People throughout Wyoming and Idaho drive hundreds of miles, sometimes through snow and rain, to get to a clinic at the base of the Teton Mountains in Jackson, Wyoming, to see Brent Blue.

Blue is the only doctor in the state who openly provides surgical and medication abortions, but soon his services may no longer be available there.

Abortion-rights activists say his absence would create a large gap in Wyoming’s health care options and leave them more exposed to anti-abortion protesters who picket outside clinics and doctors’ homes, sometimes damaging property or sending death threats.

While some doctors in Wyoming still discreetly provide abortions to a few longtime patients, Blue, 71, has advertised his services for decades in the sparsely populated state of 576,851.

“If I succumbed to the threats and the risk, the anti-choice people win, and women lose,” Blue said. “If health care providers don’t stand up for women’s health care rights, who will?”

Blue sold the clinic he started 19 years ago, Emergacare, to St. John’s Health in 2020. He remained there as a physician but resigned in October with a 120-day notice, claiming a hostile work environment. His last day is scheduled for Feb. 10.

St. John’s Health did not respond to requests for comment.

Blue, who is divorced with three adult children, said he’s considering moving to Idaho, where he believes it may be easier to establish a new clinic and would be closer to some of his patients than Jackson.

He said he plans to sue St. John’s next week and ask the court to void a stipulation in his contract that bars him from working in Teton County, Wyoming, for three years after he leaves the company.

But at this point, he’s not even sure he will continue to practice medicine at all.

“It’s quite emotional,” said his physician’s assistant, Duane Mortenson, 51, who has worked for Blue for three years. “I mean, it’s really a bummer. I’ve worked with a lot of physicians during my time as a PA, and he’s the best doctor that I’ve ever worked with and for.”

Blue is one of only two providers of medication abortions in Wyoming. Women typically cannot access medication abortions, administered by prescription pill, after 10 weeks of pregnancy, said Dr. Giovannina Anthony, a physician at the other provider, Women’s Health and Family Care.

“Dr. Blue was really willing to stick his neck out, he was willing to advertise, and I think he was a lightning rod for the issue for many, many years here,” said Anthony, adding that she considers abortion service an essential element of reproductive health care.

With Blue’s possible exit on the horizon, anti-abortion activists have been anonymously calling Anthony’s practice or standing outside, watching patients enter, she said, and there’s not much she can do but ignore them and hope they go away.

Casey Cochran, 30, who has worked for Blue since 2019 as an office manager, said he grew used to the anti-abortion protesters who stood outside Emergacare, holding signs with violent images and vulgar language.

But he also saw a sign of Blue’s character in a pride flag displayed outside the clinic’s front door. Wyoming is “the reddest state in the nation” said Cochran, who struggled with coming out. The display showed him how accepting people could be.

“I knew he supported me, whether or not he knew it,” Cochran said.

The new St. John’s Family Health and Urgent Care occupies the same building as the now-shuttered Emergacare, but the pride flag is no longer there.

Blue, who has been described by colleagues as “a blue dot in a red sea,” said he is offering a medical service that should be part of any well-rounded family care. He said he also counseled pregnant women on alternatives to abortion.

“Sometimes it’s right for somebody to be pregnant and to have a child, and other times it’s not,” he said. “It’s up to that individual woman to make that decision. It’s not up to me.”

Although leaving his longtime patients will be difficult, he said he is more concerned about the future of medical services in his home state.

Lawmakers in the state will likely present anti-abortion bills during the February budget session, including a possible “Texas copycat bill” that would ban abortions after six weeks of pregnancy and another that would ban medication abortions, said Sharon Breitweiser, executive director at NARAL Pro-Choice Wyoming.

“All of them are bad public policy and bad for health care access,” she said. “They’re all very, very troubling.”

With both the budget session drawing near, and possibly his last day practicing in Wyoming, Blue has been thinking lately about why he risked his safety to advocate for women’s health. He remembers a long day in San Francisco at the start of his career when he used to make obstetric house calls.

After delivering a healthy baby, he sat down to an Italian dinner with the patient’s family, surrounded by generations of women: the young mother who had just given birth, her mother, her grandmother and her great-grandmother. In tough moments, he looks back on that day and his question is answered.

“I’ve always felt that women’s rights and women’s health are an important issue,” he said. “And I’ve never understood why women get the short end of the health care stick.”