Podcast Title: Serial
Episode: The Retrievals S02 Episode 2: The Speech
Release Date: August 7, 2025
Host/Author: Serial Productions & The New York Times
Description:
In this episode of “The Retrievals, Season 2,” titled “The Speech,” listeners delve into the harrowing experiences of obstetric anesthesia and the systemic issues surrounding pain management during cesarean sections. The story centers on Dr. Heather Nixon, an obstetric anesthesiologist who confronts a disturbing incident that challenges her professional beliefs and propels her to advocate for change within the medical community.
1. The Agonizing C-Section: An Unsettling Revelation
The episode opens with Dr. Heather Nixon recounting a distressing experience during a colleague, Clara’s, cesarean section. Heather, the head of obstetric anesthesia, discovers that Clara endured severe pain despite receiving multiple medications intended to alleviate anxiety and discomfort.
Heather Nixon (00:34): “I just remember all of a sudden... It was an unfathomable amount of pain. And I remember begging them to stop.”
Heather confronts the anesthesiologist responsible, who had administered excessive doses of midazolam, fentanyl, and ketamine, failing to convert to general anesthesia due to fears of airway complications.
Heather Nixon (03:11): “He was using all the language, all the culture, all the fears that have been bred into us for years.”
2. Confronting Institutional Norms
Heather’s realization that pain during C-sections is often normalized within medical practices shocks her. She begins to question the established protocols and the collective rationalizations that prevent adequate pain management.
Heather Nixon (07:42): “How do I not know that this happens? How do I not know that patients afterwards are choosing to not go back and have a second baby...”
Her investigation leads her to discover numerous patient testimonials online, revealing widespread suffering that contradicts her previous assumptions about standard care during cesarean deliveries.
3. Preparing to Speak Out: The Catalyst for Change
Moved by Clara’s ordeal and numerous other patient accounts, Heather decides to address the issue at a major national medical conference. Initially assigned to deliver a technical speech on pain management, the tragedy shifts her focus to advocating for honest discussions about intraoperative pain during cesarean sections.
Heather Nixon (22:37): “I'm not going to make this a scientific presentation. I am going to make this something that is emotional because for the patient, it is right.”
4. The Conference Presentation: Igniting a Dialogue
At the SOAP 2023 conference, Heather delivers a powerful 90-minute talk that breaks the conventional mold of medical presentations. Instead of data and graphs, she shares Clara’s story, highlighting the emotional and physical trauma endured by patients experiencing pain during C-sections.
Heather Nixon (26:27): “Jennifer is Clara... Jennifer gets 150 of ketamine, 300 of fentanyl, and 6 of midazolam.”
Heather engages the audience by asking how many have encountered similar incidents, revealing that a significant number of specialists face this issue regularly.
Heather Nixon (30:42): “How many people in the last month have had a patient who's had severe intraoperative pain?”
The immediate response from the audience underscores the prevalence of the problem, leading to an open and candid discussion among the anesthesiologists present.
5. Collective Acknowledgment and Vulnerability
During the Q&A, several doctors share their fears and experiences, breaking the silence surrounding intraoperative pain management. Dr. Dan Katz from New York City expresses his deep-seated fear of general anesthesia complications.
Dan Katz (32:16): “I'm scared of the biggest thing of all... I will lose the airway and the mom will die.”
This vulnerability fosters a supportive environment, encouraging others to voice their concerns and contributing to a collaborative effort to find solutions.
6. The Ripple Effect: Impact Beyond the OR
Heather’s speech sheds light not only on the immediate pain experienced by patients but also on the long-term psychological and relational impacts. Clara’s trauma extends to her relationship with her twins and her professional environment, where returning to work triggers ongoing retraumatization.
Clara (14:53): “I couldn’t believe I had to be... back. Everything about it made me so mad.”
Heather emphasizes the urgent need for systemic change to prevent such traumatic experiences, advocating for a culture that prioritizes patient well-being over procedural adherence.
7. Confronting the Broader Medical Community
Despite the progress made within the specialized group of obstetric anesthesiologists at SOAP 2023, Heather acknowledges the challenge of extending these conversations to the wider medical community. With only a fraction of anesthesiologists specializing in obstetrics, the systemic change required to address intraoperative pain during C-sections remains daunting.
Susan Burton (36:51): “But what about all the people not here? Let's back out of the ballroom now into the large, carpeted, empty open space.”
8. Moving Forward: Seeking Solutions
The episode concludes with Heather contemplating the next steps in her mission to eradicate pain during cesarean sections. She explores innovative approaches and collaborates with professionals from diverse backgrounds to develop effective strategies for change.
Heather Nixon (42:05): “How do you solve this problem? On the other side of the ocean, up north in the English countryside, a former wedding photographer with no medical training have been quietly working on the answers.”
Notable Quotes and Timestamps
- Heather Nixon (00:34): “It was an unfathomable amount of pain. And I remember begging them to stop.”
- Heather Nixon (03:11): “He was using all the language, all the culture, all the fears that have been bred into us for years.”
- Heather Nixon (07:42): “How do I not know that this happens? How do I not know that patients afterwards are choosing to not go back and have a second baby...”
- Heather Nixon (22:37): “I'm not going to make this a scientific presentation. I am going to make this something that is emotional because for the patient, it is right.”
- Dan Katz (32:16): “I'm scared of the biggest thing of all... I will lose the airway and the mom will die.”
- Clara (14:53): “I couldn’t believe I had to be... back. Everything about it made me so mad.”
- Heather Nixon (42:05): “How do you solve this problem? On the other side of the ocean, up north in the English countryside, a former wedding photographer with no medical training have been quietly working on the answers.”
Conclusion
“The Retrievals’” episode “The Speech” poignantly reveals the often-overlooked issue of pain management during cesarean sections. Through Dr. Heather Nixon’s journey—from confronting a traumatic incident to advocating for systemic change—the episode underscores the critical need for open dialogue, empathy, and innovation within the medical community to ensure the well-being of patients undergoing childbirth.
Listeners gain a profound understanding of the emotional and professional challenges faced by healthcare providers and are encouraged to reflect on the importance of patient-centered care in obstetric anesthesia.