The Blue Cotton Gown

by Patricia Harman

  That night, still obsessed about the possibility of being sued, I leave the office early to avoid the five-o’clock traffic. I can’t see that I was negligent. I’m sure I would have done a careful breast exam, especially knowing that Rae’s sister was dying of breast cancer. But I’m not perfect. It haunts me that as I did her exam, I could have been paying more attention to Rae’s emotional pain than to her breast tissue under my fingers.

  After dinner, sitting on the porch, I tell Tom about the request for records. It’s the first time we’ve chatted in weeks. Dottie Teresi is now out of intensive care and improving. There’s even talk of a discharge, though Tom’s not holding his breath.

  “Let it go,” he says, holding my hand. “You do the best you can. You use your best judgment. You listen to the patients and you try to help them. It doesn’t matter. You can still be sued. Most of these threats of lawsuits don’t materialize anyway. Let it go.”

  I love my work, but do I love it enough to go though the fear of a medical-liability suit? I shake my head, squinting at the violet sky and the lake and the stars, trying to get some perspective on things. The full moon is just coming over the house, and there’s the smell of drying leaves in the air.

  The universe is endless, without a center and without an edge. Tom and Patsy Harman are just two little specks in the cosmos, two spirits trying to do some good on this planet.

  I still feel like crying, and I’m not sure if it’s because Rae Blandon is dead or because McKenzie, Rogers and Clager, PLLC, are getting ready to take me to court for ten million dollars.

  ARAN

  Aran goes into labor almost two weeks late, and the birth goes better than expected. My husband’s required to take call one night a month for the department of OB-gyn at Torrington State University Medical Center in order to keep his surgical privileges there, so on rare occasions he’s allowed to attend one of our own patients’ births. Though the university hospital, not Tom, will get paid for the delivery, it doesn’t matter. He promised Trish and Aran he’d be there.

  “I was surprised to see Jimmy in the birthing room,” Tom tells me as he crawls into bed at three in the morning. “He looked a little green.” We laugh.

  Tom’s exhausted and hasn’t shaved for two days, but he’s relaxed and his eyes twinkle. I lie now in his arms, listening to the story by the light of the prayer candle, missing the smells of amniotic fluid and blood, the grunts and groans and ecstatic shouting of birth.

  “Trish was with Aran as her labor coach,” Tom goes on. “Dan stayed with their other kids in the waiting room. Aran squatted on the bed and pushed the baby out in twenty minutes.”

  “What did she have? A girl?”

  “Yep, a seven-pound girl. Apgar scores nine and ten. She looks great.”

  Tom has to get up at six so I leave the detailed questions for Trish. How did Aran handle the pains? How long was she in labor before she started pushing? Did Jimmy help with the coaching? What did Dan think? We kiss a little, just enough to leave me lying wide awake; he’s asleep before his eyes close.

  The next day I go to the postpartum unit to help Aran breast-feed and find that she’s already nursing. “I did it! Almost natural!” the girl says, smiling. “I stayed on my feet during labor just like you told me. I got in the shower the last two hours and they couldn’t get me out. All I had was a little IV medicine at the end. I don’t even have any stitches.” She’s wearing a new pink flowered nightgown and is still running on adrenaline.

  Jimmy’s there too. He’s holding the seven-pound girl, tenderly wrapped from her toes to her chin in white flannel with a white knit cap on her head. I reach over and peek under the hat to look at her black curls and smell the new life.

  Jimmy looks up, his brown eyes brimming with tears, his short red hair still plastered down over his forehead from sweat. “She’s a rosebud of a baby,” he says.

  They name her Melody. Mellie for short.

  PENNY

  “You have a patient in room two.” Abby, my nurse today, is dressed as usual in a gingham uniform, this time lavender checks. She stands in the door to my office and hands me a chart.

  “You okay?” I ask. Now Abby’s dad is in the hospital too. He had a stroke and is not doing well.

  Abby shrugs. “I’m worried about my father, but it’s my mom and my sister that are driving me nuts. They want me over at the hospital with them every minute, but I can’t just leave work. I can’t afford to take more time off.” She sucks in a deep breath. There are tears in her eyes. “You know, my mom’s losing her memory. She doesn’t understand I have a job, I have family.”

  “First Donna’s dad and now yours’”

  “Yeah, I got to go.” Abby flies off and I sit for a minute, giving my patient time to put on her thin cotton exam gown. All night the rain and wind sang together, and now, through the window, I see trees that only yesterday were alive with color are today half bare.

  I flip the chart open and stare at the notations, not really reading. This morning I found a letter from the IRS in my stack of mail. I didn’t want to open it, afraid of what I might find. We’d paid the twenty-one thousand dollars we’d owed them because of our former accountant’s screwup. What now? It was a letter claiming we are behind in our last-quarter taxes. When I called Rebecca Gorham’s office to inquire about what was going on, her receptionist had told me Rebecca was in Europe. The part-time secretary, a college student more interested in painting her nails than in accounting, assured me she’d have Mrs. Gorham contact us as soon as she gets back. I push back my chair with a giant groan then head heavily toward the exam room.

  Tapping twice on the door, I slide in and ease myself onto the stool. “So how are you, Penny?”

  The bleached blonde gives me a half smile. “Pretty good, I guess.” Her hair is showing dark roots and her nose is too big for her oval face, but she has pretty, full lips and round gray eyes. The problem’s her skin. It’s pockmarked and covered in thick pancake makeup.

  “So what brings you here today? Do you just need a yearly exam or are you having some problems?” I press my aching back against the wall and wait. Penny sits at the end of the exam table with her arms crossed, the sheet pulled up to her chin. “Are you cold?” I ask.

  “No, I’m okay.” The patient’s voice is low for a woman, the kind of voice you get with a sore throat or smoking. “I just need a Pap test and a refill on my birth control pills.” Her eyes slip away.

  I open the chart to review her history. The patient was in the clinic for vaginitis a few months ago. “Any further discomforts with yeast …” I ask—then I stop. What catches my eye is my last note: Patient relates history of sexual seduction and abuse by gynecologist when she was seventeen. Now I remember Penny, and I feel just as sick as I did before.

  On automatic, I go though my usual health-related questions, thinking about the story the patient told me at her last visit. “It appears you’ve had a problem with your skin,” I mention, just to get the image of the warped gynecologist out of my mind. “What treatments have you tried?” The scars on Penny’s face are deep. Some are new.

  The patient shrugs. “Over-the-counter stuff.”

  “Have you ever been to a dermatologist?”

  The woman shakes her head no. “I just got health insurance this year.”

  I gesture for Penny to lie down. The patient complies but keeps the sheet pulled up over the exam gown. I listen to her heart and lungs. “Now I need to check your breasts.” Penny presses her arms up tight to her sides. “Can you go like this?” I say, putting my hands up behind my head. Penny hesitates, and then follows my directions. The same sorts of divots I’d noticed on her face cover her arms.

  “Penny,” I say, taking her hand and inspecting her forearm carefully. “Do you have a drug problem?”

  “No.”

  I scrutinize the other arm. “Then what’s this, these marks?” Both arms are covered with the same fresh red and old white scars.

  “I didn’t kn
ow you’d be looking at my body. I thought this was a gyn checkup.”

  “Well, I’m concerned. How do you get these scars?” I ask again.

  The woman stares at me defiantly. “I’m a picker. It’s a habit. I pick.” She spits out her words like bullets.

  “You pick when you’re nervous?” I glance at her face again.

  “Yeah, I pick when I’m nervous, when I’m upset, when I’m stressed … I pick until I bleed.” She explodes. I see Penny’s pain then. “I’ve tried to stop, but I can’t … I’ve done it since I was a teenager.”

  “What have you tried?” I run my hands over the patient’s arms. “Have you gone to a counselor or a therapist?”

  “A long time ago.” Penny shrugs again. “It was a waste.”

  I have a sudden insight. “Did this start after you were abused by that doctor?”

  “No, before that.” She shakes her head, looking inward. “It was some before that.”

  I hesitate. “What started it? Do you know?”

  Penny stares at me, then at the white-tiled ceiling. “My uncle.”

  “Your uncle? How long ago was this?”

  The exam room is very quiet, no sounds from the hall. “What I told you before,” the patient starts out, as if seeing it all on video. “My husband. He wasn’t my first, or the gynecologist either …” I give up the exam and draw my stool closer. Penny continues, describing it like it happened in another life.

  “I was thirteen. We lived in the country on Milford Pike. You know where that is?” I nod. “My mom worked and my uncle, her younger brother, roomed with us for a while. He was twenty-two.”

  I know the road. There’s a nursery out there. The boys and I used to go out in the spring to buy plants.

  “Did your uncle force you? Rape you?”

  “Nah, not really.” She stops. “Do I have to talk about this?”

  “No, you don’t, but you can if you want …” I picture the patient at thirteen. Her hair would be golden and long, her skin clear with maybe a few light freckles.

  Penny hesitates, then begins. “At first I liked the attention and having a secret from my mom, who if you have to know is a hard-assed bitch.” She looks away. “He told me he loved me … I had two younger brothers, but they played outside most of the time. That’s when we’d do it. My dad was killed in the mines.” I don’t even blink. “My uncle, he told me if anyone found out, we’d both be locked up. I believed him.”

  “Twenty-two?” I ask. “Your uncle was almost a man, almost ten years older than you. Did that feel okay?”

  Penny shrugs. I’m not sure if that means yes or no, but she goes on. “One day she came home early, my mom. She worked in the shirt factory at the edge of town and the power went out. You know the old shirt factory? It’s closed now. She caught us on the floor of the pantry.” Penny’s face flushes and she checks from the corners of her eyes to see if I’m shocked. I am, but try not to show it. I’m picturing them on the uneven worn floorboards in the small corner room pumping away with their jeans half down when the mother comes in. What the hell are you doing? the woman would yell. Get the hell off of her.

  “When my ma discovered us, we told her we were just goofing around, that it was the first time and would never happen again, but she knew the truth.”

  “So what happened to your uncle? Did he get in trouble?”

  “Yeah, but it wasn’t all his fault. My mom and grandparents got together and decided if he joined the army and didn’t come back for twenty years they would forgive him and wouldn’t involve the authorities. They didn’t want trouble from the welfare department or the courts. My grandpa drove him to the recruiters in Pittsburgh the next day. I never even got to say good-bye, and I’ve never seen him again. It was a scandal, but they mostly kept it hush-hush from the rest of the community.” She trails off. I don’t even look at my watch.

  “After that my mother never said my name again. She never forgave me; she turned bitter. I’d shamed the whole family. I wasn’t allowed to go anywhere but school, not even with girls. That’s when I started picking and had to go to a therapist.”

  My mouth is half open; I’m stunned, and I lay my head back on the wall. I have no clue where to go with this.

  Penny shakes her foot nervously. I asked why she picked and she told me, but I’m unsure if the cause was the sexual relationship with her uncle or the subsequent rejection from her mother. “So, the picking … tell me about it.”

  “I just pick … I don’t know. If I start, I can’t stop.”

  “But doesn’t it hurt?”

  “Yeah, it hurts, but that’s part of the pleasure. If I’m upset, it gives me something to do with my hands. The therapist told me years ago that picking is obsessive-compulsive.”

  “But you’re ruining your skin. You’re a pretty person.” I stand up to start the internal exam. Neither of us speaks except for the simple directions I give, the words women have memorized at their gyn exams over the years. Can you slide down? A bit farther. One more jump. That’s good. And, Can you open your legs a little? A little more … I’m going to be touching you now.

  When I’m finished, I wash my hands, then lower myself onto the stool again. Penny sits up on the end of the table. There’s a hole in the toe of her blue sock and she tries to hide it with her other foot. “What does your family say about the picking? Do they try to help you?”

  “Well, my mom.” Penny shrugs. “I don’t see her. She’s all but disowned me. But my husband tries. If he sees me picking he kisses me. He’s real sweet, but then I just pick in secret.”

  I make a decision. “Would you like me to see if I can help? I have some ideas.”

  “I don’t see what you can do. I won’t go to a shrink.”

  “Well, that was one of my ideas, actually. I think it would help and I know a good counselor, but if you won’t, you won’t. I was also thinking about the microdermabrasion treatments we have here. Do you know about them?”

  “I saw the handout and sign, but I can’t afford it.”

  “That might not matter. I could give you free treatments now and then if you’d stop picking. I don’t do this for everyone. In fact, I’ve never done it for anyone before.”

  Penny listens, touching her face, but then pulls her hand away and sits on it.

  “The microderm machine sprays little crystals on your face. There’s no chemicals. Then it sucks off layers of the dead skin. It will take off the scar tissue little by little. If I see that you’re picking your face again, I’ll have to give up the treatments. It won’t be worth our time if you’re making fresh marks.”

  Penny looks doubtful. “What about my arms?”

  “I’d like you to stop picking them too, but I realize that might be asking too much at first. Just don’t pick your face. Maybe we can help you with your arms later.”

  Penny frowns. “I don’t know why you care. What’s it to you if I pick?”

  “I don’t know …” All over West Virginia, all over Appalachia, there are women and girls with bad skin, rotten teeth, scars, and untreated deformities; what’s this one woman matter?

  “I don’t know,” I repeat. “I just like you. I want you to stop.”

  What I mean is Because you’ve suffered; because you deserve something better. But I leave it at that: “I just like you.”

  Dream of the Dance

  All night I’ve felt sad for Penny, felt like sending her flowers. As if that would do any good, would give her back her mother, take away her pain.

  “Breathe in … breathe out. Let your mind be at peace. Breathe in …” I peer at the clock. It’s 3:00 a.m. My mind is clacking away like Donna’s keyboard. I get up and slug down my sleep medicine. There’s no sipping. Then I snuggle up to my husband, who didn’t notice I was gone, and try once again. “Breathe in … breathe out.” I try counting backward from one thousand and then I’m … I’m in an open meadow …

  I hear music. It’s a waltz, gentle and easy in the slanting green light.
One-two-three, one-two-three … The melody is floating up from a golden dome. Curious, I run down the long grassy slope and open the door. The piano gets louder, the golden light brighter.

  This is a ballroom, but there are only women here, women I know. Candles flicker from candelabra set into the walls. The music swells. There’s Holly, wearing blue satin, dancing with Nora, who’s dressed in rose silk. There’s Shiana in green chiffon. Then Aran, Trish, and Nila move in.

  A bleached blonde walks up to me. It’s Penny, who picks until she bleeds. She holds out her arms, and we begin to waltz, awkward at first. One-two-three, one-two-three. I’m getting the hang of it now. Everyone’s dancing, all the girls, all the women, in their beautiful rainbow dresses. Feet flash in golden slippers as we spin faster and faster, laughing, holding on to each other.

  When Penny, my partner, throws back her head, all the scars on her face are gone.

  Serpent

  At 5:05 p.m. Linda sticks her curly red head in my office door. “I’m about to leave. There’s a call on hold for you. Do you have a minute to talk to Blake Rogers, or should I take a message for tomorrow?”

  “Sure, put him on.”

  She transfers the call, and I answer. “This is Patsy Harman, nurse-midwife, how can I help you?”

  “Hi, Patsy,” says a warm baritone. “Hey, thanks for taking my call. I know you’re busy. I’m Blake Rogers; I represent the family of Mrs. Rae Blandon.” Now I know the name, Blake Rogers of McKenzie, Rogers and Clager, PLLC. I go very still and my hand grips the phone.

  “We’ve been examining some discrepancies in Mrs. Blandon’s chart. There seems to be a few pages missing. I wonder if you could send us another copy? We could reimburse you.”

  Instant hot flash, but I don’t say a word. I’d checked the copy of the records myself. Nothing was missing.

  “Mrs. Harman?”

  The snake. What was he up to? Why would he want another copy of Rae’s gyn chart? Does he think he can catch us at something?