At seven o’clock on Friday morning, Ivy turned on the lights of the Houston Women’s Clinic, the largest abortion provider in the state, where she has worked as a supervisor for nearly two decades. Since May, when the draft of a Supreme Court decision leaked, revealing its conservative majority’s intention to overturn Roe v. Wade, Ivy, who is fifty-six and asked to be identified only by a nickname, went to work each day knowing that it might be her last. But neither the likely end of a woman’s right to an abortion, nor Texas’s existing onerous regulations against it, had altered her brisk morning habits. Tucking her graying, hip-length hair into a bun and covering it with a black surgical cap, she sterilized all the syringes, counted the curettes one by one, and waited for her colleagues to trickle in. Only Ivy’s message to her patients had changed. Now every greeting had to come with a disclaimer.
A ruling on Roe v. Wade was imminent and the procedure could be banned at any time, Ivy would warn the pregnant women who approached the front desk, after the perfunctory good mornings. Friday, patients began arriving at eight o’clock, having negotiated picketers who were working the parking lot. “Let me see your I.D., mija,” Ivy said to the first woman to reach the light-filled lobby, where a large fish tank was murmuring away. The woman, dressed in black pants and a gray hoodie, was assigned a patient number to protect her privacy. Only four weeks along, she, like the vast majority of the morning’s patients, was coming for her second of two visits. As mandated by Texas law, women have to wait at least twenty-four hours after receiving paperwork and a sonogram that confirms their pregnancies. Now she was returning in hopes of having a second sonogram and then the abortion. To the right of the desk where Ivy checked her in was a framed proclamation, signed by the mayor of Houston, honoring the forty-fourth anniversary of Roe v. Wade.
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That day, despite Ivy’s warnings, only a few women at the front desk seemed to register that their access to abortion was in jeopardy. The dominant concern was whether the ultrasound would determine that they were more than six weeks pregnant or had electrical activity in fetal cells—eventualities that, following the passage of a state law last September, would mean they’d be barred from receiving an abortion in Texas and need to seek care in a different state.
One by one, women were called into the back of the clinic to receive their ultrasounds and counselling sessions, or to await the doctor, who had not yet appeared. A row of stiff wooden chairs where they bided their time faced a framed photograph of Portofino’s cerulean bay. As the women stared at the Italian village, or their phones, a dozen anxious staff members huddled by the front desk. One of the medical assistants placed her phone against a stack of patient files so that her colleagues could see the Supreme Court’s schedule for the day. A nurse started braiding the receptionist’s brightly dyed hair. Ivy’s boss, Sheila, who directs the clinic, had been in touch with lawyers at the A.C.L.U. “It can come any minute,” she told her colleagues of the decision, adding with a nervous smile, “My sister is trying to distract me. She just sent me an article: ‘How to Stop Dating People Who Are Wrong for You.’ ” Someone yelled from another room: “Send it to me!”
Despite the tension, for the next hour, the workers tried to focus on their particular responsibilities, including answering the phone, which rang constantly. The faster they worked, the more patients they could ready to see the doctor, who would either give the eligible women pills to begin a medication abortion or proceed with a surgical one. But at 9:11 A.M., before the doctor had walked through the door and any abortions had commenced, Sheila heard from an A.C.L.U. lawyer. “Roe, overturned,” she said flatly. Ivy, emerging from the lab, hadn’t caught Sheila’s exact words, but she understood them when she saw her hands shaking.
For a few seconds, no one said a word. Ivy retreated to an area of the clinic where women’s vitals were taken and a urine sample awaited analysis. Alone, she pressed her fingers to her welling eyes. Other workers wrapped their arms around one another. Confused, one of the patients left her seat and interrupted their silence. “Why are y’all crying?” she asked. Sheila, trying to collect herself, wiped her tears away and turned to the woman and three other patients in the waiting room. “Ladies, I’m so sorry to tell you that the law for abortion has been overturned,” she said. “We are not able to perform any abortions at this time, but that doesn’t mean that you don’t have an option, O.K.?”
Two of the patients, wearing bright fluffy slippers, stared into space, speechless. A third, who wore black horn-rimmed glasses, burst into sobs. The fourth, who spoke no English, asked, “Qué pasó?” Sheila kneeled by her side, and, in broken Spanish, said, “No podemos hacerlo ahora,” meaning “We can’t do it now.” The woman, who was of Cuban origin, had no reaction, so Sheila asked Ivy to do a better translation. “Mi amor, the Supreme Court just ruled that abortion is banned in Texas,” she said in Spanish. “We cannot assist you.” The woman froze, in disbelief.
Ivy handed her a leaflet with the National Abortion Federation’s phone number and urged her to call it to learn about options in other states. The leaflet was in English. The guidance it contained included contact details of three abortion funds, two of which had immediately ceased operations upon announcement of the ruling. “They don’t do it in Texas anymore?” the woman asked, her eyes widening. Ivy shook her head, resting her hand on the woman’s shoulder.
Over and over again, Ivy conveyed the same message to two dozen other women who had been waiting to see the doctor. She could share the results of the ultrasounds the women had just done, but the clinic was unable to perform the procedure that they’d come for. “Abortion, no more,” Ivy told one woman sitting in the lobby, eyes down. In her distress, her perfect fluency in two languages seemed to disappear, momentarily, but then she gathered herself. “You’re gonna call them,” Ivy said, handing over the now outdated leaflet while fighting back her own tears, “and they’re gonna guide you, O.K.?”
Some patients fled the clinic the moment that they heard the news. When Ivy called their numbers to offer what little advice she could give, there was silence. Sheila felt especially pained by a woman whose previous medication abortion had failed and who had come back that morning believing that, this time, the treatment would work. Other patients simply refused to accept the news and leave the clinic. One of them clasped Ivy’s arm and would not let go. “Please help me,” she whispered, offering to give her a stash of money in exchange for abortion pills. “We can’t do it,” Ivy insisted. “It’s against the law.” The woman begged her: she would take the pills at home—no one would have to know. “Your husband has to take you to another state,” Ivy said, her tone severe. “Abortion is not legal.”
Several hours later, when Ivy entered an exam room, a woman named Brittany, twenty-two, was perched on the table, her white T-shirt wrinkled and hands clenched. She had come for a follow-up appointment, a week after her abortion, and had already heard the news. She was chilled by how close she’d come to being kept from the procedure and having “this target on your back.” Could she now get in trouble for having had an abortion a week ago, she asked Ivy. You haven’t done anything illegal, Ivy assured her, but suggested it would probably be better for her if she didn’t tell other people about her abortion.
When the last patient of the morning left, the clinic’s reception area turned into a kind of mission control. Ivy began storing patient records in boxes while two of her colleagues tried to call women who had appointments that afternoon to tell them not to come. Other staffers struggled to understand how the decision would impact their livelihoods. Business in the clinic would vanish, and it wasn’t hard to figure that they’d all be losing their jobs. “There are two laws,” Sheila said to one of the nurses, going off of what the lawyers had told her. “There is a pre-Roe, 1960 law, in the Constitution, and then there’s a trigger law,” she said, describing various Texas laws. Texas’s attorney general threatened to enforce the former immediately. The latter would take effect thirty days after the Court’s judgment and make it a felony to provide an abortion.
Before long, the afternoon’s patients started showing up, despite the voice mails that workers had been leaving. Every time the door alarm chimed, staff members turned in unison to the front entrance, their faces drawn. “I’m not sure if you’ve heard the news,” the receptionist told a woman who seemed on the brink of tears. Another patient arrived and, baffled, asked Sheila what the law was now. “Since Roe v. Wade has been overturned, it goes back to each state making the decision,” she explained. “So, obviously, we live in a conservative state and it becomes illegal.” Around her, Sheila’s colleagues were already starting to refer to Roe in the past tense, as if evoking some distant era in which abortion had been a right.
During a momentary lull in patient traffic, Sheila sank back against a cabinet to rest. “We can fall down now,” she told the others. A staffer in her sixties named Linda, who had been working at the clinic for forty-two years, respectfully disagreed. She remembered the years when picketers would break into the clinic with stink bombs or flood the premises with hoses through the front door’s mail slot—often enough that drain holes had been drilled into the clinic floor. “If you fall down,” Linda said, in a grave voice, “they’ll walk right over you.”
The clinic’s eighty-year-old doctor, Bernard Rosenfeld, had stayed away from the clinic that morning, worrying that even showing up after the decision came down might expose him to state prosecution. But he couldn’t stay away for long, and in the early afternoon arrived to console his staff. Like Linda, he remembered the old days of abortion all too well. He’d attended medical school in the late nineteen-sixties and early seventies, before Roe legalized abortion in 1973. “We were routinely trying to save women from septic abortion and hemorrhage,” he said, of his years at Boston City Hospital. “It was a disaster.” Rosenfeld then took an internship at Los Angeles County–U.S.C. Medical Center, and in 1975 became the primary whistle-blower on a case of forced sterilization inside the hospital. Hundreds of Latina women were asked to sign papers consenting to tubal ligation in the midst of labor. Some women weren’t even aware that they had been sterilized until a civil-rights lawyer who was working with Rosenfeld came knocking on their door.
Rosenfeld eventually joined the faculty at Baylor College of Medicine, in Houston, becoming a specialist in tubal reversal, and, in the early eighties, taking charge of the clinic in the center of town. The day before the Court decision, he, Ivy, and Sheila had sat in the plush leather armchairs where patients usually rest after surgical abortions, debating what would happen after the ruling. All three of them wondered where the law would end. Would it impact fertility treatments? Would I.V.F. still be legal? And what would the implications be for genetic research? Just as worrying to Rosenfeld was the fact that younger generations of doctors were shying away from the practice. For years, he had been unable to find a physician to replace him. “I never thought I would retire so early,” he said, flashing a bitter smile. He’d been feeling the pressure of state regulations to stop performing abortions for some time. When the governor of Texas, Greg Abbott, ordered all such clinics to shut down during the pandemic, Rosenfeld was summoned before the Texas Medical Board and accused of disobeying state orders. He was eventually found innocent, but feared he’d be similarly scrutinized and challenged by state officials post-Roe. “You need to stop immediately, or else they’re coming after you,” he said.
On Friday, after the decision, Ivy and Sheila took a moment away from the patients to grab some duct tape and go outside. They needed to put up a large poster that the doctor’s wife had made the day before. It read “HWC is no longer able to provide abortion care.” Ivy enlisted the clinic’s security guard in the effort. “Juan!” she said. “Los abortos ya no son legales”—abortions are no longer legal. The guard, a thin man of sixty, who has been serving the clinic for fourteen years, was too busy locating a drill to fully process the news that he’d be out of work. All three of them climbed on a bench beneath an existing sign that read “WE ♥ HWC.” As Juan loosened the screws, the sign dropped to the ground, its fasteners tumbling behind it.
Inside, a decision that had been in the air for months was suddenly concrete: after more than forty years, the clinic would be closing. On the phone with one of the medical assistants, a pregnant woman screamed furiously, before dropping the phone, “I guess I’ll just have to take matters into my own hands, won’t I?” The clinic’s counsellors knew of patients who had thrown themselves down a flight of stairs or had seriously contemplated suicide. “We’ll see more babies in the dumpsters,” Lupe, another medical assistant, said. She was most worried about the women who could not travel out of state and Latina patients she had treated throughout the years, some of whom were illiterate. With the staff at the clinic gone, who would pass on information about alternatives now?
Lingering in the parking lot, uncertain, was the Cuban woman who had earlier been given a leaflet that listed options she couldn’t read. As she left the clinic, a picketer named Raúl had tried to lure her into a large bus that could take her to the Houston Coalition for Life, which he referred to as a “medical center,” but she decided to walk past him. “I can’t keep the child. I already have three,” she said, adding that they were aged two, four, and eight. The woman was five weeks into her pregnancy. “Why would they do this?” she said of the Court. The woman said that she couldn’t afford to travel to another state. Even the fund that was meant to pay for her abortion that day had gone dark. But she was convinced that she would find a way. A friend of hers had told her about a Mexican man who could go to her home and perform the procedure. “She told me that, if things didn’t work out at the clinic, I could always call him,” she said hopefully, looking straight at the closed clinic door. ♦