The Blue Cotton Gown (11 page)

On Saturday we drive down the rutted dirt road into their hollow. On either side of the narrow lane, redbud and dogwood are blooming, everything’s alive and expanding. The barn, a huge, sturdy, insulated two-story structure, comes into view. I’m impressed when Lou gives us a tour. Each family has its own space in the loft. The common areas are downstairs: kitchen, living room, and library. The commune even boasts an indoor commode and hot running water. After dark, when a spring snowstorm comes up, we decide to sleep over rather than get the jeep stuck in the mud. Tom, Mica, and I are shown to an empty bedroom, and after a luxurious hot shower, we settle down for the night.

Around three I hear rustling, low voices, and footsteps back and forth to the john. Maybe one of the commune’s toddlers is sick . . . Tom sleeps through it all. At four in the morning, Star comes to our door. “Can you come, Patsy? Please! Something is happening.”

I pull on my jeans and turtleneck and follow the woman up wooden stairs. Star wears a long paisley skirt and has disheveled golden hair down to her waist. She looks as if she’s been up all night. “At first it just seemed like a backache,” she whispers. “But it’s got to be more than that. I’ve never had a kid, so what do I know? Laura’s been up most of the night. Now she’s started to puke and there’s blood down her legs.”

The small woman pads down the hall on her calloused bare feet and leads me up narrow wooden steps. We stop at the door to a bedroom illuminated by dozens of candles. Pachelbel’s
Canon
plays low on the stereo. On a mattress on the floor, Laura crawls naked, moaning and swinging her head.

Lou kneels beside her in shorts and a tie-dyed shirt, massaging her back. His long ponytail droops over his shoulder. “It’s coming, Patsy! I don’t know what to do. We planned a home birth and I was

supposed to catch but I can’t. I just can’t . . .” His face is as white as the bedsheets. “
You
have to do it,” he says to me.

I go very still.
Pregnant woman . . . almost full term . . . moaning

. . . blood . . . muddy roads . . . hospital two hours away.
That’s what I’m thinking. Then there’s a pop, Laura groans, and a gush of clear fluid squirts out of her vagina. “Go get Tom, Star, he’s hard to wake up. You’ll have to shake him—and get the birth kit. You have something prepared, don’t you, Lou, some supplies?” The man looks around wildly.

“Top drawer—bureau,” Laura snaps between moans. “My back hurts so bad. Damn! I have to push, but when I do it only hurts worse.” She lets out a wail and starts shaking. So much for childbirth breathing. “Get a grip, Laura,” I tell her. “Yelling is not gonna help, and it scares the baby.” I don’t know where I came up with that line, but it works. I’ve used it a hundred times with women in labor since then. She shuts up.

Then Tom steps into the room with Star and takes in the situation at a glance. “Where’s the birth stuff ?”

“Inside the chest. I need some gloves. She’s gotta push.”

Something is bulging between Laura’s legs as she wags her butt back and forth, and I haven’t even washed my hands. Tom pulls a paper sack out of the drawer and finds a box of exam gloves. They aren’t sterile, but neither is anything else, and they’ll have to do. “It’s almost over, Laura. I’m going to touch you. Don’t move around.” I part her labia and am startled to find a head covered with

dark wet hair, about the size of a large apple.

Laura moans again. “I got to get this fucking baby out of there. It’s killing me.” She growls like something coming out of the earth, and the head moves a quarter inch into my hands.

“What’s in the bag besides gloves, Tom? Shoe strings, scissors?” Tom isn’t a paramedic or a doc. He hasn’t even thought of being one yet. He’s a bearded hippie beekeeper with the shoulders and arms of a carpenter and the soul of a string bass player.

“Scissors in a plastic baggie with shoelaces. Some gauze and a blue infant suction thing. There are some worry beads, a baby blanket, and a laminated picture of Krishna.” He drops the beads in the drawer and hands Lou the picture of Krishna. The medical supplies he lays out on a pink flannel baby blanket, and then he puts on gloves himself.

“I don’t suppose you could roll over?” I ask Laura between her contractions. She’s still rocking back and forth on her knees. “Lay on your back?”

“Oh, shit,” she says, and she’s right. As the baby slides down the birth canal, some BM moves through the rectum and out of the way. Tom takes some gauze and wipes it up. Everything is moving fast now, but the baby’s head doesn’t flex. I know from the drawings in the emergency-childbirth manual that you should
keep the head flexed,
but this baby’s upside down with its chin tucked under the pubic bone, and I haven’t a clue what to do so I just hold on and put my hands around the head like a crown.

“Breathe it out now,” I say with authority. “Breathe it out slowly.” Laura breathes. “Now pant!” A baby’s face is emerging from between Laura’s legs, scrunched and blue, looking up at the ceiling. Tom reaches over and suctions the mouth like he’s done this be-fore. “It’s trying to suck on the bulb,” he says, laughing. “Good sign.”

Then the whole wet mass swivels and shoots out onto the bed. I scoop it up. The infant’s still dangling from the umbilical cord.

“A baby!” the father yells, then slumps into the fetal position. The newborn screams.

Laura laughs. “That wasn’t so bad!” Women always say that when it’s all over. I look between the infant’s wet legs.

“It’s a girl.”

“I told you!” says Lou, raising his head.

After we tie off the cord and dry the infant, I hand the baby to her mother. The placenta slips out easily a minute later. Lou pulls himself together, and the three of them squirm to the head of the bed,

where it’s still dry. I throw a blanket across them, and the candlelight shines on their faces.

Behind Star, in the doorway, stands the rest of the commune. Three men and two women in various states of dress or undress, two sleepy toddlers, and one baby, who’s being held by his mother and sucking on a breast. Mica sleeps through it all.

No one says anything, not even the kids, not a word. Pachelbel still plays on the stereo, music of holiness . . . Tom and I just kneel on the bed in the wet amniotic fluid.

Baptized.

shiana

“I think I might have herpes,” the young coffee-skinned woman bursts out and then begins to sob. She doesn’t just leak tears. She floods. There’s no way to ask what’s going on, or why she thinks she has an infection. “
The son of a bitch,
I’ll never forgive him.”

When a woman says she has herpes, it’s usually fifty-fifty; half the time it’s herpes, half the time it’s something else. Sometimes it’s a painful yeast infection, a boil, or an abrasion after sex. Sometimes it’s a bump in the mucosa that’s been there all along but the patient has just noticed it . . . and sometimes it’s herpes.

We deal with alphabet soup nowadays. HSV (herpes simplex virus), HPV (human papillomavirus), HIV (human immunodefi-ciency virus). They’re all sexually transmitted. Only one of them can directly kill you. The rest are just uncomfortable and with you for life.

I sit and wait for Shiana’s tears to stop so I can ask her why she thinks she has herpes.

She’s wearing the regulation thin cotton gown, sitting on the end of the exam table, with her dark hair pulled back under the pink baseball cap. I roll my stool up and hand her the tissues.

Shiana wipes her face, glances at me, then starts crying again. I pat the girl’s knee and say something soothing. “It’s okay now, sweetie. It’s okay, hon. Tell me what’s happening.”

The young woman wipes her face and takes a deep breath. “Why do you think you have herpes? What’s going on?” I ask

again softly.

Shiana swallows hard and lets out some air. Then her almond eyes water and it seems for a minute like I’m losing her again. I reach out and take the young woman’s hand. “Let me take a look. Let’s see what’s going on down there. Maybe we can do cultures to find out for sure. Sometimes I can tell by examining you.” I want to cut to the chase, but the girl doesn’t lie back or put her feet in the footrests.

“Do you remember me?” Shiana asks. “I know you meet a lot of patients . . . I’m the girl with the condom. The blue one.”

“I remember.”

“Well, it’s been downhill since I saw you. I got your nurse’s call about the positive chlamydia test and I took the antibiotics like you told me, but then I got a yeast infection.” She’s talking fast now. Try-ing to get it all out. “I’d never had one before, but they said it was common after taking antibiotics . . . Now I’m all swollen and have little blisters down there. I checked on the Internet and I don’t know what else it could be. It has to be herpes.”

She starts leaking tears again, but before she gets too far, I say, “Shiana, stop now. I need your cooperation. I want you to lie down. I can usually tell by looking, but if I can’t, I’ll send cultures to the lab. Have you been sick with a fever or had any difficulty peeing?”

“It burns awful. It hurts so bad that I try not to pee. All I did yesterday was stay in bed. I didn’t even tell my roommate what was wrong. I’m so ashamed.”

I spread the young woman’s outer labia with my gloved fingers. I don’t need cultures, but I’ll get them anyway. Along the right side are a row of white ulcers, tiny moist craters. There’s no question. “It’s herpes,” I say. “I was hoping it wasn’t.” Shiana puts her arm

over her eyes and begins to sob again, this time silently, but her whole body shakes. It’s hard to tell if it’s sadness or anger.

“Shiana, I know you’re upset, but I want you to sit up and listen to me. I’m going to tell you what we need to do.” Shiana wipes her face and sits up, her hands folded in her lap on the blue exam gown, like a schoolgirl in the principal’s office. She blows her nose on the tissues I give her.

“The first thing is, I’m going to give you medicine to make the sores go away. I want you to stay on the pills for two weeks. I’ll get you something for the pain, and you’ll probably need to take a few days off school. I know you’re upset, but this isn’t the end of the world.” Shiana squints like she doesn’t believe me. “No, really. I see two or three women a week with herpes.” This is a lie, but sometimes I exaggerate to make the patients feel better. Really it’s more like two or three cases a month.

“Will the medicine cure it?”

“No, it can’t, but it can control the virus and dry up the sores. I had a herpes outbreak once.” Shiana stops crying, paying close attention now, her brown eyes still shining with tears.

“You?”

“Yeah. I was about your age, nineteen or twenty. We didn’t know about chlamydia then, or herpes, or HIV. This was back in the hip-pie days.”

Shiana watches me, no doubt picturing the young Patsy Harman with hair to her waist, a long calico skirt, and maybe a flower behind her ear, like girls on a PBS special about the protest days. She wouldn’t be far off.

“I had it much worse than you, and there weren’t any antiviral medicines. I was at home on spring break and I got sores all over down there, and in my mouth too.” For a second, I wonder if I’m being too graphic. I can’t picture Tom or any other health-care provider telling a patient something like this, but I continue. Maybe it will help Shiana to know that someone else has been through this.

“It stung so bad when I had to go to the bathroom, I had to stand up in the tub to urinate.”

“That’s what I did too.” The girl smiles. “I stood in the shower and tried to get the water to spray on me while I was peeing. It didn’t help much.”

I write my patient a script for acyclovir ointment and tablets and give her a pamphlet on living with herpes. “In seven days I’ll see you again and we can discuss how you’ll need to protect yourself and any future partners.”

Shiana regards me, startled. I can tell she hadn’t thought about what she would tell a new boyfriend. She’s dressed now in a loose gray Torrington State University sweat suit. For a minute, I think of taking her to my home. The sweet young woman could use some mothering. But I resist. Like most professionals, I try to draw a line between my relationships with patients and my personal life. Though I’ve thought of doing it many times, I don’t take them home.

“Well, I won’t be telling
any
partners. I’m planning on being celi—

bate from now on,” the girl says, and the tears well up. This time there’s no smile.

I give her a hug. I’ve said that myself. More than once.

kasmar

Straightening the stethoscope around my neck, I take a deep breath and then open the door. “Hi, Kasmar.” I reach out my hand, hoping I won’t regret my decision to help her become a man. There are so many things I haven’t thought out. Will the nurses object and re-fuse to give her the injections of testosterone? Will the other patients be offended to see someone who appears to be a man sitting in the waiting room?

The tall, thin woman sits in the guest chair; she’s wearing neatly pressed gray slacks with a light green checkered shirt, the long sleeves rolled up. This time her dark hair is cropped even shorter and the neck shaved; no makeup, no earrings or jewelry, only a large square-faced gold watch with a leather band. Kasmar looks at me ex-pectantly.

“So, how are you today?” I ask. It’s been more than a month since her last visit.

“Fine, thank you.” Kasmar shifts her ankle up on her knee and leans forward, waiting.

“Well, I suppose you’re wondering what we’ve decided, so I might as well get to the point.”

Kasmar watches my face.

“Dr. Harman and I had a discussion. We’ve decided that though your request is out of the ordinary, it’s something that we can help you with.”

She swallows hard, relief in her blue eyes.

I go on. “We’ll help you so long as the testosterone injections aren’t hurting your health. If we start to feel the situation is out of our league or requiring too much time, we reserve the right to stop treatment. I’ve also drawn up a consent form for you to sign in which you acknowledge that there are possible side effects to the—” I haven’t finished my sentence but Kasmar is reaching for the heavy black ballpoint clipped in her front shirt pocket.