The Blue Cotton Gown

by Patricia Harman

  The first thing I notice is the child’s red vulva. No bruising. No obvious trauma. No exudate, but redder than usual. “Do you hurt down here, Tilly?” The girl shakes her head no. “Want to play with my stethoscope?” The girl nods her head yes. While she tries to put it in her ears, she relaxes her legs.

  I gently part the tiny labia, which are more like skin folds in a four-year-old female. No lesions, I note. Then I take the Q-tip and run it across the opening and in as far as it goes. The child is playing now, trying to listen to her mother’s heart as she babbles away. I put K-Y on my gloved pinkie finger and gently lubricate the introitus, the opening of the vagina. Tilly’s legs close reflexively but open again as Nila discusses what kind of ice cream they’ll get after lunch.

  Now I can see the hymen. It’s intact but redder and more engorged than most.

  “Has anyone else checked you down here, Tilly?” I ask softly.

  “Huh?”

  “Has anyone touched you down here?”

  “Just Daddy, after we take our bath. It makes him feel better to rub me down there, and it doesn’t hurt.” My eyes meet Nila’s. Both our faces are limestone.

  “All done,” I say. Nila is having a coughing fit in the corner to hide her tears. “You were great, sweetie,” I tell the child. “When you get dressed you can pick out some stickers. We keep them in a drawer in the lab for good children. You’re the best four-year-old I’ve seen all week.” Like I’ve seen more than one.

  I step into the hallway and call Abby. Her dark eyes meet mine with a question, but she takes Tilly down to the lab.

  “What kind of stickers do you like? We have horses and kitties and dogs,” I hear her say. Tilly wants one of each.

  Returning to the exam room, I give myself time by washing my hands at the sink. Nila sits in the guest chair, her legs crossed and the upper one swinging fast. Her small hands open and close into fists.

  I roll my stool over. “I can’t find any real evidence of trauma. I don’t think she’s been penetrated.” My tone is clinical, like I’m giving report in the hospital, not talking to a mother of a sexually abused child. “The hymenal ring is still present, but it’s red. Gibby may have been putting his finger in there, but probably nothing bigger. I’ve done cultures for STDs. It’s all I know to do.” I wait for Nila to say something, to ask me questions or cry. Her almost golden eyes are glazed over; she must be picturing the bathroom and her ex-husband naked, fondling her daughter.

  “Did you understand me?” I ask. The mother nods once. “I told you it’s not my expertise, but I think you’re right. I believe her. Tilly said it so calmly, that Gibby has been touching her after her bath. That may be why she hates going into the bathroom. I think you need to see a counselor, and also the cops. I’m going to give you a name and phone number of a social worker. Hanna Westfield knows about these things, and you should also call your lawyer … Nila?” The woman’s face is so pale. “Are you listening?”

  “Oh shit,” Nila bursts out. She’s twisting the ends of her long flannel shirt as if it’s someone’s neck. “Oh shit, Patsy. What should I do? And him a big Christian. What should I do? I’ll kill him. I swear.” She begins circling the room, then grabs the pillow off the exam table. I’m afraid she’s going to swing it into the wall, knock down the picture of the river at Black Water Falls. “What should I do?”

  “Nila, stop. You have to get hold of yourself.” The patient turns to me, crushing the pillow against her chest. “Nila, I’m telling you what to do. You have to see a counselor and call your lawyer. Do you want me to do it for you?” We’re both standing in the middle of the exam room now.

  “No, I’ll do it.” Nila moves to the sink and throws cold water on her face. “I’ll do it.”

  “You’ll have to report this to child welfare too, and Tilly will need to be interviewed. Under no circumstance can you let Gibby have any of the kids, any of them. He can’t have them. Do you understand?”

  “The son of a bitch will never see them again.”

  I take a deep breath. “Well, don’t do anything rash. Mrs. Westfield, the counselor, will know the procedures. Everything has to be documented. I’ll write a detailed note in your chart.”

  There’s a tap at the door, and when I open it little Tilly comes in holding a streamer of stickers longer than she is. “See what they gave me?” she says proudly, holding them up to her mom.

  “That’s nice,” Nila says numbly as she jerks on the child’s tiny pink coat with rabbit ears on the hood.

  “You’ll do what I say? You promise? You’ll report it? If you don’t, I’ll have to.”

  Nila flashes a look. Her face is a mask with dark holes for eyes. “I’ll do it,” she says once more.

  I reach out to touch her, to give her a hug, but Nila, half dragging little Tilly, shrugs me off and marches out of the exam room, a soldier going into combat.

  PENNY

  It’s Friday afternoon. “Hi, Penny,” I say to the bleached blonde who sits on the end of the exam table. She’s wearing a low-cut lavender T-shirt with a sheet over her lower half. Penny’s bare feet swing back and forth and I notice a fungus is affecting her toenails but I don’t say anything. “What brings you in today? You look great, by the way. I can tell you’ve stopped picking.”

  Penny gives me a slow sideways smile and shrugs. “I guess I’m doing pretty good. I haven’t picked for weeks. I never thought I could give it up. My family doctor put me on an antidepressant. It helps too.” She furrows her brow. “I’m afraid I have a yeast infection again, though.”

  I stroll over and examine the patient’s face, turning it up to the light. Before we did microderm cosmetics I never touched women’s faces like this, and I like the intimacy. The pockmarks that previously marred the woman’s pale cheeks and chin are fading. Her skin is pink and healthy. I wonder if she looked like this at seventeen when the gynecologist sexually molested her. Probably better.

  “I know it’s frustrating to keep getting yeast, Penny,” I start off after I return from the lab, where I looked at the slide of her discharge. “And I’m going to give you the medication, but I think we may need to give you long-term suppression and test you for diabetes if the infection comes back again. I want you to schedule a follow-up with me in about a week so I can be sure that it’s really gone. If it isn’t, we’ll try something different.”

  “Yeah,” she says. “I’m tired of this.”

  I clear my throat. “There’s one other thing I want to talk to you about.” Penny’s eyes shift to the floor. “I know you think I’m being overly persistent, but I keep worrying about what happened to you at the university gyn clinic years ago, the way that doctor sexually assaulted you. What if he’s out there still preying on young girls?” Penny stares at her hands, opening and closing them. “Wouldn’t you want to stop him if you could?” Now the patient’s fingers are twitching. She reaches for her face, then bites her knuckles. “I’m sorry. This is upsetting you, isn’t it?”

  Penny nods. She has tears in her eyes. When she speaks, her voice is so low, almost a growl, I have to move closer to hear. “You have to understand, Patsy. This happened a long time ago. I’ve forgiven the man. Maybe you haven’t. It wasn’t the worst thing to happen to me. I’ve got to go.” She stands abruptly and pulls on her jeans. She steps into her tennis shoes but doesn’t take time to tie them. “I know you’re disappointed in me.”

  “I’m sorry,” I repeat. “I didn’t mean to make you feel bad. I—”

  Penny takes a ragged breath and snatches the prescription out of my hand. “I can’t talk about this. Don’t you see?” she says frantically. “I really don’t want to start picking again!”

  “Wait, please. I’m sorry.” I reach out for her, but the woman slips by. She twists away and opens the door. Penny runs down the hall past the checkout desk. She doesn’t stop. “I’m sorry,” I whisper. She doesn’t look back. She doesn’t even notice her shoelaces flapping.

  Water Dream

&nb
sp; It’s been raining for three days, and the creek at the end of Blue Rock Drive is coming over the banks. Tonight I’m exhausted and fall asleep without effort, barely aware of the steady sound of water pouring over the gutters. In the thin light of dawn I dream again:

  Cold floodwater is coming up from the floor, keepsakes and books float around me. I’m searching for babies, dipping down in the brown muddy water. Where are the babies?

  In a roar, the walls of the house collapse. I scream for Tom, but he’s washed away.

  People are crying. Children are screaming but I can’t save them. I’m swallowing water, swept away in the current. Then I remember my boys. Where are my boys? My small boys! Frantically I scan for their little blond heads, hoping to see them bobbing along in the muddy river.

  They’re gone.

  I open my eyes, my skin wet, the sheets damp. At first I just think it’s a hot flash, but then I remember. In the gray light of morning, I replay the dream of grief and remorse and shake the sleep from my head. Mica and Orion and Zen are men now. They would be saving the babies.

  I am moved by this insight and lie next to my snoring husband, seeing my now adult children, as steady and calm as their father, leading rescue parties, risking their own lives, working through the night, selfless and brave.

  They may or may not have gainful employment. They may or may not have a sense of their own life directions, but they would be first at the disaster site. Mica would be organizing a relief crew. Zen would be building dikes to hold back the river. Orion would be out in a rowboat searching for survivors.

  It’s 4:30 a.m. Through the open porch door, I hear the sound of rain everywhere, still pouring off the roof, off the leaves, off every exposed living thing. I pull a chair up to the window in the dim light and sit thinking about my kids until dawn. Then the rain hits again, harder, slanting under the eaves.

  Break in the Weather

  Noelle stands in the door to my office. There’s a stack of charts on my desk a foot high, and two patients waiting in the exam rooms. I glance over my shoulder at her, but keep signing off labs.

  “What?” I don’t like being rude but am not in the mood for chitchat. “If it’s more bad news, I don’t want it.”

  Noelle doesn’t say anything, just dances from foot to foot.

  “Okay.” I swivel in my desk chair, stretching my back. “Sorry. You need something? I’m just way behind.”

  Our billing specialist is grinning from ear to ear, her face shining like Hope Lake when the sun breaks through the storm clouds.

  “What?” I ask again, a smile flickering on my face. “Is it some kind of joke? Are you and Linda up to something?” Her joy is contagious.

  “We’re going to get it back!”

  “What?” I’m still clueless.

  “The thirty-three thousand dollars!”

  “Come on, Don Collins said it was very complicated, very difficult, that it would take months, maybe years, if we even ever got it back. He said we might have to write our congressman or get a lawyer. I haven’t talked to him lately, but he told me his partner, a tax specialist, was working on it.”

  Noelle does a little victory jig and turns around. “You can pat me on the back.”

  I shake my head quizzically, patting her. “I don’t get it.”

  “I was talking on the telephone to a supervisor at the main Accordia Medicaid office today.” Noelle perches on the edge of the guest chair. “And I pointed out that they’ve been sitting on thousands of dollars of our payments for months. Miss Hooper, she pulled our file on the computer and said, ‘This isn’t right.’ Well, we knew that!

  “I stayed on the phone for twenty minutes while she looked through the account. She said there were records on us about a mile long but there had been so many people involved at the IRS that the attachment of our funds had never been challenged. She said she’ll get us a check for the Medicaid portion, about twenty thousand, by next week, and she’ll notify PEIA and the other state payers. Maybe a week, she said, maybe two, we’ll get a check.”

  I want to stand up and hug Noelle, swing her slender body up to the ceiling, but Noelle is not a hugger. She’s told me before, she needs her personal space. I want to run down the halls shouting, throw open the exam room doors, shocking the patients who are sitting on the tables in their thin blue cotton gowns. I want to shout, Noelle found our money. She’s gonna get it back!

  Instead I say, gratefully, “Thank you, Noelle. Thank you.” I look into her shining blue eyes. “You are my hero!”

  At dinner with Tom, I save the news for dessert, a treat I picked up at Shop ’n Save for the occasion, Ben & Jerry’s. We’re eating on the porch, the sun sinking behind the black silhouette of trees against a pink magnolia sky. “A toast,” I say, holding out my first spoonful of Cherry Garcia. We clink silverware. Tom looks at me, puzzled.

  “Noelle talked to someone at the Accordia office today and they’re going to release our money next week. I don’t know how she found this woman. She just kept persistently calling. This afternoon she was reviewing unpaid patient accounts on the phone with a representative and she mentioned our problem, told the woman, this Miss Hooper, our IRS story. The lady looked at our computer file and says she is going to put it right. Can you believe that? They are going to send us a check.”

  “That’s great,” Tom says, smiling. He isn’t the type to get up and dance. He takes another bite of ice cream. “Don’t forget, Don had his accountant working on it too.”

  “Yeah, I’m sure they were filing petitions and sending letters on our behalf, but he wasn’t that optimistic. Noelle was persistently on the phone with everyone, secretary and supervisor, at Medicaid. When we get the money, I’m going to send flowers to everyone: Noelle, the lady at Accordia, and Don’s office too. What do you think?”

  Tom scrapes out his ice cream bowl, smiling. “Yeah, send something big. All three of them.”

  NILA

  Going through a pile of labs at the end of the day, I come to Nila’s and wonder briefly if she’s called the counselor. There’s a computer-generated lab report clipped to the front of her chart. All the results are normal but one. I don’t even remember requesting the serum pregnancy test on the requisition but I’d checked everything else having anything to do with fatigue. No doubt about it. It’s positive. Nila is pregnant again.

  How could this be? Doug’s been gone, what, a month? It must be his baby. I flip open the chart. There were two weeks when Nila was bleeding and she stopped the birth control patches. Maybe then? I shake my head and try twice to call her, staring out the window at the rain. When there’s no answer, I leave a message. “Nila, it’s Patsy at the gyn office. I have some lab results for you. Can you return my call at your earliest convenience?”

  At 11:15 p.m. my cell phone goes off. Tom and I are snuggled in bed watching a video. We both groan. I’m on call for emergencies. “Turn it down, will you?” I whisper. “Hello?” I’m expecting the answering service. Patients aren’t supposed to have my personal number. “Hello,” I say again. It’s still hard to hear and I carry the phone into the living room.

  “Patsy?” a woman’s breathless voice asks.

  “Yes, this is Patsy Harman. Who is this?”

  “It’s Nila. I’m sorry to get you on your cell at home, but I still had the number saved on mine from when you answered my page the other morning.”

  “Yeah, what’s up, Nila?” I shift the receiver to my other ear and sink down on the couch, waving Tom through the doorway to go on with the movie. “Did you get my message from the office?”

  “About the lab tests?”

  “Yeah, I’ve got your results.”

  “Don’t worry about that. I’m okay. I found Doug. I found him! I’m going back to South Dakota. I’m so happy!” she bubbles out.

  Then her voice drops four notes. “But I have to get out of town fast. Gibby is going crazy that I won’t let him see the kids. Buddy, my nine-year-old, says his dad has a gun.”
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br />   “What do you mean, a gun? Is Gibby after you? What kind of gun?”

  “I don’t know the type. What does it matter? Buddy just told me his dad bought a gun. Gibby was bragging about it when he talked to him on the phone. Doug wants to come get me from South Dakota, but I can’t wait. We’ve got to get out of town. We’re leaving Torrington tonight.” Nila hesitates.

  “Tonight?” I say, wondering why she’s calling me about this. “But it’s so late and raining so hard …”

  “Well, you can say no if you have to, but I need to ask you a favor. It’s a big one.”

  “What? What can I do?”

  “I have to get some cash. I feel real bad asking and I swear I’ll pay you back, but we have to get out of here and there’s no one else. I’m not waiting around until something terrible happens. Can I borrow a hundred dollars?” She stops abruptly.

  “You need money for gas?”

  “Yeah, Doug’s good for it. He’s working at the propane plant in Sioux City.”

  I shake my head and draw in a breath. “This is crazy. What about your furniture, all your household things? You can’t just split.” Tom has turned off the video and come into the living room. He leans against the doorway in his tie-dyed T-shirt and plaid boxers, listening. He can tell it’s some kind of crisis. “Nila, hold on, I have another call coming in. Stay right there.” This is a lie, but I put her on hold.

  “What’s going on?”

  “It’s Nila.” Tom knows the story of the patient’s earlier road trip west with seven kids in a van, the subsequent return to Torrington pregnant, the late miscarriage, and the sexual abuse of little Tilly by her father. “She’s found Doug, her lover, and she’s going back to South Dakota with all the kids. She sounds desperate and says she has to leave tonight because she just found out that her ex-husband purchased a gun. She sounds desperate, thinks he’s coming after her. She wants to borrow a hundred dollars. Do we have any cash?”

  Tom frowns. “I guess we could get some at the money machine at Quik Mart, but this is a little over the top, isn’t it? Lending money to a patient. We’ll probably never get it back.”