Welcome to THE "Based on a True System" storytelling proJECT

We always thought the worst thing that could happen out here was the mill closing. Or the storm flooding out the bridge again.

Turns out, it was them shutting down the maternity ward.

I remember the day they posted the sign on the old sliding doors at [redacted]. “Labor & Delivery Unit Permanently Closed.” All official-looking, printed on crisp white paper. Cold words, neat font, like it wasn’t gonna kill nobody.

Like it wasn’t gonna kill me.

I was five months pregnant when the clinic turned me away the first time.

“Lena, baby,” Nurse Carla said, not meeting my eyes. “We lost the discount contract for the pharmacy. Can’t fill your meds anymore. And your Medicaid app still pending?”

I nodded. I’d been waiting three months for the state to call me back.

“We can see you in three weeks,” she said, quiet.

I smiled, polite-like. But in my head, I was counting the miles to the next closest place that still saw Black mamas with no insurance.

Sixty-four.

Most folks out here never even heard of no 340B. I ain't neither, not till they started talking about it in the clinic.

It’s this federal thing. They say it's meant to help hospitals like ours, ones that treat poor folks and folks with no insurance. Drug companies are supposed to give big discounts on medicine, and in return, those hospitals stretch the savings to keep the lights on, keep the doors open. Ain’t tax money. Just a deal: lower drug prices for places that need it.

Back when the program worked like it should, the clinic could afford to hand out prenatal vitamins, fill prescriptions for folks like me, even pay for things like blood pressure meds or a ride to the big hospital if you needed it.

But Nurse Carla said, the drug companies started changing the rules. Said they’d only give the discount if the clinic jumped through all these hoops or handed over private patient information. She said some even told the clinics and hospitals like ours, they had to pay full price up front and maybe get some money back later. Folks in charge of the clinic called it a chokehold.

All I know is, once they did that, our pharmacy shut down, and I couldn’t get my meds no more.

They say it was something about “rebates” and “data-sharing,” but all I saw was the shelves go empty and the clinic stop calling.

While we were out here rationing blood pressure pills and praying a fever would break on its own, you just know somewhere...somewhere behind some glass tower conference table, them people were laughing their long, rich people laughs.

The kind that sound like an old hog laughing from the belly: fat, full, and far away from the butcher’s block. Laughing that drawn-out, greasy kind of “hohhh—hoh—hoh—hoh” that don’t mean joy, just money. Clinking glasses over our clinic’s death.

That’s what it’s like to be forgotten. Like your whole town got turned inside out, and nobody but you noticed it was bleeding.

Our car ain't got no AC, tires bald, transmission slips if you take the hills too fast. But that day, I tried to drive to Tifton for the check-up anyway. Got as far as Alma before I turned around. The gas light came on. My back hurt. And my babies, two of ‘em already, were home alone with peanut butter sandwiches and gospel on the radio.

I told myself I’d go next week.

Then the week after that.

Then came the blood pressure.

I knew something was wrong. Felt it in my ankles, thick and tight like someone had stuffed cotton under my skin. Felt it in my head too, like a dull hammer behind my left eye. I laid in bed and listened to the walls creak with the heat, sweat rolling down my stomach. I thought about the "rebate" program the way folks used to talk about food stamps: something you didn’t want to need, but when it was gone, you knew just how much it saved you.

They took it, piece by piece. First the pharmacy discounts, then the maternity ward staff, then the whole damn ward. Said it was “unprofitable.”

You know what else is unprofitable?

Me bleeding out in a truck cab on Route 19.

---

I went into labor too early.

I tried to stay calm. My oldest, Nia, was crying. My son was banging on the bathroom door, saying he couldn’t find his sneakers. I called 911 but the operator said the ambulance was 40 minutes out.

“There’s only one crew on tonight,” she said, flat like it wasn’t life or death.

Keonte, my neighbor’s boy, heard me screaming. He came running, shirtless, keys in hand.

“Miss Lena, let’s go,” he said, voice shaking. “Hold on. I’ll get you there.”

But we didn’t make it.

My water broke near the county line. We pulled over on the gravel shoulder and I screamed into Keonte’s hoodie while Miss Adella, bless her, held my legs apart and prayed louder than the cicadas.

Promise came out purple. Quiet.

I thought she was gone. Honest to God, I thought I was too.

But she gasped once. Then again.

Keonte took us the rest of the way fast as he could. I don’t remember much else...just waking up with a line in my arm and a nurse saying we “got lucky.”

The hospital flew Promise to Macon just to be sure. She stayed a few days.

I named her Promise anyway, because they broke theirs and I had to fight every day to keep mine.

---

Now I sit here on this porch, rocking her while the heat clings to our skin like sorrow.

I hear about women in Atlanta with birthing tubs and doulas and apps that track their baby’s heartbeats. White women with choices. White women with time.

Me?

I got a cardboard box of meds the clinic gave me from leftover stock.

They reopened the maternity ward rotation last month...only Tuesdays and Thursdays. The news say they got some state grant or the other, some church money, a lawsuit that went through, something about West Virginia holding the line on them "rebate" contracts. The details are murky, but I know for a fact is, we didn’t die.

They took photos of me and Promise for a story and put it on the clinic wall. I didn’t want it at first. I didn’t want to be the poster child for surviving what shoulda never happened.

But then I thought of all the girls like me: Black, rural, broke, pregnant, scared, walking into the same quiet rooms, wondering if anybody sees them.

I let them take the picture and hang it on the wall. Not for the clinic...just for the ones the system don’t make no space for.

The ones who have babies with first breaths outside a system that forgot how to hold us.

                                                                          ###

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Inspired by the lived experiences of thousands. Told through fictional voices. Rooted in real policy and real harm. This story is a work of fiction and is a part of CRPHI's "Based on a True System" storytelling project. Any resemblance to specific individuals is coincidental — but the systems, patterns, and consequences are real.

© 2025 Center for Regulatory Policy and Health Innovation (CRPHI). All rights reserved. No part of this story may be reprinted, republished, or reproduced without the express written consent of CRPHI.

For more information, please contact info@crphi.org or visit www.crphi.org 

I didn’t plan to cry in the parking lot of the Circle K off Highway 18.

But when the blood pressure cuff beeped loud, real loud, and I saw those numbers skyrocket, it broke something loose in me, but didn't set me free. The tears just spilled outta me, not from fear exactly, more like... frustration. Embarrassment. Exhaustion. I dunno, maybe all of it.

I’m Marie. Thirty-two. Born in Warm Springs, raised in Manchester, been all around Troup County and back. I work nights at a warehouse outside LaGrange spending ten hours on my feet, lifting, counting, sweating through uniforms that never fully dry by the next shift. My husband Freddie takes construction work when he can get it, and we live in his grandma’s old trailer off a road people forget about unless they grew up here. The porch leans, the pipes knock, but it’s solid. It’s ours.

We’ve been together nine years. Married six. We’ve had good seasons and hard ones. This season? It felt like we were always a day late or one paycheck short. 

---

This was my second pregnancy, and I thought I knew what to expect. I’d done it before. With KJ, my first, I delivered at the hospital in Thomaston, just ten minutes from home. It wasn’t fancy, but the nurses knew your name, and the maternity wing stayed busy enough. They closed it a year after I gave birth. Said it didn’t bring in enough to justify the cost. That’s how it goes out here. If it doesn’t make money, it disappears, no matter who’s depending on it.

So when I saw the second pink line on the test this time around, I sat in the bathroom for a long time, test in one hand, grocery receipt in the other, trying to do the math. Not just the dollars, but the distance. The time. The risk.

The nearest hospitals were in Columbus and LaGrange. Columbus had more options, more specialists, more everything, but it was just too far. LaGrange was closer. Not close, but reachable...on a good day...if the tank was full...if Freddie’s work truck didn’t need a repair...if we got time off...if nothing else went wrong...

We tried to plan ahead. Split shifts. Skipped meals. Counted coins and stretched every dollar until the numbers bled. Every appointment was a puzzle: find gas money, figure out who’s watching KJ, make sure the car makes it, hope nobody calls out sick at work. Something always had to give. Sometimes it was groceries, sometimes it was sleep, and sometimes, it was me.

By six months in, I’d already missed two prenatal visits and I could feel the weight of it. The rope felt shorter this time, and we didn’t have much give left in it. What nobody tells you is how different it hits when the system around you is more broken than it was the last time. When care is farther, cost is higher, and no one’s coming to close the gap.

---

Like I said, by month six, I’d missed two appointments. My OB, Dr. Renee, over at West Med, told me she was worried about my blood pressure. I’d had headaches, some swelling, floaters in my vision. She said it might be preeclampsia starting and that it was serious.

I nodded, promised I’d come back next week. We didn’t have the gas, so I couldn't.

One afternoon, I was sittin’ on the couch with KJ curled next to me, cartoons playing low, and my head poundin’ like a drum. The pressure was building, not just in my skull, but in my life. I knew something was off. Dr. Renee had told me if I ever found a way to check my pressure, even at a drugstore machine, it could help catch something early.

So I grabbed the last twenty Freddie and I had, filled a red gas can with three gallons, and drove to Circle K. That store had a cuff machine by the bathroom. Old, beat up, but it still worked.

170 over 112.

I didn’t know the science behind it, but I knew enough. That number was too high, and that beep was too loud. I walked back to the car, sat there in the hot silence, hands on the wheel shaking, and started crying ‘cause I’d done everything I could and it still wasn’t enough.

I called Freddie. My voice cracked before I even got the words out, and then I just cried. Five minutes, maybe more. I couldn’t explain what was happening; I didn’t have the breath for it. Just me, in a gas station parking lot, trying not to come apart while holding the phone to my cheek like it could anchor me.

He listened. Didn’t rush me. Just said, “Go,” real soft. Said he’d try to get off work and meet me there.

That meant losing money we didn’t have. Money we were already behind on, already watching stretch thinner than it ever should’ve been. But he didn’t say that. Neither did I. We both knew what it would cost.

What people don’t understand, people who’ve never been broke down to the bone, is that being poor isn’t just about what you don’t have. It’s about what it costs to survive the next day. Every choice is a trade-off. Every emergency is a bill. Every moment you take to care for yourself means risking something else falling apart.

And still, I started the car and headed for the hospital. Because sometimes you have to choose yourself, even when you can’t afford to.

---

They admitted me as soon as I walked through the door. Preeclampsia. Caught just in time.

They hooked me to machines, whispered things I couldn’t follow, then started me on medication and monitoring. I stayed for three nights. Nurses came and went like clock hands, each of them moving fast, too fast. One sat on the edge of my bed during her break and told me they were running the whole wing with half the staff they used to have. She looked tired but kind. I remember thinking, How long can any of us keep this up?

Freddie came after his shift. He walked into the room still in his boots, drywall dust across the front of his shirt, eyes red, shoulders pulled tight like he’d been holding his breath since I left.

He didn’t say much. Just sat in the corner chair, elbows on his knees, rubbing his hands together like he was trying to pray without saying the words.

“You scared me,” he said finally. His voice cracked on scared, and he looked away fast, like saying it out loud cost him something he couldn’t afford to spend.

I told him I was scared too.

What I didn’t say — couldn’t say — was that I’d wanted to protect him from it. I didn’t want to see that look in his eyes: that mix of helplessness and guilt that Black men carry so heavy, because the world’s always asking them to fix things without giving them anything to fix it with.

And I could see he’d done the same thing. Held it in all day. Tried not to call too often, tried not to panic, tried to trust that I’d be okay so he could keep working. Because not working meant a missed check. And a missed check meant the water got shut off. Or the car didn’t get fixed. Or KJ didn’t get what he needed.

We were both pretending to be strong for the other. And we were both failing at it. The masks didn’t fit right anymore.

That night, after the nurse left, he stood up and walked over to me. He didn’t say anything. Just kissed my forehead and rested his hand on my belly like he was trying to apologize to the baby for not being there sooner.

I didn’t need the words. I just needed the weight of him beside me. Something solid in a room full of uncertainty.

---

The morning I was discharged, Dr. Renee came in and sat across from me. She looked at me the way you do when you know a storm’s passed, but the next one’s already rolling in.

“You made the right call,” she said. “You trusted your gut. You acted. That saved you.”

I thanked her. But all I could think about were the cracks I nearly slipped through.

If the cuff at Circle K had been broken. If we hadn’t had that last twenty dollars. If I’d waited one more day. If Dr. Renee hadn’t still been here, holding up the last corner of the safety net.

---

People talk about healthcare innovation like it’s a promise. Like it’s a download or a dashboard, a solution just waiting to be accessed. They talk about smart cuffs and telehealth and video check-ins and remote monitoring like the technology itself is easy to get.

But that kind of care lives somewhere else.

It doesn’t live in our trailer, where the phone loses signal the second you step outside. It doesn’t live in houses without Wi-Fi or patients who work through pain because they can’t afford to stop. It doesn’t live in counties where the clinic’s open three days a week and the nurse practitioner rotates between five towns. It doesn’t live in systems that expect you to survive without asking what you’ve got to survive with.

The hospital that took me in? Dr. Renee said it only stays open because of outside support that helps them keep their doors wide for people who can’t pay right away. Folks like me, whose insurance ends if they miss a paycheck. If that support disappears, so does the OB wing.

Then what?

Another closed unit. Another empty hallway. Another woman driving too far, too late.

---

Mariah was born a few weeks later. A little early, but strong. She came out with her fists clenched and her eyes wide open like she already knew the world she was entering.

She’s five months old now. KJ calls her "Boss Lady" and insists she likes his knock-knock jokes even though she hasn’t cracked a smile at one yet.

Georgia gives me twelve months of Medicaid after birth now. That’s something. It’s meant follow-ups, medication, even therapy. I’ve used it. But coverage doesn’t always equal access. Not if the roads are too long. Not if the care is too far. Not if the system only reaches the people who were already close enough to touch it.

What we need is technology and a net that actually catches people. A map where the dots don’t stop at city lines. Clinics that don’t close. Nurses who aren’t burned out. Tools that work for people with no signal, no data, no backup plan.

Because in places like ours, survival still feels like something you piece together with scraps. And sometimes the only thing standing between you and the worst-case scenario is a cuff machine at a gas station, a good doctor still holding on, and someone you love showing up, covered in dust and fear, just to sit in the corner and let you breathe.

###

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Inspired by the lived experiences of thousands. Told through fictional voices. Rooted in real policy and real harm. This story is a work of fiction and is a part of CRPHI's "Based on a True System" storytelling project. Any resemblance to specific individuals is coincidental — but the systems, patterns, and consequences are real.

© 2025 Center for Regulatory Policy and Health Innovation (CRPHI). All rights reserved. No part of this story may be reprinted, republished, or reproduced without the express written consent of CRPHI.

For more information, please contact info@crphi.org or visit www.crphi.org