Dr. William F. Harrison has forgotten how many children the woman had. He remembers she was poor and, most vividly, he remembers her response when a physician diagnosed her distended stomach as pregnancy.
"Oh, God, doctor," the woman said. "I was hoping it was cancer."
This was in 1967. Harrison was a medical student and his wife was expecting their third child. It had never occurred to him that a woman would be anything but happy to learn she was pregnant.
The next year, he trained on a maternity ward. In a 24-hour shift, it was not unusual, he said, for four or five women to come in feverish or hemorrhaging from botched abortions.
Harrison opened an obstetrics and gynecology practice, but after the Supreme Court established abortion as a constitutional right in 1973, he decided to take on an additional specialty. Now 70, Harrison estimates he's terminated at least 20,000 pregnancies.
His clinic has not been picketed for years, but Harrison feels very much on the front lines these days.
Debate over President Bush's nominee for the Supreme Court, Samuel A. Alito Jr., has centered on abortion. Activists on both sides warn -- or pray -- that if Alito is confirmed, the court may one day reverse Roe vs. Wade.
At least a dozen states, and perhaps as many as 30, would probably continue to allow most abortions. But abortion rights activists predict that terminating a pregnancy would become a criminal act across much of the South, the Midwest and the Rocky Mountain region.
In Arkansas, for instance, the state constitution sets out "to protect the life of every unborn child from conception until birth." At least 10 other states -- including Illinois, Louisiana, Pennsylvania and Utah -- have similar language in their constitutions or legal codes.
Harrison warns every patient he sees that abortion may be illegal one day. He wants to stir them to activism, but most women respond mildly.
"I can't imagine the country coming to that," says Kim, 35, in for her second abortion in two years.
A high school senior says the issue won't weigh heavily when she evaluates candidates. "There's other issues I see as more important," she says, "like whether they'll raise taxes."
Patients asked to be identified only by their first names or, in some cases, by their ages to protect their privacy.
Harrison is beyond such concerns. For several years in the 1980s, his clinic was picketed, vandalized and once firebombed. Protesters marched outside his home and death threats became routine. Harrison responded by making his case.
He answered every phone call, replied to every letter in the newspaper and appeared at public forums to defend abortion rights. Eventually, the protesters in this college town left him alone. (Arkansas Right to Life focuses instead on educating women about alternatives to abortion, Executive Director Rose Mimms said.)
In the years since, Harrison has become more outspoken.
He calls himself an "abortionist" and says, "I am destroying life."
But he also feels he's giving life: He calls his patients "born again."
"When you end what the woman considers a disastrous pregnancy, she has literally been given her life back," he says.
Before giving up obstetrics in 1991, Harrison delivered 6,000 babies. Childbirth, he says, should be joyous; a woman should never consider it a punishment or an obligation.
"We try to make sure she doesn't ever feel guilty," he says, "for what she feels she has to do."
It is a few minutes before 11 a.m. when Harrison raps on the door of his operating room and walks in.
His Fayetteville Women's Clinic occupies a once-elegant home dating to the 1940s; the first-floor surgery looks like it was a parlor. Thick blue curtains block the windows and paintings of butterflies and flowers hang on the walls. The radio is tuned to an easy-listening station.
An 18-year-old with braces on her teeth is on the operating table, her head on a plaid pillow, her feet up in stirrups, her arms strapped down at her sides. A pink blanket is draped over her stomach. She's 13 weeks pregnant, at the very end of the first trimester. She hasn't told her parents.
A nurse has already given her a local anesthetic, Valium and a drug to dilate her cervix; Harrison prepares to inject Versed, a sedative, in her intravenous line. The drug will wipe out her memory of everything that happens during the 20 minutes she's in the operating room. It's so effective that patients who return for a follow-up exam often don't recognize Harrison.
The doctor is wearing a black turtleneck, brown slacks and tennis shoes. He snaps his gum as he checks the monitors displaying the patient's pulse rate and oxygen count.
"This is not going to be nearly as hard as you anticipate," he tells her.
She smiles wanly. Keeping up a constant patter -- he asks about her brothers, her future birth control plans, whether she's good at tongue twisters -- Harrison pulls on sterile gloves.
"How're you doing up there?" he asks.
Harrison glances at an ultrasound screen frozen with an image of the fetus taken moments before. Against the fuzzy black-and-white screen, he sees the curve of a head, the bend of an elbow, the ball of a fist.
"You may feel some cramping while we suction everything out," Harrison tells the patient.
A moment later, he says: "You're going to hear a sucking sound."
The abortion takes two minutes. The patient lies still and quiet, her eyes closed, a few tears rolling down her cheeks. The friend who has accompanied her stands at her side, mutely stroking her arm.
When he's done, Harrison performs another ultrasound. The screen this time is blank but for the contours of the uterus. "We've gotten everything out of there," he says.
As the nurse drops the instruments in the sink with a clatter, the teenager looks around, woozy.
"It was a lot easier than I thought it would be," she says. "I thought it would be horrible, but it wasn't. The procedure, that is."
She is not yet sure, she says, how she is doing emotionally. She feels guilty, sad and relieved, all in a jumble.
"There's things wrong with abortion," she says. "But I want to have a good life. And provide a good life for my child." To keep this baby now, she says, when she's single, broke and about to start college, "would be unfair."
Politicians on both sides of the abortion debate often talk up adoption as a better alternative. Harrison's patients do not consider it an option.
A high school volleyball player says she doesn't want to give up her body for nine months. "I realize just from the first three months how it changes everything," she says.
Kim, a single mother of three, says she couldn't bear to give away a child and have to wonder every day if he were loved. Ending the pregnancy seemed easier, she says -- as long as she doesn't let herself think about "what could have been."
By law, Harrison's staff must offer patients two pamphlets from the state. One lists adoption services and groups that provide free diapers, day-care subsidies and other aid. The second contains photos of the fetus at various stages of development.
Patients don't have to accept either pamphlet. Most wave them away, their minds made up.
For the few women who arrive ambivalent or beset by guilt, Harrison's nurse has posted statistics on the exam-room mirror: One out of every four pregnant women in the U.S. chooses abortion. A third of all women in this country will have at least one abortion by the time they're 45.
"You think there's room in hell for all those women?" the nurse will ask.
If the woman remains troubled, the nurse tells her to go home and think it over.
"If they truly feel they're killing a baby, we're not going to do an abortion for them," says the nurse, who asked not to be identified for fear protesters would target her.
The 17-year-old in for a consultation this morning assures the nurse that she does not consider the embryo inside her a baby.
"Not until it's developed," she says. "That would be about three months?"
"It's completely formed about nine weeks," the nurse tells her. "Yours is more like a chicken yolk."
The girl, who is five weeks pregnant, looks relieved. "Then no," she says, "it's not a baby." Her mother sits in the corner wiping her tears.
Harrison draws his own moral line at the end of the second trimester, or 26 weeks since the first day of the woman's last menstrual period. Until that point, he will abort for any reason.
"It's not a baby to me until the mother tells me it's a baby," he says.
But Harrison refuses to end third-trimester pregnancies, even if the fetus is severely disabled. Some premature infants born at that stage, or even a few weeks earlier, can survive. Harrison believes they may be developed enough to feel pain in utero. Just a handful of doctors around the nation will abort a fetus at this stage.
"I just don't think it should be done," says Harrison, who calls the practice infanticide.
Most women seek abortions much earlier in pregnancy; nearly 90% are in their first trimester. As long as Roe vs. Wade stands, states cannot ban abortions that early but legislatures can impose a variety of conditions.
At least 28 states, including Arkansas, require patients to receive counseling before the day of their abortion. Arkansas is also one of 26 states to require underage girls to get parental consent.
Abortion rights activists say such laws burden women unnecessarily, forcing them to miss work, find child care and pay for transportation to make two trips to the clinic, which may be hundreds of miles away. There's one abortion clinic in Mississippi and one in South Dakota. There are two in Missouri and two in Arkansas.
Amanda, a 20-year-old administrative assistant, says it's not the obstacles that surprise her -- it's how normal and unashamed she feels as she prepares to end her first pregnancy.
"It's an everyday occurrence," she says as she waits for her 2:30 p.m. abortion. "It's not like this is a rare thing."
Amanda hasn't told her ex-boyfriend that she's 15 weeks pregnant with his child. She hasn't told her parents, either, though she lives with them.
"I figured it was my responsibility," she says.
She regrets having to pay $750 for the abortion, but Amanda says she does not doubt her decision. "It's not like it's illegal. It's not like I'm doing anything wrong," she says.
"I've been praying a lot and that's been a real source of strength for me. I really believe God has a plan for us all. I have a choice, and that's part of my plan."
Before, after and even during an abortion, Harrison lectures his patients on birth control. He urges them to get on the pill and to insist their partners use condoms.
They promise. But Harrison knows many will be back.
His first patient of the day, Sarah, 23, says it never occurred to her to use birth control, though she has been sexually active for six years. When she became pregnant this fall, Sarah, who works in real estate, was in the midst of planning her wedding. "I don't think my dress would have fit with a baby in there," she says.
The last patient of the day, a 32-year-old college student named Stephanie, has had four abortions in the last 12 years. She keeps forgetting to take her birth control pills. Abortion "is a bummer," she says, "but no big stress."
Harrison does not get frustrated with such patients.
He has learned to focus on the facts he considers most important: This woman does not want to be pregnant. He can give her back control of her life and keep a child from coming into the world unwanted. He believes in this so strongly, he waives his fees for women who can't come up with the money.
Last February, Harrison injured his head in a fall. He underwent three surgeries and spent months in rehabilitation. His wife urged him to retire.
"There's no one to take my place," he told her.
As soon as he felt strong enough, Harrison was back in surgery.
He'll keep at it as long as his stamina holds, or as long as it is legal.
Three abortions before lunch and three more after: The appointment book is always full.
(BEGIN TEXT OF INFOBOX)
Abortion in the U.S.
The U.S. abortion rate has been dropping since 1990, but abortion remains one of the most common surgical procedures for women. A quarter of all pregnancies end in abortion. A third of all American women will have had an abortion by the age of 45, according to the Guttmacher Institute, a research organization that supports abortion rights.
Who has abortions
Under 15: 1%
Abortions by gestational age
(Weeks of gestation at time of abortion)
*--* BTRLess than 9 59.1% BTR9-10 19.0% BTR11-12 10.0% BTR13-15 6.2% BTR16-20 4.3% BTR21-plus 1.4%
The normal gestation period is about 40 weeks
Sources: Centers for Disease Control and Prevention, Guttmacher Institute