The Blue Cotton Gown (6 page)

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 su-permarket 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, Kas-mar?”

“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 any-

thing.

“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?”

“I do. But I also have a complete protocol from the Gender Dys-phoria Association.” She hands over a thick document entitled “Standard of Care for Gender Identity Disorders, Sixth Version.” I glance at the cover. Committee authors include ten MDs, six PhDs, a physician’s assistant, and a doctor of public health. The index indicates that the manuscript has chapters on the initial labs, the exam schedule, the follow-up labs, and the graduated doses of testosterone injections.

I hate to ask again, but I do. “And you’re
sure
you want to do this?”

She doesn’t hesitate. “I
am
going to do this. Once I made the decision I felt a huge weight lift off me, a feeling of hope that I could be free of a mask I’ve always worn. I wasn’t meant to be a woman. I’m sure of it. It just took me nearly forty years to come to that con-clusion.”

“And you’ve talked to your partner?”

“Jerry’s gone to some of my therapy sessions and is supportive.” “What about your family, do your parents understand? I know you’re a grown woman and they can’t stop you, but do they understand?”

“My mom’s dead. She died a few years ago. My dad understands.”

“And why again do you want
us
to help you? Couldn’t you go to

Pittsburgh?”

“I will if you say no, but it’s a three-hour drive and then another forty-five minutes across the city. I figured I would have to take a day off work for each visit, and at first I’m supposed to come once a month. I thought I would ask you because Jerry said you were open-minded . . . I just thought I would ask.” There are no tears. She’s not begging. It took a lot of courage for her to disclose her plan.

I could say no and be done with it, as I imagine most providers in Torrington would, but I hedge instead. I need to think this over carefully. “You know, this is something I want to consult with Dr. Harman about. I’ll ask him to read over the protocols and see what he thinks. I’ll tell him you seem like a thoughtful and intelligent woman.”

“Tell him I’m Jerry’s husband. He knows her. He did a laparoscopy on her a few years ago for an ovarian cyst. I met him at the hospital.”
Jerry’s husband,
I mentally echo.

Standing, I reach for Kasmar’s hand and shake it. “It’s not that I have any judgment against this, you understand. I just have to sort it all out. Can I get back to you in a few weeks? I want to do some research and I want to talk to Dr. Harman.”

“That’s fine.”

I watch the patient walk down the long white hall as she leaves.

Is it true what I said, that I don’t have any judgment against it?

Kasmar is tall and thin, with narrow hips and a long stride. From the back she
could
be a man. Inside she already is.

Searchlight

I don’t write down the patients’ stories every night, the stories they tell in the exam room. Some nights I sleep. Not many. Some nights I write poetry in a worn spiral notebook. Some nights I go over the practice’s low bank account or lie on my back in the dark and worry about our three mostly grown boys. My mind works like a searchlight, moving back and forth through the shadows, looking for trouble.

Tonight I wander the living room in my white robe like a ghost, worrying about Orion. This is my middle son’s first year in the mas-ter of fine arts program at the University of Cincinnati. His live-in

girlfriend of seven years, Lucy, left him six months ago. He’s alone in a place where he knows hardly anyone, and he’s still mourning her loss.

Zen, at the College of Santa Fe, asks for spending money too often but is doing okay. Tom’s been tight with the handouts, told him to get a part-time job, but that’s hard when he’s taking so many credits.

I turn my beam on Mica. He’s settled in Atlanta with his fiancée, Emma, and he’s unemployed but never asks for help. I’m not sure what he lives on. He does some Internet consulting occasionally but hasn’t phoned or e-mailed for weeks.

I hate telephoning my oldest son. When I get his answering machine, I’m afraid I’ll sound like a mother in a sitcom. “Hi, Mica,” the recording will say in a thin nasal whine. “It’s your
mom
calling, for the sixth time.” I can picture him deleting my messages and rolling his eyes. I take a deep breath. He would call if he needed me, wouldn’t he?

There was a dark time for us when Mica was fourteen. Tom and I had left the farm to go back to school, and for two years our old-est went back and forth between the commune on the ridge and our home in Ohio. When we moved to Minnesota so I could go to the graduate program in midwifery, he refused to come. He wanted to stay in West Virginia with his biological father, Stacy. It made sense in a way. He’d grown up there. All his friends were in Spencer. Why would he want to be dragged around the country and attend school in a different place each year? But I missed him so.

That’s when I started the long conversations on my knees with God. “Protect my boys. Shine your light on them.” For almost two years we had no contact with Mica. I would write a letter every week, but he never answered, and I never knew if he got them. There was no phone on what was left of the commune. It was as if the child I had breast-fed for twenty-four months, read countless stories to, taught how to tie his shoes, was dead. Then, almost as

suddenly as he left us, he rose from the grave. We started seeing him on weekends when Tom began medical school at Ohio State in Columbus.

Now whenever I don’t hear from Mica for a month, I fear he will disappear again forever. Like tonight. I pace the porch missing him and worrying about him . . .

I’m making myself sick thinking like this! I gulp down the scotch and go back to the bedroom. As I pass the dresser, I feel in the dark for the small red prayer box and place my hand on the round wooden lid.

trish

“Do you have a minute?”

I look up at the clock. It’s one thirty in the afternoon, and I’m just finishing charts in my office. If Tom and I don’t leave by three, we’ll miss the ferry to the island, but Trish is my friend, and even if she weren’t, I’d pull up the guest chair and close the door with my foot, as I do now. “What’s up?”

Trish sits but doesn’t say anything. Then quietly, “Aran’s pregnant.” There are tears in her eyes. “She’s been sexually active since she was sixteen, but she’s always taken birth control pills. It’s exactly what happened to me. I was planning to go to college and took my pills every day. I got pregnant at seventeen too.” Trish wipes her lightly freckled face with the back of her hand. “I guess we’re just fertile.” A weak smile. “It’s Jimmy. He’s the father. The one she went to the prom with. You know how Dan feels. He thinks the kid’s bad news, into drugs. I think he’s okay, maybe a little lazy, maybe just immature.” Trish never says anything bad about any-one, so her characterizing Jimmy as lazy is saying a lot. My friend’s straight sandy hair is parted to the side; she’s a sweet-looking

woman with a soft oval face. She stares over my head out the win-dow, then continues.

“Aran’s a little on the wild side but she’s an A student. She’s already been accepted at State with a full scholarship.” Trish pauses and runs her hands over her flowered scrub top, smoothing the wrinkles. I notice her name tag is crooked. “I make an effort to like Jimmy, I really do.”

She clears her throat. “I’ve been trying to go easy on Aran. She feels so bad. She said she was never going to have kids, and now this. And she’s not just a
little
pregnant. She’s been hiding it. I bet she’s four months along. She was afraid to tell us, just wore baggy clothes, and I didn’t notice. Dan found out last night when one of her friends made a comment.” Trish laughs bitterly. “I think what hurts most is she didn’t tell us.”

I study my friend as she gazes out the window at a sky filled with rolling gray clouds. She rocks back and forth as if cradling a baby. There isn’t a sound in the office.

Aran’s probably already in her second trimester, past the point of miscarrying or considering a termination. She won’t be going to college next year. Maybe any year. She’ll lose her scholarship. Trish and Dan live month to month. They’ve been fixing up a three-bedroom ranch house on Perry Mountain. They have an eight-year- old, an eleven-year-old, a seventeen-year-old . . . and soon a new baby. There will be no money for the university.

“Do you think they’ll get married?” I ask.

“I’ve been thinking about that. I hope not. I don’t want her to rush into it just because of the baby. If it doesn’t work out she’ll have to get a divorce. Truthfully, we haven’t talked about it yet. We haven’t talked
at all.
After everything came out, Dan slammed the door and went into the garage. He didn’t come to bed until midnight, and Aran locked herself in her room. He left for work early and then Aran got on the school bus.”