The Blue Cotton Gown (16 page)

Now, when a patient confesses to me that her son is in jail or her daughter is out on the streets, I’ll roll my stool closer and tell the mother my story. I tell it because there was a time when I told no one.

I told no one because I knew no one who I thought would understand.

nila

“Hi, you didn’t expect to see me back so soon, did you?” Nila looks about like she always looks: tidy, with her midlength blond-brown hair tied back in a ponytail. Her clear skin is now tanned from the summer sun. She wears size 2 jeans and a blue T-shirt that says
world
’
s best mom
on the front of it.

“I
am
surprised. So, how are you doing?” It’s been months since Nila Wilson transferred to her new nurse-midwife, and I’d assumed she was settled in mid-pregnancy.

Follow-up gyn problem,
the note on the chart says. Must be some mistake; Nila ought to be five or six, maybe seven months pregnant by now. I glance at the woman’s belly, checking for the swelling that should be there.

The patient meets my eyes, placing both hands on her abdomen protectively. “Well, you probably heard. I lost it.”

“No, I’m sorry, I didn’t know. I guess the other ob-gyn practice didn’t think to tell me . . . I’m really sorry.” Nila begins to spill tears. I grab the box of tissues and slide my stool closer. “So what happened? How pregnant were you? Are you doing okay?”

“I lost it,” Nila says again. That’s all she says.

“But what
happened,
did you just start bleeding? What happened?”

“Yeah, I’m sure it’s my fault. Doug told me to slow down. But

you remember, I never had problems with my first seven pregnancies, and I kept working as hard as I could. We got that old place on Weimer Road. I told you about it, the big farmhouse? Well, it was a dump, but perfect for us, six bedrooms, two baths.

“No one had lived in it for years. The kids and I started with three rooms, the kitchen, the living room, and the one bathroom that worked. We got those livable and then we just camped out, cleaned and painted another room every few days. I mean
serious cleaning.
Some of the windows were broken, so there were leaves and bird nests everywhere, all kinds of shit.” She checks to be sure her language has not offended, and when she sees that it hasn’t, she goes on. “Literal
shit!
Bird poop, mice poop, some bigger stuff, maybe raccoon. It was hard work, but fun. The kids and I slaved all day and half into the night for two weeks. Of course, I was working harder than anyone through the heat of August. I was obsessed. Nesting instinct, I guess.

“All that time we were bringing in furniture, whatever we could scrounge or get at yard sales and flea markets. We got cheap paint at the discount place out on Bobtown Road and whitewashed everything. I couldn’t ask Gibby for any of my old things, you know, my ex-husband, so we had to outfit the whole place. We worked our butts off, me and the kids. Doug was at Select-Tech ten hours a day, and I applied for food stamps.

“The first night Doug and I got settled into our new bedroom we made love. That’s when the bleeding started. Doug blamed himself. I’d spotted once before, with my fourth pregnancy, so I told him it would be all right.” Nila stops for a minute. I picture a stocky, good-looking guy in his early forties who hasn’t had much to do with childbirth staring down at the streak of red blood on the sheets. “But it wasn’t all right. When I went to my midwife she couldn’t find a heartbeat. They did an ultrasound, and the baby was dead. It wasn’t the intercourse. I’m sure of it. It was all the hard work. I should have known better. I was four months along. I just thought I was superwoman. Now I know that I’m not. Eventually, I had to

tell the kids. They didn’t even know miscarriages happened, since all of my pregnancies had gone fine before.”

Nila is quiet for a moment, remembering. She just sits there, a deflated balloon. “Then my sister, you know, Marnie?” I shake my head no. “Yeah, you do. She was at my last birth. Anyway, she’s
real Christian
and she told me the miscarriage was punishment from God for adultery. You know how she is.

“If I was a drinking woman, I swear, I would have started right in. Doug was crying and blaming himself because the miscarriage happened right after intercourse. And Marnie was telling me it was some kind of holy curse, and the kids were looking all worried. I had to go into the hospital for a D and C. My doctor told us that miscarriages just happen sometimes, that it wasn’t anyone’s fault, but I don’t know
. . . I was working too hard.
” Nila studies my face, waiting to see what I think.

“I agree with the OB,” I tell her. “Sometimes the baby’s not forming right, or the placenta comes loose. It hardly ever has anything to do with what you
did
or
didn’t
do
.
One out of five pregnancies ends in miscarriage. Some say one out of two if you count the real early ones. You’ve just been lucky before. Will you and Doug try again? I know you were happy about the baby.”

Nila shrugs her narrow shoulders. “Maybe, but I want to get the kids settled first, and then we’ll see. School is just starting. And I want to get a divorce from Gibby. He’s driving me nuts. When he heard about the miscarriage he sent me flowers, started calling, wanted to get together again. He says I wasn’t meant to be with anyone else. He keeps going on that
our
babies always came out good, and I can’t have one with another man . . .
I gotta get a divorce.
I’m thinking of going to some kind of legal aid. He’s driving me nuts.” She says it again.

I’ve never seen Nila so distressed. “Maybe I can help you with that. Didn’t you tell me that Gibby had been hitting you after his head injury? Wasn’t there something about that?”

“Not really hitting. He always stopped short.”

“What, then?”

“Just picking on me. Telling me I was lazy, that the house wasn’t clean, that I wasn’t taking care of the kids. He’d get real angry but he never
hit
me. One time I thought he was about to. He shoved me against the stove and it was turned on. I burned my arm. He didn’t mean it to happen, but I took the kids and went to Marnie’s that night. A few weeks later, I left in the van.” I remember Nila’s impressive dawn getaway with the six kids.

“So did he
threaten
you with violence? Did he do anything else?” “Oh sure, he
threatened,
but it was all hot air. He’d mouth off, say he’d kill me if I ever left. I didn’t believe him. We’d been together

forever. I know he loves me in his own way.”

“Nila, I’m going to give you the number for the Rape and Domestic Violence Center. They may be able to assist you. There are lawyers in town who volunteer at the shelter to help abused women get a divorce.”

Nila frowns. “I wouldn’t want to get Gibby in trouble. I wouldn’t want that. We were together for so many years and he’s the kids’ fa-ther.”

I stop the discussion. I’ve heard this before. “Well, I’ll give you the card with the phone number. At least you think about it. Gibby sounds potentially dangerous to me. If a man threatens you with death, it’s serious.”

“I’m okay now,” Nila reassures me. “He sent me flowers, and I have Doug.”

I smile resignedly. No use pursuing it, but I’ll give her the card. We always keep a stack of them in the restrooms so women can take them without having to tell us their problems. “So what brings you here today? Have you had a period since the D and C?”

“Yeah, I’m fine. I just had a few days of spotting but I think I need to get some kind of birth control. I’ve never used any before. I read you shouldn’t take contraceptives after the age of thirty-five if you smoke cigarettes, but I gave up the fags when I was in South Dakota. Could I get the birth control patch I’ve been reading about?”

“That’s great. You quit? Not easy to do.” I check Nila’s blood pressure and write her a script for the patches. Then I give her a long hug. “I’m sorry about the baby,” I say gently, patting the woman’s flat stomach. Nila peers down at my hand. She takes my fingers and puts them up to her cheek.

“Thanks,” she says. “Thanks for listening to me.” There are tears in her eyes again.

Nila is scheduled to return in three months for a birth control check
.

Superwoman.

heather

“Hi, Heather, how’re you doing?” I touch the slender young woman’s shoulder as I enter the exam room. I’m mildly surprised to see T.J. standing in front of the mirror that’s mounted on the wall in the corner, staring at himself. His long hair is gone and his head is now shaved. There’s a tattoo of an eagle on the back of his neck, and two wooden plugs in his earlobes.

A few months ago, I’d written the patient a prescription for birth control patches; now her urine test is positive for pregnancy. “Hi, T.J.,” I say, wishing he weren’t here but obliged to include him. “Did you guys get a frost out your way this morning?” I have nothing against the boy, but the only time I’ve had any real communication with Heather was the time she came to the clinic alone. My conversational gambit flounders.

The kid shrugs. “I don’t know. I wasn’t up until noon.”

Heather sits hunched on the end of the exam table in an exam gown that could wrap around her two times. Her arms are folded tightly over her front, and she’s working her angular jaw back and forth. She glances up at me.

“So how
is
everything?” I begin. Heather rubs her bare feet to-

gether and shoots me a look. I notice her stubby nails are magenta now. Something is wrong, more strained than usual.

T.J. turns back to his reflection in the mirror. “New haircut?” I ask, to be friendly.
The guy’s
so
self-centered
is what I am thinking, but maybe he just feels out of place.

He continues to inspect himself. “Nah, had it for a while.”

“So what’s happening, Heather? I see by the nurse’s note that you’re pregnant again. Is this something you wanted?” No eye contact. “Last time you were here, you were going to start the birth control patches. Did you change your mind or did you forget?”

“She didn’t
forget,
” T.J. mumbles.

“What did you say?”

“She didn’t
forget!
She wanted to get pregnant.”

“
You
did too!” Heather snarls. “You
said
you did, anyway.”

I suck in a long breath. “It sounds like there’s some tension about this.”
That’s putting it mildly.
I raise my inner eyebrows but keep my face deadpan.

“It’s him,” Heather says.

T.J.’s head snaps up and he glares at his lover.

“She already knows,” the young woman continues. “I told her about the drugs.”

I turn from my patient. “You still pretty heavily involved in drugs, T.J.?”

He rests his long, narrow body against the wall. “Some.” “What are you using?”

“Just grass, a little crack . . .” “Any narcotics?”

T.J. glances at Heather, then at me, wondering how much I know. He fiddles with the thick silver wallet chain attached to his belt. “Not much, just now and then.” I flip the chart back and forth, waiting.

“Just tell her, T.J.
You shoot up.
” Heather looks at me. “I
told
you.

He shoots heroin and Oxy and any other thing he can get his hands

on. I’m tired of it! I’m pregnant. I can’t babysit him and take care of a kid too. Every night I have to watch him snort or shoot up, wondering if I’ll have to call the emergency squad again. I’m fed up,” she snaps at T.J. “For
real!
”

I sigh. I’m not in the mood to do couples’ counseling, and the emotions in the room are swilling around me like sewage. “T.J., I’m going to assume you are a relatively intelligent person. It’s not just that some of these drugs can eventually kill you, it’s that the lifestyle that goes with them is incompatible with being a parent. You know what I mean? It’s not an environment you want to raise a kid in.”

T.J. gazes at the ceiling with disgust. “I’m going to quit when she has the baby.”

“Right,” says Heather.

“It’s easier said than done, T.J. You may need some help. Have you ever tried a treatment center or therapy? I know some good drug counselors.”

“I don’t need help. It’s not like I’m addicted. I’ve quit before.” “For about six days,” says Heather.

“How about two weeks! Remember last year?” They’re raising their voices.

I decide to change the subject. “Heather,” I break in, “let me go over your OB dates and see how far along you are.” I glance at the nurse’s note in the chart and see that Heather has listed the bleeding after the twins as her last menstrual period. “No bleeding since the miscarriage?”

“No. Well, maybe one day, but just spotting.” “Did you use the birth control at all, Heather?”

“No.” The girl is inspecting the bulletin board’s colorful handouts on laser cosmetics and sleep problems.

Great.
I look at the man, waiting for
his
excuse.

“You told me you
wanted
a baby,” T.J. says, squinting at Heather. Taking the round metal pregnancy wheel, I withdraw into my calculations and come up with her estimated date of delivery based

on the last episode of bleeding, but it’s just a guess. The young woman could have ovulated any time and may already be through the first trimester. I have the patient lie down on the exam table, cover her legs with the white sheet, and pull up the thin blue gown to her navel. “Any cramps this time?”

“None,” Heather answers, staring up at the ceiling.

T.J. is squirming in his chair like a kid. I wonder why he even bothered to come but decide I should give him credit for trying to act like a man. When I feel Heather’s lower abdomen, the uterus is easily palpable.

“I’m going to try to find the baby’s heartbeat,” I tell them as I place the small Doppler above the patient’s pubic bone. “It’s probably too early, so don’t be disappointed if we don’t hear it. I rarely pick it up before ten weeks.” The room goes quiet, and T.J. turns to watch. At first there’s just static, and then suddenly the faint click of the fetal heartbeat. I catch Heather’s eye. Her gaze slips to T.J. He’s alert, but unsure. “That’s
it,
” I exclaim, using my index finger to mimic the rhythm. Looking at the second hand on my watch, I count 140 beats per minute, a nice average rate for a fetus. “It’s a good strong heartbeat. Congratulations!”