The Blue Cotton Gown

by Patricia Harman

  I should quit! What the hell … I brood for a moment then open the chart on the desk in front of me. When I think of the stories my patients tell me, my troubles always seem small. Like Rosa’s story.

  I push back my desk chair and stand, stretching my back. It’s time to go home. Downstairs in the parking lot, most of the cars are gone, and the street lamps glow yellow. It gets dark so fast in the winter. I see Trish plowing steadily across the parking lot, her long blue coat blowing open, and I tap on the window, but it’s four stories down. I know she won’t hear me.

  It’s 5:15, and through my closed office door, I hear the staff joking as they clock out. Linda is clowning around. Apparently they have no idea how they hurt me. To hell with them all!

  When their voices fade, I throw on my coat and scarf. Outside the wind has come up and it’s raining hard. The roads will be icy, and the storm will be worse before I get home.

  ROSA

  Rosa’s annual exam and wellness visit is going smoothly until, after reviewing her medications, I inquire, “You’re taking both Xanax and Prozac? Is there a reason?”

  “Is there a reason you need to know?” Rosa asks. Her dark brown eyes flash defensively. The fifty-year-old Hispanic woman I recognize as the secretary for the VP at the university hospital. Her smooth, unlined brown face belies her age.

  “I guess, I just wondered because both medications will work for anxiety, but Xanax is quite addicting.”

  The woman takes a deep breath, looks down at her blue cotton gown, and then back up at me. “I might as well tell you. My son is in prison. He’s in prison and every day when I think of him, I cry. He’ll be there for ten years. No parole. I don’t usually like to get into this.”

  “I’m sorry. It’s okay if you don’t want to talk about it.”

  “No, it’s all right.” The patient softens her low voice. “It’s just that, how do I explain … He was an ordinary kid, a good kid. We’re not this kind of family. Do you have children?” I nod. “Well, eight years ago, my husband had an affair with a woman in Delmont. To tell you the truth, it wasn’t the first, just the most blatant. I got a divorce. I couldn’t trust him again. I could never forgive him. I tried, but I couldn’t. I just couldn’t.”

  She clears her throat. “It was bad timing. Darren had just turned fifteen and began hanging out with the tough kids. He was living with me. One night he was beat up. I don’t know who started it or what the fight was about. Some racial slur, maybe; he was sensitive like that. While he was in the ER they did a drug test. Turns out it was positive for marijuana and cocaine.

  “They can’t arrest you for testing positive. You know that. But it was a wake-up call. We tried counseling, and for a while Dee seemed to fly straight. We call him Dee, did I say that?” Rosa tells me all this as she stares at the wall directly behind me. I glance back, imagining a small TV screen with the marquee announcing the afternoon-movie feature: A Mother’s Nightmare. “He was put on probation for the fight; they called it assault and battery, something like that, and he cleaned up his act. He had to be drug tested every week, but in less than a year he was picked up downtown, this time with marijuana on him. Somehow we got him out of that scrape. It was only a small amount of grass. They lengthened his probation, but gave him another chance.

  “Then, a few years after he’d started college at State, it came out he was gay.”

  I swivel on my exam stool, close Rosa’s chart, and lay it on the sink counter. I hadn’t expected this turn in Rosa’s story. “Gay?” I ask.

  Rosa continues, “Yeah, but I was relieved about that. Everything made more sense. He’s very good-looking, but his girls never lasted. Somehow, when he told us, I loved him more, but his father couldn’t get over it.” She takes a deep breath.

  “And then Dee shot someone … He shot him, and the boy died. You probably read about that. Headline news in the Torrington Tribune. This was over a year ago now.”

  The story has twisted again in a direction I wasn’t expecting. I rarely have time to read the Tribune and get most of my local news from Linda, who reads the paper each night.

  “Dee was on cocaine,” the patient tells me. “We know now that he’d been dealing drugs for some time. That’s why he had so much money and so many new clothes. This other boy was in the process of breaking into his apartment to steal drugs when it happened. Darren was high and got scared. He pulled a pistol from under his pillow and shot the young man right in the chest. I don’t think he’d ever fired a gun before, but what do we really know about our kids?”

  I flash on the gun Tom found hidden in Orion’s bedroom five years ago, a sawed-off shotgun. Tom was so pissed he ran down to the lake and threw it as far as he could. Orion denied it was his. Said he was just keeping it for a friend. What the hell were our boys doing with guns? We’re pacifists, for God’s sake! They’d been on peace marches before they could read! Rosa goes on with her story.

  “At first Darren was freaked and hid out with friends, but in three days he turned himself in. We got a good criminal lawyer, Rock Durban. You know him?” I nod. I remember Mr. Durban. I know personally how good he is. He was our youngest son’s lawyer when he was caught in the high school parking lot with ten little baggies of grass.

  “Because of the break-in, the shooting was considered manslaughter and Dee was put on probation again. A lot of people in town were bitter about that, felt he should have been tried for murder.”

  “So if he got off, why is he in prison now? Did he violate his probation?”

  “I guess you could say so. He got caught robbing a bank in Delmont with a rifle a month later.” Rosa pauses. “He was high on meth this time. You see why I don’t talk about this?” Our eyes finally meet. “It feels like someone else’s life I’m describing. This can’t be me. This can’t be my boy. Anyway,” she says, taking a deep breath, “there’s no possibility of probation or parole. Armed robbery is a mandatory ten years in West Virginia.”

  For the first time there are tears in the woman’s eyes. She wipes them at the corners with an actual hankie. “I’m sorry,” she says.

  “It’s okay.” I reach for her hand. It’s cool and brown, white on the inside. “So, do you see him often?” I whisper.

  “No. It makes me too sick. After I visit him in the prison I can’t sleep; I cry all night. That’s when I take the Xanax. I can’t face him there, you know? I write him every week, but that’s all I can do.

  “He’s just a beautiful kid … man, I should say. And so smart. He has his dad’s height, but my coloring. He’s clean now. No drugs in prison. But he’s too beautiful. You know what I mean? He sold dope and had a gun, but I know him, he’s not a tough guy. He’ll be used. He’ll be knifed or come out with HIV. If he learns to survive, he’ll have to become member of a gang, a thug himself. Either way he’s gone …”

  We sit in silence. Rosa is thinking of her son. I think of my sons. Finally I stand and silently begin her examination. When I listen to her heart it is ticking away. Lub-dub. Lub-dub. I count the beats, eighty per minute. I would like to take her heart into my hands and hold it against my cheek. Not the real heart, you understand, the soul of the heart. The mother soul …

  NILA

  “Good, I caught you!” Abby whispers as she hurries down the hall toward me. “I’ve got to talk to you before you go in there.” She indicates the exam room with a nod of her head and pulls me back into the lab. “Nila is back with irregular periods, and she’s got a black eye, but don’t say anything. You’re not supposed to notice.”

  “What do you mean, not notice the black eye?” I counter. “Does Nila have makeup over it? How did she get it?”

  “All she would say is, ‘Just tell Patsy I don’t want to talk about it.’ That’s all she said.”

  I close my eyes. I’m not good at ignoring something and keeping my mouth shut.

  Nila was supposed to return in three months for a birth control check. It hasn’t been that long. Hesitating for a moment, I knock my
gentle greeting, tying to be casual. “Hi, Nila,” I say as I enter.

  The woman sits on the end of the exam table with her back to the door. “So, how are you doing?” I’m trying to be upbeat. “What brings you in today?” Nila’s sandy brown hair, which she usually ties up in a ponytail, hangs down around her face. It’s not just her eye. Her whole left cheek is mottled and purple. I make a quick assessment, then look away.

  “The birth control patch wasn’t working,” the patient says flatly. “I spotted heavily for the first two weeks, so I took it off. Now I’m really messed up.”

  I glance again at the eye; messed up in more ways than one. “How much are you bleeding? Like a period?”

  “No, I finally stopped, but it was real heavy for a while. I think I’m anemic.”

  “What makes you say that?”

  Nila still hasn’t made eye contact. “I’m just so tired. I can barely get out of bed. I figure I’m low blood, and the bleeding has caused it, first the miscarriage and then a period that lasted forever.” She hunches at the end of the exam table, a deflated balloon.

  I let out a breath. “Nila, I can’t do this. Abby told me I’m not supposed to mention the black eye, but you think I’m blind? What’s going on? The birth control problem is one thing, but you look like hell and you’ve lost weight. Is it Doug?”

  “No, not Doug. It’s Gibby.”

  “Did he hit you?” I’d forgotten about Gibby, the estranged husband.

  “Not hit, really. He was trying to get in the house. While I was struggling to lock the door, he pushed it open and it bashed up my face. He’s real sorry.”

  “Well, what was Gibby there for? What did he want?”

  “Oh, he said he was there to talk, but I didn’t want to. He’s still sending flowers, trying to get back with me.” I remember the small man, about five foot six, muscular, with a thick neck and blond hair that showed on his chest at the front of his open work shirt. He’d never come to prenatal visits but was at the births of their younger children.

  “What does Doug say?”

  “Oh, he was going to go after Gibby. He’s a big man and could do some damage, but I said, Leave it be. Gibby didn’t mean to hurt me. Now Doug’s fed up. Says I shouldn’t be talking to Gibby at all, that I’m leading him on. Says we should at least call the police again.”

  “Call the police again?”

  “Yeah, we tried before but they didn’t do anything. They said they couldn’t make an arrest or set up a restraining order based on his making threats.”

  “What do you mean, threats? Gibby has threatened you?”

  “No, not me. It’s Doug. He says he’ll kill him.”

  I’m silent for a minute. This is out of my league. “So do you love Gibby? Do you want to be with him?”

  “No, I love Doug, but he says Gibby’s crazy, that he’ll never leave us alone. He wants to go back to South Dakota, but I have the kids to think about. They just started school. Gibby will get over it once the divorce is final.”

  “You’ve filed for a divorce?”

  “Yeah, I saw an attorney. I’m just hoping the black eye goes away by the next time I see him.”

  I shake my head. “Nila …”

  “Gibby is not an evil guy, Patsy. He’s just upset. I understand. We grew up together. You excuse a person you’ve known and loved for this long. You understand them. Doug is the one I’m worried about. He’s not used to this.”

  We both study the floor.

  “Well, let’s get your periods straightened out. Maybe the patch isn’t strong enough.”

  “No, I don’t think birth control hormones agree with me. We’ll just use condoms.”

  “But can you be real careful with condoms, Nila?”

  The small woman crinkles her eye, her one good eye, then tilts her head. “I guess we’ll have to.”

  I fill out a requisition for a CBC and thyroid labs to check the patient’s blood count to see if she’s anemic or has a thyroid disorder that would screw up her periods, then I reach into the cupboard over the sink and hand Nila a month’s supply of multivitamins with iron. “Don’t bother to cancel your other return appointment. I want to see how you’re doing.” Nila nods.

  I don’t just mean the woman’s periods. I mean everything else.

  CHAPTER 13

  Money Changer

  For once I’ve not relied on my husband or others to make a decision. I’ve found an accountant, Donald Collins, CPA, of Collins and Redman Financials. He’s employed by five other medical groups in Torrington, and they all think he’s great. Mr. Collins has already reviewed our quarterly tax statement and found three errors. The bill is now down to $11,341, which is still not small change, but better than fifteen thousand dollars.

  It was hard firing Rebecca, but it’s done. In cowardly fashion, we sent her an e-mail telling her that we needed an accountant who had more experience in health-care management. It was the chicken’s way out. We never explained how disappointed we were with her. She shot a sharp e-mail back and warned that we’d be sorry for dropping her, but we held firm.

  Donald has already met with us twice in the office. He understands our frustration at having no fiscal leadership and suggests that Tom take a temporary salary reduction until we catch up. I don’t like it. My husband works hard, harder than many gynecologists who make far more money, but Tom agrees. He says he would rather earn less and have more peace of mind.

  This evening after work, sitting near the corner window in the living room, staring at snow drifting sideways like feathers after a pillow fight, I wonder if we did the right thing when we gave up OB, but what choice did we have?

  When the cost of medical-liability insurance almost doubled, we looked at what it would cost to continue obstetrics, and we couldn’t break even. Bringing new life into the world in a gentle way was our calling, but a calling we could no longer afford.

  JEANNIE

  A quiet Saturday afternoon, with a cup of tea, watching the gray squirrels rob our birdfeeders. Seeing Jeannie Perry yesterday for her gyn annual reminded me of the nonmonetary rewards of delivering babies. The slender, dark-haired, thirty-six-year-old woman had been Tom’s infertility patient. She’d been trying to get pregnant for five years and had been through all the tests, even surgery. She’d also tried artificial insemination with her husband’s sperm three times, without success. Then the couple got pregnant on their own one warm spring night. Wouldn’t you know it?

  A year before we gave up our OB liability policy, we sent out letters to all our patients, telling them that as of January 1, we would no longer be doing deliveries. There were hundreds of women trying hard to get pregnant in the following months. Jeannie was one of them, and she just made our deadline. Her due date was January 3, three days after our insurance would be terminated, but we were counting on her going early.

  As the holidays came and went, Tom and I waited for a phone call from Jeannie, but no call came. A few days before New Year’s, I checked the young woman in the exam room and what I found wasn’t good. The baby was head down, but Jeannie’s cervix was closed. “Are you having any contractions, Jeannie?”

  “Not many. I think something’s wrong.” Jeannie pulls her long straight dark hair back from her face.

  “Yeah, can’t you do something?” Nathan, her husband, mutters leaning forward in the guest chair. “It took so long to get this baby. How many more days do we have wait for it to come out? What will we do if you can’t deliver?”

  I go over all the things I usually recommend to stimulate contractions’make love, take primrose oil, go on long walks—and then I sum up the situation. “If by December twenty-ninth nothing has happened, we’ll admit you to the birthing center and give you a jump start. Sound like a plan? We won’t let anything happen to your baby. Don’t worry.”

  Saturday the twenty-eighth comes and goes. No phone call from Jeannie. Sunday morning. Coffee in front of the Christmas tree with Tom. (This was last year, before our IRS troubles,
the gallbladder surgery, and cancer; before our little world blew apart.)

  “So, Jeannie’s coming into the hospital this afternoon,” I remind Tom. “Today’s the day … or tonight. One of us will have to go into town to admit her and get things going. I hate to tie up our weekend, but there are only a few more days left before January one.”

  He flips his warm palm over to hold my hand. “Let’s both go. It’s probably our last birth together. Call it a date. We’ll get the induction started, then go to a movie. I’ve been nervous about this delivery all week.” This catches my attention, and I wait for more. Tom’s rarely anxious about obstetrics. “You heard what happened a few months ago to Dr. Gorday? Her last delivery before she retired? It was a disaster. The baby’s head came out but the body was stuck, shoulder dystocia. She did a big episiotomy, cut almost down to the rectum, tried McRoberts’ position with the woman’s knees pulled back to her neck, tried the screw maneuver, even broke the baby’s clavicle to get him out, but nothing worked. Gorday was shitting bullets. Finally had to do the Zavanelli procedure.”

  “The Zavanelli?” (All OB providers know about the Zavanelli. It’s a last resort: you flex the fetal head, push it back in the mother’s pelvis, and then do an emergency C-section.) “Did it work?” I ask.

  Tom smiles. “Yeah, it worked. The baby was in intensive care for a few days, but he was all right. Now I understand Dr. Gorday’s fear. I was never scared before, but I just want to get this last one over. I have a weird feeling.” The shadow of a hawk passes over the snow. I stand to look out the window but the raptor is gone.

  By five on Sunday afternoon, Tom and I are sitting in an almost empty movie theater with a tub of popcorn and a Diet Pepsi. Not much of a midwife, I think, watching a film instead of my patient, but Jeannie was so totally comfortable after we’d placed the misoprostol in her vagina, I couldn’t see the point of sticking around.