The RN catches my eye and turns up the volume on the fetal heart monitor. Beep … beep … … … beep … … … … … beep … … … … … … beep. The fetal heart rate is dipping with each contraction. This baby needs to be born.
Nila closes her eyes, as if she actually thinks we might let her nap, then coughs. It’s a raspy deep smoker’s cough, and with the abdominal effort the baby’s dark hairy head moves down an inch. “Hey, do that again.”
“What?” Nila asks, her eyes still shut.
“Cough. Cough again. It’s moving the baby.”
The patient rouses. “Like that?” She coughs again and the fetal head pokes out a little more. I glance at the monitor. Heart rate to seventy, but back to 120 by the end of the contraction.
“Yeah, keep going. You might be my first patient to cough her baby out.” Nila giggles, forces another cough, and laughs at herself. The rhythmic shaking of her belly works even better than the cough, and the baby’s head shows some more.
“Look,” says the nurse, pulling over a mirror on a wheeled stand. “You can see your baby being born.” Now we are all getting into it, telling Nila we’ll tickle her and offering knock-knock jokes. Even Gibby participates, whispering something into his wife’s ear that makes her blush and giggle some more.
I place my hands around the baby’s emerging head like a crown, easing back the perineum. The nurse slips me warm compresses and oil to help the skin stretch, and a small vigorous baby slips into my hands.
“Gonna call him the Joker,” Gibby quips as the nurse places the wailing pink infant into his arms. Nila has already fallen asleep …
I smile now, remembering … then shake my head and return to the exam room.
“So you and Gibby moved west. Did he get work there?”
“No, I went by myself, just me and the kids. All but the oldest, who’s a senior in high school. He wanted to stay in Torrington to graduate. After the accident, Gibby wasn’t quite right. He took it out on me. So one day I just loaded up and moved out.”
My mind’s reeling. First, I can’t remember what accident she’s talking about. Had it been before or after the last birth? Second, how many kids in a car would that be?
“He took it out on you? You mean, hit you?”
“No, not really hit, but it was going that way. Pushed me around, just a few bruises and one time a burn.”
“So you just left?”
“Yeah, I planned it all out. I waited until he’d left for work. He was gone by six. I was packed and loaded by six thirty, then I woke up the kids.”
I can see Nila bustling around getting the six children dressed, her short brown-blond hair whipping as she works. No school today, she says cheerfully. We’re going on a trip, an overnight. A big adventure.
Where? Where? the little kids say.
What about my baseball tonight? What about my slumber party? the middle ones ask.
The oldest daughter tries to get the kids into their jackets. She doesn’t complain. She knows her mom needs her.
At last they pile into the van. It would have to be a van, with that many kids. Nila passes out the juice boxes and the Pop-Tarts for breakfast, and they shut up. She turns on some oldies rock music on the radio and pulls out of the drive. The sun’s just rising over the mountains.
“You just left?” I ask now. “You took the kids and went to South Dakota? Did you know someone there?”
“No, I just drove and drove, and when I got to Independence, it was a smallish town and seemed like a nice place to raise children, so I stayed.”
“But how did you live?” I ask, amazed. “Did you find work?”
“I had a few hundred dollars saved, and then Gibby had to send money.”
I squint, trying to understand. “Did you sort of run away from home?”
“You could say that.” Nila laughs. “Well, I met a fella out there, his name’s Doug and he was real nice to me, and here I am.” She pats her belly, which is already rounding. So it’s not Gibby’s baby. She doesn’t seem upset. In fact, she seems happy. I’m still pondering the overwhelming prospect of getting in a car with that many kids and just hitting the road.
“Do you have a place to live? Did Gibby take you back?” If he had taken her back when she was pregnant by another man, that would be as amazing as Nila’s packing up and leaving home in the first place!
“Oh, no. Doug and I found an old farmhouse out on Weimer Road.”
“Doug came back with you and all the kids? Did you mean to have his baby?”
“Well, not right away, but we thought maybe later.”
I frown. “Were you using any birth control, pills or condoms?”
“No, not really.” Nila giggles and rolls her eyes.
“So, has Doug found a job?”
“Oh, yeah, right away, at Select-Tech, that telemarketing place downtown.” Nila smiles proudly.
“But what about your husband? How’s he handling this?” I picture the quiet blond man who had come to Nila’s births. He’s employed in maintenance for one of the big student-housing companies in Torrington.
“Oh, Gibby’s acting like a jerk, keeps coming over or trying to call me. If Doug’s home and answers, he hangs up … I shouldn’t have expected him to be decent. I have to let him see the kids, though. Unless he’s drinking. If I smell alcohol on his breath, he’s out of there.”
I warm up my hands by rubbing them together and motion for Nila to lie back on the exam table. Her uterus is easily palpable under my fingers. “Have you felt movement yet? It’s probably too early.”
“No, I feel it. Not every day, but I feel it.” She smiles at the ceiling. “After seven kids, you know that the baby is in there.”
There are red flags waving, but I don’t see them. I’m worried about how late I’m running and how many other women are waiting in the reception area. I’m thinking about all my patients who feel trapped by unhealthy relationships, financial burdens, or family troubles, women with many more resources than Nila but not a bit of her courage. They come into the office year after year, enduring the same old things, taking Paxil or Prozac so they can cope.
“So why’d you come back?”
“I missed the Green Mountains. I just missed them.”
HEATHER
At 10:15 a.m., Heather Moffett and her family return and are escorted to the ultrasound room. The little group shuffles past my office door and heads down the long hall. Today Mrs. Gresko is dressed in a long navy-dotted shirtwaist. She stops to straighten a framed photograph of a lone oak tree on the wall as she passes.
I wait for them to get settled, staring out the window at the gray sky for a few minutes. I saw trillium blooming this morning on my way to work, white bells at the edge of the forest. Outside, the sun goes in and out of the clouds.
This morning Tom’s ultrasound room is crowded. T.J. sits in the only chair available, and Mrs. Gresko stands, still clutching her white purse. Heather lies passively on her back with her legs bent; a white half-sheet is over her lap, and she’s wearing a skimpy pink T-shirt. The large ultrasound machine stands in the corner, a printer beside it. The family smells strongly of cigarettes.
Dr. Harman has already started. His RN, Sherry’black shiny hair cut short in a bob, always pleasant, the archetypal nurse’stands ready to assist. “If the baby’s too early we may not see a heartbeat yet,” Tom is explaining. He adjusts a few knobs. Today he wears his tan Dockers and a pale blue dress shirt. A stethoscope hangs around his neck. His close-cut gray hair needs a trim.
“By my exam,” I interject, “Heather feels about fourteen weeks pregnant, but she can’t remember her last period, so we’re not sure how far along she is, and there’s been some spotting.”
Tom is silent. He’s in a get-it-done mood, no chitchat. As he does the internal vaginal ultrasound, he uses his more sensitive right hand to palpate the abdomen. Then he presses a few more buttons on the console. A tiny fetus resembling a tadpole comes into view. I expected it to be
bigger.
Dr. Harman points out the baby. I always call Tom “Doctor” when we’re with patients. It’s a formal convention, a way of reminding myself that our relationship in the clinic and the hospital is professional. I motion T.J. to come closer. Despite the young man’s reserve, he stands up. “There it is!” I whisper. “There’s the heartbeat.” I squeeze Heather’s gaunt arm. She’s so thin, it crosses my mind that she could be anorexic. No one seems as excited as I am, but the tension drops in the room. Despite the spotting, the baby’s still alive. It’s always a thrill to see that heart beating.
“It’s about seven weeks, and has a good pulse,” Dr. Harman informs the group, printing out a picture. He hands it to Heather. “There’s your baby.” He grins. I like that smile, wide with straight teeth. Heather and her grandma inspect the small photograph. T.J. glances down but doesn’t move closer. The screen swirls as Tom inspects the patient’s ovaries. He’s surveying for cysts or any other abnormality.
“Looks pretty good,” he says. “You can turn the lights up.” He nods to me and I reach for the rheostat. “Wait,” he says, inspecting the screen intently, moving the vaginal transducer from side to side. I dim the lights again and the mood dims as well, each of us wondering what could be wrong.
“There’s another one,” Tom announces. Two tiny fetuses lie side by side. Heather looks at me.
“There are two babies. Two heartbeats. You have twins!” I tell her, understanding now why my estimate of her dates was so wrong. “No wonder you’ve been so sick.” The girl smiles for the first time, and her thin pixie face lights up. She glances at T.J., who stands just a little taller. On the other hand, Grandma tightens her square jaw and looks away. She knows how hard it is to take care of one baby, let alone two.
By the time Heather gets to the checkout desk, everyone in the office, from RN to billing specialist, knows the young woman is having twins. The staff gathers to congratulate the family. Sometimes I think that they miss the thrill of doing deliveries more than I do.
It’s odd how excited people get about twins. In my mind, it’s double trouble, a difficult pregnancy with preterm labor and maybe preeclampsia. And a potentially difficult delivery, with cord entanglement or fetal malpresentation.
Before the family leaves, I give them a packet of OB handouts and a lab-requisition slip. I manage to explain that we no longer deliver babies because of the high cost of medical-liability insurance. Heather seems disappointed. T.J. is mad, Grandma exasperated. “So who will she go to?” Mrs. Gresko demands.
“We can take care of Heather until she gets through the first three or four months. That will be three more visits. When we get her labs back and know the pregnancy is stable, I’ll sit down with you and go over the options. There aren’t as many choices in OB providers as there used to be, but I can find someone you’ll like. Try not to worry too much about the bleeding. There’s a good chance it will stop.”
It occurs to me that Heather may not have insurance, and a glance at the front of the chart confirms it. SELF-PAY, the sticker reads. “Have you applied for a medical card yet?” I ask quietly.
“We will,” Mrs. Gresko says firmly. At least she’s aware of the financial reality. I’m just hoping that Heather will qualify. If a woman is poor enough, there isn’t a problem. It’s the folks slightly above that line who get screwed, the working poor and the self-employed. If you’re living on minimum wage, there’s no way you can pay seven hundred dollars for a family health-care policy.
There’s so much I’ve not had time to talk to the girl about. Carrying twins changes everything. There will be an increased need for nutrition, increased need for rest. I write on the checkout slip for Heather to return in two weeks so I can finish her new-OB exam and we can talk more. Then, as we stand in the reception area, I manage to whisper in the girl’s ear that she and T.J. shouldn’t have intercourse until after the bleeding has stopped for ten days.
Heather gazes at me as if that’s the last thing in the world a teenager would do.
HOLLY
Holly Knight, an attractive forty-five-year-old, is examining her manicured nails. “It’s okay if you don’t want to talk about it,” I say. The exam room is quiet. There are no clocks ticking, except in my mind. I’m already half an hour behind schedule.
The prominent Torrington real estate agent is here for her annual exam. She’s taller than I am, almost six feet, with broad shoulders. Since I’m tall myself, I notice these things. Her angular jaw and long limbs speak of a former athlete, maybe a tennis player. “It’s okay if you don’t want to talk about this,” I repeat. I had asked her about her stress level.
Finally, Holly clears her throat, straightens her blue exam gown, and adjusts the silver clip that holds back her shoulder-length, highlighted hair. “It’s my oldest daughter. She’s just a beautiful girl. She was beautiful. Now she’s in intensive care at a hospital in Charleston and looks like a skeleton. She has an eating disorder … I’ve never told anyone about this. If women ask at church or at the country club, I just say she has severe colitis.”
I wait, imagining the young woman, a shadow of Holly, her translucent skin just covering the blue life pumping within her, propped up in a white hospital bed. There’s a tube in her nose, IVs in both arms, and a heart monitor beeping away at the bedside, all that connects her to life.
The patient looks down, and the mask falls away. “Nora was so bright and lively and involved when she was in high school. She was in soccer, in debate club, in the school plays. I don’t know how this happened. It must be my fault. She never seemed to have any weight problems when she was a kid. She would eat a good dinner. We even drank whole milk then.” Holly looks up at me. Her green eyes are brimming. “I’ve thought about this a lot. Now I realize she was vomiting everything up. Now she can’t stop vomiting. It must be my fault, but I don’t know what I did.
“Think about it.” She snorts a short laugh and with the tips of her fingers wipes her eyes. “Anyone who can drink that much whole milk and not gain weight has a problem, but I didn’t see it. Maybe you only see what you want to.”
I listen spellbound as the patient tells her story. I’m seeing myself only a few years ago, so alone with my troubles, embarrassed to tell anyone, a seemingly successful woman, sturdy, competent … crumbling inside. Holly continues, “I’m just so worried. I’m terrified she’s going to die. Maybe this time or next time she’ll die. We’ve been to counselors and clinics.” She looks around as if she’s lost her place in the story, but she hasn’t. “This is the third time she’s been hospitalized this year.”
I say nothing. It isn’t a therapeutic silence. I just can’t think what to say.
There’s a scratch at the door. It’s my nurse Abby, alerting me patients are waiting. I glance at my watch and shake my head. I’m absorbed in this woman’s pain and I know why. Once, I, too, had had no one to confide in, no friend or colleague whose children had been busted for grass, or for scrawling graffiti on the undersides of bridges, or for driving with an open bottle of alcohol.
I’m now an hour behind, but in the next five minutes I finish Holly’s exam, write her a script for her antidepressant, and give her a handout on calcium. Then I sit again on my gray rolling stool, unsure how to end the encounter. Holly breaks the silence.
“Thank you for listening. I’ve never confessed this to anyone. No one knows but my husband and our three boys.” She clears her throat. “We should have seen it coming. We should have gotten help sooner … I recognize it now.”
When I stand, I don’t know my intention. I could give the woman a hug. That’s what I usually do, but instead I take Holly’s head between my hands and press my forehead against hers, my straight short gray-brown hair against the silky waves. I’m surprised and not sure what I mean by this gesture, what I’m trying to tell her, but I stand there for a moment, the silence in my brain going into hers. She smells like roses. It hurts to be a mother. It hurts to give birth. And it can hurt a lot worse late
r.
Then I start to leave but pause at the door. “What did you say her name was? Your daughter?”
“It’s Nora.”
“I’ll say a prayer for her,” I whisper. Holly’s eyes meet mine. “I’ll say a prayer for her.”
Prayer
There aren’t many words to my prayers. I have a little box on our dresser. It’s a round red wooden box, with a yellow moon and stars on the lid. I can’t remember where it came from, probably a present from one of the boys.
Nora, Holly’s daughter. May she eat and enjoy life and love herself, I write on a tiny slip of paper. And on another, Holly, mother of Nora, may she forgive herself and find peace. I open the box and gaze at the multicolored folded squares. There’s a prayer for my brother Darren, crippled after a surgery and living in Texas. There are prayers for each of my sons, Mica, Orion, and Zen. And for Maria, who has breast cancer. And for Ruth, whose daughter was killed in an auto accident. I refold the prayers. The box is getting full, but I’m superstitious. If I take someone’s prayer out too early, something bad might happen.
In my first years of nurse-midwifery school, I was taught not to mix religion with medicine. It wasn’t considered professional, but lately I’ve broken the rule. I used to pray on my knees for the boys, passionately calling out for someone to hear. “Please, keep my boys out of trouble. Help them learn to walk away from danger. Give them some sense. Shine your light on them.” I prayed the same words over and over every night. After a while, I realized I was badgering God. The Great Spirit had heard me the first time. I was probably getting on his or her nerves.
Now, each night I light a small white candle. I put my hand on the round red box. “God be with you,” I say, and my love goes into the air with the light, to my patients, my kids, whoever’s in trouble. I don’t know if it helps. It’s my prayer.
One name I finally took out of the box is Lyndie. Lyndie died of breast cancer. I took her prayer out after the funeral.
One name I haven’t put in is my own.
The Blue Cotton Gown Page 2