By 2004, Ní Fhlannagáin had burned out on anarchist activism and moved to Washington with her girlfriend Chrissy, where Willow was doing a residency. Ní Fhlannagáin needed money, and Willow had an "eBay addiction" where she would buy old medical equipment and fix it up. They hatched a plan.
"I don't want this to come off as like, there was this mission," says Ní Fhlannagáin. "People get this idea that I was anything other than a low bagger who needed to make money... we were dumb punk kids, man!"
Still, both women had been involved in abortion activism, and they drew political inspiration from
an underground women's abortion service called the Jane Collective. Operating in Chicago between 1969 and 1973, it was founded as an antidote to unsafe illegal abortions often done by unqualified men.
While the Jane women’s actions were criminal at the time, legal compliance for a rural orchi clinic turned out to be surprisingly simple.
"What's a doctor's clinic?" asks Ní Fhlannagáin. "A doctor's clinic is a clean room that's up to a certain standard, with clean instrumentation that's up to a certain standard, that has records up to a certain standard, drug supplies and how it's stored up to a certain standard, and a licensed doctor and all your taxes and your business stuff up to a certain standard.
"We just met those standards, and the standards are not difficult to meet... we've just grown up with western medicine and basically surrendered ourselves to their whims."
Although they couldn't afford medical malpractice insurance, they also wouldn't make enough to need a business licence, and nor would they store opiates or narcotics on site. Ní Fhlannagáin went through medical privacy law training and put out the word.
They didn't tell the neighbours, nor the landlord. Nobody out there knew that Willow, Ní Fhlannagáin, or Chrissy were trans – rural women weren't expected to be feminine in the same way as city women – and they intended to keep it that way.
One week before the first surgery, on the 256-acre farm that Ní Fhlannagáin and Chrissy were renting, they built a front and sides onto one of the bays in the tractor barn; put in a door and a window, ran in electricity, and tiled and sealed the floor.
That tiling, Ní Fhlannagáin adds, is still there today, though the room is now used as an organic chicken processing factory. "They still don't know what I did in that room," she says, "which I plan on never f***ing telling them, ever."