The Blue Cotton Gown (12 page)

“Thanks so much,” she says, signing the document after glancing over it, her tanned, freckled face flushed with excitement. “This is great.” She’s grinning from ear to ear. “This is just great.”

I go over the potential side effects again. “Most of them are minor and reversible, like acne, cessation of periods, headaches, mood change, and masculinization.” We both smile at that. “But some might be
irreversible,
like hair loss, liver problems, hyperten-sion, or elevated cholesterol.” Kasmar nods. She knows all this. Then I write the first script for the testosterone injections. Kasmar

will pick up the syringe at the pharmacy and bring it to the clinic every two weeks.

If the patient had been born with a deformity, some error of na-ture such as a cleft lip or a clubfoot, someone would help her. To Kasmar, her female body is just as much of a mistake.

Kasmar stands, reaches for my hand, and pumps it firmly, still beaming. “This is great. Just great,” she says again.

Her voice is already a few notes lower.

holly

On sunny summer days, everyone at the clinic, from Dr. Tom to Junie, our junior secretary, is eager to go home early. Sometimes we close at four, but not often. We find ourselves dreaming of what we could be doing outside: working in the garden, biking, swimming, or just reading a book out on the porch.

Today’s that kind of day. It’s lunch break, and having finished my charting, I gaze for a minute out the window at the billowy white clouds being swept across the blue sky. Last night was that kind of night too! I smile, remembering.

Tom and I had our first skinny-dip of the season. The air was warm, the dark waters of Hope Lake a little cold, just enough to make you holler when you dove in, although two minutes later you were swimming around and saying, “This is great!” “Not too bad.” “Actually pretty warm.”

In the cove below the house, skinny-dipping has the added benefit of being a little risky. How would it look if a well-known middle-aged physician and his wife were caught naked in the spot-light of a motor boat?

We swam on our backs, looking up at the stars. Dark sky, no moon yet. We dog-paddled into the streaks of silver and gold that

floated over the black water from the cottages on the other side of the cove. We swam together, our bare bodies wrapped around each other. We played like little kids, grabbing each other’s private parts. Well, I grabbed his, anyway, and joked about a snapping turtle.

There’s a tap at my door, and I snap back to the here and now. “Your first patient is ready, chickie,” says Celeste, my nurse for the afternoon, handing me a yellow chart. “Time to go back to work. Sure would be nice to leave early today.” I know what she’s really saying:
Try to keep up so we can leave on time, maybe even early.
I’ll try. I always
try.

I knock my usual greeting—
dum-de-dum-dum
—and enter exam

room 1.

“Do you think this microdermabrasion would do me any good?” Holly Knight asks before I even get through the door. She inspects her face in the small gold-framed mirror mounted in the dressing corner.

“I think it does
good
for everyone. For you, it would take off the

dry skin and some of the fine wrinkles. It would fade the sun dam-age.” I turn Holly’s face to the light. “It would clean out the pores

. . . And it
feels
great.”

It strikes me as odd that I, an ex-hippie who rarely wears makeup, promote medical cosmetic microdermabrasion, but I’ve come to feel that if a person can afford it, she should have her interest encouraged. In Torrington, because of the university, there are plenty of female professionals who travel, who read. They’re curious how such procedures can help them.

Women don’t do enough nice things for themselves. They give to their kids, their husbands, their parents and families. Sometimes they volunteer in the community or at church, but they rarely give to themselves. Whenever a patient signs up for a package, it’s a celebration for us all.

I pat Holly on the back. “You should try it. Abby, our nurse, does a facial massage afterward and she has soft music playing. Every

time I get one I think,
I’ve got to take better care of myself.
It makes me want to eat healthier, to exercise, to begin doing yoga again. We started doing the treatments when we stopped delivering babies. It helps pay the bills, and it’s fun to help women feel good.”

Holly sits down in the guest chair. Today she’s dressed in a sleeve-less aqua tunic, linen cropped pants, and taupe slides. Her highlighted hair is held back with a clip, but there are circles under her eyes and she looks tired.

I wonder how her daughter, Nora, is doing but hate bringing it up. The last I’d heard, she was in the ICU for bulimia. “So, how you been?” I start out, opening the chart.

“Oh, not too bad.” Holly slides down in her chair with her long legs stretched out. “I think I need to change my antidepressant, though. It’s not working. I’m so cranky I can hardly stand myself. Maybe I just need to increase the dose.” She looks at me.

“Are you on it for perimenopausal symptoms, stress, anxiety, or depression?”

Holly laughs. “All of the above.” That’s what I like about this woman. She isn’t a whiner, and except when it comes to her issues around her daughter, she can make fun of herself. We’re quiet for a moment.

“So, how are you doing with your hormone replacement? Do you have enough to get you through till your annual gyn visit?”

“Yeah, I’m okay. I stopped taking the medication for a while. Did I tell you? But I went back. I started hot flashing and sweating all day. I thought I could make it naturally, but I can’t and I don’t know how some women do. I feel like a wimp.” She waits for reassurance. “We’re all different, that’s for sure. Some women’s menopausal symptoms aren’t that bad, others are so affected they can’t work, they can’t sleep, they can’t make love, they can’t remember their

own kids’ names.” We laugh, both knowing how
that
is.

I laugh a lot with my patients. I joke with them about constipation. I kid about periods. We poke fun at aging, at looking in the

mirror and seeing our mothers looking back at us. “We’re being silly,” I say when our laughter gets too loud, but sometimes if you don’t laugh you might cry.

I open Holly’s chart to her history. “You have no personal or fam-ily experience of breast cancer or early strokes, so the risk, if there is one, is worth the improvement in the quality of your life. You know what Dr. Harman says about hormone replacement, don’t you?” Holly shakes her head no
.
“There’s a risk in getting in a car and going across town too, but that doesn’t mean you stay home.” I raise my eyebrows to make the point. Holly grins.

“I always feel better when I come to see you, Patsy. I feel
almost

normal, like you understand.”

I smile and nod. We are all
almost
normal. “So how’s your stress level? Stress makes hot flashes worse, you know.”

“Better, I guess. Nora’s home from the treatment center and tak-ing classes at State. I think she’s still vomiting but she’s holding her own. I told you she went to Atlanta to a treatment center for a month, didn’t I?”

I shake my head no. “Did it help?”

Holly continues. “It seemed to at first, but then she comes home and starts puking again. My husband tells me I can’t save her. I know he’s right. She has to save herself.” The patient’s husband is the vice president of First Mountain State Bank. I met him once at a United Way fund-raiser.

“Why does she do it? The vomiting. Is it insecurity? Is it pressure at school?” I lean back against the cool white wall, wanting to understand. I wish I could take Holly home with me and have tea. We’d sit in my living room with our feet on the coffee table and talk about our kids and where we’d gone wrong. We’d eat brown-ies and maybe drink Stress Relief tea. I’d get out the pictures of Mica and Orion and Zen, and she’d open her wallet and show me her boys and Nora.

“I don’t know why she vomits. I don’t even think
she
knows anymore. It started when she was in junior high school. Now she can’t

stop. We have a new counselor but I’m afraid to hope
.
It’s been such a struggle. I try to be optimistic, but if she gets really sick again I’m clueless what we’ll do next, where we’ll go.

“Thank God we have health insurance. I don’t know what peo-ple do who don’t have coverage. Do you know how much it costs to stay at a center for eating disorders? Fifteen hundred a day.” Holly widens her eyes, waiting for my reaction. She gets what she expected.

“Fifteen hundred
a day?
” I know I heard right, but I can’t comprehend it. “That’s
forty-five thousand
for a month. Did you look around? Is that the going rate? Forty-five thousand!”

“Of course I did. Are you kidding? I got on the Internet to investigate and called every program. And there’s only a limited amount of reimbursement on most health insurance plans for men-tal health, anyway. Did you know that?” the mother continues. “When you use it up, you’re done, there’s no more. Some of the centers will give you a break if you don’t have coverage, but there’s so much demand and so many young women with bulimia and anorexia. What would you do if she was your child? Mortgage your house? What would you do?” Her voice breaks. “You couldn’t let your own daughter starve.”

I nod. I know the passion mothers have for their children, and I wonder where Tom and I would get that kind of money if one of our kids were dying and we didn’t have insurance. I would sell everything we own for one of my boys. You give birth to them in pain. You nurse them at your breast. You hold them at your heart forever. I write Holly a script for her increased dose of antidepressants, give her a couple months’ worth of samples of hormone replacement, then hold out a pamphlet on coping with stress. “Maybe this will help,” I say, smiling. We both know it won’t. I put my arms around Holly, saying a silent prayer for her daughter. Sometimes the mother needs mothering. We’re almost the same height, both

tall, big, capable women. Both little girls.

Shame

Okay, I’m ashamed about the alcohol . . . but not about the insomnia. I know from talking to so many women that half of them don’t sleep well either. I’ve come to think of the sleeplessness as a disability, something I just have to live with. I never tell my patients about my sleep medicine. I don’t tell Holly or Trish or Nila. I don’t know why.

Okay, I do know. It’s the shame of not being able to turn off my thoughts, of using a drug that, though legal, when taken too long and in excess can destroy your liver and maybe your mind.

I’m a midwife. When I discuss sleep problems with my patients, I talk about herbal teas, relaxed deep breathing, leaving their troubles out of the bedroom. Those things don’t work for me. I doubt they work for them. Sometimes I prescribe pills for my patients or refer them to the sleep clinic. I went there myself a few years ago, but it was a waste. And I’ve tried sleeping pills too. I’ve never found one that both works and doesn’t make me too groggy in the morning.

I used to believe my wakefulness came from delivering babies. For almost twenty years I was on call, and the phone would ring in the night. Someone would be in labor or in some kind of trouble. Sometimes I would lie awake just waiting for the telephone to ring or the pager to go off.

In reality, the wakefulness started long before, in a small tract house in California where I would lie listening to my parents shouting and to furniture crashing. It was my mama screaming, my father throwing things. I was eight or nine then, huddled in a twin bed in a small bedroom I shared with my brother. My bed was against the wall, his by the window. I used to wonder if I could get him out that window if I had to.

chapter 7

heather

I lean on the lab counter, skimming my last progress note. My teenage patient, Heather Moffett, has returned to the clinic. It’s a follow-up visit for the emergency D & C of her twins. I dread the visit, expecting to be grilled by the stern grandmother, Mrs. Gresko, and perhaps also by the angry young man, T.J.

I’m surprised to find only Heather in the room, sitting in the vis-itor’s chair and reading
Vogue.
She’s dressed in worn blue jeans with a striped knit top. Her red curly hair is cut shorter, almost a buzz, and she sports a silver nose ring along with the stud in her eyebrow. “Hi, Heather,” I say, touching her arm. “How are you today?” I cringe at the slick magazine. Tom has asked me to get rid of the “trashy reading material” in the waiting room but I’ve argued that women enjoy reading the articles. When else do we have time to catch up on Tom Cruise’s love life or take quizzes on our sexual IQ? “So how are things?” I ask Heather. The smell of the periodical’s

perfume advertisements fills the exam room. “Pretty good, I guess.”

Four words in a row. It’s practically the most I’ve ever heard Heather say in her surprising soft alto voice. “Any bleeding or spotting?” I start charting her responses.

“No.”

“Any cramps?” “No.”

“Have you thought about birth control?”

Heather doesn’t answer, just turns a page. Then finally, “Do you think drugs could have made the twins die?”

“What?”

“Drugs? Can drugs kill babies if the father takes too much?”

I stop charting. Tilting my head to one side, I envision the thin, long-haired T.J. “You guys into a lot of drugs?” I ask casually.

“T.J. is. He was in the ICU last night. Overdosed . . . He’s got IVs in both arms and an oxygen thing up his nose.” Heather stares va-cantly around the room. “I was there all night. They let me see him this morning, but mostly I was in the waiting room. I thought for sure he would die this time.”

“It’s happened before?”

Heather rolls her eyes and snorts, indicating this should go without saying.

“So what does he use? Heroin? Cocaine?”

Torrington is not the big city, but I’ve heard hard drugs are around. Some of my boys’ old high school buddies have been busted, and I suspect they were selling more than grass.