The Blue Cotton Gown Read online

  I go through the usual introductions and then get down to business. “Aran, I know this pregnancy isn’t what you expected. Your mom told me you’d never planned to have children. It must be a hard adjustment. You doing okay?”

  “I guess …” Aran doesn’t look up. Her pink flip-flops hang from her toes.

  “Do you think you’re going to be able to handle it? Because there are alternatives. If you aren’t already too far along you could have a termination or think about giving the baby up for adoption. You’re pretty young to be a mom.”

  “I could never do that!” Aran says adamantly, now looking straight at me. Her blue eyes flash. “I don’t believe in abortion unless there’s something wrong with the baby, and I wouldn’t consider adoption. How would I know if the baby got a good home or was being abused?”

  “You could contact an adoption agency. All the prospective parents are carefully screened.” Jimmy is shaking his head no, but he still hasn’t spoken.

  I decide I’ve gone on enough about alternatives. Clearly, they won’t consider them, and I don’t want to push it. After the physical exam and the review of the information in the OB packet, I take the couple down the hall to the ultrasound room for an unofficial scan. As I’m typing in Aran’s demographics, there’s a tap at the door. “Can I watch too?” Trish pokes her head into the darkened room. Abby, my nurse, must have called her to come up from the family medicine suite just in time.

  “Okay with you?” I ask her daughter. The girl shrugs. The three of them, Aran, Jimmy, and Trish, stare at the screen as unidentifiable shapes swirl around and I get my bearings. I’m not a whiz at ultrasound but I can usually find the embryo’s heartbeat. “There’s the fetus.” I point to the flicker of white life. “See its heart beating?” Aran and Jimmy stare at the screen without expression. Maybe they were hoping this whole thing was a mistake, that there wasn’t really a baby, that it was just going to go away.

  Trish tries hard to be upbeat. With appropriate enthusiasm she says, “Well, hi there, little fellow.” The fetus raises its arm and waves. “He is an active one!” Then the room is dead silent. Nobody else says anything.

  When I glance up from the monitor to turn on the lights, I’m surprised to see Jimmy wiping his eyes.

  Courage

  It’s 2:00 a.m. and I’m still not asleep. I turn on my side, inspecting the stained-glass mandala that hangs in the window at the peak of the high ceiling, then I plump another pillow under my head. The full moon moves in and out of the clouds. This bedroom is a big box of moonlight. It’s so large, our whole log cabin at the farm would fit in the space. All over the world, families of ten live in houses smaller than this room.

  I’m worried about Aran. I wish she would look into adoption. In this part of Appalachia, neither abortion nor adoption is seriously considered. There’s a strong feeling for family. Kin will take care of kin.

  Though it’s rare for a mother in West Virginia to give up her baby, I’ve always thought it one of the noblest things a woman can do. And one of the hardest. I pad out to the porch with my dose of scotch and sit looking across the lawn toward the gazebo. Two deer stand under the peach tree. I recall one young mother …

  She was twenty, unmarried, a college student. What was her name, Kari or Karen? She and her boyfriend came for every prenatal visit, and just like any other couple they got excited to hear the heartbeat, excited to see the baby on the ultrasound. By her seventh month she’d already visited a social worker and arranged for a placement.

  During the delivery of a baby that’s going to be given up, you have to be careful with the words that you use. You don’t whisper to the woman in great pain while you hold her, “Think about your baby. Your baby will be here soon.” You don’t urge when she’s pushing, “Come on, Mom, you can do it!” And you don’t exclaim when you lay the wet infant on her chest, “Congratulations, you’re a mother!”

  If you say anything at all as you hand the infant to the waiting RN, you quietly declare, “The baby’s doing great. It looks healthy.” You don’t even mention the sex. Then the nurse wheels him or her out in a bassinet, and the room is so quiet you can hear the moaning of the woman still in labor next door.

  The day of Kari’s discharge, after she’s had the baby, my patient and her boyfriend ask over the intercom for the infant to be brought to their room. The RNs at the nurses’ station look at one another knowingly, thinking the young couple will change their minds and refuse to relinquish. That’s what you call it when you give a baby up for adoption, relinquish. We’ve seen young women change their minds at the last minute, more often than not. The baby is brought to the young couple. At two o’clock, the light over their door starts blinking again.

  I rise from the desk and drag down the hall, not in a hurry to get there. A couple like this, in college but with family support, could do all right taking a baby home. However, if they do that, an adoptive mother and father who’ve been expecting to bring home their infant tonight will feel that the baby they’ve carried near their hearts for months has died.

  I knock quietly, and Kari pushes the bassinet to the door. She stands in her green-striped hospital robe with the boyfriend touching her arm. “You can take him now,” Kari says, her face red from crying. “We’re done saying good-bye.” Then she reaches into the bed and pulls the blue flannel blanket up to the tiny boy’s neck. The father’he is about the same age as my youngest son’puts a small stuffed monkey in the bassinet. I take both their hands and stand with them for a few minutes saying a prayer, then I roll the cart down the hall … It still brings tears to my eyes.

  The scotch has kicked in and the moon is already sinking into the lake on a stream of silver. I rest my head on the rail. The couple had made the baby by accident and given him away on purpose, a gift to a family that couldn’t conceive. At the foot of our bed, I drop my robe to the floor and slide in beside Tom’s big, warm body.

  I’ve never forgotten their courage.

  Affliction

  By dawn I’ve vomited three times. My husband still sleeps, but I’m pacing the floor. When the pain moves into my chest and I throw up again, I can’t put it off any longer. I sit on the side of the bed. “Tom, we have to go to the emergency room.”

  “What?”

  “We have to go to the ER. I’ve been up since three. It was abdominal pain at first, but now it’s up here.” I press my fist to my chest. We’re both thinking the same thing. Heart attack. We dress quickly, say nothing.

  If it hadn’t been Friday, I would have gone to the ER hours ago. But on Friday night in a college town, it’s nothing but drunks and overdoses. When we get there we have to wait anyway. I moan, holding my stomach. “I think I’m going to throw up,” I tell Tom. He taps on the window and says three magic words, chest pain and vomit, and an orderly comes quickly to get me. Then a team in blue scrubs whips into action.

  Cold sticky pads are pressed on my chest. An oxygen cannula is placed in my nose, and an overweight male nurse gets the IV in with one try. My stomach is hurting so bad, I don’t even notice the pinch of the needle. The doc glances up from the EKG readout. “It’s normal,” she says to no one. So it’s not a heart attack after all. I ask for a sip of water.

  I’ve never had heart trouble before, have never been sick except for the usual colds and seasonal viruses. But this time, I was sure it was the big one. Whole grains and veggies are protective up to a point, but stress and guilt have a way of catching up with you.

  Soon I’m given some IV Nubain for the pain and I’m floating three feet above my bed. I watch from my perch as a bevy of nurses wanders over to say hello to my husband. The tall blonde, whose name tag says CAROL, swishes her shiny, straight hair and announces that she’s made coffee in the doctors’ lounge. I can tell Tom’s one of their favorites and wonder if it’s anything more than that … My inner eye squints, watching them chatter.

  Tom’s short gray hair is receding, but his face is still young. I check him out as a single woman
might. Not a bad-looking guy, a straight nose and straight teeth, broad shoulders, nice hands. He could lose a few pounds, but only a wife would notice.

  The nurses are laughing at something he’s said. Tom’s not really flirting. I doubt he knows how. He’s just so damn good-humored, all women like him. My eyelids are drooping and … and then the medication wears off. The pain is back.

  The doctor in a rumpled white lab coat, who is probably the same age as Orion, my middle son, comes by to discharge me. I remember her now. I helped her deliver her first baby, my hands over hers, at the university hospital when she was in med school.

  “Your heart’s fine and all your labs are normal,” she tells us, looking at Tom. “The X-ray shows a hiatal hernia, a weakness in the diaphragm that allows the stomach to expand into the chest.” She turns to me. “Did you know that?” Her breath smells of coffee and exhaustion.

  “No, not really. I’ve never had any trouble before. I had bad acid indigestion when I was pregnant years ago.” She nods, as if reflux when I was expecting confirms her diagnosis.

  It all sounds too simple, but I’m relieved. If I go home and don’t eat for a few days, the pain will go away.

  I’m not dying after all.

  The pain does get better, but after three days it hasn’t gone away. I still feel the fist in my chest, my temp is 103, and I’m sent back to the hospital for more tests. Everything blurs after that. I’m starting to chill, but getting the CT isn’t as bad as I expected. The tech, a man with greased-back hair and braces, says they’re going to get a “wet reading” in the next half hour. Tom is in the office seeing patients, and I just want to go home and lie down, so I dress and find my car in the ER parking lot. Twenty minutes later, as I’m crossing the bridge over Hope Lake, my cell phone goes off. I consider ignoring it—I’m sick, for God’s sake!—but dutifully pull onto the berm. The phone has stopped ringing but I check the caller ID and return the call.

  “Monroe, radiology,” a clipped bass voice answers. I picture a dark-eyed, opinionated man I met once at a hospital holiday party.

  “Patsy Harman, nurse-midwife, you called?” I respond just as formally.

  “Where are you?”

  “What … ? I’m in my car, almost home.”

  “Well, you better come back,” Monroe growls. “I could be wrong, but I think you have a gangrenous gallbladder.”

  Gangrene in my gallbladder? I blink, not knowing how to respond. “Okay, where should I go?”

  “OR admissions, third floor. You know where that is? I’ll call Jamison, the general surgeon. They’ll fit you in as an emergency case. He’ll meet you there, and I mean now!” This man must have been in the military.

  Speed-dialing the office while I’m driving, I take the entrance back onto the freeway too fast, and the rear of the Civic swings out in the gravel. “Is Tom with a patient?”

  “Yeah. What’s up?” Linda answers. “You doin’ okay? You want me to get him?”

  “Tell him they think I have gangrene in my gallbladder. Just tell him,” I shout. “Can you hear me?” The phone reception is breaking up as I come over the bridge. “Tell him I have gangrene in my gallbladder and I’m being admitted to the hospital right now.” Some women would cry. That’s not my way. I’ll cry later.

  In an hour, I’m lying in a pre-op bed.

  It’s hard to argue with gangrene.

  I didn’t even try.

  “They’re going to try to do it through the scope,” the nurse with bleached, spiked hair tells me briskly. I’m being brave and overly calm, asking all the right questions about the procedure. Though I’ve worked in hospitals for the last twenty years, I haven’t been a patient in one since Mica was born. Zen and Orion, the two younger boys, were both delivered at home.

  “Mrs. Harman?” asks an orderly with five-o’clock shadow who reminds me of someone in a gangster movie.

  I nod.

  “Ready for a little ride?” He smiles slyly, thinking he’s cute.

  I better get it together. I don’t want to go into the OR for removal of a gallbladder and come out minus a kidney. I glance at my IV and shake my head to clear it. They may have already given me a sedative. “Yes,” I say, holding out my arm with the plastic ID band on it, wanting him to double-check my name. He did say Harman, didn’t he? Not Hammond or Hartman?

  The orderly glances at the band without really reading it. “It’s time to go. They’re ready for you.” As we roll away, I view the action in the large pre-op bay.

  Nurses and doctors in blue scrubs transport patients back and forth, consulting with one another as I pass by. The professionals sound like they’re speaking another language, and I feel like a character in someone’s bad dream. We’re inside an alien spaceship. They’re the crew and I’m the stranger about to be probed. Then I’m moving fast down the hallway into the belly of the craft, and there’s the smell of Betadine and antiseptic soap.

  “Good luck,” someone calls.

  At the last minute my husband shows up, dressed in scrubs and wearing a green paper hat. He’s not going to assist with the surgery; he’s just here to make sure my soul doesn’t float away in the middle of the operation. Tom’s not an assertive guy, but if they’re screwing up and letting my blood pressure drop, he’ll say something. I think he’ll say something … he won’t let me die.

  Tom jokes with the nurses, shakes hands with Dr. Jamison. I watch them discuss my case, leaning in toward each other. Then Tom comes over and touches my arm. “How you doing?” The OR is as comfortable to him as his study, the scrubs as comfortable as his pajamas. Not to me. As a midwife, my place is in the birthing room or the mother’s bedroom. I enter the surgical suite, hesitantly, only when I assist with a C-section.

  My husband’s green eyes twinkle above the surgical mask as he bends over me. I want to touch his smooth tan cheek, and lifting my hand, I beckon him closer. “If I die,” I whisper, pressing my forehead against his and not caring who hears us or what they may think, “I’ll meet you in heaven.”

  I have tears in my eyes and I haven’t loved him this much for a long while. Tom smiles indulgently. “Did you hear me?” I insist seriously. He’s probably thinking it’s the pre-op sedation making me goofy, but he pulls down his mask and kisses me.

  I know Tom doesn’t believe in heaven, but right now he needs to. This might be our last time together. “Promise?”

  “Yeah,” he says. “But you won’t die.”

  They are rolling me into the OR now … “You never know,” I say. “It could happen.”

  I don’t die. But three days later, I’m still in the hospital and I’m not doing well. I feel like shit. My blood oxygenation is poor. I’m short of breath, in too much pain, and my abdomen resembles an eight-month pregnancy.

  I’ve decided I must have a pulmonary embolism, or maybe a massive hematoma under my diaphragm, but Dr. Jamison and my husband don’t seem concerned. Maybe they’re covering something up, trying to be reassuring.

  I don’t trust the nurses either. I’m an RN myself and I know I’m not getting the kind of care I would give. I time how long it takes them to answer the call light. Twenty minutes. I’d have been dead by then if I’d been having a stroke. I remind myself that there’s a national nursing shortage and I should try not to be so demanding. They’re probably attending to too many patients. That doesn’t help. Now I’m really afraid.

  Three days after the surgery, a massive transport aide with a triple chin comes to room 770 and says, “X-ray?” I didn’t know I was getting an X-ray. I wonder what’s up.

  Across from the nurses’ station, the orderly parks me; I’m on display while we wait for the elevator. He leans against the wall and salutes the ward secretary. Visitors’ eyes linger, they’re wondering what’s wrong with me. I imagine how I must look; pale, disheveled. I haven’t washed my hair for a week. Some of these people are my patients or families of patients that I have delivered. I pretend to be asleep, or maybe comatose. If I can’t see them, mayb
e they won’t see me.

  Late in the afternoon, when the sun slants in through the window, Dr. Jamison comes by to tell me that the X-ray showed I have an ileus. “It’s unfortunate, but as you know it’s not uncommon in prolonged or difficult surgeries. Your bowels have stopped moving and the gas in them is compressing your lungs, that’s why you’re short of breath and your oxygen saturation is so low.” He looks rumpled and tired but takes time to ask about the huge bouquet of daisies and irises on the bedside table. “My sons,” I explain, smiling fondly through the pain.

  “If you can walk more,” Jamison says, “you might increase the peristalsis of the bowels and get the gas moving. Otherwise, I can have the nurses put in a rectal tube.” That sounds delightful.

  I’m determined to get my paralyzed bowels in motion. After countless trips up and down the hall, pushing my IV pole and an oxygen tank, there are actual gas pains, spasms that almost double me over, and finally a fart. I stand in the carpeted corridor and let one rip, don’t hold it back, and don’t care if anyone hears. I fart some more, laughing.

  That afternoon, since I’m feeling better, I decide to see what America’s watching on TV. On Oprah, a couple discuss their history of domestic violence. The man is a cop. He got counseling.

  I think of all the patients I’ve known who have lived with violent men. I think of my father and mother; their passion, their fights. A foreman at a trucking depot in the California Bay Area, my father commuted to Oakland from our subdivision in Walnut Creek. Every other Friday was payday, and that meant a stop at the pub. He came home five hours late, loaded and jolly, smelling of booze and cheap perfume. He sat at the piano with me, played “Chopsticks,” and laughed. My mom, a substitute schoolteacher, as jealous as a cat, didn’t say a word.