The Blue Cotton Gown

by Patricia Harman

  I take a long, shaky breath. I would like to hunt this pervert down, but I imagine he’s long gone. Penny sits calmly, her head tilted, inspecting one of the framed photographs on the wall. It was a long time ago for her. To me, it just happened.

  “This is like where I live,” the woman says, nodding at the picture. “Where was it taken?”

  “At the state park.” The photograph is one of mine, a view of the forest in the fall when the leaves are in full color. There’s a mist blurring everything, and the sun pouring through.

  “I’m sorry all that happened to you,” I say, apologizing on behalf of the 99.9 percent of doctors, physician’s assistants, midwives, nurses, and nurse-practitioners in the world who are decent and caring people. Penny shrugs.

  “Let me get you some samples of vitamins and calcium. Do you need anything else?” She shakes her head no. When I return with the bag, I want to hug the young Penny, the seventeen-year-old Penny. The middle-aged Penny is waiting near the door, her black cloth handbag over her shoulder, dressed in jeans and a bright red sweater.

  I close my laptop and look out at the golden sun setting into Lake Erie. I could have taken the photograph off the wall and given it to her. I wish that I had.

  MRS. TERESI

  My husband exhales in a drawn-out sigh. “What’s up?” I ask.

  “Huh?” We are hiking along the beach on Pelee Island, about a mile from the cottage. The waves lap up on a slate rock surface as smooth as poured concrete. A round boulder sits exposed, left by a glacier millions of years ago. The air smells of rotting fish.

  “The long sigh, what were you thinking?”

  Tom breathes out again slowly. “I’m just thinking about Dottie, Mrs. Teresi, and the phone call I made to the hospital yesterday. I was wondering how she is now, hoping she’s better. When I called Dr. Hazleton from the Pelee Tavern, he said the clot was resolving and she was starting to eat, but if she gets febrile again I’ll have to take her back to the OR for the third time. If the infection is resistant to the antibiotics, I’m not sure what I’ll do.” He pushes back his rimless glasses and smiles sheepishly. “I know,” he says. “We said we wouldn’t talk about work this weekend, but I’m still worried. Sometimes I think I just want to walk away from it all.” He whistles for Roscoe, who’s wandering along the edge of the lake but getting too far away. If that dog sees one rabbit, she’ll run for miles.

  “Remember when the phone rang at home the other night about three?” Tom goes on. “It was the nurses calling. I had this sense of dread that something else would go wrong and I’d be called in for a hearing in front of the peer-review committee.” He picks up a stone and skips it across the water. “You know that happened to Dr. Runnion, don’t you? Hal Runnion? He was harassed for two years by the committee. They’re a board of docs authorized by the hospital to investigate surgical complications or medical errors, a real power group. They looked at every surgery Hal had ever performed, criticized him for every minor complication. Dr. Jamison told me he thought Runnion’s competitors on the committee were trying to destroy him. If that’s so, it worked.

  “The peer-review committee has no checks or balances.” Tom shrugs and walks on. “Their meetings are secret, the minutes protected by law. I don’t know what went on in there, but he finally lost his privileges.”

  “Dr. Runnion? I remember it now. There was a big article on the front page of the Torrington Tribune. They made it sound like he was a quack, a danger to the community.”

  “Yeah, it ruined him, and the hospital’s required to report any restriction of a physician’s privileges to the National Practitioner Data Bank, on the Internet. After that, Dr. Runnion was finished, couldn’t get liability insurance and couldn’t get privileges anywhere else. He ended up having to close his practice and leave town. Too bad. He was a good doc … Really cared.”

  I listen, for once not saying a word. I’ve never heard Tom talk like this before.

  “There’s no way any surgeon can be without complications forever,” he goes on, “especially with the cases I have. But when the phone rang, I thought, I like my work and I think I take good care of my patients. I know I do. But this tension isn’t worth it. I don’t like being a surgeon that much.”

  “Do you think that’s what’s going to happen to you? Peer-review harassment? Like with Dr. Runnion? Burrows and Hazleton are on that committee, aren’t they?”

  My husband shrugs. We trudge on in silence, watching Roscoe run into the water and back.

  Tom is a compassionate doctor, so careful in the OR, so competent, so calm. I know how much he’s concerned about his patients, and the OR nurses like him. Many of them come to him for gyn care, and they’re good judges of competence. It makes me sad to hear my husband ready to give up a career in medicine he’s worked so hard for.

  “We can quit any time,” I say, reaching for his hand. “Maybe it would be for the best. There are lots of other things we love to do. Making ceramics, writing, photography, taking care of the honeybees.” I pull him over to a smooth square boulder and we sit down. Far across the water, against the red sunset, two sailboats lean into the wind.

  “Red sky at night, sailors delight. Red sky in morning, sailors take warning,” I say aloud.

  Tom stares straight ahead, not seeing any of it, not the silver water reflecting the pink and red clouds, the seagulls gliding across the bay, or the white sailboats on the horizon. “Unfortunately,” he counters, “ceramics, photography, and honey don’t pay the bills.”

  “But the boys will be out of college soon. That will help. We could put the house on the market, get a smaller place, and go back to being hippies. Well, sort of hippies … but we’d have to have indoor plumbing!”

  I go on, pressing my point. “I could sell my photography. You could expand the beehives and market the honey.” If we closed the practice, the worst part for me would be letting go of the staff, women who’ve stood by us since we started.

  We rise and head back toward our cottage. Tom whistles again for Roscoe. She’s as rebellious as our boys, and she runs the other way. Finally we catch her and put her back on her leash. The knot that had loosened in my stomach over the last few days begins to tighten again, like the collar around the dog’s neck.

  Later I ask him, “Do you think we should call the hospital and check on Mrs. Teresi after dinner?” We’re at the Tim Goose Inn, the only gourmet restaurant on Pelee. It’s our last night on the island.

  “No, I’ll call in the morning. Dr. Hazleton is competent to cover.”

  “But don’t you want to know how she’s doing?”

  “No,” Tom snaps. “I called yesterday. I don’t want to hear about it until tomorrow, when we get back to Torrington. Even if she’s worse, there’s no way to get off the island tonight.”

  “It’ll be okay,” I say quietly, wanting to mean it.

  “Yeah, probably.”

  Then we say nothing. After dinner, we pick up our bikes where we left them in the bushes and pedal back to the cottage. It’s almost dark now. Roscoe follows on her leash as we roll through the dusk over gravel roads, past the campground with campfires burning and the marina with the little lights from the fishing boats. I think again how it would be to sleep without concerns about taxes, office finances, peer-review committees, surgical complications, or the suffering of patients. Tomorrow we will go home again, back to the cares of the world.

  It has been a long time since the only responsibilities we had were to ourselves, our family, and God.

  Dream of Flying

  For three days I’ve managed without my sleep medicine. Tom’s worried I’m drinking too much. Maybe I am, but I’m trying … I stand in the bedroom, listening resentfully to his soft snore, then open the glass door to the porch. High in the sky the crescent moon holds a bright star in its arms. I’m restless tonight and I don’t know why; I’m exhausted, but my brain won’t turn off. With a shrug of disgust, I go back to the bathroom for the jam jar of scotch, then ret
urn to the deck chair overlooking Hope Lake.

  Mica hasn’t called for a month. If I say anything, he’ll be consumed by guilt and even less likely to telephone. My oldest has a problem with guilt. I don’t know if he got that trait from Stacy or me, but it wasn’t learned from Tom. I don’t think Tom ever feels guilty. We’re out of milk and toilet paper. I should stop at the store after work. The thoughts free-fall through my mind as I stare into the woods.

  It’s quiet tonight. Then the wind comes up, and the alcohol settles me. “Thank you,” I say out loud into the darkness. Thank you to whom? Thank you to God? Thanks to the booze? Thank you to the comfort of the dark forest and lake below?

  At the foot of my bed I drop my terry robe and crawl in beside my gentle, hopeful husband. I sleep … then I dream:

  Four women, naked under their thin blue cotton gowns, wait on four chairs in the exam room. They sit like a Greek chorus, muttering secrets they won’t tell the midwife.

  One is young and afraid. Her long brown hair hides her eyes. She’s pregnant by her fifty-year-old stepfather. One is tall and impatient. Her coiffed wig hides her baldness. She has eight months to live. One is obese and ashamed. She has bruises on her back and doesn’t please her husband anymore. One is shrunken and wise. She had sex with herself before breakfast.

  From the corner of the exam room, I watch unseen. I too am naked under my exam gown.

  Kneeling on the cold linoleum floor, I pray, adoring these women whose lives are as knotted and scarred as my own. The sun rises in the windowless exam room and the walls fall back.

  Like a red hawk, I rise.

  When I look back, the four women are flying with me, and their blue exam gowns open like wings.

  Fall

  CHAPTER 8

  CAROLINE

  The first day back in the clinic after a break is the hardest. It takes me a while to get in the swing.

  This morning the office is tense. Donna is crying in the kitchen, but before I can find out what’s going on, a petite Asian woman stops me in the hall. “Hi, Patsy. Do you remember me?” I’ve got other things on my mind, but I answer politely, “Mmmmm, you look familiar.”

  “You did my first delivery, don’t you remember? I’m Caroline, the patient whose baby was breech at thirty-eight weeks, then head down, then breech again. Dr. Harman was planning to do a C-section, but just before going into the OR, he did one last scan and found the baby was head down again.” She waits for me to remember.

  “You’re Caroline Akita.” My face lights up. “How could I forget.”

  “I just wanted to say hi. I saw the other nurse-practitioner for my gyn annual. Your schedule was full.”

  As always, I’m apologetic. “Sorry.” I give her a one-armed half-hug. Watching the tiny woman walk away, I think back to the birthing room. When was this, six months ago, a year?

  “So what do you want to do?” Dr. Harman is asking the patient after doing the final ultrasound in the triage room of the birthing center. “The baby’s in position, head down again. You’re already three centimeters. Maybe we should get labor started before the little guy turns again.” We all agree.

  Tom breaks Caroline’s water bag with an amnihook, a slender plastic device that looks like a long white crochet needle. I write on the admission note, Induction of labor at term, artificial rupture of membranes. Diagnosis: Unstable lie. The fluid is clear, not bloody or stained, so Tom goes back to the office.

  Two hours later, the patient is dilated to five centimeters. Contractions are coming every six minutes, but Caroline never groans, never moans, never asks for pain medicine. Once she says something in Japanese to her husband. The man places his hands on each side of her face and kisses both her eyes.

  There’s nothing much for me to do, so I observe from the rocking chair, occasionally murmuring words of encouragement. “You’re doing so well.” “That’s perfect, Caroline.” “Go with your body. Don’t try to get away from the pain. The contractions will only hurt more.”

  Mozart plays on the boom box, the fetal heartbeat remains 145 with good accelerations, and the mother’s vital signs are all normal: my favorite kind of labor. But when I do the next vaginal exam, I’m surprised to discover that the fetal head, which was engaged at zero station earlier, is now transverse and out of the pelvis, meaning that the baby has moved backward and is now turned sideways. This isn’t good.

  “How’s she doing?” asks Jay, the concerned husband.

  “Still five centimeters, but don’t be discouraged. The baby’s just trying to get into position. Time to get up and moving again, Caroline. Why don’t you try squatting, and, Jay, you can stimulate her nipples. See if you can make the contractions stronger.” The labor nurse, Joy, draws me toward the door.

  “Everything okay?”

  “The head’s not engaged anymore. It’s turned sideways now, transverse. I know I could start Pitocin, but Caroline’s doing so well, and she wants to go naturally if she can … I’m going to give her two more hours, then if there’s not good progress we’ll augment her labor. You’d better check fetal heart tones more frequently, and I better level with the couple. Let them know what I’m thinking.”

  From two until four, Jay holds Caroline as she sways back and forth in a slow dance, one of his hands on her breast, twiddling her nipple. Contractions are now three minutes apart. When I next examine the young woman, I’m pleased to find the head back deep in the pelvis again and the cervix eight centimeters dilated.

  “Why don’t you start pushing, Caroline? Just lean on the baby, add a little oomph to the contractions.”

  An hour later, the patient is completely dilated. That’s when everything hits the skids. As the baby begins to descend into the birth canal, the fetal heart rate drops below ninety. We roll Caroline on her side and I feel in the vagina for a thick rubbery cord coming in front of the baby’s head, one of my worst nightmares, but there’s no cord, just a little round head as hard as a potato. As Caroline’s pain eases off, the fetal heart rate improves. Four more contractions, same story. Each time, the fetal heart rate falls lower, takes longer to return to where it is supposed to be.

  “Call Dr. Harman, Joy. Tell him I need him here now.” The nurse nods and bustles out of the room. I have dealt with many complications, including babies born with the cords around their necks, but part of being a good midwife is knowing when a patient might need a cesarean section and when to call an OB to your side.

  “Oh no, I have to poop!” Caroline cries with big eyes. Then, realizing it’s not poop, the young mother puts her chin to her chest and pulls back her legs, instinctively. Her labia open, and a baby’s head, covered with black hair, is right there. The fetal heart drops again, this time to fifty.

  “Push hard, Caroline. This is the most difficult part for the baby. Push like your baby’s life depends on it.”

  The nurse returns, sees what’s happening, and pulls up the gooseneck lamp and the stainless-steel table. “Dr. Harman’s on his way. It will take five minutes, maybe ten.” She glances at the clock on the wall. Caroline growls deep in her throat, not waiting for Tom, and I don’t want her to.

  “Push!” I exhort. “Push like you mean it. Make every push count.” I give a low, prolonged groan from deep in my abdomen to demonstrate. Jay, aware of the slow fetal heartbeat, bends low with his arms around his wife and grunts too.

  Then suddenly the head is crowning. “Blow, blow!” I hold up my hand like a traffic cop. “I have to check for a cord around the neck and then you can push again one more time.”

  Running my fingers along the side of the baby’s neck, I feel for a smooth rope-like piece of flesh. An umbilical cord around the neck is not unusual, but when I find this one and try to slip it over the infant’s head, it’s too tight. I try again, put some muscle into it, and this time the rubbery cable of flesh slides over. But wait! There’s another loop.

  “I got to push again!” yells Caroline as she uncontrollably bears down. “It’s coming!”
/>   “No! Blow! Jay, make her blow. There’s more cord here and if she pushes it will tighten.”

  But there’s no stopping Caroline now. As the baby emerges, his face dark blue from near strangulation by the umbilical noose, he lets out a cry and spins in my hands, unwrapping the cord that is still tangled around his chest and shoulders.

  At that moment, Tom walks into the room, pulling a blue sterile gown over his shirt and tie. “Hey, nice work,” he says, noting the crying baby I’m placing in Caroline’s arms. “I shouldn’t have hurried.”

  “Cord around the neck times two and twice more around the chest,” I report, holding up the now flaccid rope of flesh, twice as long as normal. “It must be almost four feet. We’ve had deep decelerations with every contraction for the last fifteen minutes.” Tom pats me on the shoulder, understanding the pressure I was under.

  “Nice work, everyone. No wonder your baby couldn’t make up his mind which way to come out; he was dangling from a bungee cord.” My husband smiles his wonderful smile.

  Such a special event, bringing new life into this world, how could I ever forget the Akitas’ birth? Still, I comfort myself, there are so many birthing stories, more than a thousand, and even though I’d barely recognized Caroline’s face, when she’d reminded me of the details of her delivery, it was all right there, her labor and birth, embroidered with colored thread on my heart.

  “Better get a move on, babe. You’re running behind.” Celeste swats me on the butt with a yellow chart, and I drop with a thud back into the world of the clinic. Seven more patients to see before lunch.

  At ten thirty, Dr. Harman shows up, wearing scrubs and two hours late for clinic. He doesn’t speak to anyone, just grabs his stethoscope and heads for his first exam room. There’s no chitchat among the nurses, no joking, no gossip, no stories about their families. When I get a chance, I pull Celeste into my office. “What’s going on?” I ask her. “I saw Donna crying.”