He wrote a textbook, "Abortion Practice," in the 1980s. After the first printing, he said, the publisher bowed to public pressure and declined to reissue the book. Hern then paid to have it published himself.
In time, he began to focus on more difficult abortions performed in the later weeks of pregnancy -- typically, he said, because of medical complications or fetuses with abnormalities. Such abortions now make up the bulk of his practice.
Each of his patients, Hern said, receives counseling to explain the procedure and to make sure she wants it. Women seeking later abortions usually have already made the decision with their own doctors, he said.
Hern recalled a disturbing situation his staff encountered 15 years ago during the counseling phase. The parents of a 14-year-old girl wanted her to terminate her pregnancy. The girl did not. As she was filling out a form, she wrote, "I think you should all be killed."
The clinic manager called in Hern and, after more discussion, the doctor refused to perform the abortion. He has no idea what the family decided to do.
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Even early on in his practice, Hern did not shy away from confrontation. When people protested outside his office, he stood in the parking lot and wrote down their license plates. When they shouted during his speeches, he shouted louder. When a protester hurled a rock through a clinic window, Hern hung up a sign: "This window was broken by those who hate freedom."
But his fear grew along with his defiance. When people called his mountain home with death threats, he started keeping a rifle by the bed. "You think, 'Is it OK to go for a hike? What about walking my son to school? What about going skiing?' " he said.
In 1988, a gunman fired five shots into his clinic's waiting room, prompting Hern to install four layers of bulletproof glass and an electronic security system. That year, Hern and his wife of six years divorced, a breakup Hern attributed in part to the stress of his work.
The ever-present threats made it hard to develop relationships, Hern testified at a 1999 trial in which he and other doctors sued an antiabortion group for placing their names and personal information on a "Deadly Dozen" list. "It has made me feel a great sense of personal isolation, and that has been the most painful part of this experience," Hern said, according to the Associated Press.
He and the other doctors won a verdict of about $108 million, although an appeals court later reduced that to $16 million.
Enyart has no sympathy. "The perpetrators of widespread injustice like slave traders and Nazis expect to go home and live in tranquillity. That's an absurd expectation."
These days, Hern's clinic -- a drab, yellow-brick building across the street from a hospital -- is not the epicenter of protest as it was in the '80s and '90s. But opponents regularly show up, and Enyart said his group pickets outside Hern's home on holidays every year.
This week, after the news of Tiller's death, the streets outside the clinic were quiet. But inside, one staff member described her tension: "Tight jaw, low-level anxiety."
But the doctor said he had no choice but to show up for work. "We're pretty busy taking care of people who said they couldn't find anyone else to do it."
A staff member knocked at the door, and Hern stood to go. He had patients waiting.
