The Blue Cotton Gown Page 4

  Shiana is talking more to herself than to me. “He didn’t kiss me good-bye or anything, he just grabbed his cap off the dresser and left. I felt bad, but I thought, Well, what a jerk!” Her almond eyes flash. “But now I know why. He left the condom in me.” She looks down. “I tried to get it out, but it’s still in there.”

  I move the stool a little closer. Her voice is so soft, I can hardly hear. “Can you tell me when this happened?”

  “Friday night.” Shiana looks up at me, tears welling in her eyes. It’s now eleven in the morning on Tuesday, much too late for the emergency birth control pill.

  “It’s okay, Shiana. Come on now; let’s start by getting this thing out. Put your feet in these gadgets.” I never call them stirrups. I have a thing about that. It reminds me of cowboys and cowboy boots with silver spurs. I take the young woman’s red-socked feet and guide them into the cloth-covered footrests. “Just slide your bottom down to the end and try not to be embarrassed. I can get the condom out, and then you’ll feel better and we’ll talk about what else we should do.”

  It isn’t very difficult. The condom is wadded behind the cervix. I find it with a gloved index finger and work it toward the opening. Then I grab it with a ring forceps. It smells about like you’d think a four-day-old condom with semen in it would smell, and it’s bright blue.

  I don’t say anything about the odor. The girl knows. I bury it deep in the trash and secure the stainless-steel lid. “If you don’t mind, Shiana, I think I should check you for infection, since you’re here. I know this is your first exam so I’ll be real careful. It won’t hurt.”

  “Go ahead,” says the girl, “I want to be checked for everything. I was always so careful … I never did it without a condom. Ever. I know some girls do.”

  I put the swab in a tube so I can send it to the lab and have them test for gonorrhea and chlamydia. There are other tests that need to be done. Some results don’t come back for days. Some infections take weeks or years to appear. Some have no treatment. Some are deadly. The girl knows this. She’s always used condoms.

  While I work I ask Shiana where she’s from. It’s my habit to keep the women talking so they won’t be so nervous. She isn’t from Philly. She’s from Erie. Her mom’s a teacher. Her dad’s in business. They don’t know she’s sexually active. “They would die.”

  Shiana wipes her face with her hands. She has a silver ring on every finger. She lies squinting at the ceiling while tears run down the sides of her soft brown cheeks. I want to take her in my arms and hold her, but I’m afraid my warmth would scare her away.

  When I’m finished, I fill out the lab slip. We’ll get tests for everything: gonorrhea, chlamydia, hepatitis, syphilis, herpes, and HIV. In a few weeks, some may need to be repeated. It’s too early for a pregnancy check. That’s a wait-and-pray item.

  Shiana’s period is due in two weeks. Very bad timing. If she has a regular twenty-eight-day cycle, she may already have ovulated. Still, the young woman might get lucky. I’m not sure how a wadded-up condom will affect sperm motility, probably slow them down some.

  When the lab slip is filled out, I seat myself again on the round swivel stool. “This was a hard thing that happened,” I say. “Some guys are assholes.

  “The nurse will call you with the results of the tests. It will take a few days. I’ll give you antibiotics as a precaution, but they won’t treat every infection. They won’t cover a virus. Do you think you should start birth control pills? You know, just as a precaution for next time?”

  “There won’t be a next time,” Shiana mutters, then lights the room up with a grin. It’s her first smile, and I see the outgoing, optimistic person she used to be, the woman before the condom. “Or at least not for a long time,” she continues. “I’m through with men.”

  I smile. “Well, if you don’t get your period in three weeks, come back and see me. We’ll do a pregnancy test and I’ll help you figure out what to do.” Shiana has no one to tell. No one else to talk to. Not her mother: “No way!” Or sorority sisters: “It’s so humiliating …” So the we means a lot.

  I walk Shiana to the checkout desk with my arm around her like we’re old friends.

  Plague of Locusts

  The thought of the twenty-one-thousand-dollar IRS debt rests like a stone in the bottom of my stomach, and I sit on the porch with my jam jar of booze, wondering if I’ve tried hard enough to go back to sleep. In the moonlight I can just see the shadow of the gazebo with the purple clematis climbing the rail. I can’t see the asparagus pushing up in the garden. I can’t see the peach tree now in full bloom.

  It’s not just the money. It’s our being inept. We should have known, should have kept better track. But we’re always so busy, so tired. And then, let’s face it, if it comes to rechecking an accountant’s figures or sitting on the porch and watching an osprey soar in circles over Hope Lake, you know what we choose. In my worst frame of mind I call us airhead hippies. I said this to Tom and it pissed him off.

  I’m tired of trying so hard, but it’s not like we have a choice now. We can’t walk away. If the practice doesn’t survive, Tom and I will still be responsible for the twenty-one thousand dollars we may owe the IRS, as well as all the money we borrowed: the fifty thousand dollars to start up the practice, the forty thousand dollars for the laser equipment, the sixty-five thousand dollars for the ultrasound machine, and the seventy thousand dollars to purchase the mandatory OB insurance policy tail, which will cover us for the next eighteen years for any prior acts of alleged obstetrical negligence.

  I feel like I’m always running in front of a plague of locusts, running to see patients, running to promote the practice, running to keep ahead of the bills. This past year, Tom has worked longer and longer hours, asking the secretaries to keep his surgical schedule full. Each day we get home later. The cost of salaries, employee benefits, and rent for the office goes up, while what insurance companies pay keeps plummeting.

  Rebecca Gorham e-mailed today that she found someone in the Cleveland IRS office who’s willing to review our case. She’ll meet with him at the end of the week. I’m hoping they’ll find it’s an error. If they don’t, I’ve no clue what we’ll do.

  “What the hell.” I take a sip of the sleep medicine. When a breeze wakens the wind chimes, I can smell peach blossoms, and my stomach relaxes around the warm scotch.

  This night of blossoms is my world, not the worry and hassle of running a practice. I rise heavily and lean over the rail. Rain was predicted, but the moon floats in and out of the clouds.

  Saluting all that is good and uncomplicated, I raise my hands to the sky.

  CHAPTER 3

  Forever and Ever, Amen

  “Did you see that girl?” Linda asks. “The one with the purple hair?”

  “Which one?” I kid her, like there were three. She gives me a look. The secretary’s frizzy red hair bounces when she talks. I’m at the microwave in the clinic kitchen, heating up lentils.

  “The young woman with the two kids. The hippie chick.”

  “You couldn’t help noticing.” Donna pops open her soda. “Not just the hair, but she sat right there in the waiting room with her boob hanging out.” Everyone snickers.

  “Her breast? Why?”

  “She was feeding the kid,” chimes in Linda.

  “Well there’s nothing wrong with her breast-feeding here,” I respond. “This is a women’s health practice.”

  Donna rolls her eyes. “But the kid must have been three years old. He could practically read!”

  I’m settling down with the staff for lunch. I usually eat in my office next to a stack of unfinished charts, but I’ve caught up with my work for a change. I can take a few minutes to relax. The kitchen is small. There’s room only for a white table, a fridge, and a sink. Today everyone has gone out to eat except Linda, Donna, and our junior receptionist, Junie. They’ve brought their cafeteria trays back from the hospital and are opening drinks, reaching for napkins and condiments.
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  I dip into my homemade bean soup, surreptitiously checking out my officemates’ selections. The array of fried food amazes me: fried chicken fingers, fried cheese, and french fries. For dessert, there’s chocolate cake. It’s not that it doesn’t smell good, but where are the veggies? I don’t say anything, just munch on my baby carrots.

  “So, you were a hippie, weren’t you?” asks Linda, stretching across for the salt. She’s been with the practice almost since it began, and loves to get me going. “Did you have purple hair?”

  I wink at Junie, the new staff member, twenty-one and a little bit of a hippie herself, a kindred spirit. “I’m still a hippie, at heart, anyway.” Today all three of the women wear lavender gingham scrubs, but Junie has a huge rhinestone brooch pinned to hers. The girl has flair, I’ll give her that.

  “Tell Junie how you and Dr. Harman got married,” Linda persists. “You were naked in a field of daisies, right?”

  I shake my head. The three look at me, expecting a story, and I feel like an elder sitting down at a campfire.

  “It was in a field of daisies,” I begin. “We lived on the commune then. You’ve heard about this, Junie?” The youngest woman nods. “It was down near Spencer. We lived on top of a beautiful ridge with a group of other peaceniks. Tom had asked me probably twenty times if I’d marry him. I’d always said no. My parents were divorced, and I figured if we got married we’d just break up like everyone else. If we stayed lovers, there might be a chance.” Donna nods, understanding.

  “You said no?” Linda’s heard this before.

  “Yeah, I said no all those times, then this one day … We slept in a tent with a wooden floor. We called it the butterfly tent because it was in a field of daisies and butterfly weeds. You know that flower, the butterfly weed? It’s bright orange and blooms in midsummer.

  “Well, this day, Dr. Harman was sick, running a high fever, with chills. We didn’t have a thermometer then. He was probably about one hundred and three, but he wasn’t a doctor, remember, just a scrawny hippie with a beard and long hair. I wasn’t a nurse or a midwife. I think it might have been a kidney infection, but we didn’t have health insurance, so we made herbal teas, drank lots of fluids, waited it out.

  “So, this one day he looks up at me when he’s all pale and sweaty and he says, ‘Will you marry me?’ This must have been the twenty-first time … I wasn’t counting. He looked pitiful, really. I’m sitting in the hot tent in June wringing out warm compresses for his back and for some reason I smile and say, ‘Yeah.’ That’s all, just ‘Yeah.’

  “The next morning we wake up. The fever had broken, and he felt weak but lots better. We were lying in the tent looking out the netting at daisies and orange butterfly flowers and monarchs flitting around, and I asked him, ‘So, are we married?’

  “And he said, ‘Yep.’

  “And I said, looking into his eyes, ‘Forever?’ and he said, ‘Yep.’

  “And that was it. A few months later we went to a friend who was a priest and he made it legal, but in our hearts it happened that day. Later I realized it was Friday the thirteenth, but we’ve been together now for almost thirty years, so I guess it was lucky for us.” I stand up, signaling the story has come to an end.

  Everyone sighs. “So were you naked?” Donna asks with a twinkle, coiling her long brown hair up in a French twist.

  “Yes,” I say as I bag up my soup container and wipe off my place at the table, “I imagine we were.”

  KASMAR

  “Hi, Kasmar. Am I saying that right? How are you today?” The freckle-faced woman nods and flashes a tight smile. She’s dressed in the blue exam gown and her clothes are piled neatly on the guest chair. I reach out my hand before I sit down and she takes it firmly.

  Reading the history clipped to the front of Kasmar Layton’s chart, you wouldn’t know there was anything remarkable about her. She’s forty-eight, already through menopause, apparently healthy; no bowel, bladder, or sexual problems; never smoked, eats a low-fat diet, and teaches horticulture at Torrington University’s School of Agriculture. She’s a new patient and here for her annual exam.

  I’m on a roll today, hoping to be out of the office early. I need to pack tonight, and I have to go to the bank, the pharmacy, and the supermarket for dog food. Tomorrow Tom and I and Roscoe, our short basset-beagle, will leave for a long weekend at our Lake Erie cottage.

  I palpate the patient’s breasts. “So when did you have the breast reduction? Recently?” Wide white scars make crosses below the nipples on both sides.

  “Two years ago.”

  “Were you happy you did it?”

  “Yes. It’s something I always wanted to do and I finally got up my nerve. I wish I’d had them made smaller though. I hate to think of going back for another surgery.” I’m mildly surprised. Her breasts are already cup size A.

  “Do you do your own breast exam?”

  “Yes.”

  I assist Kasmar to place her feet in the covered footrests, then put on my gloves and sit between her legs, adjusting the exam sheet so I can still see her face. “You can pull down the pillow if you want.” The woman appears tense but reaches above her head with both hands and adjusts the flowered pillow, smoothing her close-cropped black curls. Kasmar wears no makeup and no jewelry. She’s pretty in an angular way: high cheekbones, arched eyebrows over blue eyes, a long face with a prominent jaw; a good strong face.

  First I inspect the outside of the patient’s genitals. The labia are small and dry, a sign of decreased estrogen. “Are you married, Kasmar?”

  “I have a long-term partner.”

  The vagina’s so tiny I use the smallest speculum, watching the patient’s face as I carefully open it. “Do you have intercourse regularly?”

  “Not very often.” Kasmar grimaces. You can tell the exam hurts, but she doesn’t move or make noise. She’s one tough lady. I appreciate this.

  “You doing okay?”

  “Yeah.” Kasmar stares at the ceiling.

  Finished with the exam, I assist the patient to a sitting position and hand her the box of tissues. “Well, everything seems fine. You did great. Your vagina’s a little dry and tight, though. Does it hurt when you make love?”

  “No.”

  “Are you sure? Because there’s an estrogen cream I could prescribe. It’s very effective with problems like this.”

  “It’s not a problem.” The patient flinches and pinches her mouth shut.

  I drop the subject. The woman and her husband must have come to some agreement about sex. “Why don’t you get dressed and I’ll fill out your mammogram requisition.” I slip out the door and check my watch, smiling. Fifteen minutes from start to finish. If I could do this more often I might get to leave on time in the evening, like the other nurse-practitioners.

  When I return to the exam room, Kasmar is waiting, dressed in a soft blue long-sleeved shirt and navy slacks with black heavy-soled walking shoes. It’s the kind of outfit you might expect a horticulture professor to wear; she looks ready to go out into the fields to inspect the tassels of corn. Opening her leather briefcase, Kasmar removes a file. “I want to discuss a few things with you, if you don’t mind.”

  Shit, I was doing so well. I return to my stool. This could be anything.

  “I wanted to get that over so that I could talk to you.” She takes a big breath. “I really hate those exams. They make me so tense. But I need to get this out in the air … I’m a lesbian. My partner is a woman. I think you know her, Jerry Slater?”

  I do a double take like in the cartoons but keep my face impassive. I hope it’s impassive. First I recall Jerry Slater, a petite graying blond who teaches nursing at the university. Surely not! I can’t remember the details of her face, but I recall a gentle, sweet woman. I contemplate Kasmar in a new way. “I do remember her. She’s been in a few times. Is she the person who referred you?”

  “Yeah, she and my therapist, Karen Rossi. You know her?” I nod. Karen is a woman in my meditation group.
“I needed a checkup, but I also wanted to present something to you. I’ve been attending the Persad Center for Diversity in Pittsburgh for the last three years.” She announces this as if it’s significant and I should know what that means.

  “Persid? Persidio?” It doesn’t ring a bell, but then I don’t get up to the city that often. It must be some kind of support group. “I’m afraid I’m not familiar with that organization.”

  “It’s the Center for Transgender Therapy.”

  I’m still slow getting the drift.

  Kasmar continues, “I want to become a man and I was hoping you could assist me.”

  I can’t help it, my eyes widen.

  “I’ve been going to counseling for a long time and I feel it’s what I was meant to be. These are letters of support from my therapist and my doctors in Pittsburgh.” She hands over the two manila files. “What I need is someone locally who can prescribe the testosterone and do the follow-up exams and labs for me.” She waits for my response.

  “You know, this is something that’s never come up before,” I say, stalling. I’m thinking women do all sorts of things to themselves. They get nose jobs, boob jobs, and dye their hair blue. They pierce their nipples. They have cellulite removed and lips plumped up. We do laser treatments for the removal of unwanted hair and spider veins in our office. Is this so different?

  “My husband’s a surgeon, but I d-don’t think he’s qualified …” I stutter. “I’ve never been asked this before.”

  “I’m not surprised.” Kasmar responds with her first real smile. She has a wide generous mouth, soft lips, and white teeth. “I’m not planning on surgery at this point.”

  I clear my throat. “And you’re sure you want to do this? There are potential risks to high doses of testosterone. You know that?”