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In a post-Roe country, a Florida doctor wonders where to call home

As abortion restrictions increase, a medical exodus poses broader consequences for patients.
 
For as long as she had been working in medicine, Rachel Rapkin had told friends and family that she was worried about the overturn of Roe v. Wade. “Don’t be dramatic,” people would say.
For as long as she had been working in medicine, Rachel Rapkin had told friends and family that she was worried about the overturn of Roe v. Wade. “Don’t be dramatic,” people would say. [ JEFFEREE WOO | Times ]
Published Sept. 6, 2023|Updated Sept. 6, 2023

TAMPA — The doctor stood in her driveway early on a balmy spring morning, sipping coffee, scanning the plastic tubs and hanging racks splayed across the pavement.

She hadn’t cried since making the decision. Still, the garage sale made her think of home videos, as if a decade of life were in fuzzy fast-forward. There, in one pile, were Alex’s ballet slippers. In another, the painted wood blocks that Miller, then Carter, used to learn the alphabet.

Beach chairs, a cooler, a sun umbrella. All relics of the Florida life she was leaving behind.

Rachel Rapkin and her mother-in-law, Enid Rapkin, look on as garage sale aficionados, local dog walkers and neighborhood moms pore over items.
Rachel Rapkin and her mother-in-law, Enid Rapkin, look on as garage sale aficionados, local dog walkers and neighborhood moms pore over items. [ JEFFEREE WOO | Times ]

The kids were at school. Her husband, a fellow physician, was asleep after an overnight shift on the labor and delivery unit. Rachel Rapkin hadn’t slept much, and now she braced for the buyers.

First came the deal hunters, then the dog walkers. By midmorning, carrying insulated coffee cups the size of a Big Gulp, came the neighborhood moms.

“I need that gone before my children get back,” Rapkin said, smiling at a woman looking over a Fisher-Price tool bench. “They’ve already put it back in the playroom like three times.”

The woman laughed, then grew serious.

“I don’t think we’ve met in person before, but I just wanted to say that we’re really sad to see you go,” she said. “We’ll be following your journey online.”

Rapkin nodded. This sort of conversation had become familiar.

She and her husband had spent long, quiet winter months deliberating at the kitchen table. They’d filled nights scouring the fine print of state laws, taking phone calls between patients to figure out where they could land. And every time Rapkin couldn’t take care of a patient who had come seeking help, the conversations grew in urgency.

“We gotta get out of here,” she’d say to her husband, David Rapkin, while sipping evening beers.

Junette "Junie" Vegas, the Rapkins' nanny, helps Alex Rapkin prep for the day, while Rachel Rapkin gets ready to pack lunches. "They're my babies," Vegas said of the three kids, whom she's helped care for since they were infants.
Junette "Junie" Vegas, the Rapkins' nanny, helps Alex Rapkin prep for the day, while Rachel Rapkin gets ready to pack lunches. "They're my babies," Vegas said of the three kids, whom she's helped care for since they were infants. [ JEFFEREE WOO | Times ]

For Rachel Rapkin, a doctor whose mission includes providing abortions and training doctors to perform them, this meant solving a difficult equation amid a minefield of shifting formulas. To keep her family safe was paramount. So was continuing her work where she was truly needed.

They had to go — but where?

• • •

One day earlier, Rapkin had stood offstage at a luncheon in Tampa as an announcer read out her credentials to a crowded room.

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It was April, and the Florida Legislature was in session. Just this once, she wanted to wipe her mind of Tallahassee and its politics, so she slipped her phone into “do not disturb.”

Rapkin listened as the speaker ran through the high points of her 20-year career. Thousands of patients had come to her for sexual health tests and cancer screenings, hysterectomies and C-sections. She’d delivered hundreds of babies, counseled women through painful choices, and behind closed doors, pushed hospital brass to better prepare the next generation of providers. It was no exaggeration to say some medical students came to Tampa specifically to learn from her. And today, Planned Parenthood was honoring her work advancing reproductive freedom.

Rachel Rapkin
Rachel Rapkin [ Provided ]

For years, Rapkin had felt the ever-present threat of change. She’d spent hours on the phone explaining to lawmakers the arbitrary nature of restrictions they said would “save unborn lives.” She’d gone to the Capitol to testify. But after the passing of Florida’s 15-week abortion ban, then the June 2022 overturn of Roe v. Wade, she feared once-routine parts of her job could now land her in prison.

To the sound of applause, she walked to center stage.

In a steady tone — her clinical voice — Rapkin shared stories from her work.

“I cannot stress enough how much our patients need you right now,” Rapkin said. “They are absolutely the most vulnerable among us.”

But now, one of their fiercest advocates was leaving. Other doctors around the state were writing paragraphs on Facebook about how they, too, were sorry to go.

Onstage, a Planned Parenthood representative presented Rapkin with a crocheted speculum as a token of appreciation — something “easy to carry” for the move.

Offstage, Rapkin exhaled.

Within a few hours, texts streamed in.

“WTF”

“Unbelievable.”

Seventy Florida representatives had sent a bill banning abortion at six weeks — before most women know they’re pregnant — to the governor’s desk. It would be signed into law by day’s end.

“Today we stand for life,” Rep. Jenna Persons-Mulicka, R-Naples, told the chamber, her voice quivering with emotion.

Rapkin thought of her patients from two days earlier.

Of the 34 who had come for abortions, 28 were more than six weeks pregnant. Soon, patients like them would have to travel hundreds of miles — if they could afford it.

Rapkin slid her phone into a pocket, felt her shoulders tense and then let them relax.

The movers were coming in less than a week.

• • •

The question was never whether Rapkin would become a doctor. It was what type of doctor she would become. Even from an early age, her family referred to her affectionately as “Doc.”

She grew up in Baltimore, caring for a mother with an autoimmune disease, her first introduction to medicine.

Though she was not a people-pleaser, there was some core part of her that wanted people to feel comfortable, never judged.

When she left home for the University of Maryland in 1998, with an eye on medical school, she began volunteering at a campus health clinic.

She’d answer phones and help with scheduling. It was all fairly routine until a student came in pregnant. She wanted an abortion.

This was the early 2000s. Rapkin flipped through the Yellow Pages and sent the patient on her way.

That evening, she kept thinking: What if the clinic wasn’t safe? The next morning, she went to check it out.

Rachel Rapkin smiles at the matching ceremony for her residency program in Pittsburgh after finishing medical school in Miami in 2007.
Rachel Rapkin smiles at the matching ceremony for her residency program in Pittsburgh after finishing medical school in Miami in 2007. [ Courtesy of Rachel Rapkin. ]

The drop-in turned into an interview, then an offer to work the desk.

Her face was the first a patient saw. She was the one to whom they waved goodbye on their way out.

She felt good helping people make decisions about their bodies, their lives. But a contrast was eating at her.

The patients were young women.

The doctors were old men.

She brought the observation to her clinic manager, who shrugged, like, what do you expect?

“Rachel, these are the doctors we have,” she remembers the manager saying. “If you want to change that, then you go to medical school and become an OB-GYN so you can perform abortions.”

Rapkin promised she would.

• • •

They built their home in 2013, on a plot of land in a South Tampa neighborhood with scores of families and kids, less than a mile from Bayshore Boulevard, where they’d grow to love going for runs along the water.

Rapkin had done medical school in Miami and wanted to come back to Florida after she finished her residency and fellowship in Pittsburgh. Her husband and fellow OB-GYN, David Rapkin, had grown up in the north and was eager to escape the cold.

Rachel came first. When she saw the land, she saw their future.

Rachel Rapkin, an OB-GYN, right, walks her children, Miller, left, and Alex to school near their home on April 21 in Tampa.
Rachel Rapkin, an OB-GYN, right, walks her children, Miller, left, and Alex to school near their home on April 21 in Tampa. [ JEFFEREE WOO | Times ]

“How much do you trust me?” she asked David over the phone.

They drafted plans for a home with a big open kitchen, a backyard pool and outdoor bar where they could entertain.

But it wasn’t the sunshine that drew Rapkin back south so much as the work.

Although Florida had few abortion restrictions when Rapkin was in medical school, and was largely seen as a safe haven for abortion in the South, the reality was trickier. Where legal restrictions were absent, institutional restrictions filled in.

Many hospitals, for example, opted not to provide abortions on-site, instead sending patients to clinics like Planned Parenthood. There was also a general shortage of doctors.

At the same time, medical students and residents were getting virtually no abortion training in-state. Florida didn’t have a single Ryan Program — a national program that trains OB-GYN residents in abortion and family planning. As a medical student, Rapkin only saw one abortion performed.

In coming back to Florida, Rapkin saw a way to take this oddly siloed corner of OB-GYN care and make it as ordinary as any other.

Shortly after she arrived at the University of South Florida, she told USF Health faculty that she would be providing medication abortions. Somebody forwarded her email to the university president. Debate ensued about whether a public institution should be offering abortions at all, and quickly a response came from the administration shutting down her initiative.

“Don’t even say the word abortion,” a department leader told her, Rapkin recalled.

Then, later, when she began performing surgical miscarriage procedures, Rapkin said the tools she used — the same as in certain abortions — went missing.

Friends told her to get out, go north.

“I’m not leaving,” Rapkin remembers telling them. “Nobody else is ever going to come here if I leave with a story like that.”

She bought new equipment and began locking it up.

Rachel and David Rapkin, both OB-GYNs, help their children Miller, left, and Alex get ready for school at their home in Tampa. It's the last time they'll leave for school from this house.
Rachel and David Rapkin, both OB-GYNs, help their children Miller, left, and Alex get ready for school at their home in Tampa. It's the last time they'll leave for school from this house. [ JEFFEREE WOO | Times ]

With time, tides began to change. Faculty turned over, and she found support across the medical school.

She created a contraception clinic to help women get affordable birth control and patches.

She pushed for hospital policies that allowed patients facing diagnoses of fetal abnormalities to end their pregnancies with the USF Health doctors who had been treating them all along.

Anytime she performed an abortion, she made sure a trainee was there, and sent students to Planned Parenthood clinics to see routine abortions outside the teaching hospital.

And in 2020, after seven years of campaigning, she secured funding to establish a Ryan Program at USF Health and Tampa General Hospital. Rapkin was named the director.

For a time, she felt hopeful, fulfilled.

At the end of difficult appointments, some patients would turn to her with looks of surprise and marvel, “Nobody made me feel bad today.”

That always got her.

“Why should somebody make you feel bad? You’re a good person,” she’d tell them. “It’s your life, and you’re the expert.”

By 2021, she had trained more than 40 doctors in comprehensive abortion care and family planning. And outside of the clinic, her life felt the fullest it ever had.

She and David had three spirited young kids, a balancing act that worked with the help of hired child care.

On the weekends, she’d host backyard cookouts and pool parties with colleagues, giant Thanksgivings with neighbors as close as family.

Rachel Rapkin sits at a folding table with her husband, David, the night before movers come to clear the home. They laugh, recalling warm memories of life in Tampa.
Rachel Rapkin sits at a folding table with her husband, David, the night before movers come to clear the home. They laugh, recalling warm memories of life in Tampa. [ JEFFEREE WOO | Times ]

She made friends with other moms who were lawyers and doctors and media personnel, with kids the same ages. They were the kind of friends she could call late at night for a glass of wine when she needed to blow off steam, who with next to no notice would open their homes and offer child care, knowing she would return the favor.

Rapkin’s dad now lived in Fort Myers. Her in-laws had moved to Wimauma, 40 minutes away. They loved being close to their grandkids.

Her life was in Florida. But she never once forgot how fragile it was.

• • •

She was in an operating room in Tampa, performing a hysterectomy with a colleague, when another doctor came in: Roe had been overturned.

Her colleague, she remembers, turned pale.

“We can’t stay here,” she said to Rapkin, through tears.

The hospital halls felt ghostly. In practical ways, business was carrying on, but in the shared glances and head shakes, a shell-shocked heaviness blanketed the ward.

Doctors’ work had already gotten tangled in Florida’s 15-week ban and the subsequent legal challenges. They feared a misstep could get them fired or their medical licenses stripped. Talk of a six-week ban was spreading.

For the rest of the day, Rachel’s phone pinged with people wanting to know how to help.

“I kind of wish you had asked this like five years ago,” she wanted to reply. Instead, she sent donation links for abortion funds.

Outside the hospital, Rapkin saw people gathering in the streets, reinvigorated, speaking openly about their abortions for the first time.

But inside, her patients were already confronting the consequences.

Related: Some Florida Supreme Court justices have known anti-abortion views as big case looms
Allan Siders of Clearwater holds a sign while protesting outside of an abortion clinic in Clearwater in January.
Allan Siders of Clearwater holds a sign while protesting outside of an abortion clinic in Clearwater in January. [ CHRIS URSO | Times ]

There was the patient whose water had broken, whose placenta was blocking her cervix, putting her at risk of a catastrophic hemorrhage. She needed a surgical abortion to prevent potentially deadly bleeding and infection.

Because she was 19 weeks pregnant, and because after 15 weeks Florida requires that doctors prove a patient’s life is in jeopardy to perform an abortion, the woman was sent home to get sicker before she could have the procedure.

There was the 17-year-old who came in at seven weeks pregnant to learn that she wasn’t seven weeks pregnant at all. She was 21 weeks along. An abortion in Florida was no longer possible — and she didn’t have the means to leave.

She was forced to give birth.

Then there was the 14-year-old who had lost her mother to an overdose and had been shuffled between foster families. Struggling with drug and alcohol use, she learned she was pregnant. To get clean, she felt sure, she couldn’t have a baby.

Without parental consent, Florida law stated she had to go before a judge to ask permission.

Rapkin performed her abortion, after that delay, at 11 weeks. The girl cried. The clinic staff cried, too. But as she left, the teen told Rapkin she felt hopeful for the first time.

Then there were the abortions she’d performed for patients aligned with the movement to outlaw them — like the woman who wished for Roe’s downfall but was trapped in an abusive relationship. She feared for her safety, and her children’s safety, should her partner learn she was pregnant again. She thought of them, too.

Rapkin and her husband struggled. They knew there were patients in Florida who still needed them, many with increasing desperation. Would leaving mean giving up?

But what would it mean to stay? Wasting expertise, surely. Turning a shoulder on Rachel’s life’s work. Their peers were making a similar calculation.

With every goodbye came a haunting reality.

The Rapkins knew what lawmakers seemed to brush past, that these laws, and the exodus that followed, had inadvertently damaged a care system that half of the population relied on.

Wait lists for pap smears and OB-GYN checkups were already months out for many patients. Last year, nearly a third of Florida counties were without a single OB-GYN.

Part of the exodus included doctors — like Rapkin’s husband — who didn’t provide abortions, but delivered babies and screened for cancer, as well as physicians working in other specialties.

Meanwhile, local residency programs were already seeing a shift: Top-tier candidates were balking.

Stephanie Ros, the OB-GYN residency director at USF, recalled one interviewee specifically saying she loved everything about the program but couldn’t risk gambling on her education in a state that limited the full spectrum of training.

Fellows, residents and medical students based in Florida began navigating the changed landscape. Natasha Rich and Peeraya Sawangkum were both mentees of Rapkin. Neither was sure anymore about their future here.

And should Florida’s bans stand, doctors hoping to get experience providing abortions would have to rotate to hospitals out of state. Ros said her residents were already leaning on donations to fund travel.

The logistics were a mess, the legislation a morass, but for Rapkin, one thing was horrifyingly clear: Women were going to die.

People attend an abortion rights rally on the steps of the county courthouse in downtown St. Petersburg after a leaked draft of a majority opinion from the U.S. Supreme Court detailing the intent to strike down Roe v. Wade was reported by Politico in May 2022.
People attend an abortion rights rally on the steps of the county courthouse in downtown St. Petersburg after a leaked draft of a majority opinion from the U.S. Supreme Court detailing the intent to strike down Roe v. Wade was reported by Politico in May 2022. [ MARTHA ASENCIO-RHINE | Times ]

The same procedure used during surgical abortions is the procedure doctors use to save a patient’s life when hemorrhaging during miscarriage.

And in a state where doctors can’t get practice performing abortions, statistics indicate they won’t be as ready in life-or-death moments. According to the Gender Equity Policy Institute, women are nearly three times as likely to die during pregnancy or childbirth in states with abortion bans than in those with access.

Her colleague was right, Rapkin decided. They couldn’t stay.

First, the Rapkins thought of California or Massachusetts, blue states with good school systems, where they had family. But OB-GYNs were a dime a dozen there. And with doctors pouring into liberal states, Rachel wasn’t convinced.

She wanted to go where she was needed.

• • •

First, she felt guilt: for leaving her patients, many of whom she’d guided through multiple pregnancies. For taking her kids from their only home, from their friends and their nanny, Junie, who had been with them since they were born.

Then came a practiced peace. What use was it to dwell? Rapkin had always been a problem-solver, a Band-Aid ripper.

David and Rachel Rapkin, both doctors, discuss which items to pack and which to leave behind as they prepare to move their family abroad.
David and Rachel Rapkin, both doctors, discuss which items to pack and which to leave behind as they prepare to move their family abroad. [ JEFFEREE WOO | Times ]

It was in the kitchen, around the table where they’d blown out a near-decade of birthday candles, that Rachel and David Rapkin sat their children down and announced that their time in Florida was coming to an end.

David had made bowls of popcorn to soften the news.

“We were thinking that a super cool adventure for us as a whole family would be if we all moved to a new place together,” Rachel began.

“I think you’re kidding,” said Alex, 9. She was the oldest, with two brothers who looked to her to lead the way. A “little adult,” as described by her nanny, with a maturity well beyond her years.

“We’re not kidding,” David told her. “Mommy and Daddy have been thinking about this for a long, long time.”

Carter, 4, squirmed.

“What if we move somewhere really cool, like somewhere outside of Florida?” Rachel said.

Miller, 7, had been disinterested. Now he was listening intently.

“I want to stay in Florida,” he said, his brows furrowed.

“We were thinking of a really big adventure,” David said.

“Like, another country,” Rachel added.

And before she could say more, Alex burst into tears.

“We’re moving to New Zealand,” Rachel finally got out.

After a moment of panic, Alex tried to be brave. But it’s hard being 9 and being told that your life is about to change.

Miller, still looking to his sister, started crying, too.

Carter smiled. Aloud, he wondered: Do people eat breakfast in New Zealand? Would he get new grandparents there?

Rachel Rapkin and her daughter, Alex, tear up while talking about leaving their life in Tampa, as well as their nanny, Junie, during their final dinner in their home in April.
Rachel Rapkin and her daughter, Alex, tear up while talking about leaving their life in Tampa, as well as their nanny, Junie, during their final dinner in their home in April. [ JEFFEREE WOO | Times ]

David brought out a globe, and Rachel pointed to islands in the southwest Pacific.

In New Zealand, abortion was legal, but there was a shortage of doctors. Rapkin was going to help lead a training program in the country’s capital, much like the one she’d built here, but with less red tape. This time, she would be paid by the government for her work, not singled out for it.

They’d be making less money, living in a place that’s a fraction of the population of Tampa Bay. They’d be trading in the flattest state in the country for an island made of mountains. There’d be more gun restrictions and a lot less plastic.

They didn’t know where they were going to live, didn’t have bank accounts or a school for the kids — but Rachel promised they’d figure it out.

• • •

Rapkin couldn’t bring herself to take down the family photos. The movers would have to do it in the morning.

In the kitchen, her husband slid a folding table into the nook where their dining set used to be. Rapkin set out plates with burgers.

In the months since that winter talk, the kids had come around. Miller seemed to have accepted his fate. Carter remained excited but devastated that they had to leave the cat.

Alex really got it.

Rachel Rapkin sits with Alex, left, and Carter in their home in Tampa, at the spot where the kitchen table used to be.
Rachel Rapkin sits with Alex, left, and Carter in their home in Tampa, at the spot where the kitchen table used to be. [ JEFFEREE WOO | Times ]

On a spring afternoon, she and her mom were on their way to synchronized swim team practice when she turned to Rapkin.

“I’m really sad because I have to leave my friends,” she said as they drove. “But I’m happy that we won’t have to do lockdown drills in school anymore, and that girls can be in control of their bodies.”

Rapkin swelled with pride.

Now, sitting in this kitchen one last time, it was heartache that she was feeling.

For months, she had been upbeat, unwavering. She sang Taylor Swift songs while packing boxes, laughed with friends who had stopped by to help. She did not cry.

Deciding what to take and what to leave behind was a challenge for the Rapkins. Rachel took a box of childhood photographs down to her dad's house in Fort Myers. Old paintings and other artworks were sold or given away.
Deciding what to take and what to leave behind was a challenge for the Rapkins. Rachel took a box of childhood photographs down to her dad's house in Fort Myers. Old paintings and other artworks were sold or given away. [ JEFFEREE WOO | Times ]

She and David had taken on the role of hype people. Did Miller know the Women’s World Cup would kick off not long after they got there? They’d get tickets. Alex already had a swim team waiting for her.

And for Carter — maybe, just maybe — they’d get another pet.

She was sure this was the right move for her family and for her work. For all of the future doctors she would train in a country that supported her calling. But now, in this empty house they’d built, the scale of the loss hit.

Rachel Rapkin spends time with her son Carter while he gets ready for the day at their home in Tampa. Every night since moving to New Zealand, he asks to look at pictures of the cat they left behind.
Rachel Rapkin spends time with her son Carter while he gets ready for the day at their home in Tampa. Every night since moving to New Zealand, he asks to look at pictures of the cat they left behind. [ JEFFEREE WOO | Times ]

“It just hasn’t really felt real,” Rapkin said, tears falling for the first time. “But the movers are coming tomorrow.”

Alex put a hand on her mother’s shoulder.

“We can’t really change anything now,” her daughter said in a soft voice.

“No, and I don’t want to change it,” Rapkin said. “I’m just sad that we have to go. I’m really going to miss it here.”

• • •
Rachel Rapkin poses with a colleague on her first day of work in New Zealand.
Rachel Rapkin poses with a colleague on her first day of work in New Zealand. [ Courtesy of Rachel Rapkin. ]

Since the spring, the Rapkins have settled into New Zealand. They miss the warm gulf waters but are enjoying the mountains. The kids are making friends, and Rachel Rapkin started work last week.

Meanwhile, in Florida, legal challenges against abortion bans are ongoing. On Friday, the state Supreme Court will hear oral arguments amid an effort to overturn the 15-week ban.

If the court rules to drop the lawsuit, a six-week ban — passed last legislative session — could take effect 30 days later.

The Rapkins attend a USA game during the Women's World Cup in New Zealand in July.
The Rapkins attend a USA game during the Women's World Cup in New Zealand in July. [ Courtesy of Rachel Rapkin. ]