The Blue Cotton Gown

by Patricia Harman

  After dinner at our favorite Indian café and a short trip back to the birthing center, we go home to bed, fully expecting the nurse to call us in the middle of the night, but on Monday morning the sun rises and Jeannie’s mild contractions have petered out.

  It is high time to get serious, only two more days to go. I do an amniotomy early and start IV Pitocin, recognizing, with some discomfort, that I’m messing with nature, just so we can be the ones to deliver our patient’s long-awaited baby. Then I settle down in the rocking chair to wait.

  As the sun moves across the birthing room and shadows collect in the corners, Jeannie begins to moan. By six p.m., her uterine contractions are four minutes apart and moderate in strength, but her cervix is still only at three centimeters, still stiff and fibrous. Jeannie tries standing and swaying at the bedside, sits up in a chair, rocks on her hands and knees, but she’s getting weary. “I don’t care anymore about natural childbirth,” she snaps at her husband when he tries to get her to do her breathing. “I want an epidural.” No argument from Nathan. His wife’s been a trouper.

  At midnight, we switch. Tom settles down for the night in the doctors’ call room, while I go home to our big king-size bed. Twice I wake and call the nurse for report, but at six in the morning I give up my effort to sleep and go back to the hospital.

  When I walk into the pastel-wallpapered birthing room, Jeannie is snoring like an old man, poor thing; worn out. I nod to Tom, showered and dressed in clean blue scrubs, ready for the OR. “How dilated?” I whisper.

  “Eight centimeters. I was up every few hours checking on her. The baby’s fine. Should be out by noon.” Always the optimist. I walk him to the doors of the surgical suite, where he’s scheduled to perform a laparoscopy and two tubals.

  At nine a.m., I help Jeannie wash up and braid her long hair. “Will we have the baby today?” she asks, her face pale with fatigue.

  “Yep.” (There are only fourteen hours until our OB privileges end. It has to be today.)

  At eleven, Jeannie announces emphatically, “I need more pain medicine!” I glance at the monitor and pull on a sterile glove to check her cervix. “You don’t need more medicine.” I grin. “The baby’s right here, ready to be born. It’s time to push!”

  So we push … And we push … For two hours, we push. It’s a group effort.

  We try every position the nurse and I can think of. “Can’t we just do a C-section?” Nathan asks, eyeing the tracing as the fetal heart rate dips into the nineties, then bounces back to 150 again, a nice normal baseline. “Maybe he’s too big.” That thought has crossed my mind too, but it’s not time to give up yet.

  “Come on, let’s go back to work. We’re missing some of these contractions. Here, Jeannie, pull on my hands. Pull!” An hour later, when Tom returns from the OR, he enters the birthing room as if he means business, and I’m glad to see him.

  “How you doin’?” he asks Jeannie and shakes hands with Nathan. “Getting tired?” I catch his eye and glance toward the monitor. The decelerations are steeper now but always returning quickly to baseline.

  Another big contraction and Jeannie grabs her butt then flops back in bed, trembling. “I don’t think I can do this!” After two days of labor and three hours of pushing, the young woman is spent.

  “Ready for some help?” Tom asks, slipping into a long green sterile gown. Terry, the RN, uncovers the delivery table and places a vacuum extractor, a modern alternative to forceps, near the corner. Clearly, she thinks it’s time.

  “You bet I’m ready!” says Jeannie. “Is this finally gonna happen?”

  Though the extractor, which comes with a soft plastic suction cup, is less risky than metal forceps, it’s not without danger. It can cause bruising, laceration, a hematoma, or worse, a shoulder dystocia, like Dr. Gorday ran into, in which the baby’s head emerges but the rest of the baby gets stuck.

  Dr. Harman parts the labia. “This may hurt a little,” he warns as he applies the vacuum cup to the fetal head.

  I center my attention. “Okay, Jeannie. Tom can’t pull the baby out by himself. That would be too much strain on the little neck. You’ve got to push as hard as you can and soon you’ll be holding your little one.”

  But I’m wrong. Each time Dr. Harman pulls, the head moves only a quarter inch. Once, the vacuum slips off. Then again it slips off. And again. The head is crowning now, and, by protocol, the provider gets only three tries with the extractor; any more may cause damage. Tom lays the mechanical device aside, then sits on the stool between Jeannie’s legs, checking the vagina for stretch. Neither of us routinely does episiotomies’in fact, rarely, if ever’but I can tell he’s thinking about it. Nathan stares numbly at the top of his baby’s bruised head.

  I reach over and pour a little oil, which the nurse has placed on the delivery table, over Tom’s fingers as he massages the vaginal opening; our gloved hands touch and he smiles. Our last delivery together. Shoulder to shoulder.

  When the monitor shows a good contraction, I lean over the bed and whisper to Jeannie, “This is it, babe! One more push. You’re on your own now, no vacuum extractor. The head’s almost out.” With valor, the worn-out woman pulls back her legs once again. Nathan goes into position, holding her head, and I bend over, showing more optimism than I feel, to help Tom support the perineum.

  Imperceptibly, there’s a shift, and the fetal head dips below the public bone. There’s no stopping Jeannie now. All at once, the baby rotates a quarter turn and hurtles into Tom’s waiting hands. I place the wet squirming bundle in Jeannie’s outstretched arms, cord still attached. “Thank you,” she cries. “Thank you, everyone. My baby! My baby girl.” Nathan is sobbing. There are tears in Tom’s eyes. Our last delivery together.

  I smile to myself now at the memory and take a sip of my peppermint tea, watching two scarlet cardinals, a male and a female, pecking around on the wooden bird feeder. Did we do the right thing by giving up OB? Are we better off now? A cloud crosses the sun, and Hope Lake turns gray. Then the clouds part again and the water is golden.

  ARAN

  Trish isn’t at work when I call downstairs to family med to see if I can borrow some antibiotics for a patient that has no insurance and no money for medication. “Trish didn’t come in,” their nurse Cora tells me. “Give me a minute; I’ll dig up samples and meet you on the back stairs.” I trot down to the fourth-floor landing and greet Cora Jackson, a tall, lanky black woman wearing green scrubs.

  “Trish sick?” I ask.

  “Didn’t you hear? Aran’s in the hospital from a drug overdose. She was found behind Powell’s Hardware, clinically dead.”

  I go very quiet. “When did this happen? Yesterday?”

  “No.” She opens her eyes dramatically. “Sometime this morning, real early this morning, around four.”

  “Is Aran okay now?” I may look calm, but I’m sick with concern.

  “She’s lucky she didn’t freeze to death. There was a heavy frost this morning. I had to scrape my windows. She was hypothermic, but she’s stable. Some guy found her. He thought she was dead and called nine-one-one.”

  “But what was she doing behind Powell’s?”

  “Nobody knows. She probably won’t know either. There are no bars around there, just some fast-food joints and a few little stores, but nothing open that time of night’well, morning. Maybe someone just dropped her off.”

  “Was it Jimmy? Could it be him?” I ask.

  “Where you been, girl? Jimmy left the state. He got involved with some bad dudes and took off in a hurry. It was over drugs or something. I doubt he’ll be back. Trish said he was going to clean his act up and join the army, but he’ll be gone a long time.”

  “So, do you think some drinking buddies just dumped her?”

  Cora shrugs.

  I take the steps back upstairs slowly, thinking of Aran, thinking of Trish, my heart heavier than the forty-pound buckets of water I used to carry from the spring across the ridge to the cabin when we lived on the c
ommune.

  MARISSA

  I glare at the last chart in the rack by the exam room door. I was hoping to get out early for a short bike ride, but it’s not going to happen. Marissa Lewis, a new patient, is booked as a gyn exam but she’s noted on the intake sheet that she has many health concerns. I take a deep breath, tap on the door, and reach out my hand. “I’m Patsy Harman, nurse-midwife and gyn practitioner.”

  The woman’s cold fingers press mine. “I’m Marissa Lewis,” she responds. Her dark-penciled brows give her a look of perpetual surprise and there’s something fragile and strange about her. I’m thinking of white roses blown in the wind. Some of the petals are already gone. I go through my usual questions, asking about her reproductive health.

  The patient is forty-four and menopausal, doing okay, she tells me, except for the night sweats and hot flashes. “They’re horrible. I get wet all over. Sometimes I have to change my clothes twice before I leave home.” She seems to accept the difficulty with good spirit, and laughs, but it soon becomes apparent that she’s not well.

  On the back of the patient-history form she’s recorded her medical problems and surgeries. Five years ago, she had a total hysterectomy; afterward she experienced delayed healing and an infection. “It was awful. Now I have constant diarrhea. I go to a GI specialist at Torrington State University Medical Center. They say it may get better with time. And my pain is worse than it was before the operation.” Marissa places her hand on her lower abdomen. “It’s taken me a while to forgive the doctor. At first I thought of suing him, but what good would that do? I don’t really know what he did wrong.”

  I squint at her medical history. Marissa has indicated that she sees an allergist, a cardiologist, a dermatologist, and an internist. She has joint pain and weakness. She’s cold all the time and has allergies to eleven medications. She has skin sensitivity, rashes, and numbness of the tips of her fingers, not to mention the diarrhea and night sweats.

  “Marissa, let’s move on to the exam. Because you’re attended to by so many other providers, I’m going to concentrate on your gyn health.” I begin with the breasts and work toward her bottom. There isn’t a lot to do. I assist the patient to rise. “Do you check your breasts monthly?”

  “No, they hurt too much.”

  “Hurt all the time?”

  “Just the skin. It hurts to touch my own skin, so I avoid it. Sometimes, even the air hurts my face.” With the fingers of both hands, she circles her cheeks as if she’s applying makeup. “Just the barest touch hurts.”

  The gesture’s so eloquent. “Marissa, I know you’re already seeing several specialists and I don’t want to interfere, but you don’t seem well. You have so many generalized problems. Have you been worked up for an autoimmune or a connective-tissue disorder?”

  “Didn’t I tell you? Didn’t I write it down? I swear, I have brain fog. There’s so much to remember.” She rolls her light brown, almost golden, eyes to the ceiling. “It’s one of my symptoms, forgetting things, like cotton was stuffed in my head. I’ve been to them all: Mount Sinai in New York, Johns Hopkins, and UCLA. That’s where I finally got the diagnosis, at UCLA.”

  “The diagnosis?”

  “Yes, fibromyalgia and—”

  “Chronic fatigue,” I finish. Now it made sense.

  “Chronic fatigue syndrome,” the patient corrects me. “It took years and a lot of tests and a lot of money, but we had to find out what was wrong. I was married then and had insurance. After the surgery, everything changed. I was a publicist in Pittsburgh and had lots of clients, writers mostly. I lost them all. I couldn’t keep the pace. Then my husband left. He told me he hadn’t signed up to marry an invalid. He thought I could snap out of it if I tried.”

  From my stool in the corner of the exam room, I listen as Marissa pours it all out, the pain, the worry, as she traveled from doctor to doctor. She stops her recitation. “I like your earrings.”

  I feel for my ears to see what I have on and touch my long woven silver links with blue beads. “Thanks. They’re old. I stopped wearing such arty jewelry about ten years ago, but lately I’ve noticed it’s back in style so I dug through my jewelry box and got them out.”

  “Oh, very in style.” Marissa laughs.

  Who is this woman? One moment she’s talking about serious medical problems, the next moment earrings. “Are you married, Marissa?”

  “I never know why doctors ask that. No. I’m single and happy with it.” Her golden eyes sparkle and she raises those eyebrows. “Funny how sex helps with the pain.”

  “Really?” I ask. “It helps with the pain?”

  “Yes, it does. I have much less muscle soreness after I make love. John, my lover, is very gentle. And here’s something else. I tremble less after sex too. It seems to release something.” She laughs. “I guess that’s the idea, isn’t it?”

  I step out of the exam room to get a requisition for the patient’s mammogram, and when I return, she’s pulled on her sleek cream pants with an elegant wool stole draped over the sweater. “Nice outfit,” I say. “You really do look radiant.”

  “Funny you should say that. You’re not the first person. The more I let go of my anger about being sick, the better I feel. I’ve finally even forgiven myself for being weak, for being damaged.”

  I look at the petite, thin woman, in awe of her courage. Just thirty minutes before, I was in a hurry to get out of the exam room; now I’m reluctant to let her go. When she holds out her arms and hugs me, despite the difference in our sizes, I feel enfolded. She smiles and the room gets brighter.

  “There really is something about you that shines, Marissa.”

  “It’s the Lord,” the patient replies. She picks up her engraved silver cane and steps out into the hall, then turns. “When all else fails, trust the Lord.”

  Weaver Dream

  The full moon wakes me, shining through the high bedroom window right on my face. There was music, wind chimes, I think. There was a dream.

  I sit straight up in bed, wondering what it could mean, and shake my head, struggling to understand. The red numerals on the alarm clock say 4:30 a.m. Through the window, I watch the clouds move fast across the sky. The full moon gives a false dawn. I remember then …

  In a place of beauty, a forest carpeted with white trillium flowers, a woman sits at a loom. The wind flaps her skirt against her bare legs and she’s weaving a tapestry of songs, fiber spun of scars, yarn dyed with tears.

  This tapestry reflects faces I know: Trish and Aran, Holly and Heather, Kaz, Shiana, and Marissa. When the weaver is finished, she spreads the cloth on the earth and lies down. I see that my face is embroidered there too.

  She closes her eyes and breathes deeply. The white bells of flowers sing her to sleep.

  Spring Again

  CHAPTER 14

  KAZ

  It’s snowed all night, and patients are dropping out of the schedule like flies. As usual, the empty slots trouble me. Traditionally, this is a low month for billings, and we badly need money. I stand inspecting the list of appointments taped to my door. Three patients have already canceled. The next patient should be Kasmar Layton. He’s never missed. Will he too call in? Outside my window, the thick wet flakes cover everything, a sloppy, wet spring snow, and the roads are too slick.

  Kaz doesn’t cancel. In fact, he comes early. I’m in the front office using the copier, and I watch though the glass over the receptionist’s desk as he shakes the white off his hooded brown jacket and stomps his boots. His freckled face is red from the cold. If you didn’t know different, he could be the FedEx guy delivering a package.

  Later, in the exam room, after I’ve reviewed Kaz’s labs, I sit on the stool and ask how things are. It’s a slow day. I’ve got time to talk.

  “Better,” Kaz says. “Lots better. Things are settling down. Jerry and I have been getting counseling and feeling closer.” He smiles. “Sex is the best it’s ever been.” Kaz goes on. “My only problem now is the faculty bathroom.” Ka
z’s voice is low and doesn’t have the adolescent breaks it did last time. His beard has thickened, and he’s making an effort to dispose of the feminine gestures. I watch him, still amazed. Women can make their breasts large or small, slim down their thighs. We can alter our faces, smooth out wrinkles, lift drooping lids. We can even become men if we want to.

  “So what’s the deal with the bathroom? Last time I talked to you, you’d used the guys’ john in that restaurant and got a kick out of it. You told me you’d passed the test!”

  “That was relatively simple, but last week I got a memo from the university that they don’t want me to use the men’s john in the agriculture building.”

  “Well, where are you going to go? The women’s? I wouldn’t think female students or faculty would be comfortable with that. I can imagine coming into the lavatory, seeing a guy like you at the sink, and walking right out again.” We both chuckle.

  “Exactly. That’s what I told ’em.” Kaz scratches his face.

  “So, who’s harassing you, the administration? The university lawyers?”

  “Neither. Somehow the Department of Social Justice is involved. I think my chairman just didn’t want to make a decision, so he handed it over to them. I never met more unhelpful people.”

  I frown. “So, what do you think the solution should be?”

  “They should let me use the men’s john and tell anyone who doesn’t like it too bad!” Kaz grins. “Or build me my own bathroom. The chairman has one.”

  “Is there anything I can do? You know, write a letter saying that it’s medically necessary for you to urinate on a regular basis or you’ll have bodily harm?” I think this is funny, but Kaz doesn’t smile. There’s a pause. “Everything else okay?”

  Kaz shrugs. “No big deal. Enrollment for my classes is stable. I mostly work with grad students anyway, but I’m not getting fan mail. Actually, I’ve been getting hate mail every day, e-mails and snail mail, obscene. I don’t even want to tell you what the letters say. I’m sure the persecution is coming from only a few people, but my skin isn’t as thick as I thought it would be. I keep looking around at faculty and students, wondering who it could be.”