When private equity destroys your hospital
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As someone who writes a lot of fiction about corporate crime, I naturally end up spending a lot of time being angry about corporate crime. It's pretty goddamned enraging. But the fiction writer in me is especially upset at how cartoonishly evil the perps are – routinely doing things that I couldn't ever get away with putting in a novel.
Beyond a doubt, the most cartoonishly evil characters are the private equity looters. And the most cartoonishly evil private equity looters are the ones who get involved in health care.
(Buckle up.)
Writing for The American Prospect, Maureen Tcacik details a national scandal: the collapse of PE-backed hospital chain Steward Health, a company that bought and looted hospitals up and down the country, starving them of everything from heart valves to prescription paper, ripping off suppliers, doctors and nurses, and callously exposing patients to deadly risk:
https://prospect.org/health/2024-02-27-scenes-from-bat-cave-steward-health-florida/
Steward occupies a very special place in the private equity looting cycle. Private equity companies arrange themselves on a continuum of indiscriminate depravity. At the start of the continuum are PE funds that buy productive and useful firms (everything from hospitals to car-washes) using "leveraged buyouts." That means that they borrow money to buy the company and use the company itself as collateral: it's like you getting a bank-loan to buy your neighbor's mortgage out from under them, and using your neighbor's house as collateral for that loan.
Once the buyout is done, the PE fund pays itself a "special dividend" (stealing money the business needs to survive) and then starts charging the business a "management fee" for the PE fund's expertise. To pay for all this, the PE bosses start to hack away at the company. Quality declines. So do wages. Prices go up. The company changes suppliers, opting for cheaper alternatives, often stiffing the old company. There are mass layoffs. The remaining employees end up doing three peoples' jobs, for lower wages, with fewer materials of lower quality.
Eventually, that top-feeding PE company finds a more desperate, more ham-fisted PE company to unload the business onto. That middle-feeding company also does a leveraged buyout, pays itself another special dividend, cuts wages, staffing and quality even further. They switch to even worse suppliers and stiff the last batch. Prices go up even higher.
Then – you guessed it – the middle-feeding PE company finds an even more awful PE bottom-feeder to unload the company onto. That bottom feeder does it all again, without even pretending to leave the business in condition to do its job. The company is a shambling zombie at this point, often producing literal garbage in place of the products that made its reputation. Employees' paychecks bounce, or don't show up at all. The company stops bothering to pay the lawyers that have been fending off its creditors. Those lawyers sue the company, too.
That's the kind of PE company Steward Health was, and, as the name suggests, Steward Health is in the business of stripping away the very last residue of value from community hospitals. As you might imagine, this gets pretty fucking ugly.
Steward owns 32 hospitals up and down the country, though its holdings are dwindling as the company walks away from its debt-burdened holdings, after years of neglect that have rendered them unfit for use as health facilities – or for any other purpose. Tcacik's piece offers a snapshot of one such hospital: Florida's Rockledge Regional Medical Center, just eight miles from Cape Canaveral.
Rockledge is a disaster. The fifth floor was, at one point, home to 5,000 bats.
Five.
Thousand.
Bats.
(Rockledge stiffed the exterminators.)
The bats were just the beginning. One of the internal sewage pipes ruptured. Whole sections of the hospital were literally full of shit, oozing out of the walls and ceiling, slopping over medical equipment.
That's an urgent situation for any hospital, but for Rockledge, it's catastrophic, because Rockledge is a hospital without any hospital supplies. Steward has stiffed the companies that supply "heart valves, urology lasers, Impella catheters, cardiac catheterization balloons, slings for lifting heavier patients, blood and urine test reagents, and most recently, prescription paper." Key medical equipment has been repossessed. So have the Pepsi machines. The hospital cafeteria had its supply of cold cuts repossessed:
https://www.reddit.com/r/massachusetts/comments/1agc1j4/comment/kolicqo/
It's not just Steward's nonpayments that reek of impending doom. Its payments also bear the hallmarks of a scam artist on the brink of blowing off the con. The company recently paid off a vendor with five separate checks for $1m, each drawn on "a random hospital in Utah" (Steward recently walked away from its Utah hospitals; its partners there are suing it for stealing $18m on their way out the door).
This company – which owns 32 hospitals! – has resorted to gambits like sending photos of fake checks to doctors it hasn't paid in months as "proof" that the money was coming (the checks arrived 22 days later).
Steward owes so much money to its employees – $1.66m to just one doctors' group. But the medical staff keep doing their jobs, and are reluctant to speak on the record, thanks to Steward's reputation for vicious retaliation. Those health workers keep showing up to take care of patients, even as the hospital crumbles around them. One clinician told Tcacik: "I watched a bed collapse underneath a [patient] who had just undergone hip surgery."
Rockledge has nine elevators, but only five of them work – the other four have been broken for a year. The hospital's fourth floor has been converted to "a graveyard of broken beds." The sinks are clogged, or filled with foul gunk. There's black mold. Nurses have noted on the maintenance tags that the repair service refuses to attend the hospital until their overdue bills are paid. The fifteen-person on-site maintenance team was cut to just two workers.
Steward is just the latest looting owner of Rockledge. After the Great Financial Crisis, private equity consultants helped sell it to Health Management Associates. The hospital's CEO took home a $10m bonus for that sale and exited; Health Management Associates then quickly became embroiled in a Medicare fraud and kickback scandal. Soon after, Rockledge was passed on to Community Health Systems, who then sold it on to Rockledge.
Steward, meanwhile, was at that time owned by an even bigger private equity giant, Cerberus, which then sold Steward off. That deal was performatively complex and hid all kinds of mischief. Prior to Cerberus's sell-off of Steward, they sold off Steward's real-estate. The buyer was Medical Properties Trust, who gave Cerberus $1.25b for the real-estate: three hospitals in Florida and three more in Ohio. Steward then contracted to operate these hospitals on MPT's behalf, and pay MPT rent for the real-estate.
This complex arrangement was key to siphoning value out of the hospital and to keeping angry creditors at bay – if you can't figure out who owes you money, it's a lot harder to collect on the debt. The scheme was masterminded by Steward founder/CEO Ralph de la Torre. De la Torre is notorious for taking a massive dividend out of the company while it owed $1.4b to its creditors. He bought a $40m yacht with the money.
De la Torre was once feted as a business genius who would "disrupt" healthcare. But as Steward's private jet hops around "Corfu, Santorini, St. Maarten and Antigua"
as its hospitals literally crumble, he's becoming less popular. In Massachusetts, politicians have railed against Steward and de la Torre (Governor Healey wants the company to leave the state "as soon as possible").
Florida, by contrast, is much more friendly to Steward. The state Health and Human Services Committee chair Randy Fine is an ardent admirer of hospital privatization and is currently campaigning to sell off the last community hospital in Brevard County. The state inspectors are likewise remarkably tolerant of Steward's little peccadillos. The quasi-governmental agency that inspects hospitals has awarded this shit-and-bat-filled, elevator-free, understaffed rotting hulk "A" grades for quality.
These inspectors jointly represent a mismatched assortment of private and public agencies, dominated by a nonprofit called Leapfrog, the brainchild of Harvard public-health prof Lucian Leape, who founded it in 2000. Leapfrog likes to tout its "transparent" assessment criteria, and Steward are experts at hitting those criteria, spending the exact minimum to tick every box that Leapfrog inspectors use as proxies for overall quality and safety.
This is a pretty great example of Goodhart's Law: "every measurement eventually becomes a target, whereupon it ceases to be a good measurement":
https://xkcd.com/2899/
But despite Steward's increasingly furious creditors and its decaying facilities, the company remains bullish on its ability to continue operations. Medical Properties Trust – the real estate investment trust that is nominally a separate company from Steward – recently hosted a conference call to reassure Wall Street investors that it would be a going concern. When a Bank of America analyst asked MPT's CFO how this could possibly be, given the facility's dire condition and Steward's degraded state, the CFO blithely assured him that the company would get bailouts: "We own hospitals no one wants to see closed."
That's the thing about PE and health-care. The looters who buy out every health-care facility in a region understand that this makes them too big to fail: no matter how dangerous the companies they drain become, local governments will continue to prop them up. Look at dialysis, a market that's been cornered by private equity rollups. Today, if you need this lifesaving therapy, there's a good chance that every accessible facility is owned by a private equity fund that has fired all its qualified staff and ceased sterilizing its needles. Otherwise healthy people who visit these clinics sometimes die due to operator error. But they chug along, because no dialysis clinics is worse that "dialysis clinics where unqualified sadists sometimes kill you with dirty needles":
https://www.thebignewsletter.com/p/the-dirty-business-of-clean-blood
The bad news is that private equity has thoroughly colonized the entire medical system. They took hospitals, fired the doctors, then took over the doctors' groups that provided outsource staff to the hospital:
https://pluralistic.net/2020/04/04/a-mind-forever-voyaging/#prop-bets
It's illegal for private equity companies to own doctors' practices (doctors have to own these), but they obfuscated the crime with a paper-thin pretext that they got away with despite its obvious bullshittery:
https://pluralistic.net/2020/05/21/profitable-butchers/#looted
The financier who decides whether you live or die depends on an algorithm that literally sets a tolerable level of preventable deaths for the patients trapped in the practice:
https://pluralistic.net/2023/08/05/any-metric-becomes-a-target/#hca
Private equity also took over emergency rooms and boobytrapped them with "surprise billing" – junk fees that ran to thousands of dollars that you had to pay even if the hospital was in network with your insurer. They made billions from this, and spent a many millions from that booty keeping the scam alive with scare ads:
https://pluralistic.net/2020/04/21/all-in-it-together/#doctor-patient-unity
The whole health stack is colonized by private equity-backed monopolies. Even your hospital bed!
https://pluralistic.net/2022/01/05/hillrom/#baxter-international
Then there's residential care. Private equity cornered many regional markets on nursing homes and turned them into slaughterhouses, places where you go to die, not live:
https://pluralistic.net/2021/02/23/acceptable-losses/#disposable-olds
The palliative care sector is also captured by private equity. PE bosses hire vast teams of fast-talking salespeople who con vulnerable older people into entering an end-of-life system before they are ready to die. Thanks to loose regulation, the nation is filled with fake hospices that can rake in millions from Medicare while denying all care to their patients (hospice patients don't get life-extending medication or procedures, by definition):
https://pluralistic.net/2023/04/26/death-panels/#what-the-heck-is-going-on-with-CMS
If you survive this long enough, Medicare eventually tells the hospice that you're clearly not dying and you get kicked off their rolls. Now you have to go through the lengthy bureaucratic nightmare of convincing the system – which was previously informed that you were at death's door – that you are actually viable and need to start getting care again (good luck with that).
If that kills you, guess what? Private equity has rolled up funeral homes up and down the country, and they will scam your survivors just as hard as the medical system that killed you did:
https://pluralistic.net/2022/09/09/high-cost-of-dying/#memento-mori
The PE sector spent more than a trillion dollars over the past decade buying up healthcare companies, and it has trillions more in "dry powder" allocated for further medical acquisitions. Why not? As the CFO of Medical Properties Trust told that Bank of America analyst last week, when you "own hospitals no one wants to see closed." you literally can't fail, no matter how many people you murder.
The PE sector is a reminder that the crimes people commit for money far outstrip the crimes they commit for ideology. Even the most ideological killers are horrified by the murders their profit-motivated colleagues commit.
Last year, Tkacic wrote about the history of IG Farben, the German company that built Monowitz, a private slave-labor camp up the road from Auschwitz to make the materiel it was gouging Hitler's Wehrmacht on:
https://pluralistic.net/2023/06/02/plunderers/#farben
Farben bought the cheapest possible slaves from Auschwitz, preferentially sourcing women and children. These slaves were worked to death at a rate that put Auschwitz's wholesale murder in the shade. Farben's slaves died an average of just three months after starting work at Monowitz. The situation was so abominable, so unconscionable, that the SS officers who provided outsource guard-labor to Monowitz actually wrote to Berlin to complain about the cruelty.
The Nuremberg trials are famous for the Nazi officers who insisted that they were "just following order" but were nonetheless executed for their crimes. 24 Farben executives were also tried at Nuremberg, where they offered a very different defense: "We had a fiduciary duty to our shareholders to maximize our profits." 19 of the 24 were acquitted on that basis.
PE is committed to an ideology that is far worse than any form of racial animus or other bias. As a sector, it is committed to profit above all other values. As a result, its brutality knows no bounds, no decency, no compassion. Even the worst crimes we commit for hate are nothing compared to the crimes we commit for greed.
If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:
https://pluralistic.net/2024/02/28/5000-bats/retaliation#charnel-house
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1968 [Chapter 2: Hera, Goddess Of Childbirth]
A/N: Enjoy Chapter 2 a little early! See you on Sunday for Chapter 3 🥰
Series Summary: Aemond is embroiled in a fierce battle to secure the Democratic Party nomination and defeat his archnemesis, Richard Nixon, in the presidential election. You are his wife of two years and wholeheartedly indoctrinated into the Targaryen political dynasty. But you have an archnemesis of your own: Aemond’s chronically delinquent brother Aegon.
Series Warnings: Language, sexual content (18+ readers only), violence, bodily injury, character deaths, New Jersey, age-gap relationships, drinking, smoking, drugs, pregnancy and childbirth, kids with weird Greek names, historical topics including war and discrimination, math.
Word Count: 5.4k
Tagging: @arcielee @huramuna @glasscandlegrenades @gemmagirlss1 @humanpurposes @mariahossain @marvelescvpe @darkenchantress @aemondssapphirebussy @haslysl @bearwithegg @beautifulsweetschaos @travelingmypassion @althea-tavalas @chucklefak @serving-targaryen-realness @chaoticallywriting @moonfllowerr @rafeism @burningcoffeetimetravel-fics @herfantasyworldd @mangosmootji
💜 All of my writing can be found HERE! 💜
You are buzzed at a private party in the Rainbow Room of Rockefeller Center, Midtown, February 1966, chandeliers and candlelight, pink and red hearts made of paper hanging from shimmering strings and littering the floor. Your roommate Barbara Nassau Astor—yes those Astors, Astor Avenue in the Bronx, Astoria in Queens, “the landlords of New York”—brought you along tonight, and the chance to be swept up into her glittering existence is precisely why your father sent you to a school like Manhattanville College of the Sacred Heart. Barb knows people who know people who know other people and every single individual in that grand design is wealthy and worldly and could possibly lead you into the generous arms of your future husband. You are from Tarpon Springs, Florida, heiress to a sea sponge fortune, and your father nurses powerful ambitions of intermingling his blood with the Northeastern elite.
You scan the selection as you sip your Pink Squirrel. You could marry a doctor and sit in the living room waiting for him to come home at 9 or 10 or 11 p.m., fix him a Whiskey Sour or a Sazerac, listen to him bemoan the complexities of nerves and veins before accompanying him to bed and repeating the whole process the next day. You could marry a lawyer or an advertising executive, and your fate would be much the same. Your own parents are partners in life and business, but you have seen enough to know how rare this is. These men of the Rainbow Room, 65 floors above icy streets radiant with headlights, want a wife whose hands will stay manicured and idle: nannies will tend to the children, maids will clean the house, mistresses will massage the knots out of the muscles of his back. And you—a relative upstart, new money among ancient bloodlines—will have no right to demand otherwise.
A man interrupts your reverie. He wants to know about the pendant you wear around your neck. You sigh before you turn to him; you resist the instinct to roll your eyes. And then you see him. Tall, blonde, blue-eyed, with a curious intensity and a teasing little smirk, an Old Fashioned in his grasp like molten gold. You don’t know it yet, but he is a senator from New Jersey, very recently elected, victorious yet still hungry. He steals the oxygen out of your lungs. He drowns you in the amber-musk warmth of his cologne.
“It’s Athena,” you say, touching your fingertips to the silver medallion self-consciously; and you are rarely self-conscious. The black polish has been scrubbed from your nails and replaced with a soft, shimmering champagne. You spent two hours this afternoon having your hair painfully teased and arranged into a Brigitte Bardot-inspired updo.
“Goddess of wisdom.”
“And war and peace. And math.”
“Math?” He is intrigued.
“That’s what I’m studying at school. Math.”
“And yet you are not disinterested in the humanities. You know Greek mythology.”
“Well, Tarpon Springs has a lot of Greeks, and that’s where I’m from, so.”
“Studies math. From Tarpon Springs, Florida. I’m learning everything about you.” He smiles, this magnetic stranger who has captured you like a moon lured into a planet’s gravity. He swallows a mouthful of his Old Fashioned, moisture glistening on his lips. “Do you like Greek food?”
You can’t seem to follow his words. Blood is rushing into your face, hot and dizzying. “What?”
“Greek food. Have you tried it? Hummus, tzatziki, gyros, spanakopita, horiatiki, baklava.”
“Oh yeah, I’ve had it. It’s great.”
“My family owns a house on Long Beach Island,” he says casually. “We eat a lot of Greek food there. You should join us for dinner sometime soon.”
“Really?”
“Yes. Very soon. Maybe this weekend. Are you free?”
No, you’re not; but you’ll cancel plans until you are. “Um, okay. Sure. And who…sorry, I might have missed it, but…who are you…?”
“Aemond Targaryen.” And he shakes your hand like you’re someone who matters. “I’m a senator. I’m trying to end the war.”
With him, you could be a part of something magnificent. With him, you could help save the world.
~~~~~~~~~~
Asteria is the goddess of falling stars, but the home of rising ones. On the north end of Long Beach Island, New Jersey—only 100 miles south of the sleek bladelike skyscrapers of Manhattan—lies the sprawling Targaryen estate. The nine-acre property features one main house and another three for guests, a swimming pool, a tennis court, a ten-car garage, a boathouse, a pier, and an ample stretch of beach that abuts the Atlantic Ocean, open water with nothing interrupting the infinite, miles-deep blue from the East Coast to the Iberian Peninsula. It is the first week of July, 1968, and your 23rd birthday. You are lazing in a lounge chair on the emerald green lawn and eating your third slice of melopita, a cheesecake-like dessert made with honey and ricotta. It originates from the Greek island of Sifnos.
“You two can’t murder each other while I’m gone,” Aemond says. He’s sitting between you and Aegon. His stitches have healed, the worst of his pain has subsided, his poll numbers have only improved since the assassination attempt. He has a glass eye that he can insert for public appearances, but he dislikes it; at home he wears a leather eyepatch that still unnerves the children. Tomorrow, Aemond is flying to Tacoma to campaign ahead of the Washington State Convention on the 13th. Most of the family will be joining him, with only three Targaryens remaining at Asteria: ailing Viserys, useless Aegon, and you, officially too pregnant to travel by plane. You are wearing a floral, flowing, two-piece swimsuit. The sun is blazing in a clear sky. The record player is piping out Time Of The Season by the Zombies.
Aegon waves a hand flippantly, then adjusts his preposterously large blue-tinted plastic sunglasses; he is shirtless, flabby, very sunburned. “I’ll barely be here.”
Aemond looks over at him, amused. “Oh yeah? And what pressing engagements do you have to attend to? I’d love to know.”
You take a bite of your melopita and scatter crumbs across the swell of your belly: seven and a half months along. “I’m sure the prostitutes miss him.”
“They do,” Aegon snaps. “I’m their favorite customer.”
“Well you’re a reprieve for them. It’s always over so quickly.”
Aemond is snickering. Aegon says to him: “23, huh? A 13-year age difference. She could almost be your daughter.”
“And 17 years younger than you. She could definitely be yours.”
“That’s how Aegon likes his girls,” you say. “Too inexperienced to recognize end-stage degeneracy. Still stumbling their way through Shakespeare for English class.”
“Why can’t she stay at the brownstone?” Aegon asks irritably. Aemond owns a historic townhouse in Georgetown for when Congress is in session, though he’s rarely been there since he announced that he was running for president.
“Because Doxie is here to make sure she’s taken care of,” Aemond replies. Eudoxia has been the head housekeeper of Asteria for decades, a formidable battleaxe of a woman who speaks very little English and has a seemingly endless supply of patterned scarves to wrap around her ink black dyed hair. There currently aren’t any permanent staff stationed at the brownstone, and Aemond does not trust strangers. “And because my future first lady is hosting a tea party on the 10th.”
“A tea party!” Aegon gasps, mocking you. “Surely that will patch the wounds of our troubled nation. She’s an inspiration. She’s motherfucking Gloria Steinem.”
“She’s Aphrodite,” Aemond says, beaming with pride, his remaining eye fixed on your belly. He’s lost one piece of himself, but in a month and a half he’ll gain another. “Goddess of love.”
“There must be a more appropriate mythological character. Medusa, perhaps. Lyssa was the goddess of rabies, Epiales was the goddess of nightmares.”
“Aegon, I had no idea you were so…” You search for the right word. “Literate.”
“Io was turned into a cow.” He grins at you, toothy, malicious.
“She’s also one of Jupiter’s moons,” Aemond muses. He draws invisible orbits in the air with his long, graceful fingers. “Beautiful, celestial, pristine…”
“A satellite,” Aegon says. “Mindless. Aimless. Going wherever she’s told.”
Aemond insists as he twists the bracelet around your right wrist, a delicate gold chain he bought during your honeymoon in Hawaii: “Aphrodite.”
“Didn’t she fuck around with, like, everyone?”
“Maybe you should be Aphrodite,” you tell Aegon.
Mimi appears, tottering across the lawn with the straps of her sundress sliding off her shoulders and her Gimlet sloshing precariously in its glass. The children are playing in the surf with the nannies and Fosco, who is entertaining them by diving for seashells and delivering his treasures into their tiny, grasping palms. Criston is supervising from the sand, though he steals frequent glimpses of Alicent as she feeds a wheelchair-bound Viserys—much diminished after a number of strokes—his own slice of melopita, one careful, patient spoonful at a time. “Can we…” Mimi bursts out laughing and almost falls over. She claws her way upright again using the back of Aegon’s chair. “Um…I was thinking…”
“What?” Aegon asks, annoyed, avoidant. If they’ve ever been happy, it was a transient epoch that came and went long before you joined the family. It was before the asteroid killed the dinosaurs.
“We should go back to Mykonos. We had such a nice time in Mykonos. Didn’t we? Didn’t we just adore Mykonos?”
Aegon sighs, glowering out over the ocean. “Yeah, we sure did. Ten years ago.”
“Exactly!” Mimi gushes, oblivious. “When can we go? Next week? Let’s go next week.”
“Mimi, you and the kids will be in Washington, remember?” Aemond says. Alicent will have to be her handler; usually it’s your job to make sure Mimi is ready for photos, eats enough to stay conscious, doesn’t trip over her own feet, doesn’t talk too much to the press.
“Washington?” Like she’s never heard of it.
“The state. Not the city. For the convention.”
“Oh right. Right.” She gulps her Gimlet. You could set your watch by Mimi’s drinking. Tipsy by lunch, drunk at dinner, crawling on the floor chasing the dogs around by 8 p.m. The Targaryens keep a drove of Alopekis, small and white and foxlike. “Well…maybe some other time.”
“After the election,” Aemond says with an abiding, encouraging smile. He tolerates Mimi because he needs her: happy wholesome family, American Dream. Down at the water’s edge, the nannies are giving towels to Fosco and the children as they scamper out of the frothing waves, Mimi’s five and Helaena’s three: Daphne, Neaera—no one can ever seem to spell her name correctly, least of all the six-year-old girl herself—and Evangelos.
Mimi departs, on the hunt for a fresh Gimlet. Aegon reaches into the pocket of his swim trunks—Hawaiian print, royal blue—and pulls out a joint and a Zippo. He sticks the joint between his teeth and goes to light it.
“No,” Aemond says immediately, yanking the joint out of Aegon’s mouth and stomping it into the earth. Then he points down the beach towards the sand dunes. “You know journalists will sneak around trying to get photos. You know we’re never truly alone out here.”
“They can’t tell what I’m smoking!”
“Don’t argue with me.”
“You know there are teenagers getting their limbs blown off in Vietnam right now? I think society has bigger problems than me smoking grass.”
“And yet to solve those bigger problems, I have to win in November. And the suburban housewives will not vote for me if they think I support legalizing marijuana. Trust me, I know. I’ve met them.”
“I wouldn’t want those people’s votes,” Aegon says derisively.
“You’d rather Nixon get them?”
Aegon doesn’t have a speedy rebuttal this time. He contemplates the Atlantic Ocean, the wind tearing at his hair.
“It’s hot as hell,” Aemond says to you, gathering up the newspapers he’s been leafing through, never not thinking about the election, never not strategizing. “Come on. Let’s go inside.”
As you accompany Aemond towards the main house—and of course you follow him, always, anywhere—Alicent waves you over to where she and Viserys are sitting to wish you a happy birthday again. From this vantage point, you can just barely spot Otto and Helaena strolling through her garden, a jungle of butterfly bushes and herbs. The stricken Targaryen patriarch beams at the swell of your belly. Viserys likes you, you are his favorite daughter-in-law, though perhaps this is not so lofty an achievement. Moreover, he likes that you are carrying the child of his decent son. Aemond has already decided on the baby’s name: Aristos Apollo. If it is in fact a boy, you suppose you’ll call him Ari, but he doesn’t feel real to you yet. He belongs to Aemond, to the Targaryens, to the nation, but not quite to you. He is more myth than flesh.
“Nothing is more precious than children,” Viserys tells Aemond, raspy and frail. “I would have had at least five more if I could.” Alicent bows her head, an acknowledgement of her failure in this regard. Viserys expects it. You and Aemond politely avert your gazes.
“Thank God for this baby,” Alicent says. “After the year we’ve had? That the whole world has had? We all need something to be grateful for.”
“Yes,” Aemond agrees, smiling. It must be the promise of a son that has made his maiming go down smoother, and maybe it is his soaring poll numbers too, and maybe it is gratitude that he escaped with his life, and maybe it is even the fact that he has you.
But long after dusk when you’re getting ready for bed—slathering yourself in Jergens, stepping into your chiffon nightgown—as you pass through the sliver of light pouring out of the bathroom, you catch a glimpse of something that stops you. Aemond is standing in front of the mirror with his hands on the rim of the sink, his eyepatch slung over the towel rack, his voided eye socket exposed and gory and irreparably wounded. There’s something in his scarred face that you can’t recall ever seeing before. There is a seething, secret, animal rage. There is fury for everyone who has ever denied him anything.
You remember who you were before you met Aemond at the Rainbow Room in Manhattan at a party you were almost not illustrious enough to attend. You wore your hair long and loose, you downed shots, you smoked, you swore, you slept through class almost every Monday; and then you packed all of this away in your allegorical attic and became someone who could stand beside a senator, and then a candidate, and then a president, someone who could tip the scales of fate.
And you think as you lurk unnoticed in the doorway: Maybe he’s been hiding parts of himself too.
~~~~~~~~~~
July 10th, 10 a.m. He’s snoring on a couch in the living room, the one patterned with sailboats. He’s hugging his acoustic guitar like a child clinging to a teddy bear. Sometimes he plays it for the kids: Get Rhythm, Twist And Shout, Stand By Me, You Can’t Hurry Love. That’s about the extent of his involvement in their lives. He has a law degree from Columbia that his father bought for him. Aside from a brief and disastrous stint as the mayor of Trenton, he has never been gainfully employed. You pour the cupful of ice cubes you collected from the freezer all over his bare chest.
“What the fuck!” Aegon screams as he startles awake. “What is wrong with you?!”
“The guests are arriving in two hours. And you’re going to help me host.”
“I’m not slobbering at the feet of those manicured elitists.”
“It’s easy to say ‘vive la révolution’ from your family’s mansion that you reside in as a professional failure.”
“Yeah, you’re right, I’m so worthless. If only I spent more time hosting tea parties.”
“I can’t small talk with governors and congressmen, so I have to charm their wives instead. That’s how it works, you idiot.”
Aegon rolls off the couch and rubs his forehead, wincing, hungover. In the dining room, Eudoxia is readying cups and plates, polishing silverware, folding napkins. The caterers will be here soon, and there are also three dishes that you made yourself: stafidopsomo, a bread with raisins and cinnamon; rizogalo, Greek-style rice pudding; and baklava you spent hours chopping walnuts for. At least one show of domestic prowess is an expectation, two is impressive, three is above and beyond, something for the other political wives to chatter about. You know the importance of making a good impression on them. They are as much a part of their husbands’ careers as the speech writers, communication directors, fundraisers. “I need a Bloody Mary,” Aegon groans.
“You need to pull your goddamn weight. Everyone else is working to get Aemond elected. Your five-year-old kid is out on the campaign trail and you can’t walk around with a tray of hummus and mini spanakopitas? Are you serious?”
“I’m dead serious,” he says, standing with some difficulty and then shoving by you. “Fuck off, Miss America.”
“Aegon!”
But he’s padding off towards the kitchen with his bare feet, tiki print boxer shorts, bedraggled hair. You follow after him in your spotless white heels and sundress patterned with common blue violets. Your earrings are pearls. You’ve wrangled your hair into a tidy French twist. Aegon is getting a pitcher of tomato juice out of the refrigerator, a bottle of vodka from a cardboard Apple Jacks box. He keeps booze and pills hidden everywhere; you’re always stumbling across his caches.
You open your mouth to unleash something hurtful, something hateful, but then you feel the cold flare of liquid on your thighs as the ocean breeze gusts in through the windows. My dress, you think, alarmed. What did I spill on it? One of the ice cubes you threw at Aegon must have caught on the skirt somehow and melted. That’s your first guess, and it is welcome; water doesn’t stain, and you aren’t sure if you have another outfit that is both formal enough and will still fit you. But when you reach down to touch your leg—now the liquid reaches your knees—your hand comes away red.
You look up at Aegon. He’s staring back at you, thunderstruck, horrified. His Bloody Mary ingredients are now forgotten on the countertop. He shouts for the housekeeper: “Doxie?!”
There is indistinct, cantankerous Greek grumbling in return.
“Doxie! Call an ambulance!”
“I don’t understand,” you say to Aegon, bright clotless blood dyeing the whirls of your fingerprints. I ruined my dress, you think nonsensically. “It doesn’t hurt. Shouldn’t it hurt?”
“Don’t move, don’t do anything, just wait for the paramedics.”
But the edges of your vision are going dark and hazy, and the room spins like a flipped coin. Your knees and ankles fold, bones turned to paper. As you drop, Aegon dives for you. You clutch at him, but there’s nothing to grab onto, no suit jacket, no tie, only skin that glows with sunburn. “If I don’t wake up, tell Aemond—”
“You’re not dying, bitch. My luck’s not that good.”
But his eyes are panicked; and they are the last thing you see before you black out.
~~~~~~~~~~
Arteries of cement, bones like lead, heavy eyelids opening to reveal strange white walls.
Am I dead?
But no: you hurt all over. Heaven isn’t supposed to hurt. There are needles pierced through the backs of your hands, a splitting rawness in your throat.
Was I intubated? Did I have surgery…?
You try to sit up. The pain is blinding; the severed and sutured latticework of your abdominal muscles is a pit of glass. You gasp, moan plaintively, fumble for the nurse call button on the wooden nightstand.
“Will you stop moving?” Aegon says as he walks into the room. He’s slurping on a straw that pokes out from a Dairy Queen cup. The fluid inside is clumpy and red. Instantly, you think of blood, and a wave of nausea punches through the shredded gore that was once your belly. Aegon flops down into the salmon pink armchair beside the bed and props his combat boots up on the ottoman. “They sliced you up like the Black Dahlia. You’re gonna rip your stitches.”
“They did a c-section…?”
“Yeah, you had some kind of uterus…thing. I don’t remember.”
The baby?? Is the baby alright?? “An abruption?”
More slurping. “No…I think it started with a P.”
“Previa?”
“Yeah, that one.”
You remember waking up a few times: on the kitchen floor as men were lifting you, in an ambulance as the siren shrieked. Someone said you were being taken to Mount Sinai in Manhattan. And that makes sense, that would have been Criston’s plan. Mount Sinai is one of the best hospitals in the country. You look around the room for a bassinet or a crib. Instead you see a wheelchair and a myriad of flower bouquets; word has already gotten out, and so the customary well wishes are pouring in. Lady Bird Johnson sent bluebonnets, the state flower of Texas; Abigail McCarthy sent lilies of the valley; Muriel Humphrey sent roses, traditional, safe, uninspiring; Pat Nixon sent blood orange gladioli. Mrs. Wallace, newly deceased, neglected to call a florist. “Where’s the baby?”
“He’s fine. He’s downstairs in an incubator.”
Ari, you think, though he still doesn’t seem real yet. “What…?”
“His lungs are underdeveloped. But the doctors think he’ll be alright. You want a Mr. Misty? There’s a Dairy Queen like two blocks from here.”
“No, I don’t want a Mr. Misty,” you say, incredulous. “I want to see the baby.”
“Well they can’t move him and they can’t move you, so you’ll have to wait.”
“I’m going to see him—” You swing your feet off the bed and feel daggers, fire, a splintering like someone has taken a hammer to your bones. You almost scream; it takes everything in you to choke it down and only gasp as your flesh becomes an inferno. I want a joint, you think randomly, an urge you’d believed you had exorcised from yourself, an archaic relic of a past life.
“Told you,” Aegon says smugly.
You lie panting, helpless, glancing at the phone on the nightstand. “Aemond knows?”
“Oh yeah, I’ve called everyone. He knows.”
“Good. So he’ll be here soon.”
“Sure,” Aegon says, perhaps a tad noncommittally.
“Okay.” You’re still trying to catch your breath. Tacoma is a six hour flight away. Even if Aemond doesn’t leave until morning, he’ll be here by sundown tomorrow. “You can go now.”
“Go?!” Aegon exclaims, then laughs, one of his reckless, taunting cackles. “Oh no. I’m not going anywhere.”
“You definitely are.”
“No, I’m not,” he insists, grinning. “For once in my life, I’m the person who’s exactly where he’s supposed to be. I’m the honorable one. The sacred heir of the favorite son has just been born, and the blessed mother has been sawed in half like Saint Simon the Zealot, and where is Aemond? Where is literally everyone else? Across the continent shaking hands and forcing smiles to win him the great state of Washington. I’m not going home. I’m collecting every second I spend here like coins from a slot machine. I won the jackpot, babe. No one is ever going to be able to call me the family fuckup after this.”
The pain is horrible, insurmountable; you can’t think through it. You close your eyes and try not to sob, to wail, to split yourself open in body and soul. I can’t let him see me break down.
“What’s up?” Aegon asks. “What’s wrong with you?”
“I want a Mr. Misty. Go get me a Mr. Misty.”
“Okay,” Aegon says doubtfully. “What flavor?”
“I don’t care. Not red.”
“They have orange, lemon-lime, grape—”
“Just pick one!” you shout, tears brimming in your eyes. Get out, get out, get out.
“Calm down, psycho!” he yells back, heading for the door.
As soon as he crosses the threshold, you snatch the call button off the nightstand and press it frantically until a nurse arrives. You get more morphine and sink into a stillness like deep water, down, down, down.
~~~~~~~~~~
It’s dark outside, stars and a crescent moon. On the television is grainy footage from the Battle of Khe Sanh. American soldiers younger than you are dragging their wounded brethren to a Chinook helicopter for evacuation: bandages, burns, missing limbs and faces. Aegon had dozed off in his chair—assisted by an ample amount of Vicodin, surely—but is stirring awake now. He blinks groggily at the screen.
“It’s so fucking awful,” you say, and Aegon’s eyebrows shoot up; it’s the first time you’ve ever sworn in front of him. You trained yourself to stop when you met Aemond. “30,000 Americans dead, God knows how many Vietnamese peasants, Buddhist monks setting themselves on fire, and for what? So we can say we did everything we could to stop communism? So we can humiliate the Russians? There is no liberation of Vietnam. All we’re doing is making those people hate us. And we’re destroying ourselves too.”
“I didn’t know you cared about the war.”
You look at him, mystified. “Everything I do is about the war.”
“But you never really talk about it.” Aegon yawns and stretches, reaching up towards the ceiling. “You talk about Chanel dresses and tea parties.”
“Well yeah, because it’s…it’s unseemly, I guess. For me to speak on the war. Me specifically.”
He snorts. “Because you’re a woman? Who told you that? Aemond?”
You hesitate, watching the television again. Now there are napalm bombs incinerating villages and rice paddies. “I had a boyfriend before Aemond, you know.”
“What, in kindergarten? Chasing each other around the playground? Illicit snuggles beneath the slide?”
You chuckle, shaking your head. “A real boyfriend.”
“No way. You did not.”
“I did,” you insist, smiling a little. “We met at a party my freshman year of college. He was at NYU studying…oh, I always forgot, that was one of our jokes. It was either archaeology or anthropology. I actually thought I was going to marry him for a minute there.”
“Scandalous.” Aegon is gazing at you with his murky blue eyes, grinning, playful. “What happened?”
“He had a moral crisis about poor kids getting shipped off to Vietnam to be slaughtered while he was tucked safely away in his ivory tower. So he enlisted, and honestly it was shocking how quickly I started to forget about him. We exchanged a few letters, it didn’t last long, I think he was forgetting about me too. But he ended up getting killed in action in October, 1965. His old roommate told me.”
Now Aegon is thoughtful. His crooked grin dies. “I’m sorry.”
“It’s his parents I feel bad for. He was an only child. I heard his father drank himself to death.”
“You’ve been carrying a story like that around with you and you never used it? Not in an interview or an article, not at one of your asinine little tea parties?”
“I can’t,” you confess. “Aemond doesn’t want me to. He doesn’t like to be reminded about…you know. That there was someone else before.”
Aegon throws his head back and cackles, combing his fingers through his disheveled blonde hair. “As if Aemond was a virgin when you met him.”
But it’s not the same. It isn’t to Aemond, and it wouldn’t be to the rest of the world either. It is your eternal disgrace. It is something you will be expected to atone for until you’re in the grave. “Give me a joint.”
Aegon is amazed. “What?”
“I know you have some, you always do. I want one. Give it to me.”
“You smoke grass?”
“I used to. Then I gave it up. But I’m making an exception.”
He gawks at you for a while, then slips a joint out of one of the front pockets of his green army jacket. He places it between his lips, lights it with his little chrome Zippo, and inhales deep and slow. Then he offers it to you.
“I don’t want herpes.”
Aegon laughs. “I don’t have herpes. I swear.”
“Not yet, maybe. Give it time.”
“Are you gonna smoke or not?”
You take the joint and fill your lungs with earth, floral notes, a tinge of spice. It’s been years, but it comes rushing back in an instant as the high hits your bloodstream: calm quiet weightlessness, a sense of wellbeing that fills the honeycomb hollows of your bones. “I need to see the baby.”
Aegon stalls. “The doctors were really insistent that you stay here.”
“And all the sudden you care about rules.”
He considers this, drumming his palms on his thighs. His jeans are ripped; he’s biting his lower lip. Then abruptly, he stands. “Alright.” He grabs the wheelchair and pushes it up against the bed. “Let’s go.”
You take another drag and then discard the joint in your empty Dairy Queen cup. You throw off your blanket and try to touch your bare feet to the cool linoleum floor. It hurts, it feels like razor blades, but you keep going. Then you remember you still have one IV in the back of your left hand. “Wait, how am I going to…?”
“You’re in luck. I am well-versed in needles.” Aegon holds out a palm. Nervously, you give him your hand. He peels off the medical tape, takes a moment to examine the vein, then slides out the needle so smoothly you don’t feel it at all; it barely even bleeds. He balls up a Kleenex from the box on your nightstand and secures it to the wound with the same strip of tape. “You’re welcome.”
“Junkie.” You try to lower yourself into the wheelchair and a yelp rips from your throat.
“Oh, this is pathetic,” Aegon says, but not quite unkindly. “Here.” He leans down in front of you. Too desperate to be prideful, you link your arms around the back of his neck. Aegon’s shaggy blonde hair tickles your cheek; his hands skim gingerly to settle on your waist, steadying you without too much pressure. He helps you into the wheelchair, where you collapse gasping and sweating bullets.
“If you ever mention this again, I will guillotine you.”
He winks. “Relax, little Io. I never kiss and tell.”
“I’d assume you’re usually too plastered to remember the details.”
“Be nice. I could roll you down a staircase.” But he doesn’t; he rolls you into the hallway instead.
The lights in the corridor are dim for night, for dreams. You see a few nurses shuttling in and out of other rooms from a distance, but none seem to notice you and Aegon. He steers the wheelchair into the elevator and you ride it down two floors, then cross another hallway and pass through a set of doors. There must be a dozen incubators, half of them occupied. The nurse on duty—currently cradling a tiny infant in her arms, a girl judging by the pink hat, and feeding her from a bottle of formula—gapes at you.
“Ma’am? You aren’t supposed to be—”
“Shut up,” Aegon tells her, and the nurse doesn’t say another word.
Aegon pushes the wheelchair down the line of incubators until you reach the one with a name card labelled Targaryen, Aristos Apollo. And there he is: unmistakably fragile, impossibly small, blue veins like a roadmap beneath translucent skin, tangled in tubes and wires. In his sleeping face you don’t see Aemond or even yourself, but rather an inexplicable familiarity. You feel like you’ve met him before. You feel like you’ve known him all your life.
You press your hand to the clear, domed wall of the incubator; shadows in the shape of your outstretched fingers fall over Ari’s face. “He’s real.”
“Of course he is.” Aegon is watching you; you can see him on the periphery of your vision, a blur of blonde hair and high cheekbones. When you turn to him, he immediately looks away.
“What?” you ask.
“Nothing.” But his voice is distracted, bewildered, like someone fumbling for a light switch in a dark room.
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Hey trans Florida folks - things suck, but I want to make sure y'all have more info so you can better gauge the urgency and expected risk for a new bill.
This is another long post, but please read because a lot of folks are in a huge panic at some misleading info.
You've probably seen this by now:
This is misleading. Be incredibly concerned at the path we're on because it is bad, even plan to leave the state (I am), but drag isn't punishable by the death penalty:
From the Twitter screencap: "Florida has now: 1) made drag in public illegal as a 'sex crime against children'."
Misleading. SB 1438 censors drag in front of minors w/vague, subjective language and threatens misdemeanors, fines, and license revocation for violations. This is meant to scare businesses, and even cities. We are already seeing Pride parades canceled in Florida in response:
From the Twitter screencap: "2) made sexual crimes against children punishable by death"
Too broad. Sexual battery against a child is being made into a capital felony (aka, punishable by death) in the currently proposed SB1342 .
The bill says:
"A person 18 years of age or older who commits sexual battery upon, or in an attempt to commit sexual battery injures the sexual organs of, a person less than 12 years of age commits a capital felony".
If we want a definition of "sexual battery" itself, we can jump to Florida statues at:
https://m.flsenate.gov/statutes/794.011
"Sexual battery” means oral, anal, or female genital penetration by, or union with, the sexual organ of another or the anal or female genital penetration of another by any other object; however, sexual battery does not include an act done for a bona fide medical purpose."
Also of note in this statute:
"Serious personal injury” means great bodily harm or pain, permanent disability, or permanent disfigurement."
I am not a lawyer, but to me, this looks like less of an attack against trans people for existing (via conflation with anti-drag bills), and more a way to target those providing gender affirming care -- healthcare providers or even a child's affirming guardians.
Many states are already trying to set up "aiding and abetting" laws (from the anti-abortion playbook) to punish anyone offering any kind of gender affirming care (from general therapy to vocal coaching) to a trans kid.
Florida might be hoping someone applies the "injures the sexual organs of" component of SB1342 to gender-affirming puberty blockers. Yeah, it's a stretch, but I would not be surprised to see someone try it.
Because we are already seeing the HHS committee consider sending subpoenas to gender-affirming clinics:
"House Speaker Paul Renner said he wants the House to examine how the organizations adopted their recommendations. He questioned whether the guidelines were the result of scientific analysis or whether “the integrity of the medical profession has been compromised by a radical gender ideology that stands to cause permanent physical and mental harm to children and adolescents.”
Emphasis mine. Again, I am not a lawyer, but I would not be surprised to see someone try to hold a gender-affirming clinic accountable for "sexual battery" against a child.
All these separate actions paint a grim picture.
Back to our Twitter screencap: "3) Began allowing death penaltymsentencing at at 8-4 vote instead of a unanimous vote"
Yes, true. This one is scary all on its own because it makes it that much easier for the DeSantis administration to target political enemies.
Everyone should be terrified of this:
Back to making child sexual battery a capital felony & SB1342:
Could we eventually see bills proposed that further broaden - via deliberately vague language or otherwise -what kind of "sex crimes" are punishable by death, thus fully targeting trans people?
For sure, we will absolutely see fascists try to get away with whatever they can and I hope we see more resistance against what is happening now to prevent the escalation towards genocide.
But this specific bill isn't targeting drag and it's important we understand the current threat landscape so we can plan accordingly.
Like. I'm still working on my own plan to flee Florida asap (I am a trans man) but I don't feel at risk of the death penalty just yet, so my "leave asap" is "sell the house in a month" instead of "grab the bugout bag and get in the car NOW".
It is very, very important to understand the threats we face so we don't make rash decisions that could have permanent consequences for already vulnerable people. We need to plan and act on plans with haste, but afford ourselves every opportunity to make decisions with as much accurate information as possible.
What's the status of SB1342?
As I type this, still with the senate, but check for updates at the link below. If passed, it would enact October 1, 2023.
In closing
Again, be careful, be safe, be informed. I am not a legal expert; I'm just a little guy, but the risk landscape has enough threats trans people need to respond to without us thinking drag is currently eligible for the death penalty.
Every trans person in the United States, not just Florida, should be watching what is going on across the country and noting how all these bills connect and escalate. And what could become blueprints at the federal level.
Keep hope, but plan for contingencies that could threaten your job, your housing, your liberty, and possibly even your life. Watch the news, watch your local bills, and do your best at figuring out when you need to break that emergency glass.
My biggest advice to be better informed is to learn where your state posts bills and look them up when they hit the news:
Get used to reading bills and noting when they would take effect
Learn how to follow a bill on its way into law - the stages are usually through various committees, then both the House and Senate can file amendments and ultimately vote in separate sessions to approve, then the governor signs it into law
Understand that a lot of reporting on bills can make it sound like it has passed into law, when it might still just be in a committee.
Not all bills pass, and when they do, not all pass as originally proposed. (This can work for or against us.)
Follow trans political commentators like Erin or Alejandra for more context
Again, it all sucks right now and I don't want to underscore the danger so many transgender Americans are already in (and lord knows I am very lucky to be able to leave Florida). But knowing what we're up against is one of the few defenses we have right now.
I have more advice for trans Floridians here.
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