CHARLESTON, W.Va. (AP) — Danielle Maness has squeezed the hands of hundreds of anxious patients lying on tables in the procedure room, now empty. She’s recorded countless vital signs and delivered scores of snacks to the recovery area, now silent.

Peering into each darkened room at West Virginia ‘s only abortion clinic, the chief nurse wondered whether she’d ever treat patients here for abortion care again.

“It literally just sickens me, and we don’t know what their futures hold for them,” Maness said of the residents who rely on the Women’s Health Center of West Virginia. “It’s the kind of heartbreak that’s difficult to put into words. There are all these ‘what- ifs.’”

The waiting room should have been filling up with patients on two days last week, when the clinic reserves all slots for abortion appointments. But since the U.S. Supreme Court overturned Roe v. Wade days earlier and ruled that states can ban abortion, the clinic was forced to suspend the procedures because of an 1800s-era state law banning them. The ACLU of West Virginia filed a lawsuit on behalf of the clinic, asking that the law be declared unenforceable so staff can immediately resume abortions. Other states are in various stages of legal limbo.

Nationwide, workers at clinics that shuttered abortion services are feeling fear and stress as they try to pick up the pieces and chart a path forward. At the West Virginia center, the days following the historic court ruling brought on a different kind of grief for staff as their new reality set in, one Maness said will linger long after the initial trauma of the decision.

The conversations with frantic patients that first day play on an inescapable loop in her head.

“I don’t think any of us can block it out,” she said. “It’s constantly on our minds.”

Like many clinics that perform abortions, the facility did not offer the procedure daily. Several days of the week are dedicated to routine gynecological care — cervical exams, cancer screenings — mostly for low-income patients on Medicaid with nowhere else to go. The resolve to continue that work has buoyed employees.

Immediately after the decision’s release, Maness was one of a few staff members tasked with calling patients to cancel abortion appointments. On the other end of the line, she’d never before heard people speak with such fear.

The entire staff found themselves in crisis mode for days, though they and others across the country expected the ruling for months. “You think you think you’re prepared for the moment, but you’re never really prepared until it’s a reality,” executive director Katie Quiñonez said.

She watched her staff break down and sob. Some called patients or answered phones. Workers who had the day off showed up, some still in pajamas, to relieve colleagues and offer support. Quiñonez encouraged all to take breaks, often managing the phones herself.

She’ll forever remember that Friday as one of the worst days of her life. Over the weekend, she shut off her phone, lay under a weighted blanket on her couch, ate junk food and watched television. It was the only way she could escape and cope.

When she and her staff returned to work, she held off on filling the vacant slots from canceled abortion appointments. Some patients still needed other services, but she wanted to let workers catch their breath. She told them to come in late if needed. Clinic rooms remained largely empty, dark and quiet.

But still, the phones rang.

Beth Fiddler sat at her desk behind the clinic’s glass reception window in the waiting room. She had no patients to check in, no Medicaid data to scan into charts, no informative packets to hand out.

Instead, she found herself answering the same questions again and again, referring callers to a hotline or website to help them find the nearest out-of-state abortion provider.

“You guys are going to close up soon, right?” No, the clinic will be open to provide other services.

“Can I get Plan B – the ‘morning after’ pill? What about an IUD, or other birth control?” I’ll help you make an appointment.

“You’re sure I can’t make an abortion appointment? Isn’t there a loophole, an exception?” There are no abortion services at this clinic.

Some callers were in denial. Some remained stoic, others cried. A few responded with hostility, insisting Fiddler was wrong. She tried to be polite, empathetic — but the conversations take a toll.

“It frustrates me,” she said. “I’m already stressed out and upset. I understand wanting to find a way, but there’s no way.”

As one of the first workers patients see, Fiddler takes pride in making people feel welcome and safe. Having to turn them away and simply refer them to a website is gutting, she said.

“As helpless as I feel about it, I can’t imagine how they must be feeling,” she said.

Outside the clinic, it’s quiet, too. There’s no buzz of patients arriving in the parking lot to be escorted by volunteers in pink vests. The only cars belong to staffers and a security guard. Across the street, a lot owned by an anti-abortion organization is vacant except for a large white cross.

A regular protestor, a pastor with a “Jesus Loves You” sign, prayed outside a few early mornings, but the usual crowd pleading with patients to reconsider is gone. Some cars slow as they pass. Workers recognize some as protestors’ vehicles, and they imagine the clinic is being watched — to make sure patients aren’t arriving for abortions.

Director Quiñonez said she knows the next steps will be challenging, with a long road for workers to recover from pain.

“Our staff need space and time to process this very traumatic loss,” she said. “And all of the secondary trauma that we’re experiencing from all of the patients.”

Simply being at work is hard, but the employees are dedicated to helping patients.

“We came in Monday and I was kind of like, ‘OK, what do I do now?’” said Kaylen Barker, who handles the clinic’s public messaging. “It’s somber to come back here and realize we’re not going to be able to do the lifesaving care that people need and that we’re going to have to refer them to websites. That’s the best thing we can do right now.”

Barker came to the clinic as a patient during a breast cancer scare 12 years ago. She got care when she had no other options. She knew she wanted to work at this place that helped save her, so she applied until she was finally hired. Knowing she can help others like her keeps her going, whether abortions are scheduled or not: “People deserve to receive healthcare in a welcoming space, without bias or judgement.”

So Quiñonez and her staff focus on keeping the clinic open. Abortion services account for 40% of clinic revenue, leaving a gap that could mean layoffs — but Quiñonez is determined to avoid that.

She’s encouraging residents to transfer their gynecological care to the clinic, and she plans to offer new services. The clinic recently added gender-affirming hormone therapy services, along with HIV prevention and treatment. She hopes more programs will follow.

And donations are flooding into the clinic’s abortion fund. Before this year, the fund’s balance never exceeded $50,000. In one weekend after the ruling, they raised $75,000. Staff will use the money to help send people out of state for abortions.

“Yes, we are tired, we are devastated, we are angry,” Quiñonez said. “But this is far from over. I want to reassure people that regardless of how hopeless and dark it feels right now, this isn’t the end.”

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By LEAH WILLINGHAM Associated Press