BOULDER, Colo. — Dr. Warren Hern doesn't have to imagine what could befall many women in America if the Supreme Court strikes down Roe v. Wade.
In 1963, he was a resident working nights at Colorado General Hospital in Denver. Women would arrive in septic shock, some probably hours from death.
"Nobody talked about why they were there," Hern recalled.
He soon discovered they were suffering complications from illegal abortions. In one case, a woman shot herself in the belly and drove to the emergency room.
Hern had found his calling: ensuring access to legal abortions, a mission he believes is worth dying for, as several of his friends have.
With the court expected to deliver a ruling in the next few months that could trigger abortion bans in as many as 26 states, Hern has recommitted himself to his life's work at the center of one of the most contentious debates in American political history.
Abortion rights will most likely survive in Colorado, where he grew up and has worked for more than 50 years, performing about 20,000 abortions. His clinic is already a refuge for women seeking the procedure as other states have restricted access.
Now 83, Hern figures there's a reason he lived to see Roe threatened. He must help more women. In his view, those will be the lucky ones.
"I think we'll see a lot of unsafe abortions and women dying," he said.
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When Hern was a high school sophomore, he read a book that changed his life: the autobiography of Dr. Albert Schweitzer.
Like the Alsatian German Nobel Prize laureate, Hern had broad interests, including music, photography and theology. Schweitzer ultimately dedicated himself to medicine, and Hern decided he would too.
It wasn't until his third year of medical school — and his rotations in obstetrics, gynecology and pediatrics — that the specifics of that vision began to take shape.
Hern loved delivering babies. But he hated having to treat children abused by their parents. It felt wrong that women with unplanned pregnancies had only two legal choices: motherhood or adoption.
During one break from medical school, Hern spent several months in Peru, where he worked at a small jungle hospital founded by a protege of Schweitzer.
Most patients were native Shipibo, whose villages lined tributaries of the Amazon. Hern visited them in a dugout canoe outfitted with a motor.
"I looked at these women who were having eight or 10 babies, and they were begging for fertility control," he said. "They were falling apart from having so many births."
Elders gifted the athletic, blue-eyed American seed necklaces that would become lifelong staples of his wardrobe. A chief named him Caibima, "the traveler who comes from afar but always returns."
After graduating from the University of Colorado School of Medicine in 1965, he served two years in the Peace Corps in Brazil, where he worked in a maternity ward. Then he went to graduate school, eventually earning his master's in public health and doctorate in epidemiology.
In 1970, while Hern was still in graduate school, federal officials hired him to prepare policy statements on sterilization and abortion, which Colorado and then California had recently legalized. Hern found that Black women were dying from illegal abortions at nine times the rate of white women, probably because they had less access to safer procedures.
He testified later that year in U.S. v. Vuitch, the first abortion case to make it to the Supreme Court. The case involved a doctor arrested for performing an abortion in Washington, D.C. The doctor argued that the city's ban was unconstitutional, saying it failed to provide sufficient guidance on its exception for the health of a woman. He lost. But the case galvanized the abortion rights movement.
That year, Hern volunteered at Washington's first private abortion clinic, where he performed his first abortion, under the health exception. The 17-year-old patient told him she hoped to become a doctor too.
"I was terrified, and so was she," Hern wrote in a medical journal. "She cried after the operation for sadness and relief. Her tears and the immensity of the moment brought my tears."
"I felt I had found a new definition of the idea of medicine as an act of compassion and love for one's fellow human beings, an idea that I gained from learning about Albert Schweitzer."
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On Dec. 13, 1971, Hern joined abortion rights advocates in the U.S. Supreme Court gallery for oral arguments in Roe.
He felt history turning as he watched Sarah Weddington, the 26-year-old lead attorney arguing for abortion rights, hold her own against Jay Floyd, a Texas assistant attorney general.
"He made some sort of smart remark about being up against a pretty woman," Hern recalled. "Nobody laughed."
The decision guaranteeing the right to abortion up to the point of fetal viability — now generally considered to be about 24 weeks — didn't come until Jan. 22, 1973. Three months later, a group of Boulder residents persuaded Hern to help start Colorado's first free-standing private abortion clinic.
He still had little experience with the procedure, but figured that "Roe v. Wade had to be implemented, or it doesn't mean anything."
Even in a liberal college town like Boulder, it took Hern a while to find a landlord who would lease him a building and a local hospital willing to grant him admitting privileges.
That first year, demand soared. There were few new clinics, and Hern's was always in the news because of anti-abortion protests.
As the clinic's only doctor, Hern performed 20 to 25 abortions a week, all without major complications, he said.
At the time, most doctors believed abortions couldn't be done after the first trimester without risking women's lives. Hern proved them wrong, pioneering new approaches to make later abortions safer, including dilating cervixes with Japanese seaweed tubes called laminaria.
"I thought and still do that this was better for many reasons," he said. "But it's difficult work, and not everyone can do it."
Hern was passionate about his innovations, but they didn't help him when it came to dating or starting a family.
"You'd get to know someone, and as soon as they found out I did abortions they didn't want anything to do with you," Hern said. "I felt like damaged goods."
That didn't stop him from growing more outspoken about his work. In 1974, he had to be escorted out of a ceremony where he was being honored by the local chapter of the National Organization for Women after abortion opponents rushed the stage, screaming that he was a murderer.
"I began to realize this is a real fanatic movement," he said.
He started sleeping with a rifle by his bed.
The next year, Hern took out the first of many loans to buy his own clinic. Most others had names like Women's Health Care or The Ladies Center. Hern didn't want to hide what he was doing.
He spelled it out across the front of the yellow brick building in large, copper letters: "Boulder Abortion Clinic."
The choice reflected Hern's personality: direct, often to the point of brusqueness, especially when it came to the things he cared about most.
Hern's employees shared his dedication based on their harrowing experiences before Roe.
Lolly Gold went to work with Hern in 1975 as head counselor. She had been a 19-year-old college student in Michigan when she discovered that she was about six weeks pregnant. A friend referred her to a man who demanded her driver's license and $400, which she had to borrow.
"Afterwards he sort of said, 'Do you want to see it?'" recalled Gold. "I just said, 'No.'"
"That is what took me to eventually working in clinics, because I knew people needed emotional support," she said. "So it became a mission."
The work took an emotional toll on Gold, now 74, who left after about five years, feeling she had done her part.
"It was such a journey to get to where abortions were legal at all," she said. "At that point, we thought we were done."
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After Roe, the U.S. abortion rate climbed for about seven years, peaking around 1980, then dropped steadily as more women gained access to birth control.
But Hern's job became increasingly dangerous as attacks on clinics surged. Dozens were bombed or torched in the 1980s. Protesters stalked Hern, tried to run him over outside his clinic and slashed tires in his parking lot.
Hern and his wife, a nurse from another abortion clinic whom he married in 1982, lived in a house he had built with his father in the mountains. But their idyllic isolation began to feel like a liability.
During the week, they would sometimes stay at an apartment behind his office, where they could hear protesters outside praying, shouting slogans and calling for Hern. When a protester threw a stone through the window, Hern posted a sign: "This window was broken by those who hate freedom."
He said the stress contributed to the end of his marriage in 1988. The same week his divorce was finalized, five bullets pierced the clinic's window, barely missing a staff member. Hern offered a $5,000 reward, but no one was ever caught.
"I really thought seriously about saying the hell with it, sell everything and move to Peru with the Shipibo," he said, thinking maybe he would remarry and finally have a family. "But I decided against it."
"I didn't feel responsible for upholding the pro-choice movement," he said. "I was making a commitment of my own, to help women."
Hern installed a security system, put steel doors on the operating room and replaced the front window with four layers of bulletproof glass. Still, he dreamed about people trying to kill him.
"This week, I began wearing a bulletproof vest to work," Hern wrote in The New York Times in 1993. "I am not a policeman setting out to raid crack houses. I am a doctor who does abortions."
In an interview on Christian radio that year, Randall Terry, founder of the national anti-abortion group Operation Rescue, explained why he was praying for Hern's execution: "It is a biblical part of Christianity that we pray for either the conversion or the judgment of the enemies of God."
The same week, Hern's friend Dr. George Tiller, who ran an abortion clinic in Wichita, Kansas, was shot and wounded in both arms by a protester.
The two doctors had skied together. Hern attended Tiller's daughter's wedding. They were both dedicated to their work. But their attitudes toward their opponents diverged.
"George would give people coffee and doughnuts, anti-abortion people," Hern said.
Hern has never tried to hide his disdain for his ideological enemies and often makes them the butts of his jokes, delivered with a straight face. He said he once considered giving protesters hot chocolate laced with laxatives.
After the shooting, Hern was placed under federal guard and escorted to a vigil for the wounded doctor.
"Is it possible in the most pro-choice community in America, for a doctor to walk a few blocks without armed guards to give a speech on the subject of abortion without the serious risk of assassination?" Hern asked the crowd gathered at Boulder City Hall. "The answer to that question is no. My next question is: Is this still America?"
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After 18 weeks of pregnancy, it takes several days to perform an abortion.
Hern starts by giving patients the abortion medication mifepristone. Next he injects digoxin into the fetus, which stops the heart. Then he begins dilating the cervix.
Then they wait.
On day three or four, Hern releases the amniotic fluid and then uses two drugs — misoprostol and oxytocin — to make the uterus contract.
Then he can remove the fetus.
The work has caused some of his employees "serious emotional reactions that produced physiological symptoms, sleep disturbances, effects on interpersonal relationships and moral anguish," Hern reported in a medical journal.
Some said they dreamed that they vomited fetuses.
Hern acknowledged that the work was intense: "I felt a sense of awe, fear and trepidation being at the intersection of life and death, something like I might feel if I were standing on the edge of a cliff with a high risk of falling."
Abortions after 18 weeks are extremely rare. It's precisely because they are so controversial that Hern considers them foundational to democracy. On this he sees no room for compromise. A fetus is never a baby, a pregnant woman is not a mother, abortion at any stage should never be illegal — and anybody who disagrees is simply wrong.
"Every totalitarian regime has shut down access to reproductive health," he said. " ... Doing abortions matters for the woman, for her family, for society and now for freedom."
His outspokenness put him at odds with some in the abortion rights movement, who worried that highlighting the reality of abortions in the second and third trimesters alienated the public and undermined their cause.
In 1995, Sen. Edward M. Kennedy invited Hern to testify before a Senate committee considering a proposed ban on certain late abortions, which opponents refer to as "partial birth."
Hern arrived at the hearing only to discover that leaders of abortion rights groups had barred him from speaking, although his testimony was still submitted. They didn't trust him to defend the technique for later abortions, because he had commented in the press about how it could cause fatal complications.
"The pro-choice people said no, we want somebody who's a respectable doctor, not this guy who's actually doing late abortions," he said. "I was furious."
When President Bill Clinton vetoed the law — which ultimately passed during the George W. Bush administration — Hern wrote another piece in The New York Times: "Hunted by the Right, Forgotten by the Left."
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Hern knew that if he was ever going to have a family, he needed a partner who was equally committed to abortion work.
He was 68 when he married his second wife, a Cuban doctor almost 30 years his junior. They had met at a medical conference in Spain, where she ran an abortion clinic.
His wife, whom Hern insisted not be identified for security reasons, said that when their relationship began, he told her: "We are going to have a life together, the life is beautiful, but I could be killed tomorrow."
She and her 3-year-old son moved to Boulder, and she started working at his clinic as a medical assistant, counselor and Spanish interpreter.
They had been married for three years when Hern received a phone call from Tiller's wife, Jeanne. She was sobbing. They had been at church when an anti-abortion activist shot her husband in the head.
Hern had come to think of Tiller as a brother.
"It was very painful and almost beyond belief to know that he had been assassinated," Hern said.
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As pregnant women arrived at Hern's clinic on a recent Tuesday morning, a dozen protesters lined the sidewalk reciting the rosary while toting signs that read "There are other choices," and, "Life at 18 weeks."
Many had been protesting for years and were now cautiously optimistic that the law would change.
"I'm hoping for the best," said Joe Corrigan, 71, who retired two years ago from running a construction and maintenance company. "You never know with the Supreme Court, how far they're willing to go."
Another protester, 66-year-old Kevin Williams, a retired oilfield worker and born-again Christian, said he opposes violence and believes that anyone can be redeemed, even Hern: "There's always hope, until he breathes his last, that he might repent."
Williams said abortion bans should be absolute, with no exceptions for incest or rape.
"Children that are conceived in assault are gifts," he said.
A car with an Uber sign in the window pulled up, dropping off a patient.
"Can you come talk to us?" Williams shouted at the woman. "We have resources."
Ignoring the protesters, the woman entered the clinic's fenced walkway, passed through two doors of bulletproof glass and placed her ID into a wheel that spun it across the window to the receptionist, who buzzed open another bulletproof door.
Many of the abortions Hern has performed involved fetuses with severe abnormalities. His patients have also included victims of incest and rape, drug addicts, an autistic teenager, a 10-year-old girl and a mother of three living in her car.
Private health insurance rarely covers late abortion, for which Hern charges between $8,500 and $25,000 — compared with $1,500 for first-trimester abortions, which are far simpler. Patients receive assistance from national abortion funds.
Some patients arrive with no money for food, transportation or lodging, so Hern stocks a pantry in his office, keeps a van on standby and sometimes pays for hotel rooms.
"Some patients are desperate because they are trying to escape an abusive relationship and we help them find shelters," he said.
It is not unusual for patients far along in their pregnancies to want to pose for photographs with the fetus. Hern offers them doll-size clothes and blankets sewed by his wife and former patients. Hern takes the pictures.
"It helps them in the grieving process," he said.
Many of the pregnancies were planned, but doctors did not detect abnormalities until the third trimester.
"We had no idea the complicated web of abortion laws in this country," said Erika Christensen, whose fetus was diagnosed with clubfeet and other medical issues that led doctors to conclude it wasn't viable.
She was 31 weeks pregnant and living in New York state, which at the time banned most third-trimester abortions. After her doctor referred her to Hern, she said, "We flew across the country and slipped our IDs under bulletproof glass."
The experience in 2016 turned Christensen into an abortion rights activist. She testified for a law that expanded late abortion in New York, then returned to Colorado two years ago to help defeat a ballot measure that would have banned late abortions. Each year on the anniversary of her abortion, she sends Hern's clinic a gift.
"We feel like we owe an unpayable debt to them," Christensen said. "These are small private clinics operating in a really hostile environment."
During the last decade, states have chipped away at abortion rights, passing laws that made it harder for doctors to do abortions and to keep their clinics open. Six states are down to a single clinic.
For Hern, it's as if Roe has already been overturned in slow motion.
After Texas banned most abortions in September, Hern's clinic saw its caseload surge, with up to 15 women booked weekly, appointments made weeks in advance.
Colorado is one of just six states — plus Washington, D.C. — that place no gestational limits on abortions. Since last summer, Hern's clinic has only accepted patients who are at least 20 weeks pregnant — abortions few other doctors perform.
"This is an abortion intensive care unit," Hern said.
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Hern's mind remains sharp enough to recount intricate details from decades ago, and his body is still strong enough to ski.
He calls retiring "ridiculous."
He's still doing patient intake and reviewing charts, but for the first time in his career he has hired two other doctors to do abortions full time while he plans for a future without Roe.
He said he plans to employ a car service to ferry patients to the clinic to drop them where they can avoid protesters. He also expects to institute more security measures, but he declined to discuss details.
Security costs and debts have become so "crippling," Hern said, that he delayed building a new clinic. For now, he's stuck with the 70-year-old building's plumbing problems, finicky water heater and uneven clay foundation.
Back home on a recent evening, Hern considered the stunning mountain vista framed by the front window of his living room. His wildlife photography covered the walls surrounding his gleaming grand piano.
He doesn't play as much as he used to. His adopted son, a 22-year-old senior at the University of Colorado, had been studying at home for his Medical College Admission Test and needed quiet.
Hern shuffled sheet music, Beethoven and Chopin, before settling on an improvisation: "O Barquinho," Portuguese for "little boat."
"Amor," he said, summoning his wife, who brought him reading glasses and sat down to listen.
The doctor's thoughts drifted. What might his life have become had it not been consumed by America's battle over abortion?
He sobbed.
"I love Brazil," he said, remembering his Peace Corps days. "I left a lot of myself there."
His wife looked concerned. "He sacrificed so much in his personal life," she said.
Hern continued to play, all the while acutely aware that his back faced the window.
As darkness fell, he abruptly stopped and rose to help his wife close the shades.
"That's how they kill doctors," he said.
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