The Blue Cotton Gown

by Patricia Harman

  I watch Kaz, watch the tears hang on the edge, and I wonder what kind of courage it takes to go from a woman to a man in front of your colleagues. He wipes the tears away with the back of his hand, which has hair on it now. Moving out of state, starting fresh in a new community where the professor could pass for a male from the start, would be so much easier. “I’m sorry; I guess I never thought how that could hurt. How can you help being bitter? You never did anything to them. Do you have people to talk to who’ve been through this?”

  “I’ll be okay. It doesn’t help to be angry. I just let it go. Anyway, I have the support group at the Persad Center. I’ll probably start going to meetings again. I’ll be okay.”

  “There aren’t any threats, are there?” I’m worried for my patient’s safety. This could get ugly. What if something happened to Kaz, like those incidents of gay-bashing you read about? I could never forgive myself.

  Kaz smiles. He sees where this is going. “No threats. Just harassment. Don’t feel responsible. I knew it wouldn’t be easy. I could report the letters to the Department of Social Justice, but they wouldn’t be sympathetic. You see how they are about the bathroom. I’ve made the choice to become a man. This kind of discrimination isn’t like skin color or a disability. Anyway don’t worry … I’m making muscles.” He squeezes his biceps and hits his chest a few times like Tarzan. “I’ll fight them all off!”

  This time I do hug Kaz. I feel his back under my hands, harder, heavier, and probably hairier.

  LEVY

  At four, Noelle, our quiet billing specialist, comes into my office looking sober and closes the door behind her. “Do you know anything about an IRS levy on our Accordia reimbursements?” Her normally pale face is whiter than usual and tight around the mouth. “I just discovered, while finishing the monthly report, that we haven’t been getting our West Virginia Medicaid payments. When I called the regional office in Charleston, they told me they’ve been withholding our money for months at the Internal Revenue Service’s request. They’re always so slow in paying … I didn’t realize. Apparently, that’s why our cash balance is so low. They’re holding over twenty thousand dollars.” She gives me a faxed correspondence with a shaking hand.

  I’d seen something about this before Christmas, a warning letter that we were behind in our taxes and that our account could be attached, but I thought they meant the business bank account. I’d never dreamed they could take away our insurance reimbursements! Rebecca Gorham had said it was an error and that she would take care of it.

  “This is a mistake,” I reassure Noelle. “We don’t owe them twenty thousand!” I toss the fax from Medicaid into my in-box. “We do owe eleven thousand for last fall’s quarterly taxes, but we still have two weeks to pay. I’ll have Don Collins straighten this out tomorrow,” I say calmly. “Don’t worry about it.” Noelle looks doubtful but turns to go back to her desk. As soon as she leaves, I frantically shoot off an e-mail to our new accountant.

  Don: We just heard from West Virginia Medicaid today that they’ve withheld $20,000 of our reimbursements because of some IRS levy. A letter came through from the Internal Revenue Service a few weeks before we hired you, referring to this, but Rebecca said it was a mistake and she’d take care of it. How can they take our money? We only owe the Feds $11,000 for the late fall taxes, and we’re not even to the deadline. I’m freaking out: $20,000! Please call me. P. Harman.

  I’m drowning in a net of levies, attachments, extensions, low bank accounts, and loans. I’m a good swimmer, but I’m going down! With all my concerns about the IRS, I realize I’ve neglected to call Trish. Her daughter almost died, and all I’m thinking about is money.

  SHIANA

  “You’ve got to come right now,” says Donna, standing at my office door. “There’s a girl out here that’s having a fit.” I have no idea what I may find, a belligerent or mentally ill patient or a young woman having a seizure. The receptionist pulls me by the sleeve around the corner, but there’s no patient. “They must have taken her into an exam room,” says Donna.

  Running down the back hall, we find a small woman lying on her side on the floor of room 1. Celeste is trying to rouse her. The patient moans. Thank God, she’s still breathing. No need for CPR. Though we’re all trained, we’ve never had to resuscitate anyone. “Let’s turn her over. Can you get her blood pressure?” I reach for the pillow. When I turn back, I’m shocked to see a pink baseball cap on the cream tile floor. It’s my young patient Shiana. The girl with the blue condom.

  “I’m so hot,” the patient moans.

  “Shiana, honey. It’s me, Mrs. Harman. Are you okay?” Her light brown skin is clammy. A tall blonde with an overbite stands in the corner, clutching a cell phone. She wears tight black leggings and a gray sweatshirt with the same Greek letters as the pink cap. “Are you her friend?” I ask.

  “I’m her sorority sister, but I am her friend, her good friend,” she says, as if fearing I’ll ask her to leave.

  “Can you tell me why she’s here today?”

  “She’s been real sick. She was in the emergency room last night with an ovarian cyst. Dr. Harman was going to do surgery tomorrow. We were about to go to the hospital to get pre-admission testing when she said she had to lie down. I thought she was going to collapse right at your checkout desk, but the nurse and I dragged her in here. We were trying to get her on the exam table and she slid to the floor.”

  The patient is mumbling.

  “Sweetie, can you sit up?” I ask. “Shiana, honey …”

  The girl shakes her head no.

  Celeste returns with a cool cloth and the blood pressure cuff. “Dr. Harman is already at the hospital,” our LPN tells me. “I hate to see her lying on the floor. Can we move her? Is she in pain? Maybe the cyst burst.”

  “Floor feels good,” the patient says. “It just feels good. Cool.” Her blood pressure is 80/40, too low, and her pulse is tachycardic, way too high, 120.

  I turn to the friend, who still stands flipping her cell phone open and closed, ready to call someone but not sure who. “Do you think she hit her head when she fell? Do you know if she has any history of seizures?” The girl shakes her head no to both questions.

  A voice comes from the floor. “I’m just so weak. I can’t sit up.”

  “We’ll let you rest then. If you feel better in about ten minutes we’ll take you in a wheelchair across the street to the hospital. If you don’t, we can call nine-one-one. You stay with her, Celeste. I’ll tell the other nurses you’re in here.” When I come back ten minutes later, they’re gone. Celeste has taken her to the emergency room. Celeste doesn’t need much instruction.

  That night, I hear more about Shiana, but the news isn’t good. Before dinner, I page Tom to ask his estimated time of arrival. A circulating nurse tells me Dr. Harman’s still in the OR. It’s been over two hours.

  Shiana had been added to the schedule as an emergency case, but Tom should have been home by now. If she’d just had a simple cyst on her ovary, why would the surgery be taking so long? Ever since Dottie Teresi’s prolonged hospitalization, I worry about the slightest surgical problem.

  I take my cup of chamomile tea out on the porch and rest my head on the railing. There’s the scent of dirt and new things growing. The ice on Lake Hope creaks, shifting in the thaw. Then a crack like a gunshot cuts through the night as a chunk breaks away out on the cove. A few minutes later Tom walks through the door, whistling. It’s eleven at night, and he’s been on his feet since six a.m.

  “What happened?” I ask anxiously. We both know what I mean, but he’s looking like a cat that’s enjoyed a bowl full of cream. He holds out a digital photograph taken through the laparoscope.

  “It was really something. There wasn’t just a large ovarian cyst. When I got in there, her ovaries and fallopian tubes were inflamed and swollen. Her uterus was enlarged too. At first, it looked like cancer, but when I saw all the pus …” He stares down proudly at the photo of his handiwork. I can’t figure out
why he’s so pleased.

  “PID?” I ask. “Pelvic inflammatory disease?”

  “Yeah, infection all through her pelvis. There was nothing else I could do, I had to take a seven-centimeter cyst off, take down the adhesions, and irrigate the whole pelvis. She’ll be in the hospital for a few days with triple IV antibiotics but she’ll be okay.”

  I remember Shiana lying on the floor of the exam room. She must have been close to septic shock, bacteria already coursing through her bloodstream, shutting her organs down. “I guess we’ll have to notify her parents in Erie,” I worry aloud. “Remember, she’s the girl I told you about, the college student who came in with the condom left in her vagina. Since then, she’s had herpes, chlamydia, a yeast infection, and now PID. Her parents don’t even know she’s sexually active, and all this came about from that one condom accident.”

  “Oh, they’re already at the hospital. Her friend must have called. I stopped by the waiting room and talked to them after surgery.”

  “What did you tell them? What did you say? You didn’t tell them about the STDs, did you?”

  “They’re fine. They think the infection came from the cyst, and I didn’t elaborate. Her folks are just glad she’s alive.”

  Tom is exhausted and falls right to sleep. For a while I lie in the dark thinking about Shiana. Then my mind shifts to Medicaid withholding our payments. With the worry about Shiana’s collapse, I hadn’t told Tom that the Feds have twenty thousand dollars of our money. Maybe I should have called the IRS myself, months ago, when we got the letter warning us that our bank account could be levied for late tax payments, but I was facing cancer then and Rebecca had assured me she would take care of it.

  Tom rolls on his back and starts snoring. I poke him. “Tom.” I poke him again. “Tom … you’re snoring.”

  “Okay,” he mumbles and turns back on his side. In a few hours he will start snoring again. He does this when he’s exhausted.

  Outside the high window, the silver moon slips through the feathered clouds. I pray that the pelvic inflammatory disease won’t make Shiana sterile. I pray that she won’t get an abscess, like Mrs. Teresi, or chronic pelvic pain syndrome, like so many of our patients. For now she’s okay. She survived being septic and lived through a complicated surgery. I just hope she will survive the emotional trauma.

  In the dim hospital room, her parents keep watch at her bedside. I picture a vase of pink roses on the windowsill. The father, a big man, sleeps soundly with his bare brown arms hanging over the edge of a narrow fold-up cot. The mom, wearing the pink baseball cap over her dark curls, is still awake, sitting in the beige guest chair. She reaches over and tenderly places the back of her hand on Shiana’s brow, checking for fever, as mothers do, as Trish has done for Aran, and Holly’s done for her daughter, as I have done for my boys.

  My husband starts to snore again. This time I let the poor guy be. I remember what Tom said one time: “I like being a surgeon. I like fixing people. It makes me happy.”

  Blame

  Tonight Tom and I had a royal fight, and we’ve gone to bed mad. It’s too bad. We’d had a great bike ride, our first one this spring.

  Bluebonnets bloomed at the side of the path. The green river moved along on the right, and the sky rippled with clouds like the scales of a fish.

  Later at home, sitting on the porch in the dark with our peppermint tea, I cautiously bring up the office finances. For weeks, Tom’s been too tired or preoccupied to talk about our situation. He’s off to the hospital at six in the morning and not home until nine at night. His face is blotchy, with scaly patches of eczema. He’s literally working himself sick to make money. He says I dwell on the problems, but someone has to.

  For the first time in months, I sleep alone in my study. Not that I’m sleeping. Don Collins called this morning to confirm that Noelle’s information is correct. The IRS has, in fact, been withholding our money. All payments from West Virginia Medicaid and PEIA state employees’ insurance have been withheld and will continue to be withheld until the agency receives verification that we’ve paid our taxes. Meanwhile, even though we owe only eleven thousand dollars, they continue to withhold more of our money. And it’s worse than Noelle thought, not just twenty thousand but thirty-three thousand dollars! Don has filed an appeal with the IRS but says in his experience it will take months, possibly years, to get it all back. The Feds have no record of Rebecca ever requesting an extension for the fall quarterly taxes.

  Our financial problems are not really Tom’s fault, and I know that, but I don’t understand how this happened. He has the office accounts on his computer. Couldn’t he see that our balance was crashing? Tom thinks I’m responsible. As the practice administrator, I should have followed our insurance payments more closely. Really, we’re both just scared.

  There’s four hundred dollars left in the checking account, and staff salaries yet to pay. The eleven thousand is due in a week, and we’re still not clear where we’ll get it. Don has suggested we go back to the bank, but we owe so much money already. The practice debts are guaranteed by a mortgage on our home on Hope Lake. If the business goes down, Tom and I will lose everything. Maybe it would be for the best. We could start over, go back to being hippies. I smile wryly and let out a long sigh, picturing us out on a farm in the hills, chopping wood, carrying water, canning and drying our homegrown crops. Outside my study window, there’s nothing but blackness and the shadow of the red-leafed ornamental plum just budding out. No moon, no stars.

  All day, Noelle has been on the phone trying to collect patients’ past-due accounts, her black hair knotted at the back of her neck with a rubber band and a pen stuck into the knot. The staff knows what a mess we are in. Donna at checkout is insisting on payment at the time of service. Linda is calling patients with outstanding bills; some still owe us thousands of dollars. Everyone is doing what she can, but I’m afraid the bank will deny us more credit and I feel like a fool even asking them. If we can’t manage our finances better than this, why would they trust us to pay the loan back?

  I think of crying, but what good will that do? I turn the light out and reach for the jam jar of scotch, imagining Tom sleeping soundly in our spacious bedroom in our big, soft king-size bed while I toss and turn on this narrow cot. He’s in the OR again in the morning and on call at Torrington State University Medical Center tomorrow night.

  There’s no getting around it, and there’s no other choice. I can’t wait for my husband, and I can’t put it off any longer. I’ll call the bank in the morning.

  The forecast for today is for partial sun, but there’s no sign of it yet. For six days it’s rained, and the lake as I cross the bridge is shit brown. Gray skies, brown lake, that’s my life. All night I’ve been worried about the staff meeting. Tom, as usual, has slept like a log.

  Though getting the loan wasn’t as hard as I thought, it’s only a stopgap to pay off the quarterly taxes and get us through another pay period. Don has told us straight out that we’re spending more on overhead each month than we earn. He suggests that Tom and I cut employee benefits to save money, but it’s hard. Both our fathers were union men, and we feel a sympathy for the workers. These benefits are part of the package they signed on for.

  We’ve finally agreed, as a compromise, to cut back our contribution to their 401(k). As Mr. Collins points out, no other doctor’s office contributes nearly as much as we do. If the business goes under, the staff will be out of their jobs. A cushy retirement fund won’t mean much then. Don has promised to come to the meeting for support. I’ll need it. I still burn from the harsh words directed at me at the meeting a few months ago.

  At four, we close early and gather in the waiting room, where there are enough chairs for everyone. The atmosphere is as cloudy inside as out. Nobody says anything. Abby stares at the large framed photographs of pink magnolias. She has to go to her mother’s farm outside Helvetia this weekend. Her mom’s slowly losing her mind, and Abby desperately needs to hire someone to stay wi
th her, even if she has to pay for it out of her own pocket. Usually bouncy Linda gazes out the long windows at the dark clouds. Her husband is still out of work at the mines. Now her paycheck is all that they live on. The rest of the secretaries and nurses sit waiting, no joking, no gossiping. Then everyone turns toward the door.

  When Donald walks in with his briefcase in hand, I’m sure they’re expecting the worst. I, as usual, play master of ceremonies when everyone gets settled, too anxious to keep quiet and give my husband an opportunity for leadership. “We’ve asked Donald Collins, our new accountant, to join us today to give everyone an overview of the practice’s financial picture.” Tom slumps in his chair, staring down at his shoes, while I babble nervously on. He’s still wearing his scrubs from the OR.

  “I know some of you have been concerned about the money picture for the practice, and this meeting will give everyone an opportunity to ask questions.”

  Donald pulls a ream of paper out of his briefcase. “How’s everyone doing this afternoon?” he asks cheerfully, a ray of sunshine in the gloom.

  He summarizes our situation: “The practice is spending more than it makes and is gradually going deeper and deeper in debt. In addition, the IRS has instructed several government insurance plans to withhold your payables, and that has hurt your bank account significantly. I’ve come up with some recommendations.” All eyes are pinned on his face. “I’ve told Patsy and Dr. Harman that, while I respect their generosity to their employees”—he looks around the group to be sure everyone is listening—“it’s part of the practice’s financial problems.

  “Since Dr. Burrows resigned and you dropped obstetrics, what you collect isn’t equal to what it costs to do business. Now, there isn’t any way to cut most of that expense. The rent for the office, supplies and so forth, are fixed. To make up the deficit, we could cut staff or health insurance benefits.” People shift in their seats uncomfortably. “Or we could cut salaries.” A telephone rings, but no one gets up to answer it.