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HOUSTON — Kathy Kleinfeld’s cellphone lit up for the first time on Monday at 3 a.m. By 7 a.m., she had 13 missed calls. When she couldn’t be reached by phone, she said, patients emailed, desperate to schedule their abortion with Houston Women’s Reproductive Services before Wednesday, Sept. 1, when Texas is on track to ban abortions after six weeks gestation, before most people know they’re pregnant.

Calls soared once Kleinfeld got to work. The ringing of the office phones reverberated as Kleinfeld, the clinic director, and three other staff members juggled up to seven calls at once, jumping up every few minutes to buzz in a patient at the door. While S.B. 8 could still be stopped before Wednesday, clinic staff counseled patients as if the law was a certainty.

First, they asked for the date of the patient’s last period. If they were further than six weeks along, they clinic staff said, they’d have to leave the state. They were fully booked before Sept. 1.

Clinic educator Marjorie Eisen returns calls. (May-Ying Lam for The Washington Post)
Clinic educator Marjorie Eisen returns calls. (May-Ying Lam for The Washington Post)

When Texas Gov. Greg Abbott (R) signed S.B. 8 into law in early June, many abortion rights advocates assumed it would be overruled before it ever took effect. Similar six-week bans, passed in 11 other states since 2013, have all been blocked in court. But unlike all the other bans, this one could be enforced by almost anyone. Any individual in the country could sue any person or organization that helps a Texan access abortion after the six-week limit. That would make it very difficult for abortion rights organizations to figure out who to sue, said John Seago, legislative director for Texas Right to Life, the antiabortion organization that helped draft the law.

Abortion rights advocates, including Planned Parenthood and the Center for Reproductive Rights, filed an unconventional lawsuit to challenge the law in July. A district court judge was supposed to hear arguments at a hearing on Monday, after which he could have issued a preliminary injunction to stop the law. But the 5th Circuit Court canceled that hearing, a move Seago called a “phenomenal victory” for antiabortion advocates.

Now abortion rights advocates are asking the U.S. Supreme Court to step in.

Abortion providers like those at Houston Women’s Reproductive Services are preparing for the law to take effect this week, working overtime to squeeze in as many appointments as possible before the deadline. Wary of lawsuits from antiabortion advocates, newly empowered to sue them, many clinics have been extremely intentional in their messaging to patients: Come Wednesday, they will fully comply with S.B. 8. While providers and patients hope that something might change before then, they’re not counting on it.

The exterior of the building that Houston Women’s Reproductive Services is in. (May-Ying Lam for The Washington Post)
The exterior of the building that Houston Women’s Reproductive Services is in. (May-Ying Lam for The Washington Post)

At 9:28 a.m., Kleinfeld announced it was time to “set the phones.” For the rest of the day, the calls would go to voice mail; Kleinfeld and others would return them when they could. By lunchtime on Monday, Houston Women’s Reproductive Services had received over 400 calls. On a typical Monday morning, Kleinfeld said, they might get 100.

The clinic’s Monday and Tuesday appointments had filled up the previous Wednesday. At this point, all they could do was refer callers to a clinic in Tulsa, where pre-visit consultations can be done over the phone.

It’s a seven-and-a-half-hour drive from Houston.

After the law passed, Marjorie Eisen spent several weeks “in denial,” she said. A patient advocate at Houston Women’s Reproductive Services, Eisen has been working in abortion care for 30 years. Over the years, she’s had to inform patients seeking abortion care of various waiting periods and timing restrictions instituted by the Texas state legislature. During the coronavirus pandemic, she had to explain that services had been temporarily suspended when abortion was left off a list of “medically necessary” procedures in Texas.

These phone calls have been the hardest, Eisen said.

Kleinfeld has also been doing this work since the 1980s. When she opened Houston Women’s Reproductive Services in 2019, her goal was to provide an abortion experience that didn’t feel cold and clinical. She keeps a vase of lilies in the waiting room and a eucalyptus-scented diffuser in the bathroom. Sometimes clients tell her that the clinic feels more like a spa, she said.

With purple and blue bangs and chunky silver earrings, Kleinfeld greets every patient with a warm smile, quick to strike up a conversation about the band on their T-shirt.

In between difficult calls, she chooses a new song from a Spotify playlist called “Peaceful Piano.”

On Monday, Aug. 23, Kleinfeld decided that her staff would start telling patients about S.B. 8. When patients called to make their appointments, staff members urged them to come in as soon as possible. By the end of the week, they’d filled most of their remaining slots. Staff members started pointing patients to clinics out of state, just in case.

“Here’s the difficult news I have for you,” said Eisen, when she answered the phone on Monday. The woman was over the six-week limit, Eisen said.

“Have you tried the other clinics in Houston?”

The woman went quiet.

Eisen apologized that she couldn’t do more to help and wished her luck.

“She sounded young,” Eisen said as she hung up the phone.

Clinic administrator Kathy Kleinfeld. (May-Ying Lam for The Washington Post)
Clinic administrator Kathy Kleinfeld. (May-Ying Lam for The Washington Post)

Last week, callers asked more questions about the bill, said Jeana Nam, a student who works part-time at the clinic. They hadn’t heard about it — or they weren’t quite sure when it was due to take effect. Now, Nam says, they seem to know what she is going to tell them. They know there are no more appointments, because they’ve already called every clinic in Houston.

Hope Hanzlik, a 21-year-old in the Army, arrived at the clinic around 11 a.m. on Monday. She called to schedule her abortion on Aug. 23, knowing that S.B. 8 could take effect soon. To take the day off for a medical procedure, she said, she had to get approval from her commanding officers. Then she drove three hours to the clinic with a friend.

“It was a race against time for me,” she said.

Hanzlik felt “relieved” once she finally arrived for her appointment, she said. “I’m not ready to have a child.”

The older women working at the clinic say they’re not particularly surprised by S.B. 8 — or the 5th Circuit’s decision to upend Monday’s preliminary hearing. After years of working on abortion issues in the state, they have learned to expect the worst, Kleinfeld said.

“We’re no longer shocked by anything. You can’t be,” Kleinfeld said. “Because it happens again and again.”

Texas has been a testing ground for antiabortion laws largely because of the 5th Circuit, said Seago, the legislative director with Texas Right to Life.

“Texas is about to be more bold because we know the 5th Circuit will actually take its role as the judiciary seriously,” Seago said. “That is what we don’t see in abortion cases all over the country.”

When Kitty Kahn counsels women like Hanzlik, in the face of legislation like S.B. 8, she sometimes remembers what things were like before Roe v. Wade. In 1971, she volunteered at a Planned Parenthood clinic based out of a three-bedroom house in Austin. The bedrooms were examination rooms, she said. The kitchen was the lab.

“We had nothing to offer women,” said Kahn, a part-time patient advocate and educator at Houston Women’s Reproductive Services. “We had condoms and diaphragms.”

Kitty Kahn returns calls. (May-Ying Lam for The Washington Post)
Kitty Kahn returns calls. (May-Ying Lam for The Washington Post)

A few years later, she said, she organized travel to New York and Los Angeles, where abortion was legal.

It’s not hard for Kahn to imagine the United States returning to a pre-Roe world, she said.

When she sees what’s happening today, she says, “I feel like I’m on a conveyor belt going backward.”

Just before Kleinfeld stops taking calls Monday morning, she receives good news. Someone has canceled. She spins around in her rolling chair to face Nam and the other staff members answering phones.

“We have an opening tomorrow at 3:30.”

They’ve turned away dozens of women at this point: How will they choose who gets the spot?

The next caller will be the “lucky person,” Kleinfeld tells them.

They look at their phones, and wait.

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