Clinic consultation

Pandemonium, then silence: Inside a Texas abortion clinic after Roe’s fall

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

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

In the few minutes she was in the exam room, the U.S. Supreme Court had overturned Roe v. Wade, paving the way for Texas to completely ban the procedure she had just prepared a patient for.

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

[Abortions in Texas have stopped after Attorney General Ken Paxton said pre-Roe bans could be in effect, clinics say]

Before they could even decide how to proceed, the door to the clinic slammed open and a young woman came running in, screaming about Roe v. Wade and saving babies. They did not 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 eyes staring at them from the chairs in the waiting room.

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

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

A patient returns for an appointment on Friday to make sure her abortion treatment was successful. The clinic is still offering follow-up appointments for people who have recently had an abortion, some of the last patients the clinic might see. Credit: Kaylee Greenlee Beal for The Texas Tribune

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

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

But in a notice published on Fridaytexas attorney general Ken Paxton said abortion providers could be held criminally liable immediately because the state never repealed abortion bans that were on the books before Roe v. Wade was decided in 1973.

Rather than risk criminal charges, clinics in Texas stopped offering abortions on Friday.

Andrea Gallegos, executive director of Alamo Women’s Reproductive Services, said she hopes the clinic’s lawyers can find a way to allow her to briefly resume abortions before the trigger ban takes effect.

Either way, abortion will soon be outlawed in the nation’s second largest state. The clinics will close. Staff will move or find new jobs. And the people they would have served will fade into the shadows, fleeing state lines, seeking illegal abortions, or quietly devoting themselves to decades of raising children they never wanted.

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Carrying the bad news

Alamo Women’s Reproductive Services staff are no strangers to bad news. For years, they have had to deal with ever-tighter restrictions that force them to delay care or turn away patients.

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

Some just got up and left. A woman got upset, angrily demanding that Braid have an abortion anyway. She had driven hours to get 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 him was that it wasn’t because of us, it was because of the Supreme Court.”

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

She arrived at the clinic on Friday morning, shortly after the Supreme Court decision. When the staff told her the news, she was bereft – rocking back and forth, moaning, begging the staff for help.

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

Executive Director Andrea Gallegos talks to some of her employees at Alamo Women’s Reproductive Services in San Antonio after the Supreme Court on Friday overturned Roe v. Wade. Credit: Kaylee Greenlee Beal for The Texas Tribune

Gallegos said it was devastating how easily they could have helped this patient.

“Sometimes it’s just a matter of giving someone a pill, and for surgery [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 fire her.

After clearing the waiting room, staff turned to the pile of two dozen appointments scheduled for the rest of the day. They distributed the files, took a deep breath, and started dialing the number.

They explained, again and again: No, you can’t have an abortion here anymore. No, you cannot reschedule. No, you can’t go to any other clinic in Texas, or even Oklahoma, or many other states. No, it doesn’t matter if you are less than six weeks old. No, not even if you come right away. No, it’s not 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 set up when Texas banned abortions after about six weeks of pregnancy. They spent most of the day listening to busy signals and voicemails from clinics in New Mexico, where abortion will remain legal.

They make this effort because there is not much 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 travel out of state to have abortions.

And even if they can find babysitters, get time off work and safely leave the state, Friday’s decision will only make it harder for low-income Texans to access the resources to pay those trips. Texas Abortion Funds 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 much worse settled in the clinic: silence. Staff sat around the check-in counter, filing papers and tidying up. Someone ordered a pizza.

They listened to televised press conferences, hoping to glean information about their own fate. They talked about where the fight could go from here and some of the biggest battles they’ve had to fight over the years. They talked about what it meant to their daughters, the patients they had treated over the years and those they would probably never have the chance to see.

Many staff members have worked for the clinic for years. Hernandez was there with Braid when this location opened in 2015.

“That’s what I do well. That’s what I want to continue doing,” says Kristina Hernandez. Credit: Kaylee Greenlee Beal for The Texas Tribune

“It’s my baby,” she said. “It’s my life, isn’t it? That’s what I do well. That’s 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 of all the patients she’s been able to help over the years, it’s heartbreaking. Women came to see her at HEB, years after helping her have an abortion, and hugged her before disappearing down the aisles.

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

The clinic plans to keep the doors open and staff employed for as long as possible. They are clinging to the hope that they may be able to get a few more patients in before the trigger ban takes effect.

And they still offer follow-up appointments for patients who have recently had abortions — perhaps the last patients the clinic will ever be able to treat.

A young woman showed up for her follow-up appointment on Friday afternoon, accompanied by her 3-month-old baby. She is a single mother in her early thirties, already raising four children.

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

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

She received the two-drug medical abortion regimen at the clinic earlier this week. It was an easy process, she says, and she was extremely relieved to learn that it was successful.

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

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

This article originally appeared in The Texas Grandstand at

The Texas Grandstand is a nonprofit, nonpartisan media organization that educates — and engages with — Texans about public policy, politics, government, and statewide issues.

Disclosure: HEB financially supported 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 journalism of the Tribune. Find a suit list here.