Jewel is a student in her early 20s who lives in Texas. When her doctor confirmed she was pregnant, Jewel felt panicked. She knew it wasn’t the right time for her to have a child, and that abortion was illegal in her state.

Fortunately, Jewel had resources. After doing her research, she packed a bag and flew to New York City, where her sister lives. From there, the two women came to see one of us — Joan Fleischman, a family medicine doctor who has been providing abortions in her small practice in New York City for over 20 years.

Jewel, who asked to be identified by her middle name, told Dr. Fleischman about her experience in Texas. Medical staff members “were trying to push a happy pregnancy, while I was miserable and crying,” she said. Jewel sensed her doctor was afraid to even talk about other options because the doctor feared losing her license.

Dr. Fleischman performed an ultrasound, which dated the pregnancy between five and six weeks. She discussed Jewel’s options and, after confirming that Jewel wanted to end the pregnancy, completed a manual uterine aspiration procedure. This method uses a hand-held device and takes a few minutes to complete in a regular exam room.

Dr. Fleischman then conducted a routine tissue examination. This involves rinsing the tissue with water using a fine sieve. She identified decidual tissue, or uterine lining, as well as a gestational sac, the visible evidence of the pregnancy. At this stage of pregnancy, the embryo is not typically visible to the naked eye.

Afterward, she offered to show Jewel the early pregnancy tissue. Jewel told Dr. Fleischman that it wasn’t what she expected. “I thought you were going to bring in something that was shaped like a little fetus or something, and it was not that at all,” Jewel said.