On Friday morning, a voicemail popped up on the patient’s phone: She needed to call the clinic right away.
The Supreme Court had just overturned Roe v. Wade, throwing into chaos an already fragile and limited system of abortion care across the South, and hundreds of women learned that the abortions they were seeking were now illegal. That wasn’t yet the case in Tennessee, but the reprieve was temporary.
The patient connected with a staff member at Choices, an independent clinic in Memphis, around noon. The worker told her that they were canceling some upcoming appointments, and would call her back soon to let her know about the status of hers. Her procedure was scheduled for Monday. By then, there was a chance it would be too late.
Tennessee is one of the handful of states with trigger laws where bans on abortion won’t go into effect immediately; the delay here is expected to last at least 30 days. But there’s another measure that is expected to kick in first. On Friday, Tennessee’s attorney general asked the Sixth Circuit Court of Appeals to allow a state law largely banning abortion around six weeks of pregnancy to take effect, which would halt about 90% of the procedures at Choices. A decision could come as soon as Monday.
The patient, 31, who asked for anonymity to protect her privacy, had five children at home, the youngest not yet 2. She was in her first trimester of pregnancy, but past six weeks.
Daycare already cost her family nearly $900 a month, which she paid with earnings from her job at a big-box store. Infant care was expensive, she remembered telling her partner. She had applied for WIC benefits, but had been turned down.
She remembered giving birth to her youngest during the pandemic, when the hospitals were so crowded that she labored for a day before being admitted into a maternity ward.
“This is not something I want to do,” she said.
She waited at home in panic.
On Thursday, Jennifer Pepper, Choices’ CEO, met with the Illinois State Police about the new clinic Choices is opening in the state, where abortion is expected to remain legal. She was sitting in a coffee shop in Alton, Illinois, Friday morning when she saw the Supreme Court’s decision.
“Oh my God,” she thought. “It’s here. It’s here.”
Her body began to shake.
The clinic’s attorney called, and then called again. Did the clinic need to halt abortions immediately? The attorney advised: Keep going, and try to see as many people as you can.
Pepper drove south toward Memphis. The husband of a board member called her, as she passed a series of billboards with anti-abortion messages. One read, “If babies could vote, abortion would be illegal.”
“You are on the worst stretch of highway right now,” he told her.
Back at Choices, the staff decided to prioritize seeing patients who had already come in for their initial consultation and waited 48 hours, a pause required under Tennessee law. The goal was to offer abortion care to as many people as possible, before the six-week ban took effect.
In a city where the fault lines of poverty and a history of racial segregation have pushed many to the margins, Pepper had little doubt of who would carry the brunt of the fallout.
“Pregnancy is dangerous in this country. That danger just increased exponentially for whole communities of people,” she said, listing Black and brown women, women living in poverty, women who use drugs, single women and transgender people. “Our health care system is fundamentally broken, especially the system that cares for the most vulnerable among us.”
It was almost 3 p.m. Friday when the patient in Memphis heard back from the clinic. The staff had moved up her appointment from Monday to Saturday. She would be able to receive abortion care, likely among the last trickle of patients in Tennessee.
So much of what had to line up for her to get that appointment in post-Roe America was out of her control.
At least 48 hours had passed since she had received the initial consultation that Tennessee requires; patients who hadn’t yet come in for their consultation couldn’t do so over the weekend.
She was early enough in her first trimester that the clinic didn’t require her to receive sedation, which was important because the anesthesiologist was not able to work this Saturday; patients who were further along in their pregnancies had their appointments canceled.
If she had been one of the cancellations, she would have continued her pregnancy.
“I wasn’t going to travel past the Tennessee state lines, because I have to be at work,” she said.
Her children were in summer camp. The stress of figuring out a travel plan, she said, would “overwork” her body.
Friday’s decision felt “like a man ruling down,” she said.
She felt for the others who lost their appointments, and for those who wouldn’t be able to make appointments in the future.
“I hate that for them,” she said. “It’s going to be hard for a lot of women forced to have kids they are not ready for. It’s just going to be hard.”
Joy Evans, a patient educator at Choices, was on the phone Friday morning with a patient who wanted to reschedule a June appointment for early July when her daughter sent a text.
“Did you hear the news?” it read.
Shortly afterward, the staff gathered in the clinic’s call center. Evans stood with her arm wrapped around a co-worker, she later recalled. Some people were crying. Others were angry.
“We knew it was coming, but the reality of it did not set in until we actually heard it and saw it from the directors,” Evans said.
When Evans, 44, returned to her desk, she took a moment to meditate. She didn’t want to become emotional as she spoke to patients.
She called back the patient who wanted to come in on July 1.
She began each call the same way: “This is Joy with Choices.” She asked the woman on the other end to verify her date of birth.
Then she recalled saying gently: “I’m sorry to be able to tell you, but unfortunately, we won’t be able to provide your services.”
“No, why?” the voice on the other end cried.
Evans asked if she had watched the news.
“We didn’t have a timeframe,” Evans recalled telling her. “We were hoping and holding on to July 11th.”
“I cannot have this baby. I already have four,” the patient said.
Before each call, Evans took a moment to steady herself.
She dialed a woman who had previously tried to get an appointment at a clinic in Missouri, but had ultimately scheduled with Choices hoping to be seen earlier. At one point, the caller’s partner got on the phone. “Ma’am, I don’t know what to do. I can’t have no babies,” he pleaded, Evans recalled.
“It broke my heart,” Evans said. “This was a young couple. This was her first pregnancy.”
She gave the caller the number to Hope Clinic for Women, an abortion provider in Granite City, Illinois, nearly 300 miles away.
“As the day went on, it didn’t get easier,” she said.
Eventually, the phone lines became so overloaded that the building’s system crashed. The clinic received over 5,000 calls, as many as they usually receive in a week.
Evans is having trouble sleeping, as are other clinic staff members.
“We try our best not to take work home with us, but things like this — it’s just,” she paused, searching for the right words.
Late Saturday morning, the 31-year-old patient sat upright with a blood pressure monitor wrapped around her right arm and a blanket draped across her waist. Her recliner in the recovery room at Choices was equipped with a button that she could push to heat up the seat, to help with the discomfort.
She was one of 16 women who received abortion care there on Saturday.
A medical assistant took her temperature and watched her vitals, vigilant for rare complications. The patient planned to go home soon to her five children and try to rest.
Choices is usually closed on Sundays, but the staff opened the doors at 8:30 a.m. Twenty-three abortions were scheduled, the final ones the clinic plans to offer to pregnant patients after cardiac activity is detected, at about six weeks.
Among the patients who arrived Sunday morning was a 25-year-old studying law at the University of Memphis. Like most of the patients waiting in the lobby, she was Black. She was an undergraduate when she learned that she was pregnant with her now 5-year-old daughter. She did not feel financially ready to have another child.
“I want to have myself set by the time I’m in my mid-30s,” she said.
Her procedure was initially scheduled for early July, but the clinic moved the appointment up after the Supreme Court decision.
“They shouldn’t take that right away,” she said. “A lot of women are in situations where some might not be financially capable of keeping a child.”
On Monday, rather than the 20 patients the clinic sees on a typical day, just a handful of appointments are scheduled. Three patients are early enough in their pregnancies that the staff believe they could still receive medication abortions even if the six-week ban goes into effect.
It’s also unclear when the clock starts on the 30-day window before Tennessee’s trigger ban can be enforced, Pepper said.
For now, with so much uncertainty, the clinic will schedule only a week in advance.