Episode 2: The Nurse - Ampoule Co.,Ltd

For more audio journalism and storytelling, download New York Times Audio, a new iOS app available for news subscribers.

transcript

At first, the nurse uses the fentanyl at work. She takes vials from storage and injects herself in the bathroom. Then, she starts taking the vials home — a 30-minute drive to a Connecticut town in a more rural part of the state.

This is where she’s raising her children, three of them. It’s a wealthy town, but not hedge-fund wealth. Kids go to public school and play little league. For a while, the nurse taught catechism at the church.

The nurse is divorced from her children’s father, who, according to court documents, is a volatile presence in their lives. The tooth fairy will be coming a lot, because I’m going to knock your teeth out, and maybe the ambulance will have to come, because your jawbones will break, is an example of the kind of thing the nurse claims the father has said.

According to a police report, the father denies making this and all such threatening statements. But the children have said they are scared of him. The nurse is scared when they are with him.

The nurse sees herself as the stable parent. That is who she needs to be. But now, she is doing this thing, this thing that she needs. In fact, she needs it to remain stable.

Sometimes she tries to stop, but she can’t. She can go for a couple of days without using. But as the withdrawal symptoms build, she starts again.

What she does is she removes the fentanyl from the vial with a syringe, and then replaces it with saline, one clear liquid with another. No one can see. She does this uncountable times, and she returns an uncountable number of these vials that say they contain fentanyl, but actually contain saline, to the stock of drugs at work.

And then, one day, October 31, 2020, an anesthesiologist notices that a cap comes off a vial too easily. The loose cap is discovered on a Friday, and the following Wednesday, the nurse is questioned. She denies taking the fentanyl, but when the results of her drug test come back positive, the nurse confesses. She is terminated.

In January 2021, law enforcement authorities send out a letter to approximately 200 patients at the Yale clinic, telling them they are, quote, “a potential victim in a federal criminal case.” How old-fashioned that news keeps arriving in the mail.

But unlike the letter from Yale, this letter demands to be noticed. It’s from the Department of Justice. And this letter says the name of the nurse. The name of the nurse is Donna.

Donna was the person handling all the phone calls. Donna was the person ordering your meds. Donna was the person you called when you were in pain. Donna was — you know, it was all Donna. In fact, I had the number saved in my phone as Donna REI. OK?

Donna was not every patient’s point person at the clinic, but for a time, she had been Leah’s. The day Leah got the envelope from the Department of Justice, she brought it into her kitchen.

And I remember opening it up. It was like one page. And I saw her name, and I, like — I mean, I just, like, lost it. I was, like, weeping.

Leah knew Donna. But now that the nurse had a name, something was different for even the patients who’d never encountered her. Now, there was a distinct individual behind their pain. Who was she?

The patients googled her. One woman’s husband noted that Donna had become a nurse when already in her 40s. What was up with that? Another patient zillowed her house. Someone else looked up whether her town had well water. It did.

Because how could anyone really be sure she’d replaced the fentanyl with saline? And what if she was just refilling the vial from her home tap? Others looked back at my chart messages.

You know, looking back, I know that I did correspond with Donna. We talked about medications at one point in my chart messages. So I did correspond with her, and she did work with my insurance company to get fentanyl approved for the procedures and, I guess, ordered for the procedures.

After a pretty intense Google search, I am pretty certain that I met Donna the couple of times I was at the clinic doing the preliminary kind of testing.

The patients’ identities had shaped the ways they’d made sense of their pain. Now, their identities were shaping their reactions to the person who caused it. What Angela was looking for had as much to do with her own identity as with Donna’s.

Sometimes I have a very hard time connecting with the idea of being a victim, especially in light of my job. So I’m a criminal defense attorney for indigent persons, and there’s always a reason why. Why did they steal this? Why did this assault occur?

Most people aren’t just stealing things because it’s funny. There’s an actual reason behind it. And I wanted desperately, I think, to give her a reason, so that I felt a little bit better.

What would — that’s so interesting. How would knowing or imagining her reason make you feel better?

When you’re going through, I would assume, most fertility procedures, but with IVF for me, you’re at your most vulnerable. You are physically laying your body on the line, saying, do what you need to do to correct, kind of, the brokenness that is me.

And so every step of the way, it’s personal, and I’ve blamed myself. And I wanted to make this not personal, that she wasn’t trying to punish me. Whether it was twisted, however it was, I wanted her justification to feel worth it.

Donna’s justification wasn’t going to be in Google, or whether she justified her actions at all. What was in her heart, how she would explain this, whether she was remorseful or callous — that wasn’t data Angela or any of the other patients were going to be able to find. The patients wanted to know not just who Donna was, but what her story was.

What was the story Donna would tell about her own pain? How would she answer for what she had done? From Serial Productions and “The New York Times,” I’m Susan Burton, and this is “The Retrievals.” This is Episode 2, “The Nurse.”

The Department of Justice invited the patients to a video conference to learn more about the case. On a Thursday afternoon in late January, about 50 patients logged on. Katie, the addiction researcher, was among them.

Yeah, I was at home. You know, it was still sort of peak COVID, so I was on my laptop, signing into this call with the Department of Justice. And very quickly, they were, kind of, letting us know, we’re here to explain to you about the criminal case, and what’s sort of at stake, and what your role might be.

This call isn’t necessarily a for us to get your stories. We will talk to you and — but for this moment, this isn’t the place for us to necessarily tell our stories. But many women really needed to tell their stories, and that was really emotional. You know, I mean, I think people felt — you feel really like you have to get this out.

And I just — I heard other women who had nearly verbatim stories to mine, just being in this procedure, realizing in the moment that they were having this procedure sober, and even looking to their nurse and having their nurse say, I’m giving the most I can legally give you, and then getting kind of similar post-procedure false narratives about their pain. So it was just really interesting. I mean, it was devastating to hear that that’s — you know, I was shocked by how many women were on the call and how long this had sort of gone on.

And I remember, like, I was like, I thought I would feel better hearing that. I felt worse, actually. You know?

Leah was on the call, too.

Well, it doesn’t — you’d think that it would make you feel better knowing other people were in pain like you. But you don’t, actually. You feel worse. You feel angrier. You feel more hurt. It’s more sad.

There was a woman who was talking about how she was screaming out during the surgery, but her voice — you couldn’t hear her voice. But she was like, her — her mouth was open, and Donna’s squeezing her hand, you know. I still can’t get that image out of my head, you know.

Donna had been in the room during some of the retrievals. She had administered the saline herself. Lynn wasn’t on the call that day, but when she learned this, she was startled.

I just remember thinking, you know, how sick she must be to be able to do that, and then watch the women suffer on the operating tables, knowing the reason why, and just sort of trying to figure that out — how someone could do that. It’s, you know, tough to comprehend.

These stories raised questions about how Donna had reconciled the patient’s pain or didn’t, how she split that off, how profoundly dissociated she would have needed to have been, how deep in her addiction. In a way, these stories speak to the suffering of both parties. But it is possible to have empathy for addiction, and also find some of the interactions the patients recall chilling, like this exchange that one patient remembers having with Donna after her retrieval.

And the next thing I remember is waking up in the recovery room. And I was in quite a bit of pain, a lot more pain than I ever would have expected for an egg retrieval. And Donna was my nurse, and I remember asking her if it’s normal to be in that much pain. And she looked at me and said, yes.

It’s almost like watching a kind of, like, horror reel, where women are — all of a sudden, everyone’s kind of like, oh, yeah, I was worried. Oh, it was like — it was like kind of being bombarded by all these women who were told to shut the fuck up while they were experiencing something that they knew was wrong.

That was what became alarmingly clear. That became alarmingly clear to me. People had complained that something was up with the fentanyl. People had complained about Donna. People had complained about the treatment by the physicians and the nurses. And you know, at a certain point, like, not everybody’s crazy.

The people from the Department of Justice tell the patients where things are with Donna’s case. Some of the patients want to know about Yale. Shouldn’t Yale be responsible?

But that’s a different question. That will be a different case, and not one the Department of Justice will handle. Right now, they’re working on a plea deal with Donna, which means there will likely not be a trial, though there will be a sentencing hearing that the patients can attend. It’s possible Donna will be sent to prison. Leah isn’t sure how she feels about this.

I had to think long and hard as a person, again, who teaches work on injustice, incarceration, trauma, et cetera, et cetera. I had to think about what it meant for me, as someone who’d been injured, victimized, hurt, abused, to then — what I needed — what I wanted the outcome to be for someone who had inflicted that on me and other people.

You know, there’s this whole abolition movement going on. So you have to think, like, well, what do I — do I want — do I want to see this person in jail? What do I want — what do I want to have happen to Yale? What is the right outcome?

For months after that call, Leah would continue to wrestle with questions about the right outcome. For Katie, the addiction researcher, at least part of the right outcome was already clear.

During the call about the criminal case, my immediate take was more about the system, you know, Yale’s responsibility, and what kind of system was in place or not in place that allowed this to happen. Why were we ignored when we were reporting pain — so many of us over so much time?

And I wanted, at that time — and I still want to be really careful and sensitive to the other people who are pursuing pregnancy, who were rightfully very upset with the nurse. But for me, as someone who studies addiction and works with individuals with addiction, it was more important to me that the nurse got substance use treatment. I don’t really believe in prison for drug crimes. I believe in substance use treatment. That was my immediate reaction. And I think that’s very much founded in my research.

Katie uses brain imaging to explore how pathways in the brain are altered by addiction and how people living with addiction have the power to rewire those pathways to change the way they think and behave. The patients wanted to know what was going on in Donna’s head. Katie had a picture of that.

Katie’s identity offered her clarity about how the criminal justice system should treat Donna. And on that call, she learned that her perspective could be taken into account. The patients were told that they could submit victim impact letters to the judge. Katie got to work on hers almost immediately.

You know, I was careful in writing the letter. You know, I say to you, like, I don’t really believe in prison for drug crimes. You know, I was chatting with my Yale Law professor friend whose house I stayed at after this egg retrieval, getting his advice on writing this letter. You know, how can I write a letter to a judge that doesn’t minimize my experience, but that — he mentioned, you can’t tell a judge that you don’t believe in prison for drug crimes, because they do.

You know, what you can do is explain, based on your expertise and what you study and research, like, that you believe in substance use treatment and your preference for that. So yeah, I can read you this letter.

It’s not that Katie thought that addiction absolved Donna of responsibility for her actions. She thought that Donna had a great deal of personal responsibility. Katie’s argument is about what we do with that in the criminal justice system, where research shows that substance use treatment leads to better outcomes than incarceration. Katie finished her letter and sent it off.

“And because of this, I ask for leniency in her sentencing, based on my understanding of addiction as a neuroscientist and addiction researcher. Thank you. Kathleen Garrison.”

I want to read now from another letter to the judge. “Dear Judge Hall, I’m respectfully writing to Your Honor in advance of my sentencing hearing. In this letter, I’m hoping to explain to you what I have done that brings me before the court, the circumstances surrounding my actions, and to express the remorse that I feel for the crime that I have committed.”

This is Donna, of course. The letter is a few pages long, and I’ll say more about it. But I’m stopping here to say that Donna has not responded to my many requests to speak with her. I’ve also not spoken at length with anyone who loves her or is close to her or who knows her outside of the clinic, also not for lack of trying.

I’ve thought carefully about how to tell Donna’s story without her participation. Her case generated many documents that have become part of the public record, documents that include very personal information. I’m choosing to tell a story that includes some of these details. Who Donna is and what she was dealing with when she came to the clinic matter, especially because by her own telling, what she was dealing with was the reason she did what she did.

Donna herself told a story about what happened, to investigators, to friends and family. Her friends and family, in turn, told their own stories. I’m telling you about these stories, about how Donna and the people in her life explain these events.

Some of what I know about Donna comes from a sentencing memorandum prepared by Donna’s public defender. The memo includes more than 40 letters from friends and family, beginning with one from Donna’s parents, and ending with testimonials from people Donna has met in recovery. The sentencing memo was both an argument to keep Donna out of prison and an intimate look into her life.

Here is how the memo lays that life out. Donna was born in 1971 and grew up in New York State, in a place kind of like the one she lives now — a comfortable town, but not a fancy one. Three siblings, lots of cousins, Catholic Church.

She went to a state school for college and waitressed when she was home on break. She didn’t get her nursing license until she was in her 40s, and by then, her life was complicated. She had three children — the oldest two twins — and she was in and out of family court with her ex-husband, their father, over custody and visitation.

There was DCF involvement, a finding of emotional neglect against the father. Donna asked the court for protective orders. For her, it was expensive and intensely stressful.

Donna is described in the letters as a devoted mother and a good friend, as generous, tenacious, and trusted. Many of the letter-writers seem to be working to reconcile their astonishment at what Donna has done with the integrity of the person they know. One woman read an article about it. And the first time she read the article, she thought Donna was the one who caught the nurse stealing the drugs.

Most of the letters describe this kind of initial shock, and then a quick move to support. Thus, the letters where tension is allowed to exist stand out. The letter from Donna’s parents is one that acknowledges complexity.

“We saw our daughter starting to break, but she always said she would be fine. Turns out, she was not fine. It was with great sadness that we read her confession. Our sadness turned to disbelief and anger.

We are now at the point of broken hearts. How could she make the choices she made?”

Yes, how could she? This is a question the letters are trying to answer.

And the explanation they offer, the central story they tell, has to do with Donna’s ex-husband. As one friend sums it up, “I’ve done a lot of thinking about what led Donna to do what she did. And I believe her main problem, and what directly led to her actions in this case, is her relationship with her ex-husband.”

The ex-husband’s perspective is not represented. I contacted him through his lawyer. He did not respond.

There are lots of examples of the ex-husband’s behavior in the court record. The one I’ll offer here is not especially shocking. It comes from a letter written by the only person who says she knows Donna’s ex well.

She says that Donna didn’t ask her to write this letter, that she saw Donna sitting alone in her car at soccer, and she approached her. This writer characterizes Donna’s ex’s behavior as aggressive and often humiliating. She says you would see Donna and her ex at, quote, “opposite ends of the soccer field, each trying to be there for their children. She often keeps one eye on him, waiting for the next outburst,” unquote.

The mother who was always alert for an explosion — that kind of vigilance, these letters seem to be saying, that kind of vigilance can wreck you.

So in the story told by the letters, this chronic stress builds and builds for Donna, until she reaches what many of the writers refer to as a breaking point. What exactly is that breaking point? That is a part of the story Donna writes herself. That’s coming up, when Episode 2 of “The Retrievals” continues.

The way Donna explains it in her letter, she started taking the fentanyl during COVID. She tells the story about her ex-husband taking the kids for visitation in March 2020. Scary time, right? Everybody newly shut inside their houses, everything closing down.

Donna’s ex has been sick — a stomach bug, he calls it — and has postponed a scheduled visit. The night the kids finally go over to their father’s, it seems like he’s still sick. They call her, and they’re like, Dad is coughing a lot, and he’s shivering under three blankets on the couch.

And he said it’s hard to breathe and it hurts to breathe. He claims that he’s negative for COVID, but he winds up in the hospital for over a month. Donna is frightened for her children and is furious at her ex for knowingly exposing them to his illness, rather than canceling the visit as a precaution.

After he is home and recuperated, he wants his regular visitation with the kids, but Donna wants proof that he’s no longer contagious. When she refuses to let him see the children, he takes her to family court, demanding sole custody. This is entry number 205 in their docket. And for Donna, it is a tipping point.

“I was overwhelmed by the sense that I would never be free,” she writes, “that I would have to take more time off of work, find more money to pay the lawyer, and engage in yet more litigation.” She continues, “I suddenly couldn’t see or think straight anymore.” She says that it was around this time that she resorted to taking fentanyl at work.

Donna says that a few years earlier, she had a prescription for pain in her feet. “During the course of time that I had the prescription, I did end up taking more than prescribed as a coping mechanism. I turned to fentanyl, because I knew from prior experience with narcotics that it would help me to cope emotionally and mentally with what was going on in my life.

It helped quiet and keep my mind calm. In those moments, it’s what I felt I needed to do to endure and hold it together for my children. How this makes any sense as difficult to convey.”

Donna is far from the only medical professional to have a substance use disorder. That part is not unusual. I asked a former coworker of Donna’s what might have happened if Donna had told someone at the clinic that she was addicted to fentanyl and that she needed help.

“I don’t think medicine tolerates that,” the former coworker said, “even though we say that we do. I think she’d have lost her job.”

The people I talked to who worked at the clinic with Donna characterized her in different ways. Donna was not touchy-feely. Donna was efficient. Her presence was authoritative, no nonsense.

Donna was attentive. She seemed like she genuinely cared. There were also more negative impressions. Donna was cold, not empathetic. She was like, these patients complain so much.

Donna’s former coworkers knew that she was contending with a lot at home. When her ex was in the hospital, all the nurses hoped he would die, one person said.

This is the exchange that I found most telling.

I asked one former coworker, who was Donna close to? The person thought for a moment. “I don’t think Donna was close to anyone,” they said, “but I think some of the nurses felt close to her.”

The Yale Fertility Center is dedicated to helping couples reach their dream of having a family, with a team of competent and compassionate professionals.

A promotional video for the Yale Fertility Center shows Donna at the clinic, sturdy, brunette, a white turtleneck under her scrubs. She looks a little bit like Joan Cusack. She’s in a room with a patient, and the patient has her sleeve rolled up. And Donna is preparing to draw blood.

By helping you navigate the technological, psychological, and physical needs of the IVF process, you will gain perspective, understand your options, and feel confident —

In her letter to the judge, Donna describes feeling trapped and stuck. She brings up an image of spinning around in a cage, unable to get out. When I see Donna in this video, outwardly capable, I wonder about what she felt inside, if she felt trapped.

Everybody saw what was going on with her ex-husband, but nobody saw that.

Nobody seems to see what’s really going on with Donna until that loose cap. Remember, the loose cap is discovered on a Friday. On Sunday or Monday, it’s kind of unclear. But on Sunday or Monday, Donna comes to work with 175 used vials of fentanyl, meaning 175 vials from which she has extracted fentanyl.

She’s been keeping these vials at her house. She’d been planning to eventually reintroduce them into the supply at the clinic, but now, her plans have changed. That evening at work, she goes out to her car to get clothes.

She walks out to the parking lot, and from her car, gets a plastic grocery bag, and then she brings the bag inside and disposes of the 175 vials and two sharps containers. It’s last-ditch behavior, right? It’s something you do when you are frantic, panicked, and the jig is up. It also seems like something you do when maybe you want to be caught, when maybe you want to be seen.

A little more than two weeks later, Donna will confess to a team of federal and state investigators. She will do so without a lawyer present. She will tell them how she did it, how she would puncture the septum of the vial up to four times a day to extract fentanyl.

She will say she always used a clean needle to put the saline in. She will say that she’s been doing this for five months. She will estimate that during this time, she has tampered with 75 percent of the fentanyl given to patients at the clinic.

She will say that some of the vials had all saline and that some were a mix. She will tell the investigators about her money problems and about her protective orders against her ex-husband. She will tell them about the stress in her life. She will tell them that her children don’t know. And at the end of the interview, she will tell the investigators that talking to them has been the best thing for her and that she feels much better.

Donna’s sentencing hearing is scheduled for a Tuesday morning in May. It’s going to be hybrid. You can attend on Zoom or in person. Most patients who decide to go will attend on Zoom.

It’s spring 2021 of the pandemic. Vaccines are still new. It doesn’t feel like a whole new world yet, but Leah decides she will go in person.

I kind of needed to see her. I was fascinated with how she was going to fashion herself in this whole — in the theater. Right? So I was fascinated by that. And also, I was — again, I’m like, I was really, really angry. I wanted to see if she was upset. I wanted to see if she was —

I wanted to see if she was going to cry.

But Leah’s still ambivalent about what she wants to happen to Donna.

I heard 51 to 63 months, right? And I had to do the math in my head. OK, 51. And I think they had reduced, because she was admitting to being guilty. The time that she could potentially be sentenced was reduced.

I remember already being like —

I don’t know how I feel about that. I don’t want people to go to prison. But at the same time, well, what do we want to have happen?

What happens to Donna, and whose pain matters more? That’s next on “The Retrievals.”

“The Retrievals” is produced by me and Laura Starcheski. Laura edited the series, with editing and producing help from Julie Snyder, additional editing by Katie Mingle and Ira Glass, research and fact-checking by Ben Phelan and Caitlin Love, music supervision, sound design, and mixing by Phoebe Wang, with production help from Michelle Navarro, original music by Carla Pallone and music mixing by Tomas Poli.

Ndeye Thioubou is the supervising producer for Serial Productions. At “The New York Times,” our standards editor is Susan Wessling, legal review by Dana Green, art direction from Pablo Delcan, producing help from Jeffrey Miranda, Kelly Doe, Renan Borelli, Desiree Ibekwe, and Anisha Muni. Sam Dolnick is the assistant managing editor. Special thanks to Pierre Cattoni. “The Retrievals” is a production of Serial Productions and “The New York Times.”