Abortion clinic staff grapple with trauma after the end of Roe v. Wade

CHARLESTON, W.Va. (AP) – Danielle Maness has clutched the hands of hundreds of anxious patients lying on tables in the procedure room, which is now empty. She has recorded numerous vital signs and delivered dozens of snacks to the recovery room, which is now quiet.

The chief nurse peered into every darkened room of the only abortion clinic in West Virginia, wondering if she would ever treat patients here for abortion care again.

“It literally makes me sick, and we don’t know what their future holds for them,” Maness said of the residents who depend on the Women’s Health Center of West Virginia. “It’s the kind of heartbreak that’s hard to put into words. There are all these ‘what-ifs’.”

The waiting room should have been filled with patients for two days last week, when the clinic is reserving all seats for abortion appointments. But since the U.S. Supreme Court overturned Roe v. Wade days earlier and ruled that states can ban abortion, the clinic has been forced to suspend the procedures because of a 19th-century state law that prohibits them. The West Virginia ACLU has filed a lawsuit on behalf of the clinic, requesting that the law be declared unenforceable so that staff can resume abortions immediately. Other states are in various stages of legal uncertainty.

Across the country, workers at clinics that have closed abortion services are feeling anxiety and stress as they try to pick up the pieces and chart a path forward. In central West Virginia, the days following the landmark court ruling brought a different kind of grief to staff as their new reality kicked in, said one of the Manesss who will linger long after the decision’s initial trauma.

The conversations with hectic patients on the first day play an inescapable loop in her head.

“I don’t think any of us can block it,” she said. “It’s constantly on our minds.”

Chief Nurse Executive Danielle Maness stands in an empty exam room used to perform abortions at the Women’s Health Center of West Virginia in Charleston, W.Va. on June 29, 2022.

Leah Willingham via Associated Press

Like many clinics that perform abortions, the facility did not offer the procedure on a daily basis. Several days of the week are devoted to routine gynecological care — cervical exams, cancer exams — mostly for low-income patients on Medicaid with nowhere else to go. The determination to continue that work has captivated the employees.

Immediately after the decision was published, Maness was one of the few staff members tasked with calling patients to cancel abortion appointments. On the other end of the line, she’d never heard people speak with such fear.

The entire staff was in crisis mode for days, though they and others across the country had been anticipating the verdict for months. “You think you think you’re prepared for the moment, but you’re never really prepared until it’s a reality,” said Executive Director Katie Quiñonez.

Katie Quiñonez, executive director of the Women's Health Center of West Virginia, sits in her office at the clinic in Charleston, W.Va, on June 29, 2022.
Katie Quiñonez, executive director of the Women’s Health Center of West Virginia, sits in her office at the clinic in Charleston, W.Va, on June 29, 2022.

Leah Willingham via Associated Press

She saw her staff collapse and sob. Some called patients or answered the phone. Workers on a day off showed up, some still in pajamas, to relieve colleagues and offer support. Quiñonez encouraged everyone to take breaks, often managing the phones herself.

She will forever remember that Friday as one of the worst days of her life. On weekends, she turned off her phone, lay on her couch under a weighted blanket, ate junk food, and watched television. It was the only way she could escape and cope.

When she and her staff went back to work, she stopped filling the vacancies of canceled abortion appointments. Some patients needed other services, but she wanted the workers to catch their breath. She said they should come later if needed. The clinic rooms remained mostly empty, dark and quiet.

But still the phones rang.

Beth Fiddler sat at her desk behind the glass reception window of the clinic in the waiting room. She had no patients to check in, no Medicaid data to scan on charts, no informational packets to hand out.

Instead, she found herself answering the same questions over and over and directing callers to a hotline or website to help them locate the nearest out-of-state abortion provider.

“You’re going to close soon, aren’t you?” No, the clinic is open for other services.

“Can I get Plan B – the ‘morning after’ pill? What about an IUD, or other birth control?” I will help you make an appointment.

‘Are you sure I can’t make an abortion appointment? Is there no loophole, an exception?” There are no abortion services in this clinic.

Some callers were in denial. Some remained stoic, others wept. A few reacted with hostility, claiming Fiddler was wrong. She tried to be polite and empathetic, but the conversations take their toll.

“It frustrates me,” she said. “I’m already stressed and upset. I understand I want to find a way, but there isn’t one.”

Beth Fiddler, a receptionist and telephone consultant at the Women's Health Center of West Virginia, staples paperwork in her office outside the clinic's empty waiting room on June 29, 2022 in Charleston, W.Va.
Beth Fiddler, a receptionist and telephone consultant at the Women’s Health Center of West Virginia, staples paperwork in her office outside the clinic’s empty waiting room on June 29, 2022 in Charleston, W.Va.

Leah Willingham via Associated Press

As one of the first worker patients sees, Fiddler prides itself on making people feel welcome and safe. Having to turn them away and simply point them to a website is daunting, she said.

“As helpless as I feel about it, I can’t imagine how they must feel,” she said.

It is also quiet outside the clinic. There is no buzz of patients arriving at the parking lot to be escorted by volunteers in pink vests. The only cars are staff and a guard. Across the street, a piece of land belonging to an anti-abortion organization stands empty, except for a large white cross.

An ordinary protester, a preacher with a ‘Jesus Loves You’ sign, prayed outside a few early mornings, but the usual crowd begging patients to reconsider is gone. Some cars slow down as they pass. Workers recognize some as protesters’ vehicles, and they imagine the clinic being watched — to make sure patients don’t arrive for abortions.

Director Quiñonez said she knows the next steps will be challenging, with a long road ahead for workers to recover from pain.

“Our employees need space and time to process this very traumatic loss,” she said. “And all the secondary trauma that we experience from all the patients.”

A sign for the Women's Health Center of West Virginia will be displayed in the clinic's empty waiting room on Wednesday, June 29, 2022 in Charleston, W.Va.
A sign for the Women’s Health Center of West Virginia will be displayed in the clinic’s empty waiting room on Wednesday, June 29, 2022 in Charleston, W.Va.

Leah Willingham via Associated Press

Just being on the job is hard, but the staff are committed to helping patients.

“We came in on Monday and I was like, ‘Okay, what do I do now?'” said Kaylen Barker, who handles the clinic’s public messaging. “It’s bleak to come back here and realize that we won’t be able to provide the life-saving care people need and that we’ll have to direct them to websites. That’s the best we can do right now.”

Barker came to the clinic as a patient 12 years ago during a breast cancer scare. She received care when she had no other options. She knew she wanted to work in this place that helped save her, so she applied until she was finally hired. Knowing she can help others like her keeps her going whether abortions are scheduled or not: “People deserve healthcare in a welcoming space, without bias or judgment.”

That’s why Quiñonez and her employees focus on keeping the clinic open. Abortion services account for 40% of clinics’ revenues, leaving a gap that could lead to layoffs, but Quiñonez is determined to avoid that.

She encourages residents to transfer their gynecological care to the clinic and plans to offer new services. The clinic recently added gender-affirming hormone therapy services along with HIV prevention and treatment. She hopes more programs will follow.

And donations are pouring into the clinic’s abortion fund. Before this year, the fund’s balance never exceeded $50,000. In a weekend after the verdict, they raised $75,000. The staff will use the money to send people out of the state for abortions.

“Yes, we are tired, we are devastated, we are angry,” said Quiñonez. “But this is far from over. I want to reassure people that, as hopeless and dark as it feels right now, this is not the end.”

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