78 Patients and 10 Hours Inside an Abortion Clinic in the South
“There’s a zombie-apocalypse mind-set in this building: We are going to survive.”
On a disgustingly hot Thursday in June, car after car pulled into the parking lot of A Preferred Women’s Health Center in Charlotte, North Carolina, and left their engines running to cool off the abortion seekers sitting inside. They could be waiting well over two hours before getting a notification on their phones that it’s their turn to enter the clinic. Two years after Dobbs, APWHC is one of vanishingly few places in the South where someone can get an abortion.
Thousands of patients now travel to North Carolina for care despite considerable barriers: After Republicans rammed through an abortion ban last summer, patients can only terminate their pregnancies until 12 weeks of gestation. They also are forced to make two in-person clinic visits with a 72-hour waiting period in between, the first to receive state-mandated counseling and the second to get their abortion. This means North Carolinians and abortion seekers from out of state compete for limited appointment slots while providers do their best to keep up with the demand and the extra paperwork.
APWHC now operates at about 40 percent higher capacity than it did before Roe v. Wade was overturned. When I visited, some of the cars outside had South Carolina and Georgia plates, hinting at how far some patients had traveled. Inside the crowded waiting room, a handful of abortion seekers wore pajamas as they settled into their chairs, some of them accompanied by their partners or friends. Soon after the clinic opened for the day, the Supreme Court released its decision in the mifepristone case that preserves access to abortion pills for now — but there was no cheering or celebration. Workers were too busy to notice the news as they scrambled to take care of dozens of patients while down a few members of their staff. Still, their attitude was one of cheerful determination: They’d make it work. They always do.
8:30 a.m.: The Clinic Escort
Staff and six escorts with Charlotte for Choice are on-site preparing for the day well before the clinic opens at 9 a.m. A bus affiliated with a local crisis pregnancy center parks across the street, but the escorts largely ignore the protesters’ taunts and focus on the patients arriving. One volunteer who joined the team a year and a half ago talks me through his morning.
During the week, there’s anywhere from three to six protesters, and they are a lot more aggressive as far as walking up to cars and trying to stop patients. On Saturdays, there’s a lot more people. They’re less aggressive, but it’s more intimidating when you have a swarm of a hundred people outside your doctor’s appointment and you’re wondering what the heck is going on.
We try to be as quiet as possible and guide people into the parking lot so that they don’t get stopped by protesters. One of our escorts will come up to the car and get the patient checked in. We let them know we have restrooms, snacks, and water for them, and that they’ll get a message when they’re ready to come in. We also offer to walk them in. They wave one of us down and we come with an umbrella and escort them into the building. We’re here until about 12:30 p.m., 1 p.m. every day. The last patient of the day comes in around then.
We’re getting calls from South Carolina, Georgia, Alabama, Tennessee, Texas, Louisiana, Florida.
The protesters leave around then as well. Sometimes they have an afternoon shift, but they’re much less effective because there’s less traffic coming in and out. Most of these protesters are so-called Christians, and being a gay man out here, I get people using profanities, calling me a pedophile, all sorts of horrible things. As far as the patients, I absolutely love working with them. Some patients have driven seven to 12 hours to get here, and you can tell they’re exhausted. They’re emotionally spent, and then you have people protesting, getting in your business, trying to intimidate you. The political climate is outrageous, so this is my way of helping.
9 a.m.: The Front-Desk Staffer
The clinic has scheduled 100 patients for the day. Of those, 37 are “day one” patients who will receive in-person counseling required by the state. Of the remaining “day two” patients, 38 are scheduled for a medication abortion and 25 for a surgical abortion. The rush of patients starts slowly, and then all at once. The front-desk staff tells them their appointments can last between three and five hours. “Day one” patients go to a secondary waiting room in the back, where they are called for labwork and to receive the state-mandated counseling in groups; the others stay in the front until it is time for their abortion. A patient-care advocate comes to reception to check how many abortions were planned. When she hears the number of procedures scheduled, she says, “Well, I’ll be darned.” At the front desk, one staffer takes care of paperwork while another checks in patients.
Patients scan a QR code to join the wait list. When it is their time to come up to the window, I take their ID. If there’s a payment, I collect it. If there’s a pledge, like any financial assistance, I’ll apply it. If they are “day one,” they’ll finish filling out any remaining paperwork and I’ll let them in the rooms back in here. If they are “day two,” they have a seat in the waiting room until it’s their turn. What takes the most amount of time is that there’s about 100 people on the schedule and it’s one person in each front-desk station. While it’s not that difficult and the process is fairly simple, there’s so many people to see at once.
10:30 a.m.: The Doctor
It’s common for abortion clinics to fly in providers due to the safety concerns and stigma around providing this care. The doctor landed in Charlotte earlier in the morning and arrived at the clinic shortly after 10 a.m. When I meet her, I ask whether she had seen the Court’s mifepristone decision. She has not and immediately lights up. “Oh my God! We’re not checking our emails right now,” she says happily, before opening her arms up. “Do you mind if I give you a hug?”
You’re catching us on a very short-staffed day where the staff are dancing with me. All of the patients that I’m seeing now have already had their “day one” visit. They’re here for their abortion. I have to make sure — this is a pain in the ass — that the documents staff have given me have my name. If you miss a signature, you’ve broken the law. I’m reviewing the ultrasound — making sure it’s adequate, which it is — and signing off on the plan for today. The medication-abortion patients are in the room and they’re ready to go. They already have their class, so I come in and answer questions.
The doctor realizes one of the patients’ ultrasounds did not clearly show the uterus. She asks the staff to redo the imaging so she can review it and then attach it to the patient’s file.
There’s the bladder and there’s the uterus. I’m sure the patient’s grateful, too — she doesn’t have to drop her place in line. This next patient has a C-section. I’m going to slow down when I look at her ultrasound and look even more closely, because once in a while the pregnancy is attached to the C-section scar. Last week, I saw a patient in another state who was 15 weeks along and had previous C-sections. I was not convinced that it was safe to continue. We sent her for a formal ultrasound. Her placenta was so deep into the scar and into the uterus that they’re taking her to do an abortion by hysterectomy, because they’re afraid she would die if they do anything else. Can you imagine? In my career I’ve never seen that before. It’s rare, but we see a lot of patients and a lot of them have had C-sections. You need to look closely every time.
The doctor collects the files and goes to see five patients who just finished a video class explaining what to expect during their medication abortion. When the doctor asks whether the women had any follow-up questions, everyone says no. She gives them their instructions and a small cup with mifepristone; a small envelope with misoprostol to take at home; a copy of their consent form; and a yearlong courtesy prescription for birth control. Before the patients leave, the doctor asks them to please vote in November and in future elections. She then walks to the procedure room, where a patient is waiting for her surgical abortion. It’s a straightforward and safe procedure: The abortion takes three minutes from start to finish. The patient thanks the doctor, who gently touches her shoulder.
11:30 a.m.: The Patient-Services Director
The clinic’s call center employs 20 people who work the phones from 7 a.m. to 9 p.m. scheduling appointments. According to the patient-services director who oversees the team, the clinic used to receive about 400 calls a day. Now there are days where they field up to 800 calls.
The hardest part is when young girls come through. They’ll come with their mom or dad. The youngest patient I’ve seen was 12 years old.
We’re getting calls from South Carolina, Georgia, Alabama, Tennessee, Texas, Louisiana, Florida. Once we get to a certain number of appointments, the staff will come to me and they’ll be like, “I have this girl and this situation. She’s going to be this amount of weeks and it’ll be down to the very last day.” I’ll make an exception. Then I have another one and I’ll have to make another exception.
I’m put in this position to make a call. Do we refer this patient out when I know it’s already difficult for her to get a bus? Deep down, I know this girl isn’t going to be able to do this. It’s difficult to tell women, “I’m sorry, we can’t help you.” But I also have to think about the staff, because burnout is real. I have to make sure that they’re okay. We also have an after-hours line. One of us is available 24/7, so patients can call that number. It comes through a page on our phone and we call patients back. It’s supposed to be for emergencies, but they just need reassurance most of the time.
12:30 p.m.: The Clinic Director
Around noon, the clinic is buzzing: There’s not a single empty seat in the waiting room and staff rush around as they shepherd patients from one step to the next. The executive director is in her office, snacking on gummy bears as she tries to catch up with emails and her ever-growing to-do list.
My morning has been running around and problem-solving. I’m usually not physically on-site this early, but I came this morning at 7:30 a.m. because I’d gotten some complaints from the Charlotte-Mecklenburg Police Department about protesters and volunteers. I spray-painted a section of the driveway, and everyone can look at it and tell it’s part of an active driveway, but apparently, that’s up for debate. Then, I was problem-solving with funding. We were a lucky recipient of a grant to fund patients coming to North Carolina from banned states. That grant is ending soon. I then was on my weekly therapy call. One of the things that I’ve constantly had to talk about is that I’m in a no-win situation. If I choose to prioritize myself, there’s a potential that patients will not get seen. If I prioritize the clinics, I don’t see my kids and obviously put myself through the wringer.
There’s a zombie-apocalypse mind-set in this building: We are going to survive. I know that other clinics have a much larger staff, but a small staff is how we have managed to keep prices down and maintain a more streamlined model. It can get rough. Something that has been a constant thorn in our side is how we make sure that staff is actually taking a break. It sounds stupid to say, but we didn’t have to have set breaks because it was really flexible. We could all be like, “I don’t have charts. I’m going to take 15.” There’s no natural break anymore. Having the two-visit, in-person requirement means we see just as many appointments but fewer patients.
2:30 p.m.: The General Manager
In the afternoon, things quiet down. Everyone who was scheduled for a medication abortion has been cared for. The front-desk staff double-checks paperwork and the appointment schedule for the next day. A few people approach the window to ask how much longer their partners’ appointments will take. The staff politely respond that they cannot share any private patient information. The clinic’s general manager walks around the building to check that staff have everything they need.
It is essential for me to help out as needed if it can relieve someone long enough to come into the break room and get a snack. That’s my role. Most days I’m not needed on that level, but I intervene when necessary. When I first started, patients could come in at their leisure. I’ve witnessed the laws restricting abortion tighten over the years. Dobbs sent us in a frenzy because we had been doing our patients a courtesy of calling and making it convenient for them to complete that counseling over the phone. Now the law has forced patients to come in person. We deal with a lot of disgruntled patients in regards to that inconvenience alone, but most ladies in this situation need a resolution. They’re willing to do whatever it takes.
The hardest part is accommodating the patients that are traveling sometimes by bus, by plane. They had to bring enough to suffice here in North Carolina until they got home. We sometimes deal with big bags, which we can’t take for granted that they’re not threatening. Some days there’s the verbal battery from patients. I’ve come to understand that they’re not mad at us, they’re mad at the situation that they’re in. They’re not only disgruntled about having to travel to our city, but about the challenges that they face outside trying to come into the clinic. But we help these ladies. The days that we get that hug when they leave or that “thank you,” that’s what keeps me going.
3:30 p.m.: The Patient-Care Advocate
Patient-care advocates help people navigate their appointment, but they also do labwork, ultrasounds, and paperwork, and they observe patients in the recovery area after surgical abortions. One of the advocates is cleaning the ultrasound room so it can be ready for the next day.
People would rather die than go home pregnant, they say that to me all the time, but I still can’t do it. That is the worst part of the job.
I began today at the lab pricking fingers. We need to do bloodwork to know patients’ blood type and iron levels. We also take their vitals. Today, there were between 30 to 35 patients who came through the lab. Then the team needed me in the ultrasound room, so I worked there for a while. Patients frequently will come in thinking they are eight weeks pregnant, when in reality they are further along. It is difficult for them to get here before 12 weeks; some can’t afford it. If they get an ultrasound and are past 12 weeks, we can’t treat them, and they become desperate. Some cry. But we put ourselves in their shoes. All we want to do is to show them compassion and empathy, to hug and comfort them.
4:15 p.m.: The Front-Desk Staff
At this point of the day, there are still seven patients scheduled for a surgical abortion. The waiting room in the front is empty. The second front-desk staffer pauses preparing files for tomorrow’s patients and grabs supplies to clean the room. She has been working in the clinic for almost three months.
There are just so many patients. We’ve had patients who do not speak English or who do not know how to read; they need to understand what forms they are signing, so they need to have someone with them to help them. Sometimes patients have a bad attitude — they get upset because of the long wait times or because they were late to their appointments. But the hardest part is when young girls come through. They’ll come with their mom or dad. The youngest patient I’ve seen was 12 years old.
5:30 p.m.: The Doctor
The doctor finishes the last abortion of a challenging shift. Out of the 100 patients who were scheduled that day, only 78 showed up. But since the clinic didn’t have enough nurses and patient-care advocates on duty, more patients chose to have a surgical abortion than usual, and the doctor spent extra time with three patients.
One patient was ambivalent. She said things that are red flags, like, “I feel so guilty.” I was like, “Wait a minute, slow down, let’s talk.” She ended up not doing her abortion today. The second was a patient coming for her follow-up. She didn’t need treatment, but didn’t like her symptoms. The third was somebody who spoke English well, but it was not her native language. I went start to finish through the whole process with her again; that takes time, but she left with a hundred percent clarity. It’s the right thing to do.
The hardest is when a patient has come from far away and there is a medical reason why I cannot do an abortion. The most common situation is people coming from Alabama or Georgia, they don’t have insurance, and they have a history of C-section where their pregnancy might be attached to their scar. They need a high-level ultrasound to be read by a specialist to make sure it’s safe to do an abortion. If it’s not, then we figure out what they are going to do. I’m sending them off into the ether, trying to make arrangements elsewhere for them; they are beside themselves crying, begging. People would rather die than go home pregnant, they say that to me all the time, but I still can’t do it. That is the worst part of the job.
But I love abortion care because in the space of a few minutes, you can give people another chance at life. The most common emotion people express is relief and gratitude. Yes, they are often sad, but you can be sad and be sure you’re doing the right thing. You’re giving people another chance to come out of poverty, to go to nursing school, to take care of a child with a developmental disability, which was the case with one of the patients today. She would’ve loved to carry on the pregnancy, but she was overwhelmed with this high-needs child. You have to listen to the story and be there for them.
6:15 p.m.
The remaining staff trickles out to a mostly empty parking lot. There is no sound except for the birds singing in the trees that surround the clinic. The doctor’s ride drives her away; a nurse and patient-care advocate walk to their cars; the front-desk staffer calls an Uber. The clinic director is the last to leave, rushing out of her office around 6:30 p.m. to make it home for her kids’ bedtime. Tomorrow, they will do it all again.
The Cut offers an online tool you can use to search by Zip Code for professional providers, including clinics, hospitals, and independent OB/GYNs, as well as for abortion funds, transportation options, and information for remote resources like receiving the abortion pill by mail. For legal guidance, contact Repro Legal Helpline at 844-868-2812 or the Abortion Defense Network.