Inside a Texas abortion clinic after the fall of Roe

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SAN ANTONIO — On Friday morning, a nurse at Alamo Women’s Reproductive Services in San Antonio ushered a patient into an exam room. She gave her a gown, told her the doctor would be in shortly and stepped back out of the room into a changed world.

“I saw the other nurses standing in the hallway,” said Jenny, a nurse who has been with the clinic for five years and asked to be identified only by her first name for fear of being targeted by anti-abortion protesters. “And I just knew.”

In the few minutes she’d been inside the exam room, the U.S. Supreme Court had overturned Roe v. Wade, clearing the way for Texas to fully ban the procedure she had just prepped a patient for.

Jenny and four other staff members stood in the hallway, paralyzed. They had a dozen patients sitting in the lobby awaiting abortions, all seemingly unaware of the seismic shift that had just rocked the reproductive health care world.

Before they could even decide how to proceed, the door to the clinic slammed open and a young woman ran in, yelling about Roe v. Wade and saving babies. They didn’t recognize her but believed she was associated with the anti-abortion protesters who often massed outside the clinic.

The woman quickly fled, leaving the clinic staff alone with a dozen sets of eyes staring back at them from the waiting room chairs.

“Obviously, that wasn’t how we had wanted it to come out,” Jenny said.

While other nurses addressed the elephant in the waiting room, Jenny returned to the patient she had just left.

“I just said, ‘You have to get dressed and come back out to the lobby,’” she said. “I told her, ‘The doctor will explain more … but we can’t even give you a consultation today.’”

The legal status of abortion in Texas was murky in the immediate aftermath of Friday’s ruling. The state has a “trigger law” that automatically bans abortion 30 days after the ruling is certified, a process that could take a month or more.

But in an advisory issued Friday, Texas Attorney General Ken Paxton said that abortion providers could be held criminally liable immediately because the state never repealed the abortion prohibitions that were on the books before Roe v. Wade was decided in 1973.

Rather than risking criminal charges, Texas’ clinics stopped providing abortions Friday.

Andrea Gallegos, executive director of Alamo Women’s Reproductive Services, said she’s hopeful that the clinic’s lawyers may find a way to allow it to resume abortions briefly before the trigger ban goes into effect.

But either way, abortion will soon be banned in the second-largest state in the country. The clinics will close. The staff will relocate or find new jobs. And the people they would have served will melt into the shadows, fleeing over state lines, seeking out illegal abortions or quietly consigning themselves to decades of raising children they never wanted.

Bearing the bad news

The staff at Alamo Women’s Reproductive Services are no strangers to bad news. For years, they’ve had to navigate ever-tightening restrictions that force them to delay care or turn patients away.

But never have they had to deliver so much bad news in such a short period of time. Dr. Alan Braid, who owns the clinic, told the women in the waiting room — and those who had already been admitted to exam rooms — that they were halting all abortions immediately.

Some just got up and left. One woman got upset, angrily demanding that Braid go through with the abortion anyway. She had driven hours to make it to this appointment after her home state of Oklahoma banned all abortions.

“I understand why she’s upset, and she has every right to be upset, but we’re not the enemy here,” Gallegos said. “The only thing we could tell her was this wasn’t because of us, it was because of the Supreme Court.“

One woman was on her fourth visit to the clinic. She’d been too early in the pregnancy for an abortion during the first two appointments, but finally, yesterday, staff were able to detect a pregnancy on the sonogram. But Texas requires clinics to wait 24 hours after a sonogram to perform an abortion, so they sent her home.

She arrived at the clinic Friday morning, not long after the Supreme Court ruled. When staff told her the news, she was bereft — rocking back and forth, wailing, begging for the staff to help her.

“I just told her, you did everything right and we did everything that we could, but unfortunately, our hands are tied today,” clinic director Kristina Hernandez said.

Gallegos said it’s devastating to know just how easily they could have helped that patient.

“Sometimes it’s just a matter of handing somebody a pill, and for the surgical [abortion], it’s less than five minutes,” she said. “It’s fast, it’s easy, it’s safe, it’s done. It’s health care.”

Instead, they had to send her away.

After they cleared the waiting room, the staff turned to the stack of two dozen appointments scheduled for the rest of the day. They distributed the files, took deep breaths and started dialing.

They explained, again and again: No, you can’t get an abortion here anymore. No, you can’t reschedule. No, you can’t go to another clinic in Texas, or even Oklahoma, or a lot of other states. No, it doesn’t matter if you’re under six weeks. No, not even if you come in right now. No, this isn’t our fault. No, no, no, no.

They offered a list of out-of-state clinics and groups that help fund abortions and travel that they put together when Texas banned abortions after about six weeks of pregnancy. They spent most of the day listening to the busy signals and voicemail boxes of clinics in New Mexico, where abortion will remain legal.

They make this effort because there is little else they can do. But they are well aware that many of their patients struggle to find babysitters for the duration of their appointments, let alone traveling out of state to get abortions.

And even if they can find babysitters, and get time off from work, and safely leave the state, Friday’s ruling is only going to make it harder for low-income Texans to access resources to pay for these journeys. Texas abortion funds have stopped paying for out-of-state travel and abortions until they can better assess the legal implications of their work.

Fear for the future

As the pandemonium of the morning subsided, something far worse settled over the clinic: silence. Staff sat around the check-in desk, filing paperwork and tidying up. Someone ordered pizza.

They listened in to televised press conferences, hoping to glean information about their own fates. They talked about where the fight might go from here, and some of the bigger battles they’ve had to wage over the years. They talked about what this meant for their daughters, and the patients they’d treated over the years, and those they would likely never get the chance to see.

A lot of the staff members have been working for the clinic for years. Hernandez was there with Braid when this location opened in 2015.

“This is my baby,” she said. “This is my life, right? This is what I’m good at. This is what I want to keep doing. I can’t do anything else. I mean, I can, but I don’t want to.”

When Hernandez thinks about all the patients she’s been able to help over the years, it’s overwhelming. She’s had women come up to her in H-E-B, years after she helped with their abortions, and give her hugs before disappearing into the aisles.

On days like this, she thinks a lot about a young woman she spent three hours having a theological discussion with before the woman ultimately decided to have an abortion, and her own sister, who decided not to.

The clinic plans to keep the doors open and the staff employed as long as it can. They’re holding on to hope that they may be able to squeeze in a few more patients before the trigger ban goes into effect.

And they’re still offering follow-up appointments for patients who had abortions recently — perhaps the final patients the clinic will ever get to treat.

A young woman showed up Friday afternoon for her follow-up appointment, with her 3-month-old in tow. She’s a single mom in her early 30s, raising four children already.

When she found out she was pregnant again, she decided she couldn’t responsibly raise another child. She’s already struggling financially, and she was trying to leave her boyfriend, who she said was physically abusive.

“I have to figure out who’s gonna watch my babies on the weekends so I can go to work, and it’s stressful,” she said. “So I’m not gonna bring another baby into this.”

She got the two-drug medication abortion regimen at the clinic earlier this week. It was an easy process, she said, and she was hugely relieved to hear that it had been successful.

But with four kids, if she’d been turned away, she said she wouldn’t have even tried to leave the state or find another way.

“It’s not worth all that effort,” she said. “I would have just kept it.”

Disclosure: H-E-B has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.

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