The Blue Cotton Gown

by Patricia Harman

  “It was awful last week. Nora was beside herself. She would run in and out of the house screaming, ‘It’s my life! I can do what I want with it.’ I couldn’t calm her down. Nothing seemed to work.” Holly stares at her clenched fists. “We never did anything to hurt her, always helped her. Sometimes I’m so angry. This hurts me so much … but I know she hurts more. I just don’t understand it. John says it’s out of our control now.”

  Holly shakes her head. “She has to want to live. I know he’s right, but a few nights ago, after I thought she was sleeping, I went to her bedroom, just to check, and there was blood all over the pillow. She was hemorrhaging. They think it’s her esophagus. She looked so white in the dark, for a minute I thought she was dead. Then I saw she was breathing, and eventually she opened her eyes. I was on my knees and her breath smelled so bad. Old blood was all over her teeth. I took her face in my hands and I whispered, “We have to go. I have to take you to the hospital. I can’t let you die like this. I wanted to shake her.”

  I can see it. Holly is crying. Nora is crying. All right, Mom, I’ll go. I’ll go if you want me to. Then the long-limbed mother crawls on the bed and holds her leggy daughter. Holds her like a baby, and rocks her too. The girl is so weak from starving herself and raging against the world that she doesn’t resist. Outside the bedroom window the first flakes of snow fall in the dark.

  Holly continues. “I didn’t beg her to eat like I usually do. I just cleaned the blood off her face with a warm cloth and took her to the hospital. They’re giving her hyperalimentation, electrolytes, protein, and fluids by IV. They think they’ll be able to save her. They have to.” She stops. “I just don’t know what we did to make her this way.”

  I take out my pad and write scripts for the sleep medication and a slight increase in Holly’s hormone therapy. She’s waiting for me to say something, but I don’t know what to say.

  I reflect to myself that we are not such screwups, she and I. Holly was just an ordinary mom doing what she thought was right. We both love our children. Did we give our children too much? Did we give them too little? The exam room fills with our collective guilt and mother love. We are drowning in it. Finally I struggle to the surface.

  “Okay, John might be right,” I tell her. “Nora has to want to live. She has to want to live and get well. But it’s in your nature to try to save her. That’s what a mother is programmed to do. It’s what we have to do, if we can.”

  Winter

  CHAPTER 11

  PATSY

  “You bleeding?” Tom asks as we get ready for bed a few days after Thanksgiving. He stares at my pink cotton underpants in the laundry basket.

  “Off and on. Not that much. It’s just spotting. It doesn’t happen every month.”

  “Why didn’t you say something?” He’s brushing his teeth and the foam dribbles out as he talks. “We should do an ultrasound and an endometrial biopsy. You know being on unopposed estrogen can cause endometrial hyperplasia.”

  “It’s probably just a period. I’m cramping a little.” I reach around him for my hairbrush. “My periods used to be irregular. It hasn’t been that long since I stopped.” I’m thinking it’s no big deal. “Did you call Rebecca Gorham today?”

  Tom shakes his head, no, but he’s not diverted. “You’re on estrogen replacement without progesterone, you have to get regular ultrasounds. Tomorrow get an appointment with me, and I’ll do one. We should have done it months ago. And no, I forgot to call Rebecca. Why don’t you talk to her? You have more time.” He’s crabby tonight. He pulls back the quilt and adjusts his pillows.

  “I already left two messages. She hasn’t returned my calls. She better not be in Europe again. If you telephone her, it might have more clout.” I jump out of bed to blow out the prayer candle, placing my hand on the round wooden box. “Peace be with you,” I whisper. Orion, Zen, Mica, Heather, Aran, Trish, Holly, Nora … everyone.

  “Will you please help me out and do it tomorrow?” I ask again. “We haven’t had a meeting with her in months.”

  Tom mumbles something and then he’s asleep. As usual lately, I lie there resenting him. I’m weary of worrying about the practice problems while he sees patients and sleeps like a babe. I remember Mrs. Teresi and take back my malicious thoughts. The man works his butt off, what can I say. I’ll try to call the accountant again myself in the morning and be more insistent with her little cat of a receptionist.

  My ultrasound doesn’t happen the next day or the next week, and neither does the meeting with Rebecca. I’m busy seeing patients and getting ready for Christmas, and then I stop spotting.

  Most women do fine on a combination of estrogen and progesterone. I’m one of the exceptions. The progesterone makes me so depressed I can’t stand it. When I finally have Donna pull my gyn chart, I’m surprised to see that my last ultrasound was ten months ago.

  Now it’s six in the evening, already dark, and Tom and I are the last ones in the clinic. I lean on the open door to his office. “Hey, want to do an ultrasound on me tonight?” I ask, as if inviting him out on a date.

  He turns slowly from his computer. “Tonight? You still spotting?” His white shirt is rumpled and his tie is pulled loose.

  “I wasn’t, but it started again. Really, it completely stopped so it just slipped my mind.”

  Tom throws down his pen. “Give me a break, Patsy. You’re really being irresponsible here. You’ve got to take care of yourself. We talked about it, what, a week, two weeks ago?” I feel like a schoolgirl reprimanded by her favorite teacher. He’s right and I know it. “Okay, come on.” He stalks past me.

  We go back to the exam room. I’ve already turned on the ultrasound machine and typed in my name. I skip the blue exam gown and sheet, just pull off my slacks. Tom puts on gloves and gently inserts the vaginal transducer.

  “Ovaries are fine,” Tom says. “The endometrial thickness is excessive, though … way over.”

  I can see that he’s right by looking at the monitor screen. My pear-shaped uterus is lined with white. “How much?”

  “Fifteen millimeters. It should be under five.” This is not good.

  “So, a biopsy?”

  “Yep. Should have had one months ago.” He shakes his head. Tom’s not pissed anymore, just worried. He carefully inserts a small pipelle the size of an IV tube into the opening of my cervix and withdraws bloody tissue to be sent to the lab. It hurts, but I do my childbirth breathing and it’s over in minutes.

  “So I guess I better get started on the progesterone, huh? Make myself have a period and get rid of that stuff?”

  “I’d say so,” says Tom. “But I don’t want to be your doctor on this.”

  “You don’t want to be my doctor?” I’m shocked and a little hurt.

  “No, this is potentially serious. You need to see someone else. I can’t take care of you. If you need something done, I can’t do it.”

  “Like what? Like surgery?” I frown. “It won’t come to that. I’ll start the progesterone tonight. I know I should have been doing it all along, at least every few months, but it makes me so low.”

  In the lab I dig around for some samples of medication. I’ll have to take the pills for almost two weeks. A few days after I stop the progesterone, I’ll have an artificial period, which will get rid of the excessive bloody tissue. Meanwhile, we’ll wait for the results of the sampling Tom did tonight.

  Unopposed estrogen can cause uterine cancer, but I’ve had biopsies before. They were fine. This will be fine too. Sometimes Tom Harman gets on my nerves. In the bathroom I swallow two progesterone pills. Might as well get the show on the road, I think grimly, looking at my face in the mirror. When I check my pink cotton underpants, there’s more blood.

  ICY

  I’m stuck in a line of vehicles on Turkey Run, a narrow blacktop that runs between the agricultural school and the freeway. It’s five o’clock, as close as you get to a rush hour in Torrington, and I’m on my way home from work, listening to a CD of John
Sousa marches. I’d be better off on days like this if I rode my bike, only there’s no berm to ride it on. To my left, the sun is dipping behind the bare trees. The stirring music reminds me of Icy, a patient I saw in clinic today.

  Icy Miller is an eighty-six-year-old widow, a fluffy, soft, pink-skinned, white-haired lady who lives at Valley Manor, a retirement village not far from the office. I was the first woman she’d ever seen for a gyn exam. Now she sees me four times a year for a pessary check and cleaning. The three-inch rubber device, shaped like a doughnut, is worn by some older women in the vagina to support a vaginal prolapse. It’s an alternative to surgery. Icy’s in good health except for her blood pressure. At eighty-six, she still drives her own car.

  In the exam room I ask Icy how she is. “I’m fine really, just having a problem.”

  “What’s going on? Didn’t I see you just last month?”

  “Well, it’s a little embarrassing. I went down to Florida to see my sister and I got real constipated. I strained too much and now the pessary’s out of place.”

  “Did you fix your constipation?”

  “Oh yes, days ago. You know how it is when you travel. You don’t take care of your bowels, you don’t eat the foods you’re used to.”

  I help Icy lie down and put her narrow arthritic feet in the footrests and then with a gloved finger carefully remove the pessary. It was halfway out and rubbing the side of her vagina. Simple for me. Not so easy for her.

  “So how’s the rest of your health? Did you have a good time in Florida?” I stand and wash the rubber disk at the sink, looking over my shoulder, taking my time. It’s a treat to hang out with Icy. There are some patients you just like, you don’t even know them that well and you like them. It’s their life force or something. I replace the pessary with a little push.

  I’m finishing up, writing a few notes in the chart about the short visit. “Do you know where you’ll get your flu shot this year, Icy? There may be a scarcity again.”

  “No, I don’t. I went to Dr. Sutton last week, he’s my internist, and they don’t have them, don’t think they can get them either. I don’t know what this country’s coming to that we can’t make our own flu shots. We seem to have plenty of money to throw around the Middle East.” Her brown eyes snap in her wrinkled pink face and I raise my eyebrows. This is interesting.

  “You think that’s a waste?” The patient turns sideways on the exam table as easily as if she were a girl, and leans forward. “Of course, and I think it’s wrong. What do they think they’re doing with our American boys and girls? Throwing their lives away. It makes me sick, really. This country is falling apart, the economy and all. And that money we’re spending over there, it’s over three hundred billion dollars already and it will be over five hundred billion before we get out! Maybe a trillion. Think of the highways and hospitals we could build. Think of the schools and housing for the poor.”

  Right now, I look out my side window at Turkey Run Road, full of potholes, the berm washed away. I had no idea; could Icy be right? I think of the homeless; the high school dropouts; the loss of lives in the war, ours and theirs; the amputees … five hundred billion dollars?

  “You know what, Icy? I think like you do, but I rarely say so to patients. Dr. Harman and I used to go to marches and sit-ins. Now we donate money to a few causes, but otherwise I don’t say much.”

  “Well, you should. Not enough people say what they believe. That’s how the government gets away with it.”

  I wince, knowing she’s right. “But don’t you suppose it would offend my patients?”

  The line of vehicles on Turkey Run moves ten feet forward and I’m now only two cars from the intersection.

  “Oh, honey, you won’t. They know you love them and take good care of them. You might even have a good influence. That’s one of the privileges of getting older. You get to say what you believe. Your words are worth something. You need to march on.”

  “You think so?”

  “I know so!” The patient’s brown eyes sparkle. “Now give me a hug.”

  Mrs. Miller throws out her arms and I move into them against her big soft breasts. She smells like cedar, good sense, and courage.

  It’s finally my turn to cross Bobtown Road. I wait for two minutes and at last shoot through the traffic. Then I open my window, turn up “Stars and Stripes Forever,” and let it blast, not caring who hears or who it disturbs.

  PATSY

  It’s been a brilliant blue day, cold and clear, and the sunset is just as radiant. Tom and I have finished dinner, stir-fried vegetables with chicken. We sit now in the living room, watching the sky turn from gold to red to lavender, until it’s dark. As I rise to carry the dishes into the kitchen, he clears his throat. “The pathologist called about your endometrial biopsy today.”

  “And … ?”

  “It’s complex hyperplasia with atypia. He can’t rule out endometrial cancer.”

  “I don’t get it.” I understand it isn’t good, but I don’t know how bad.

  “Well, it means you have an overgrowth of abnormal cells in your uterus that could be cancer, he’s not sure.”

  “What’s he think?”

  “Pathologists don’t think. They don’t guess. That’s why they say ‘a low-grade carcinoma cannot be excluded.’” My husband pulls the printed biopsy report, which is neatly folded in quarters, from his front shirt pocket. I spread it out on the kitchen counter and read the words twice, then go back to rinsing the stainless-steel sink. I feel Tom watching, but I don’t look up. I’ve just been pushed off a cliff and am falling.

  “I didn’t want to tell you at the office.”

  I’m having a hard time hearing. The wind is roaring too loud as I plunge, tumbling over and over again.

  “So what do we have to do to find out?” I say finally, shaking my head to clear it.

  “Well, the usual treatment is a hysterectomy.”

  I’m sick with remorse. If I’d gotten the ultrasounds on a regular basis or told Tom when I first started spotting, this might not have happened. I’m always so busy, in so much of a hurry. Now I may have cancer, and it’s my own fault.

  “So what are the chances?” I ask as we return to the living room. The Christmas tree, decorated with tiny white lights, birds of all kinds and golden pinecones, sits in front of the windows that face the lake. The smell of Scotch pine fills the room. “I don’t feel tired or ill. I don’t think I have cancer. Shouldn’t I have pain or be losing weight? I feel great.”

  Tom shrugs. “The thing is, I can’t take care of you in this. I told you. I can’t be your doctor.”

  “I know that,” I snap. “I’ll find my own doctor. I just wondered, if I were your patient sitting in your exam room, what advice would you give me?”

  “Have a hysterectomy. Then the problem is solved. You can use estrogen and never worry about taking progesterone again and you’ll know you don’t have endometrial cancer because you won’t have a uterus.” He smiles a half smile, thinking that’s amusing, and squeezes my hand.

  I don’t squeeze back. “I told you, I really don’t want a hysterectomy. Aren’t there alternatives? It just seems wrong to have a hysterectomy if we don’t even know for sure I have cancer.” It pisses me off. I know that the removal of a woman’s reproductive organs is the second most common surgery performed in the United States. Cesarean section is first. Each year, more than six hundred thousand are done. One in three women in the United States has had a hysterectomy by age sixty.

  Tom shakes his head and lets his air out. “Okay,” he says. “We can do a lit review on the Internet. I’ll get on PubMed. What do you need to know?”

  “Well, I want to know what the chances are with this kind of endometrial biopsy. What’s the chance I have cancer.? Fifty percent? Five percent?”

  “Yeah, endometrial cancer grows slowly so we have some time.”

  “No, I need to know tonight.”

  Tom shakes his head and reaches for me. “Come here.” I
scoot across the couch, and he wraps his arms around me. “It will be okay. Even if you have a hysterectomy, what’s the big deal?”

  I draw back to stare at him. He doesn’t get it. Jumping up, I move to the Christmas tree. “I just got over surgery with the gallbladder eight months ago. I hated it. I felt so vulnerable and out of control. It was one of the worst things that have happened to me.”

  “You did fine. You recovered great once you got home.”

  The smell of the pine needles fills the room as I stand with my back to him, randomly crushing them. “And what about sex?” I ask, wiping my tears surreptitiously. “Don’t you care about that? Sex won’t be the same.”

  “Actually, that’s not true. They’ve studied that,” Tom says this in his doctor voice. “The majority of women after hysterectomy have more frequent intercourse and more pleasure.” He sounds like an actor in a white coat playing a physician in a TV ad. “More frequent intercourse and more pleasure—”

  “Yeah, right! That’s because most of them had pain before the surgery or were bleeding all the time, so of course sex is better. I see those women in the clinic, the same as you. Some even have worse pain after surgery because of adhesions or scar tissue at the top of the vagina.”

  The room is illuminated only by the miniature Christmas lights. I pace behind the couch and love seat, crying again, but he can’t see.

  “It won’t be the same! When I have an orgasm I use my whole body. I feel the contractions in my uterus as much as my vagina. How would you like to have an orgasm without a penis?” I’m getting carried away here. Tom slides down on the sofa, looking up at the ceiling.

  “Well?” I ask.

  “Sex is ninety percent in the mind.”

  “So you don’t think a woman needs a uterus?” I’m offended and irrational but I can’t stop.

  He stands up. “Let’s cool off. We don’t have to do anything tonight. Do you want an appointment with Dr. Parsons, Dr. Hazleton, or Terrance at State?”