How a conservative doctor defended abortion in Appalachia

BRISTOL, Va. — When Wes Adams’ youngest son was little, he’d sometimes toddle over to the TV, pop in a cassette, and watch himself being born. It was a home video, filmed by his older brother. There was his mother, her belly anesthetized but her head very much awake, asking the doctors to keep the incision small, please. There was his dad’s medical partner, making the cut for the C-section. And there was his dad, an OB-GYN, helping to maneuver him, slick and bawling, out into the world.

It took a few tries. He wasn’t head down, the way he’d ideally have been for a vaginal delivery. Instead, he was horizontal, back to the floor, as if lying in a hammock. That meant delivering the legs together, so one didn’t get caught. “You have to reach up, get both feet. But we reach up, get a leg and an arm,” Adams recalled. “Put ‘em back, reach up, and get a leg and an arm.” Finally, they got the right hold. “He grew up about two inches as we were pulling him out, just ‘cause he’s got a big head like me.”

Adams was telling this story in the abortion clinic he co-founded last year. He knew it seemed unorthodox, to help deliver your own kid while your older son films over your shoulder. But what was striking was how normal it sounded — both the scene itself, everyone laughing, joking about ridiculous baby names, and his narration of it, as if it were just another dinner-table anecdote. That’s almost an article of faith: No matter how prudish and weird and puritanical people are about it, to Adams, reproductive health care is fundamentally normal. It’s un-shameful, unawkward, undeserving of squeamishness, judgment, legal restriction, or sermonizing. People have babies, get Pap smears, require gonorrhea testing. They have pain during sex and need cysts removed. They seek hormone shots to treat the hot flashes and vaginal itchiness of menopause.

“We did everything,” he said of his longtime practice. “We were a gynecologist’s office and we delivered babies. And we just happened to do abortions.” It was just another part of providing care, as routine as doing hysterectomies and prescribing birth control.

That puts him at odds with some of his neighbors. Since 1978, Adams has lived in Bristol, a community that straddles the Tennessee-Virginia state line — unapologetically Trump country, unequivocally part of the Bible belt. His belief that sexual health care is normal has meant that his life is anything but. You might say that he’s the face of abortion in Bristol if it weren’t for the fact that he doesn’t really want people to know what he looks like. He’ll do the occasional interview, but no photos or videos. “Nothing to gain, everything to lose,” he explains. Any time he brags about his kids’ master’s degrees or military service, the details are off-the-record. He knows the stories of peers who’ve been murdered; it’s impossible to work in the field and not know them.

To be a physician who performs abortions in a small southern town is to be in a state of rational hypervigilance, a whisper of worry pervading the everyday. That has persisted even after Adams was cornered into retirement last summer — itself another reminder of the not-normal-ness of his life. He is his own security detail: That day, he had one gun in his pocket, another in his jacket, and a third in his car. At a town meeting earlier this year, some locals compared his work to the Holocaust, while an elected official mentioned him by name, called him a serial killer, and talked about how easy it was to look up the tax records for his home.

His wife, he said, has been called a “blonde Botox baby-killing f—cking whore” while out around town. Other unpleasant incidents, which he chalks up to plain old jerks or just bad luck, have caused people in his circle to speculate about “the antis.” He’s had to be in near-constant touch with a small army of attorneys. After Roe fell, he ordered himself a custom bumper sticker. “ABORT SCOTUS,” it said, in all-caps, red on black. He checked with his lawyers before sticking it on his truck.

That morning, he’d driven by his old medical office to find that the sign with his name had been taken down. It was one of the last things to go. It was late January 2023. In a few weeks, a new OB-GYN would be in here, seeing patients, some of whom he’d referred after seeing them for 40 years. “Theoretically, it’s still mine,” he said, gesturing through the slosh of the windshield wipers. “But I’m not supposed to go in there now, since we’re leasing it out.”

In recent years, he’d been mumbling about retiring soon. He’d quit delivering babies in 1992, when he started feeling too old to wake up at all hours. His longtime partner retired in 2015, for health reasons. Adams was nearing 75, a grandfather. But then, last year, he heard that the Supreme Court was about to overturn Roe. It infuriated him. He thought the justices should be impeached. He couldn’t retire now. Nor could he keep providing comprehensive care here, on the Tennessee side of town. Abortion would be banned before the summer was out.

The person he called was his old friend Diane Derzis. She had a reputation for being a savvy businesswoman, and generally unfazable, responding to trouble with a laugh — half mirth, half cigarette smoke. They’d first heard about each other in the ’70s, at an abortion clinic in Alabama where she was an employee and he was a fly-in doctor. Since then, she’d gone on to run clinics all over the South and Southwest. One ended up being bombed. Another was at the center of the case that overturned Roe. “The Abortion Queen,” people called her. She liked the title enough to start using it herself.

What did the Queen of Abortion think, Adams asked, about opening a clinic with him on the Virginia side of Bristol?

Soon, she was staying in his guestroom, riding around in his car, auditioning commercial rentals for a role as one of the most strategically-placed medical centers in the south.

“We looked at this building — that’s an old bank — but it’s half-Tennessee, half-Virginia,” said Adams, pointing toward a business with a drive-thru. The light turned green and he roared through, over the state line, into a jurisdiction where the Senate was controlled by Democrats and so abortion was bound to remain legal until at least January 2025.

In many ways, Adams and Derzis were similar, both heat-packing Southerners who’d persisted in the field through protests and threats and legal snarls. But there was a difference in their approach. Adams had terminated pregnancies as part of a wider gynecologic practice. It didn’t keep away demonstrators, but it made his work more palatable to some people. His nurse wouldn’t have worked there if he were doing abortions and nothing else.

Philosophically, Derzis agreed: Abortion is a normal part of medicine, and should be treated that way. It isn’t, though. It gets separated out, distanced from “normal” care, as if in moral quarantine. States regulate clinics down to the width of their halls. Tissue that’s nearly identical to surgical waste tossed out by hospitals instead has to go to funeral homes. Providers have to fill out special paperwork to prescribe abortion pills, though they’re safer than Tylenol. The stigma creates an imbalance: In 2016 and 2017, 72% of OB-GYNS encountered patients seeking abortions, but only 24% performed them — and that was while Roe was still law.

Derzis says she wanted to deliver only the care that’s hard to find elsewhere, to zero in on the desperate, unmet demand. “I was real clear: This is an abortion clinic. I have no problem saying that. I’m proud to say that.”

Here it was: a long brick building, blinds drawn, with a No Trespassing sign. They’d thought about renting only half, but realized that could allow “the antis” to become co-tenants and protest in the halls. There was enough trouble as it was. “The landlords are suing us,” Adams announced, pulling into a parking spot. Then he started rummaging through his truck for the key.

The fact that Adams seemed both unperturbed and offended by the lawsuit wasn’t all that surprising. It’s the sort of incongruity he often inhabits. To spend time with Adams is to have your expectations scrambled, as if he contains within him a whole colorful cast of strange bedfellows. He keeps a low profile in some ways and zips around in a jade-colored Mustang, gearshift crowned with a cue-ball. He’s deeply conservative and deeply committed to abortion rights. He’s courtly one second and cursing the next. He extols the virtues of Bristol, where some of his neighbors think of his medical practice as the work of the devil.

He grew up in Winder, Georgia, an old mill town outside of Athens, “the pants capital of the world.” His mom was a teacher, his father an insurance salesman. Little Wes went to Methodist church camp. Teenaged Wes worked in the shipping room of a pants factory for $1.40 an hour. Sometimes, his aunts would take him to the family farm in North Georgia, where they sat reading books and picking muscadines from overhead tendrils. Scuppernongs, they called them. They did their laundry in a big black pot.

He was raised with an old-fashioned sort of politesse. After traveling, his aunt would always write a letter to the bus company, thanking Greyhound for the most wonderful trip, noting that so-and-so had been such a courteous driver. She instilled in him an ear for grammar. He still cringes when he hears a poorly conjugated verb.

“To me, a doctor was the hometown guy you saw at church — came in late, stethoscope hanging out,” Adams said. “Standing outside afterward, writing prescriptions.”

That wasn’t so far from the small-town physician he became. His Bristol practice was built on word-of-mouth. He ran into his patients at parties, asked about the kids he’d brought into the world. Ronan King, a longtime patient and friend, thinks she might’ve met him first through her then-fiancé’s menswear store, or perhaps at a cocktail party held in Adams’ honor when he arrived in town — a doctor’s debutante ball.

At her first appointment, she was so nervous her hands shook. He set her at ease chatting about college football. She imagines she threw off his entire schedule — but it was like that every time, for 40 years, Adams talking with her as if he had all the time in the world. “I knew that I could call him at 2 in the morning and he would see me at 2:15 if I needed it,” she said.

He’d come to town for a job under three older OB-GYNs. They were conservative, but that didn’t necessarily mean anti-abortion. Two of them were eager to learn. He taught them how to angle the dilators, how to dose the anesthetic.

He hadn’t planned to become an evangelist for reproductive choice. He just happened to be in medical school in 1973, when Roe became law. He’d covered bits of his tuition with odd jobs — drawing blood, babysitting — and after he’d learned to terminate pregnancies as a resident, he’d started doing that, too, spending his weekends in Montgomery or Birmingham. He believed women should have control over their own bodies. He needed work. It was neither mercenary nor radical. It was just one of the things he’d been trained to do.

He kept moonlighting elsewhere in the South once he moved to Bristol. After a year, though, his bosses insisted he stop traveling to clinics out of town. They wanted him to spend his weekends home, making a genteel impression in Bristol. But he was still paying off student debt, and like the Reaganite he was, he had a strong sense of individual liberty. What he did with his time off was none of their business. In 1980, he and his partner went out on their own. Eventually, they opened clinics in Charleston, S.C., and Nashville. There, too, they did abortions, Pap smears, check-ups. They printed out ultrasounds for people’s baby books.

It’s easy to forget that abortion was once a non-partisan issue. But when Roe was decided, many Southern Baptists were for, and a young Democratic senator named Joe Biden was against. “You could be a Republican and support abortion rights. That was not a misnomer,” said Elizabeth Nash, of the Guttmacher Institute.

Our history is full of such reversals. Ben Franklin published an abortifacient recipe in 1748. Abortion was not only legal but widely accepted until quickening, a first flutter of movement felt around 16 to 20 weeks. Only in the mid-1800s did the American Medical Association start a crusade to criminalize abortion, to wrest control over pregnancy from midwives and to bolster the Anglo-Protestant birth rate in the face of immigration. The Vatican banned abortion entirely in 1869.

Fast forward 100 years, and hospitals had whole wards for women suffering from sepsis after illegal terminations. That was one reason state legislatures began to legalize the procedure. There were politicians for and against in each party. There were evangelicals who saw it as objectionable but necessary — a form of harm reduction in an imperfect world. The loudest anti-abortion voices were Catholic, and Catholics tended to lean Democrat, in a pro-labor sort of way.

After Roe, that started to shift. “You began to have politicians, especially Ronald Reagan, believing that leaning on abortion would actually help Republicans peel away socially conservative Democrats,” said Mary Ziegler, professor at the University of California, Davis.

It was a political calculus — one element in a strategy to build a broad coalition. As Gillian Frank, a historian and visiting fellow at Princeton, points out, “Reagan had a lot of simultaneous messaging going on.” You might hold your nose at his anti-abortion talk and vote for his small-government ideals.

Adams is a case in point. He trusted that with Roe in place, abortion access was safe, and so voted for the candidates who spoke to him, no matter their party. He voted for Reagan, both Clintons, both Bushes. Now, on many issues, he has bootstrap Republican leanings. He is “pro-gun and anti-illegal immigrant.” About some things, he even agrees with the court his bumper sticker proposes to abort. He opposes affirmative action and student debt relief. He doesn’t see why his taxes should go to helping with loans when he spent years paying off his own.

This is the irony of the landlords’ lawsuit. Adams is an abortion provider some conservatives could get behind. Even the landlords, in Adams’ telling, had a positive word to say about some of his work when they met in June 2022. As Adams sees it, they were trying to flatter him, to forge an allegiance with him so he’d turn against Derzis, but still. They were sitting in the new clinic, which would eventually be decorated with cartoonish personifications of abortion pills — misoprostol winking, mifepristone in cowboy boots — in the hope of ousting the business. When Derzis left the room, they told Adams they’d heard good things about him, that he helped put babies up for adoption. This was true: He’d kept a list of patients who were unhappily childless, whom he’d call if someone decided to carry to term, but couldn’t raise the kid.

He’s also never performed abortions past 13 weeks and six days. He didn’t think they should be illegal, he just didn’t provide them himself. If patients expressed any hesitation at all before an abortion, he insisted they wait 24 hours. That might sound to some like paternalism, but to him, it’s just what he was comfortable with for himself.

None of that stopped the two landlords, who respectively declined or didn’t respond to interview requests, from suing for fraud. Before the lease was signed, documents specified the building would be a “medical clinic,” but no one had said anything about abortion at that point. Adams says he absolutely would have told them if they’d asked.

What seemed to ruffle him most was the accusation of duplicity — that, and the fact that they had “said uncomplimentary things about Diane.” He’d told them about a 10-year-old he’d treated, who’d become pregnant after being raped, that he did the work for free, because he believed in it. One landlord responded he was sorry that the girl was raped, but that was God’s baby, God had a plan for that baby, that baby should have been born.

You could hear the seen-it-all skepticism in Adams’ voice as he talked about it: After the landlords found out the place would perform abortions, they waited six months, accepted another $10,000 in rent, and only then went to court to kick the tenants out. It wasn’t so different from the sort of behavior that had soured him on the Republican party. There was Scott DesJarlais, a current U.S congressman, who’s described himself as 100% against abortion and was caught on tape pressuring his mistress to have one, according to HuffPost. There was Adams’ neighbor, state Senator Jon Lundberg, who’d come over when he was first seeking signatures to run for office — “drank my bourbon, sat on my couch,” Adams recalled — and said he wasn’t personally against abortion but that it would be political self-sabotage to say so openly. He went on to support bills that would make the procedure a felony.

“That account is not factual,” Lundberg wrote in an email. He remembers that visit, but insists he’s “always been pro-life (publicly and privately).” He says he considers abortion murder and had no problem with his doctor-neighbor wanting to sign his petition.

“Hello, stranger,” came a voice from down the hall.

It was Olivia Nickels, the then-director of the new clinic. At the old medical practice, she’d done everything from assisting Adams in the operating room to helping him master his smartphone. They thought of each other as family. He liked to step out from behind doors to surprise her, she said. He often emailed her cat videos.

“Hello, I’m here.” He was standing near the threshold, looking around. “Feels like I haven’t been here in forever.”

If all had gone according to plan, this would’ve been his workplace, too. He might’ve started here as early as August 2022. But not long after the signing of the lease, one of his many lawyers sent him a grim analysis. The district attorney in the county where he lived was ready to prosecute abortion providers to the full extent that Tennessee law allowed. Even remaining part-owner, the lawyer said, seemed risky.

Around the same time, in June, he’d called his longtime malpractice insurer — “just out of courtesy; to be, as my aunt would say, mannerly” — and said that he planned to take his staff over to Virginia to perform 10 to 20 medication abortions on Mondays. The person on the phone said that was fine.

But then, his insurers called him back. “They said, ‘We’re not going to cover you for that.’ I said, ‘Why?’ ‘Well, we’re not.’”

It was still OK for him to provide abortions in Tennessee as long as it remained legal?

Yes.

But they wouldn’t insure him in Virginia?

No.

Why not?

They just wouldn’t. After Roe, it was controversial.

The back and forth went on in maddening, logic-defying loops. He’d heard the company was covering Tennessee medical residents as they traveled to Virginia to learn abortion care. But they wouldn’t cover him after 40 years of performing them in three states. (The State Volunteer Mutual Insurance Company said that it does not provide information about clients’ insurance coverage.)

He could’ve found a way to keep going. He could’ve been the test case for the district attorney’s threats. Instead, he called up Derzis, his voice quiet, and told her he had to get out.

The new clinic opened without him in late July 2022. For a while, a doctor was coming into town from Richmond. Then, she left, and for a few months that fall, there was no doctor. If, like most of the clinic’s patients, you were really early in your pregnancy, you were fine. You could come in, see a clinician over Zoom, and take abortion-inducing pills. Still, a few people came in despite the receptionist’s warnings, only for the ultrasound machine to read them as too far along for pills. They had to be turned away. “That might be another five hours they have to drive,” said Nickels.

That meant more patients were trying to book appointments in Roanoke, two hours away, but that clinic only had a doctor present on Wednesdays. As Sophie Drew, of the New River Abortion Access Fund, put it, “Someone retiring or moving away — or even if one provider is on vacation — that can change the type of care that is available for weeks or months.”

“One more good story,” Adams said. He was at the wheel again, whizzing past where the hospital used to be and the high school where his wife still held the record for the 100-yard-dash. Here was the NASCAR racetrack, a monument to American speed, Bristol’s answer to the Roman colosseum. There was the lake, rippling with so many trout he’d given up fishing; it was too easy.

Last June, someone called wanting to give money for the new clinic. He’d left his email, and Adams sent along the clinic’s GoFundMe page.

Crowdfunding had been his wife’s idea. Adams was skeptical, but donations started trickling in, $25 here, $100 there, eventually adding up to more than $100,000. One woman gave $1,000 and wrote, “Dr. Adams delivered me 40 years ago. Thank you for everything you do for the women of Appalachia.”

But this new stranger didn’t want a GoFundMe link. He wanted to give serious cash — and he wasn’t satisfied by Adams’ response.

“He didn’t say ‘Wow, isn’t that nice!’ No, it was like he was sitting on a partially inflated whoopie cushion,” the prospective donor said recently. Then again, he understood Adams’ mistrust. “A physician who’s been harassed by people outside his clinic for decades. That’s not an easy life,” he said. “You have to grow armor plating.”

The man turned out to be the managing director of The Secular Society, a Virginia-based nonprofit. He didn’t want his name used. “It’s not about me, I’m not out there to be eulogized, it’s about the idea of The Secular Society,” he said. The organization began with his grandfather buying a square mile of mineral rights in West Texas. There was a first gush of income from raw oil, collected by the man’s father — and then, one generation later, the land began spewing proceeds from fracking and other activities.

The Society was formed to funnel that money into good deeds and named for Thomas Jefferson’s idea of separating church and state. It has paid over 23,000 people’s medical debt, endowed a chair for a female cellist at the New York Philharmonic, funded journalists’ jobs at two news outlets in Virginia, and bankrolled women’s education in East Africa, among other things.

Now, the board had chosen Adams’ brainchild. The donor said he was leaving for Kenya and Madagascar in the morning, would $25,000 be enough to tide the new clinic over until he got back?

Another check appeared. Then another. The donations totaled $75,000, with more on the way. The managing director visited Bristol. Adams took him to lunch at the casino. He asked if there were any extra “ABORT SCOTUS” stickers. For once, the not-normal-ness had swung in the other direction, away from hypervigilance and legal worries; for once, a random event would make it easier rather than harder to ensure access to routine reproductive health. It seemed fitting: a philanthropist who doesn’t like being called a philanthropist using the proceeds from fossil fuels that he acknowledged were responsible for climate change to support the abortion clinic dreamed up by a Republican-leaning doctor.

But it was not to be. A few weeks after Adams relayed this story in January 2023, the funding stopped. What the stranger had liked was Adams’ approach, of offering abortion as a normal element of comprehensive gynecologic care. Once he learned that wasn’t how the new clinic worked, The Secular Society was out. The donor referred to Diane Derzis as “the business lady” and to the clinic as “an abortion mill.”

He wasn’t the only person to raise concerns about the new clinic, though the others had no issues with Bristol Women’s Health focusing in on abortion care. In the summer of 2023, a year after it opened, and about six months after the Secular Society stopped providing funding, a number of employees described leaving after disagreements with Derzis about her management style. Some of them had been abortion advocates who’d volunteered outside Adams’ office. The New River Abortion Access Fund stopped funding services at Bristol Women’s Health once staffers the team knew and trusted had left, according to Sophie Drew, the fund’s interim executive director; the organization had worked closely with Adams’ practice for years.

Derzis acknowledged that there had been a disagreement, and said the former employees had wanted to run the clinic their way, rather than following her directives.

Adams said he was flabbergasted by the whole thing, but didn’t know the details, given that he has had no involvement with the clinic since the summer of 2022. The last time he was there, in March, the volunteers who used to defend his practice all seemed happy. The next thing he heard was that they’d all left, and there were disputes. “I’m very disappointed that all this is going on,” he said.

Lunch on that day in January was normal. Rather, lunch was spectacular, in a very East Tennessee sort of way. It involved hams that had reportedly been hickory-smoked for nine hours, then spice-rubbed, chilled, and shaved so thin the resulting morsels were almost frilly. Then they were griddled to a shawarma-like crispness before the addition of a dark sauce, the recipe of which is rumored to be so secret that it’s only written down when one generation needs to pass it on to the next, and once memorized, the paper is burned. There were sweet, pork-flecked beans in clay pots. There were fries that were huge and gnarled, like tree branches, which Adams couldn’t eat because they were cooked in the same oil as chicken, but which he insisted anyone without a poultry allergy must try.

Lunch was normal insofar as no one accosted Adams to accuse him of being a serial killer, it engendered no new lawsuits, and there was no occasion to reach for any of his guns. Nor did anyone appear out of the blue to offer him $75,000. He peeled the paper off his straw, used it to poke the juice out of a lemon wedge into his sweet tea, and then put it aside and drank from the rim of the cup. He ate his pork sandwich with a fork and knife.

“This place is at least 55 years old,” he said, sitting in view of the griddle and the deep-fryer, about a 25-minute drive out of town. “It was here way before I came here in ’78. Hasn’t changed.” He talked about the stray cats he and his wife cared for outside their house, feeding them, getting them fixed. He talked about a local dam that could’ve been repaired much faster if the government hadn’t gotten involved to protect “the black-eyed yellow-belted purple-striped something-worm.” He talked about his beloved Georgia Bulldogs.

He was still unsure about retirement. “Haven’t figured it out yet. We’ve had a multitude of little things go wrong,” he said. A few months after that lunch, the judge would remove him from the landlords’ lawsuit, so he was no longer personally being sued.

For now, he was sitting outside in his truck, parked near the hickory pit, pulling up photos and videos of his kids and grandkids on his phone. There was the son who’d been filmed being born, a grown-up now. There was the son who’d been acting as videographer, a parent himself. There were Adams’ grandkids, running along a beach somewhere, yelping with excitement and pointing as a plane passed low overhead. He watched the whole video, transfixed, as if nothing could be more urgent in the world. Then he put his truck in gear and headed back toward Bristol.

This story is part of ongoing coverage of reproductive health care supported by a grant from the Commonwealth Fund.