The Blue Cotton Gown

by Patricia Harman

  As soon as my brother and I were tucked in bed, the fight would begin. That’s when I learned to be on guard, waiting for something bad to happen. The voices would rise and then something would smash against the wall: a piece of furniture, a dish, or sometimes my mother. I pulled a pillow over my head so I couldn’t hear the swearing and the crying and things shattering. It didn’t work. I could still hear.

  In my hospital bed, flicking through the channels, I stop at a country-western video. It’s about the passing of time and the shortness of life. I lie with tears running down my face. I’m weary of working so hard, of always worrying about patients and finances. How long have we been on this not-so-merry-go-round? The illness and the pain have burned a hole through me and cleaned something out. In the emptiness is hope. All day I am quiet inside myself. My life is a handful of sand. Whatever I have, however much sand is in there, it’s all I’ve got left, all I’ll ever have and it’s leaking away, grain by grain, minute by minute.

  On the sixth day after admission, I’m finally discharged from the hospital. At home, I sit on the porch with a pink quilt tucked around me, thinking about my remaining grains of sand and what I’m going to do with them. All my thoughts about the IRS, the practice’s debt, and my patients’ problems have been washed away.

  As I look out across our garden, I see that the beans are now four inches high. Below in the woods, redbud are blooming, pink against the dark trunks of maple. The intense West Virginia green almost hurts. Something catches my eye and I turn slowly, aware of my incisions.

  Over the lake, a red-tailed hawk soars, and it seems that it’s there for me personally, a sort of message. We are all here for one another, it says, winding through the tops of the trees. Gifts to one another. The green beans shooting through the soft earth, the redbuds, and the raptor soaring through the high branches, just glad to be here.

  We are all here for one another and that is enough.

  CHAPTER 5

  ARAN

  “It’s going to be a girl. It is a girl, I mean,” Aran bubbles when she sees me walking down the clinic hall. She stands at the checkout desk wearing skimpy jean shorts and a tight white T-shirt over her rounding tummy. Her dark golden hair is clipped short, like a boy’s. Jimmy stands with her, his muscular left arm, tattooed with barbed wire, wrapped protectively around her waist. He’s let his hair grow, and the messy red thatch sticks up at the top. Except for the multiple studs in Aran’s ears, the girl has no other piercings, and no tattoo, I note. Unusual, these days.

  “That’s great,” I say, admiring the ultrasound photo that Jimmy reverently holds out. “Do you have a name picked out yet?”

  “Not yet. We had to find out if it was a girl or a boy.” Jimmy gently places the black-and-white photo in my hand as if it were a baby bird. I inspect it, and the young father contributes, “You can see the head, even the eyes and nose.” He points them out with a thick grubby finger.

  “Are you taking good care of yourself, Aran? Taking your vitamins and eating okay?”

  “She’s doing good,” Jimmy answers. “I make sure she gets fruits and vegetables and meat every day.” So far he’s doing most of the talking, and it’s the most I’ve ever heard him say.

  The young couple live in a thirty-foot trailer in Green Hills, out on Route 26. I’ve seen the place from the bike trail along Wolf Creek. It’s clean inside but smells like mold, Trish told me. Still, it’s all they can afford, and Trish and Dan had to lend them money for that. Jimmy has a job as an assistant bricklayer, and the young couple are doing better than might have been expected.

  “Well, you look great, Aran. Doesn’t she, Donna?” Donna, who sits at the checkout desk, glances up and smiles but keeps her fingers moving over her keyboard.

  Today Aran’s a rose in bloom. I return the ultrasound image to Jimmy. “It’s a beautiful baby,” I say. “Appears to be smart.” I’m kidding, but the young couple inspect the photo like they’re wondering how I can tell. Laughing, I give them both hugs then turn to go to my office. Halfway there, I glance back.

  Aran and Jimmy are still leaning their elbows on the checkout counter, admiring their unborn baby. Maybe they’ll be okay yet, I think, taking a breath.

  It could happen.

  Fall from Grace

  At 2:15, I roll over in bed. I’ve been lying awake thinking about Aran and Trish, wondering how they are doing, and about the memo that came late yesterday from our accountant. I wish Mrs. Gorham had called or told us in person, but the woman acts as if coming to the office is an imposition, and she always writes letters or communicates by e-mail. Pittsburgh is three hours away. Maybe I expect too much. Tom would say so.

  Our experience with accountants is limited. We’ve only had two. The first one, Bob Reed, was a total disaster. Bob, a short, balding ex-hippie with a ponytail, was affable and met with us in the conference room monthly, but he was incompetent. Since Tom and I had never been in business before, it took us two years to find out just how bad he was, and then another three months to fire him.

  The new accountant seems to know what she’s doing. I think she does, anyway; there’s that air about her. And the woman has all kinds of awards and certificates on her office walls. There’s a framed diploma from the University of Georgia and a plaque from the chamber of commerce. There’s an article from the Pittsburgh Post-Gazette saying she’s one of the rising businesswomen in the state, and a letter of appreciation from the ACLU for volunteer work.

  I pull on my robe. In the bathroom, I find the jam jar of scotch and carry it into my study. This was the TV room a few years ago. I took it over for an office when our youngest boy went to college. The large white corner desk has space for my laptop and my printer, and there are two rows of cubbyholes for photographic equipment, prints, and negatives. There are two tall white bookshelves, a narrow daybed with a pink patchwork quilt, and a long bulletin board with snapshots of the boys.

  There’s a photo of Mica at ten kneeling next to Orion, who is three and carries his grandpa’s lunch pail. There’s Zen at six, with his new spiked haircut, all of them little blond boys. On the walls of the study and in every spare corner are prints, hand-thrown pottery, photography, and sculpture. After rummaging around in my briefcase, I pull out Gorham’s letter and read it again.

  Dear Dr. and Mrs. Harman,

  Recent communication with Andy Bowlin at the regional IRS office in Chicago has confirmed that the $21,000 adjustment to your income tax for the previous two years is not an error. I explained to Bowlin that the error was unintentional, but it doesn’t matter. Unless the back taxes are paid in full, in the next ten days, there will be additional penalties. Please let me know when you will be able to send the check.

  I’m not sure why I needed to read the letter again. The meaning was plain the first three times. And the news is still bad. On my way to the porch, I pass through the kitchen, its white tile and whitewashed oak cabinets gleaming in the moonlight. I could say it isn’t fair, or that the government’s crooked. I could blame it on Bob Reed, but I just feel stupid.

  Leaning against the porch rail, I tilt my head up. The stars are full out. How can my husband sleep? I resent it. Isn’t he worried? I take a big gulp of scotch. Tomorrow I’ll have to call Mrs. Gorham and tell her the truth, that we have no money. No doubt she assumes we have assets we can cash in, but we don’t. We’ve no personal savings or surplus in the practice checking account, and no one to borrow from either, no sugar daddy anywhere.

  Rebecca probably thinks that because Tom is a doctor, he’s loaded, but he didn’t go to med school until he was thirty, and he didn’t finish his residency until he was thirty-eight. We’re paying off his student loans at the same time we’re putting the kids through college.

  I take a deep breath and let it out slowly, remembering something I heard in my women’s meditation group: “Let go and let God.” I say it three times, trying to mean it. The sleep medicine has kicked in and I’m tired now. I leave the door to the porch open a
nd crawl under the covers. Tom sleeps on blissfully, curled on his side with a pillow under his arm to support his bad shoulder.

  I married an agnostic who has the faith in life of a born-again Christian. Sometimes I’d like to wake him up, make him wander the house with me. Make him stand on the shadowy deck, watching like a sea captain for icebergs ahead. If he were more concerned about office finances, the boys’ futures, and the high cost of medical-malpractice insurance, I might worry less.

  Other times, I’d like to wake him just to sit on the porch with me, sit in the dark looking out at the stars. We could share the mystery of unseen wild things moving through the woods, the sound of the water, the holy smell of the earth.

  HEATHER

  I am surprised to see Heather, my teenager pregnant with twins, added to the schedule late Friday afternoon. Her name appears in red, appropriately, on the computer printout: Add-on: OB, bleeding. I cringe. With the urgency of my gallbladder attack, the prolonged hospitalization, and three weeks of sick leave, I hadn’t realized the young woman missed her last OB appointment. It’s been over a month. At three o’clock, I knock apprehensively on the exam room door, not looking forward to the visit.

  Before I have time to open my mouth, Mrs. Gresko starts in. “Well, she has cramps now too,” the grandmother says. There’s something about her tone that blames me. T.J.’s not present.

  I settle myself on the stool. “Can you tell me how much bleeding you’re having, Heather?” I want to ask why she’d skipped her last appointment. She could have seen Tom or one of the other nurse-practitioners while I was sick, but it doesn’t really matter at this point.

  Mrs. Gresko answers. “Not much now. It stopped for three weeks but there was a lot last night. There was blood all over the place.” She still clutches the old white leather bag. Today the older woman is wearing a dark gray polyester jacket. I notice again how thin Heather is. Her little arms poke out of her lavender turtleneck, and I can see the nipples of her tiny breasts through the knit. Her skin is almost translucent.

  “I’d like to see the sanitary pad with the blood on it,” I say. The patient glances at her grandmother.

  “She just changed in the bathroom. We didn’t know you’d want it.”

  “Well, yes. It helps to see how much blood there is, and what color. I’ll need to examine you too, Heather. Why don’t you take off your bottoms while I go hunt for the pad.” I hand her a folded white sheet.

  “Do you have to check her? Can’t you just do another ultrasound?”

  “No, now that she’s having cramps, I really need to look inside her vagina and feel her cervix to see if it is starting to open. What Heather is experiencing …” I hate having to address the older woman when she isn’t my patient. I swivel and direct my comments to Heather. “What you are experiencing, Heather, is called a threatened miscarriage. We always hope for the best in situations like this, but it’s still important for me to see if anything’s changed inside.”

  “Don’t you think all this poking around could make her lose the babies? I don’t really think it’s a good idea.” I see Mrs. Gresko’s eyes narrow through the clear plastic cat’s-eye frames.

  Feeling like shouting, I force myself to answer calmly. “I’ll be very gentle, Mrs. Gresko. What I’ll be doing could never cause a miscarriage. Now, Heather,” I say to the girl, who still hasn’t spoken, “please undress while I hunt for your sanitary napkin. Just take off your pants and put this sheet over your lap. You don’t need a whole gown. I’ll put a disposable pad under your bottom to protect the exam table in case you bleed.”

  In the bathroom across the hall I put on gloves, fish through the stainless-steel trash can, and find the half-soaked mini pad under some paper towels. That’s all I need. I tap on the exam room door and enter again. Heather has followed my instructions and is already lying with her feet in the footrests, her very thin legs spread apart passively. “I found it,” I say. “It was right on top. Is that the most bleeding you’ve had?” I’m addressing Heather, with my back to the older woman, but Mrs. Gresko still answers.

  “I told you it was a lot more last night. It’s slowed down considerable.” She has the upland accent of a family that’s lived in Appalachia for generations. Without saying anything more, I sit down on the stool between Heather’s legs. It’s been a long week.

  The amount of bright red blood pooled in Heather’s vagina surprises me in light of what I’ve just seen on the pad. It takes three large cotton swabs to soak it all up. When I pull the swabs out, the vagina fills up with blood again. This isn’t good. I glance up at Heather to see if she’s hurting. It’s impossible to tell. The girl stares intently at the ceiling.

  “There is a fair amount of blood. Does this hurt?” I palpate the young woman’s cervix and uterus.

  “Does it hurt? Tell the doctor,” says Mrs. Gresko. Heather hasn’t had a chance to answer, but the old lady says it a second time, louder. “The doctor wants to know if it hurts,” she shouts. Heather shakes her head no. When I pull off my gloves, I keep them low and quickly throw them into the trash to hide the red. It’s a useless gesture. They know.

  And I ignore the appellation of doctor. To remind Mrs. Gresko that I’m a nurse-midwife would only confuse things right now. Washing my hands, I notice my reflection in the small mirror next to the sink and straighten my dangling silver earrings. I look older today, and my head hurts. Maybe I look older because I’m so tired. I pull back my shoulders, run both hands through my hair, and smooth my aqua silk shirt, then I sit back on the stool.

  “Well, there’s good news and there’s bad,” I start off. “I really don’t like the appearance of all that blood. It’s more than I expected.”

  “I told you there was a lot,” says Grandma.

  I nod. “Still, the cervix is closed. That’s a good sign. We need to do another ultrasound to check the fetal heart tones.”

  “That’s what we came for,” says Mrs. Gresko.

  “Well, that comes next. I need to go see if the ultrasound room is empty.”

  As I round the corner, I get lucky. “Hey, am I glad to see you,” I say, coming up behind Tom. He’s squatting down in his office, searching for something on the bottom shelf of his bookcase. He’s wearing light blue scrubs that hang low on his hips. His royal blue scrub cap is tied at the back of his head. Grinning, he pulls me toward him, trying to get his mouth on my neck. I struggle a little. Now I don’t feel so old!

  “Come on. Be serious.” I laugh, trying to straighten my collar. “Let’s have a little professionalism around here!”

  “What’s up?” He lets go and flops down in his leather chair.

  “You remember Heather? The young woman with twins?”

  “Yeah? They’re taking my patient into the OR any minute, I have to go back to the hospital.” He knows I’m going to ask him for something.

  “Well, she called with increased bleeding. The nurse had her come in, and there’s a lot of blood, not just a little. I was surprised. Could you do another ultrasound?”

  He’s standing up. “Come on. Let’s go. Is she in there?”

  “No, I’ll get her. She’s already undressed. You set up.”

  I run back to the exam room and explain to the patient that if we hurry we can do the ultrasound right now. Trying not to be rude, I wrap a sheet around Heather and rush both women down the hall to the corner exam room, where Dr. Harman is waiting. For the first time, I see that the older lady limps. I’d noticed her dark swollen legs before. She’s a setup for blood clots.

  In contrast to the last time, this visit is cheerless. Tom explains that twin number one no longer has a heartbeat. The threatened miscarriage had turned into an actual miscarriage, complicated by the presence of a remaining live fetus.

  “There’s not really anything we can do now but watch and wait. The other twin might still make it,” he tells the young woman and her grandmother. Then his pager goes off. “I’m sorry, I have to go. They have a patient ready for me in the
operating room.” He rests a hand on Heather’s shoulder. “I’m sorry,” he says again. Then he pats her arm, nods at Grandma, and leaves.

  I slowly turn up the lights with the rheostat, then sit on the exam stool. In the dark, I’d thought Heather showed no emotion and I’d wondered if she even understood, but now I see her wipe her eyes with the tips of her fingers. For once, Mrs. Gresko is quiet. She adjusts the strap of her white leather bag, fiddling with the gold buckle.

  “I’m sorry too. I was hoping both babies would make it. Even with all that blood, I thought they might.” The two women are silent. “Do you understand what Dr. Harman said, Heather, Mrs. Gresko? One baby has died. The fetus closer to the opening is still alive, but it’s at risk. If the bleeding gets too heavy, you may have to have a D and C to take both babies out, but there’s no way to take out the one that’s dead without hurting the live baby. Eventually your body will absorb it. We’ll have to watch carefully for infection, of course. We can’t take a chance on your health or your ability to have more children.”

  Heather clears the tears from her throat. “I don’t understand why it happened.” It’s the first time today the girl has pronounced a full sentence, and her beautiful low voice still surprises me. I scoot up closer on the rolling exam stool and touch Heather’s knee, expecting her to pull away, but she doesn’t. She stares at my lined, freckled hand, which looks almost as old as Mrs. Gresko’s. I stare at it too. That’s what washing your hands at the exam room sink before and after each patient will do. I should use more lotion.

  Mrs. Gresko is probably not even near seventy, she just looks it. Hard life in the mountains, cigarettes, and poor nutrition make women age prematurely. I wonder whether Mrs. Gresko raised Heather or if she’s just standing in for Heather’s working mom, but I don’t want to ask.