embarrassed, and I've learned a lot, and I feel very forgiving of myself for doing that because I was. I was a kid and I wasn't told what was going on. But, yeah, no, there's this. I think there's such an. Oh, my God. We could talk forever about just.

[01:24:55] NICOLE FREEHILL: Yeah, I know, no problem. I heard that. I didn't know if that was gonna interfere.

[01:25:04] HALEY BEAVERS KHOURY: Yeah, yeah. I don't tell a lot of people about that. Yeah, right.

[01:25:07] NICOLE FREEHILL: I don't tell the story of me being at an anti abortion protest.

[01:25:13] HALEY BEAVERS KHOURY: I was so young and, like, it was what I knew.

[01:25:17] NICOLE FREEHILL: Yeah, you're still such a kid.

[01:25:18] HALEY BEAVERS KHOURY: You're such a kid. And, like, until I met somebody who needed an abortion, I was totally, like, anti abortion. But then you meet people who, like, need abortions or want abortions or. And you're like, oh, okay.

[01:25:32] NICOLE FREEHILL: This is what it means.

[01:25:33] HALEY BEAVERS KHOURY: Yeah, this is what it means.

[01:25:34] NICOLE FREEHILL: And that's something that I've tried to educate not only my family members, but a lot of people on is abortion means so many things, and there's so many different nuances to it, and it's so multifaceted and so complex. And my take home point that I tell a lot of people is it's so complex, and it is such a personal decision, no matter what the situation is, whether it's an elective or there's a problem going on. With the pregnancy, it's so hard. It needs to be left between the doctor and that patient, and it's all about choice. And that's what I think a lot of legislators and a lot of, quote, pro life people are like, oh, these, you know, I've been called the abortion cartel, which is, like, my favorite. I'm a cartel. But is that, you know, we're making people have abortions. I'm like, no, I've never. I will never make somebody have an abortion. Even if there's a very clear, like, oh, you are going to die, or have a very high chance of dying, or whatever it is. It is. I'm not gonna make anybody do anything. I think that the option of choice and the concept of bodily autonomy and choice is what it all boils down to. And just because if someone say, you, hailey, would never choose to have an abortion, no matter what the situation, that is your choice. It does not have to be the next person's choice. It does not have to be my choice. It is a highly individualized decision. And just, like, do you want to pierce your ears? I'm not going to make you pierce your ears. Maybe I want to. And you don't want to. I think you can boil it down to, like, anything that somebody should have a choice on. And anybody has a own personal journey that's going to bring them to whatever their choice is. And to take away a choice, though, is just. It's wrong. Yeah, do that again.

[01:27:36] HALEY BEAVERS KHOURY: Yeah. I attended the march for life when I was a junior and senior in high school with my catholic church youth group, and it was billed as, like, a retreat. We got on a bus, we drove to dc overnight. We did some sightseeing. Like, I got to see, like, all the memorials, and then also was just, like, chucked a defund. Planned parenthood, like, mass produced. I still have pictures, which. Which that's, like, I guess, I don't know. The unfortunate part about growing up in this time is, like, I have these pictures, but it is a good reminder of, like, I am so frustrated sometimes with people who are very anti abortion, especially people who I feel like one of the greatest honors that as physicians, we get to, that I will get to do someday, is just walking with people in the hardest times of their lives. You know, it's this journey that we're taking with patients to, like, the depths of despair and back. And when I am confronted by people who don't have to make that walk, who don't want to make that walk, who would never choose to make that walk with anybody but who are insisting upon their, like, thrusting their beliefs onto people, it makes me so upset because I'm like, you don't even understand. Like, you just don't understand. But then I think about, like, 16 year old me, 17 year old me, who was holding a defund Planned Parenthood sign in Washington, DC in 2012, and how just, like, much I have changed. Like, I am sitting here for this. I was president of med students for choice at my school. Like, I am testifying, you know, at the legislature. Like, if me at that point, who is again, going to the Capitol again, there was a lot of, like, naivete and just really not understanding the situation, but, like, the change is possible. Like, I really, I really, in my best days and my best moments, I'm like, okay, if I can do it, I know other people can, too, because, like, I did it and I. I did it. I'm the example. Like, I know you can change your mind, and I know that you don't have to believe this.

[01:29:42] NICOLE FREEHILL: Absolutely. Yeah. And I think what a great journey. I mean, I know you said you're kind of, like, embarrassed to say this, but it is a great story to have to be. Like, I did this. And then I kind of realized through the course of getting older, maturing, being more educated, understanding the process, and then going, wait, we shouldn't be forcing people to continue pregnancies or we shouldn't be taking away these options.

[01:30:08] HALEY BEAVERS KHOURY: Yeah, absolutely.

[01:30:10] NICOLE FREEHILL: So it can. It can absolutely happen.

[01:30:12] HALEY BEAVERS KHOURY: It can. I've seen it in myself.

[01:30:14] NICOLE FREEHILL: That's what we have striving for.

[01:30:16] HALEY BEAVERS KHOURY: Yes, absolutely. An hour and a half.

[01:30:20] NICOLE FREEHILL: Okay.

[01:30:21] HALEY BEAVERS KHOURY: I know we've taken a lot of.

[01:30:22] NICOLE FREEHILL: Time and we'll wrap up, but I.

[01:30:24] HALEY BEAVERS KHOURY: Just have a kind of specific follow up where the first birth that you.

[01:30:29] NICOLE FREEHILL: Did, we always see, like, the patient in bed pushing, but we never see, like, the view that the doctor has. So could you paint a picture of that birth? Like, what were you seeing?

[01:30:40] HALEY BEAVERS KHOURY: What were you feeling? Literally?

[01:30:43] NICOLE FREEHILL: Yeah. I mean, I just remember being all gowned up and feeling very important in my medical attire that I had never worn before and seeing the beginning of the head coming out of the vagina, and I was like, oh, okay, this is interesting. And I've never had this viewpoint. And then it gets bigger and bigger and bigger, and you're like, oh, my gosh, when is this going to end? And this poor vagina. And then all of a sudden, I mean, it seems to take a while for the head to get out. It just keeps getting bigger and bigger, and you're like, oh, my gosh, there's a sea monster in there. And then all of a sudden, it's like, full head, and you're like, oh, okay, that's it. And then the body comes right after, and it's, wow. And then you're just holding a baby in your arms. It's like, this is incredible. I can't even believe that this just happened. And then there's this waterfall of fluid afterwards, this gush, and it's very messy. That's why we have all the gear and the boots and the gown and the mask on our face and all of the things, because there's a lot of. A lot of fluids involved, but just such an incredible process. Like seeing this mom just strain and push and get to the point of delivering her child, and then just the utter amazement at that whole process. And I can tell you, being in between a patient's legs doing that delivery and all of the thousands of delivery sense, it's such a uniquely different experience than having your own child because I've had that experience twice myself, too. Just very, very different. To be on the other side of things, I want to give you two.

[01:32:22] HALEY BEAVERS KHOURY: An opportunity to just ask each other any last questions that you have to.

[01:32:26] NICOLE FREEHILL: Kind of close the conversation and shaping.

[01:32:32] HALEY BEAVERS KHOURY: Right now.

[01:32:35] NICOLE FREEHILL: I don't have any further questions, but I just want to tell you that I'm super proud of you.

[01:32:39] HALEY BEAVERS KHOURY: Thank you.

[01:32:39] NICOLE FREEHILL: And I think that you are going to do, again, like I said, my first impression, you're going to do amazing things, and you're going to be a fantastic physician, no matter what it is you decide to do. And you have the right mindset of keeping your patients first. And I think the best advice I can give you is just keep that fire in your belly and do whatever it is you love.

[01:33:04] HALEY BEAVERS KHOURY: Yes, thank you. No, I really appreciate that. Thank you. I don't have any questions either. Yeah, this has been great. I've really enjoyed learning more about you and chatting about this. One cool thing about being a medicine is learning from amazing physicians like you who are doing the work and not just the patient care, but the advocacy and, like, the things you have to take vacation days for because it's so hard to do that. And so seeing your example makes me know that it's possible. I'm seeing it, and I can believe that it can happen. So thank you for everything.

[01:33:40] NICOLE FREEHILL: Thank you. I do have one more.

[01:33:41] HALEY BEAVERS KHOURY: I'm sorry. Okay.

[01:33:42] NICOLE FREEHILL: You talked about fear a lot.

[01:33:44] HALEY BEAVERS KHOURY: I'm wondering if you can ask each other what your fears are now.

[01:33:49] NICOLE FREEHILL: Okay.

[01:33:50] HALEY BEAVERS KHOURY: That's a really sad one to end on. I'll do it. Yeah, maybe. Yeah, that would be good.

[01:33:57] NICOLE FREEHILL: Thought we weren't even gonna hide it.

[01:33:59] HALEY BEAVERS KHOURY: Yeah. What are your fears now?

[01:34:05] NICOLE FREEHILL: So it's hard to give you just a couple, but I think I am fearful for all of the people of Louisiana and our country as far as the forward progress that we've made for so long with regards to medical care is now taking a huge march backwards. And I'm very fearful for all of my patients and people I will never meet that will be negatively affected by these changes, these laws, when we could do so much better. I'm very fearful of the lives that are going to be impacted, that have already been impacted, but also will continue to be impacted. And how much worse is it going to get? Where are we going? I'm doing my best to fight it getting worse, but I don't know if that's going to happen. Am I going to make things better? Am I not? I'm fearful of that. I'm fearful of my safety, of my family's safety. I've put myself out there a lot, and I think it's the right thing to do. My husband and I had a very long discussion, thought for several days about should I keep doing this work? Should I get more involved? Should we stay in Louisiana? Even when we heard the leaked decision and even before the actual DObbs decision came down, and I just knew that I couldn't leave and abandon all of the people and all of my family and all of my friends and all my patients and colleagues and everybody, but I also fearful that somebody who doesn't think like me and thinks that what I'm doing is wrong is going to come and harm me or harm my family. Yeah, that's probably one of my biggest fears.

[01:36:00] HALEY BEAVERS KHOURY: Yeah. It is sad that that is valid, you know, like, that's. It's really sad.

[01:36:07] NICOLE FREEHILL: Yeah.

[01:36:07] HALEY BEAVERS KHOURY: I'm sorry that you have that fear.

[01:36:11] NICOLE FREEHILL: I got through the whole thing without crying. I just haven't verbalized that often. That's why it really affects me. There's a lot of other things that I could cry about, but I don't because I haven't really verbalized it much.

[01:36:24] HALEY BEAVERS KHOURY: Yeah, yeah, yeah. Please wait.

[01:36:29] NICOLE FREEHILL: I didn't get a chance to ask Haley or do you want not one?

[01:36:32] HALEY BEAVERS KHOURY: No, it's okay. I'll talk about what am I most afraid of.

[01:36:35] NICOLE FREEHILL: Yeah. What are you most afraid of right now?

[01:36:37] HALEY BEAVERS KHOURY: Oh, my God. Like you said, there's so many things to be afraid of. I. I guess for me my biggest fear is just not knowing when this is gonna end and seeing it get worse before it gets better. And I think that can be a very dangerous mindset to live in because, oh, it's a slippery slope to bad, bad things, but we're seeing it in real time. Like, I think what happened recently with the reclassification of misoprostol and mifeprestone is huge. And it is a step in a direction that is going to continue to make it harder to provide care. It's going to make it harder to provide or just protect patients privacy. We haven't even talked about privacy issues and all of these things that come into play when it comes to providing medical care. So, yeah, that slippery slope of the people who want to restrict access to reproductive healthcare are in a great position to continue doing so. And kind of, like, just off of that, before I went to medical school, I worked at shelter for unhoused youth Covenant House New Orleans. And a lot of our youth were either pregnant or parenting, had experiences with homelessness directly related to parenting or becoming pregnant and, like, not being welcome in the home or, you know, all of these things. And so when I think about the people who are going to be harmed the most, it's those, like, teenagers who are pregnant and have nowhere to go and have no access to healthcare and don't know their, you know, rights in terms of, you know, what they can and cannot request and, like, what they can and cannot say. So I just think of, like, the disparities that are continuing to widen because of, you know, there are people, you know, I'm gonna be a physician. My husband's a physician. Like, if I ever needed to go out of state for an abortion, easy done. I mean, it wouldn't be easy, you know, but, like, you could do it. I could do it. I could do it. And it would not be great. And I am sure it would be extremely traumatizing, but I can do it. But there are people who can't. Yeah. And I just. I am so fearful for them because there are many people, especially in a state as poor as Louisiana, that will continue to stay poor and will continue to be just, I mean, like, oppressed by these things. And that is so scary to me.

[01:39:10] NICOLE FREEHILL: Absolutely. And most of them are black and brown.

[01:39:12] HALEY BEAVERS KHOURY: Yep.

[01:39:13] NICOLE FREEHILL: And that is just horrific.

[01:39:16] HALEY BEAVERS KHOURY: Yeah.

[01:39:18] NICOLE FREEHILL: We strived for so many years to make those differences in that drastic medical outcomes and everything else socially, the differences that were there between black and brown individuals and non. And now we're just going to make it that much worse.

[01:39:36] HALEY BEAVERS KHOURY: Yeah, it's really scary. It's really scary. Happy?

[01:39:42] NICOLE FREEHILL: Yes, happy. Happy. So I wanted to go back to.

[01:39:46] HALEY BEAVERS KHOURY: Haley when you were talking about, you know, your family members who are, like, when are you gonna leave? When are you gonna get out?

[01:39:52] NICOLE FREEHILL: And, you know, you mentioned the, like.

[01:39:54] HALEY BEAVERS KHOURY: You know, I'm learning to survive here. Like, yeah. And also just, like, having a lot of you having a lot of respect for the activism that goes on, the sense of community.

[01:40:03] NICOLE FREEHILL: And I. I don't know.

[01:40:04] HALEY BEAVERS KHOURY: I'm also from the south, and I have a lot of those similar thoughts. I'm wondering if. If you guys could talk about maybe something about living in this place that really inspires you or that you love about being here that is happy. I like it. Yeah, I love that. I. So I moved to New Orleans in 2020, so I'm still a newcomer, really. I believe in here four years, and I love it so much. Like, I would really. It would really break my heart to leave. Like, I mean, I. It's this, like, sense of knowing almost, you know, where. You know, like, when you walk in your house and you're like, I'm home. That's what I feel like when I come back to the city. Like, I was out of town yesterday, and I got back last night, and I was like, I'm home. And I had, you know, like, that wasn't talking about my house. I was, like, watching the city, like, come into view on the airplane, and I. People are always like, well, why do you love New Orleans? Because unless you're from New Orleans or spend a lot of time here, I think people have a very interesting idea of what New Orleans is like. And it's fun, for sure, but I really feel like the community that I've made here and that I found here and the people are not like any other place I've ever been. And I've lived in several states and several cities, and I, you know, I'm gonna be 30 next year. You know, I've had. I've had. I've got some, like, miles under me at this point in my life, and so feeling like, I'm like, oh, my God, I've finally found my place, especially, like, in my late twenties has been great. The spirit here is just, like, unshakable. I mean, like, it's. I can't even put to words like, what it feels like. But for me, an example that I think that is probably most tangible is I was working for the homeless shelter in 2021 when Hurricane Ida hit. And that was a pretty big deal for the city, we lost, the entire city lost power for two weeks. There wasn't a mandatory evacuation because it came so fast. So, like, a lot of people stayed. And, like, again, I was working at a shelter, and, like, the shelter that we have, we had evacuated people who were living in our physical shelter to Houston, but a lot of the people serviced by Covenant House were using their case management services and were living in apartments throughout the city and they couldn't evacuate. And so I just remember feeling very scared, like in a hurricane, but then also the community response to Hurricane Ida. And, like, I was, like, dming people on Instagram for supplies and tarps and, like, dropping bottles of water off to, like, these young moms who, like, were, you know, unable to feed their babies because we couldn't, you know, we didn't have water for two weeks and they weren't breastfeeding. They were doing formula feeding. And. And I was going to strangers houses and they were like, yeah, just like, walk on in and grab the tart. It was just like, I felt like it was such a horrible situation. Like, the city smelled like garbage. There's people starving. It was awful. But I was like, oh, my God, I love it here so much because everybody came together and there was not. It was just so. I was like, I want to be a part of a community that cares for each other like this. I love that. I love that.

[01:43:16] NICOLE FREEHILL: Yeah. And that's why you were getting me, like, teary eyed. Because anytime I think about my home, I think about New Orleans and the whole area. It's. It is such a unique, special place for, you know. Yes. All the fun stuff. I mean, we have fantastic festivals, great food, great music, a lot of culture. I mean, so much fun stuff. And that adds to it for sure. But it is the, I would say the resilience factor, right. And the people of New Orleans and of the surrounding area are just so resilient. And, you know, you can throw a major hurricane at them. And I remember I was not physically here for Katrina. I graduated medical school in 2005. So may of 2005, left and moved to Philadelphia for residency. Was in Philadelphia, very safe and secluded from Hurricane Katrina, but my entire family had to evacuate and then obviously greatly impacted not only my family, but the entire area. But there was, I remember the first time I came back home after Katrina was November, so, like, not even three months after. And to see just everybody, you know, pitching in and helping each other. All of the piles of trash that were waiting for, you know, people to be taking them away, the, all the tarps that were on the roofs because nobody's leaving. Like, people. I mean, people had to evacuate, but then a lot of people came back because they're like, I'm not leaving this place. I'm not leaving my people. I'm not leaving my community. And that resilience factor. And I think that what you think that you can tell a lot about people and how they respond to something negative or something bad, right. You push them, what are they gonna do? How are they gonna respond? Inevitably, New Orleans are like, we got this. We're gonna get through this. They have a lot of grit.

[01:45:09] HALEY BEAVERS KHOURY: Yeah. I love it.

[01:45:10] NICOLE FREEHILL: Yeah. Thank you. Thank you.