The Blue Cotton Gown (17 page)

Both the young people are beaming now. “I think this baby is going to make it,” I say. “There’s never a guarantee, but I’m estimating that you’re almost out of the danger zone for miscarriage.” There are tears in Heather’s blue eyes.

T.J. stands with his hand resting on his lover’s narrow bare foot. Maybe there’s hope for them yet. You never know what will make people change.

“So when do we get an ultrasound?” T.J. demands, slipping like a snake back into his old skin. “We need to know if there’s one or two babies.” He’s standing too close. I can smell beer on his breath and I move backward toward the door. This guy’s wound too tight. “Since you’re already nearly twelve weeks, Heather, and I don’t think you’re going to have a miscarriage, I’ll be transferring you to your new provider next week. They’ll want to do the ultrasound

there. You’ll need to get a medical card before your first visit at the new OB’s office. I’m sending you to Sara, one of the other nurse-midwives. She’s a little younger than me, but real nice. You’ll like the whole group. There are three midwives and two ob-gyns.”

T.J. is pissed about not getting the ultrasound and tries to act huffy, but he’s not arguing and sits down. Heather has already started to dress, pulling on worn hot pink thong underpants and low-cut faded jeans.

“I’ll get you some samples of prenatal vitamins.” I stop with one hand at the door. “T.J., I want to say again that it’s important, for you as a couple and for the baby, that you get this drug thing under control. This is no way to start a family. Will you try to get help?” The young man shifts his gray-blue eyes sideways then back. Finally, he nods without expression. That’s all, one nod, and that’s all I’m going to get.

A few minutes later, when I bring the samples of prenatal vitamins and the OB packet back to the exam room, Heather is tying her worn Adidas, and T.J. is already moving down the hall, anxious to leave. I watch his lean body turn the corner, power and grace like a ballet dancer. “Will you be okay with him?” I ask my patient. “I could try to find you somewhere else to live for a while.”

Heather shrugs. “If he
tries
. . . I have to give him a chance, if he

tries. He’s the baby’s father.”

I’ve heard this a hundred times before. “He’s the baby’s fa-ther . . .”

Her young eyes look old.

Fear of Failure

With the two of us working, both professionals and one a surgeon, money shouldn’t be a problem. It wouldn’t be for most people, but for the last few years, our situation has been borderline and seems

to be getting worse. Tom pays our household bills monthly, always writing checks for the minimum on our credit cards, holding the mortgage aside for a week if he has to. It’s ironic. We’re just like the average West Virginians, trying to scrape by, except we have more money, a nicer house, kids in private colleges, and bigger debts.

This morning Rebecca, our accountant, telephoned the office and asked Noelle, our billing secretary, if she had any checks to de-posit. The quarterly installment for our medical-liability coverage, eighteen thousand dollars, is due at the end of the week, and we’re four thousand short. Each year the cost of malpractice insurance goes higher, and Medicaid, Medicare, Blue Cross, and Aetna payments shrink. I wish Gorham wouldn’t get the staff involved in our financial difficulties. They know we’re not in great shape. When she calls like this and asks what insurance-reimbursement checks have come in, they worry about the practice’s stability and wonder whether they’ll have jobs next year, or even next month.

It’s 1:35 a.m. I had just fallen asleep when Tom’s pager went off. Now I’m up walking the floor in my white terry robe. Dottie Teresi has spiked a fever of 104, and Tom has gone back to the hospital. I don’t ask questions anymore. “Good luck,” I call out as he closes the door. For the first time it occurs to me that this patient may die. If she has an antibiotic-resistant infection she could slip into sep-ticemia or go into cardiac arrest. I can’t even remember how long she’s been hospitalized. Though the general surgeons have taken over her care, Tom says he feels chained to her hospital bed.

It’s become his whole lifestyle. He makes rounds on her at six in the morning, then sees her again at noon. He’s back on her ward at seven in the evening, waiting to talk to her husband, Dr. Teresi. Sometimes, if she takes a turn for the worse, he goes in again later. Like tonight.

Unable to sleep, I decide to make myself a cup of Sleepytime tea. I’ll try it, anyway. I swipe a cloth over the counter, staring around as

the kettle heats. The dishwasher needs replacing. A white plastic panel came off the bottom six months ago and we haven’t had the money or time to buy a new one.

Two years ago, when we’d hired Pete Burrows, we leased a larger office and furnished it; paid for his ads in the newspaper; invested in marketing; paid his salary, paid his malpractice premiums and retirement fund; and enlarged the staff. A big investment. Then we encouraged all new patients to see Pete while he built up his practice.

I take a sip of the tea and walk out onto the side porch. I still don’t comprehend what clouded our judgment, or what we should have done differently. He
seemed
like a good man. We shared liberal political views, a love of nature, and a passion for the environment, but that wasn’t enough.

Maybe we were just too hippie for him. Our ways of doing things and his ways were too different, and we couldn’t talk about it. Pete resigned suddenly, taking his patients and leaving us with the costs of expansion. Later we realized he’d been planning his move for months.

It’s like we were hit on the side of the head without warning, and we’ve never gotten back on our feet, never righted ourselves, never caught up. Pete still doesn’t speak to us, and we don’t know why. I shake my head, trying to lose the paranoia. How did a flower child who had faith that if you just trusted the decency in all people everything would work out become a middle-aged woman who can’t sleep, she’s so worried about everything? Reaching over the porch rail, I hold my hands open and let the starlight pour into them. I take the light and splash it up on my face. Four or five times, I let it pool and pour it over my head.

Then I take off my robe and walk down the steps into the grass, which is colder and wetter than I expected. With my hands raised, I dance in my short pajamas, dance in the moonlight at the edge of the garden.

I smell fall coming. You know that smell? The smell of dead leaves and rain. Then, with my hands clasped together, I kneel down in the wet grass and pray. Pray for Dottie Teresi.

rebba

I am staring at a lavender envelope lying in the center of my desk, addressed in careful feminine handwriting to Patsy Harman. The return addressee is Rebba Tobin, Seattle, Washington. That name rings a bell. It must be a patient. Picking up the phone, I ask Noelle, our billing secretary, “Can you bring me Rebba Tobin’s chart?” I spell the name out. “I
assume
she’s a patient.” Then I unseal the flap. In-side there’s a flowered thank-you card, but the message is puzzling. No words, just a drawing. I frown at the cryptic symbols.

A few minutes later, Noelle steps into the office and hands me the yellow chart. Her normally composed oval face is flushed. “I’m sorry if I freaked out on you,” she says sheepishly, shaking her head. “That woman in the waiting room was just really scary. I think she’s an
addict,
and that boyfriend of hers, I bet she shares the pills Dr. Harman gives her with him. He gave me the creeps.” She shivers and folds her arms over her chest.

Only an hour ago, I was standing in the reception area insisting a patient leave our office. I would have called Tom, but he was in the OR, so it was up to me. A stringy-haired, rail-thin redhead in jeans was pounding on the glass window, harassing the secretaries, demanding a script for Oxycontin.

“It’s okay,” I tell Noelle. “I was scared too, but not all patients on narcotics are alike. Remember that, okay? Most of them are fine and take their medicine the way Tom instructs them.” Noelle shrugs and backs out the door. I can see she doesn’t believe me.

Sometimes, we judge too harshly, I think. We’ve never walked in

these women’s shoes. As clinicians, it’s difficult to know what to do. Pain is real. A health-care provider’s role is to relieve suffering, but narcotics are addicting, and for the vulnerable patient, that’s trouble. For others, narcotics make living bearable.

The angry woman this morning called me a controlling bitch and a few other unmentionables, but when she realized throwing a fit wasn’t going to get her more Oxycontin, she finally stomped out the door. Afterward I was shaking and didn’t know whether to laugh or to cry.

I take a sip of my Stress Relief tea, skimming Rebba Tobin’s chart until I get to the last progress note. Now she comes back to me, and I smile. Rebba was the slim, auburn-haired girl, a flower in spring, who thought she was frigid. Months ago I’d given her detailed instructions on how to fix that. Apparently, my advice worked.

I glance through the window just as the sun shoots through the high cumulus clouds. Beams of golden light streak down like in the movies and I hear the chorus on high that goes with it.

Now
the symbols inside the thank-you card make sense: a heart

with a big smile and, underneath it, an oversize exclamation mark. At least
this
patient appreciates me.

The girl had an orgasm!

chapter 9

Jeopardy

I can’t decide if I want to vomit or go into the break room and eat three pieces of German chocolate cake. The name on the chart is Rae Blandon. It’s a name that wouldn’t mean anything if it weren’t for the record’s request clipped to the front.

I reread it carefully.
McKenzie, Rogers and Clager, PLLC, representing

the family of Rae Blandon, requests all patient records be sent to them, including laboratory and radiology reports.
The signature on the request is not Rae’s but
William
Blandon’s, executor of the estate. He must be a son or husband. I don’t know what
PLLC
means, but it’s nothing good. And the signature of the executor can mean one of two things: Rae Blandon is mentally incapacitated, or she’s dead.

McKenzie, Rogers and Clager.
The names are familiar. I reach for the telephone directory and turn it over. These are the guys with the full-page color ad on the back of the phone book.

mckenzie, rogers and clager, attorneys at law. medical malpractice specialists.

representing injured patients and their families. it
’
s all about getting what
’
s fair.

In the center of the ad are three smiling men in black suits with red ties.
It’s all about getting the money,
I think.

I study their faces and then turn back to the chart, trying to remember Rae Blandon, trying to remember her story. A tall, anxious middle-aged woman obsessed with her health? Was that her? There

are so
many
anxious women. I flip back to the last progress note, two years ago. The patient had never returned.

My last exam is well documented. The patient was doing fine physically that day, but I’d made a notation:
Patient’s sister dying of breast cancer after long struggle with chemo and radiation.
In Rae’s history, I’d written that not only did Rae’s older sister have breast can-cer, her mother and aunt had it too.

When did she leave the practice? In the correspondence section I find a transfer form and a surgery report from the Torrington State University Medical Center. One year after her last visit, forty-seven- year-old Rae Blandon had received a double mastectomy for an ad-vanced malignant mass with involvement of the lymph nodes. The report from the Breast Care Center had been filed in her chart, but I’d never seen it.

The previous mammogram twelve months before had been nor-mal. I shake my head, puzzled. It wasn’t like I could have done anything for the sick woman at the point we got the surgery report in the mail, except maybe call or send her a card. That would have been nice, but the chemotherapy and radiation had probably come too late. Was it my fault? Could I have missed something?

For the rest of the afternoon, between seeing patients, I meticu-lously study the records with the eyes of a malpractice lawyer. The woman had gone for a mammogram every year. Her breasts were dense and the radiologist had always qualified his report with the usual words that the mammogram was not infallible and should be used as only a
part
of the information when making clinical decisions. My notes indicate that there were no discrete lumps but that the breasts were fibrocystic. I’d even written,
Instructed patient in breast self exam.
Had Rae found the lump herself and gone directly to the Breast Care Center without calling me?

That night, still obsessed about the possibility of being sued, I leave the office early to avoid the five-o’clock traffic. I can’t see that I was negligent. I’m sure I would have done a careful breast exam, especially knowing that Rae’s sister was dying of breast cancer. But

I’m not perfect. It haunts me that as I did her exam, I could have been paying more attention to Rae’s emotional pain than to her breast tissue under my fingers.

After dinner, sitting on the porch, I tell Tom about the request for records. It’s the first time we’ve chatted in weeks. Dottie Teresi is now out of intensive care and improving. There’s even talk of a discharge, though Tom’s not holding his breath.

“Let it go,” he says, holding my hand. “You do the best you can. You use your best judgment. You listen to the patients and you try to help them. It doesn’t matter. You can still be sued. Most of these threats of lawsuits don’t materialize anyway. Let it go.”

I love my work, but do I love it enough to go though the fear of a medical-liability suit? I shake my head, squinting at the violet sky and the lake and the stars, trying to get some perspective on things. The full moon is just coming over the house, and there’s the smell of drying leaves in the air.