(theme music) Thanks for tuning into Sound School. The backstory to great audio storytelling. I’m Rob Rosenthal. I make this podcast for PRX and Transom. I have a lengthy clip to start off the show. About five minutes. There’s a writing maneuver I want you to listen to. I think it will be useful if you hear a lot of it. It’s something very unusual. An approach I’ve never heard before. Susan Burton says same with her. She’d never heard any one do it – until she wrote like this herself. Clip - Susan (narrating) - 6 a.m. In Chicago. Of course the shot starts at the lake. Camera pans over the water and the magnificent buildings rise from the shoreline, twinkling in the dawn light. We continue across the city, still bird's-eye view, over the grid, over the elevated tracks and wide highways, coming to rest in a western suburb. Drop down to a brick bungalow where, inside, a woman, late thirties. Moves softly past the bedrooms where her children sleep and steps out the front door to meet the morning. Windchill of 20 below. She hurries to a minivan, and as she pulls away from the curb, we see the streets frosted with salt, the moon shining high and hard, and we see her work ID where she keeps it on the center console, the words board-certified RN, and her name in all caps. This is Mindy Figueroa. Mindy says she was made to be a nurse. Mindy - I think I was just born to be in healthcare. Like, as a kid, my sister would find all the dolls and the ballet slippers at the Dollar Tree section, but I always got the doctor kit. The stethoscope, the little syringe, always, always, so it was just always a thing. Susan - Mindy was the first one in her family to go to college. Her parents came to this country undocumented, from Mexico, worked factory jobs, earned citizenship. Mindy paid her way through school, got her degree, started out at a small hospital, and after a few years, transferred up to a big one, UI Health at the University of Illinois at Chicago. She works on the labor and delivery floor, with patients about to have babies. Mindy - I've been told many, many times that as soon as I walk in a room, they know I like my job, and I love coming to work, and I feel like they feel that. So I walk into a room and “Good morning. My name is Mindy. I will be here until 7 p.m.” Susan - Watch this happen. Mindy, stepping cheerfully into a labor room, her face framed by two neat braids, and then we carousel through shots of Mindy at work. Mindy strapping a fetal monitor to a patient's belly. Mindy at the nursing station, holding a plastic pillow up like show and tell, her colleagues doubled over in laughter. Mindy her face grave, bursting through the door of the OR. Mindy loves the intimacy of labor and delivery, and that adrenaline that switched from it's calm to now it's time to run. Mindy - And also, I mean, I just like blood in general. I like- Susan (in tape) You do? Mindy - Yes. Susan (in tape) - Like, do you mean like literally like you like blood? Mindy - Yes, and everyone on the unit knows it. If there is a hemorrhage, if there is heavy bleeding, they know I am the person. I like to weigh it. I like quantify the blood. I like clean it up. Blood clots coming out of after delivery and we're pushing on their belly and there's, it's almost- Popping a pimple. Like, okay, let's get it out of there to prevent more bleeding. And I feel like I'm really good at recognizing when we're trending towards too much blood because I am actually watching. I watch every birth. I watch ever C-section. Like I don't sit and chart. As soon as the incision starts, I watch it because it's just intriguing to me. I've been doing this for 14 years. And it still amazes me that there's an incision on an abdomen, but there's a baby there. So I watch every delivery. Susan (narration) - This story is going to be about one of those deliveries that Mindy watched. One that changed things for her and for her hospital. There are more than 2,000 deliveries a year at UIC. It's a public hospital, not a fancy one. And it's located right in the middle of the city in the medical district. Establishing shot of the hulking building, dawn breaking open the sky above. A humble hospital in Chicago, a hardworking nurse, a delivery with stakes. How could we not tell this like a medical drama? A medical drama. Its emphasis is on the world inside the hospital. On the heart and the heroism of the people who work there. On their relationships with one another. On how their interactions with patients are shaped by their own stories. But what happens in a hospital also reverberates outside. And on this show, we're going to see that too. Because this delivery that Mindy watches, it doesn't just change things at UIC. It could change things for the entire country. And now let's pull back, get the whole hospital in the frame and end the opening credit sequence with this image. This boxy building on a sub-zero morning. But we know that behind that imposing facade it's warm. We're already invested in the human drama inside. Black screen. Listening to that again, I’m just noticing that Susan, the reporter and host, she didn’t offer a show post after that opening. Something where she says “From Serial Productions and The New York Times, I’m Susan Burton, and this is The Retrievals, season 2, The C-Sections.” That actually comes at the very end of the first episode about 40 minutes later. An interesting choice. Anyway, that’s not what I hoped you noticed. I’m sure you caught the way Susan described images like they were notes in a script for a TV show, a medical drama. Notes like “Camera pans over the water” and “Establishing shot of the hulking building.” Normally, a narrator would just describe the scene like they’re looking at it. As opposed to the narrator describing what a camera might see. So, my obvious first question to Susan was this: Why? Why write the story this way? Susan - This is gonna be a really long-winded answer. I hope you'll bear with me. Is it okay if I answer it by going back to season one of The Retrievals and then talking about the choice to use the style of a medical drama for portions of season two? Would that be okay? Rob – Absolutely. Yeah. Susan – Okay. Great. So, season one of The Retrievals told the story of an experience had by a number of patients at the Yale Fertility Center. These patients experienced unexpected pain during a procedure called the egg retrieval. And I was interviewing these patients about what happened to them. And I was struck by the echoes in their stories. I was hearing the same sort of beats, plot points, emotions again and again. And there came a stage when I understood that the story I had, had enough heft…. And I sat down one weekend to write a pitch to Serial. And the first sentences that came out in that pitch are ultimately the first sentences that opened episode one, season one of The Retrievals. “The women are seeking fertility treatment for a variety of reasons. Clip - S1, Ep 1 The Retrievals - The women are seeking fertility treatment for a variety of reasons. They've had a couple miscarriages and they're pushing 40. They don't have fallopian tubes or they need sperm. One woman has a diagnosis that's like a metaphor from feminist sci-fi. A uterus with a single horn like a unicorn. All of them wind up at the fertility clinic at Yale University. Susan - I continued along in the pitch using that phrase, the women, the woman. Clip (continues) - To some of the women the clinic seems to live up to its billing. They like their doctors. (fades under) Susan - It was just sort of what came out when I sat down. And it was an intuitive stylistic choice that felt right. Clip (continues) – The day of the retrieval. The women arrive at the clinic. They check in on different mornings. And different months. And calendar years. None of them are here on the same day. But they will come out of the day with the same story. Susan - And it was only by engaging it that I figured out its possibilities, that I figured its intellectual underpinnings, that I figured out why this style for this story. So in the case of season one, there are a lot of reasons that voice worked for that story. But among them, “the women, the woman,” it evoked a chorus. It evoked volume and pattern. Clip (continues) – Woman 1 - The egg retrieval you know they kind of do them one by one or like a couple at a time you know my impression and so you have moments in between pain to say like what the fuck is going on. Woman 2 - I do remember I think I swore I was using curse words because it was just so painful. Woman 3 - You know I don't know if I can do this any longer. Woman 2 - You know you just have to get through it. It's going to be over before you know it. Woman 1 - OK this is going to be over eventually. Woman 2 - You can do this you can do this . Woman 4 – You just want this moment over. Woman 1 – Get through it. Get through it. (fades under) Susan - To pivot to season two. So that was a similar thing where intuitively I arrived on that medical drama style. Only by engaging it did I figure out what it did. In that case, it took me longer to get there. I started out trying to tell the story. I had the idea that I was going to tell an intellectual history of pain during C-sections, which is the subject of the podcast... And I'd even begun drafting something in that vein, but I was continuing to report. And it became clear to me that some things that were happening at a particular hospital in Chicago were actually really important to the story I was trying to tell. And it was the kind of thing where I was just sort of outside one morning walking to get a bag of coffee beans and a baguette. And I thought, “Well, wait, what if I tell it like a TV show? What if I'd tell it, like a medical drama?” And I came home and just started writing. And that's sort of what came out. And it took a little bit to figure out, “Well, why this voice? Why would this voice be important to telling this story? And… my animating question this season was like, how do you solve these big problems in medicine. How do you solve this problem of patients feeling pain during C-sections? How do you solve this in medicine of dismissing or minimizing women's pain? And the people in the story I report on are using storytelling to solve these problems. They're harnessing the power of stories to come up with solutions. And so there was a way that the style sort of reflected the content. Rob - I heard you use the word intuitively. Susan – Yeah. Rob - That it was just sort of born from your thinking about it. It just came to you. Susan – Yeah. Rob – Hunh. Somehow I imagined there was a table of people at Serial all sitting around, perhaps having a baguette and some coffee… Susan – (laughs) Rob - …and discussing how best to approach this. But for you, it sounds like the seed for this style of writing was just… born from your thinking. Susan – Yeah. Rob – So, I’m wondering as you were thinking about this if there was some television show or movie or series that you had in mind that you kept returning to as you were unfolding this idea and trying it out in writing. Susan – Yeah… I was thinking of, I mean even just like the opening, looking at Chicago, like if you've watched The Bear, right, which is a show that's very much about restaurants and Chicago. You know, I think that certainly, like those beautiful images of that city, Chicago is a city I love and think is beautiful, and certainly that was in my head. It was the, you know, a portion of the opening script that you just played where I described, you know so “pull back from the hospital, see the sky breaking over that hulking building.” You know if you watched Saint Elsewhere in the ‘80s, you know at the beginning of the opening credit sequence, you know, you always end with the shot of the big hospital that is Saint Elsewhere. So certainly I was nodding to conventions of… opening credit sequence of television shows that we watch in that opening passage. Clip – Susan (narrating) - The action of the episode begins with Mindy in a nearly empty elevator. Closer to 7 a.m. Change of shift. You can barely fit, sardines. But Mindy's early today. She's almost always early. She's the one who will have cleaned the break room by the time her coworkers arrive. At UIC your coworkers have your back. Mindy could say this about all of the nurses on her crew. One of those nurses is Clara Hochhauser. We see her emerging from the locker room in gray scrubs and a scrub coat. Not everyone wears the scrub coat, but Clara does because it has better pockets and because it covers her tattoos. Clara has large wise eyes as if she sees more than other people. She's a natural at nursing, but it wasn't obvious that it was where she would wind up. Rob – Have you written this way before? Susan – No. I haven’t. No. Rob – How did you learn to write like this? Susan - It, gosh, I mean it didn't feel that much different than any other kind of writing. You know, I did, there were definitely times when I was aware of how amateurish it must sound. I actually haven't spoken to anybody who actually writes for TV. Like I'm sure I'm using some incredibly like hacky phrases. Like I'm almost positive that, you know, fade to black, right? Like that's just some, probably some cliche that no self-respecting TV writer would ever use in their script. But that wasn't exactly the idea, right? The idea wasn't to sort of get it right, to, you know, ape what a real TV writer would write in the script. It was to sort speak in this language that would be immediately accessible to all. “Oh, I hear what she's doing. She's telling me it's a TV show. Okay, so what does that feel like?”… Rob – Did you consult actual TV scripts? Susan – Yes. Sometimes I would like glance at something to just, you know… If you listen to the four episodes, like there's a lot I'm overusing. I mean, you now, I think I use the phrase, “now we see” a million times or, you know, close up or focus or zoom or pan or, you know I mean I have my very basic vocabulary. So occasionally I would look at scripts to just see like what am I missing here? What are the other terms I can use here? But sometimes I would try a term and it would just seem too specific, too precise. Like there was a sentence I had at one point about, you know, “now we dolly out of the ballroom” and “dolly” just like it drew attention to itself. You know, it took you out of it. It wasn't right. Rob - Sometimes you use this device to set a scene and describe action and then other times, it's meta. You stand back describing the story for us as opposed to telling us the story. And here's an example. Clip – Susan (narrating) - On a medical drama, when the healthcare provider becomes the patient, it's a twist. But this isn't a twist, it's our premise. We don't know how this matters yet, but it will. It matters that this patient is not a visitor, that she's not someone who leaves, but someone who stays. Susan - You know, it felt important early on to give the listener a couple reasons why you're hearing the story this way. To reflect, to acknowledge, you know that this story is being told like a medical drama… And…One of the things that was really important here was that this happened to somebody who worked at the hospital. That matters. And so, you now, so I’m… noting that there are ways in which the story you are hearing conforms to conventions that are familiar to us from watching medical dramas and ways it subverts them. And those matter. And of course, it's real life, right? Ways in which the real life story subverts those conventions. Rob - I was keenly aware of what was happening to me as I listened. And I found myself paying attention to your narration in a way that felt like I was watching TV, like actually watching a television. Not just what was happening on the screen, but the whole television itself. Like, I felt like I was on a couch and over there was a TV. And, when you shifted into this mode, I shifted. I guess what I'm trying to say is, I felt like the TV came between me and the story. And I'm wondering what, if you have any thoughts about that. Susan - Well did it did it distance you from the story or did it engage you? Rob - Well, I think both things are true. I thought the writing engaged me because I was curious. Like, what the heck is she doing? And how is this working? And why did she make these choices, et cetera, et cetera? And so in that sense, I found it valuable. It drew me in because it was a unique way of telling the story. And that's advantageous. On the other side of the coin, what it ended up doing though, is I felt more distant from the story and if I can just continue the thought. So if you were doing this in a more traditional way, you would just sort of describe what was happening. But because you wrote it as notes in a TV script, I then, I guess I had the TV between me and what was happening as opposed to just seeing what was happening. Does that sound weird? Does that make any sense at all? Susan - No it does make sense and I mean I think that… it was important for me to play with the idea of just, just the function of health care storytelling, the role of medical storytelling in in making change. So, so, so the fact that a listener is reflecting on on storytelling, you know in whatever way is you know is part of that. But it's interesting to me that… you saw you saw the TV in front of you and, and it it came between you and the story, you know and sometimes the trauma that we're dealing with at points in the story. Sometimes it's helpful right to to have that mediating. You know, yeah that that mediated technology… protecting you somewhat. Clip - Cutting someone's body open and then operating when they can feel it, that is not supposed to happen. That's something from history or from war. But in the United States, it happens a hundred thousand times a year. That's the best estimate of how many patients have significant pain during cesarean. Not all of these patients feel the exact same intensity of pain or at the same parts of the surgery or for the same length of time. But the pain they feel is significant. Most people don't know about this. Until recently, I didn't. I learned of it from listeners to season one of this podcast. It doesn't matter if you haven't heard season one. The details are less important than the common experience it described. Pain a doctor didn't listen to, pain a doctor did not adequately treat. That experience resonated with many listeners and hundreds of them, mostly women, began writing to me with their own stories. One afternoon, I opened a note that was unlike any I'd received so far. I had a C-section, the email began, where anesthesia was not properly administered. I remember telling them I could feel the cutting, the moving of my organs, the burning, shocking, brutal pain, and being told that wasn't possible and that I would just have to tough it out. To me, this listener's experience seemed so out of range that it might be singular. Then I opened two more of these notes. Soon I understood this was a subject that would come up again and again. C-sections are the most frequently performed surgery in the world. In the U.S., there are 1.2 million of them a year. So 100,000 patients a year feeling pain during cesarean. That's 8%. Some people say the rate is even higher. There's no other surgery where this happens. No other major surgery where it would be acceptable for 8% of patients to feel that surgery. Rob - What were you trying to accomplish by choosing this approach… as opposed to a more traditional writing for radio style? Susan – Um, this podcast is about a lot of hard stuff. There’s trauma. There’s darkness. I think that… pain during C-sections is not a new problem but for a lot of time it’s been a hidden one. And, one of the ways to bring it into the light is to confront it directly. To talk about it. And, to talk about what it feels like for a patient and to talk about what’s really going on. So, for instance, to stay with episode one… we, we learn about a very painful C-section undergone by a nurse at this hospital, the nurse is named Clara. And it was interesting to think about the role of a camera, right? So this is a traumatic surgery. It's a painful surgery. You know, even if nothing goes wrong in a C-Section, it's still a major abdominal surgery. There's still level of like, well, what do you need to see? And there was a way in which sort of... Pointing the camera and saying, I'm not gonna show you this part. I'm gonna show this part, this is hard to look at, but you need to see this…. So, the camera, is sort of doing what we and what the people who want to work on this problem and solve this problem need to do themselves. Clip – Susan (narrating) - There's a decision to make about the C-section, how much of this procedure to show. Like Mindy said, how graphic are we doing? We're not going for gore on this series for showing open bodies for the kick of it, but we do want visceral, all the meanings of that word. Viscera, literally, that's what's inside a patient's abdomen. But also how that word is applied to art. Art that's visceral. It's of the body. It attends to the body and hopefully it makes you feel something in your body. A visceral esthetic, muscular, close to the bone, raw but not sensational, not shying away. Okay, enough self-regard, enough theory. What does this mean in practice? Now the surgeon calls out incision and then cuts into Clara's abdomen just above the pubic bone. We're not seeing the scalpel in her flesh, okay? But just know that this kind of cut is called a bikini incision. Bikini sounds tiny, but this cut is big. Once Clara's, abdomen is open, the surgeon needs to reach the uterus. The uterus is behind a pair of muscles. Now we see, actually see, the surgeon and the OB resident position themselves on either side of Clara. And pull. These two women in scrubs pull so hard to separate this muscle that their bodies lean back like in tug of war. This is a very physical surgery. When Clara is a nurse in a C-section, she either covers her eyes or looks away for this part. But of course, today Clara is the patient. We go behind the drape now, tight on her face, but something's different, radically different. It was just moments ago that she was beatific. But now her mouth is tight. Rob – Did you feel like you needed a camera for that? Susan - I mean, I probably, you know, I definitely could have told this story, right, without a camera, for sure, right? It's not necessary to the telling in the same way that the chorus wasn't necessary to season one, but it was interesting to play with. And I think that style is just something that's really important to me as somebody who makes this work. It's exciting to me that... we are all working in such, you know, what is essentially a pretty new medium, and we all have so much opportunity all the time to make it new. And, you now, in the same way that, you know I want listeners to be excited for the next piece of tape, like it's exciting, I find it exciting to be exciting about the writing, too. Oh, well, oh, for me. I mean, I think I meant, I hope that the listener finds the writing interesting too. That’s Susan Burton. She wrote and reported The Retrievals from Serial and The New York Times. (theme music) I’d hate for you to come away from this episode of Sound School thinking that this series from The Retrievals is all doom and gloom and gore. It is not. It is actually, I think, an excellent example of solutions journalism. The series moves beyond the incident partially described in this episode to include the stories of four women who, as Susan puts it, listen to women patients and adequately treat their pain. While we were talking, Susan told me something interesting – well, actually, she told me a lot of interesting things. But, one that I didn’t include here is her observation about her overall writing style. That despite the mantra to write conversationally, she doesn’t. Susan – I think some of it is temperamental. I’m someone who is much more comfortable writing than speaking. If I were to write like I speak, there might be something missing. Hear more at Transom dot org. If you want to learn how to make your own radio stories, heads up: the Transom Traveling Workshops are coming to Bloomington, Indiana and Moab, Utah next year. They’re geared for new producers and early career reporters and producers. David Weinberg is the instructor. I can guarantee you’ll work long hours and laugh your tuchus off. Details, dates, and applications will be announced soon. Stay tuned over at transom dot org! This is Sound School, the backstory to great audio storytelling. I’m Rob Rosenthal coming to you from the radio center of the universe – Woods Hole, Massachusetts. Genevie Sponsler, Jay Allison, and Jennifer Jerrett have my back. My thanks to PRX and Transom for their generous, long-time support of Sound School. ##