The Blue Cotton Gown (2 page)

“Can you tell me when your last real period was?” Heather shrugs.

“We can’t be sure,” says Grandma. “I tell her to write down her

time
but she don’t.”

Great,
I think. “Well, why don’t you lie back on the exam table and I’ll feel your belly to see if I can get an idea.” My hands palpate Heather’s lower abdomen. There’s a bulge halfway between her jeweled belly-button ring and the pubic bone, about right for fourteen weeks. Could the girl really be that far along?

“Give me a minute. I want to see if my husband, Dr. Harman, is available for an ultrasound.” I leave, shaking my head, and trot down the hall. Looking through the window in the nurses’ station, I see storm clouds have come in from the west.

Tom’s two exam rooms are on the opposite side of the clinic, and both doors are closed, indicating there are patients inside. Be-hind one, I can hear voices, and I knock softly, nervous about interrupting him.

No one answers, and I tap again, louder, hoping he’s not in the middle of a pelvic exam. Finally he opens the door. “What’s up?” He’s wearing a red checked shirt with a Beatles tie and black Dockers. His white lab coat is reserved for the hospital. He would wear jeans and a corduroy shirt to the office if I let him.

“I have a new OB that’s spotting; can you do an ultrasound for vi-ability and dating?” I ask. “Do you have time?”

Tom glances at his watch and shakes his head. “I have three patients to see before I go to the OR. Is she bleeding heavily? Can we do it tomorrow?”

I shrug. “It’s not like she’s hemorrhaging. But it’s not good ei-ther, and they’re anxious.”

“Get her here in the morning, I’ll squeeze her in.” A middle-aged woman sitting on the exam table glares at me through aviator glasses. Tom closes the door, and I head down the hall, trying to de-cide what to say.

I could scan Heather myself, but even if I can find the heartbeat she’ll need a second ultrasound to get an accurate gestational age. And if it
is
a miscarriage, I want Tom to be there to confirm it. The family won’t like having to return, but tomorrow is best.

When I reenter the exam room I find the small group standing in a knot next to the sink. They quickly sit down. “She
threw up,
” says Mrs. Gresko, as if it’s my fault.

“What about the ultrasound?” demands T.J. “I’m sorry,” whispers the girl, looking down.

I go to the sink. They’ve cleaned it, but it still smells like vomit. The nurses will have to spray with disinfectant. “We’ll have to do the ultrasound tomorrow. I’m sorry. If the bleeding gets worse tonight, come to the ER. I know you’re worried, but you have to understand that if a miscarriage is going to happen, nothing can stop it. Just rest, get some ginger ale for hydration, and come in around ten. I’ll write you a script for medicine that might help with the nausea, and you could try some peppermint tea. I have a feeling everything’s going to be all right . . .” I’m not sure why I say this.

Mrs. Gresko shifts in her seat and sighs with irritation. T.J. crosses his long legs in disgust. Heather studies her stubby blue fingernails.

So far she’s uttered all of four sentences, and that’s all I’m going to get.

Blood

When I got up to pee in the white enamel commode, it was dark and I couldn’t see the blood dripping down my legs. I didn’t bother to light the kerosene lamp. This was downstairs in the log cabin, back in the commune days.

Because my first pregnancy with Mica had gone without a hitch, miscarriage was the last thing I had on my mind. When I saw the

brown streak in my underwear that morning, I didn’t even know what it was. It didn’t occur to me that the streak was old blood, and I didn’t bother to call my doctor. Then again, I couldn’t have, since we didn’t have a phone; not that there was anything a doctor could have done anyway.

By afternoon I began to bleed in earnest. I wasn’t a midwife yet, but I understood. Tom and I cried together. In the night, the fire in the woodstove went out, but we had thick quilts and were used to the cold.

Most women don’t have more than menstrual cramps when they miscarry, but for me the pain came like labor contractions. If I could have gotten up and walked around, it would have been easier. I might have built up the fire or asked my husband to, but I just stayed under the covers.

With a towel between my legs, I lay doing my childbirth breathing. Mica slept curled in his little homemade bed across the room. Tom adjusted the pillow under his bad shoulder. He knew what was happening but he wasn’t a physician then, hadn’t even thought of becoming one. He asked if I needed anything. I didn’t. What could he do?

When I got up at dawn I was dizzy. In the gray light I saw the sheets covered in red. I lay back down in the warm blood and stared out the window. During the night, it had snowed. The oaks and maples on our West Virginia ridge were covered in white; the pine trees, the cedars, everything.

nila

Nila speaks first. “So, I guess you’re surprised to see me.” The five-foot-tall dishwater blonde leans back on the exam table, swinging her bare legs like a girl. The blue cotton exam gown is three sizes too big.

“No, not surprised to see you, just surprised to see you
pregnant.
I thought Gibby was going to get a vasectomy. Did he change his mind?”

“Nah, he never got it.” Nila pauses. “I’ve been living in Independence, South Dakota, for over a year.”

“Did the receptionist tell you we stopped delivering babies?” “That’s what I heard; they said you gave up births a few months

ago, but I don’t have any money and I haven’t been to the health department to get a medical card. I figured you’d see me anyway.” She gives me a smile, and she’s right. At our clinic, we see new OBs even if they aren’t established patients, regardless of payer sta-tus. We try to help them get medical cards, back-billing if they qualify, setting up payment plans if they don’t. Tom and I were poorer

than poor when we lived on the farm. We know how it is.

“It was the cost of malpractice insurance. Last year the practice premiums for obstetrics went from seventy thousand dollars a year to a hundred and ten thousand. We just couldn’t do it
. A hundred and ten thousand a year!
You could buy a pretty good house in West Virginia for a hundred and ten thousand dollars, a new one every twelve months.” The patient nods sympathetically. I tell all the new OB patients why we gave up deliveries. I give them the numbers, hoping they’ll understand.

Nila is a “grand multip,” meaning she’s had more than five ba-bies. In all her pregnancies she’s never had a miscarriage, a C-section, or a stillbirth. She smokes, has poor nutrition, and when not pregnant weighs about a hundred pounds. I delivered babies five, six, and seven. Most people think the more babies a mother has, the eas-ier it gets, but that’s not true. After baby five, it gets harder. By that time, the uterus is so stretched, it doesn’t contract well. Malpresentations (breech, transverse, face), prolonged labor, and hemorrhage are common. Nila’s seventh one was the worst.

I can still see Nila lying in the birthing bed, thin, flat-chested, with smooth tan skin. She has the high cheekbones and small chin of a lot of Appalachian women, and when she smiles, her two front

teeth gap a little, but not badly. The petite thirty-eight-year-old was fully dilated, her epidural topped off, and she was as comfortable as a breast-fed baby, but she wouldn’t push.

“Come on, Nila,” I pleaded. “Come on. You can do it! Two or three more pushes and it’ll all be over.
Then
you can rest.”

“I’m tired; I want to rest
now.
”

Nila’s labor had been long. It started at two in the morning. At four in the afternoon, she’d been given Phenergan IV for her nausea.

*

Now sunset, the baby is poised at the opening of the vagina, ready to be born, but the mother’s half drunk from the medicine and won’t cooperate.

“
Please,
Nila. Just grab my hand and push hard.” I nod at her husband, Gibby, indicating
he
should say something.

“Yeah, come on, honey . . .” Not much enthusiasm. He’s tired too.

The RN catches my eye and turns up the volume on the fetal heart monitor.
Beep . . . beep . . . . . . . . beep . . . . . . . . . . . . . . . .

beep . . . . . . . . . . . . . . . . . . . beep.
The fetal heart rate is dipping with each contraction. This baby needs to be born.

Nila closes her eyes, as if she actually thinks we might let her nap, then coughs. It’s a raspy deep smoker’s cough, and with the ab-dominal effort the baby’s dark hairy head moves down an inch. “Hey, do that again.”

“What?” Nila asks, her eyes still shut. “Cough. Cough again. It’s moving the baby.”

The patient rouses. “Like that?” She coughs again and the fetal head pokes out a little more. I glance at the monitor. Heart rate to seventy, but back to 120 by the end of the contraction.

“Yeah, keep going. You might be my first patient to
cough
her

baby out.” Nila giggles, forces another cough, and laughs at herself.

The rhythmic shaking of her belly works even better than the cough, and the baby’s head shows some more.

“Look,” says the nurse, pulling over a mirror on a wheeled stand. “You can see your baby being born.” Now we are all getting into it, telling Nila we’ll tickle her and offering knock-knock jokes. Even Gibby participates, whispering something into his wife’s ear that makes her blush and giggle some more.

I place my hands around the baby’s emerging head like a crown, easing back the perineum. The nurse slips me warm compresses and oil to help the skin stretch, and a small vigorous baby slips into my hands.

“Gonna call him the Joker,” Gibby quips as the nurse places the wailing pink infant into his arms. Nila has already fallen asleep . . .

*

I smile now, remembering . . . then shake my head and return to the exam room.

“So you and Gibby moved west. Did he get work there?”

“No, I went by myself, just me and the kids. All but the oldest, who’s a senior in high school. He wanted to stay in Torrington to graduate. After the accident, Gibby wasn’t quite right. He took it out on me. So one day I just loaded up and moved out.”

My mind’s reeling. First, I can’t remember what accident she’s talking about. Had it been before or after the last birth? Second, how many kids in a car would that be?

“He took it out on you? You mean, hit you?”

“No, not really hit, but it was going that way. Pushed me around, just a few bruises and one time a burn.”

“So you just left?”

“Yeah, I planned it all out. I waited until he’d left for work. He was gone by six. I was packed and loaded by six thirty, then I woke up the kids.”

I can see Nila bustling around getting the six children dressed,

her short brown-blond hair whipping as she works.
No school today,

she says cheerfully.
We’re going on a trip, an overnight. A big adventure.

Where? Where?
the little kids say.

What about my baseball tonight? What about my slumber party?
the middle ones ask.

The oldest daughter tries to get the kids into their jackets. She doesn’t complain. She knows her mom needs her.

At last they pile into the van. It would have to be a van, with that many kids. Nila passes out the juice boxes and the Pop-Tarts for breakfast, and they shut up. She turns on some oldies rock music on the radio and pulls out of the drive. The sun’s just rising over the mountains.

“You just left?” I ask now. “You took the kids and went to South Dakota? Did you know someone there?”

“No, I just drove and drove, and when I got to Independence, it was a smallish town and seemed like a nice place to raise children, so I stayed.”

“But how did you live?” I ask, amazed. “Did you find work?”

“I had a few hundred dollars saved, and then Gibby had to send money.”

I squint, trying to understand. “Did you sort of run away from home?”

“You could
say
that.” Nila laughs. “Well, I met a fella out there,

his name’s Doug and he was real nice to me, and here I am.” She pats her belly, which is already rounding. So it’s not Gibby’s baby. She doesn’t seem upset. In fact, she seems happy. I’m still pondering the overwhelming prospect of getting in a car with that many kids and just hitting the road.

“Do you have a place to live? Did Gibby take you back?” If he had taken her back when she was pregnant by another man, that would be as amazing as Nila’s packing up and leaving home in the first place!

“Oh, no. Doug and I found an old farmhouse out on Weimer Road.”

“Doug came back with you and all the kids? Did you
mean
to have his baby?”

“Well, not right away, but we thought maybe later.”

I frown. “Were you using any birth control, pills or condoms?” “No, not really.” Nila giggles and rolls her eyes.

“So, has Doug found a job?”

“Oh, yeah, right away, at Select-Tech, that telemarketing place downtown.” Nila smiles proudly.

“But what about your husband? How’s he handling this?” I picture the quiet blond man who had come to Nila’s births. He’s employed in maintenance for one of the big student-housing companies in Torrington.

“Oh, Gibby’s acting like a jerk, keeps coming over or trying to call me. If Doug’s home and answers, he hangs up . . . I shouldn’t have expected him to be decent. I have to let him see the kids, though. Unless he’s drinking. If I smell alcohol on his breath, he’s out of there.”

I warm up my hands by rubbing them together and motion for Nila to lie back on the exam table. Her uterus is easily palpable under my fingers. “Have you felt movement yet? It’s probably too early.”

“No, I feel it. Not every day, but I feel it.” She smiles at the ceiling. “After seven kids, you know that the baby is in there.”

There are red flags waving, but I don’t see them. I’m worried about how late I’m running and how many other women are waiting in the reception area. I’m thinking about all my patients who feel trapped by unhealthy relationships, financial burdens, or family troubles, women with many more resources than Nila but not a bit of her courage. They come into the office year after year, enduring the same old things, taking Paxil or Prozac so they can cope.