If there was any morning to be off the streets in Louisville, Kentucky, it was a Saturday in early May, as downpours flooded the streets and drenched pedestrians to the skin. Yet storms didn’t stop a hundred or so abortion opponents from gathering as early as 6 a.m. to celebrate Mother’s Day, one day early, outside of EMW Women’s Surgical Center, the only abortion provider in western Kentucky and southern Indiana.

Forty Catholic “prayer warriors,” as they described themselves, lined the block along the right-hand side of the clinic, holding up umbrellas while they prayed the rosary and sang hymns. Students from a local Bible college, holding graphic posters of aborted fetuses, lined up on the sidewalk to the left of the clinic entrance, where they could be closer to the front window and the drop-off zone for patients entering the building. The entrywayitself was a platform for variety of others: sidewalk preachers giving sermons on sin, murder and the lies told in abortion clinics; self-styled anti-abortion “counselors” pleading for patients to turn back before they harm themselves and their babies; and escorts trying to help patients through the clinic’s doors.

What’s happening in front EMW Women’s Surgical Center represents perhaps the worst harassment of abortion providers across the country. For clinics in states or cities that have buffer or bubble zone ordinances — about 40 states have no statewide ordinances protecting clinics — patients have more freedom to enter a clinic unencumbered. That is not the case in Louisville, where the clinic is perched in the center of a business district, lacking any of the protections that come from private parking or fencing around the premises. In that situation, public sidewalks become a fearsome gauntlet — crowded with crosses, pictures of the Virgin Mary, signs about murder or Jesus’s love and the massive graphic images becoming more commonplace every day. Add in the bodies of the escorts in orange vests, and the yellow-vested abortion opponents known as Speak for the Unborn racing them to reach the patients first, and the sidewalk becomes a scrum of noises, signs and people.

In McCullen v. Coakley, the Massachusetts buffer-zone case currently before the Supreme Court, which will be decided by the end of June, lawyers for abortion protesters have tried to portray their clients as “plump grandmothers” wanting to quietly hand out pamphlets. “What these people want to do is to speak quietly and in a friendly manner, not in a hostile manner, because that would frustrate their purpose, with the people going into the clinic,” Justice Antonin Scalia said during questioning, echoing the plaintiffs’ lawyers.

In McCullen, defendants of the state’s 35-foot buffer surrounding a clinic entrance say that the zone allows anti-abortion activists ample room to express their right to protest abortion as well as attempt to influence patients, without being directly in front of the clinic doors where they may become a barrier to their ability to access the building and an abortion. The plaintiffs, on the other hand, argue that the zone violates their freedom of speech and makes it impossible for their “sidewalk counselors” to approach patients, offer literature about abortion alternatives or otherwise try to persuade them out of terminating a pregnancy.

What Scalia’s argument doesn’t acknowledge is that the civility of those encounters is largely dependent on laws ensuring buffer zones themselves. In September 2013, the National Abortion Federation or NAF, the professional association of abortion providers in the United States, reported that 92 percent of providers in areas without buffer zones said they were concerned about the safety of their workers and their patients in the areas directly surrounding the clinic; 90 percent reported that they had patients themselves express concern about their own safety when they entered a clinic; and 80 percent stated that they had at some point had to call law enforcement because of a safety or criminal concerns from an anti-abortion presence at the clinic.

“It’s pretty clear that there are real problems outside clinics across our country,” Vicki Saporta, president and CEO of NAF, told me. “This is not ‘sidewalk counseling’ that is taking place outside these clinics. … Patients have been physically assaulted, have had to endure threats and hate speech — things that they shouldn’t have to endure in order to obtain medical care.”

So the court’s upcoming decision will be pivotal. Those clinics that already have buffers are likely to see challenges mounted against their own laws, while others that are already experiencing issues with protesters may find more gathering on their own sidewalks if the court decides that freedom of speech trumps the ability to access a clinic’s front doors unhindered. In other words, if the court follows Scalia’s logic, the Louisville circus could soon be coming to a clinic near you.

To see this future right now, you can visit Louisville on the Saturday before Mother’s Day, a big day for the city’s anti-choice protesters.

The Catholic Church has had a presence outside the clinic for more than a decade, with volunteers handing out pamphlets and imploring patients to rethink their decision to abort, or simply praying silently. The evangelical presence here, under the auspices of Speak for the Unborn, has swelled in recent months, as leadership has encouraged local churches to make clinic activism a scheduled event. These activists in their yellow vests man the corners and parking lot entrances in small groups, searching for patients to follow back to the clinic, pleading with them to reconsider and offering them financial assistance, adoption advice and an invitation to their churches; clinic escorts call these protesters “chasers.” For their part, Kentucky Mountain Bible College students, predominately missionaries-in-training, come by bus with their loud chants and gruesome posters displaying aborted fetuses once a month.

All of these groups pulled out the stops for the pre-Mother’s Day effort. Joining them was a street preacher from the newly formed Louisville chapter of the extreme anti-abortion group Abolish Human Abortion, which believes abortion must not only become illegal but that the pregnant person, not just the abortion provider, should be charged with crimes if it is.To AHA, committing one’s life to Christ is the only way that abortion will ever be ended, and the conversion of a soul is as important of a goal as the “saving” of a potential human life. With a microphone hooked to his belt the preacher stood on a stepstool 20 feet from the waiting room window. From there he bellowed his sermons of sin and redemption, which could be heard by patients inside.

Meanwhile, just outside the clinic’s front door stood an African-American woman, who from 7 until 8:30 a.m. kept up a rapid-fire speech ranging from the alleged dangers of abortion to how much Jesus loves the people in the clinic to how the doctors don’t care about them. At one point she warned that an abortion could be unsuccessful and a woman could end up caring for a disabled baby. Or worse. “You may not make it out of there alive,” she shouted at the waiting-room window. “I know that’s harsh, but that’s the facts.”

While the prayer warriors took over most of the block to the right of the clinic, escorts, who were also on hand in unusually large numbers on that day, lined the sidewalk up the left. By arriving before 6 am, they had taken many of the parking spots in front of the clinic and organized themselves to vacate spaces to accommodate patients, who they guided through the gauntlet of protesters. The plan to expedite drop-off and minimize contact with protesters was highly successful: Some patients were dropped directly in front of the clinic, which allowed escorts to form a human wall to keep protesters behind them all the way to the clinic door.

“It reminds me a little of how we used to have to crowd-surf patients over the antis’ heads and to the door at my old clinic in D.C. before the FACE Act,” said Natalie, an Indiana clinic escort, referring to the Freedom of Access to Clinic Entrances (FACE) law passed in 1994 that made blocking an abortion clinic entrance a federal crime.

The tactic caused some obvious frustration among abortion opponents. Some tried to pop up and shout to patients over the escorts. One yellow-vested “chaser” positioned by the door tried to snake his arm over an escort, brochure in hand, as the patient was already past the property line.

The drama surged each time a car pulled into a parking spot and was surrounded immediately by a group of six students from Kentucky Mountain Bible College, who would place their signs — “Jesus Saves,” “Babies are Murdered Here” — or gruesome pictures directly in front of the windows or windshields while the patient and companion attempt to exit the vehicle.

In between the arrival of patients, some protesters spent time talking to, and at, the escorts.

“You have a lot of bloodlust,” one protester informed the line of escorts at the front door. “After this, are you going to go get you a puppy? Kick it, beat it, gut it? Encourage it. Encourage that bloodlust.” He paused, walked over to another group and added, “What if I brought you an opossum the next time. Would you want to stamp its head?”

Once the check-in hour for patients had passed, escorts began to disperse. But the protesters remained. The Bible college students gathered together outside the waiting room window, holding their signs and singing, “Jesus Loves The Little Children,” as the woman in the doorway continued her shouts. “When you are crying because you realized what you did, that you killed your unborn child, when you have all forms of addictions, when you have cancer, when you have abdominal cramps today, they didn’t give you their number for you to call,” she warned through the glass. “Nobody cares about you there. We care.”

The buffer-zone argument being heard in front of the Supreme Court is meant to clarify how close is too close when it comes to abortion opponents interacting with those seeking an abortion. The FACE Act already makes it a crime to block a clinic’s entrance, and a protester who is blocking an entrance or touching a patient could be arrested on a FACE Act violation.

What becomes clear in Louisville, however, is that the FACE Act doesn’t address what happens when the interaction isn’t just a few moments on a woman’s way through the door, but a continuing situation that follows her into the building, at the reception area and even while she waits inside for the procedure to begin. It’s not just a few seconds or minutes but often hours, and it encompasses not just her, but her companion as well.

While patient-escorts leave, the activists remain, hoping a patient may peek through the blinds and change her mind. Companions who exit the clinic for a cigarette, a walk or to feed a parking meter will be approached and often urged to go back into the clinic and bring the patient out of the waiting room. Often, these companions hear appeals to their “manhood” or their role as a parent.

Staying inside isn’t always protection, either.

“I talk to the patients a lot. We hear from the patients all the time that it was horrible,” said Pat Canon, one of the Louisville escorts. “When you are in the waiting room, [the protesters] can be heard. The closer to the windows, the more you can hear. When they are amplified, you can hear them all the way around the waiting room, no matter where you sit. We have people frequently saying ‘It was horrible. I couldn’t get away.'”

Those on the sidewalk admit that they can get louder at the last minute, when a patient is entering the clinic doors, even if they have been calm and peaceful up until then. “I guess yes, I do yell at the end,” admitted one sidewalk regular. “After all, if you saw someone walking into a burning building, wouldn’t you do everything you can to stop them?”

Every protester has his or her own way of interacting with a patient, some more aggressive than others. Escorts talked about one sidewalk regular, whom they referred to as “Bandana Dave,” who would paint a heart onto his hand, then get up in front of the patient entering the clinic, saying, “Mommy, don’t kill me. I love you Mommy.”

“He’d run backward, jump in from the side,” said an escort. “‘I love you Mommy, don’t kill me Mommy.'”

Some abortion opponents use tiny models of fetuses, sometimes as informational tools but in more threatening ways. “This last week [a protester from St. Martin’s Church] actually touched one woman’s nose with the fetus doll because she was holding it so close,” Canon told me.

And the numbers are growing — along with the tension. Protesters have averaged 300 to 500 per month for the first four months of 2014, compared with 200 to 300 per month in 2013, according to records kept by the escorts at the clinic. Escorts, in response, have stepped up their own presence to about 150 per month, up from 100 per month the previous year. “I’ve seen an uptick in aggression over the last six months,” said Canon. “They are screaming loud.”

Although some Catholics, such as the “prayer warriors” from nearby St. Martin’s Catholic church, can be aggressive, Canonsaid that overall they tend not to physically interact with patients the way the Speak for the Unborn “chasers” do. According to Canon, prior to October 2013 activists who identified with the organization would offer pamphlets, but not actually “chase and block,” as she put it.

Andrew King, the leader of Speak for the Unborn, doesn’t consider his group to be “aggressive.” He said his team wears neon-yellow vests with “Immanuel” printed on the back not to confuse patients, but to show clearly who belongs to him if there is trouble at the clinic. “It’s just to help me be able to say, ‘All of those in yellow, those are with me. I’m responsible just for them,'” King said.

Still, the city is well aware of the mounting tension surrounding the clinic. Louisville Councilwoman Tina Ward-Pugh said via email that the local police force has informed her that although there has been no physical violence, “the tension is always at a fevered pitch.” Ward-Pugh said that waiting for actual violence to occur before de-escalating the sidewalks isn’t an option. “Make no mistake,” she said. “I’m not simply waiting for a tragedy to occur.”

On the day before Mother’s Day, an officer was stationed across the street from the clinic, videotaping the events, aware that the day could bring out the greatest and most aggressive number of anti-abortion activists on the sidewalks. That same day, four police vehicles surrounded the building, doing the same. More than 100 protesters were on the sidewalks; more than 60 escorts joined them.

And just nine patients entered the clinic for abortions that day.

This story was reported in partnership with The Investigative Fund at The Nation Institute, now known as Type Investigations.