FAYETTEVILLE, Ark. — 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.