Portside

My wife has breast cancer.

I write this, with her permission, while sitting in the hospital waiting room as she undergoes surgery. Afterward, there will be another surgery, radiation, and probably chemo, but what else might be in the offing is guesswork at this point. I’ll know more this afternoon, when the operation is over.

Theresa discovered the lump four weeks ago while we were watching television. Fortunately, as a doctor with excellent health insurance, she was able to take quick action. The next day, she had a mammogram and sonogram. Soon after, a radiologist biopsied the growth; we were notified that it was malignant in a call from her doctor seconds before a flight attendant told us to shut off our phones in preparation for takeoff. We quickly met with the surgeon and scheduled today’s operation. Before Theresa left the office, she had a blood test for genetic markers. The next day, an M.R.I.

The whirlwind of activity sometimes allowed us to sidestep our feelings; at the beginning, the diagnosis seemed more like a list of things to do rather than a potentially life-threatening condition. There was, of course, denial. When we informed our sons of what was happening, Theresa wasn’t able to use the words “breast cancer.” I did, and she later told me that, when I said the term, she felt like I was talking about someone else.

Of course, there was fear: she worried about the possibility of a mastectomy, I only worried that she would die. And finally, in that very short time frame of a few weeks, we reached some level of acceptance.

But there were other feelings that struck us hard: fury, dismay, contempt. Not at our situation, but at the realization that untold thousands of women would not be as lucky as Theresa. Instead, they will die because of conservatives’ endless efforts to block poor women from having access to mammograms, breast exams and treatment. Theresa detected her cancer early enough that we feel confident she will survive. But we’re both aware that, right now, there are other women who don’t know they have this vicious invader growing inside them and will not find out until it is too late. Their husbands and loved ones will not have the chance, as I do, to sit in the waiting room of the hospital, and instead will stand at the entryway of the funeral home.

Many Republicans, either out of self-delusion or deceit, deny they are causing any such thing. But there is no question that, in their obsession with zygotes, embryos, and non-viable fetuses as part of their supposed pro-life stance, they are effectively murdering real, walking, talking women—mothers and daughters, grandmothers and sisters, all sacrificed on an altar of Pecksniffian hypocrisy and contemptible disregard by people who have the insurance, connections, and available health care to feel certain their politics won’t kill their loved ones. Perhaps Theresa and I are re-directing our anger from the cancer, but so be it; our rage has focused on the financially comfortable, morally blind, and arrogantly self-righteous who tyrannically conspire to rob poor women of years of life they might otherwise have. It is for this reason that Theresa is willing to disclose her condition, in hopes that, in doing so, we will help highlight how politicians are blithely choosing to kill women who are not as fortunate as she is.

We live in Texas, a state that often makes us proud of its communities and ashamed of its politicians, and have been dealing with our breast-cancer scare at the same time Republicans in the state House have been rushing forward with the now-infamous anti-abortion legislation (or, as I prefer to call it, the forced-birth bill). For a moment, forget the scientific nonsense and bogus assertions that have fed this debate—that rape kits used by law enforcement to collect evidence can prevent pregnancy, that fetuses feel pain at 20 weeks (contrary to scientific evidence), that proof of that pain can be seen in the “fact” that male fetuses masturbate at 20 weeks, that the American economic crisis was caused by abortions, that an abortionist distributed ineffective birth control to teenagers so he could make millions of dollars performing the procedure, and on and on.

What is scary here is not that kind of silliness, but what it shows about a scientific debate devoid of science: the advocates just don’t care. Like a boy trying to justify what he wants to believe, rather than forming belief around demonstrable facts, the Texas legislators and their mostly G.O.P. counterparts around the country aren’t making arguments. They’re just saying things based on a woeful ignorance of the issues involved. And small wonder: working in the Texas state legislature is a part-time job, involving people whose knowledge comes not from public-policy analysis but from all sorts of other professions. Lawyers, farmers, real-estate title searchers, and the like. One of the primary supporters of the House bill, Rep. Cindy Burkett, is the owner of three Subway sandwich restaurants. Given that she and other legislators are ignoring the recommendations and input from the American Congress of Obstetricians and Gynecologists, where have they learned about medical issues in public policy?

Apparently nowhere. Let’s set aside the 20-week debate, since that is unrelated to the issue of access to breast-cancer screening and other women’s-health care. Also, it is a topic I think honest people can have reasonable disagreements about. Instead, let’s talk about the other rules in this legislation that will kill people.

One of the requirements of the legislation is that any facility performing abortions must have a doctor on staff who has admitting privileges at a hospital no more than 30 miles away that has an obstetrical or gynecological health service. This is something that the Texas Hospital Association says is a bad idea. But when asked in the course of the House “debate” to define the words in this requirement, Burkett could not even explain what admitting privileges are! She, like the other forced birthers in the debate, just picked up the idea from the anti-abortion crowd that advanced it in states around the country as a means of shutting down clinics that provide the procedures.

But her lack of knowledge is nothing compared to that of Rep. Jodie Laubenberg, the bill’s author and the primary proponent of both the “rape kits can stop pregnancies” and “fetal pain at 20 weeks” nonsense. (She is also the legislator who, famously in Texas, opposed state funding of prenatal care—essential for the health of babies—because fetuses “aren’t born yet.” The sanctity of life, it seems, is not as important as the sanctity of tax dollars.) If the consequences of her ignorance were not so dire, Laubenberg could perhaps be forgiven for it. As she has zero medical training and her sole background credit is as a city-council member in a town of just under 4,000 people, there is no reason to expect that she would know anything about health issues.

And boy, did it show: when questioned by her colleagues earlier this month about what the bill contained, she was not only unable to answer questions, but she seemed unfamiliar with the legislation. She didn’t comprehend how doctors receive admitting privileges. While the legislation requires significant, expensive, and often financially impossible upgrades in the facilities that provide abortions, she refused to consider amendments to provide the clinics with money to meet new standards. She dismissed concerns that the bill would shut down health clinics as “hypothetical” (even though her forced-birther allies proclaim that is the reason for the clinic restrictions). And, whenever she faced a difficult question, she simply refused to respond.

Since you don’t understand the issue beyond your desire to limit abortions, Rep. Laubenberg, let me put the meaning of what you have done in clear terms: through your ignorance or incompetence or general lack of interest in the well-being of people who don’t look like you or have your size bank account, you will be responsible for the deaths of untold numbers of Texas women. You, Rep. Laubenberg, will be a murderer, no different than some street punk who shoots up a liquor store. His weapon is a gun; yours, a smug satisfaction with your limited understanding of health policy. If Theresa and I were among the rural poor, she would now almost certainly be one the many people you would kill as a result of her inability to gain access to breast screenings. And for that, you deserve not only our contempt, but the contempt of every decent human being with the humility and intelligence to recognize the impact of the legislation you have “written,” yet aren’t bright enough to understand.

Here is reality: Women’s-health clinics have been under assault for years. The legislature already barred Planned Parenthood—the conservative’s abortion boogeyman—from the state’s Women’s Health Program because it funds abortion clinics. Abortions make up just 3 percent of the services the organization performs (a number that was lyingly transformed in a speech by United States Senator Jon Kyl into 97 percent; an aide to Kyl later famously proclaimed that the falsehood “was not intended as a factual statement.”) Planned Parenthood estimates that 130,000 women in Texas go without preventive health care, like breast-cancer screenings, due to the cuts to women’s-health-care funding.

Such services are now available at other clinics that are not affiliated with Planned Parenthood, but not for long under the dictates of Laubenberg and her murderous allies. Since few of the clinics in Texas meet the strict and almost unprecedented standards in the legislation—nor do they have the money to meet the demands—many will have to close, even though abortions have proven to be among the safest procedures conducted in the state.

I just took a break. Theresa is still in surgery, and Dr. Aditi Anand, her pathologist, stopped by the waiting room to discuss her case with me. After our talk, I mentioned what I was writing and why. Dr. Anand’s eyes flashed. Not only did I strike a nerve, but she told me of a problem I didn’t know about that is caused by the onslaught against health clinics that provide abortions: even when doctors are willing to provide the services for free, the actions of the Texas legislature are all but guaranteeing that poor women at risk of cancer will not be able to find them.

Dr. Anand told me she is part of a Texas group known as the Bridge Breast Network, a coalition of physicians, mammographers, pathologists, and surgeons who have all volunteered to provide care for women who suffer from breast cancer. In other words, the treatment is available for these women— not because the state government makes the effort to help, but because the doctors are willing to donate their services. But the linchpins of this whole system, Dr. Anand said, are the clinics that provide referrals—the very clinics Texas is shutting down.

“These women go to Planned Parenthood and other clinics where women who have no insurance go, and they get referred to the Bridge,” she said. When these clinics get closed down, there is no way for these women to go anywhere. “This is just a strata of society that isn’t savvy, that nobody thinks about, nobody fights for, nobody cares about.”

When the clinics close, “the clients cannot reach you,” Dr. Anand said. “They are going to have advanced disease.”

Dr. Anand left and another hour has passed. It is now late in the afternoon, and Theresa’s surgeon just came out to the waiting room to speak with me. The operation went well, she told me. The bleeding was controlled, although the tumor was large enough that Theresa will likely require chemo starting in the next few weeks. Still, while there will be a need for a second surgery, there was no sign that the cancer had spread. We had caught it early enough, thanks to our own knowledge and our access to top-flight medical care.

The surgeon told me that I would be able to see Theresa in the recovery room in about 45 minutes. She left, and I closed my eyes. Then, to my everlasting shame, I thanked God that we aren’t poor. I don’t want my wife to die of breast cancer, the way so many other Texas women soon will.